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Background: Mindfulness-based interventions such as Mindfulness-based Stress Reduction (MBSR) and Mindfulness Cognitive Behavior Therapy (MCBT) have been used to treat adults with psychiatric disorders. This article describes initial modification and development of a mindfulness-based intervention group program for adolescents with psychiatric disorders. It was hypothesized that the intervention would improve mindfulness, mental health outcomes and decrease psychological distress and symptoms. Method: Adolescents from a mental health clinic attended a 5-week group pilot mindfulness-based intervention. Adolescents and parents completed questionnaires at pre- and post-intervention and at 3-month follow-up. Baseline measures indicated moderate to severe range of mental health symptoms. Results: After the intervention, adolescents reported significant decreases in psychological distress and increases in mindfulness and self-esteem. Qualitative data revealed the intervention to be engaging and beneficial. Parents also reported significant overall improvements of adolescents’ functioning. Conclusions: These promising preliminary results suggest that the intervention was feasible, acceptable and offered positive impact on mental health problems, and the intervention warrants further research in a randomized controlled study. [ABSTRACT FROM AUTHOR]

[ABSTRACT FROM AUTHOR]

Non-suicidal self-injury (NSSI) and under-age alcohol use are dysfunctional coping behaviors used to alleviate negative feelings. However, little is known regarding what mechanisms lead to engagement in NSSI as opposed to alcohol use, or what might influence co-occurrence of these behaviors. A total of 2,590 secondary school students (aged 12-17) from five Australian states completed self-report questionnaires measuring NSSI, alcohol use and a range of sociodemographic and psychosocial factors. The findings suggest that adolescent engagement in NSSI is associated with more internal factors, such as psychological distress, poor coping and problem-solving skills, whereas alcohol use is associated with age and gender, as well as more external factors, such as social support and coping by turning to others. Co-morbidity between alcohol use and NSSI is associated with a combination of these factors. Implications of these findings will be discussed with regard to prevention and early intervention initiatives. [ABSTRACT FROM AUTHOR]

The author discusses the need for active help-seeking behavior to ensure mental health for people with illnesses. He states that alcoholics are less likely to answer research questionnaires as compared to people with mental depression or anxiety disorders. The author notes that some physicians treat self-inflicted injuries of patients without anesthesia to assert some sort of penalty to them to discourage the repetition of such actions.

Sensory ecology investigates the information that underlies an animal's interactions with its environment. A sensory ecology approach provides a framework in which to investigate a wide range of topics in ornithology. This review provides a range of examples of this approach. Discussed are some of the more general principles which apply with respect to the ways in which information from different sensory systems may complement each other, or information is traded-off within a sensory modality in the achievement of particular tasks. The emphasis is upon the task of foraging, but other behaviours, such as locomotion and predator detection, are also addressed. Examples discussed consider: (1) the perceptual challenges of nocturnal activity and how they are differently solved by information from different sensory system in owls, kiwi, oilbirds and penguins; (2) the use of tactile information in foraging and how this interacts with visual information in probing birds, and in skimmers; and (3) the visual information used to guide stealth foraging in herons, and how vision is influenced by the filter feeding techniques of ducks and flamingos. In addition, two case studies are discussed. These explore: (a) the restrictions on the information available to guide foraging in turbid waters by cormorants, and (b) the application of a sensory ecology approach to understanding why birds collide with artefacts, such as power lines and wind turbines, which intrude into the open airspace. Among the general conclusions discussed are: (1) the idea that all sensory systems are selective within their own modality and that the range of information that is available to a particular species have been tuned to particular perceptual challenges through natural selection; it is also argued that this tuning can take place at the individual species level such that there may be key differences in sensory information even among birds in the same genus; (2) sensory systems detect only a small part of the total information that is available in the environment; no species has available to it all the information that is potentially available in its environment; in essence, all species share the same planet but live in different worlds that are dictated by the information that their sensory systems extract from the environment; (3) there may be complex and subtle trade-offs between different types of sensory information; and (4) the overall conclusion is that the world through birds' eyes is quite different from the world as seen through human eyes but there are many different 'bird eye views'. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Although child maltreatment is associated with later non-suicidal self-injury (NSSI), the mechanism through which it might lead to NSSI is not well understood. The current retrospective case–control study examined associations between child maltreatment and later NSSI, and investigated the mediating roles of dissociation, alexithymia, and self-blame. Methods: Participants were 11,423 Australian adults (response rate 38.5%), randomly selected from the Australian Electronic White Pages, aged between 18 and 100 (M =52.11, SD =16.89), 62.2% female. Data were collected via telephone interviewing. Main outcome measures were reported history of child maltreatment (sexual abuse, physical abuse, neglect) and reported 12-month NSSI. Dissociation, alexithymia, and self-blame were examined as potential mediating variables in the relationship between child maltreatment and later NSSI. All analyses were conducted using logistic regression and adjusted for age and psychiatric diagnosis. Results: Results differed by gender. Compared to no child maltreatment, physical abuse (OR 2.75, 95% CI 1.68–4.51) and neglect (OR 2.56, 95% CI 1.65–3.99) independently increased the odds of NSSI among females. Physical abuse (OR 2.69, 95% CI 1.44–5.03) increased the odds of NSSI among males. Sexual abuse did not independently increase the odds of NSSI for males or females. For females, self-blame had the greatest effect on the child maltreatment–NSSI relationship (OR decreased by 14.6%, p <.000), although dissociation and alexithymia also partially mediated the relationship. For males, dissociation had the greatest effect (OR decreased by 12.9%, p =.003) with self-blame also having a relatively strong effect. Conclusions: The results indicate that child maltreatment, and in particular, physical abuse, is strongly associated with the development of subsequent NSSI and may be partially mediated by dissociation, alexithymia, and self-blame for females and dissociation and self-blame for males. Altering attributional style (through cognitive therapy or emotion focussed therapy) and improving the capacity to regulate emotions (through dialectical behaviour therapy) may contribute to reduction or cessation of NSSI. [Copyright &y& Elsevier]

Participatory forums, in which lay citizens or users of public services contribute to the governance of public services, have proliferated in recent years. In debates about the quality and influence of such processes, there has been increasing recognition of the importance of emotional as well as rational deliberation, and criticism of the way in which the structures imposed on such forums can exclude certain participants and discourses. This paper presents a study of one such forum, convened by an independent organization to influence the development and management of state services, and governed by self-determined norms of participation and conduct. It highlights both the potential of such public deliberations beyond the state to generate novel outputs that influence public-service provision, but also the way in which such forums, and their lack of imposed rules and norms of deliberation, can themselves work to exclude certain participants and discourses. [ABSTRACT FROM AUTHOR]

Self-injury represents a common yet perplexing set of behaviors, considered difficult to treat. The current study aimed to identify social and personal resources that may aid in cessation of self-injury. A community sample of 312 participants completed an online questionnaire. In line with Brown and Williams (2007), we compared all self-injurers (current and past) (106, 34%) with those who had never self-injured (206, 66%), and then current (38, 12.2%) with past self-injurers (68, 21.8%). Overall, self-injurers reported significantly lower levels of perceived social support, social connectedness, resilience, self-esteem, and life satisfaction compared to those with no such history. Further analysis indicated that family support, self-esteem, resilience, and satisfaction with life were significantly better for past compared to current self-injurers (at the p < 0.01 level). Logistic regression suggested that self-injurers could be distinguished from non self-injurers on Self-esteem and Social Connectedness. A further logistic regression suggested that past self-injurers could be distinguished from current self-injurers by their level of Resilience. The research has important preventive and clinical implications. [ABSTRACT FROM PUBLISHER]

Abstract: This paper considers the rise of ‘leadership’ in discourses relating to the British health service, and the application of the term to increasingly heterogeneous actors. Analysing interviews with NHS chief executives from the late 1990s, and key policy documents published since, we highlight how leadership has become a term of choice among policymakers, with positive cultural valences which previously predominant terms such as ‘management’ now lack. We note in particular how leadership is increasingly conferred not only on those in positions of formal power but on frontline clinicians, patients and even the public, and how not just the implementation but the design of policy is now constructed as being led by these groups. Such constructions of the distribution of power in the health service, however, contradict the picture drawn by academic work. We suggest, therefore, that part of the purpose of leadership discourse is to align the subjectivities of health-service stakeholders with policy intentions, making their implementation not just everyone’s responsibility, but part of everyone’s sense of self. Given the realities of organizational life for many of the subjects of leadership discourse, however, the extent to which leadership retains its current positive associations and ubiquity remains to be seen. [Copyright &y& Elsevier]

The author discusses the significance of publishing journals online to meet the readers needs who are passionate to know about advancing mental health. He cites that rapid turnaround time means that articles can be read, commented on by the journal's readers, and amended much more quickly than can be done with print. Moreover, he mentions the advantages of electronic journals.

Objectives: There have been calls for greater exchange between research and practice in health care policy and management, but little empirical research on what commissioners of research and researchers themselves consider appropriate, good quality research knowledge. This paper addresses this gap, considering the views of commissioners and producers of policy and management research in health care and other fields. Methods: Qualitative semi-structured interviews with 18 commissioners and producers of research, in central government, the NHS and other commissioning organizations, and in universities and independent sector providers. Results: Commissioners and producers agreed that research often fails to fulfil policy-makers' and managers' needs, and that greater interaction is required to improve this relationship. However, they offered differing accounts of the nature of research knowledge (as a 'product' or a 'mindset'), and of what constitutes value, validity and originality in research, reflecting the differing priorities and pressures faced by the two groups. Conclusions: Efforts to promote greater interaction between research, policy and practice, and more critical, reflexive engagement between policy-makers, managers and researchers, are likely to face significant obstacles given these competing constructions of research knowledge and their reinforcement by divergent priorities. [ABSTRACT FROM AUTHOR]

Masked boobies Sula dactylatra, like many other species of Sulidae, do not construct elaborate nests. However, their nest sites produce a characteristic 'nest signature'.We found that these nest signatures could apparently be seen in freely available satellite images (Google Earth™) of the main island of Ascension in the south Atlantic. We verified that this was the case by comparing nest signatures detected on these satellite images with field reports of occupied nests. We found that the locations of these nest signatures determined from satellite images agreed closely with the coordinates of actual nests on the ground. We used this information to determine the position and size of a previously unreported masked booby colony on the island. Thus, we show that the presence and abundance of some species can be estimated using freely available satellite imagery if a suitable signature in the satellite image can be found. Regularly updated satellite imagery of target sites could also be used for population monitoring. While this would be expensive, initial evaluation of the technique for particular species or populations can be achieved using freely available images. We encourage wildlife managers to view their study sites on Google Earth™ for evidence of their target species. [ABSTRACT FROM AUTHOR]

Background: There is a growing recognition of the importance of introducing new ways of working into the UK's National Health Service (NHS) and other health systems, in order to ensure that patient care is provided as effectively and efficiently as possible. Researchers have examined the challenges of introducing new ways of working-'organisational innovations'-into complex organisations such as the NHS, and this has given rise to a much better understanding of how this takes place-and why seemingly good ideas do not always result in changes in practice. However, there has been less research on the medium- and longer-term outcomes for organisational innovations and on the question of how new ways of working, introduced by frontline clinicians and managers, are sustained and become established in day-to-day practice. Clearly, this question of sustainability is crucial if the gains in patient care that derive from organisational innovations are to be maintained, rather than lost to what the NHS Institute has called the 'improvement-evaporation effect'. Methods: The study will involve research in four case-study sites around England, each of which was successful in sustaining its new model of service provision beyond an initial period of pilot funding for new genetics services provided by the Department of Health. Building on findings relating to the introduction and sustainability of these services already gained from an earlier study, the research will use qualitative methods-in-depth interviews, observation of key meetings, and analysis of relevant documents-to understand the longer-term challenges involved in each case and how these were surmounted. The research will provide lessons for those seeking to sustain their own organisational innovations in wide-ranging clinical areas and for those designing the systems and organisations that make up the NHS, to make them more receptive contexts for the sustainment of innovation. Discussion: Through comparison and contrast across four sites, each involving different organisational innovations, different forms of leadership, and different organisational contexts to contend with, the findings of the study will have wide relevance. The research will produce outputs that are useful for managers and clinicians responsible for organisational innovation, policy makers and senior managers, and academics. [ABSTRACT FROM AUTHOR]

Background: Collecting population data on sensitive issues such as non-suicidal self-injury (NSSI) is problematic. Case note audits or hospital/clinic based presentations only record severe cases and do not distinguish between suicidal and non-suicidal intent. Community surveys have largely been limited to school and university students, resulting in little much needed population-based data on NSSI. Collecting these data via a large scale population survey presents challenges to survey methodologists. This paper addresses the methodological issues associated with collecting this type of data via CATI. Methods: An Australia-wide population survey was funded by the Australian Government to determine prevalence estimates of NSSI and associations, predictors, relationships to suicide attempts and suicide ideation, and outcomes. Computer assisted telephone interviewing (CATI) on a random sample of the Australian population aged 10+ years of age from randomly selected households, was undertaken. Results: Overall, from 31,216 eligible households, 12,006 interviews were undertaken (response rate 38.5%). The 4-week prevalence of NSSI was 1.1% (95% ci 0.9-1.3%) and lifetime prevalence was 8.1% (95% ci 7.6-8.6). Methodological concerns and challenges in regard to collection of these data included extensive interviewer training and post interview counselling. Ethical considerations, especially with children as young as 10 years of age being asked sensitive questions, were addressed prior to data collection. The solution required a large amount of information to be sent to each selected household prior to the telephone interview which contributed to a lower than expected response rate. Non-coverage error caused by the population of interest being highly mobile, homeless or institutionalised was also a suspected issue in this low prevalence condition. In many circumstances the numbers missing from the sampling frame are small enough to not cause worry, especially when compared with the population as a whole, but within the population of interest to us, we believe that the most likely direction of bias is towards an underestimation of our prevalence estimates. Conclusion: Collecting valid and reliable data is a paramount concern of health researchers and survey research methodologists. The challenge is to design cost-effective studies especially those associated with low-prevalence issues, and to balance time and convenience against validity, reliability, sampling, coverage, non-response and measurement error issues. [ABSTRACT FROM AUTHOR]

For people who self-injure, the internet can provide an anonymous environment where users feel safe to divulge feelings and experiences which are not usually socially sanctioned. However, internet users can encourage each other to engage in self-destructive behaviour. This qualitative study aimed to simulate a typical search an adolescent might perform if he/she was looking for support and information about self-injury. The aim was to determine whether the resulting content was helpful or harmful. Seven queries - 'cutting', 'self injury', 'self-injury', 'self harm', 'self-harm', 'self-mutilation', and 'self mutilation' - were entered into www.google.com and each link from the first webpage from each search was opened and judged for relevancy. Thirty-nine links were analysed and grouped into five categories: websites (n=5); webpages (n=11); book results (n=8); news results (n=11); and other (n=4). Examination of the quality and content of the links obtained from our search showed mainly recovery oriented, supportive information about self-injury. Despite this positive outcome, more specific searches such as 'pro-self-injury' would likely result in less encouraging results. Mental health professionals should be aware that their self-injuring clients have probably used the internet for support and information, and consider how this use might impact on therapy. Mental health professionals could use the results of this study to recommend quality internet sites to their clients. [ABSTRACT FROM AUTHOR]

The author reflects on the aspects of the emergence of self-injury in Australia. He notes the need to consider a wide range of self-injury committed by adolescents to help in promoting treatment programs that will control their emotions and prevent them from injuring themselves. He also points out various studies carried out by researchers to learn insights which factors motivate these young individuals to commit self-injuries, along with exploring the best available therapies for self-injury.

Objectives: To compare embryo survival, pregnancy and implantation rates after cryopreservation of human cleavage-stage embryos with slow-rate cryopreservation or vitrification. Study design: 262 patients, attending for assisted reproduction, were prepared for oocyte retrieval using standard controlled ovarian hyperstimulation protocols. Excess embryos were cryopreserved on day 3 either by vitrification, or slow-rate cryopreservation in a programmable freezer. Cycles of thawing were monitored for thaw efficiency, pregnancy and implantation rates. Results: Clinical pregnancy and implantation rates were highly comparable between cycles in which day 3 embryos were thawed either after slow-rate cryopreservation or vitrification. Conclusions: These data suggest that vitrification of human embryos during assisted reproduction cycles achieves comparable success rates to fresh cycles and therefore can be applied in the laboratory of assisted reproduction. [ABSTRACT FROM AUTHOR]

A general purpose block-to-block affine transformation estimator is described. The estimator is based on Fourier slice analysis and Fourier spectral alignment. It shows encouraging performance in terms of both speed and accuracy compared to existing methods. The key elements of its success are attributed to the ability to: 1) locate an arbitrary number of affine invariant points in the spectrum that latch onto significant structural features; 2) match the estimated invariant points with the target spectrum by the slicewise phase-correlation; and 3) use affine invariant points to directly compute all linear parameters of the full affine transform by spectral alignment. Experimental results using a wide range of textures are presented. Potential applications include affine invariant image segmentation, registration, affine symmetric image coding, and motion analysis. [ABSTRACT FROM AUTHOR]

The author reflects on the government's response to the increased suicide rates of students due to bullying in school in Australia. He discusses the task assigned by the government to create a suicide awareness program for the Australian Defense Force Cadets (ADFC). The author believes that a mental health promotion program will reduce suicide risk and will directly solve the issue. He also relates the topic to various research studies.

Natural images contain considerable redundancy, some of which is successfully captured using recently developed directional wavelets. In this paper, an affine symmetric image model is considered. It provides a flexible scheme to exploit geometric redundancy. A patch of texture from an image is rotated, scaled and sheared to approximate other similar parts in the image, revealing the self-similarity relation. The general scheme is derived as follows. A texture model is required that identifies structural patterns. Then the affine symmetry is exploited between structural textures at a local level, the objective being to find the minimum residual error by estimating the affine transform relating two patches of texture. Having developed a local model, the methodology is extended to the whole image to estimate the global affine relation. This global model is further developed in a multiresolution framework for multiscale analysis, by which the self similarity of the image is exploited across space and scale. The multiresolution model can be applied to a series of practical problems. Experimental evaluation demonstrates the effectiveness of the approach in affine invariant texture segmentation and image approximation. [ABSTRACT FROM AUTHOR]

The author reflects on how to reduce a number of suicide incidents in young people in Australia. He raises several issues such as the role about best practice in crisis work, clinical management, and prevention strategies to limit the possibility of suicidal behaviour. He urges a consistent change in providing mental health services in the country.

Population attributable risk (PAR) estimates have been used in suicide research to evaluate the impact of psychosocial and socioeconomic risk factors, including affective disorders, traumatic life events, and unemployment. A parallel concept of preventive fraction (PF), allowing for estimation of the impact of protective factors and effectiveness of preventive interventions, is practically unknown in suicidology. The study authors discuss the application of both concepts to suicide research and prevention, and review literature on the subject. Despite several methodological and conceptual limitations, both PAR and PF are valuable instruments to inform development and evaluation of suicide prevention programs. [ABSTRACT FROM AUTHOR]

Objectives: Developments in genetic knowledge and clinical applications are seen as rendering traditional modes of organizing genetics provision increasingly inappropriate. In common with a number of developed world countries the UK has sought to increase the role of primary care in delivering such services. However, efforts to reconfigure service delivery face multiple challenges associated with divergent policy objectives, organizational boundaries and professional cultures. This paper presents findings from an evaluation of an English initiative to integrate genetics into 'mainstream' clinical provision in the National Health Service. Methods: Qualitative research in 11 case-study sites focusing on attempts by pilots funded by the initiative to embed knowledge and provision within primary care illustrating barriers faced and the ways in which these were surmounted. Results: Lack of intrinsic interest in clinical genetics among primary care staff was compounded by national targets that focused their attention elsewhere and by service structures that rendered genetics a peripheral concern demanding minimal engagement. Established divisions between the commissioning of mainstream and specialist services, along with the pressures of shorter-term targets, impeded ongoing funding. Conclusions: More wide-ranging policy and organizational support is required if the aim of entrenching genetics knowledge and practice across the Health Service is to be realized. [ABSTRACT FROM AUTHOR]

The article focuses on a randomized study which determines the rapid response outpatient treatment and the group therapy intervention in relation to the number of self-harm among adolescents in Australia. Participants in the study are composed of young adolescents of 12-16 year olds who have referred to a child and adolescent mental health service and reported to have at least two episodes of self-harm. Methods of the study include randomized personal interviews and assessment of suicidal behavior. The study asserts that there is a tendency for those adolescents who extended a randomized experimental treatment to show greater improvement than the controlled group.

Objective: Community surveys have shown that many otherwise well individuals report delusional-like experiences. The authors examined psychopathology during childhood and adolescence as a predictor of delusional-like experiences in young adulthood. Method: The authors analyzed prospective data from the Mater-University of Queensland Study of Pregnancy, a birth cohort of 3,617 young adults born between 1981 and 1983. Psychopathology was measured at ages 5 and 14 using the Child Behavior Checklist (CBCL) and at age 14 using the Youth Self-Report (YSR). Delusional-like experiences were measured at age 21 using the Peters Delusional Inventory. The association between childhood and adolescent symptoms and later delusional-like experiences was examined using logistic regression. Results: High CBCL scores at ages 5 and 14 predicted high levels of delusional-like experiences at age 21 (odds ratios for the highest versus the other quartiles combined were 1.25 and 1.85, respectively). Those with YSR scores in the highest quartile at age 14 were nearly four times as likely to have high levels of delusional-like experiences at age 21 (odds ratio=3.71). Adolescent-onset psychopathology and continuous psychopathology through both childhood and adolescence strongly predicted delusional-like experiences at age 21. Hallucinations at age 14 were significantly associated with delusional-like experiences at age 21. The general pattern of associations persisted when adjusted for previous drug use or the presence of nonaffective psychoses at age 21. Conclusion: Psychopathology during childhood and adolescence predicts adult delusional-like experiences. Understanding the biological and psychosocial factors that influence this developmental trajectory may provide clues to the .pathogenesis of psychotic-like experiences. [ABSTRACT FROM AUTHOR]

Efforts to ‘modernize’ the clinical workforce of the English National Health Service have sought to reconfigure the responsibilities of professional groups in pursuit of more effective, joined-up service provision. Such efforts have met resistance from professions eager to protect their jurisdictions, deploying legitimacy claims familiar from the insights of the sociology of professions. Yet to date few studies of professional boundaries have grounded these insights in the specific context of policy challenges to the inter- and intra-professional division of labour, in relation to the medical profession and other health-related occupations. In this paper we address this gap by considering the experience of newly instituted general practitioners with a special interest (GPSIs) in genetics, introduced to improve genetics knowledge and practice in primary care. Using qualitative data from four comparative case studies, we discuss how an established intra-professional division of labour within medicine—between clinical geneticists and general practitioners—was opened, negotiated and reclosed in these sites. We discuss the contrasting attitudes towards the nature of genetics knowledge and its application of GPSIs and geneticists, and how these were used to advance conflicting visions of what the nascent GPSI role should involve. In particular, we show how the claims to knowledge of geneticists and GPSIs interacted with wider policy pressures to produce a rather more conservative redistribution of power and responsibility across the intra-professional boundary than the rhetoric of modernization might suggest. [Copyright &y& Elsevier]

Recent health policy in England has demanded greater involvement of patients and the public in the commissioning of health and social care services. Public involvement is seen as a means of driving up service quality, reducing health inequalities and achieving value in commissioning decisions. This paper presents a summary and analysis of the forms that public involvement in commissioning are to take, along with empirical analysis from a qualitative study of service-user involvement. It is argued that the diversity of constituencies covered by the notion of 'public involvement', and the breadth of aims that public involvement is expected to achieve, require careful disaggregation. Public involvement in commissioning may encompass a variety of interest groups, whose inputs may include population needs assessment, evaluation of service quality, advocacy of the interests of a particular patient group or service, or a combination of all of these. Each of these roles may be legitimate, but there are significant tensions between them. The extent to which the structures for public involvement proposed recognize these possible tensions is arguably limited. Notably, new Local Involvement Networks (LINks), which will feed into commissioning decisions, are set as the arbiters of these different interests, a demanding role which will require considerable skill, tenacity and robustness if it is to be fulfilled effectively. [ABSTRACT FROM AUTHOR]

Introduction Joseph Heller’s Catch-22 is regularly invoked to critique the irrationality inherent in supposedly rational bureaucracy. We explore a Catch-22 for policy concerning public involvement in English health care: you have to be ordinary to represent the community effectively, but, if you are ordinary, you cannot effectively represent your community. The nature of public participation groups Starting with community health councils, we trace government policy about involving local people in health care, up to the current arrangements for local involvement networks and show how the above Catch-22 works. We do this in two principal ways. First, by an analysis of some of the unrecognized paradoxes in current government policies designed to populate health-care participation groups and second, by providing a series of narrative vignettes, drawn from our own experiences of working in such groups, which illustrate the nature of the dilemmas members face. Conclusions Our proposal to get out of the worst of the Catch-22 for effective public involvement groups is (paradoxically) to suggest focusing less on effectiveness, or more precisely, focusing less on those conventional, managerially defined notions of effectiveness that are now pretty much taken for granted within public services. This is because, if bodies like LINks are to do more than provide unthreatening, homogenous and tokenistic public perspectives, they need to be given space and time to pursue their own agendas. [ABSTRACT FROM AUTHOR]

Abstract: There is an emerging interest in children and adolescents who have hallucinations and other psychotic-like experiences to enable identification of those potentially at risk for schizophrenia in adulthood. This study examines the prevalence, demographic and clinical correlates of hallucinations in the adolescent subgroup of the Australian National Survey of Mental Health and Well-Being. Participants were a nationally representative sample of 1261 adolescents aged 13–17 years. Adolescents completed self-report questionnaires with two questions relating to hallucinations and questions pertaining to depressive symptoms and cannabis use. Parents completed the Child Behavior Checklist (CBCL) and the Diagnostic Interview Schedule for Children (DISC-IV). Hallucinations were reported by 8.4% of adolescents. Those living in blended or sole parent families were more likely to report hallucinations than those living with both biological parents (OR 3.27; 95% CI 1.93, 5.54; OR 2.60; 95% CI 1.63, 4.13 respectively). Hallucinations were more prevalent in adolescents who scored in the highest decile of the CBCL or had elevated depression symptoms (OR 3.30; 95% CI 2.10, 5.20; OR 5.02; 95% CI 3.38, 7.45 respectively). Hallucinations were associated with depressive disorder (OR 2.70; 95% CI 1.16, 6.28) and were more prevalent in those adolescents who had smoked cannabis more than twice in the month prior to the survey (OR 3.27; 95% CI 1.76, 6.08). Hallucinations occur relatively frequently in adolescents and are associated with a range of demographic and clinical correlates. Further research may assist in understanding the variable trajectory of children and adolescents who hallucinate. [Copyright &y& Elsevier]

In the UK, new intermediate care services have been established to prevent unnecessary hospital admissions, facilitate effective discharge and prevent premature care home admissions. This paper reports findings from a national evaluation of intermediate care, focusing on the relationship between hospital services and intermediate care. Participants included key managers and practitioners involved in the planning, management and delivery of intermediate care in five case study sites. During the study, they identified a range of tensions between hospital services and intermediate care, including concerns about the role and involvement of acute clinicians; the safety, quality and appropriateness of intermediate care; access to and eligibility for intermediate care; a lack of understanding and awareness of intermediate care; and the risk of intermediate care being dominated by acute pressures. Although participants were able to identify several practical ways forward, resolving such fundamental tensions seems to require significant and long-term cultural change in the relationship between acute and intermediate care. Overall, this study raises questions about the extent to which intermediate care will be able to rebalance the current health and social care system and make a substantial contribution to tackling ongoing concerns about emergency hospital admissions and delayed transfers of care. [ABSTRACT FROM AUTHOR]

Public participation in health-service management is an increasingly prominent policy internationally. Frequently, though, academic studies have found it marginalized by health professionals who, keen to retain control over decision-making, undermine the legitimacy of involved members of the public, in particular by questioning their representativeness. This paper examines this negotiation of representative legitimacy between staff and involved users by drawing on a qualitative study of service-user involvement in pilot cancer-genetics services recently introduced in England, using interviews, participant observation and documentary analysis. In contrast to the findings of much of the literature, health professionals identified some degree of representative legitimacy in the contributions made by users. However, the ways in which staff and users constructed representativeness diverged significantly. Where staff valued the identities of users as biomedical and lay subjects, users themselves described the legitimacy of their contribution in more expansive terms of knowledge and citizenship. My analysis seeks to show how disputes over representativeness relate not just to a struggle for power according to contrasting group interests, but also to a substantive divergence in understanding of the nature of representativeness in the context of state-orchestrated efforts to increase public participation. This divergence might suggest problems with the enactment of such aspirations in practice; alternatively, however, contestation of representative legitimacy might be understood as reflecting ambiguities in policy-level objectives for participation, which secure implementation by accommodating the divergent constructions of those charged with putting initiatives into practice. [Copyright &y& Elsevier]

The authors explore the views of practitioners and managers on the implementation of intermediate care for elderly people across England, including their perceptions of the challenges involved in its implementation, and their assessment of the main benefits and weaknesses of provision. Qualitative data were collected in five case study sites (English primary care trusts) via semistructured interviews ( n = 61) and focus group discussions ( n = 21) during 2003 to 2004. Interviewees included senior managers, intermediate care service managers, clinicians and health and social care staff involved in the delivery of intermediate care. The data were analysed thematically using an approach based on the ‘framework’ method. Workforce and funding shortages, poor joint working between health and social care agencies and lack of support/involvement on the part of the medical profession were identified as the main challenges to developing intermediate care. The perceived benefits of intermediate care for service-users included flexibility, patient centredness and the promotion of independence. The ‘home-like’ environment in which services were delivered was contrasted favourably with hospitals. Multidisciplinary teamworking and opportunities for role flexibility were identified as key benefits by staff. Insufficient capacity, problems of access and awareness at the interface between intermediate care and ‘mainstream’ services combined with poor co-ordination between intermediate care services emerged as the main weaknesses in current provision. Despite reported benefits for service-users and staff, the study indicates that intermediate care does not appear to be achieving its full potential for alleviating pressure within health and social care systems. The strengthening of capacity and workforce, improvements to whole systems working and the promotion of intermediate care among doctors and other referrers were identified as key future priorities. [ABSTRACT FROM AUTHOR]

Healthcare organisations' responses to concerns and complaints often fall short of the expectations of patients and staff who raise them, and substandard responses to concerns and complaints have been implicated in organisational failures. Informed by Habermas's systems theory, we offer new insights into the features of organisations' responses to concerns and complaints that give rise to these problems. We draw on a large qualitative dataset, comprising 88 predominantly narrative interviews with people raising and responding to concerns and complaints in six English NHS organisations. In common with past studies, many participants described frustrations with systems and processes that seemed ill-equipped to deal with concerns of the kinds they raised. Departing from existing analyses, we identify the influence of functional rationality, as conceptualised by Habermas, and embodied in procedures, pathways and scripts for response, in producing this dissatisfaction. Functionally rational processes were well equipped to deal with simple, readily categorised concerns and complaints. They were less well placed to respond adequately to concerns and complaints that were complex, cross-cutting, or irreducible to predetermined criteria for redress and resolution. Drawing on empirical examples and on Habermas's theory of communicative action, we offer suggestions for alternative and supplementary approaches to responding to concerns and complaints that might better address both the expectations of complainants and the improvement of services. • Processes for addressing concerns and complaints often frustrate those who raise them. • We use Habermas's systems theory to identify the reasons why and how to address them. • Processes tend to be well formed to deal with simpler, easily categorised concerns. • They are often ill-suited to respond to complex, multifaceted or cross-cutting concerns. • Communicative rationality offers useful principles for improving these processes. [ABSTRACT FROM AUTHOR]

The clinical identification of frailty is increasingly thought to be important in countries with ageing populations. Understanding how older people labelled as frail make sense of this categorisation is therefore important. A number of recent studies have reported negative perceptions of the term among older people themselves. Building on this, we focus on how and why those assessed to be frail make sense of frailty as they do. We draw on 26a discourse analysis of situated interviews with 30 older people accessing emergency care in an English NHS hospital. Three interpretive repertoire pairs (Frailty is 26a bodily issue/frailty is about mind-set; Frailty is 26a negative experience/frailty is an inevitable experience; I'm not frail/I feel frail), identified across the participants' talk, are outlined and discussed in relation to discourses of the fourth age and precarity. We conclude that frailty is often seen in terms what others have referred to as 'real' old age and is linked to discourses of dependence and precarity. • Older people determined to be clinically frail often resist the term frailty. • Older people determined to be clinically frail in this study drew on three interpretive repertoire pairs to make sense of the term and experience 'frailty' • The shared narrative of the fourth age as 'real' old age is associated with a precarious and unwanted identity. [ABSTRACT FROM AUTHOR]

Heritage professionals are keen to see analytical science applied in support of the long-term preservation and access of our heritage. While textiles and other organic artefacts can be characterised by laboratory-based, non-destructive microanalytical techniques, rapid analytical methodology which is non-invasive, requires no sampling and can be performed on-site conveys particular advantages. Here we present an overview of our recent studies which have been directed at developing near infrared (NIR) spectroscopy as such a non-invasive collections management tool to assist textile curators and conservators. We review some of our earlier studies on FTIR and Raman spectroscopy, which were the prelude to our recent venture, before recounting our experiences with the NIR technique in the textile heritage context. It is our contention that a NIR spectrometer will become an essential part of the conservation scientist’s tool-kit for interrogating textiles directly, enabling the identification of modern fabrics that inform decisions on storage and display, and the non-inteventive, routine condition assessment of aged textiles such as historic silks, informing the collections management strategy. [ABSTRACT FROM AUTHOR]

Great cormorants Phalacrocorax carbo are foot propelled diving birds that seem poorly suited to locomotion on land. They have relatively short legs, which are presumably adapted for the generation of high forces during the power stroke of aquatic locomotion, and walk with a pronounced “clumsy waddle”. We hypothesise (1) that the speed, independent minimum cost of locomotion ( C min, ml O2 m−1) will be high for cormorants during treadmill exercise, and (2) that cormorants will have a relatively limited speed range in comparison to more cursorial birds. We measured the rate of oxygen consumption $$ (\dot{V}_{{\rm O}_{2}}) $$ of cormorants during pedestrian locomotion on a treadmill, and filmed them to determine duty factor (the fraction of stride period that the foot is in contact with the ground), foot contact time ( t c), stride frequency ( f), swing phase duration and stride length. C min was 2.1-fold higher than that predicted by their body mass and phylogenetic position, but was not significantly different from the C min of runners (Galliformes and Struthioniformes). The extrapolated y-intercept of the relationship between $$ \dot{V}_{{\rm O}_{2}} $$ and speed was 1.9-fold higher than that predicted by allometry. Again, cormorants were not significantly different from runners. Contrary to our hypothesis, we therefore conclude that cormorants do not have high pedestrian transport costs. Cormorants were observed to use a grounded gait with two double support phases at all speeds measured, and showed an apparent gait transition between 0.17 and 0.25 m s−1. This transition occurs at a Froude number between 0.016 and 0.037, which is lower than the value of ~0.5 observed for many other species. However, despite the use of a limited speed range, and a gait transition at relatively low speed, we conclude that the pedestrian locomotion of these foot propelled diving birds is otherwise generally similar to that of cursorial birds at comparable relative velocities. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Microskin™ is a sprayed on, computer color-matched, skin camouflage which can last for up to 5 days after application. It binds to the epidermis and the patient can sweat and swim with it on. The purpose of the current study was to determine whether Microskin™ produces psychosocial benefit in pediatric burns patients. Procedure: Twenty children with mature burn scars took part in the study and used Microskin™ for 5 weeks. Initially, 10 children were randomized to a treatment group while the remaining 10 became a wait-list group for 7 weeks. The wait-list group subsequently received Microskin™ for 5 weeks. Before and after using Microskin™, children completed three psychosocial measures; the Strengths and Difficulties Questionnaire (SDQ), the Family Assessment Device—General Functioning scale (FAD-GF), and the Microskin™ Questionnaire (MQ—a questionnaire about their experience using Microskin™ developed specifically for this study). All children were followed up with the same measures 6 months after their completed use of Microskin™. Results: After the 5-week Microskin™ trial there was improvement on all scales of the SDQ for the 10 children in the first treatment group but not for the wait-list group. After the wait-list group used Microskin™ for 5 weeks they too improved on all scales. Combining the results for all 20 children from before to after using Microskin™ there was a statistically significant improvement in the SDQ Emotional Symptoms and Total Difficulties. There was also improved perception of family functioning after using Microskin™. Six-month follow-up data showed continued psychosocial improvement. Overall, children felt more confident, happier, and enjoyed social outings more when they had Microskin™ on, with 95% intending to continue to use Microskin™. Conclusions: Microskin™ improves psychosocial functioning in pediatric burn patients and is well-tolerated and acceptable. The small sample size precludes sophisticated statistical analyses and generalization of results. There is a need for a full scale randomized controlled study of Microskin™ with a larger sample size. [Copyright &y& Elsevier]

Objective: The aim of this study was to develop and pilot an instrument for the assessment of self-injury in adolescent inpatients. Methods: The Self-Injury Motivation Scale was modified for use in adolescents. Thirty-eight consenting adolescent inpatients with a history of self-injury completed the Self-Injury Motivation Scale - Adolescent version (SIMS-A) and the Self-Injury Interview (SII) to collect information about a range of factors associated with self-injury, other clinical variables and demographic details. Results: The SIMS-A was acceptable to this adolescent sample and motivations for self-injury were similar to those of adults using the original SIMS scale. Adolescents were, however, more likely to use self-injury for communicating to/influencing others compared to adults. The participants most frequently reported self-injury by hitting, cutting and burning. The clinical diagnosis most frequently associated with self-injury was major depression. Females reported earlier onset, higher frequency and multiple methods of self-injury compared to males. Distraction from emotional pain was the most common motivation for self-injury in both males and females. Conclusions: This pilot study suggests the SIMS-A is a useful self-report measure to assist clinicians and adolescent patients to understand a behaviour that may be associated with shame, guilt or other difficult emotions for the adolescent. Results also support the contention that there are often multiple and conflicting motivations for self-injury. Self-injury in this population was more common and severe in female adolescents compared to males, while clinical depression was a risk factor for self-injury in both males and females. The small sample size of adolescent inpatients is an important limitation of this pilot study, and research using the SIMS-A in larger samples is warranted. [ABSTRACT FROM AUTHOR]

The inner experience of spiritual and religious feelings is an integral part of the everyday lives of many individuals. For over 100 years the role of religion as a deterrent to suicidal behavior has been studied in various disciplines. We attempt to systematize the existing literature investigating the relationship between religion/spirituality and suicide in this paper. After an overview of the attitudes of the dominant religions (e.g., Catholicism, Islam, and Buddhism) toward suicide, the three main theories that have speculated regarding the link between religion and suicide are presented: "integration theory" (Durkheim, 1897/1997), "religious commitment theory" (Stack, 1983a; Stark, 1983), and "network: theory" (Pescosolido & Georgianna, 1989). Subsequent to this theoretical introduction, we report on studies on religion/spirituality keeping the suicidal path as a reference: from suicidal ideation to nonlethal suicidal behavior to lethal suicidal behavior. Studies presenting indications of religious beliefs as a possible risk factor for suicidal behavior are also presented. The last section reviews possible intervention strategies for suicidal patients and suicide survivors. Indications for future research, such as more studies on nonreligious forms of spirituality and the use of qualitative methodology to achieve a better and deeper understanding of the spiritual dimension of suicidal behavior and treatment, are offered. [ABSTRACT FROM AUTHOR]

Abstract: An efficient contour-based method for the coding of binary shape information is described. Conventional chain coding techniques show high coding efficiency for lossless compression, but they exploit the coherence of the contour in only a restricted manner. Higher coding efficiency can be achieved by realising the neighbourhood relation as a Markov chain, and this is exploited in a new coding scheme, the directional grid chain coding (DGCC). The method is computationally efficient and the coding process adapts to the inherent changes in the contour. Two schemes are proposed, a lossless and a quasi-lossless method. The lossless scheme achieves 32% saving in bit rate compared with the conventional differential chain code (DCC). The second, quasi-lossless technique achieves 44% bit reduction compared with the DCC and the distortions present in the reconstructed contour are hardly noticeable to the human eye. [Copyright &y& Elsevier]

A complexity reduction algorithm tailored for the H.264/AVC encoder is described. It aims to alleviate the computational burden imposed by Lagrangian rate distortion optimization in the inter-mode selection process. The proposed algorithm is described as a hierarchical structure comprising three levels. Each level targets different types of macroblocks according to the complexity of the search process. Early termination of mode selection is triggered at any of the levels to avoid a full cycle of Lagrangian examination. The algorithm is evaluated using a wide range of test sequences of different classes. The results demonstrate a reduction in encoding time of at least 40%, regardless of the class of sequence. Despite the reduction in computational complexity, picture quality is maintained at all bit rates. [ABSTRACT FROM AUTHOR]

Public involvement in healthcare is a prominent policy in countries across the economically developed world. A growing body of academic literature has focused on public participation, often presenting dichotomies between good and bad practice: between initiatives that offer empowerment and those constrained by consumerism, or between those which rely for recruitment on self-selecting members of the public, and those including a more broad-based, statistically representative group. In this paper I discuss the apparent tensions between differing rationales for participation, relating recent discussions about the nature of representation in public involvement to parallel writings about the contribution of laypeople's expertise and experience. In the academic literature, there is, I suggest, a thin line between democratic justifications for involvement, suggesting a representative role for involved publics, and technocratic ideas about the potential ‘expert’ contributions of particular subgroups of the public. Analysing recent policy documents on participation in healthcare in England, I seek moreover to show how contemporary policy transcends both categories, demanding complex roles of involved publics which invoke various qualities seen as important in governing the interface between state and society. I relate this to social-theoretical perspectives on the relationship between governmental authority and citizens in late-modern society. [ABSTRACT FROM AUTHOR]

Different scholars have expressed the same regret for the lack of research on ethnocultural differences in youth suicide behavior and the need to conduct more comparative studies, necessary to develop culturally responsive prevention and intervention strategies. The authors reviewed 82 publications on youth suicide that have considered, to different degrees, the ethnicity/culture of the population studied. Part 1 of this article explored youth suicide rates and methods (SLTB, this issue), while the present paper examines risk and precipitating factors and attitudes toward suicide in young people from a cross-cultural perspective. [ABSTRACT FROM AUTHOR]

The study of ethnocultural aspects of suicidal behaviour is, at the moment, still a neglected area. The relatively few studies available are mainly on adults; young people usually are not examined separately. The authors reviewed 82 publications on youth suicide that have addressed, to different degrees, the ethnicity/ culture of the population studied. Following a description of the main characteristics shared by these researches (e.g., predominance of studies on Blacks, Whites, and Hispanics; lack of qualitative methodology, etc.), the rates and methods of youth suicide, from a cross-cultural perspective are discussed. [ABSTRACT FROM AUTHOR]

This paper reports the results of a postal survey of intermediate care coordinators (ICCs) on the organisation and delivery of intermediate care services for older people in England, conducted between November 2003 and May 2004. Questionnaires, which covered a range of issues with a variety of quantitative, tick-box and open-ended questions, were returned by 106 respondents, representing just over 35% of primary care trusts (PCTs). The authors discuss the role of ICCs, the integration of local systems of intermediate care provision, and the form, function and model of delivery of services described by respondents. Using descriptive and statistical analysis of the responses, they highlight in particular the relationship between provision of admission avoidance and supported discharge, the availability of 24-hour care, and the locations in which care is provided, and relate their findings to the emerging evidence base for intermediate care, guidance on implementation from central government, and debate in the literature. Whilst the expansion and integration of intermediate care appear to be continuing apace, much provision seems concentrated in supported discharge services rather than acute admission avoidance, and particularly in residential forms of post-acute intermediate care. Supported discharge services tend to be found in residential settings, while admission avoidance provision tends to be non-residential in nature. Twenty-four-hour care in non-residential settings is not available in several responding PCTs. These findings raise questions about the relationship between the implementation of intermediate care, and the evidence for and aims of the policy as part of National Health Service modernisation, and the extent to which intermediate care represents a genuinely novel approach to the care and rehabilitation of older people. [ABSTRACT FROM AUTHOR]

Abstract: A growing body of literature in geography and other social sciences considers the role of place in the provision of healthcare with particular interests emerging around the role of the psychological, social and cultural aspects of place in care provision. As healthcare stretches increasingly beyond the traditional four walls of the hospital, so questions of the role of place in practices of care become ever more pertinent. In this paper, we examine the relationship between place and practice in the care and rehabilitation of older people across a range of settings, using qualitative material obtained from interviews and focus groups with nursing, care and rehabilitation staff working in hospitals, clients’ homes and other sites in England. By analysing their testimony on the characteristics of different settings, the aspects of place which facilitate or inhibit rehabilitation and the ways in which place mediates and is mediated by social interaction, we consider how various dimensions of place relate to the power-inscribed relationships between service users, informal carers and professionals as they negotiate the goals of the rehabilitation process. We seek to demonstrate how the physical, psychological and social meanings of place and the social processes engendered by the rehabilitation encounter interact to produce landscapes that are more or less therapeutic, considering in particular the structuring role of state policy and formal healthcare provision in this dynamic. [Copyright &y& Elsevier]

Abstract: Objective: To study longitudinal relationships between perception of academic performance (PAP) and alcohol, tobacco and marijuana use at age 13 and 15 years. Method: Self-report data from students in 27 schools in South Australia (n =1579) was analysed with ANCOVA and logistic regression, controlling for confounding factors (socio-demographic, parenting, depressive symptoms, anxiety, self-esteem, antisocial behaviour). Results: Persistent or increasing perception of academic ‘failure’ (self-rated failing or below average performance), compared to improving or stable perception of average (or above) performance, from age 13 to 15 years, predicts more than weekly alcohol and tobacco use at age 15 (3- to 4-fold risks), in addition to increased risks from early substance use (e.g., 12- to 15-fold for triple combinations), controlling for confounders. Increased risks for more than weekly marijuana use at age 15 are 3-fold in those with increasing perception of failure; though relationships are fully mediated by antisocial behaviour in those with persistent perceptions of failure. Conclusion: Interventions to maintain or improve academic self-esteem in early adolescence may reduce risks for accelerating substance use in mid-adolescence. [Copyright &y& Elsevier]

The article presents information on cultural and social change in the regions of Notting Hill, London. The last 15 years or so have witnessed much academic interest in the cultural aspects of contemporary shifts in the structure of urban space. Alongside accounts of the economic processes underlying such trends as gentrification and globalization which are seen as fundamental to the social and spatial restructuring of the post-Fordist city, an increasing amount of attention has been paid to the importance of the cultural in such processes. An area such as Notting Hill, so subject to the disorientating processes of gentrification and mediated representation, would seem a potentially fascinating place in which to research the place-meanings held by marginal or subordinate groups through direct qualitative research. Much has been written about the emergence of a postmodern urban landscape in which the post-industrial order of class polarization transforms the structure of urban space through associated processes, including gentrification.