Mapping the contribution of Allied Health Professions to the wider public health workforce : a rapid review of evidence-based interventions

Objectives: The objective was to identify a selection of the best examples of the public health contributions by Allied Health Professionals (AHPs) in order to encourage a wider awareness and participation from that workforce to public health practice. Study design: A mapping exercise was used to identify evidence-based interventions that could lead to health improvements across a population. Methods: A rapid review was undertaken to identify evidence, followed by a survey of Allied Health Profession (AHP) practitioners and an expert panel consensus method to select the examples of AHP public health interventions. Results: Nine evidence-based interventions are identified and selected as examples of current AHP good practice. These examples represent a contribution to public health and include screening interventions, secondary prevention and risk management. Conclusions: This study contributes to a strategy for AHPs in public health by appraising the effectiveness and impact of some exemplar AHP practices that contribute to health improvement. There is a need for AHPs to measure the impact of their interventions and to demonstrate evidence of outcomes at population level. Keywords: allied health professions; Applied Health Professionals; evidence-based practice; health improvement; public health; rapid revie

Anatomy of the western Java plate interface from depth-migrated seismic images

Newly pre-stack depth-migrated seismic images resolve the structural details of the western Java forearc and plate interface. The structural segmentation of the forearc into discrete mechanical domains correlates with distinct deformation styles. Approximately 2/3 of the trench sediment fill is detached and incorporated into frontal prism imbricates, while the floor sequence is underthrust beneath the décollement. Western Java, however, differs markedly from margins such as Nankai or Barbados, where a uniform, continuous décollement reflector has been imaged. In our study area, the plate interface reveals a spatially irregular, nonlinear pattern characterized by the morphological relief of subducted seamounts and thicker than average patches of underthrust sediment. The underthrust sediment is associated with a low velocity zone as determined from wide-angle data. Active underplating is not resolved, but likely contributes to the uplift of the large bivergent wedge that constitutes the forearc high. Our profile is located 100 km west of the 2006 Java tsunami earthquake. The heterogeneous décollement zone regulates the friction behavior of the shallow subduction environment where the earthquake occurred. The alternating pattern of enhanced frictional contact zones associated with oceanic basement relief and weak material patches of underthrust sediment influences seismic coupling and possibly contributed to the heterogeneous slip distribution. Our seismic images resolve a steeply dipping splay fault, which originates at the décollement and terminates at the sea floor and which potentially contributes to tsunami generation during co-seismic activity

Investigation of shock waves in explosive blasts using fibre optic pressure sensors

The published version of this article may be accessed at the link below. Copyright @ IOP Publishing, 2006.We describe miniature all-optical pressure sensors, fabricated by wafer etching techniques, less than 1 mm(2) in overall cross-section with rise times in the mu s regime and pressure ranges typically 900 kPa (9 bar). Their performance is suitable for experimental studies of the pressure-time history for test models exposed to shocks initiated by an explosive charge. The small size and fast response of the sensors promises higher quality data than has been previously available from conventional electrical sensors, with potential improvements to numerical models of blast effects. Results from blast tests are presented in which up to six sensors were multiplexed, embedded within test models in a range of orientations relative to the shock front.Support from the UK Engineering&Physical Sciences Research Council and Dstl Fort Halstead through the MoD Joint Grants Scheme are acknowledged. WN MacPherson is supported by an EPSRC Advanced Research Fellowship

Development of a peer-supported, self-management intervention for people following mental health crisis

BACKGROUND: A documented gap in support exists for service users following discharge from acute mental health services, and structured interventions to reduce relapse are rarely provided. Peer-facilitated self-management interventions have potential to meet this need, but evidence for their effectiveness is limited. This paper describes the development of a peer-provided self-management intervention for mental health service users following discharge from crisis resolution teams (CRTs). METHODS: A five-stage iterative mixed-methods approach of sequential data collection and intervention development was adopted, following the development and piloting stages of the MRC framework for developing and evaluating complex interventions. Evidence review (stage 1) included systematic reviews of both peer support and self-management literature. Interviews with CRT service users (n = 41) regarding needs and priorities for support following CRT discharge were conducted (stage 2). Focus group consultations (n = 12) were held with CRT service-users, staff and carers to assess the acceptability and feasibility of a proposed intervention, and to refine intervention organisation and content (stage 3). Qualitative evaluation of a refined, peer-provided, self-management intervention involved qualitative interviews with CRT service user participants (n = 9; n = 18) in feasibility testing (stage 4) and a pilot trial (stage 5), and a focus group at each stage with the peer worker providers (n = 4). RESULTS: Existing evidence suggests self-management interventions can reduce relapse and improve recovery. Initial interviews and focus groups indicated support for the overall purpose and planned content of a recovery-focused self-management intervention for people leaving CRT care adapted from an existing resource: The personal recovery plan (developed by Repper and Perkins), and for peer support workers (PSWs) as providers. Participant feedback after feasibility testing was positive regarding facilitation of the intervention by PSWs; however, the structured self-management booklet was underutilised. Modifications to the self-management intervention manual and PSWs' training were made before piloting, which confirmed the acceptability and feasibility of the intervention for testing in a future, definitive trial. CONCLUSIONS: A manualised intervention and operating procedures, focusing on the needs and priorities of the target client group, have been developed through iterative stages of intervention development and feedback for testing in a trial context. Trial Registration ISRCTN01027104 date of registration: 11/10/2012

The role of primary healthcare professionals in oral cancer prevention and detection

AIM: To investigate current knowledge, examination habits and preventive practices of primary healthcare professionals in Scotland, with respect to oral cancer, and to determine any relevant training needs. SETTING: Primary care. METHOD: Questionnaires were sent to a random sample of 357 general medical practitioners (GMPs) and 331 dental practitioners throughout Scotland. Additionally, focus group research and interviews were conducted amongst primary healthcare team members. RESULTS: Whilst 58% of dental respondents reported examining regularly for signs of oral cancer, GMPs examined patients' mouths usually in response to a complaint of soreness. The majority of GMPs (85%) and dentists (63%) indicated that they felt less than confident in detecting oral cancer, with over 70% of GMPs identifying lack of training as an important barrier. Many practitioners were unclear concerning the relative importance of the presence of potentially malignant lesions in the oral cavity. A high proportion of the GMPs indicated that they should have a major role to play in oral cancer detection (66%) but many felt strongly that this should be primarily the remit of the dental team. CONCLUSION: The study revealed a need for continuing education programmes for primary care practitioners in oral cancer-related activities. This should aim to improve diagnostic skills and seek to increase practitioners' participation in preventive activities

Modelling and evaluating petroleum migration pathways in the Paris, Williston and west of Shetlands and Wessex Basins

Petroleum migration pathways through a basin are determined by the three-dimensional distribution of discontinuous sealing surfaces, which are usually parallel to bedding. The petroleum migrates below the sealing surface taking the structurally most advantageous route. The three-dimensional distribution of migration pathways within the petroleum system can be modelled on a personal computer using a program based on the parameters developed during the research summarised in this thesis. Application of the model to the Paris, Williston, West of Shetlands and Wessex Basins demonstrates that a good correlation can be made between predicted pathways and discovered accumulations using simple models. Migration pathways form a dense network overlying hydrocarbon generating areas in the central parts of basins. Towards the basin margins they commonly become increasingly focused into discrete pathways by the sealing-surface morphologies. The Paris and Williston Basin research showed how relatively minor structuring of geological strata can result in a significant focusing of pathways. Eventually these pathways may reach the surface as shown by seepages. Research in the Wessex Basin revealed that reverse modelling of pathways from seeps assists in the prediction of the location of leaking accumulations. Deflection of the pathways from the structurally most advantageous route below the sealing surface may be caused by lateral sealing barriers due to facies variation in the carrier rock below the seal, fault juxtaposition, or cross-formational seals such as salt intrusions. Deflection of pathways also occurs where there are hydrodynamic conditions in response to topography-driven groundwater flow

Relational trauma and its impact on late-adopted children

This paper describes work with two children, placed for late adoption who have suffered relational trauma. The paper explores the long-term consequences of such trauma, which includes problems with affect regulation, difficulties in generalising from one experience to another and shifts between phantasies of omnipotent control and sudden helplessness. Using drawings from one boy's therapy, it is argued that many children adopted at a later age live in two worlds, both internal and external, and internal objects and memories from the past vie with new experiences and representations for ascendancy within the child's mind. Which is more real: the world of the past or the present? The paper describes how these children experienced sudden and troubling shifts in focus as they were catapulted from feeling states belonging to one world to the other. The paper ends with a consideration of how findings from neuroscience may help us to understand these sudden shifts and overall argues for a pulling together of psychoanalytic thinking and child development research findings to support the child in psychotherapy