Development of the DORI-TBI: An Investigation to Develop a New Screening Measure to Determine Consultation with a School-Based Brain Injury Resource Team

Brain injury is the leading cause of disability and death in children in the United States. Student re-entry into the school setting following a traumatic brain injury is crucial to student success. Multidisciplinary teams within the school district comprised of individuals with expertise in brain injury are ideal in implementing student specific treatment plans given their specialized training and wide range of expertise addressing student needs. Therefore, the purpose of this study is to develop and initially validate a quantitative instrument that school personnel can use to determine if a student, identified as having a traumatic brain injury, will benefit from district-level consultation from a brain injury team. Three studies were designed to investigate the research questions. In study one, the planning and construction of the DORI-TBI was completed. Study two addressed the content validity of the DORI-TBI through a comparison analysis with other referral forms, content review with experts in the field of TBI, and cognitive interviews with professionals to test the usability of the new screening tool. In study three, a field administration was conducted using vignettes to measure construct validity. Results produced a valid and reliable new screening instrument that can aid school-based teams to more efficiently utilize district level consultation with a brain injury support team.

River Camel SAP Consultation

This is the River Camel Salmon Action Plan produced by the Environment Agency in 2002. The report focuses on the River Camel Salmon Action Plan (SAP). The River Camel SAP follows the format of those completed for the Rivers Tamar, Lynher and Tavy. It is the 4th of 7 action plans that will be produced for salmon rivers managed by the Cornwall Area Fisheries, Recreation and Biodiversity Team. This strategy represents an entirely new approach to salmon management within the UK and introduces the concept of river-specific salmon spawning targets as a salmon management tool. In addition, for the first time, Salmon Action Plans have attempted to evaluate in economic terms, all of the contributory components of the salmon fishery. The River Camel Salmon Action Plan contains a description of the river catchment and highlights particular features that are relevant to the salmon population and associated fishery.

River Fowey SAP Consultation

This is the River Fowey Salmon Action Plan Consultation document produced by the Environment Agency in 2003. The report pays attention on the external consultation of the River Fowey Salmon Action Plan (SAP). The River Fowey SAP follows the format of those completed for the Rivers Tamar, Lynher, Tavy and Camel. It is the 5th of 7 action plans that will be produced for salmon rivers managed by the Cornwall Area Fisheries, Recreation and Biodiversity Team. This strategy represents an entirely new approach to salmon management within the UK and introduces the concept of river-specific salmon spawning targets as a salmon management tool. The River Fowey SAP contains a description of the river catchment and highlights particular features that are relevant to the salmon population and the associated fishery. Notably, there are historic workings for copper and china clay and two significant potable supply reservoirs (Siblyback and Colliford) which have been constructed within the catchment during the past 35 years. The whole of the Fowey catchment is set at the highest water quality grading of RE1 and this standard is met in all reaches of the River Fowey and its tributaries.

The River Teign SAP Consultation Document

This is the River Teign Salmon Action Plan Consultation document produced by the Environment Agency in 2003. The report pays attention on the external consultation of the River Teign Salmon Action Plan (SAP). This approach to salmon management within the England and Wales introduces the concept of river-specific Conservation Limits as a method of assessing the status of the salmon stock. The River Teign Salmon Action Plan follows the format of those completed for the Rivers Torridge, Taw and Dart. It is the fourth of eight action plans that will be produced for salmon rivers within the Devon Area Fisheries, Recreation and Biodiversity Team. The River Teign SAP contains a description of the river catchment and highlights particular features that are relevant to the salmon population and the associated fishery. The Teign salmon stock is currently failing to meet its conservation limit. This failure is largely attributed to the reduction in the survival rate during the marine phase of the salmon life cycle. This is likely to constrain stocks to lower levels than have existed historically. Still further catch controls may contribute to a reduction in exploitation rates and allow stocks to recover to meet their conservation limit. Other important actions include the continuation of habitat improvement works which aim to maximise spawning habitat utilisation, spawning success, and juvenile survival and production.

Psychiatric disorders and psychiatric consultation in a general hospital: A case- control study

Introduction: Psychiatric consultation (PC) has been considered an efficient tool to develop research, to track and to give assistance benefiting patients, health professionals and the institution. However, it has not been much used in Brazil. Although 30 to 50% of general hospital (GH) inpatients may present a psychiatric disorder, only 1 to 12% of them are referred to assessment. The aims of this study were: to assess mental disorders in a GH; to identify which of these patients are sent to psychiatric care; to verify alleged reasons for referral to psychiatric consultation, and to examine the relationship between PC and psychiatric learning (during medical school and residence). Methods: A case-control patient study was conducted (47 cases and 94 controls) to analyze in detail the following variables: socio-demographic; clinical; degree of information (about the disease and diagnostic/therapeutic procedures), and relationship between patient and health team. Psychiatric diagnoses were made according to the ICD- 10 criteria. The Self Report Questionnaire (SRQ), the CAGE and Brief Psychiatric Rating Scale (BPRS) were used as well as a specifically designed questionnaire to collect clinical and demographic data. Results: Behavioral alterations, either of elation or of depression, were the main for requesting a PC; 95.8% of the cases and 27.7% of the controls had a mental disorder. Organic mental disorders and alcohol-related disorders were the most frequent diagnoses in group I (cases), while anxiety, depressive and alcohol-related disorders were predominant in group II (controls). Control group patients were better informed and more able to establish an appropriate relationship with the health team than case patients. The logistic regression showed CAGE-positive patients having 12.85 times greater risk of being referred to PC, followed by unemployed patients (2.44 times more PC referrals). Discussion: The SRQ and CAGE were quite useful in the screening of possible patients and might be important for medical students to learn and use as generalists. Further research is needed to verify if and how the newly-established service will improve the diagnostic and treatment skills of our students.

Assessment of referrals to an OT consultation-liaison service: a retrospective and comparative study

The objective was to conduct a retrospective and comparative study of the requests for consultation-liaison (RCLs), during a period of six years, sent to the Occupational Therapy (OT) team that acts as the Consultation-liaison Service in Mental Health. During the studied period 709 RCLs were made and 633 patients received OT consultations. The comparison group was extended to 1 129 consecutive referrals to the psychiatric CL service, within the same period and that were also retrospectively reviewed. Regarding to RCLs to the OT team, most of the subjects were women with incomplete elementary schooling, with a mean age of 39.2 years, and were self-employed or retired. Internal Medicine was responsible for most of the RCLs. The mean length of hospitalization was 51 days and the mean rate of referral was 0.5%, with the most frequent reason for the request being related to the emotional aspects and the most frequent psychiatric diagnosis was mood disorder. It is concluded that there is a clear demand for the development of consultation-liaison in OT, particularly with regard to the promotion of mental health in general hospitals.

Factors influencing the quality of the consultation process

Sport psychology services have become to be an important brick stone when building athletic success. The strive for better performance is not only a characteristic of athletes, but of the whole support system in top level sport including sport psychology. Sport psychology consultants are permanently challenged to deliver highest quality services to their clients if they do not want to lose their contracts. Sport psychologists are continuously improving their consulting skills, learn new intervention techniques, read scientific papers and, last but not least, gain experience by accumulating hours of deliberate practice (Ericsson) in sport psychology. Even with increasing experience, the consultant has a certain number of degrees of freedom and has to make a series of decisions about how he or she wants to work. Quality, however, depends on a number of issues, and not all of them are under direct control of the consultant. It is argued that, in order for these choices being good, the following factors - among others - must be considered: Who is seeking assistance? What are the "issues and problems" (Gardner & Moore, 2006) the athlete is confronted with? What kind of approaches do fit with the client's need? Who is the 'client' the sport psychologist is supposed to work with? If it is a team, is the sport psychologist supposed to work with a number of individuals, with the coach, or with the whole system? Where are the boundaries of the system? What is the role of the sport psychologist in the sport system? All these issues directly affect the process and outcome quality of the sport psychology consultant. A sound theoretical basis, in connection with a distinct philosophy of the intervention, is an important cornerstone for the quality of sport psychology consultation.

Dosage form preference consultation study in children and young adults:paving the way for patient-centred and patient-informed dosage form development

Objectives: The current study aims to evaluate dosage form preferences in children and young adults together with identifying the key pragmatic dosage form characteristics that would enable appropriate formulation of orally disintegrating tablets (ODTs). Methods: International, multisite, cross-sectional questionnaire of children and young adults aged from 6 to 18 years. Eligibility was based on age, ability to communicate and previous experience in taking medications. The study was carried out at three locations: the UK, Saudi Arabia and Jordan. The questionnaire instrument was designed for participant self-completion under supervision of the study team.Results 104 questionnaires were completed by the study cohort (n=120, response rate 87%). Results: showed that ODTs were the most preferred oral dosage forms (58%) followed by liquids (20%), tablets (12%) and capsules (11%). The preferred colours were pink or white while the preferred size was small (<8 mm) with a round shape. With regard to flavour, strawberry was the most preferred (30.8%), while orange was the least preferred (5.8%). The results also showed that the most important physical characteristics of ODTs were disintegration time followed by taste, size and flavour, respectively. Conclusions: The results of our study support the WHO's claim for a shift of paradigm from liquid towards ODTs dosage forms for drug administration to young children older than 6 years. Data from this study will also equip formulators to prioritise development of key physical/performance attributes within the delivery system.

Palliative care team visits. Qualitative study through participant observation

Objectives: To describe the clinical encounters that occur when a palliative care team provides patient care and the features that influence these encounters and indicate whether they are favorable or unfavorable depending on the expectations and feelings of the various participants. Methods: A qualitative case study conducted via participant observation. A total of 12 observations of the meetings of palliative care teams with patients and families in different settings (home, hospital and consultation room) were performed. The visits were follow-up or first visits, either scheduled or on demand. Content analysis of the observation was performed. Results: The analysis showed the normal follow-up activity of the palliative care unit that was focused on controlling symptoms, sharing information and providing advice on therapeutic regimens and care. The environment appeared to condition the patients\' expressions and the type of patient relationship. Favorable clinical encounter conditions included kindness and gratitude. Unfavorable conditions were deterioration caused by approaching death, unrealistic family objectives and limited resources. Conclusion: Home visits from basic palliative care teams play an important role in patient and family well-being. The visits seem to focus on controlling symptoms and are conditioned by available resources.

DesignWorld : a tool for team collaboration in high band virtual environments

Current software tools for documenting and developing models of buildings focus on supporting a single user who is a specialist in the specific software used within their own discipline. Extensions to these tools for use by teams maintain the single discipline view and focus on version and file management. There is a perceived need in industry to have tools that specifically support collaboration among individuals from multiple disciplines with both a graphical representation of the design and a persistent data model. This project involves the development of a prototype of such a software tool. We have identified multi-user 3D virtual worlds as an appropriate software base for the development of a collaborative design tool. These worlds are inherently multi-user and therefore directly support collaboration through a sense of awareness of others in the virtual world, their location within the world, and provide various channels for direct and indirect communication. Such software platforms also provide a 3D building and modelling environment that can be adapted to the needs of the building and construction industry. DesignWorld is a prototype system for collaborative design developed by augmenting the Second Life (SL) commercial software platform1 with a collection web-based tools for communication and design. Agents manage communication between the 3D virtual world and the web-based tools. In addition, agents maintain a persistent external model of designs in the 3D world which can be augmented with data such as relationships, disciplines and versions not usually associated with 3D virtual worlds but required in design scenarios.