Two steps forward, one step back? A commentary on the disease-specific core sets of the international classification of functioning, Disability and Health (ICF)

The International Classification of Functioning, Disability and Health (ICF) is advocated as a biopsychosocial framework and classification and has been received favourably by occupational therapists, disability rights organisations and proponents of the social model of disability. The success of the ICF largely depends on its uptake in practice and it is considered unwieldy in its full format. Therefore, to make the ICF user friendly, the World Health Organisation (WHO) have condensed the original format and developed core sets, some of which are disease specific. The authors use the ICF Core Set for stroke as an example to debate if by reverting to classification according to disease, the ICF is at risk of taking two steps forward, one step back in its holistic portrayal of health

Occupational therapists' perceptions of predischarge home assessments with older adults in acute care

Predischarge occupational therapy home assessments are routinely performed with older adults in Europe, Australia and North America. Their primary aim is to facilitate a timely and safe discharge from hospital. However, there is a lack of published research on this topic, especially studies exploring occupational therapists' perceptions of home assessments. The paper aims to redress this by describing occupational therapists' perceptions of predischarge occupational therapy home assessments with older adults in acute care. All occupational therapists who undertook home assessments in an acute care hospital with older adults during the duration of the study period were invited to complete a reflective diary. In total, 15 reflective diaries were completed by six therapists. The data were analysed using thematic content analysis. The findings suggest that home assessments were carried out because of mobility or environmental concerns. Satisfaction and dissatisfaction with the outcome of the home assessment were related to the incidents that occurred during the assessment. Some of the occupational therapists' anxieties were related to the older adults' level of functioning or ill health, and the older adults' own concerns did have an impact upon the therapists' expectations of the home assessment process

Accreditation of practice educators: An expectation too far ?

The successful completion of practice placements is essential to the education of occupational therapists; however, ensuring quality placements is challenging for occupational therapy educators. In 2000, Brunel University introduced a revised system of accreditation of practice educators which involved attendance at a course, the supervision of a student and the submission of an essay to be assessed. An audit revealed that a total of 314 therapists attended 15 courses between 2000 and 2003; of these, 243 (77%) subsequently supervised students and 32 (10%) became accredited. The requirement to accredit practice educators, which is a commendable attempt to ensure quality, may paradoxically have been detrimental in achieving quality. The College of Occupational Therapists’ apparent change of emphasis on this topic is welcome

Awareness, requirements and barriers to use of Assistive Technology designed to enable independence of people suffering from Dementia (ATD)

This article is available through the Brunel Open Access Publishing Fund. Copyright @ 2012 IOS PressThis study investigated the awareness and use of assistive technology for people with dementia. The aim of the study was to explore barriers to the uptake of, and the unmet needs for, assistive technology for dementia (ATD) The work was carried out with family carers of people with dementia because carers are often the purchasers, end users and main beneficiaries of this type of technology. Focus groups were used to explore carers’ views on ATD use, and the problems that might be addressed by ATD, in order to develop a questionnaire for dementia carers. The questionnaire was administered at Alzheimer’s Society carer support groups in South Bucks and in Hillingdon Borough (UK). None of the 16 focus group participants or the 42 respondents to the questionnaire had any personal experience of ATD. The dementia carers reported a number of concerns, problems and unmet needs that could be addressed by existing, commercially available ATD products. Some needs for new technology development were identified in the study, but the lack of awareness of ATD appears to be the most important barrier to technology adoption

Using the ICF to clarify team roles and demonstrate clinical reasoning in stroke rehabilitation

Purpose: The International Classification of Functioning, Disability and Health (ICF) is advocated as a tool to structure rehabilitation and a universal language to aid communication, within the multi-disciplinary team (MDT). The ICF may also facilitate clarification of team roles and clinical reasoning for intervention. This article aims to explore both factors in stroke rehabilitation. Method: Following a review of the literature, a summary was presented and discussed with clinicians working within stroke rehabilitation, to gather expert opinions. The discussions were informal, being part of service development and on-going education. The clinicians summarised key themes for the potential use of the ICF within clinical practice. Results: Two key themes emerged from the literature and expert opinion for the potential use of the ICF in stroke rehabilitation: i) to aid communication and structure service provision ii) to clarify team roles and aid clinical reasoning. Expert opinion was that clarification of team roles needs to occur at a local level due to the skill mix, particular interests, setting and staffing levels within individual teams. The ICF has the potential to demonstrate/ facilitate clinical reasoning, especially when different MDT members are working on the same intervention. Conclusion: There is potential for the ICF to be used to clarify team roles and demonstrate clinical reasoning within stroke rehabilitation. Further experiential research is required to substantiate this vie

Giving in to Group Pressure: The Impact of Socialization and Risk on Perceived Outcomes

The current study applies the perspective of decision theory to understanding how choices are made in an in-group setting involving social pressure and risk. Two hundred sixty-one undergraduate students provided assessments of consequences associated with illegally consuming alcohol in different environments with differing degrees of risk. In addition, size of the social group was varied as three, four, or nine. In order to determine the moderating effects, if any, of susceptibility to social influence, a measure of socialization was included. Results provide strong support for socialization as an explanation for how individuals interpret risk-related social situations

Options for managing human threats to high seas biodiversity

Areas beyond national jurisdiction (ABNJ) constitute 61% of the world's oceans and are collectively managed by countries under the United Nations Convention on the Law of the Sea (UNCLOS). Growing concern regarding the deteriorating state of the oceans and ineffective management of ABNJ has resulted in negotiations to develop an international legally binding instrument (ILBI) for the conservation and sustainable use of biodiversity beyond national jurisdiction under UNCLOS. To inform these negotiations, we identified existing and emerging human activities and influences that affect ABNJ and evaluated management options available to mitigate the most pervasive, with highest potential for impact and probability of emergence. The highest-ranking activities and influences that affect ABNJ were fishing/hunting, maritime shipping, climate change and its associated effects, land-based pollution and mineral exploitation. Management options are diverse and available through a variety of actors, although their actions are not always effective. Area-based management tools (ABMTs), including marine protected areas (MPAs), were the only consistently effective option to mitigate impacts across high-ranked activities and influences. However, addressing land-based pollution will require national action to prevent this at its source, and MPAs offer only a partial solution for climate change. A new ABNJ ILBI could help unify management options and actors to conserve marine biodiversity and ensure sustainable use. Incorporating a mechanism to establish effective ABMTs into the ILBI will help deliver multiple objectives based on the ecosystem approach

The Interaction between the ISM and Star Formation in the Dwarf Starburst Galaxy NGC 4214

We present the first interferometric study of the molecular gas in the metal-poor dwarf starburst galaxy NGC 4214. Our map of the 12CO(1-0) emission, obtained at the OVRO millimeter array, reveals an unexpected structural wealth. We detected three regions of molecular emission in the north-west (NW), south-east (SE) and centre of NGC 4214 which are in very different and distinct evolutionary stages (total molecular mass: 5.1 x 10^6 M_sun). These differences are apparent most dramatically when the CO morphologies are compared to optical ground based and HST imaging: massive star formation has not started yet in the NW region; the well-known starburst in the centre is the most evolved and star formation in the SE complex started more recently. We derive a star formation efficiency of 8% for the SE complex. Using high--resolution VLA observations of neutral hydrogen HI and our CO data we generated a total gas column density map for NGC 4214 (HI + H_2). No clear correlation is seen between the peaks of HI, CO and the sites of ongoing star formation. This emphasizes the irregular nature of dwarf galaxies. The HI and CO velocities agree well, so do the H-alpha velocities. In total, we cataloged 14 molecular clumps in NGC 4214. Our results from a virial mass analysis are compatible with a Galactic CO-to-H_2 conversion factor for NGC 4214 (lower than what is usually found in metal-poor dwarf galaxies).Comment: accepted for publication in the AJ (February 2001), full ps file at: ftp://ftp.astro.caltech.edu/users/fw/ngc4214/walter_prep.p

Shot Noise Suppression in Avalanche Photodiodes

We identify a new shot noise suppression mechanism in a thin (~100 nm) heterostructure avalanche photodiode. In the low-gain regime the shot noise is suppressed due to temporal correlations within amplified current pulses. We demonstrate in a Monte Carlo simulation that the effective excess noise factors can be <1, and reconcile the apparent conflict between theory and experiments. This shot noise suppression mechanism is independent of known mechanisms such as Coulomb interaction, or reflection at heterojunction interfaces.Comment: Phys. Rev. Lett., accepted for publicatio