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PubMed2003

Rites of passage: understanding participation of children with developmental coordination disorder.

Children with developmental coordination disorder (DCD) experience difficulty participating in the typical activities of childhood and are known to have a more sedentary pattern of activities than their peers. Little research has been done to investigate the impact of these deficits on the lives of children with DCD and the importance of their participation in the typical activities of childhood. This qualitative study explored the impact of the disorder and the importance of participation for children with DCD from the perspective of the parent. Twelve in-depth interviews were conducted with parents of children with DCD who attended a university clinic specializing in using the Cognitive Orientation to daily Occupational Performance (CO-OP) approach, a cognitive-based intervention. Findings revealed that incompetence in everyday activities had serious negative effects for the children. Conversely, intervention that was focused on enablement at the activity and participation level had a significant positive impact on the children's quality of life. Emerging themes highlighted the notion that performance competency played an important role in being accepted by peers and being able "to be part of the group". As well, parents reported that successful participation built confidence in their children and allowed them to try other new activities. The World Health Organization's International Classification of Functioning, Disability, and Health provides a unique framework for analyzing and understanding the impact of the physical disability on the lives of families with children with DCD. Results illustrate how intervention that focuses on enabling children to choose their own functional goals in the area of physical activity has important implications for enabling participation and building the social networks of children with DCD.

Activities of Daily Living↗

PubMed1999

Unsupervised visual learning of three-dimensional objects using a modular network architecture.

This paper presents a modular network architecture that learns to cluster multiple views of multiple three-dimensional (3D) objects. The proposed network model is based on a mixture of non-linear autoencoders, which compete to encode multiple views of each 3D object. The main advantage of using a mixture of autoencoders is that it can capture multiple non-linear sub-spaces, rather than multiple centers for describing complex shapes of the view distributions. The unsupervised training algorithm is formulated within a maximum-likelihood estimation framework. The performance of the modular network model is evaluated through experiments using synthetic 3D wire-frame objects and gray-level images of real 3D objects. It is shown that the performance of the modular network model is superior to the performance of the conventional clustering algorithms, such as the K-means algorithm and the Gaussian mixture model.

Journal Article↗

PubMed1992

Age and the availability of inferences.

Age differences in inference availability and memory were investigated using a speeded decision procedure and cued recall. Younger and older adults read passages that directly suggested either a target inference or an incorrect, competing inference before finally supporting the target inference. At critical points in a passage, subjects judged whether each of a series of words, including either the target or competing inference, was consistent with their current interpretation. Although both groups agreed on the final target inference, younger and older adults showed different patterns of inference availability and revision. Older adults showed broader and more sustained activation of alternative interpretations and also showed lower levels of inference recall. These findings are interpretable by a framework that proposes age-related breakdowns in inhibitory mechanisms that control the contents of working memory (Hasher & Zacks, 1988).

Adolescent↗

PubMed2006

The psychotherapy adaptation and modification framework: application to Asian Americans.

Although effective treatments for many mental disorders have been developed, little research has been conducted to determine whether these interventions are effective in treating those from diverse backgrounds. Recent reports have suggested that ethnic minorities are less likely to receive quality health services and that they evidence worse treatment outcomes when compared with other groups. To improve care for those from diverse backgrounds, Western-developed psychotherapies may need to be culturally modified or adapted to become more effective in treating ethnic minorities. This article addresses the need for adapting psychotherapy and provides a conceptual framework for making such modifications. The psychotherapy adaptation and modification framework model is applied to recent Asian American immigrants as an illustrative example. However, it may also serve as a point of departure to adapt therapies for other ethnocultural groups.

Asian↗

PubMed2002

Fears and worries associated with hypoglycaemia and diabetes complications: perceptions and experience of Hong Kong Chinese clients.

AIM: This paper reports the second phase of a study that explored the perceptions and experience of Hong Kong Chinese insulin-treated clients who demonstrated fear of hypoglycaemia and worry about diabetes complications. BACKGROUND: The first phase of the study, a descriptive survey (n = 120), identified 15% of respondents as simultaneously sustaining fears and worries associated with hypoglycaemia and diabetes complications. Although a small percentage, given the increasing number of clients using insulin treatment, this finding suggests a pocket of clients suffering from undesirable emotional health. However, a search of the literature identified few studies exploring Chinese clients' perceptions and experience in this area. DESIGN: The second phase of the study employed a purposive sampling method and semi-structured interviews to collect data from 13 participants experiencing these fears and worries. FINDINGS; Two researchers independently used content analysis to code and categorize data. Six categories identified were: the influence of perceptions of glycaemic control on emotion, hypo- and hyperglycaemia as a constant threat, keeping optimal glycaemic control or maintaining a working life, financial and psychological burden of blood glucose self-monitoring, being alone with the threat and finally distancing as the coping method. An overriding issue, a sense of losing control, emerged from the findings that described participants' perceptions and experience. This issue and two major health needs, developing self-efficacy and emotional support from nurses, were drawn from the findings for discussion. It is suggested that self-efficacy theory can be adopted as a conceptual framework to guide nursing practice for enhancing clients' capacity to exercise control over diabetes self-management. CONCLUSIONS: Findings obtained from the second phase of the study illuminated those from the first phase. Implications for nursing practice were identified, including facilitating both technical and psychosocial self-efficacy, assessing clients' total life situation, strengthening competence in counselling skills and forming alliances with clients.

Adaptation, Psychological↗

PubMed2002

Clinical group supervision in an intensive care unit: a space for relief, and for sharing emotions and experiences of care.

Much has been written about models, aims and the concept of clinical group supervisional, although few studies are empirical or focus on intensive care. The aim of the study was to illuminate the process and describe, using qualitative content analysis, the content of conversations carried out during the course of clinical group supervision sessions among Registered Nurses (RN) and enrolled nurses (EN) working in an intensive care unit (ICU). During the supervision sessions, ENs talked about their life-world from a caring perspective, while RNs focused on their professional development. Both ENs and RNs regarded the supervision sessions as a space for relief and for sharing emotions and caring experiences, which helped to manage complex nursing care. The findings are viewed in the light of Roach's theoretical framework describing the attributes of professional care as five Cs. Clinical group supervision is interpreted as supportive in developing interpersonal skills and a sensitive nursing practice.

Adult↗

PubMed2003

Simulation in surgical training: educational issues and practical implications.

BACKGROUND: Surgical skills are required by a wide range of health care professionals. Tasks range from simple wound closure to highly complex diagnostic and therapeutic procedures. Technical expertise, although essential, is only one component of a complex picture. By emphasising the importance of knowledge and attitudes, this article aims to locate the acquisition of surgical skills within a wider educational framework. SIMULATORS: Simulators can provide safe, realistic learning environments for repeated practice, underpinned by feedback and objective metrics of performance. Using a simple classification of simulators into model-based, computer-based or hybrid, this paper summarises the current state of the art and describes recent technological developments. Advances in computing have led to the establishment of precision placement and simple manipulation simulators within health care education, while complex manipulation and integrated procedure simulators are still in the development phase. EVALUATION: Tension often exists between the design and evaluation of surgical simulations. A lack of high quality published data is compounded by the difficulties of conducting longitudinal studies in such a fast-moving field. The implications of this tension are discussed. THE WIDER CONTEXT: The emphasis is now shifting from the technology of simulation towards partnership with education and clinical practice. This highlights the need for an integrated learning framework, where knowledge can be acquired alongside technical skills and not in isolation from them. Recent work on situated learning underlines the potential for simulation to feed into and enrich everyday clinical practice.

Clinical Competence↗

PubMed2004

Cellular targets and mechanisms of nitros(yl)ation: an insight into their nature and kinetics in vivo.

There is mounting evidence that the established paradigm of nitric oxide (NO) biochemistry, from formation through NO synthases, over interaction with soluble guanylyl cyclase, to eventual disposal as nitrite/nitrate, represents only part of a richer chemistry through which NO elicits biological signaling. Additional pathways have been suggested that include interaction of NO-derived metabolites with thiols and metals to form S-nitrosothiols (RSNOs) and metal nitrosyls. Despite the overwhelming attention paid in this regard to RSNOs, little is known about the stability of these species, their significance outside the circulation, and whether other nitros(yl)ation products are of equal importance. We here show that N-nitrosation and heme-nitrosylation are indeed as ubiquitous as S-nitrosation in vivo and that the products of these reactions are constitutively present throughout the organ system. Our study further reveals that all NO-derived products are highly dynamic, have fairly short lifetimes, and are linked to tissue oxygenation and redox state. Experimental evidence further suggests that nitroso formation occurs substantially by means of oxidative nitrosylation rather than NO autoxidation, explaining why S-nitrosation can compete effectively with nitrosylation. Moreover, tissue nitrite can serve as a significant extravascular pool of NO during brief periods of hypoxia, and tissue nitrate/nitrite ratios can serve as indicators of the balance between local oxidative and nitrosative stress. These findings vastly expand our understanding of the fate of NO in vivo and provide a framework for further exploration of the significance of nitrosative events in redox sensing and signaling. The findings also raise the intriguing possibility that N-nitrosation is directly involved in the modulation of protein function.

Animals↗

PubMed1997

Managerial effectiveness in the NHS. A possible framework for considering the effectiveness of the clinical director.

Examines managerial effectiveness in the NHS, in particular the effectiveness of the clinical director. Based on a qualitative study of an NHS Trust hospital case study, utilizes a social cognitive perspective to analyse the data and draw conclusions. Uses the data to suggest a possible framework for examining the effectiveness of individual directors. The framework may be relevant to other messages, particularly those in professional service organizations. It may also be used as a diagnostic tool to assess these managers. The framework is grounded in the perceptions of the interviewees at the Trust: both clinical directors and managers.

Clinical Medicine↗

PubMed2006

Becoming literate in different languages: similar problems, different solutions.

The teaching of reading in different languages should be informed by an effective evidence base. Although most children will eventually become competent, indeed skilled, readers of their languages, the pre-reading (e.g. phonological awareness) and language skills that they bring to school may differ in systematic ways for different language environments. A thorough understanding of potential differences is required if literacy teaching is to be optimized in different languages. Here we propose a theoretical framework based on a psycholinguistic grain size approach to guide the collection of evidence in different countries. We argue that the development of reading depends on children's phonological awareness in all languages studied to date. However, we propose that because languages vary in the consistency with which phonology is represented in orthography, there are developmental differences in the grain size of lexical representations, and accompanying differences in developmental reading strategies across orthographies.

Child↗

PubMed2005

New understanding on phloem physiology and possible consequences for modelling long-distance carbon transport.

Most current models of assimilate carbohydrate partitioning are based on growth patterns observed under a range of experimental conditions, from which a set of empirical rules are derived to simulate partitioning. As a result, they are not good at extrapolating to other conditions; this requires a mechanistic approach, which only transport-resistance (TR) models currently provide. We examine an approach to incorporating recent progress in phloem physiology into the TR approach, which leads to a 'minimalist' Munch model of a branched system with competing sinks. In vivo whole-plant measurements have demonstrated that C-flow rates are dependent not only on the properties of the sink, but also on the properties of the whole transport system, and the detailed dynamics of this behaviour is mimicked by the proposed model. This model provides a sound theoretical framework for an unambiguous definition of sink and source strengths, with sink priority being an emergent property of the model. Further developments are proposed, some of which have already had limited application, to cope with the complexity of plants; the emphasis is on a modular approach, together with the importance of choosing the appropriate scale level for both structure and function. Whole-plant experiments with in vivo measurement of the phloem dynamics will be needed to help with this choice.

Biological Transport, Active↗

PubMedDate not supplied

Epiglottic laryngoplasty for complicated laryngeal stenosis.

The technique of epiglottic laryngoplasty, previously described for reconstruction following near total laryngectomy for glottic carcinoma, has been used in selected patients with severe glottic and subglottic stenosis. Our experience in four patients suggests that it is useful for 1) laryngeal stenosis in which there is loss or collapse of the external cartilaginous framework, and 2) laryngeal stenosis which is refractory to the usual forms of therapy. The technique is a technically simple, one-stage procedure which provides its own endolaryngeal mucosal lining, as well as autogenous cartilaginous support. It has been successful in restoring adequate airway and preserving voice without interfering with deglutition or laryngeal competence in most patients.

Adult↗

PubMedDate not supplied

Assessing community nurses' level of knowledge of lymphoedema.

As part of a major project to develop a primary care trust-based framework of lymphoedema management, the educational needs of community nurses regarding the care of patients with lymphoedema were assessed using focus groups and questionnaires. Community nurses assessed their current knowledge and skill in the care and management of patients with lymphoedema as adequate or poor. They were concerned about their lack of knowledge and skill and were uncertain regarding their role relative to other professions involved in the care of this patient group. At the same time they understood the importance of their role in providing ongoing care, recognizing problems, offering sound advice and referring on to a specialist practitioner when necessary. Any education provision that prepares community nurses for their role within a framework of lymphoedema management should emphasize the important place they occupy in providing long-term care for this patient group.

Clinical Competence↗

PubMedDate not supplied

Working complementary therapies into mainstream health care.

Complementary and alternative medicine (CAM) is speculative and practitioners and policy makers question its validity in the care of people within the NHS. However, increasing numbers of people are using private CAM therapists to address their health needs. This has consequences in terms of cost to the patient, of using CAM instead of traditional health care, and for policy makers and educators raises questions of competency, regulation and research to validate its efficacy. This article provides a personal account of a nurse educator's discovery of homeopathy as a complementary therapy, its impact upon health status, training undertaken and action taken as a result. It outlines the potential use of CAM as a holistic approach that embraces the interprofessional framework and suggests CAM practitioner inclusion within mainstream healthcare provision. The article emphasizes the need for further quantitative and qualitative research of CAM treatment.

Attitude of Health Personnel↗

PubMed2004

The new NHS framework for handling performance concerns.

There have recently been important changes in the procedures for handling performance issues among medical and dental employees. The author explains the background, explores the practicalities, and discusses the challenges and unresolved issues for medical managers.

Clinical Competence↗

PubMed2004

Expertise in cognitive psychology: testing the hypothesis of long-term working memory in a study of soccer players.

This experiment compared several theories of expertise and exceptional performances in cognitive psychology. One current conception assumes that experts in a specific domain have developed a long-term working memory, which accounts for the difference in memory performance between experts and novices. The principal characteristics of this memory are the speed with which processes of storage and retrieval function and the existence of retrieval structures that allow a temporary activation of the knowledge store in long-term memory. Other authors such as Vicente and Wang argue this notion does not account for memory performance that is not intrinsic to the domain of expertise. We attempt to clarify the two viewpoints and to focus on this debate by testing the hypothesis of long-term working memory using soccer as the domain of expertise and by comparing the cognitive performance of participants who have different expertise (novices, supporters, players, and coaches). 35 male participants were administered a new version of the Reading Span test to assess their long-term working memory according to two conditions. In the first condition (structured condition), the last word of each sentence was related to the soccer domain, and these words were related to each other in such a manner that they represented a part of the game. In the second condition (unstructured condition), the last word of each sentence was related to soccer but these words did not represent part of the game. Analysis showed that the sentence span increased as a function of expertise for the structured condition but not for the unstructured condition. The results were interpreted in the framework of the constraint attunement hypothesis proposed by Vicente in 1992 and the long-term working memory hypothesis proposed by Ericsson and Kintsch in 1995.

Adult↗

PubMed2001

Ensuring the quality of health care.

The importance of high standards and striving for excellence in the Hong Kong health care system have been affirmed in the debate following release of the Harvard Report. This paper reviews the issue of quality in health care and recommends a triad quality framework to achieve this, consisting of enhancing professional practice, empowering patients, and providing a facilitative environment in which quality of care is encouraged.

Humans↗

PubMed2002

Economic approaches to doctor/nurse skill mix: problems, pitfalls, and partial solutions.

Against a background of government calls for a radical change in the way the medical workforce is planned and trained, the concept of skill mix seeks to match clinical presentation to an intervention based on an appropriate level of skill and training. Health economics is not the only framework within which these changes can be analysed. However unless the economic issues are thought through clearly there is a danger that resources may be used inefficiently. The aims of this paper are to outline the economic issues in the area of doctor/nurse skill mix and the problems of obtaining correct solutions from the perspective of efficiency. It concludes by offering a pragmatic framework which can facilitate decisions in this area. Although this paper is written from the perspective of primary care, it is equally relevant to skill mix in the secondary care sector.

Clinical Competence↗