Use of physiotherapy and alternatives by children with cerebral palsy: a population study

Objectives: To describe the use of physiotherapy services and alternative therapies by a population of children with moderate to severe cerebral palsy (CP).
Design: Descriptive cross-sectional survey.
Subjects: A total of 212 parents of children aged 4–14 years with moderate to severe CP were identified from the Northern Ireland Cerebral Palsy Register (NICPR) and a random subsample of their paediatric physiotherapists.
Main measures: A standardized description of motor impairment or assessment form; a postal questionnaire to parents and paediatric physiotherapists (to validate parents’ reports of service use).
Response rates: In total, 85% of parent questionnaires were returned and 100% of paediatric physiotherapists responded.
Results: Service use among families was high; on average the families had contact with approximately seven services in a 6-month time interval. The overwhelming majority of children (96%) received physiotherapy during the school term and most (59%) received treatment at least twice a week for 30 min; 43% of children had their physiotherapy discontinued over the summer holidays. Over one-quarter (28%) of families had opted out of the NHS and bought alternatives like conductive education (21%) or private forms of conventional physiotherapy (16%). Children with more severe forms of CP, in special education, particularly at schools for physical disability, were high-intensity users of the physiotherapy service. Despite this, 74% of parents wanted more physiotherapy for their child.
Conclusions and implications: The demand for physiotherapy services is likely to continue given the relatively stable prevalence rate of CP, the proportion of children with disabling CP and the level of parent interest in the service. A number of quality aspects and gaps in the service have been identified.

An Examination of the Use of Coercion by Assertive Outreach and Community Mental Health Teams in Northern Ireland.

In mental health services over recent decades, the positive move away from hospital-based care to community-based services has entailed that people with higher levels of need are being supported by community mental health services. This paper begins by reviewing the literature on coercion in the field of community-based mental health care and treatment. It is argued that the lack of a critical understanding of the concept and how it is used by practitioners and agencies can have serious repercussions for the rights of service users. Using a quasi-experimental, longitudinal design, the authors then seek to test some of the ideas about coercion by comparing the activities of assertive outreach and community mental health teams in Northern Ireland, particularly the key ideas of perceived coercion, workers’ strategies and engagement with services. Key findings were that assertive outreach appeared to be more successful at reducing perceived coercion, minimizing the need for coercive strategies, engaging high-risk clients and reducing inpatient bed use. These findings are compared with other studies in this area. The authors also argue that there is a need for greater transparency in the way that practitioners use coercive measures and more explicit guidance is required in this crucial area of mental health practice.

An architecture for agent-enhanced network service provisioning through SLA negotiation

This paper focuses on two main areas. We first investigate various aspects of subscription and session Service Level Agreement (SLA) issues such as negotiating and setting up network services with Quality of Service (QoS) and pricing preferences. We then introduce an agent-enhanced service architecture that facilitates these services. A prototype system consisting of real-time agents that represent various network stakeholders was developed. A novel approach is presented where the agent system is allowed to communicate with a simulated network. This allows functional and dynamic behaviour of the network to be investigated under various agent-supported scenarios. This paper also highlights the effects of SLA negotiation and dynamic pricing in a competitive multi-operator networks environment.

On the Study of Network Coded AF Transmission Protocol for Wireless Multiple Access Channels

In this paper, the performance of the network coded amplify-forward cooperative protocol is studied. The use of network coding can suppress the bandwidth resource consumed by relay transmission, and hence increase the spectral efficiency of cooperative diversity. A distributed strategy of relay selection is applied to the cooperative scheme, which can reduce system overhead and also facilitate the development of the explicit expressions of information metrics, such as outage probability and ergodic capacity. Both analytical and numerical results demonstrate that the proposed protocol can achieve large ergodic capacity and full diversity gain simultaneously.

Performance Analysis of Novel Randomly Shifted Certification Authority Authentication Protocol for MANETs

The provision of security in mobile ad hoc networks is of paramount importance due to their wireless nature. However, when conducting research into security protocols for ad hoc networks it is necessary to consider these in the context of the overall system. For example, communicational delay associated with the underlying MAC layer needs to be taken into account. Nodes in mobile ad hoc networks must strictly obey the rules of the underlying MAC when transmitting security-related messages while still maintaining a certain quality of service. In this paper a novel authentication protocol, RASCAAL, is described and its performance is analysed by investigating both the communicational-related effects of the underlying IEEE 802.11 MAC and the computational-related effects of the cryptographic algorithms employed. To the best of the authors' knowledge, RASCAAL is the first authentication protocol which proposes the concept of dynamically formed short-lived random clusters with no prior knowledge of the cluster head. The performance analysis demonstrates that the communication losses outweigh the computation losses with respect to energy and delay. MAC-related communicational effects account for 99% of the total delay and total energy consumption incurred by the RASCAAL protocol. The results also show that a saving in communicational energy of up to 12.5% can be achieved by changing the status of the wireless nodes during the course of operation. Copyright (C) 2009 G. A. Safdar and M. P. O'Neill (nee McLoone).

Reasoning about orchestrations of web services using partial correctness

A service is a remote computational facility which is made available for general use by means of a wide-area network. Several types of service arise in practice: stateless services, shared state services and services with states which are customised for individual users. A service-based orchestration is a multi-threaded computation which invokes remote services in order to deliver results back to a user (publication). In this paper a means of specifying services and reasoning about the correctness of orchestrations over stateless services is presented. As web services are potentially unreliable the termination of even finite orchestrations cannot be guaranteed. For this reason a partial-correctness powerdomain approach is proposed to capture the semantics of recursive orchestrations.

Service User and Carer Involvement in Role-Plays to Assess Readiness for Practice

Service user and carer involvement in social work education is now well established since its inception as a compulsory requirement in the social work curriculum in the United Kingdom in 2003. Since then, there have been many examples of how such involvement has been approached by education providers. Nevertheless, one of the key obstacles and challenges in this field continues to centre on the need to achieve non-tokenistic user involvement which cements the engagement of service users and carers at the heart of social work education. This paper describes one such initiative where service user and carer colleagues in a university in Northern Ireland have been actively involved in the assessment of first year social work students’ preparation for their first period of practice learning. The paper presents the background to this initiative explaining how the project unfolded; the detailed preparations that were involved and the evidence gathered from evaluations undertaken with the students, service users and carers, and academic colleagues who were all involved. We believe that the findings from this project can contribute to the advancement of existing knowledge in the field in exploring and recommending creative methodologies for user involvement in social work education.

Social Work Students Learn about Social Work Values from Service Users and Carers

Teaching on social work values is centrally important in social work education as a core aspect of underpinning knowledge in preparing students for practice. This paper describes an innovative project occurring within the first year of the degree in social work, where service users and carers have assisted students with their understanding of social work values. The positive contribution of service users and carers in facilitating students to make links between theory and practice is now well documented. Applying this user perspective to the educational domain of values, however, is relatively uncharted territory given the challenges that have traditionally accompanied the teaching of values. Importantly, this paper describes the ‘value talk’ which occurred when first-year students sought further meaning from service-user and carer groups in their community settings following classroom teaching on values. The paper not only discusses the detailed preparations involved in the project but also the learning which resulted, drawing on the evaluation findings from the students and participating groups. Whilst the findings show that the students' understanding of social work values has been most significantly influenced by the contributions from service users and carers, it is recognized that further research is needed to monitor the longer term impact on social work students' practice after they qualify.

Telephone survey evaluation of the educational impact of a distance learning course

The educational impact of a distance learning (DL) course entitled ''Health Screening for Health Promotion, was investigated using a telephone questionnaire survey. An introduction to the DL course was distributed to all community pharmacists in England (16,400); the main body of the course, on which pharmacists were examined, was distributed free of charge to all pharmacists who requested it (1,485). Pharmacists participating in the survey (868) were organized by random selection into groups and stratified according to age, sex and postcode. A matched control group was randomly drawn from those pharmacists who had not participated in the course. The DL course improved pharmacists' knowledge about health screening/health promotion issues (e.g., mean score of 66 percent achieved by a group who had completed the course; 51 percent achieved by the control group; P<0.001). Factors influencing score achieved included sex and year of registration. Males performed better than females (P<0.008) while performance decreased with number of years on the register (P<0.001).

The VLT-FLAMES survey of massive stars: observations centered on the Magellanic Cloud clusters NGC 330, NGC 346, NGC 2004, and the N11 region

We present new observations of 470 stars using the Fibre Large Array Multi-Element Spectrograph ( FLAMES) instrument in fields centered on the clusters NGC330 and NGC346 in the Small Magellanic Cloud (SMC), and NGC2004 and the N11 region in the Large Magellanic Cloud (LMC). A further 14 stars were observed in the N11 and NGC330 fields using the Ultraviolet and Visual Echelle Spectrograph (UVES) for a separate programme. Spectral classifications and stellar radial velocities are given for each target, with careful attention to checks for binarity. In particular, we have investigated previously unexplored regions around the central LH9/LH10 complex of N11, finding similar to 25 new O-type stars from our spectroscopy. We have observed a relatively large number of Be-type stars that display permitted Fe II emission lines. These are primarily not in the cluster cores and appear to be associated with classical Be-type stars, rather than pre main-sequence objects. The presence of the Fe II emission, as compared to the equivalent width of Ha, is not obviously dependent on metallicity. We have also explored the relative fraction of Be- to normal B-type stars in the field-regions near to NGC330 and NGC2004, finding no strong evidence of a trend with metallicity when compared to Galactic results. A consequence of service observations is that we have reasonable time-sampling in three of our FLAMES fields. We find lower limits to the binary fraction of O- and early B-type stars of 23 to 36%. One of our targets (NGC346-013) is especially interesting with a massive, apparently hotter, less luminous secondary component.

SLA Brokering and Bandwidth Reservation Negotiation Schemes for QoS-aware Internet

We present a novel Service Level Agreement (SLA)-driven service provisioning architecture, which enables dynamic and flexible bandwidth reservation schemes on a per-user or per-application basis. Various session level SLA negotiation schemes involving bandwidth allocation, service start time and service duration parameters are introduced and analyzed. The results show that these negotiation schemes can be utilized for the benefit of both end users and network providers in achieving the highest individual SLA optimization in terms of key Quality of Service (QoS) metrics and price. The inherent characteristics of software agents such as autonomy, adaptability and social abilities offer many advantages in this dynamic, complex, and distributed network environment especially when performing Service Level Agreements (SLA) definition negotiations and brokering tasks. This article also presents a service broker prototype based on Fujitsu's Phoenix Open Agent Mediator (OAM) agent technology, which was used to demonstrate a range of SLA brokering scenarios.

ISOLATION, LOCALIZATION, AND CARDIOVASCULAR ACTIVITY OF TACHYKININS FROM THE STOMACH OF THE BOWFIN AMIA-CALVA

The bowfin is an extant representative of an ancient group of ray-finned fish with evolutionary connections to modern teleosts. A peptide with substance P-like immunoreactivity was isolated from an extract of bowfin stomach and its primary structure was established as Ser-Lys-Ser-His-Gln-Phe-Tyr-Gly-Leu-Met-NH2. This amino acid sequence resembles mammalian substance P only in the COOH-terminal region of the peptide. A second tachykinin with neurokinin A-like immunoreactivity isolated from the extract comprises 23 amino acid residues and shows limited structural similarity to mammalian neuropeptide-gamma. A randomly distributed population of cells in the gastric glands of the bowfin were immunostained with an antiserum raised against substance P, but no immunopositive structures were identified in the surface epithelium, lamina propria, or the nerve plexuses of the submucosa. Bolus injections of synthetic bowfin substance P (0.1-10 nmol/kg) into the bulbus arteriosus of unanesthetized bowfin resulted in a significant and dose-dependent rise in vascular resistance and arterial blood pressure (P < 0.01) and a fall in cardiac output (P < 0.05) without change in heart rate. After 5-10 min, arterial pressure and vascular resistance returned to preinjection levels, but cardiac output significantly (P < 0.05) increased over baseline values. The response to the peptide was unaffected by pretreatment of the animals with phentolamine. The study has shown that the stomach of the bowfin synthesizes tachykinins with novel structural features that display cardiovascular activity in this species.

Service user involvement in drug treatment programs: Barriers to implementation and potential benefits for client recovery

Service user forums have the potential for improving awareness of services, empowering service users and strengthening community partnerships within an inclusive treatment and rehabilitation framework. The research aimed to investigate perspectives about service user involvement in order to inform the development of effective service user forum(s) in west Ireland. A total of 30 interviews with key service providers and 12 interviews with service users were conducted, with interview questions focusing on: (1) awareness of the Service User Support Team and (2) barriers to service user involvement and the development of service user forums in the region. An integrated data collection and thematic analysis was undertaken. Current levels of service user involvement were low, restricted by one-way communication and appeared grounded in user-provider power differentials and stigma relating to drug dependency. Service providers queried the actual terms of reference, capacity and training that would be needed for service user forums to advocate and lobby for service users. The use of existing support groups, creation of internet user forums and rotation of rural meetings were recommended to promote engagement among service users. The research underscores the need for transparency, resources and a framework for good practice that reflects a participatory approach


Read More: http://informahealthcare.com/doi/abs/10.3109/09687637.2012.671860

ME and Julie:a study in narrative of illness experience and therapy in a Myalgic Encephalomyelitis sufferer

This article uses what Atkinson and Walmsley (1997) refer to as an ‘autobiographical account’ to explore the themes and relationships between narrative, illness experience and therapy in a Myalgic Encephalomyelitis (ME) sufferer. Julie is a chronic ME sufferer, having lived with ME for the past 12 years. Her life-story over those years, as she presents it, casts our attention to the intrinsically personal nature of her ‘illness experience’ and to her distinctively artistic therapeutic responses to her condition. Julie’s autobiographical narrative reveals how ME has penetrated both her body and her sense of self, her limbs as well as her dreams; as though it were a parasite feeding off her fight to regain health. In terms of narrative, Julie’s ME illness progresses from past to present, but never to the future which lies beyond contemplation. Despite this denial of the future, Julie does think of ME as a liminal phase which is to be coped through. As both spatial object and temporal event, Julie conceptualises her ME variously, dealing with it on a day-to-day basis, increasingly turning to landscape painting as a form of escapism which parallels her former physical outward bound activities. This personal therapy, so this article concludes, constitutes both narrative performance and narrative text (as canvas), both of which can only cautiously be independently interpreted by the (inter)viewer.

Variation and Change in French Morphosyntax: The Case of Collective Nouns

Collective nouns such as majorité or foule have long been of interest to linguists for their unusual semantic properties, and provide a valuable source of new data on the evolution of French grammar. This book tests the hypothesis that plural agreement with collective nouns is becoming more frequent in French. Through an analysis of data from a variety of sources, including sociolinguistic interviews, gap-fill tests and corpora, the complex linguistic and external factors which affect this type of agreement are examined, shedding new light on their interaction in this context. Broader questions concerning the methodological challenges of studying variation and change in morphosyntax, and the application of sociolinguistic generalisations to the French of France, are also addressed.

Reviews:

‘Cet ouvrage constitue un apport majeur dans le champ de la linguistique variationniste et diachronique, tant par les résultats mis au jour que par la qualité de sa démarche méthodologique.’ — Sophie Prévost, French Studies 69.4, October 2015, 578-79

‘While language variation and change have been the focal point for linguists on this side of the Atlantic, Tristram argues that studies on morphosyntactic variation in French studies are lacking due to a focus on phonology and dialectology as well as denial of variation and change in the French language. Tristram’s book is thus a welcome contribution.’ — Samira Hassa, French Review 89.3, 2016, 108

‘Anyone teaching variation in French will want to talk about the findings and reflections reported in this study. A remarkable amount of ground is covered in a small compass. This is a highly welcome addition to the Legenda list, and one must hope that further linguistics titles will be added to it before very long.’ — Nigel Armstrong, Journal of French Language Studies 26.2, 2016, 211-13