Issues in the prescribing of psychotropic and psychoactive medication for persons with learning disability: quantitative and qualitative perspectives

The administration of psychotropic and psychoactive medication for persons with learning disability and accompanying mental illness and/or challenging behaviour has undergone much critical review over the past two decades. Assessment and diagnosis of mental illness in this population continues to be psychopharmacological treatment include polypharmacy, irrational prescription procedures and frequent over-prescription. It is clear that all forms of treatment including non-pharmacological interventions need to be driven by accurate and appropriate diagnoses. Where a psychiatric diagnosis has been identified, it greatly aides the selection of appropriate medication, although a specific medication for each diagnosis, as was once hoped, is simply no longer a reality in practice. Part one of the present thesis seeks to address many of the current issues in mental health problems and pharmacological treatment to date. The author undertook a drug prevalence study within both residential and community facilities for persons with learning disability within the Mid-West region of Ireland in order to ascertain the current level of prescribing of psychotropic and psychoactive medications for this population. While many attempts have been made to account for the variation in prescribing, little systematic and empirical research has been undertaken to investigate the factors thought to influence such prescribing. While studies investigating the prescribing behaviours of General Practitioners (GP's) have illustrated the complex nature of the decision making process in the context of general practice, no similar efforts have yet been directed at examining the prescribing behaviours of Consultant Psychiatrists. Using The Critical Incident Technique, the author interviewed Consultant Psychiatrists in the Republic of Ireland to gather information relating not only to their patterns of prescribing for learning disabled populations, but also to examine reasons influencing their prescribing in addition to several related factors. Part two of this thesis presents the findings from this study and a number of issues are raised, not only in relation to attempting to account for the findings from part one of the thesis, but also with respect to implications for improved management and clinical practice.

Legacy of unresolved legal issues on mental health

ANALYSIS The time has come for a fundamental review of the Mental Health Act 2001.

Caring for the Celtic cubs: Discursive constructions of mothers and mothering in the Irish childcare debate

Drawing on an understanding of the public sphere as a multiplicity of communicative and discursive spaces this paper examines the constructions of mothers, mothering and motherhood which emerged in recent debates about childcare in Ireland. Preliminary analysis of these discursive constructions suggest that they are often based on rhetoric, informed by stereotypical assumptions and rooted in frames of reference which mitigate against the emergence of alternative ways of understanding the issues of mothering and childcare. It will be argued that the reductionist and divisive nature of the childcare debate which ensued prior to the 2005 budget, stymied childcare policy development at a time when its unprecedented prominence on the political agenda and the strength of public finances could have underpinned a shift in policy approach. The paper concludes with an exploration of the ways in which feminist scholarship can challenge the Irish model of childcare policy, which continues to be premised on an understanding of childcare and the reconciliation of work and family life as the privatised responsibility of individual women.

Burning a hole in the budget: tobacco spending and its crowd-out of other goods.

Smoking is an expensive habit. Smoking households spend, on average, more than $US1000 annually on cigarettes. When a family member quits, in addition to the former smoker's improved long-term health, families benefit because savings from reduced cigarette expenditures can be allocated to other goods. For households in which some members continue to smoke, smoking expenditures crowd-out other purchases, which may affect other household members, as well as the smoker. We empirically analyse how expenditures on tobacco crowd-out consumption of other goods, estimating the patterns of substitution and complementarity between tobacco products and other categories of household expenditure. We use the Consumer Expenditure Survey data for the years 1995-2001, which we complement with regional price data and state cigarette prices. We estimate a consumer demand system that includes several main expenditure categories (cigarettes, food, alcohol, housing, apparel, transportation, medical care) and controls for socioeconomic variables and other sources of observable heterogeneity. Descriptive data indicate that, comparing smokers to nonsmokers, smokers spend less on housing. Results from the demand system indicate that as the price of cigarettes rises, households increase the quantity of food purchased, and, in some samples, reduce the quantity of apparel and housing purchased.

Not published, not indexed: issues in generating and finding hospice and palliative care literature.

INTRODUCTION: Accessing new knowledge as the evidence base for hospice and palliative care grows has specific challenges for the discipline. This study aimed to describe conversion rates of palliative and hospice care conference abstracts to journal articles and to highlight that some palliative care literature may not be retrievable because it is not indexed on bibliographic databases. METHODS: Substudy A tracked the journal publication of conference abstracts selected for inclusion in a gray literature database on www.caresearch.com.au . Abstracts were included in the gray literature database following handsearching of proceedings of over 100 Australian conferences likely to have some hospice or palliative care content that were held between 1980 and 1999. Substudy B looked at indexing from first publication until 2001 of three international hospice and palliative care journals in four widely available bibliographic databases through systematic tracing of all original papers in the journals. RESULTS: Substudy A showed that for the 1338 abstracts identified only 15.9% were published (compared to an average in health of 45%). Published abstracts were found in 78 different journals. Multiauthor abstracts and oral presentations had higher rates of conversion. Substudy B demonstrated lag time between first publication and bibliographic indexing. Even after listing, idiosyncratic noninclusions were identified. DISCUSSION: There are limitations to retrieval of all possible literature through electronic searching of bibliographic databases. Encouraging publication in indexed journals of studies presented at conferences, promoting selection of palliative care journals for database indexing, and searching more than one bibliographic database will improve the accessibility of existing and new knowledge in hospice and palliative care.

Dimensions, issues, and bills: Appropriations voting on the house floor

One of the fundamental findings in the congressional literature is that one or sometimes two dimensions can successfully describe roll-call voting. In this paper we investigate if we can reach the same conclusions about low dimensionality when we divide the roll-call agenda into subsets of relatively homogeneous subject matter. We are primarily interested in the degree to which the same ordering of representatives is yielded across these different groups of votes. To conduct our analysis we focus on all roll calls on the 13 annual appropriations bills across eight congresses. When we concentrate on these smaller issue areas, we find that voting is multidimensional and members do not vote in a consistent ideological fashion across all issue areas. Copyright © Southern Political Science Association 2010.

Experimental measurement of preferences in health care using best-worst scaling (BWS): theoretical and statistical issues.

For optimal solutions in health care, decision makers inevitably must evaluate trade-offs, which call for multi-attribute valuation methods. Researchers have proposed using best-worst scaling (BWS) methods which seek to extract information from respondents by asking them to identify the best and worst items in each choice set. While a companion paper describes the different types of BWS, application and their advantages and downsides, this contribution expounds their relationships with microeconomic theory, which also have implications for statistical inference. This article devotes to the microeconomic foundations of preference measurement, also addressing issues such as scale invariance and scale heterogeneity. Furthermore the paper discusses the basics of preference measurement using rating, ranking and stated choice data in the light of the findings of the preceding section. Moreover the paper gives an introduction to the use of stated choice data and juxtaposes BWS with the microeconomic foundations.

Traitement de données issues d'un corpus écrit multilingue. Approche agile pour l'analyse du discours eurorégional

L'article présente quelques éléments de la procédure mise en place pour traiter un corpus écrit comportant 617 textes (près de 500 000 mots) relatifs aux eurorégions. Complexe et hétérogène à plusieurs titres (technique, linguistique, éditorial, générique, énonciatif), le corpus pose la difficulté majeure de l’appréhension de données multilingues (français, italien, espagnol, anglais, allemand, néerlandais). Sa manipulation a nécessité une réflexion adaptée et une démarche de modélisation que nous qualifions d’« agile » en raison de son caractère souple et itératif. La plateforme d’analyse élaborée permet de disposer de résultats utiles à l’analyse qualitative ultérieure du discours eurorégional. Elle articule un logiciel d'analyse morphosyntaxique éprouvé (TreeTagger) à des programmes (Perl) et à une base de données (SQLite) développés pour optimiser les requêtes multilingues simultanées et l’exportation automatique des résultats. Les fonctionnalités liées à la localisation contextualisée de mots- pivots, au recueil de dénominations et à la détection de segments répétés nous servent ici de guides pour exprimer les besoins de la recherche, les problèmes rencontrés et les solutions proposées. L'analyse d'observables récurrents, à savoir les notions de décision et de responsabilité, illustre le propos.

Computational issues in the modelling of materials-based manufacturing processes

The manufacture of materials products involves the control of a range of interacting physical phenomena. The material to be used is synthesised and then manipulated into some component form. The structure and properties of the final component are influenced by both interactions of continuum-scale phenomena and those at an atomistic-scale level. Moreover, during the processing phase there are some properties that cannot be measured (typically the liquid-solid phase change). However, it seems there is a potential to derive properties and other features from atomistic-scale simulations that are of key importance at the continuum scale. Some of the issues that need to be resolved in this context focus upon computational techniques and software tools facilitating: (i) the multiphysics modeling at continuum scale; (ii) the interaction and appropriate degrees of coupling between the atomistic through microstructure to continuum scale; and (iii) the exploitation of high-performance parallel computing power delivering simulation results in a practical time period. This paper discusses some of the attempts to address each of the above issues, particularly in the context of materials processing for manufacture.

Computing regular equivalence: practical and theoretical issues

Social network analysts have tried to capture the idea of social role explicitly by proposing a framework that precisely gives conditions under which group actors are playing equivalent roles. They term these methods positional analysis techniques. The most general definition is regular equivalence which captures the idea that equivalent actors are related in a similar way to equivalent alters. Regular equivalence gives rise to a whole class of partitions on a network. Given a network we have two different computational problems. The first is how to find a particular regular equivalence. An algorithm exists to find the largest regular partition but there are not efficient algorithms to test whether there is a regular k-partition. That is a partition in k groups that is regular. In addition, when dealing with real data, it is unlikely that any regular partitions exist. To overcome this problem relaxations of regular equivalence have been proposed along with optimisation techniques to find nearly regular partitions. In this paper we review the algorithms that have developed to find particular regular equivalences and look at some of the recent theoretical results which give an insight into the complexity of finding regular partitions.

Issues in delivering multimedia content to mobile devices

The scalability of a computer system is its response to growth. It is also depended on its hardware, its operating system and the applications it is running. Most distributed systems technology today still depends on bus-based shared memory which do not scale well, and systems based on the grid or hypercube scheme requires significantly less connections than a full inter-connection that would exhibit a quadratic growth rate. The rapid convergence of mobile communication, digital broadcasting and network infrastructures calls for rich multimedia content that is adaptive and responsive to the needs of individuals, businesses and the public organisations. This paper will discuss the emergence of mobile Multimedia systems and provides an overview of the issues regarding design and delivery of multimedia content to mobile devices.

Review of the technology and reliability issues arising as optical interconnects migrate onto the circuit board

Light has the greatest information carrying potential of all the perceivable interconnect mediums; consequently, optical fiber interconnects rapidly replaced copper in telecommunications networks, providing bandwidth capacity far in excess of its predecessors. As a result the modern telecommunications infrastructure has evolved into a global mesh of optical networks with VCSEL’s (Vertical Cavity Surface Emitting Lasers) dominating the short-link markets, predominately due to their low-cost. This cost benefit of VCSELs has allowed optical interconnects to again replace bandwidth limited copper as bottlenecks appear on VSR (Very Short Reach) interconnects between co-located equipment inside the CO (Central-Office). Spurred by the successful deployment in the VSR domain and in response to both intra-board backplane applications and inter-board requirements to extend the bandwidth between IC’s (Integrated Circuits), current research is migrating optical links toward board level USR (Ultra Short Reach) interconnects. Whilst reconfigurable Free Space Optical Interconnect (FSOI) are an option, they are complicated by precise line-of-sight alignment conditions hence benefits exist in developing guided wave technologies, which have been classified into three generations. First and second generation technologies are based upon optical fibers and are both capable of providing a suitable platform for intra-board applications. However, to allow component assembly, an integral requirement for inter-board applications, 3rd generation Opto-Electrical Circuit Boards (OECB’s) containing embedded waveguides are desirable. Currently, the greatest challenge preventing the deployment of OECB’s is achieving the out-of-plane coupling to SMT devices. With the most suitable low-cost platform being to integrate the optics into the OECB manufacturing process, several research avenues are being explored although none to date have demonstrated sufficient coupling performance. Once in place, the OECB assemblies will generate new reliability issues such as assembly configurations, manufacturing tolerances, and hermetic requirements that will also require development before total off-chip photonic interconnection can truly be achieved

Cognitive issues in information visualisation design for interaction for the visually impaired

This paper reports on the findings of a study on improving interaction design for visually impaired students, focusing upon the cognitive criteria for information visualisation.

Assessing the suitability of ship design for human factors issues associated with evacuation and normal operations

Evaluating ship layout for human factors (HF) issues using simulation software such as maritimeEXODUS can be a long and complex process. The analysis requires the identification of relevant evaluation scenarios; encompassing evacuation and normal operations; the development of appropriate measures which can be used to gauge the performance of crew and vessel and finally; the interpretation of considerable simulation data. In this paper we present a systematic and transparent methodology for assessing the HF performance of ship design which is both discriminating and diagnostic. The methodology is demonstrated using two variants of a hypothetical naval ship.