Specialist versus generic models of psychiatry training and service provision for people with intellectual disabilities

Background  Models of service provision and professional training differ between countries. This study aims to investigate a specialist intellectual disabilities model and a generic mental health model, specifically comparing psychiatrists’ knowledge and competencies, and service quality and accessibility in meeting the mental health needs of people with intellectual disabilities. Method  Data were collected from consultant and trainee psychiatrists within a specialist intellectual disabilities model (UK) and a generic mental health model (Australia). Results  The sample sizes were 294 (UK) and 205 (Australia). Statistically significant differences were found, with UK participants having positive views about the specialist intellectual disabilities service model they worked within, demonstrating flexible and accessible working practices and service provision, responsive to the range of mental health needs of the population with intellectual disabilities, and providing a wide range of treatments and supports. The UK participants were knowledgeable, well trained and confident in their work. They wanted to work with people with intellectual disabilities. In all of these areas, the converse was found from the Australian generic mental health service model. Conclusions  The specialist intellectual disabilities model of service provision and training has advantages over the generic mental health model.

Time and Location as Customer Perceived Value Drivers

Since the emergence of service marketing, the focus of service research has evolved. Currently the focus of research is shifting towards value co-created by the customer. Consequently, value creation is increasingly less fixed to a specific time or location controlled by the service provider. However, present service management models, although acknowledging customer participation and accessibility, have not considered the role of the empowered customer who may perform the service at various locations and time frames. The present study expands this scope and provides a framework for exploring customer perceived value from a temporal and spatial perspective. The framework is used to understand and analyse customer perceived value and to explore customer value profiles. It is proposed that customer perceived value can be conceptualised as a function of technical, functional, temporal and spatial value dimensions. These dimensions are suggested to have value-increasing and value-decreasing facets. This conceptualisation is empirically explored in an online banking context and it is shown that time and location are more important value dimensions relative to the technical and functional dimensions. The findings demonstrate that time and location are important not only in terms of having the possibility to choose when and where the service is performed. Customers also value an efficient and optimised use of time and a private and customised service location. The study demonstrates that time and location are not external elements that form the service context, but service value dimensions, in addition to the technical and functional dimensions. This thesis contributes to existing service management research through its framework for understanding temporal and spatial dimensions of perceived value. Practical implications of the study are that time and location need to be considered as service design elements in order to differentiate the service from other services and create additional value for customers. Also, because of increased customer control and the importance of time and location, it is increasingly relevant for service providers to provide a facilitating arena for customers to create value, rather than trying to control the value creation process. Kristina Heinonen is associated with CERS, the Center for Relationship Marketing and Service Management at the Swedish School of Economics and Business Administration

Of plants and pikas: evidence for a climate-mediated decline in forage and cache quality

Background: Animals that hoard food to mediate seasonal deficits in resource availability might be particularly vulnerable to climate-mediated reductions in the quality and accessibility of food during the caching season. Central-place foragers might be additionally impacted by climatic constraints on their already restricted foraging range. Aims: We sought evidence for these patterns in a study of the American pika (Ochotona princeps), a territorial, central-place forager sensitive to climate. Methods: Pika food caches and available forage were re-sampled using historical methods at two long-term study sites, to quantify changes over two decades. Taxa that changed in availability or use were analysed for primary and secondary metabolites. Results: Both sites trended towards warmer summers, and snowmelt trended earlier at the lower latitude site. Graminoid cover increased at each site, and caching trends appeared to reflect available forage rather than primary metabolites. Pikas at the lower latitude site preferred species higher in secondary metabolites, known to provide higher-nutrient winter forage. However, caching of lower-nutrient graminoids increased in proportion with graminoid availability at that site. Conclusions: If our results represent trends in climate, cache quality and available forage, we predict that pikas at the lower latitude site will soon face nutritional deficiencies.

A Method for siting and prioritizing the removal of derelict vessels in Florida Coastal Waters: test applications in the Florida Keys

Increased boating activities and new waterfront developments have contributed an estimated 3,000 dismantled, abandoned, junked, wrecked, derelict vessels to Florida coastal waters. This report outlines a method of siting and prioritizing derelict vessel removal using the Florida Keys as a test area. The data base was information on 240 vessels, obtained from Florida Marine Patrol files. Vessel location was plotted on 1:250,000 regional and 1:5,000 and 1:12,000 site maps. Type of vessel, length, hull material, engine, fuel tanks, overall condition, afloat and submerged characteristics, and accessibility, were used to derive parametric site indices of removal priority and removal difficulty. Results indicate 59 top priority cases which should be the focus of immediate clean up efforts in the Florida Keys. Half of these cases are rated low to moderate in removal difficulty; the remainder are difficult to remove. Removal difficulty is a surrogate for removal cost: low difficulty -low cost, high difficulty - high cost. The rating scheme offers coastal planners options of focusing removal operations either on (1) specific areas with clusters of high priority derelict vessels or on (2) selected targeted derelicts at various, specific locations. (PDF has 59 pages.)

Future requirements for and supply of ophthalmologists for an aging population in Singapore.

BACKGROUND: Singapore's population, as that of many other countries, is aging; this is likely to lead to an increase in eye diseases and the demand for eye care. Since ophthalmologist training is long and expensive, early planning is essential. This paper forecasts workforce and training requirements for Singapore up to the year 2040 under several plausible future scenarios. METHODS: The Singapore Eye Care Workforce Model was created as a continuous time compartment model with explicit workforce stocks using system dynamics. The model has three modules: prevalence of eye disease, demand, and workforce requirements. The model is used to simulate the prevalence of eye diseases, patient visits, and workforce requirements for the public sector under different scenarios in order to determine training requirements. RESULTS: Four scenarios were constructed. Under the baseline business-as-usual scenario, the required number of ophthalmologists is projected to increase by 117% from 2015 to 2040. Under the current policy scenario (assuming an increase of service uptake due to increased awareness, availability, and accessibility of eye care services), the increase will be 175%, while under the new model of care scenario (considering the additional effect of providing some services by non-ophthalmologists) the increase will only be 150%. The moderated workload scenario (assuming in addition a reduction of the clinical workload) projects an increase in the required number of ophthalmologists of 192% by 2040. Considering the uncertainties in the projected demand for eye care services, under the business-as-usual scenario, a residency intake of 8-22 residents per year is required, 17-21 under the current policy scenario, 14-18 under the new model of care scenario, and, under the moderated workload scenario, an intake of 18-23 residents per year is required. CONCLUSIONS: The results show that under all scenarios considered, Singapore's aging and growing population will result in an almost doubling of the number of Singaporeans with eye conditions, a significant increase in public sector eye care demand and, consequently, a greater requirement for ophthalmologists.

Institutional Frameworks and Structural Factors Relating to Educational Access Across Europe

In this article institutional and structural factors relating to access to education are assessed. First, the macro frameworks of institutional regulation that exert influence on the educational trajectories of young Europeans are demonstrated. Based on different aspects of these frameworks and drawing from extant research, the article presents a typology of education systems that provide varying levels of access to and accessibility of education in Finland, France, Germany, Italy, Poland, the Netherlands, Slovenia, and the United Kingdom. Second, using survey data (N = 6,366) it analyzes the impact of gender and parental education on young people’s educational aspirations and early labor-market entry across the countries.

Persistent luminescence of SrAl2O4:Ce(III), Dy, Eu nanotubes, nanowires and core-shells for people with disabilities: nano-emergency

Este estudo transversal está focado na propriedade de luminescência persistente do aluminato de estrôncio co-dopado com cério (III), disprósio (III) e európio (II), SrAl2O4:Ce3+, Dy3+, Eu2+, em sistemas de sinalização de áreas de risco e emergências para pessoas com deficiências. Na área da ciência e engenharia dos materiais, foram desenvolvidos novos materiais com características nanométricas, nanotubos, nanoarames e nanobastões luminescentes de SrAl2O4:Ce3+, Dy3+, Eu2+ para aplicações na área da reabilitação e acessibilidade de pessoas com deficiências. Os nanotubos foram obtidos a partir de micro- e nano-partículas precursoras sintetizadas por reacção do estado-sólido e tratamento térmico de recozedura (1273-1473 K). Os nanoarames e nanobastões foram preparados por moagem, sonificação e recozedura (373 K). Novas nanocápsulas de aluminatos luminescentes dopados com cério (III) e encapsulados com TiO2 foram criadas de modo a obter-se materiais multifuncionais, designadamente com acção fotocatalítica antimicrobiana, antibacteriana e resistência à água. Tais aluminatos podem ser amplamente aplicados como superfícies higiénicas, auto-limpantes, em biomateriais, no domínio de medicamentos antibióticos, na formulação de vacinas, e com ênfase à aplicação em cerâmicas fotoluminescentes. As metodologias de obtenção de tais nanoestruturas de aluminato de estrôncio dopado com cério (III) e do seu encapsulamento, desenvolvidas no âmbito desta tese, são aplicáveis a diversos aluminatos dopados com outros iões lantanídeos (Ln consiste em La, Ce, Pr, Nd, Pm, Sm, Eu, Gd, Tb, Dy, Ho, Er, Yb, Tm ou Lu) com a fórmula M(1-x-y)N2O4:Cex, Lny, onde M é Be, Mg, Ca, Sr ou Ba. Na área da oftalmologia, foi desenvolvido um equipamento médico para o diagnóstico de biofuncionalidade das células retinais fotoreceptoras, e como suporte à telemedicina oftalmológica. Este equipamento foi utilizado para realizar testes de visão cromática FM100HUE em fundo branco/preto para a personalização de materiais luminescentes. Os resultados demonstraram uma biofuncionalidade celular à visibilidade fotópica das cores em fundo preto superior no grupo de tratamento, composto por pessoas com retinopatia diabética (n=38), em comparação ao grupo de referência (n=38). Estes resultados sugerem a recomendação de materiais com fotoluminescência persistente (λem=485-555 nm), incluindo SrAl2O4:Ce3+, Dy3+, Eu2+, para o referido grupo de tratamento, em sinalização de emergência e em ambientes de baixa iluminação. Na área da arquitectura, foi proposta uma nova aplicação dos referidos nanomateriais luminescentes à base de SrAl2O4:Ce3+, Dy3+, Eu2+ em cerâmica de revestimento, tendo em vista a sua boa visibilidade e uso por pessoas com deficiências. Novos pavimentos, cerâmicos, fotoluminescentes, foram desenhados com propriedades multisensoriais (contraste táctil, sonoro e visual) e antimicrobianas, para pessoas portadoras de deficiências utilizarem, no escuro, com a prioridade de salvar vidas em emergências. Tais pisos, com relevos, podem ser combinados de modo a compor um sistema exclusivo de sinalização fotoluminescente multisensorial que possibilita a rápida evacuação mediante o uso de auxílios de mobilidade (e.g. bengala, cadeira de rodas, andadores, muletas). A solução integrada de tais inovações que potencializa a propriedade de luminescência persistente de SrAl2O4:Ce3+, Dy3+, Eu2+ de modo acessível para as pessoas com deficiências, pode contribuir para salvar vidas, no escuro, em emergências.

Best Practice for Providing Social Care and Support to People Living with Concurrent Sight Loss and Dementia: Professional Perspectives

Purpose-Approximately 100,000 people in the UK aged 75 and over have concurrent dementia and sight loss, but current understanding of their experiences, needs and preferences is limited. The purpose of this paper is to report on a research project that explored the provision of social care and support for older people with both conditions. Design/methodology/approach-The project was a collaboration between the universities of York, Worcester, Bournemouth and Cambridge, supported by the Thomas Pocklington Trust and the Housing and Dementia Research Consortium. Data for this paper were drawn from focus groups held in 2013 involving 47 professionals across the dementia, sight loss and housing sectors. Findings-Thematic analysis identified five main barriers to providing high-quality, cost-effective social care and support: time constraints; financial limitations; insufficient professional knowledge; a lack of joint working; and inconsistency of services. The requirements of dementia and sight loss often conflict, which can limit the usefulness of equipment, aids and adaptations. Support and information needs to address individual needs and preferences. Research limitations/implications-Unless professionals consider dementia and sight loss together, they are unlikely to think about the impact of both conditions and the potential of their own services to provide effective support for individuals and their informal carers. Failing to consider both conditions together can also limit the availability and accessibility of social care and support services. This paper is based on input from a small sample of self-selecting professionals across three geographical regions of England. More research is needed in this area. Practical implications-There are growing numbers of people living with concurrent dementia and sight loss, many of whom wish to remain living in their own homes. There is limited awareness of the experiences and needs of this group and limited provision of appropriate services aids/adaptations. A range of measures should be implemented in order to support independence and well-being for people living with both conditions and their family carers. These include increased awareness, improved assessment, more training and greater joint working. Social implications-People living with dementia or sight loss are at high risk of social isolation, increasingly so for those with both conditions. Services that take an inclusive approach to both conditions can provide crucial opportunities for social interaction. Extra care housing has the potential to provide a supportive, community-based environment that can help residents to maintain social contact. Originality/value-This paper adds much-needed evidence to the limited existing literature, and reflects the views of diverse professionals across housing, health and social care

The shifting terrain of feminist theory and activism : university-based women's centres and third wave feminism

This thesis, based on the results of an organizational ethnography of a university-based feminist organization in Southern Ontario (the Centre), traces how third wave feminism is being constituted in the goals, initiatives, mandate, organizational structure, and overall culture of university-based feminist organizations. I argue that, from its inception, the meanings and goals of the Centre have been contested through internal critique, reflection, and discussion inspired by significant shifts in feminist theory that challenge the fundamental principles of second wave feminism. I identify a major shift in the development and direction of the Centre that occurs in two distinct phases. The first phase of the shift occurs with the emergence of an antioppression framework, which broadens the Centre's mandate beyond gender and sexism to consider multiple axes of identity and oppression that affect women's lives. The second phase of this shift is characterized by a focus on (trans) inclusion and accessibility and has involved changing the Centre's name so that it is no longer identified as a women's centre in order to reflect more accurately its focus on mUltiple axes of identity and oppression. Along with identifying two phases of a major shift in the direction of the Centre, I trace two discourses about its development. The dominant discourse of the Centre's development is one of progress and evolution. The dominant discourse characterizes the Centre as a dynamic feminist organization that consistently strives to be more inclusive and diverse. The reverse discourse undermines the dominant discourse by emphasizing that, despite the Centre's official attempts to be inclusive and to build diversity, little has actually changed, leaving women of colour marginalized in the Centre's dominant culture of whiteness. This research reveals that, while many of their strategies have unintended (negative) consequences, members of the Centre are working to build an inclusive politics of resistance that avoids the mistakes of earlier feminist movements and organizations. These members, along with other activists, actively constitute third wave feminism in a process that is challenging, contradictory, and often painful. A critical analysis of this process and the strategies it involves provides an opportunity for activists to reflect on their experiences and develop new strategies in an effort to further struggles for social justice and equity.

A study of self-directed learning at an Ontario college of applied arts and technology

Ontario Colleges of Applied Arts and Technology (CAATs) are currently in the process of restructuring to ensure quality, accountability, and accessibility of college education. References to learner involvement and self-directed learning are prevalent. "Alternative delivery" and "paradigm shift" are current buzzwords within the Ontario CAAT system as an environment is created supportive of change. Instability of funding has also dictated a need for change. Therefore, a focus has become quality of learning with less demand on public resources. This qualitative case study was conducted at an Ontario CAAT to gather descriptive, perceptual data from post-secondary community college educators who were identified as supportive of self-directed learning and from post-secondary, traditional-aged college students who were perceived by their educators to be selfdirected learners. This college was selected because of initiatives to modify its academic paradigm to encourage what was reputed in the Ontario CAAT system to be self-directed learning. The purpose of this study was to investigate how postsecondary, traditional-aged college students and their educators perceive self-directed learning as part of the teaching-learning experience within a community college setting. Educator participants of the study were selected based on the results of a teaching and learning survey intended to identify educators supportive of self-directed learning. A total of 317 surveys were distributed to every full-time educator at the sample college; 192 completed surveys were returned for a return rate of 61 %. Of these, 8% indicated instructional beliefs and values supportive of self-directed learning. A purposive sample of six educators was selected using a maximulp variation sampling strategy. A network selection sampling strategy was used to select a purposive sample of seven post-secondary students who were identified by the sample educators as selfdirected learners. The results of the study show that students and educators have similar perspectives and operating definitions of self-directed learning and all participants believe they either practice or facilitate self-directed learning. However, their perspectives and practices are not consistent with the literature which emphasizes learner autonomy or control in course structure and content. A central characteristic of the participants represented in this study is the service-oriented professions with which each is associated. Experientiallearning opportunities were highly valued for the options provided in increasing learner independence and competencies in reflective practice. Although there were discrepancies between espoused theory and theory in practice in terms of course structure, the process of self-directed learning was being practiced and supported outside the classroom structure in clinical settings, labs and related experiences.

Understanding the Integration of Living Skills Through the Context of Health and Physical Education: A Case Study of Educators’ Experiences

The research presented is a qualitative case study of educators’ experiences in integrating living skills in the context of health and physical education (HPE). In using semi-structured interviews the study investigated HPE educators’ experiences and revealed their insights relative to three major themes; professional practice, challenges and support systems. Professional practice experiences detailed the use of progressive lesson planning, reflective and engaging activities, explicit student centered pedagogy as well as holistic teaching philosophies. Even further, the limited knowledge and awareness of living skills, conflicting teaching philosophies, competitive environments between subject areas and lack of time and accessibility were four major challenges that emerged throughout the data. Major supportive roles for HPE educators in the integration process included other educators, consultants, school administration, public health, parents, community programs and professional organizations. The study provides valuable discussion and suggestions for improvement of pedagogical practices in teaching living skills in the HPE setting.

Mineralogical And Sedimentological Studies Of Innershelf And Beach Sediments Along The Coast Between Paravur And Kovalam, South Kerala, India

Continental shelf is of particular significance in marine geology , because it links the two basically different structural zones in the earth's crust; the continents and ocean basins. The shelf area has much wider importance in many fields of activity such as scientific, economic, social, political and strategic. The pace of development has ultimately put pressure on mankind to look for exploitable resources and accessibility to the continental shelf area and beyond. Added to the above, the developmental activities in the coastal area would readily and directly influence the innershelf sediments. This situation demands a thorough geological knowledge of the continental shelf area. Moreover, a successful management of the continental shelf zone requires an optimum data base on the physico-chemical nature of the shelf sediments. Although sedimentological studies were carried out along the western continental shelf of India, a well documented systematic study of the inner shelf off Trivandrum coast is still found to be lacking. Considering the physiographic settings and the vicinity of two renowned placer deposits at Chavara and Manavalakurichi, such a sedimetological inventory has become all the more vital. In view of the above, a research programme has been drawn up to account the salient sedimentological and mineralogical aspects of the innershelf and beach sediments between Paravur and Kovalam, Trivandrum district, Kerala (latitudes 8° 7'00" to 8° 47'45" and longitudes 76°43'00" to 77° 40'45"). The findings are presented in six chapters formatted to address the aim of this research.

Contradictions within the Modern Food System: Nutritional Disbalance across the Globe, Its Main Drivers and Possible Ways Out

Contemporary food production, given the degree of technology being applied in it and the present state of scientific knowledge, should be able to feed the world. Corresponding statistics show that in fact the volumes of modern food production confirm this statement. Yet, the present nutritional situation across the globe leaves much to be desired: on the one hand the numbers of undernourished and malnourished people are still high and even growing in some regions, and on the other hand there is an increasing number of overweight and obese people who are experiencing (or are at risk of) adverse health impacts as consequences. The question arises how this situation is possible given the present state of food production and knowledge, and also in terms of nutrition basics when talking about the latter. When arguing about the main causes of the present situation with nutrition across the globe, it is the modern food system with its distortions that is often criticised with emphasis placed on inappropriate food distribution as one of the key problems. However it is not only food distribution that shapes inequalities in terms of food availability and accessibility – there is a number of other factors contributing to this situation including political influences. Each of the drivers of the present situation might affect more than one part and have outcomes in different dimensions. Therefore it makes sense to apply a holistic approach when viewing the modern food system, embracing all the elements and existing relationships between them for this will facilitate taking appropriate actions in order to target the desired outcome in the best possible way. Applying a systematic approach and linking various elements with corresponding interactions among them allows for picturing all the possible outcomes and hence finding the way for a better solution on global level – a solution to the present problem with nutritional disbalance across the globe.

Relating computer tasks to existing knowledge to improve accessibility for older adults

Routine computer tasks are often difficult for older adult computer users to learn and remember. People tend to learn new tasks by relating new concepts to existing knowledge. However, even for 'basic' computer tasks there is little, if any, existing knowledge on which older adults can base their learning. This paper investigates a custom file management interface that was designed to aid discovery and learnability by providing interface objects that are familiar to the user. A study was conducted which examined the differences between older and younger computer users when undertaking routine file management tasks using the standard Windows desktop as compared with the custom interface. Results showed that older adult computer users requested help more than ten times as often as younger users when using a standard windows/mouse configuration, made more mistakes and also required significantly more confirmations than younger users. The custom interface showed improvements over standard Windows/mouse, with fewer confirmations and less help being required. Hence, there is potential for an interface that closely mimics the real world to improve computer accessibility for older adults, aiding self-discovery and learnability.