Continuity of care for people with psychotic illness: its relationship to clinical and social functioning.

Background: The relationship between continuity of care and user characteristics or outcomes has rarely been explored. The ECHO study operationalized and tested a multi-axial definition of continuity of care, producing a seven-factor model used here. Aims: To assess the relationship between user characteristics and established components of continuity of care, and the impact of continuity on clinical and social functioning. Methods: The sample comprised 180 community mental health team users with psychotic disorders who were interviewed at three annual time-points, to assess their experiences of continuity of care and clinical and social functioning. Scores on seven continuity factors were tested for association with user-level variables. Results: Improvement in quality of life was associated with better Experience & Relationship continuity scores (better user-rated continuity and therapeutic relationship) and with lower Meeting Needs continuity factor scores. Higher Meeting Needs scores were associated with a decrease in symptoms. Conclusion: Continuity is a dynamic process, influenced significantly by care structures and organizational change.

Continuity of care for carers of people with severe mental illness: results of a longitudinal study

Introduction: Continuity of care has been demonstrated to be important for service users and carer groups have voiced major concerns over disruptions of care. We aimed to assess the experienced continuity of care in carers of patients with both psychotic and non-psychotic disorders and explore its association with carer characteristics and psychological well-being. Methods: Friends and relatives caring for two groups of service users in the care of community mental health teams (CMHTs), 69 with psychotic and 38 with non-psychotic disorders, were assessed annually at three and two time points, respectively. CONTINUES, a measure specifically designed to assess continuity of care for carers themselves, was utilized along with assessments of psychological well-being and caregiving. Results: One hundred and seven carers participated. They reported moderately low continuity of care. Only 22 had had a carer’s assessment and just under a third recorded psychological distress on the GHQ. For those caring for people with psychotic disorders, reported continuity was higher if the carer was male, employed, lived with the user and had had a carer’s assessment; for those caring for people with non-psychotic disorders, it was higher if the carer was from the service user’s immediate family, lived with them and had had a carer’s assessment. Conclusion: The vast majority of the carers had not had a carer’s assessment provided by the CMHT despite this being a clear national priority and being an intervention with obvious potential to increase carers’ reported low levels of continuity of care. Improving continuity of contact with carers may have an important part to play in the overall improvement of care in this patient group and deserves greater attention.

Wall materials and techniques available for low cost housing in Khartoum from a sustainability point of view

Khartoum like many cities in least developing countries (LDCs) still witnesses huge influx of people. Accommodation of the new comers leads to encroachment on the cultivation land leads to sprawl expansion of Greater Khartoum. The city expanded in diameter from 16.8 km in 1955 to 802.5 km in 1998. Most of this horizontal expansion was residential. In 2008 Khartoum accommodated 29% of the urban population of Sudan. Today Khartoum is considered as one of 43 major cities in Africa that accommodates more than 1 million inhabitants. Most of new comers live in the outskirts of the city e.g. Dar El-Salam and Mayo neighbourhoods. The majority of those new comers built their houses especially the walls from mud, wood, straw and sacks. Selection of building materials usually depends on its price regardless of the environmental impact, quality, thermal performance and life of the material. Most of the time, this results in increasing the cost with variables of impacts over the environment during the life of the building. Therefore, consideration of the environmental impacts, social impacts and economic impacts is crucial in the selection of any building material. Decreasing such impacts could lead to more sustainable housing. Comparing the sustainability of the available wall building materials for low cost housing in Khartoum is carried out through the life cycle assessment (LCA) technique. The purpose of this paper is to compare the most available local building materials for walls for the urban poor of Khartoum from a sustainability point of view by going through the manufacturing of the materials, the use of these materials and then the disposal of the materials after their life comes to an end. Findings reveal that traditional red bricks couldn’t be considered as a sustainable wall building material that will draw the future of the low cost housing in Greater Khartoum. On the other hand, results of the comparison lead to draw attention to the wide range of the soil techniques and to its potentials to be a promising sustainable wall material for urban low cost housing in Khartoum.

Evolution of immune systems: specificity and autoreactivity

Multicellularity evolved well before 600 million years ago, and all multicellular animals have evolved since then with the need to protect against pathogens. There is no reason to expect their immune systems to be any less sophisticated than ours. The vertebrate system, based on rearranging immunoglobulin-superfamily domains, appears to have evolved partly as a result of chance insertion of RAG genes by horizontal transfer. Remarkably sophisticated systems for expansion of immunological repertoire have evolved in parallel in many groups of organisms. Vaccination of invertebrates against commercially important pathogens has been empirically successful, and suggests that the definition of an adaptive and innate immune system should no longer depend on the presence of memory and specificity, since these terms are hard to define in themselves. The evolution of randomly-created immunological repertoire also carries with it the potential for generating autoreactive specificities and consequent autoimmune damage.While invertebrates may use systems analogous to ours to control autoreactive specificities, they may have evolved alternative mechanisms which operate either at the level of individuals-within-populations rather than cells-within-individuals, by linking self-reactive specificities to regulatory pathways and non-self-reactive to effector pathways.

Complex-valued b-spline neural networks for modelling and inverse of wiener systems

Communication signal processing applications often involve complex-valued (CV) functional representations for signals and systems. CV artificial neural networks have been studied theoretically and applied widely in nonlinear signal and data processing [1–11]. Note that most artificial neural networks cannot be automatically extended from the real-valued (RV) domain to the CV domain because the resulting model would in general violate Cauchy-Riemann conditions, and this means that the training algorithms become unusable. A number of analytic functions were introduced for the fully CV multilayer perceptrons (MLP) [4]. A fully CV radial basis function (RBF) nework was introduced in [8] for regression and classification applications. Alternatively, the problem can be avoided by using two RV artificial neural networks, one processing the real part and the other processing the imaginary part of the CV signal/system. A even more challenging problem is the inverse of a CV

Assessing pragmatic interoperability of information systems from a semiotic perspective

Most of studies on interoperability of systems integration focus on technical and semantic levels, but hardly extend investigations on pragmatic level. Our past work has addressed pragmatic interoperability, which is concerned with the relationship between signs and the potential behaviour and intention of responsible agents. We also define the pragmatic interoperability as a level concerning with the aggregation and optimisation of various business processes for achieving intended purposes of different information systems. This paper, as the extension of our previous research, is to propose an assessment method for measuring pragmatic interoperability of information systems. We firstly propose interoperability analysis framework, which is based on the concept of semiosis. We then develop pragmatic interoperability assessment process from two dimensions including six aspects (informal, formal, technical, substantive, communication, and control). We finally illustrate the assessment process in an example.

Ethics of care in supporting disabled forced migrants: interactions with professionals and ethical dilemmas in health and social care in the South-East of England

This article explores the interactions between disabled forced migrants with care needs and professionals and the restrictive legal, policy and practice context that health and social care professionals have to confront, based on the findings of a qualitative study with 45 participants in the South-East of England. In-depth interviews were conducted with 15 forced migrants who had diverse impairments and chronic illnesses (8 women and 7 men), 13 family caregivers and 17 support workers and strategic professionals working in social care and the third sector in Slough, Reading and London. The legal status of forced migrants significantly affects their entitlements to health and social care provision, resulting in prolonged periods of destitution for many families. National asylum support policies, difficult working relationships with UK Border Agency, higher eligibility thresholds and reduced social care budgets of local authorities were identified as significant barriers in responding to the support needs of disabled forced migrants and family caregivers. In this context, social workers experienced considerable ethical dilemmas. The research raises profound questions about the potential and limitations of health and social care policies, provision, and practice as means of protection and support in fulfilling the human rights of forced migrants with care needs.

Institutional pressures on financial services firms: the role of information systems in regulatory compliance

The financial crisis of 2008 led to new international regulatory controls for the governance, risk and compliance of financial services firms. Information systems play a critical role here as political, functional and social pressures may lead to the deinstitutionalization of existing structures, processes and practices. This research examines how an investment management system is introduced by a leading IT vendor across eight client sites in the post-crisis era. Using institutional theory, it examines changes in working practices occurring at the environmental and organizational levels and the ways in which technological interventions are used to apply disciplinary effects in order to prevent inappropriate behaviors. The results extend the constructs of deinstitutionalization and identify empirical predictors for the deinstitutionalization of compliance and trading practices within financial organizations.

Climate change impacts in the design of drainage systems: case study of Portugal

This paper aims to assess the necessity of updating the intensity-duration-frequency (IDF) curves used in Portugal to design building storm-water drainage systems. A comparative analysis of the design was performed for the three predefined rainfall regions in Portugal using the IDF curves currently in use and estimated for future decades. Data for recent and future climate conditions simulated by a global and regional climate model chain are used to estimate possible changes of rainfall extremes and its implications for the drainage systems. The methodology includes the disaggregation of precipitation up to subhourly scales, the robust development of IDF curves, and the correction of model bias. Obtained results indicate that projected changes are largest for the plains in southern Portugal (5–33%) than for mountainous regions (3–9%) and that these trends are consistent with projected changes in the long-term 95th percentile of the daily precipitation throughout the 21st century. The authors conclude there is a need to review the current precipitation regime classification and change the new drainage systems towards larger dimensions to mitigate the projected changes in extreme precipitation.

Low complexity equalization of HCM systems with DPFFT demodulation over doubly-selective channels

To mitigate the inter-carrier interference (ICI) of doubly-selective (DS) fading channels, we consider a hybrid carrier modulation (HCM) system employing the discrete partial fast Fourier transform (DPFFT) demodulation and the banded minimum mean square error (MMSE) equalization in this letter. We first provide the discrete form of partial FFT demodulation, then apply the banded MMSE equalization to suppress the residual interference at the receiver. The proposed algorithm has been demonstrated, via numerical simulations, to be its superior over the single carrier modulation (SCM) system and circularly prefixed orthogonal frequency division multiplexing (OFDM) system over a typical DS channel. Moreover, it represents a good trade-off between computational complexity and performance.