Effectiveness of integrated care including therapeutic assertive community treatment in severe schizophrenia spectrum and bipolar I disorders: the 24-month follow-up ACCESS II study

OBJECTIVE The ACCESS treatment model offers assertive community treatment embedded in an integrated care program to patients with psychoses. Compared to standard care and within a controlled study, it proved to be more effective in terms of service disengagement and illness outcomes in patients with schizophrenia spectrum disorders over 12 months. ACCESS was implemented into clinical routine and its effectiveness assessed over 24 months in severe schizophrenia spectrum disorders and bipolar I disorder with psychotic features (DSM-IV) in a cohort study. METHOD All 115 patients treated in ACCESS (from May 2007 to October 2009) were included in the ACCESS II study. The primary outcome was rate of service disengagement. Secondary outcomes were change of psychopathology, severity of illness, psychosocial functioning, quality of life, satisfaction with care, medication nonadherence, length of hospital stay, and rates of involuntary hospitalization. RESULTS Only 4 patients (3.4%) disengaged with the service. Another 11 (9.6%) left because they moved outside the catchment area. Patients received a mean of 1.6 outpatient contacts per week. Involuntary admissions decreased from 34.8% in the 2 previous years to 7.8% during ACCESS (P < .001). Mixed models repeated-measures analyses revealed significant improvements among all patients in psychopathology (effect size d = 0.64, P < .001), illness severity (d = 0.84, P = .03), functioning level (d = 0.65, P < .001), quality of life (d = 0.50, P < .001), and client satisfaction (d = 0.11, P < .001). At 24 months, 78.3% were fully adherent to medication, compared to 25.2% at baseline (P = .002). CONCLUSIONS ACCESS was successfully implemented in clinical routine and maintained excellent rates of service engagement and other outcomes in patients with schizophrenia spectrum disorders or bipolar I disorder with psychotic features over 24 months. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01888627.

What We Don't Know Can Hurt Us: Clinical Inference Bias and Constructed Memories of Sexual Abuse.

The false memory/recovered memory debate, research regarding the malleability of memory, and the current lack of methods for validating recovered memories all support the view that heightened care is required of therapists dealing with clients whom they suspect have been sexually abused. The judgmental heuristics that underlie the major clinical inference biases of confirmatory bias, biased covariation, base rate fallacies, and schematic processing errors are all relevant to the processes leading to therapist-client constructions of memories of sexual abuse. Suggestions for minimizing each of these biases are offered. Personal motivations of the client and client suggestibility are factors that may contribute to the construction of memories of sexual abuse, and suggestions for minimizing the impact of these motivations are offered. In conclusion, general suggestions for minimizing the impact of clinical inference biases within the sexual abuse treatment context are summarized.

Professionalism and functional outcomes

A foundation principle of professionalism is listening carefully to clients' needs. This paper reviews current studies that have sought to listen to the needs of people with aphasia and their families. The preliminary evidence to date suggests that people with aphasia have goals that cover the bio-psycho-social spectrum but place a lot of importance on functional outcomes such as participation in life's activities, relationships, and personal self-esteem. In contrast, descriptions of current aphasia management practices reflect a predominantly medical model approach that emphasizes impairment-level goals. This paper suggests that a proportion of speech-language pathologists are not truly listening and responding to their clients' needs. This leads to a mismatch between the therapists' and clients' goals in therapy. The concept of person-centred goal-setting is described. This may contribute to greater alignments of goals and better outcomes of rehabilitation. Learning outcomes: As a result of reading this work, the participant will be able to: (a) have knowledge of criticisms of aphasia therapy by people with aphasia; (b) understand the concept of person-centred goal-setting; (c) understand the complexity of mismatched goals between therapist and client. (c) 2006 Elsevier Inc. All rights reserved.

Spatial aspects of MRSA epidemiology:A case study using stochastic simulation, kernel estimation and SaTScan

The identification of disease clusters in space or space-time is of vital importance for public health policy and action. In the case of methicillin-resistant Staphylococcus aureus (MRSA), it is particularly important to distinguish between community and health care-associated infections, and to identify reservoirs of infection. 832 cases of MRSA in the West Midlands (UK) were tested for clustering and evidence of community transmission, after being geo-located to the centroids of UK unit postcodes (postal areas roughly equivalent to Zip+4 zip code areas). An age-stratified analysis was also carried out at the coarser spatial resolution of UK Census Output Areas. Stochastic simulation and kernel density estimation were combined to identify significant local clusters of MRSA (p<0.025), which were supported by SaTScan spatial and spatio-temporal scan. In order to investigate local sampling effort, a spatial 'random labelling' approach was used, with MRSA as cases and MSSA (methicillin-sensitive S. aureus) as controls. Heavy sampling in general was a response to MRSA outbreaks, which in turn appeared to be associated with medical care environments. The significance of clusters identified by kernel estimation was independently supported by information on the locations and client groups of nursing homes, and by preliminary molecular typing of isolates. In the absence of occupational/ lifestyle data on patients, the assumption was made that an individual's location and consequent risk is adequately represented by their residential postcode. The problems of this assumption are discussed, with recommendations for future data collection.

B2B service brand identity and brand performance:an empirical investigation in the UK’s B2B IT services sector

Purpose – This paper aims to apply the business-to-business (B2B) Service Brand Identity (SBI) scale to empirically assess the influence of service brand identity on brand performance for the first time. Design/methodology/approach – Based on data collected from 421 senior marketing executives, this paper applies the B2B SBI and structural equation modeling to fulfill the above purpose. Findings – Brand personality and human resource initiatives have a positive and significant influence on brand performance. Corporate visual identity, in addition to an employee and client focus, has an insignificant impact on performance. Consistent communications have a negative and significant influence on brand performance. Research limitations/implications – Data were only collected from executives in the UK. This research would benefit from replicative studies. Practical implications – This research empirically establishes the brand management activities that drive brand performance. Originality/value – This is the first empirical study to assess the influence service brand identity has on brand performance.

B2B service brand identity:scale development and validation

Several brand identity frameworks have been published in the B2C and the B2B brand marketing literature. A reliable, valid and parsimonious service brand identity scale that empirically establishes the construct's dimensionality in a B2B market has yet to be developed. This paper reports the findings of a study conducted amongst 421 senior executives working in the UK IT Service sector to develop and validate a B2B Service Brand Identity Scale. Following established scale development procedures support is provided for a B2B Service Brand Identity Scale comprising five dimensions; employee and client focus, visual identity, brand personality, consistent communications and human resource initiatives. Concluding remarks discuss theoretical and managerial implications with limitations and directions for future research. © 2011 Elsevier Inc.

Kontraszelekció és erkölcsi kockázat a politikában. Vázlat az információs aszimmetria közgazdaságtani fogalmainak politikatudományi alkalmazhatóságáról (Negative selection and moral risk in politics. An outline of the usefulness to political science of the economic concept of information asymmetry)

Az írás a kontraszelekció és az erkölcsi kockázat információ-gazdaságtani fogalmának politikatudományi alkalmazhatósága mellett érvel. Azt kívánja bemutatni, hogy a politikai piac szereplői közti információs aszimmetria mechanizmusainak éppúgy lehetnek súlyos negatív hatásai a demokratikus politikai rendszer működésére nézve, mint ahogy a gazdasági szereplők közti információs aszimmetria - Nobel-díjas közgazdászok érvei szerint - alááshatja a piaci verseny hatékonyságát. Az írás új megvilágításba helyezi a - már Platón óta ismert - politikai kontraszelekció jelenségét, továbbá részletesen foglalkozik az erkölcsi kockázat és a megbízó-megbízott relációk megjelenésével a politikában. Érinti tovább azoknak a mechanizmusoknak - a jelzésnek és a szűrésnek - a megjelenését a politikában, melyeket a közgazdászok az információs aszimmetria csökkentésére ajánlanak. / === / The paper argues in favour of employing in political science the economic concept of information asymmetry, seeking to show that the mechanisms of information asymmetry among the players on the political market may have negative effects on the operation of a democratic political system as information asymmetry among economic actors – according to arguments of Nobel prize-winning economists – has on the efficiency of market competition. The paper sheds new light on the phenomenon of negative political selection (known since Plato's time), and goes on to deal in detail with the appearance of moral risk and client/agent relations in politics. The author touches also on the appearance in politics of mechanisms – signals and filters – that economists suggest for reducing information asymmetry.

Understanding the relationship between the Talented Twenty program and college aspirations for high ranking students at a high priority school

Percentage plans such as the Talented Twenty program purport to assist and motivate high ranking students to attend college and grant access to higher education. This type of plan is particularly important to students enrolled in high priority schools who might not view themselves as potential college students. This study examined the relationship between Florida’s Talented Twenty program that begins intervention with juniors and the college aspirations for high ranking students at a high priority school. Numerous studies have established that increased levels of education lead to higher salaries, career mobility, and an increased quality of life (e.g., Bowen, 1997; Leslie & Brinkman 1988; Pascarella & Terenzini, 1991, Swail, 2000). Given the importance of students’ decisions regarding whether or not they will attend college, understanding how and when they make decisions about attending college is important for them, their parents, advisors, and educational administrators. This research examined students’ perceptions and insights via interviews. The overarching research question was: How do high ranking high school students attending a high priority school in a south Florida district perceive their college opportunities? Sixteen high ranking students, grades nine – 12 from a high priority school in Miami-Dade County participated in the study. Participants were identified by a school counselor and individual semi structured interviews were conducted at the school. Utilizing a student development theoretical framework developed by Hossler and Gallagher (1987) that centered on students’ predisposition, search strategies and choices, data were organized and emergent themes analyzed. The analysis of the data revealed that in alignment with the framework (a) parents were the strongest influence in the development of these students’ college aspirations, (b) these students formalized their higher education plans between eighth and 10th grade, (c) these students actively engaged in academic searches and learning opportunities that increased their chances to be admitted into college, and (d) there was no relationship between knowledge regarding the Talented Twenty program and their educational decisions. This study’s findings suggest that interventions and programs intended to influence the educational aspirations of students are more likely to succeed if they take place by the eighth or ninth grade.

Spectral sensitivity, spatial resolution and temporal resolution and their implications for conspecific signalling in cleaner shrimp.

Cleaner shrimp (Decapoda) regularly interact with conspecifics and client reef fish, both of which appear colourful and finely patterned to human observers. However, whether cleaner shrimp can perceive the colour patterns of conspecifics and clients is unknown, because cleaner shrimp visual capabilities are unstudied. We quantified spectral sensitivity and temporal resolution using electroretinography (ERG), and spatial resolution using both morphological (inter-ommatidial angle) and behavioural (optomotor) methods in three cleaner shrimp species: Lysmata amboinensis, Ancylomenes pedersoni and Urocaridella antonbruunii. In all three species, we found strong evidence for only a single spectral sensitivity peak of (mean ± s.e.m.) 518 ± 5, 518 ± 2 and 533 ± 3 nm, respectively. Temporal resolution in dark-adapted eyes was 39 ± 1.3, 36 ± 0.6 and 34 ± 1.3 Hz. Spatial resolution was 9.9 ± 0.3, 8.3 ± 0.1 and 11 ± 0.5 deg, respectively, which is low compared with other compound eyes of similar size. Assuming monochromacy, we present approximations of cleaner shrimp perception of both conspecifics and clients, and show that cleaner shrimp visual capabilities are sufficient to detect the outlines of large stimuli, but not to detect the colour patterns of conspecifics or clients, even over short distances. Thus, conspecific viewers have probably not played a role in the evolution of cleaner shrimp appearance; rather, further studies should investigate whether cleaner shrimp colour patterns have evolved to be viewed by client reef fish, many of which possess tri- and tetra-chromatic colour vision and relatively high spatial acuity.

Nursing and medical students as agents of change in health care: impact of schools core values and culture-a discussion paper

Within the UK the quality of care delivered in some hospitals, nursing homes and caring facilities has been the subject of significant enquiry, challenge and concern in recent years. There was need for a change in the culture of patient and client care. Traditionally a change in culture is seen as moving from an organisational head through to the organisation and in this case through to front-line care. This hasn’t necessarily achieved the desired effect and impact in terms of quality of care within the UK. Historically, certainly nurses have acted more as recipients of change, rather than agents of change
This paper suggests that schools of nursing and medicine with robust core values and a more consistently enacted culture of care, are better able and more likely to transfer this to nursing and medical students within their professional socialisation. In addition, and rather than the newly qualified nurse or doctor being absorbed into existing cultures of care delivery (which are not necessarily always reflecting high qualities of care), schools of nursing and medicine could better facilitate the development of more `agency’ within students and better equipping the students on qualification and stepping into practice, with a role and function as potential agents of change. Effective leadership within schools of nursing and medicine can both translate to quality and consistency, and enactment of organisational core values and working culture. The working culture of schools is intrinsic to developing students as agents of change

Principles and Practice of Fire Modelling: A Collection of Lecture Notes for a Short Course

Once the preserve of university academics and research laboratories with high-powered and expensive computers, the power of sophisticated mathematical fire models has now arrived on the desk top of the fire safety engineer. It is a revolution made possible by parallel advances in PC technology and fire modelling software. But while the tools have proliferated, there has not been a corresponding transfer of knowledge and understanding of the discipline from expert to general user. It is a serious shortfall of which the lack of suitable engineering courses dealing with the subject is symptomatic, if not the cause. The computational vehicles to run the models and an understanding of fire dynamics are not enough to exploit these sophisticated tools. Too often, they become 'black boxes' producing magic answers in exciting three-dimensional colour graphics and client-satisfying 'virtual reality' imagery. As well as a fundamental understanding of the physics and chemistry of fire, the fire safety engineer must have at least a rudimentary understanding of the theoretical basis supporting fire models to appreciate their limitations and capabilities. The five day short course, "Principles and Practice of Fire Modelling" run by the University of Greenwich attempt to bridge the divide between the expert and the general user, providing them with the expertise they need to understand the results of mathematical fire modelling. The course and associated text book, "Mathematical Modelling of Fire Phenomena" are aimed at students and professionals with a wide and varied background, they offer a friendly guide through the unfamiliar terrain of mathematical modelling. These concepts and techniques are introduced and demonstrated in seminars. Those attending also gain experience in using the methods during "hands-on" tutorial and workshop sessions. On completion of this short course, those participating should: - be familiar with the concept of zone and field modelling; - be familiar with zone and field model assumptions; - have an understanding of the capabilities and limitations of modelling software packages for zone and field modelling; - be able to select and use the most appropriate mathematical software and demonstrate their use in compartment fire applications; and - be able to interpret model predictions. The result is that the fire safety engineer is empowered to realise the full value of mathematical models to help in the prediction of fire development, and to determine the consequences of fire under a variety of conditions. This in turn enables him or her to design and implement safety measures which can potentially control, or at the very least reduce the impact of fire.

Options for monitoring diabetic cats

The key to successful long-term management of diabetes in cats is individualization of advice to suit cat and owner. A relationship based on trust and cooperation between veterinarian and client leads invariably to the most satisfactory outcome. Success requires knowledge of the options for monitoring diabetic cats, selection and adaptation of appropriate techniques for each individual case, and provision of ongoing support and guidance for owners. The ongoing treatment of a diabetic cat can be one of the more rewarding experiences of feline practice, and many diabetic cats and their owners come to occupy a special place within the clinic environment. This chapter provides a comprehensive overview of the current options for monitoring diabetes in cats and guidelines for application of the techniques to clinical cases.

Card sorts: Constructivist assessment tools

In a changing employment climate and with the growth of demand for careers guidance at all stages of life, careers guidance practice has moved from its positivist world view, with the counsellor as expert and client as passive responder, to more holistic 'constructivist' approaches. In essence, these approaches view the career as a holistic concept in which work and personal life are inextricably intertwined, and individuals are experts in their own lives, actively constructing their careers. The first to fully explore the constructivist approach, this book: provides a theoretical background to constructivism; outlines a range of constructivist approaches to career counselling; and gives examples of the practical application of constructivism. Essential for anyone involved in career guidance wishing to learn more about this vital new approach, this book combines theory with practicable guidance, and represents a new direction for career counselling.

O sentir do terapeuta ocupacional na relação terapêutica

A literatura específica e o percurso da terapia ocupacional ilustram a continua preocupação e a percepção da importância da relação terapeuta/cliente para o sucesso da ocupação terapêutica e consequentes resultados positivos da terapia. Isto não significa que exista um grande aprofundamento desta temática e consensos quanto aos factores e competências que a influenciam e lhe estão inerentes. Apesar de haver algumas referências de como o terapeuta deve estar, não tem sido abordado como o terapeuta sente e vive a relação terapêutica. O objectivo principal deste estudo é contribuir para a importância da postura técnica e simultaneamente subjectiva de cada terapeuta ocupacional, no contexto terapêutico. Pretende-se perceber a forma como o terapeuta ocupacional vivência alguns aspectos que o acompanham no processo terapêutico que é manifesto nas suas atitudes e se reflectem na qualidade da intervenção terapêutica e complementarmente na sua vivência pessoal. Usou-se a metodologia qualitativa, a entrevista semi-estruturada e a análise de conteúdo, por valorizar a subjectividade, indo ao encontro do objectivo definido. A amostra integrou vinte terapeutas ocupacionais, com mais de dez anos de experiência profissional e cinco da actual área de especialização profissional - Crianças e Jovens; Medicina Física e Reabilitação, Saúde Mental Adultos e outra de diversos (Toxicodependência, Geriatria e Comunidade). Concluímos que a relação terapêutica em terapia ocupacional é referida como sendo o primeiro passo no investimento terapêutico, para a maioria não é considerada um procedimento técnico, mas produto do bom senso, “dom” da pessoa / terapeuta e vivenciam as emoções e sentimentos do contexto terapêutico, solitariamente e ou com a família, alguns com colegas e poucos numa equipa organizada.

Solução doméstica para televisão digital

Mestrado em Engenharia Electrotécnica e de Computadores