Management of nut allergy influences quality of life and anxiety in children and their mothers

Nut allergy is known to impact on the quality of life (QoL) and anxiety of both the allergic child and their parents, but little is known about how the management of food allergy is associated with these variables. To investigate the impact of nut allergy on QoL and anxiety in mothers and children with nut allergy in order to identify management strategies that may influence these factors. Forty-one nut allergic children (age 6–16 yrs) and their mothers completed questionnaires to assess maternal and children’s QoL (PedsQL™, WHOQOL-BREF, FAQL-PB), anxiety (SCAS, STAI) and perceived stress scale (PSS). Children also completed a nut allergy specific QoL questionnaire. Demographic data, details of previous reactions, test results and management plans were collected using parent-report questionnaires and hospital notes. Children with nut allergy had poorer emotional (p = 0.004), social (p = 0.043), and psychological (p = 0.006) QoL compared to healthy normative data. Maternal and child QoL and anxiety were not influenced by the severity of previous reactions. Mother and child reported lower anxiety (p = 0.043 and p < 0.001 respectively) when the child was prescribed an epinephrine auto-injector. Anxiety was not associated with whether the child carried the auto-injector or whether they strictly avoided traces of nuts in foods. Prescribing auto-injectors is associated with reduced anxiety for food allergic children and their mothers, but is not associated with improved adherence with medical management or reduced risk-taking behavior.

Can illness perceptions and coping predict psychological distress amongst allergy sufferers?

Objective. The aim of the present study was to measure the extent to which illness perceptions and coping strategies are associated with the levels of psychological distress amongst allergy sufferers. Design and method. One hundred and fifty-six allergy sufferers (all members of Allergy U.K.) completed a postal survey consisting of the Revised Illness Perception Questionnaire (IPQ-R) and the COPE. Psychological distress was measured using the General Health Questionnaire (GHQ-28) and the Perceived Stress Scale (PSS). Results. Multiple regression analyses indicated that illness perceptions explained between 6 and 26% of variance on measures of psychological distress; coping strategies explained between 12 and 25%. A strong illness identity and emotional representations of the allergy were associated with higher levels of psychological distress; as were less adaptive coping strategies such as focusing on and venting of emotions. Strong personal control beliefs were associated with the lower levels of distress, as were adaptive coping strategies such as positive reinterpretation and growth. Coping partially mediated the link between the illness perceptions and the outcome; however, illness identity, emotional representations and personal control retained an independent significant association with psychological distress. Conclusion. The findings support a role for illness perceptions and coping in explaining levels of psychological distress amongst allergy sufferers. This has implications for targeted health interventions aimed at reducing the strength of illness identity and emotional representations and increasing a sense of control and the use of more adaptive coping strategies.

Impact of peanut allergy on quality of life, stress and anxiety in the family

Background: Peanut allergy (PA) is known to impact on quality of life (QoL) of the sufferer, but little research has focused on all family members. We therefore sought to establish the impact of PA on QoL and reported anxiety of children with clinically confirmed PA, their parents and older siblings. Methods: Forty-six families, who had a child with PA, completed QoL (PedsQLTM or WHOQOL-BREF), anxiety (SCAS or STAI) and perceived stress (PSS) scales. PA children completed a PA specific QoL questionnaire (Pediatr Allergy Immunol 2003;14:378). Parents and sibling also completed QoL proxy questionnaires for the PA child (PedsQLTM, Pediatr Allergy Immunol 2003;14:378). Results: Mothers rated their own psychological (P < 0.01) and physical (P < 0.05) QoL significantly worse than fathers rated theirs, and had higher scores than fathers for anxiety (P < 0.05) and stress (P < 0.001). Children with PA had significantly poorer physical health-related QoL (P < 0.05), QoL within school (P < 0.01) and general QoL (P < 0.05) than their siblings did, and greater separation anxiety (P < 0.05). The majority of differences were between girls with PA and female siblings. Mothers felt that there was a greater impact on QoL for their PA child, compared with that reported by siblings, fathers or the PA children themselves (P < 0.01). Conclusions: Mothers report that they have significantly poorer QoL and suffer more anxiety and stress than fathers do; this inter-parental difference may be an important feature of family stress caused by PA. Siblings have a similar view of how QoL affects the PA child as the PA child does, while mothers may possibly overestimate this impact.

Stress, burnout and coping strategies in the emergency and intensive care hospital departments

Doctors and nurses working at the accident and emergency (A&E), and intensive care departments are at risk of burnout. They often spend substantial time in intense interactions with other people, centered on patients? health problems (physical, psychological and social) that may lead to feelings of anger, anxiety and frustration, and eventually to burnout. Burnout is a syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment (Maslach & Jackson, 1981) The purpose of this chapter is to assess work stressors, burnout and stress-coping mechanisms among doctors and nurses at the A&E and intensive care departments. A quantitative design using the survey approach was used to collect data from a sample of 200 participants with a response rate of 71% (n=154) Work stressors were associated with burnout in both doctors and nurses. Workload was the most salient work stressor in the sample. Nurses experienced more stress (M=1.5, SD=0.4) than doctors (M=1.2, SD=0.4) in all the work stressor variables examined. The A&E department was reported as more stressful than the intensive care department. Avoidance-oriented and task-oriented coping were the most and the least frequently reported coping strategies respectively. Additionally, only emotion-oriented coping strategy was significantly different between doctors and nurses, and this strategy was also significantly positively correlated with all the variables in the adapted nursing stress scale, and the three burnout variables. Death and dying was most strongly correlated with emotion-oriented coping. This chapter provides an assessment of stress, burnout and coping experienced by both doctors and nurses within the A&E and intensive care departments. Methods that may mitigate stress in these environments may be adequate staffing, supportive management, stress management programs, as well as improvement in communication strategies between doctors and nurses.

Blurred edges look faint, and faint edges look sharp:The effect of a gradient threshold in a multi-scale edge coding model

A multi-scale model of edge coding based on normalized Gaussian derivative filters successfully predicts perceived scale (blur) for a wide variety of edge profiles [Georgeson, M. A., May, K. A., Freeman, T. C. A., & Hesse, G. S. (in press). From filters to features: Scale-space analysis of edge and blur coding in human vision. Journal of Vision]. Our model spatially differentiates the luminance profile, half-wave rectifies the 1st derivative, and then differentiates twice more, to give the 3rd derivative of all regions with a positive gradient. This process is implemented by a set of Gaussian derivative filters with a range of scales. Peaks in the inverted normalized 3rd derivative across space and scale indicate the positions and scales of the edges. The edge contrast can be estimated from the height of the peak. The model provides a veridical estimate of the scale and contrast of edges that have a Gaussian integral profile. Therefore, since scale and contrast are independent stimulus parameters, the model predicts that the perceived value of either of these parameters should be unaffected by changes in the other. This prediction was found to be incorrect: reducing the contrast of an edge made it look sharper, and increasing its scale led to a decrease in the perceived contrast. Our model can account for these effects when the simple half-wave rectifier after the 1st derivative is replaced by a smoothed threshold function described by two parameters. For each subject, one pair of parameters provided a satisfactory fit to the data from all the experiments presented here and in the accompanying paper [May, K. A. & Georgeson, M. A. (2007). Added luminance ramp alters perceived edge blur and contrast: A critical test for derivative-based models of edge coding. Vision Research, 47, 1721-1731]. Thus, when we allow for the visual system's insensitivity to very shallow luminance gradients, our multi-scale model can be extended to edge coding over a wide range of contrasts and blurs. © 2007 Elsevier Ltd. All rights reserved.

Added luminance ramp alters perceived edge blur and contrast:A critical test for derivative-based models of edge coding

In many models of edge analysis in biological vision, the initial stage is a linear 2nd derivative operation. Such models predict that adding a linear luminance ramp to an edge will have no effect on the edge's appearance, since the ramp has no effect on the 2nd derivative. Our experiments did not support this prediction: adding a negative-going ramp to a positive-going edge (or vice-versa) greatly reduced the perceived blur and contrast of the edge. The effects on a fairly sharp edge were accurately predicted by a nonlinear multi-scale model of edge processing [Georgeson, M. A., May, K. A., Freeman, T. C. A., & Hesse, G. S. (in press). From filters to features: Scale-space analysis of edge and blur coding in human vision. Journal of Vision], in which a half-wave rectifier comes after the 1st derivative filter. But we also found that the ramp affected perceived blur more profoundly when the edge blur was large, and this greater effect was not predicted by the existing model. The model's fit to these data was much improved when the simple half-wave rectifier was replaced by a threshold-like transducer [May, K. A. & Georgeson, M. A. (2007). Blurred edges look faint, and faint edges look sharp: The effect of a gradient threshold in a multi-scale edge coding model. Vision Research, 47, 1705-1720.]. This modified model correctly predicted that the interaction between ramp gradient and edge scale would be much larger for blur perception than for contrast perception. In our model, the ramp narrows an internal representation of the gradient profile, leading to a reduction in perceived blur. This in turn reduces perceived contrast because estimated blur plays a role in the model's estimation of contrast. Interestingly, the model predicts that analogous effects should occur when the width of the window containing the edge is made narrower. This has already been confirmed for blur perception; here, we further support the model by showing a similar effect for contrast perception. © 2007 Elsevier Ltd. All rights reserved.

Is gender a factor in perceived prison officer competence?

Background The introduction of women officers into HM Prison Service raised questions regarding women's ability to perform what had traditionally been a male role. Existing research is inconclusive as to whether female prison officers are as competent as male prison officers, and whether there are gender differences in job performance. This study examined prisoners' perceptions of male and female prison officers' performance. Hypotheses The hypotheses were that overall competence and professionalism ratings would not differ for men and women officers, but that there would be differences in how men and women were perceived to perform their roles. Women were expected to be rated as more communicative, more empathic and less disciplining. Method The Prison Officer Competency Rating Scale (PORS) was designed for this study. Ratings on the PORS for male and female officers were given by 57 adult male prisoners. Results There was no significant difference in prisoners' ratings of overall competence of men and women officers. Of the PORS subscales, there were no gender differences in Discipline and Control, Communication or Empathy, but there was a significant difference in Professionalism, where prisoners rated women as more professional. Conclusion The failure to find any differences between men and women in overall job competence, or on communication, empathy and discipline, as perceived by prisoners, suggests that men and women may be performing their jobs similarly in many respects. Women were rated as more professional, and items contributing to this scale related to respecting privacy and keeping calm in difficult situations, where there may be inherent gender biases. Copyright © 2005 Whurr Publishers Ltd.

Mach Bands: multi-scale spatial filtering and co-operative coding of edges and bars

Perception of Mach bands may be explained by spatial filtering ('lateral inhibition') that can be approximated by 2nd derivative computation, and several alternative models have been proposed. To distinguish between them, we used a novel set of ‘generalised Gaussian’ images, in which the sharp ramp-plateau junction of the Mach ramp was replaced by smoother transitions. The images ranged from a slightly blurred Mach ramp to a Gaussian edge and beyond, and also included a sine-wave edge. The probability of seeing Mach Bands increased with the (relative) sharpness of the junction, but was largely independent of absolute spatial scale. These data did not fit the predictions of MIRAGE, nor 2nd derivative computation at a single fine scale. In experiment 2, observers used a cursor to mark features on the same set of images. Data on perceived position of Mach bands did not support the local energy model. Perceived width of Mach bands was poorly explained by a single-scale edge detection model, despite its previous success with Mach edges (Wallis & Georgeson, 2009, Vision Research, 49, 1886-1893). A more successful model used separate (odd and even) scale-space filtering for edges and bars, local peak detection to find candidate features, and the MAX operator to compare odd- and even-filter response maps (Georgeson, VSS 2006, Journal of Vision 6(6), 191a). Mach bands are seen when there is a local peak in the even-filter (bar) response map, AND that peak value exceeds corresponding responses in the odd-filter (edge) maps.

Low spatial frequencies are suppressively masked across spatial scale, orientation, field position, and eye of origin

Masking is said to occur when a mask stimulus interferes with the visibility of a target (test) stimulus. One widely held view of this process supposes interactions between mask and test mechanisms (cross-channel masking), and explicit models (e.g., J. M. Foley, 1994) have proposed that the interactions are inhibitory. Unlike a within-channel model, where masking involves the combination of mask and test stimulus within a single mechanism, this cross-channel inhibitory model predicts that the mask should attenuate the perceived contrast of a test stimulus. Another possibility is that masking is due to an increase in noise, in which case, perception of contrast should be unaffected once the signal exceeds detection threshold. We use circular patches and annuli of sine-wave grating in contrast detection and contrast matching experiments to test these hypotheses and investigate interactions across spatial frequency, orientation, field position, and eye of origin. In both types of experiments we found substantial effects of masking that can occur over a factor of 3 in spatial frequency, 45° in orientation, across different field positions and between different eyes. We found the effects to be greatest at the lowest test spatial frequency we used (0.46 c/deg), and when the mask and test differed in all four dimensions simultaneously. This is surprising in light of previous work where it was concluded that suppression from the surround was strictly monocular (C. Chubb, G. Sperling, & J. A. Solomon, 1989). The results confirm that above detection threshold, cross-channel masking involves contrast suppression and not (purely) mask-induced noise. We conclude that cross-channel masking can be a powerful phenomenon, particularly at low test spatial frequencies and when mask and test are presented to different eyes. © 2004 ARVO.

Response normalization and blur adaptation:data and multi-scale model

Adapting to blurred or sharpened images alters perceived blur of a focused image (M. A. Webster, M. A. Georgeson, & S. M. Webster, 2002). We asked whether blur adaptation results in (a) renormalization of perceived focus or (b) a repulsion aftereffect. Images were checkerboards or 2-D Gaussian noise, whose amplitude spectra had (log-log) slopes from -2 (strongly blurred) to 0 (strongly sharpened). Observers adjusted the spectral slope of a comparison image to match different test slopes after adaptation to blurred or sharpened images. Results did not show repulsion effects but were consistent with some renormalization. Test blur levels at and near a blurred or sharpened adaptation level were matched by more focused slopes (closer to 1/f) but with little or no change in appearance after adaptation to focused (1/f) images. A model of contrast adaptation and blur coding by multiple-scale spatial filters predicts these blur aftereffects and those of Webster et al. (2002). A key proposal is that observers are pre-adapted to natural spectra, and blurred or sharpened spectra induce changes in the state of adaptation. The model illustrates how norms might be encoded and recalibrated in the visual system even when they are represented only implicitly by the distribution of responses across multiple channels.

The management of stress amongst professional carers within a social services department

This thesis considers four broad areas:(i) ANALYSIS OF THE STRESS FIELD.(a) research studies, relevant to the British Social Services considering the cultural setting, and the rigor with which they were conducted; (b) models of stress, specifically examining the theoretical soundness and practical application of the Medical, Engineering and Transactional models;(c) organisational models of stress relating specifically to human service organisations.(ii) QUALITATIVE AND QUANTITATIVE RESEARCH METHODOLOGIES.(a) the appropriate application of each respective methodology and the particular usefulness of qualitative research designs; (b) the relevance of understanding the language and terminology associated with the subject area prior to the implementation of survey methods; (iii) FIELDWORK.(a) Phase 1. By use of focus groups, in-depth interviews and diary keeping amongst a small range of teams and managers, the Researcher develops a basic conceptual framework of stress within a Social Services context. In addition a small scale personality inventory was administered to participants.(b) Phase 2. This consisted of three key elements: 6 case studies in which the Researcher implements and appraises the impact of a range of intervention strategies designed to assist teams and their managers in dealing more effectively with stress; the administration of a large scale survey to all the field social work teams within the Social Services Department; an analysis of the user role within the stress process by way of two focus groups.(iv) THEORETICAL DEVELOPMENT.

Sedation in paediatric intensive care

Paediatric intensive care is an expanding specialty that has been shown to improve the quality of care provided to critically ill children. An important aspect of the management of critically ill children includes the provision of effective sedation to reduce stress and anxiety during their stay in intensive care. However, to achieve effective and safe sedation in these children, is recognised as a challenge that is not without risk. Often children receive too much or too little sedation resulting in over sedation or under sedation respectively. These problems have arisen owing to a lack of information regarding altered pharmacokinetics and pharmacodynamics of medicines administered to critically ill children. In addition there are few validated sedation scoring systems in practice with which to monitor level of sedation and titrate medication appropriately. This study consisted of two stages. Stage 1 investigated the reproducibility and practicality of two observational sedation assessment scales for use in critically ill children. The two scales were different in design, the first being simple in design requiring a single assessment of the patient. The second was more complex in design requiring assessment of five patient parameters to obtain an overall sedation score. Both scales were found to achieve good reproducibility (kappa values 0.50 and 0.62 respectively). Practicality of each sedation scale was undertaken by obtaining nursing staff opinion about both scales using questionnaire and interview technique. It was established that nursing staff preferred the second, more complex sedation scale mainly because it was perceived to give a more accurate assessment of level of sedation and anxiety rather than merely level of sedation. Stage 2 investigated the pharmacokinetics and pharmacodynamics of midazolam in critically ill children. 52 children, aged between 0 and 18 years were recruited to the study and 303 blood samples taken to analyse midazolam and its metabolites, I-hydroxyrnidazolam (I-OR) and 4-hydroxymidazolam (4-0H). Analysis of plasma was undertaken using high performance liquid chromatography. A significant correlation was found between midazolam plasma concentration and sedative effect (r=0.598, p=O.OI). It was found that a midazolam plasma concentration of 223ng/ml (±31.9) achieved a satisfactory level of sedation. Only a poor correlation was found between dose of midazolam and plasma concentration of midazolam. Similarly only a poor correlation was found between sedative effect and dose of midazolam. Clearance of midazolam was found to be 6.3mllkglmin (±0.36), which is lower than that reported in healthy children (9.Il-13.3mllkg/min). Age related differences in midazolam clearance were observed in the study. Neonates produced the lowest clearance values (l.63mllkg/min), compared to children aged 1 to 12 months (8.52mllkg/min) who achieved the highest clearance values. Clearance was found to decrease after the age of 12 months to values of 5.34mllkglmin in children aged 7 years and above. Patients with renal (n=5) and liver impairment (n~4) were found to have reduced midazolam clearance (1.37 and 0.74ml/kg/min respectively). Plasma concentrations of I-OH and 4-0H ranged from 0-5 1 89nglml and 0-27 Inglml respectively. All children were found to be capable of producing both metabolites irrespective of age, although no trend was established between age and extent of production of either metabolite. Disease state was found to affect production of l-OH. Patients with renal impairment (n=5) produced the lowest I-OH midazolam plasma ratio (0.059) compared to patients with head injury (0.858). Patients with severe liver impairment were found to be capable of manufacturing both metabolites despite having a severely damaged liver.

PSS as a service based strategy for western manufacturers

A product-service system (PSS) is a subtle blend of products and services that are offered as an integrated solution to customers. Much existing work on PSS has originated from Scandinavia and has been motivated by a sustainability agenda. Although valuable, this form has limited appeal to western manufacturers. However, by expanding the concepts of PSS to also embrace leading thinking on large scale complex service systems and informated products and services, it is possible to put forward the basis of a service business model that offers the means to differentiate from competitors who simply offer lower priced products. This paper aims to build this case. It reports the state-of-the-art of PSS, defines the concept, reports on its origin and features, discusses examples of applications, and finally proposes a research strategy for future work on this topic.

The role of emotional labour and role stress on burnout and psychological strain in high contact service employees

This study examines the relationships between job demands (in the form of role stressors and emotional management) and employee burnout amongst high contact service employees. Employees in customer facing roles are frequently required to manage overwhelming, conflicting or ambiguous demands, which they may feel ill-equipped to handle. Simultaneously, they must manage the emotions they display towards customers, suppressing some, and expressing others, be they genuine or contrived. If the in-role effort required of employees exceeds their inherent capacity to cope, burnout may result. Burnout, in turn, can have serious detrimental consequences for the psychological well being of employees. We find that both emotional management and role stressors impact burnout. We also confirm that burnout predicts psychological strain. In line with the Job Demands and Resources Model, we examine the mitigating impact of perceived support on these relationships but do not find a significant mitigating impact.

The Birmingham relationship continuity measure:the development and evaluation of a measure of the perceived continuity of spousal relationships in dementia

Background: Qualitative research has suggested that spousal carers of someone with dementia differ in terms of whether they perceive their relationship with that person as continuous with the premorbid relationship or as radically different, and that a perception of continuity may be associated with more person-centered care and the experience of fewer of the negative emotions associated with caring. The aim of the study was to develop and evaluate a quantitative measure of the extent to which spousal carers perceive the relationship to be continuous. Methods: An initial pool of 42 questionnaire items was generated on the basis of the qualitative research about relationship continuity. These were completed by 51 spousal carers and item analysis was used to reduce the pool to 23 items. The retained items, comprising five subscales, were then administered to a second sample of 84 spousal carers, and the questionnaire's reliability, discriminative power, and validity were evaluated. Results: The questionnaire showed good reliability: Cronbach's α for the full scale was 0.947, and test-retest reliability was 0.932. Ferguson's δ was 0.987, indicating good discriminative power. Evidence of construct validity was provided by predicted patterns of subscale correlations with the Closeness and Conflict Scale and the Marwit-Meuser Caregiver Grief Inventory. Conclusion: Initial psychometric evaluation of the measure was encouraging. The measure provides a quantitative means of investigating ideas from qualitative research about the role of relationship continuity in influencing how spousal carers provide care and how they react emotionally to their caring role. © 2012 International Psychogeriatric Association.