Search results for: vulnerable narcissism.
4 Evaluation of the Role of Advocacy and the Quality of Care in Reducing Health Inequalities for People with Autism, Intellectual and Developmental Disabilities at Sheffield Teaching Hospitals
Authors: Jonathan Sahu, Jill Aylott
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Individuals with Autism, Intellectual and Developmental disabilities (AIDD) are one of the most vulnerable groups in society, hampered not only by their own limitations to understand and interact with the wider society, but also societal limitations in perception and understanding. Communication to express their needs and wishes is fundamental to enable such individuals to live and prosper in society. This research project was designed as an organisational case study, in a large secondary health care hospital within the National Health Service (NHS), to assess the quality of care provided to people with AIDD and to review the role of advocacy to reduce health inequalities in these individuals. Methods: The research methodology adopted was as an “insider researcher”. Data collection included both quantitative and qualitative data i.e. a mixed method approach. A semi-structured interview schedule was designed and used to obtain qualitative and quantitative primary data from a wide range of interdisciplinary frontline health care workers to assess their understanding and awareness of systems, processes and evidence based practice to offer a quality service to people with AIDD. Secondary data were obtained from sources within the organisation, in keeping with “Case Study” as a primary method, and organisational performance data were then compared against national benchmarking standards. Further data sources were accessed to help evaluate the effectiveness of different types of advocacy that were present in the organisation. This was gauged by measures of user and carer experience in the form of retrospective survey analysis, incidents and complaints. Results: Secondary data demonstrate near compliance of the Organisation with the current national benchmarking standard (Monitor Compliance Framework). However, primary data demonstrate poor knowledge of the Mental Capacity Act 2005, poor knowledge of organisational systems, processes and evidence based practice applied for people with AIDD. In addition there was poor knowledge and awareness of frontline health care workers of advocacy and advocacy schemes for this group. Conclusions: A significant amount of work needs to be undertaken to improve the quality of care delivered to individuals with AIDD. An operational strategy promoting the widespread dissemination of information may not be the best approach to deliver quality care and optimal patient experience and patient advocacy. In addition, a more robust set of standards, with appropriate metrics, needs to be developed to assess organisational performance which will stand the test of professional and public scrutiny.Keywords: Autism, intellectual developmental disabilities, advocacy, health inequalities, quality of care.
Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 8813 Physical Deterioration of Semi-Arid Soils as Affected by Land Use Change in North West of Iran
Authors: Ali Reza Vaezi, Fereshteh Haghshenas
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Land use has generally been considered a local environmental issue, but it is becoming a force of global importance. Extensive changes to forests and pastures are being driven by the need to provide food, fiber, and shelter for people in recent decades. Land use is an important factor affecting soil organic carbon accumulation and storage in soils which influence directly on other physicochemical soil properties, soil productivity and soil’s susceptibility to water erosion. The change of pastures to the agricultural lands has been increasing rapidly in most semi-arid regions in Iran. Information on the effect of the land use change in these areas on the deterioration of soil physicochemical properties is limited. Therefore, this study was conducted to investigate the physical deterioration of soil as affected by land use change in semi-arid pastures in north west of Iran. Toward this, seven areas covering both pasture and rainfed lands with different soil textures (clay loam, silty clay loam, sandy clay loam, silt loam, loam, sandy loam and sandy loam) were selected in a semi-arid region in Zanjan, NW Iran. Pasture in the area is covered with poor vegetation and mostly grazed in wet seasons (end of winter and early spring and autumn). Rainfed lands resulting land use change are mostly planted for winter wheat production. In each area, soil samples (0-30 cm depth) were collected from the two land uses (pasture and rainfed land) at three replications. A total of 42 soil samples were taken from the study area. Various soil physical properties consisting of bulk density, total porosity, coarse pores volume, aggregate size, aggregate stability, water-holding capacity and saturated hydraulic conductivity were determined in the soil samples using the laboratory conventional methods. The results showed that the change of pastures to rainfeds is severely deteriorated soil physical properties. However, the variation rate of the physical soil properties is different. The loss of soil physical properties as a result of the land use change was in the following order: 61% water-stable aggregates, 60% aggregate size > 41% macroporosity > 28% bulk density > 22% total porosity > 11% water holding capacity > 5% saturated point. This result reveals that the structural characteristics of soils in this area are the most important soil physical characteristics that are affected by land use change. The deterioration of these soil properties influences negatively the pore size distribution and volume percentage of macroporosity. Effects of land use change on deterioration of soil physical properties were different in various soil textures. The highest mean loss of soil physical properties was found in loam (42%), whereas the lowest value was in silty clay loam (23%). As a consequence, loam is the most vulnerable soil to physical degradation caused by land use change in the pastures. This physical loss of soil is associated with its higher percentage of larger aggregates as well as water-stable aggregates.
Keywords: Pasture, soil physical properties, soil structural characteristics, soil texture.
Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 752 Child Sexual Abuse Prevention: Evaluation of the Program “Sharing Mouth to Mouth: My Body, Nobody Can Touch It”
Authors: Faride Peña, Teresita Castillo, Concepción Campo
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Sexual violence, and particularly child sexual abuse, is a serious problem all over the world, México included. Given its importance, there are several preventive and care programs done by the government and the civil society all over the country but most of them are developed in urban areas even though these problems are especially serious in rural areas. Yucatán, a state in southern México, occupies one of the first places in child sexual abuse. Considering the above, the University Unit of Clinical Research and Victimological Attention (UNIVICT) of the Autonomous University of Yucatan, designed, implemented and is currently evaluating the program named “Sharing Mouth to Mouth: My Body, Nobody Can Touch It”, a program to prevent child sexual abuse in rural communities of Yucatán, México. Its aim was to develop skills for the detection of risk situations, providing protection strategies and mechanisms for prevention through culturally relevant psycho-educative strategies to increase personal resources in children, in collaboration with parents, teachers, police and municipal authorities. The diagnosis identified that a particularly vulnerable population were children between 4 and 10 years. The program run during 2015 in primary schools in the municipality whose inhabitants are mostly Mayan. The aim of this paper is to present its evaluation in terms of its effectiveness and efficiency. This evaluation included documental analysis of the work done in the field, psycho-educational and recreational activities with children, evaluation of knowledge by participating children and interviews with parents and teachers. The results show high efficiency in fulfilling the tasks and achieving primary objectives. The efficiency shows satisfactory results but also opportunity areas that can be resolved with minor adjustments to the program. The results also show the importance of including culturally relevant strategies and activities otherwise it minimizes possible achievements. Another highlight is the importance of participatory action research in preventive approaches to child sexual abuse since by becoming aware of the importance of the subject people participate more actively; in addition to design culturally appropriate strategies and measures so that the proposal may not be distant to the people. Discussion emphasizes the methodological implications of prevention programs (convenience of using participatory action research (PAR), importance of monitoring and mediation during implementation, developing detection skills tools in creative ways using psycho-educational interactive techniques and working assessment issued by the participants themselves). As well, it is important to consider the holistic character this type of program should have, in terms of incorporating social and culturally relevant characteristics, according to the community individuality and uniqueness, consider type of communication to be used and children’ language skills considering that there should be variations strongly linked to a specific cultural context.
Keywords: Child sexual abuse, evaluation, PAR, prevention.
Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 12401 High Cycle Fatigue Analysis of a Lower Hopper Knuckle Connection of a Large Bulk Carrier under Dynamic Loading
Authors: Vaso K. Kapnopoulou, Piero Caridis
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The fatigue of ship structural details is of major concern in the maritime industry as it can generate fracture issues that may compromise structural integrity. In the present study, a fatigue analysis of the lower hopper knuckle connection of a bulk carrier was conducted using the Finite Element Method by means of ABAQUS/CAE software. The fatigue life was calculated using Miner’s Rule and the long-term distribution of stress range by the use of the two-parameter Weibull distribution. The cumulative damage ratio was estimated using the fatigue damage resulting from the stress range occurring at each load condition. For this purpose, a cargo hold model was first generated, which extends over the length of two holds (the mid-hold and half of each of the adjacent holds) and transversely over the full breadth of the hull girder. Following that, a submodel of the area of interest was extracted in order to calculate the hot spot stress of the connection and to estimate the fatigue life of the structural detail. Two hot spot locations were identified; one at the top layer of the inner bottom plate and one at the top layer of the hopper plate. The IACS Common Structural Rules (CSR) require that specific dynamic load cases for each loading condition are assessed. Following this, the dynamic load case that causes the highest stress range at each loading condition should be used in the fatigue analysis for the calculation of the cumulative fatigue damage ratio. Each load case has a different effect on ship hull response. Of main concern, when assessing the fatigue strength of the lower hopper knuckle connection, was the determination of the maximum, i.e. the critical value of the stress range, which acts in a direction normal to the weld toe line. This acts in the transverse direction, that is, perpendicularly to the ship's centerline axis. The load cases were explored both theoretically and numerically in order to establish the one that causes the highest damage to the location examined. The most severe one was identified to be the load case induced by beam sea condition where the encountered wave comes from the starboard. At the level of the cargo hold model, the model was assumed to be simply supported at its ends. A coarse mesh was generated in order to represent the overall stiffness of the structure. The elements employed were quadrilateral shell elements, each having four integration points. A linear elastic analysis was performed because linear elastic material behavior can be presumed, since only localized yielding is allowed by most design codes. At the submodel level, the displacements of the analysis of the cargo hold model to the outer region nodes of the submodel acted as boundary conditions and applied loading for the submodel. In order to calculate the hot spot stress at the hot spot locations, a very fine mesh zone was generated and used. The fatigue life of the detail was found to be 16.4 years which is lower than the design fatigue life of the structure (25 years), making this location vulnerable to fatigue fracture issues. Moreover, the loading conditions that induce the most damage to the location were found to be the various ballasting conditions.Keywords: Lower hopper knuckle, high cycle fatigue, finite element method, dynamic load cases.
Procedia APA BibTeX Chicago EndNote Harvard JSON MLA RIS XML ISO 690 PDF Downloads 982