Naresuan University Journal
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Adapting an evidence-based intervention for autism spectrum disorder for scaling up in resource-constrained settings: the development of the PASS intervention in South Asia.
No full textBACKGROUND: Evidence-based interventions for autism spectrum disorders evaluated in high-income countries typically require highly specialised manpower, which is a scarce resource in most low- and middle-income settings. This resource limitation results in most children not having access to evidence-based interventions. OBJECTIVE: This paper reports on the systematic adaptation of an evidence-based intervention, the Preschool Autism Communication Therapy (PACT) evaluated in a large trial in the United Kingdom for delivery in a low-resource setting through the process of task-shifting. DESIGN: The adaptation process used the Medical Research Council framework for the development and adaptation of complex interventions, focusing on qualitative methods and case series and was conducted simultaneously in India and Pakistan. RESULTS: The original intervention delivered by speech and language therapists in a high-resource setting required adaptation in some aspects of its content and delivery to enhance contextual acceptability and to enable the intervention to be delivered by non-specialists. CONCLUSIONS: The resulting intervention, the Parent-mediated intervention for Autism Spectrum Disorder in South Asia (PASS), shares the core theoretical foundations of the original PACT but is adapted in several respects to enhance its acceptability, feasibility, and scalability in low-resource settings
Management and Accounting Innovations: Reflecting on what they are and why they are adopted
No full textDifferential Outcomes to Strategy: Exploring Factors Shaping the Returns to Innovation Policy of China and Russia
No full textWHERE NEXT FOR THE PARAMEDIC PROFESSION? AN ETHNOGRAPHY OF WORK CULTURE AND OCCUPATIONAL IDENTITY
No full textThe paramedic profession, along with the broader structure and mission of NHS emergency ambulance provision, is undergoing significant but rather undefined change. The clinical scope of the paramedic role has broadened, and the opening of new patient pathways has enabled a broader range of treatment and referral options for attending ambulance crews. Ambulance trusts have moved to an all-graduate intake for new paramedics, and significant advances have been made in establishing the classic steps of a ‘professionalization project’ (such as the growth of the College of Paramedics, the development of peer-reviewed practitioner journals, and the introduction of advanced paramedic roles.) Some of these changes are contentious, however, and many of the fundamentals of ambulance work and occupational culture remain unchanged to a significant degree. Long-standing problems persist around low staff morale, high levels of sickness-related absence, lack of capacity, limited resources and support, the dominance of a ‘targets culture’, and a lack of working trust between ‘management’ and ‘roadstaff.’ Working life ‘on the road’ is demanding and the emergency ambulance field is a challenging environment for the pursuit of a professionalization project. This paper provides insights from a sociology of work perspective into the everyday work culture of ambulance services. Based on qualitative interviews and ethnographic observation of ambulance crews and of mid-level ambulance trust managers, the paper provides an in-depth exploration of the culture of everyday working life in (anonymized) ambulance trusts. We identify several broad conceptions among staff as to the essence and purpose of emergency ambulance provision, of ambulance trusts as employers, and of the goals and potential pitfalls of the professionalization project. The paper thus explores the multifaceted meanings of ‘professionalism’ and considers the broad challenges facing the profession at large and NHS trusts as employers as both confront unsettling forms of change
Dissipation of Quasiclassical Turbulence in Superfluid 4He
No full textWe compare the decay of turbulence in superfluid 4 He produced by a moving grid to the decay of turbulence created by either impulsive spin-down to rest or by intense ion injection. In all cases, the vortex line density L decays at late time t as L∝t−3/2. At temperatures above 0.8 K, all methods result in the same rate of decay. Below 0.8 K, the spin-down turbulence maintains initial rotation and decays slower than grid turbulence and ion-jet turbulence. This may be due to a decoupling of the large-scale superfluid flow from the normal component at low temperatures, which changes its effective boundary condition from no-slip to slip
Developing a stated choice experiment to understand preferences for information provision in an expanded Newborn Bloodspot Screening Programme
No full textDoes patient experience of multimorbidity predict self-management and health outcomes in a prospective study in primary care?
No full textBACKGROUND: There is a need to better understand the mechanisms which lead to poor outcomes in patients with multimorbidity, especially those factors that might be amenable to intervention. OBJECTIVE: This research aims to explore what factors predict self-management behaviour and health outcomes in patients with multimorbidity in primary care in the UK. METHODS: A prospective study design was used. Questionnaires were mailed out to 1460 patients with multimorbidity. Patients were asked to complete a range of self-report measures including measures of multimorbidity, measures of their experience of multimorbidity and service delivery and outcomes (three measures of self-management: behaviours, Self-monitoring and Insight and medication adherence; and a measure of self-reported health). RESULTS: In total, 36% (n = 499) of patients responded to the baseline survey and 80% of those respondents completed follow-up. Self-management behaviour at 4 months was predicted by illness perceptions around the consequences of individual conditions. Self-monitoring and Insight at 4 months was predicted by patient experience of 'Hassles' in health services. Self-reported medication adherence at 4 months was predicted by health status, Self-monitoring and Insight and 'Hassles' in health services. Perceived health status at 4 months was predicted by age and patient experience of multimorbidity. CONCLUSIONS: This research shows that different factors, particularly around patients' experiences of health care and control over their treatment, impact on various types of self-management. Patient experience of multimorbidity was not a critical predictor of self-management but did predict health status in the short term. The findings can help to develop and target interventions that might improve outcomes in patients with multimorbidity
Becoming popular: Interpersonal emotion regulation predicts relationship formation in real life social networks
No full textBuilding relationships is crucial for satisfaction and success, especially when entering new social contexts. In the present paper, we investigate whether attempting to improve others’ feelings helps people to make connections in new networks. We contrast two distinct types of interpersonal emotion regulation (IER) strategies: cognitive (which change a person’s thoughts about his or her situation or feelings in order to regulate affect) and behavioral (which use behavior to reassure or comfort in order to regulate affect). In Study 1, linguistic analysis of the tweets from over 8000 Twitter users from formation of their accounts revealed that use of behavioral IER strategies was associated with greater popularity in terms of the number of followers gained, while use of cognitive strategies was negatively associated with popularity. In Study 2, a social network study following new networks of people for a twelve-week period indicated that behavioral IER strategies predicted growth in popularity, as indicated by other network members’ reports of spending time with the person, in work and non-work interactions. Cognitive strategies, in contrast, predicted an increase in non-work popularity, but only when they were used by people high in agreeableness. Our findings have implications for our understanding of how new relationships are formed, and the role played by IER
Acute cutaneous wounds treated with human decellularised dermis show enhanced angiogenesis during healing.
No full textThe influence of skin substitutes upon angiogenesis during wound healing is unclear. OBJECTIVES: To compare the angiogenic response in acute cutaneous human wounds treated with autogenic, allogenic and xenogenic skin substitutes to those left to heal by secondary intention. METHODS: On day 0, four 5mm full-thickness punch biopsies were harvested from fifty healthy volunteers (sites 1-4). In all cases, site 1 healed by secondary intention (control), site 2 was treated with collagen-GAG scaffold (CG), cadaveric decellularised dermis (DCD) was applied to site 3, whilst excised tissue was re-inserted into site 4 (autograft). Depending on study group allocation, healing tissue from sites 1-4 was excised on day 7, 14, 21 or 28. All specimens were bisected, with half used in histological and immunohistochemical evaluation whilst extracted RNA from the remainder enabled whole genome microarrays and qRT-PCR of highlighted angiogenesis-related genes. All wounds were serially imaged over 6 weeks using laser-doppler imaging and spectrophotometric intracutaneous analysis. RESULTS: Inherent structural differences between skin substitutes influenced the distribution and organisation of capillary networks within regenerating dermis. Haemoglobin flux (p = 0.0035), oxyhaemoglobin concentration (p = 0.0005), and vessel number derived from CD31-based immunohistochemistry (p = 0.046) were significantly greater in DCD wounds at later time points. This correlated with time-matched increases in mRNA expression of membrane-type 6 matrix metalloproteinase (MT6-MMP) (p = 0.021) and prokineticin 2 (PROK2) (p = 0.004). CONCLUSION: Corroborating evidence from invasive and non-invasive modalities demonstrated that treatment with DCD resulted in increased angiogenesis after wounding. Significantly elevated mRNA expression of pro-angiogenic PROK2 and extracellular matrix protease MT6-MMP seen only in the DCD group may contribute to observed responses
