A comparison of consumer-directed and agency-directed personal assistance services programmes

Purpose:?To compare a consumer-directed personal assistance services (PAS) programme with an agency-directed PAS programme.

Method:?A convenience sample was used for this cross-sectional study with one data collection point. Outcomes were compared for consumer-directed and agency-directed PAS. Hierarchical regressions were also used to determine the predictors of outcomes across PAS programmes. In-home interviews were conducted by a trained data collector from April 2000 to December 2001.

Results:?Participants in the consumer-directed programme reported more choices over PAS and satisfaction with PAS. Self-reported outcomes were primarily predicted by the following variables: service arrangement, type of provider, importance of directing PAS, health status, number of personal assistants used in past 12 months, sufficient PAS hours received, and social support.

Conclusions:?Consumer-directed PAS enhances outcomes for many persons with disabilities. Self-reported outcomes are affected by many factors that could be addressed in PAS programme development.     

Relationships between self-esteem,media influence and drive for thinness

The media is a powerful societal tool for expressing expectations about how men and women should look. As a result, over the past several years, women have shown an increase in body dissatisfaction (Cash, Morrow, Hrabosky, & Perry, 2004). The present study examined the relationships between drive for thinness, self-esteem, and media influence among men and women. Two hundred ninety-four college students completed the Texas Social Behavior Inventory (Helmreich & Stapp, 1974), Sociocultural Attitudes towards Appearance Scale-3 (Thompson, van den Berg, Roehrig, Guarda, & Hienberg, 2004), self-constructed questionnaire influence of media models, and the drive for Thinness Subscale (DT) from the Eating Disorder Inventory-3 (EDI-3; (Garner, 2004)). We expected to find an association between drive for thinness and media influence and between drive for thinness and self-esteem for both men and women. Finally, we expected that the use of media, social pressures and media internalization would be predictors of drive for thinness. We found a relationship between media influence and drive for thinness. There was also a relationship between self-esteem and drive for thinness. For both men and women, media models were the primary predictor for drive for thinness. However, for women the secondary predictor was social pressures; whereas for men the secondary predictor was internalization. Such findings show the importance of examining the impact of media sources on men and women in order to entangle gender differences.     

Factors influencing decision-making by social care and health sector professionals in cases of elder financial abuse

This study aimed to identify the factors that have the greatest influence on UK social care and health sector professionals’ certainty that an older person is being financially abused, their likelihood of intervention, and the type of action most likely to be taken. A factorial survey approach, applying a fractional factorial design, was used. Health and social care professionals (n = 152) viewed a single sample of 50 elder financial abuse case vignettes; the vignettes contained seven pieces of information (factors). Following multiple regression analysis, incremental F tests were used to compare the impact of each factor on judgements. Factors that had a significant influence on judgements of certainty that financial abuse was occurring included the older person’s mental capacity and the nature of the financial problem suspected. Mental capacity accounted for more than twice the variance in likelihood of action than the type of financial problem. Participants from social care were more likely to act and chose more actions compared to health sector participants. The results are discussed in relation to a bystander intervention model. The impact of the older person’s mental capacity on decision-making suggests the need for training to ensure action is also taken in cases where older people have full mental capacity and are being abused. Training also needs to highlight the more subtle types of financial abuse, the types that appear not to lead to certainty or action.     

Assessing the reproducibility of dynamic contrast enhanced magnetic resonance imaging in a murine model of breast cancer

Quantitative dynamic contrast enhanced magnetic resonance imaging estimates parameters related to tissue vascularity and volume fractions; additionally, semiquantitative parameters such as the initial area under the curve can be utilized to describe tissue behavior. The aim of this study was to establish the reproducibility of quantitative and semiquantitative analysis of dynamic contrast enhanced magnetic resonance imaging in a murine model of breast cancer. For each animal, a T₁‐weighted, gradient‐echo sequence was used to acquire two sets of dynamic contrast enhanced magnetic resonance imaging data separated by 5 h. Data were acquired at both a 0.05 mm³ (128², n = 12) and a 0.2 mm³ (64², n = 12) resolution, and analysis was performed using both the Tofts–Kety (to estimate K^trans and v_e) and extended Tofts–Kety (K^trans, v_e, and v_p) models. Reproducibility analysis was performed for both the center slice and the total tumor volume for all parameters. For the total volume analysis, the repeatability index for K^trans is 0.073 min^?1 in the standard model analysis and 0.075 min^?1 in the extended model analysis at the 128² acquisition. For the 64² acquisition, the values are 0.089 and 0.063 min^?1 for the standard and extended models, respectively. The repeatability index for initial area under the curve was 0.0039 and 0.0042 mM min for the 128² and 64² acquisitions, respectively. Magn Reson Med, 2013. © 2012 Wiley Periodicals, Inc.     

From the Cover: Ecosystem responses in the southern Caribbean Sea to global climate change

Over the last few decades, rising greenhouse gas emissions have promoted poleward expansion of the large-scale atmospheric Hadley circulation that dominates the Tropics, thereby affecting behavior of the Intertropical Convergence Zone (ITCZ) and North Atlantic Oscillation (NAO). Expression of these changes in tropical marine ecosystems is poorly understood because of sparse observational datasets. We link contemporary ecological changes in the southern Caribbean Sea to global climate change indices. Monthly observations from the CARIACO Ocean Time-Series between 1996 and 2010 document significant decadal scale trends, including a net sea surface temperature (SST) rise of ∼1.0 ± 0.14 °C (±SE), intensified stratification, reduced delivery of upwelled nutrients to surface waters, and diminished phytoplankton bloom intensities evident as overall declines in chlorophyll a concentrations (ΔChla = −2.8 ± 0.5%⋅y⁻¹) and net primary production (ΔNPP = −1.5 ± 0.3%⋅y⁻¹). Additionally, phytoplankton taxon dominance shifted from diatoms, dinoflagellates, and coccolithophorids to smaller taxa after 2004, whereas mesozooplankton biomass increased and commercial landings of planktivorous sardines collapsed. Collectively, our results reveal an ecological state change in this planktonic system. The weakening trend in Trade Winds (−1.9 ± 0.3%⋅y⁻¹) and dependent local variables are largely explained by trends in two climatic indices, namely the northward migration of the Azores High pressure center (descending branch of Hadley cell) by 1.12 ± 0.42°N latitude and the northeasterly progression of the ITCZ Atlantic centroid (ascending branch of Hadley cell), the March position of which shifted by about 800 km between 1996 and 2009.     

A randomised trial of nursing interventions supporting recovery of the postmastectomy patient

Aims and objectives. This ABC to recovery study evaluated the combined and separate components of preoperative education and the effectiveness of wearing the Papilla Gown. Background. Surgical removal of the breast may lead to activity limitation, self‐image issues, discomfort and later complication of lymphoedema. Design. This study used experimental and longitudinal design. Methods. One hundred and forty‐five women undergoing mastectomies for stages two and three breast cancer were randomised into four groups: education and Papilla Gown, education only, gown only and control. The outcomes of activity (A), body image (B), comfort (C), knowledge and lymphoedema were assessed at baseline and/or 1 week and 6 months using three measures. All 145 participants completed the study questionnaires at first two measures, and forty‐six of these participants completed the questionnaires at 6 months postoperatively. The setting for the study included two clinics and hospitals. To examine statistical significance at each time point after surgery, 2‐way anova s were performed on ABC, knowledge and tape measurement to see whether there were any statistically significant differences between the four groups. All reported p‐values are two sided. All statistical analyses were performed using sas 9.2 for Windows. Results. The mean age of the sample was 55 years. The study revealed that women who received the combined intervention demonstrated greater activity. Women who wore the gown only had a greater comfort level and decreased lymphoedema. Women that received preoperative education experienced increased knowledge. Conclusions. Outcomes suggest that the combined intervention (ABCs to recovery) can improve recovery following mastectomy. Relevance to clinical practice. The results will be used to further modify the intervention and to increase awareness of nurse practitioners and other healthcare professionals of the specific needs of postmastectomy patients.     

Photoimmunosuppression: a brief overview

Exposure to ultraviolet radiation can lead to suppression of many adaptive immune responses, both to antigens encountered within a short period of the irradiation (primary) and to antigens previously encountered (memory). The pathways involved are complex and not completely elucidated. This brief review summarizes the information available currently regarding the multiple steps involved, with the aim of providing a general overview of the main aspects of photoimmunosuppression and its clinical consequences.