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Case management is an ideal service for patients with health complexity. However, most case management models do not integrate medical and behavioral health training and interventions, and there are little data evaluating these models in privately insured populations. The purpose of this study was to evaluate impact of an integrated case management (ICM) service at the payor level.Health care insurance company.A multimethod observational study was conducted at a health care insurance company in the Pacific Northwest of the United States. We conducted focus groups of case managers, leaders, and administrators and statistical analyses of outcomes data. Measures included care quality data (discharge follow-up appointment, cost per case, depression and anxiety measures, customer experience and satisfaction, and audit scores) of members receiving ICM services and employee focus group data (acceptability, adoption, feasibility, appropriateness, fidelity, and sustainability) related to the practice of ICM.Care quality data suggest ICM reduces mental health symptoms and increases discharge follow-up appointments for members. Implementation challenges include new employee orientation to ICM model, traditional views of case management, performance evaluation, documentation, and information technology. Facilitators of implementation include training, autonomy, and leadership support.Organizations should be aware both of the benefits and challenges related to implementing ICM. Open communication between case managers and leadership and an improvement-focused culture appear to be important elements of implementation success. Future research should examine the perspective of members receiving ICM services and the implementation of ICM into health care delivery systems.

Objectives Bone conduction hearing implants (BCHIs) are an effective option to rehabilitate hearing for people who cannot use conventional, air conduction hearing aids. However, the uptake of such devices in the United Kingdom is lower than might be expected, and the reasons for this are not fully understood. The present study used qualitative methods to explore decision-making about whether to accept or reject BCHIs. Design Semistructured telephone interviews were conducted with 17 BCHI candidates who had recently accepted or rejected BCHIs. Results A thematic analysis identified four overarching themes: participants wanted to look and feel normal; potential risks were weighed against rewards; participants felt that there was a "right time" to have a BCHI; and information from clinicians and BCHI users was treated differently. Participants' perceptions of normality were influential in the final decision, and the BHCI was seen either as a barrier or facilitator of this. Participants consistently weighed up potential advantages and disadvantages of BCHIs, with potential for hearing improvement typically used as a benchmark against which other factors were measured. Some participants who rejected BCHIs felt that they could reconsider having a BCHI when they felt the time was right for them. Participants highly valued advice from clinicians, but felt that their expertise lacked validity as clinicians typically did not have experience of using BCHIs themselves. Conclusions The decision to accept or reject a BCHI was highly individual. Each participant considered a range of factors; the influence of each factor depended on the individual's perceptions and experiences. This work highlights the importance of clinical staff being able to explore the individual priorities and concerns of each patient to ensure that patients feel happy and confident with the decision that they make.

Background: The Vibrant Soundbridge middle ear implant and the Bonebridge bone conducting hearing device are hearing implants that use radio frequency transmission to send information from the sound processor to the internal transducer. This reduces the risk of skin problems and infection but requires a more involved surgical procedure than competitor skin penetrating devices. It is not known whether more complex surgery will lead to additional complications. There is little information available on the reliability of these systems and adverse medical or surgical events. The primary research question is to determine the reliability and complication rate for the Vibrant Soundbridge and Bonebridge. The secondary research question explores changes in quality of life following implantation of the devices. The tertiary research question looks at effectiveness via changes in auditory performance. Method: The study was designed based on a combination of a literature search, two clinician focus groups and expert review.A multi-centre longitudinal observational study was designed. There are three study groups, two will have been implanted prior to the start of the study and one group, the prospective group, will be implanted after initiation of the study. Outcomes are surgical questionnaires, measures of quality of life, user satisfaction and speech perception tests in quiet and in noise. Conclusion: This is the first multi-centre study to look at these interventions and includes follow up over time to understand effectiveness, reliability, quality of life and complications. Keywords: Bone conducting device, Bonebridge, Soundbridge, Middle ear implant, Implant registry, Quality of life

This study examined the link between positive body image and a range of health behaviours. Participants were 256 women who completed an online questionnaire measuring body appreciation, body dissatisfaction, sun protection, cancer screening, seeking medical attention, weight-loss behaviour and alcohol and tobacco consumption. Results indicated that body appreciation was positively related to sun protection, skin screening and seeking medical attention and negatively related to weight-loss behaviour. Body appreciation explained unique variance, over and above body dissatisfaction, in sun protection, skin screening and weight-loss behaviour. These results have implications for interventions to improve adherence to health behaviours.

Qualitative interviews were undertaken with 53 Australian police officers with specialist expertise in liquor law enforcement to ascertain their perspectives concerning the liquor licensing legislation in Australia’s eight states and territories. Respondents generally indicated that current arrangements favoured the interests of the alcohol industry and did not sufficiently empower them to reduce alcohol-related harms. Other key themes included: ambiguity surrounding the police role in liquor licensing; difficulties in enforcing drunkenness-related offences; partnerships; strategies to enhance enforcement; data/intelligence gathering; and the separation of Ministerial responsibilities for liquor licensing and policing. Overall, police in Australia are not currently being given the tools they require to effectively reduce alcohol-related harms.

ISSUE: The rationale and potential impact of Australia's recent legislative changes regulating secondary supply of alcohol to minors, particularly on private premises. APPROACH: An examination of similarities and differences between state and territory liquor licensing legislation regulating secondary supply of alcohol to minors was undertaken. KEY FINDINGS: The Northern Territory, New South Wales, Queensland, Tasmania and Victoria prohibit supply of alcohol to minors on private premises, except by parents/guardians/authorised persons. Northern Territory, Queensland and Tasmanian legislation also prescribes that supply must occur responsibly and under supervision. Elsewhere, alcohol supply to minors on private premises is unregulated. These legislative changes reflect the 'familialisation' of adolescent drinking. IMPLICATIONS: Recent legislative amendments regulating secondary supply on private premises may indicate growing awareness of adolescent alcohol-related harms and signal a shift in community norms. However, sociocultural factors, misunderstanding and challenges in enforcing the legislation may limit compliance. CONCLUSIONS: Changes in secondary supply legislation need effective dissemination as divergence between states and territories may result in confusion about legal responsibilities. A national approach may be warranted to help set community boundaries for young people's drinking. Language: en

In October 2009, a multi-disciplinary group of UK clinicians met to review issues relating to bone-anchored hearing-aid (BAHA) development. The aim was to help define a model for BAHA services and service development via a process of widespread consultation with UK BAHA professionals.A modified Delphi technique was used. Statements were proposed by the lead group and sent out for consultation. Those with ≥90% agreement were approved without further discussion. Statements with 50-89% agreement were discussed by the lead group to determine whether they should be included in the final document. Any statement with50% agreement was removed without discussion. A second consultation was then made, and the process repeated. This led to a final set of consensus statements.The final consensus comprises 33 statements validated by the modified Delphi process. All of these statements achieved75% agreement, with only six statements having90% agreement. When these statements were presented to the UK BAHA Professionals group at their annual conference there was 89% agreement from the group for the consensus statements to be accepted.The levels of agreement for the final questionnaire show that the mandate for the consensus statements was exceptionally high. Implementation of the consensus is discussed, as are each of the key areas of the consensus, such as funding and minimum assessment standards.

This study aimed to investigate prospective predictors and health-related outcomes of positive body image in adolescent girls. In so doing, the modified acceptance model of intuitive eating was also examined longitudinally. A sample of 298 girls aged 12 to 16 years completed a questionnaire containing measures of body appreciation, potential predictors, and a range of health outcomes, at 2 time points separated by 1 year. Longitudinal change regression models showed that perceived body acceptance by others (positively), self-objectification and social comparison (negatively), and body appreciation (positively) prospectively predicted intuitive eating 1 year later, consistent with the acceptance model of intuitive eating. Perceived body acceptance by others was the only proposed predictor to prospectively predict an increase in body appreciation over time. Time 1 body appreciation prospectively predicted a decrease in dieting, alcohol, and cigarette use, and an increase in physical activity 1 year later. In particular, girls with low body appreciation were more likely than girls with high body appreciation to take up alcohol and cigarette use between time points. The results highlight body appreciation as an important target for interventions designed to prevent or delay the uptake of alcohol and cigarette consumption among girls. More broadly, they suggest that a positive body image can confer considerable benefit for adolescent girls.

Objectification Theory contends that women self-objectify as a result of internalizing an observer’s perspective on their physical selves. Self-objectification has been examined as both a stable enduring trait and as a context dependent state. The present study aimed to assess the link between clothing, a neglected area of women’s appearance management, and self-objectification. Participants were 102 South Australian female undergraduate students who completed a questionnaire containing a trait measure of self-objectification, as well as four different scenarios varying in clothing worn and setting depicted, followed by state measures of self-objectification, negative mood, body shame, and body dissatisfaction. It was found that the scenarios involving revealing clothing (bathers) led to greater state self-objectification, body shame, body dissatisfaction and negative mood than the scenarios involving more modest clothing (sweater), especially for heavier women. In addition, the dressing room scenarios led to greater state self-objectification but less negative mood than the public scenarios. It was concluded that clothing represents an important contributor to the body and emotional experience of contemporary young women.

This article describes an audit of the effectiveness of solution-focused brief therapy (SFBT) in a child clinical psychology service, and consequent revision of service provision.

This study aimed to examine the protective role of positive body image against negative effects produced by viewing thin-idealised media. University women (N=68) completed trait measures of body appreciation and media protective strategies. At a subsequent session, participants viewed 11 thin-ideal advertisements. Body dissatisfaction was assessed before and after advertisement exposure, and state measures of self-objectification, appearance comparison, and media protective strategies were completed. Results indicated that body appreciation predicted less change in body dissatisfaction following exposure, such that participants with low body appreciation experienced increased body dissatisfaction, while those with high body appreciation did not. Although state appearance comparison predicted increased body dissatisfaction, neither state self-objectification nor appearance comparison accounted for body appreciation's protective effect. Trait and state media protective strategies positively correlated with body appreciation, but also did not account for body appreciation's protective effect. The results point to intervention targets and highlight future research directions.

Objective : To describe clinical, radiologic, and histological features of a foregut duplication cyst extending from the oropharynx to the thoracic inlet. Methods : The medical record of one-month-old female who was referred to a tertiary care pediatric hospital for assessment of a neck mass was reviewed. Data included relevant history and physical examination, diagnostic work up, and management. Results : The child presented with a left neck mass identified during prenatal ultrasound exam. The infant gradually developed choking, gagging, and noisy breathing with feeds. Physical examination revealed a neck mass, extending from left submandibular region to left clavicle, was well-marginated, painless, soft, immobile, and nonadherent to the skin. A computerized tomography of the neck demonstrated a unilocular cystic mass extending from the level of the posterior oropharyngeal airway to the thoracic inlet. The mass was excised and histopathologic diagnosis was foregut duplication cyst. Conclusion : Foregut duplication cyst, although uncommon in the neck region, should be considered in the differential diagnosis of neck mass in children.

Purpose To examine proposed predictors of intuitive eating, including social appearance comparison, and to test a modified acceptance model of intuitive eating in adolescent girls. Methods Participants were 400 adolescent girls aged 12–16 years who completed measures of body acceptance by others, self-objectification, social appearance comparison, body appreciation, and intuitive eating. Results Correlations showed that all proposed predictors were related to intuitive eating in the expected direction. In particular, social appearance comparison was negatively related to body appreciation and intuitive eating. After controlling for other predictors, social appearance comparison was shown to explain unique variance in intuitive eating. Using structural equation modeling, an integrated modified acceptance model of intuitive eating yielded an overall good fit to the data. Mediation analyses showed that there was a significant indirect effect of body acceptance by others on both body appreciation and intuitive eating through social appearance comparison and self-objectification. Conclusions The findings extend the acceptance model of intuitive eating to adolescent girls but also identify social comparison as an important mechanism in this process. Practically, the findings highlight several areas that may be targeted to foster adaptive eating patterns in girls.

Background Skin trauma may play a role in the development of morphea lesions. The association between trauma and the distribution of cutaneous lesions has never been examined to our knowledge. Objective We sought to determine whether patients enrolled in the Morphea in Adults and Children (MAC) cohort exhibit skin lesions distributed in areas of prior (isotopic) or ongoing (isomorphic) trauma. Methods This was a cross-sectional analysis of the MAC cohort. Results Of 329 patients in the MAC cohort, 52 (16%) had trauma-associated lesions at the onset of disease. Patients with lesions in an isotopic distribution had greater clinical severity as measured by a clinical outcome measure (mean modified Rodnan Skin Score of 13.8 vs 5.3, P = .004, 95% confidence interval 3.08-13.92) and impact on life quality (mean Dermatology Life Quality Index score 8.4 vs 4.1, P = .009, 95% confidence interval 1.18-7.50) than those with an isomorphic distribution. Most frequent associated traumas were chronic friction (isomorphic) and surgery/isotopic. Limitations Recall bias for patient-reported events is a limitation. Conclusion Of patients in the MAC cohort, 16% developed initial morphea lesions at sites of skin trauma. If these findings can be confirmed in additional series, they suggest that elective procedures and excessive skin trauma or friction might be avoided in these patients.

I recently filmed a programme for Channel 4. This involved my assessing and formulating the difficulties of four angry teenagers. The young people and I then developed their interventions. These are reflections on the process, the young people and me.

Objectives:Bone conduction implant (eg, Baha®) stability can objectively be measured over time using radio-frequency analysis (RFA). Adult studies suggest that the Cochlear Baha BI300 Implant® may be loaded as soon as the soft tissue wound is healed. We aim to discuss implant stability in children using RFA measurements.Methods:Consecutive children having a Cochlear Baha BI300 Implant had RFA measurements taken peri-operatively, 1 week post-surgery, within 3 months of surgery, and then subsequently at least 3 monthly. RFA measurements were measured at loading of the hearing processor and at 1 week post-loading. Standard practice has been to load the implant at 3-6 months postoperatively.Results:Nine children had 10 Cochlear Baha BI300 implants® (8 unilateral and 1 bilateral) with a mean age of 9 years 4 months (4 years 9 months to 13 years 5 months). The mean time to loading of the hearing processor was 3.3 months (3 to 5 months, n = 9). Mean follow-up was 9 months (6 weeks to 23 months). Peri- and postop...

Objectives:1) Highlight ear anomalies (external, middle, and inner ear) and types of hearing loss in children with CHARGE syndrome (CS). 2) Use cases to discuss surgical options for treating hearing loss in CS children, including bone conduction implants and cochlear implantation.Methods:Six children with CS referred to our tertiary service for management of hearing-loss were identified. Subsequently, 4 of these children were fitted with a bone conduction implant (Baha® system), and 2 underwent cochlear implantation. For the 4 Baha® system children, free-field speech audiometry was used to monitor hearing postoperatively. For 3 of the children, Baha® system stability was measured with resonance frequency analysis at surgery and sequentially at follow-up visits. The two children having cochlear implants were followed up with pure tone audiometry and speech perception scores.Results:Four cases of Baha® system implantation and 2 cases of cochlear implantation in children with CS are discussed including pre-o...

Introduction The standard postsurgical treatment of wounds after dermatologic procedures is currently limited. Topical corticosteroids have been used successfully in postoperative management of ophthalmologic surgeries that involve the skin of the eyelid. In particular, tobramycin 0.3%/dexamethasone 0.1% ophthalmic ointment is considered the “gold standard” of steroid-antibiotic fixed combinations and is marketed worldwide as an agent used to control postsurgical inflammation and prevent postsurgical infection. The purpose of this study is to evaluate both the efficacy and safety of tobramycin–dexamethasone ointment for the postsurgical management of Mohs or dermatologic surgery in comparison to white petrolatum. Methods The authors employed a half-scar study in which patients who underwent skin cancer removal surgery were given tobramycin–dexamethasone ointment and white petrolatum to apply to each half of their wound for 2 weeks. The study was double blinded, and physicians and the patients independently evaluated the scars for cosmetic appearance at 2 and 6 weeks postoperatively. The evaluation criteria included judging which side of the wound looked better based on color, thickness, and discomfort. Results Eighteen patients were enrolled, of which 13 patients completed the three phases of the study. After 6 weeks the wounds did not show a statistically significant difference in color, thickness, or discomfort on either side. Conclusion Results obtained to date suggest that the application of tobramycin–dexamethasone ointment to wounds after dermatologic surgery does not promote better wound healing than white petrolatum. These findings indicate that a topical steroid and antibiotic ointment may not be an effective intervention in improving postoperative outcomes in dermatologic surgeries.

The rationale and potential impact of Australia's recent legislative changes regulating secondary supply of alcohol to minors, particularly on private premises.An examination of similarities and differences between state and territory liquor licensing legislation regulating secondary supply of alcohol to minors was undertaken.The Northern Territory, New South Wales, Queensland, Tasmania and Victoria prohibit supply of alcohol to minors on private premises, except by parents/guardians/authorised persons. Northern Territory, Queensland and Tasmanian legislation also prescribes that supply must occur responsibly and under supervision. Elsewhere, alcohol supply to minors on private premises is unregulated. These legislative changes reflect the 'familialisation' of adolescent drinking.Recent legislative amendments regulating secondary supply on private premises may indicate growing awareness of adolescent alcohol-related harms and signal a shift in community norms. However, sociocultural factors, misunderstanding and challenges in enforcing the legislation may limit compliance.Changes in secondary supply legislation need effective dissemination as divergence between states and territories may result in confusion about legal responsibilities. A national approach may be warranted to help set community boundaries for young people's drinking.

The study examined the protective role of body appreciation against body dissatisfaction (a known risk factor for disordered eating), resulting from thin-ideal exposure. We also tested potential mediating mechanisms, specifically, self-objectification and appearance comparison, and explored strategies that women may use to protect their body image. University women (N = 68) first completed measures of body appreciation and media protective strategies. During a subsequent session, participants viewed 11 thin-ideal advertisements. Pre and post advertisement exposure body dissatisfaction was measured, followed by state assessments of self-objectification, appearance comparison and media protective strategies. Results showed that body appreciation predicted change in body dissatisfaction. Specifically, participants with low body appreciation reported increased body dissatisfaction after exposure, whereas participants with high body appreciation did not experience an increase. Neither state self-objectification nor state appearance comparison accounted for body appreciation's protective effect against thin-ideal induced body dissatisfaction. Trait and state media protective strategies were also found to be positively related with body appreciation. The results indicate that body appreciation is able to some extent shield young women against body dissatisfaction resulting from acute exposure to thin-ideal media. The findings have practical implications for interventions aimed at body dissatisfaction and disordered eating.

The present study aimed to assess the link between clothing choice and aspects of body image. Participants were 112 female undergraduate students who completed a questionnaire containing a measure of clothing functions, as well as BMI, self-classified weight, and trait self-objectification. Results indicated that BMI and self-classified weight were positively correlated with the choice of clothes for camouflage. Self-objectification was positively correlated with choice of clothes for fashion, and negatively correlated with choosing clothes for comfort. It was concluded that clothing represents an important but neglected aspect of contemporary women's management of their body's appearance.

Background Rapid Access Outpatient Units (RAOUs) have been suggested as an alternative to hospital inpatient units for the management of some acutely unwell children. These units can provide ambulatory care, delivered close to home, and may prevent unnecessary hospital admission. There are no qualitative data on the views of primary care practitioners regarding these types of facilities. The aim of the study was to explore the opinions of primary care practitioners regarding a newly established RAOU. Methods The RAOU was established locally at a district general hospital when inpatient beds were closed and moved to an inpatient centre, based six miles away at the tertiary teaching hospital. Qualitative, practice based group interviews with primary care practitioners (general practitioners (GPs), nurse practitioners and practice nurses) on their experiences of the RAOU. The data collection consisted of three practice based interviews with 14 participants. The interviews were recorded and transcribed verbatim. Thematic content analysis was used to evaluate the data. Results There was positive feedback regarding ease of telephone access for referral, location, and the value of a service staffed by senior doctors where children could be observed, investigated and discharged quickly. There was confusion regarding the referral criteria for the assessment unit and where to send certain children. A majority of the practitioners felt the utility of the RAOU was restricted by its opening hours. Most participants felt they lacked sufficient information regarding the remit and facilities of the unit and this led to some uneasiness regarding safety and long term sustainability. Conclusion Practitioners considered that the RAOU offered a rapid senior opinion, flexible short term observation, quick access to investigations and was more convenient for patients. There were concerns regarding opening hours, safety of patients and lack of information about the unit's facilities. There was confusion about which children should be sent to the unit. This study raises questions regarding policy in regard to the organisation of paediatric services. It highlights that when establishing alternative services to local inpatient units, continual communication and engagement of primary care is essential if the units are to function effectively.

Intuitive eating (i.e., eating in response to internal cues) has been shown to be negatively related to disordered eating in women. The acceptance model of intuitive eating proposes that intuitive eating results from increased body appreciation, lowered self-objectification and body acceptance by others. As yet, this model has not been tested in adolescent girls; a group vulnerable to eating pathology. In addition to testing the acceptance model in adolescent girls, this study aimed to examine the role of social comparison. Participants were 400 girls aged 12 to 16 years who completed questionnaire measures of perceived body acceptance by others, social comparison, self-objectification, body appreciation and intuitive eating. In support of the model, perceived body acceptance and body appreciation correlated positively with intuitive eating, while self-objectification and social comparison correlated negatively. Structural Equation Modeling showed the extended acceptance model was an acceptable to good fit to the data. In particular, the effects of perceived body acceptance were mediated by self-objectification and social comparison. The findings replicate the acceptance model of intuitive eating in adolescent girls, but also indicate that social comparison is important in this process. Practically, the findings highlight several areas that may be targeted to foster adaptive eating patterns in girls. This abstract was presented in the Prevention & Public Health stream of the 2014 ANZAED Conference.

Many people choose to use Dreamweaver instead of writing ASP in a text editor because of the way Dreamweaver can streamline your workflow. There are a number of ways you can use Dreamweaver MX 2004 to develop web applications and sites quickly.

One of the biggest strengths of Dreamweaver MX is that it makes creating database driven web sites simple. Before Dreamweaver MX, it was a real chore to sit and manually hand-code the PHP pages that retrieved data from a database and displayed it neatly in a page. To handle this, Dreamweaver MX introduced recordsets and server behaviors that can be quickly and easily integrated into an overall page design.

In this chapter, you will look beyond the three-letter acronyms that form ASP.NET to discover its origins and how it fits in the Internet technologies picture. We will show you the advantages that ASP.NET offers over alternative technologies. We will also compare it to its predecessor, classic ASP. This will ready you for Chapter 4, where we will delve deeper into the technical aspects of ASP.NET and provide you with a basic migration guide from classic ASP.

If you used previous versions of Dreamweaver, you already know that one of the great things about Dreamweaver MX is its extensibility. The base program is an extremely powerful tool that was itself created by adding extensions to a core engine. In the same way, you can add extra functionality to Dreamweaver by building your own extensions. There is also a growing market for commercial-quality extensions. This means many extensions can be purchased or downloaded, so you don’t have to create them yourself.

In this chapter you will take the techniques you learned in this book and apply them in a real-world situation.

Carrying out a site review of existing online resources Setting clear goals for a site Producing user profiles to define further the audience Planning a good, sensible site map Sketching out initial thoughts regarding the initial design Refining the design into wireframe diagrams and then producing them in Photoshop Working with Dreamweaver MX 2004 to easily construct an accessible, easy-tomaintain website

One of the great things about Dreamweaver MX 2004 is its extensibility. The base program is an extremely powerful tool but adding your own functionality to it by building extensions is what really makes the program sing as well as dance.

In the first two chapters, we took a look at the underlying technologies that drive the examples and applications in the upcoming chapters. Now, it’s time to introduce the environment that you will be working in when you build those applications.

Now that you are familiar with ASP/VBScript coding and database structures, you can delve into the fabulous server behavior features Dreamweaver MX 2004 has to offer. In this chapter, we will introduce you to the Application panel and explain what each behavior can do.

In this section of the book, we’re going to create a corporate website, geared at the smallto-medium-sized enterprise (SME) marketplace. As with the other projects in this book, the source files are in the code download for the book. Feel free to experiment with these files and incorporate ideas from this section of the book into your own websites.

There can be little doubt that XML is one of the most important web technologies to come along in the past several years. It has rapidly become the industry standard for data-transfer, interoperability, and storage solutions. The.NET Framework provides robust and integrated support for XML in two main areas: document manipulation and web services. XML includes classes for reading and writing XML data, creating XML documents, and consuming XML web service information. You can use these classes to easily integrate XML functionality into your ASP.NET applications.

Creating accessible web pages has never been more important than it is today. With the recent adoption of accessibility standards in the United States, Canada, the European Union, Australia, Japan, and Brazil, designers and developers face mandates to ensure that people with disabilities can access the contents of web sites and web applications.