Mellow Parenting : systematic review and meta-analysis of an intervention to promote sensitive parenting

Acknowledgements For part of the preparation period for this article, AM was supported by an NHS Research Scotland Career Research Fellowship. AM, LT, and PW have been involved in previous research into Mellow Parenting as well as other parenting programmes and have collaborated with the Mellow Parenting charity. PW has had travel and subsistence expenses reimbursed for attendance at a Mellow Parenting conference; otherwise the authors have not received financial recompense for any of these activities. We thank the Mellow Parenting charity for their advice about conducting this review.

Le script de l'intervention policière auprès des personnes en état mental perturbé : déroulement et facteurs de l'usage de force par les policiers

Travail dirigé présenté à la Faculté des études supérieures et postdoctorales en vue de l’obtention du grade de maîtrise ès sciences (M.SC) en criminologie, option sécurité intérieure

Non-Pharmacological Approaches for Pain Management in Sickle Cell Disease: Development of a Mindfulness-Based Intervention

Background: Sickle Cell Disease (SCD) is a genetic hematological disorder that affects more than 7 million people globally (NHLBI, 2009). It is estimated that 50% of adults with SCD experience pain on most days, with 1/3 experiencing chronic pain daily (Smith et al., 2008). Persons with SCD also experience higher levels of pain catastrophizing (feelings of helplessness, pain rumination and magnification) than other chronic pain conditions, which is associated with increases in pain intensity, pain behavior, analgesic consumption, frequency and duration of hospital visits, and with reduced daily activities (Sullivan, Bishop, & Pivik, 1995; Keefe et al., 2000; Gil et al., 1992 & 1993). Therefore effective interventions are needed that can successfully be used manage pain and pain-related outcomes (e.g., pain catastrophizing) in persons with SCD. A review of the literature demonstrated limited information regarding the feasibility and efficacy of non-pharmacological approaches for pain in persons with SCD, finding an average effect size of .33 on pain reduction across measurable non-pharmacological studies. Second, a prospective study on persons with SCD that received care for a vaso-occlusive crisis (VOC; N = 95) found: (1) high levels of patient reported depression (29%) and anxiety (34%), and (2) that unemployment was significantly associated with increased frequency of acute care encounters and hospital admissions per person. Research suggests that one promising category of non-pharmacological interventions for managing both physical and affective components of pain are Mindfulness-based Interventions (MBIs; Thompson et al., 2010; Cox et al., 2013). The primary goal of this dissertation was thus to develop and test the feasibility, acceptability, and efficacy of a telephonic MBI for pain catastrophizing in persons with SCD and chronic pain.

Methods: First, a telephonic MBI was developed through an informal process that involved iterative feedback from patients, clinical experts in SCD and pain management, social workers, psychologists, and mindfulness clinicians. Through this process, relevant topics and skills were selected to adapt in each MBI session. Second, a pilot randomized controlled trial was conducted to test the feasibility, acceptability, and efficacy of the telephonic MBI for pain catastrophizing in persons with SCD and chronic pain. Acceptability and feasibility were determined by assessment of recruitment, attrition, dropout, and refusal rates (including refusal reasons), along with semi-structured interviews with nine randomly selected patients at the end of study. Participants completed assessments at baseline, Week 1, 3, and 6 to assess efficacy of the intervention on decreasing pain catastrophizing and other pain-related outcomes.

Results: A telephonic MBI is feasible and acceptable for persons with SCD and chronic pain. Seventy-eight patients with SCD and chronic pain were approached, and 76% (N = 60) were enrolled and randomized. The MBI attendance rate, approximately 57% of participants completing at least four mindfulness sessions, was deemed acceptable, and participants that received the telephonic MBI described it as acceptable, easy to access, and consume in post-intervention interviews. The amount of missing data was undesirable (MBI condition, 40%; control condition, 25%), but fell within the range of expected missing outcome data for a RCT with multiple follow-up assessments. Efficacy of the MBI on pain catastrophizing could not be determined due to small sample size and degree of missing data, but trajectory analyses conducted for the MBI condition only trended in the right direction and pain catastrophizing approached statistically significance.

Conclusion: Overall results showed that at telephonic group-based MBI is acceptable and feasible for persons with SCD and chronic pain. Though the study was not able to determine treatment efficacy nor powered to detect a statistically significant difference between conditions, participants (1) described the intervention as acceptable, and (2) the observed effect sizes for the MBI condition demonstrated large effects of the MBI on pain catastrophizing, mental health, and physical health. Replication of this MBI study with a larger sample size, active control group, and additional assessments at the end of each week (e.g., Week 1 through Week 6) is needed to determine treatment efficacy. Many lessons were learned that will guide the development of future studies including which MBI strategies were most helpful, methods to encourage continued participation, and how to improve data capture.

The implementation of a literacy intervention 'Station Teaching' in infant classes in Irish primary schools

Background: I conducted my research in the context of The National Literacy Strategy (DES, 2011), which maintains that every young person should be literate and it outlines targets for improving literacy in schools from 2011 to 2020. There has been much debate on the teaching of literacy and in particular the teaching of reading. Clark (2014) outlines how learning to read should be a developmental language process and that the approaches in the early years of schooling will colour the children’s motivation and their perception of reading as a purposeful activity. The acquisition of literacy begins in the home but this study focuses on the implementation of a literacy intervention Station Teaching in the infant classes in primary school. Station Teaching occurs when a class is divided into four or five small groups of pupils and they receive intensive tuition at four or five different Stations with the help of Support teachers: New Reading, Familiar Reading, Phonics, Writing and Oral Language. Research Questions: These research questions frame my study: How is Station Teaching implemented? What is the experience of the intervention Station Teaching from the participants’ point of view: teachers, pupils, parents? What notion of literacy is Station Teaching facilitating? Methods: I chose a pragmatic parallel mixed methods design as suggested by Mertens (2010). I collected and analysed both the quantitative and qualitative data to answer the study’s research questions. In the study the quantitative data were collected from a questionnaire issued to 21 schools in Ireland. I used Excel as a data management package and thematic analysis to analyse and present the data in themes. I collected qualitative data from a case study in a school. This data included observations of two classes over a period of a year; interviews with teachers, pupils and parents; children’s drawings, photographs, teachers’ diaries and video evidence. I analysed and presented the evidence from the qualitative data in themes. Main Findings: There are many skills and strategies that are essential to effective literacy teaching in the early years including phonological awareness, phonics, vocabulary, fluency, comprehension and writing. These skills can be taught during Station Teaching. Early intervention in the early years is essential to pupils’ acquisition of literacy. The expertise of the teacher is key to improving the literacy achievement of pupils Teachers and pupils enjoy participating in ST. Pupils are motivated to read and engage in meaningful activities during ST. Staff collaboration is vital for ST to succeed ST facilitates small group work and teachers can differentiate accordingly while including all pupils in the groups. Pupils’ learning is extended in ST but extension activities need to be addressed in the Writing Station. More training should be provided for teachers on the implementation of ST and more funding for resources should be available to schools Significant contribution of the work: The main significance of the study includes: insights into the classroom implementation of Station Teaching in infant classes and extensive research into characteristics of an effective teacher of literacy.

Early detection of delirium in older medical inpatients: prodrome, predictors and motor subtyping

Background Delirium is highly prevalent, especially in older patients. It independently leads to adverse outcomes, but remains under-detected, particularly hypoactive forms. Although early identification and intervention is important, delirium prevention is key to improving outcomes. The delirium prodrome concept has been mooted for decades, but remains poorly characterised. Greater understanding of this prodrome would promote prompt identification of delirium-prone patients, and facilitate improved strategies for delirium prevention and management. Methods Medical inpatients of ≥70 years were screened for prevalent delirium using the Revised Delirium Rating Scale (DRS--‐R98). Those without prevalent delirium were assessed daily for delirium development, prodromal features and motor subtype. Survival analysis models identified which prodromal features predicted the emergence of incident delirium in the cohort in the first week of admission. The Delirium Motor Subtype Scale-4 was used to ascertain motor subtype. Results Of 555 patients approached, 191 patients were included in the prospective study. The median age was 80 (IQR 10) and 101 (52.9%) were male. Sixty-one patients developed incident delirium within a week of admission. Several prodromal features predicted delirium emergence in the cohort. Firstly, using a novel Prodromal Checklist based on the existing literature, and controlling for confounders, seven predictive behavioural features were identified in the prodromal period (for example, increasing confusion; and being easily distractible). Additionally, using serial cognitive tests and the DRS-R98 daily, multiple cognitive and other core delirium features were detected in the prodrome (for example inattention; and sleep-wake cycle disturbance). Examining longitudinal motor subtypes in delirium cases, subtypes were found to be predominantly stable over time, the most prevalent being hypoactive subtype (62.3%). Discussion This thesis explored multiple aspects of delirium in older medical inpatients, with particular focus on the characterisation of the delirium prodrome. These findings should help to inform future delirium educational programmes, and detection and prevention strategies.

Remédiation cognitive portant sur les aspects fluide et cristallisé de l’intelligence auprès d'adolescents présentant un fonctionnement intellectuel limite : approche par le jeu.

L’objectif principal de cette thèse était de créer, d’implanter et d’évaluer l’efficacité d’un programme de remédiation cognitive, intervenant de façon comparable sur les aspects fluide (Gf) et cristallisé (Gc) de l’intelligence, au sein d’une population d’intérêt clinique, les adolescents présentant un fonctionnement intellectuel limite (FIL). Compte tenu de la forte prévalence de ce trouble, le programme de remédiation GAME (Gains et Apprentissages Multiples pour Enfant) s’est développé autour de jeux disponibles dans le commerce afin de faciliter l’accès et l’implantation de ce programme dans divers milieux. Le premier article de cette thèse, réalisé sous forme de revue systématique de la littérature, avait pour objectif de faire le point sur les études publiées utilisant le jeu comme outil de remédiation cognitive dans la population pédiatrique. L’efficacité, ainsi que la qualité du paradigme utilisé ont été évaluées, et des recommandations sur les aspects méthodologiques à respecter lors de ce type d’étude ont été proposées. Cet article a permis une meilleure compréhension des écueils à éviter et des points forts méthodologiques à intégrer lors de la création du programme de remédiation GAME. Certaines mises en garde méthodologiques relevées dans cet article ont permis d’améliorer la qualité du programme de remédiation cognitive développé dans ce projet de thèse. Compte tenu du peu d’études présentes dans la littérature scientifique concernant la population présentant un FIL (70it important de clarifier les profils de cette population à laquelle s’adressait le programme GAME, notamment concernant son fonctionnement cognitif, adaptatif, comportemental et psychiatrique. La deuxième étude de cette thèse a donc permis de préciser le profil de cette population de manière empirique. Dans le domaine cognitif, une force a été mise en évidence au niveau langagier pour le vocabulaire réceptif et la fluence verbale. De plus, certains aspects des capacités attentionnelles et de la mémoire de travail semblaient être bien compensés, possiblement via l’effet de psychostimulants. Étonnamment, le fonctionnement adaptatif n’était pas directement relié au niveau intellectuel global et était hétérogène, suggérant l’importance d’évaluer ce domaine pour rendre compte du niveau de fonctionnement des adolescents présentant un FIL dans la vie quotidienne. D’un point de vue comportemental et psychiatrique, les adolescents avec un FIL avaient plus de manifestations internalisées et externalisées atteignant un seuil cliniquement significatif que leurs pairs. Ces manifestations comportementales expliquent d’ailleurs une part importante du niveau de stress parental dans cette population. Ces résultats sont importants à considérer lors de l’orientation académique, clinique et familiale dans la prise en charge des adolescents présentant un FIL, et soulignent l’importance de proposer une évaluation neuropsychologique approfondie. Enfin, la partie centrale de cette thèse consistait à créer un programme de remédiation cognitive portant sur les aspects fluide et cristallisé de l’intelligence, champs d’intervention qui a été négligé compte tenu de la stabilité longtemps postulée de ces processus. Ce programme de remédiation, intitulé GAME, s’adressait aux adolescents présentant un FIL pur ou partiel (soit les deux indices de raisonnement étaient dans la zone limite, soit un seul des deux), et présentait deux versants, GAME-c (portant sur l’intelligence cristallisée) et GAME-f (portant sur l’intelligence fluide). Cette intervention durait seize heures réparties sur huit semaines. Les résultats indiquent que les adolescents ayant suivi GAME-f ont amélioré leur raisonnement fluide; alors que les adolescents ayant suivi GAME-c ont amélioré à la fois leur raisonnement cristallisé et fluide. Cette étude contribue à remettre en question la stabilité des processus intellectuels. C’est par contre la première fois que des améliorations de l’intelligence sont constatées dans une population d’intérêt clinique par le biais d’un entraînement direct. Enfin, les variables cognitives, adaptatives, comportementales et psychiatriques susceptibles d’influencer la qualité de l’amélioration pour chacun des programmes GAME ont fait l’objet d’analyses supplémentaires dans un dernier chapitre et permettent de conclure à la possibilité d’adapter le programme GAME à d’autres populations (ex: déficience intellectuelle). Cette thèse a donc permis de souligner la pertinence d’utiliser les jeux comme outil de remédiation cognitive de part leur versatilité dans leur utilisation, leur facilité d’accès et leur faible coût. Elle met également en avant la nécessité de développer une meilleure compréhension de la population présentant un fonctionnement intellectuel limite et d’effectuer des évaluations neuropsychologiques exhaustives auprès de cette population (cognitif, adaptatif, comportemental et psychiatrique). Enfin, elle souligne la possibilité d’améliorer par remédiation directe les intelligences fluide et cristallisée auprès d’individus avec une intelligence subnormale et suggère qu’il pourrait en être de même pour des populations présentant des déficits cognitifs, comme la déficience intellectuelle légère. Les avenues futures de recherche et les retombées cliniques de ce travail sont discutées, en lien avec les différents résultats trouvés dans ces études.

Le script de l'intervention policière auprès des personnes en état mental perturbé : déroulement et facteurs de l'usage de force par les policiers

Travail dirigé présenté à la Faculté des études supérieures et postdoctorales en vue de l’obtention du grade de maîtrise ès sciences (M.SC) en criminologie, option sécurité intérieure

Reconceptualising International Intervention: Statebuilding, ‘Organic Processes’ and the Limits of Causal Knowledge

This article examines the transformation in the conceptual understanding of international intervention over the last two decades. It suggests that this conceptual shift can be usefully interrogated through its imbrication within broader epistemological shifts highlighting the limits of causal knowledge claims: heuristically framed in this article in terms of the shift from policy interventions within the problematic of causation to those concerned with the management of effects. In this shift, the means and mechanisms of international intervention have been transformed, no longer focused on the universal application of Western causal knowledge through policy interventions but rather on the effects of specific and unique local and organic processes at work in societies themselves. The focus on effects takes the conceptualisation of intervention out of the traditional terminological lexicon of International Relations theory and instead recasts problems in increasingly organicised ways, suggesting that artificial or hubristic attempts at socio-political intervention should be excluded or minimised.

The R2P is Dead, Long Live the R2P: The Successful Separation of Military Intervention from the Responsibility to Protect’

Roland Paris is one of those authors whose work is always enjoyable, as he exploits so well the gap between the policy world and academia. His best work reveals a high level of policy insight often before many of his colleagues in academia have caught up. His secret is an ability to analyse the shifting understandings at policy level and to then articulate them in academic terms as if critiquing current policies. This enables his work to be both popular with policy-makers and with their erstwhile critics in academia. His 2004 monograph, At War’s End, captured the shift from peacekeeping intervention and ‘early exit’ to the extended remits of international statebuilding (‘Institutionalization before Liberalization’). It provided a wonderful rationalisation of policy shifts that had already occurred in the late 1990s, starting with the extension of international mandates in Bosnia, from 1996 onwards, and further developed with the Kosovo protectorate in 1999. However, this shift was skilfully reposed as a critique of existing policy-understandings.

A proposal for a corresponsible intervention on sexual harassment at work

Sexual harassment at work is a form of gender violence barely made visible but still present in labor organizations, where it keeps generating high levels of suffering, discrimination and inequality mainly affecting women. To address it properly it is necessary an organizational change towards equity arising from the knowledge of the subjective meanings that stakeholders (staff, union representatives, employers, public administration, etc.) attribute to that reality. In this article we present the main findings of a qualitative study on the social perception of sexual harassment. The work highlights the existence of many strategies aimed at legitimize and minimize the relevance of the problem, blaming the victim, justifying the lack of support from the environment and / or the involvement of the organization in the solutions. Among the conclusions we underline the need for new models of business management involving all stakeholders in the prevention and control of the in a responsible way.

Afectividad y creaciones estéticas: intervención social con jóvenes no cualificados

Los jóvenes no cualificados, que participan en los dispositivos educativos de segunda oportunidad, recorren itinerarios de transición al mercado laboral cada vez más complejos. Por lo que conocer sus expectativas y su capacidad de agencia resulta ineludible para mejorar nuestro acompañamiento como profesionales de la intervención sociolaboral. En este artículo exploramos la adaptación de esos jóvenes a una exigencia creciente de cualificación, que los está excluyendo laboralmente. Frente a este proceso, observamos que contraponen una resistencia basada en su capital simbólico, a través de la afectividad y la estética. Nuestro interés por estas respuestas nace de la desorientación percibida entre los profesionales de los programas educativos. Incapaces de comprender las trayectorias divergentes que estos jóvenes plantean, ante los itinerarios homogéneos que se les ofrecen para su inserción social. Tras el análisis de las creaciones artísticas y estéticas de los adolescentes, intuimos que hay dos factores que activan su resistencia a las limitaciones de sus expectativas de éxito. Por un lado, una variable institucional, que apunta a una deficiente planificación de los itinerarios formativos, que los jóvenes perciben que les aboca a la infracualificación y a un mercado laboral precario e inestable. Y por otro lado, una resistencia a la exclusión, que se enraíza en un imaginario de éxito y de movilidad social propio de una juventud globalizada.

Satisfaction level of adults with University Programmes

This research analyses the degree of satisfaction of a sample of 874 students from University Programmes for adults and elderly, from Spain. The investigation is framed along the lines of positive psychology, specifically in Martin Seligman’s proposal, founder of this movement, who advocates that the main objective of this branch of psychological science is to investigate the healthy aspects of human life. The methodology applied is mixed. The level of satisfaction, collected through the survey technique was analysed by the SPSS 20.0 (using method CHAID) statistical program for the quantitative data; and by the Programme Atlas.Ti 6.0 (textual and conceptual analyses) for the qualitative data. The analysed data reveal that students are highly satisfied with the programme, the teachers and their peers. The discussion confirms these results, since it has also stood out in others studies

What's in it for us? A case study research about micro sense making processes through the eyes of front line employees, during culture change implementation

Abstract How employees make sense of change is a very complex process. Recently, academics have neglected to research sense making activities in a micro culture implementation context, through the eyes of front line employees. In contrast to a macro view, a micro perspective limits researchers to only look at an individual, departmental or group level. By doing so, we can zoom in on the details of sense making processes that employees use in their daily work life. A macro (organisational) view is based on the notion that there is a general integrated culture that can be found in all organisational units and departments. It is assumed that culture can be researched by using the entire organisation as one single research entity. This thesis challenges this assumption. In case of planned change it is usually the management community who are in charge of the change intervention. Because of their formal hierarchical position, they have the power to abort or initiate change programs. It is perhaps therefore that researchers tend to be focused on the management community rather than on lower level organisational members, such as front line employees. Apart from the micro view, scholars also neglected to research culture change implementation through the eyes of front line employees. This thesis is an attempt to fill these two gaps that currently exists in academic change management publications. The main research question is therefore: From a micro point of view how do front-line employees make sense of the impact of culture change, during the implementation phase? This thesis starts with a literature review which exposes the two main gaps. The most important outcome of this review is that only 2% of the research articles dealt with culture implementation, through the eyes of front line employees. A conceptual research model is built on the integrated sense making theory of Weber and Manning (2001) and the micro variables of Raelin and Cataldo (2011). These theories emphasize elements of sense making in a daily working context. It is likely that front line employees can identify themselves with research elements such as tasks, skills practices, involvement and behaviour. Front line employees were selected, because as lower level organisational members they are usually the change recipients. They are further away from the change initiating scene (usually the management of an organisation) and form a potential sense making ‘hotspot’ that could provide new academic insights. In order to carry out the primary research, two case organisations were selected in the leisure industry. A participative case study research method was chosen. This meant that the researcher worked in the concerning departments of the case organisations. The goal was to observe and interview front line employees, while they were performing their jobs. The most important advantage of this approach is that the researcher temporarily becomes one with the organisation and is therefore able to acquire both formal and informal narratives that front line employees use during sense making activities. It was found that front line employees make sense of organisational change by using a practical approach. They make sense of the change program by carrying out new tasks, developing new skills and sharing best practices. The most noticeable conclusion was that sense making activities predominantly take place at an individual level in relation to change acceptance. Organisational members tend to create a mental equation in order to weigh the advantages against the disadvantages. They evaluate whether the concerning change program is beneficial to them or not. For future research a sense making scheme model is suggested that is based on two methods: an introspection and an action method.

Rabbits, stoats and the predator problem: Why a strong animal rights position need not call for human intervention to protect prey from predators

Animal rights positions face the ‘predator problem’: the suggestion that if the rights of nonhuman animals are to be protected, then we are obliged to interfere in natural ecosystems to protect prey from predators. Generally, rather than embracing this conclusion, animal ethicists have rejected it, basing this objection on a number of different arguments. This paper considers but challenges three such arguments, before defending a fourth possibility. Rejected are Peter Singer’s suggestion that interference will lead to more harm than good, Sue Donaldson and Will Kymlicka’s suggestion that respect for nonhuman sovereignty necessitates non-interference in normal circumstances, and Alasdair Cochrane’s solution based on the claim that predators cannot survive without killing prey. The possibility defended builds upon Tom Regan’s suggestion that predators, as moral patients but not moral agents, cannot violate the rights of their prey, and so the rights of the prey, while they do exist, do not call for intervention. This idea is developed by a consideration of how moral agents can be more or less responsible for a given event, and defended against criticisms offered by thinkers including Alasdair Cochrane and Dale Jamieson.

Building a 'Repository of Science': the importance of integrating Biobanks within molecular pathology programmes

Repositories containing high quality human biospecimens linked with robust and relevant clinical and pathological information are required for the discovery and validation of biomarkers for disease diagnosis, progression and response to treatment. Current molecular based discovery projects using either low or high throughput technologies rely heavily on ready access to such sample collections. It is imperative that modern biobanks align with molecular diagnostic pathology practices not only to provide the type of samples needed for discovery projects but also to ensure requirements for ongoing sample collections and the future needs of researchers are adequately addressed. Biobanks within comprehensive molecular pathology programmes are perfectly positioned to offer more than just tumour derived biospecimens; for example, they have the ability to facilitate researchers gaining access to sample metadata such as digitised scans of tissue samples annotated prior to macrodissection for molecular diagnostics or pseudoanonymised clinical outcome data or research results retrieved from other users utilising the same or overlapping cohorts of samples. Furthermore, biobanks can work with molecular diagnostic laboratories to develop standardized methodologies for the acquisition and storage of samples required for new approaches to research such as ‘liquid biopsies’ which will ultimately feed into the test validations required in large prospective clinical studies in order to implement liquid biopsy approaches for routine clinical practice. We draw on our experience in Northern Ireland to discuss how this harmonised approach of biobanks working synergistically with molecular pathology programmes is key for the future success of precision medicine.