Quality of Life Outcomes in a Community Cohort of Adults With an Intellectual Disability Using the Personal Outcome Scale.

Objectives: Quality of life (QoL) is a multi-dimensional phenomenon composed of core domains that are influenced by personal characteristics, values, and environmental contributions. There are eight core domains of QoL aligned with both the United Nations and the International Association for the Scientific Study of Intellectual and Developmental Disabilities (IASSIDD). The Personal Outcome Scale (POS), is a semi-structured self and proxy instrument that specifically measures these aspects of QoL for people with an intellectual disability. Methods: A total of 85 people with an intellectual disability and their primary keyworker (n = 85) took part in this study. A convenience sample recruitment strategy was employed to recruit participants during the calendar year from January-December 2020. Participants completed the self-report and proxy POS, and clinic-demographic data was also considered. Results: QoL is higher in those who have a dedicated service planner and also for those with a less severe to profound disability. People who were in gainful employment reported significantly higher QoL as did those availing of outreach and residential services, over and above local services. Conclusions: This research shows that there are distinct and specific factors that relate to QoL for people with an intellectual disability community-based services in Ireland. Future research could aim to investigate these longitudinally, and specifically how QoL relates to cognitive and functional outcomes.

A secondary analysis to develop a scale for measuring unemployed workers' experiences of Australian employment services.

BACKGROUND: Research consistently shows that Australian employment services are failing those they are intended to serve. Based on findings in other human service areas, a valid and reliable instrument to measure unemployed workers' experiences may provide an opportunity for improvement in this sector. OBJECTIVE: To establish a basis for developing a suitable rating scale. METHODS: An exploratory factor analysis combined with qualitative cross check for face validity of an existing large survey of Australian unemployed workers. RESULTS: Six factors appear to be important elements of service delivery: (F1) useful and competent, (F2) client-centred, (F3) receptive to feedback, (F4) trustworthy, (F5) fair, and (F6) friendly. CONCLUSIONS: While each of these factors have been either described explicitly or referred to implicitly in previous studies, this study is the first to attempt to combine these factors and is a precursor to establishing a valid and reliable rating scale for use by unemployed workers in evaluating their employment service providers. At a time when Australia is exploring new approaches to employment services, such a scale using a robust set of factors may allow for the improvement of employment services and thus be held accountable to a significant stakeholder group whom they aim to serve -unemployed workers.

Poor Sleep Associated with Clinically Severe Obesity Is Independent of OSA Status.

PURPOSE: Obesity has been reported to be associated with short sleep duration. It follows that patients with a BMI >35kg/m2 could be expected to have the poorest sleep. This poor sleep could be explained by the presence of obstructive sleep apnoea (OSA), although treatment with positive airway pressure (PAP) may modify this. The purpose of this study is to determine if patients attending for bariatric surgery have poor sleep independent of OSA status. MATERIALS AND METHODS: Sleep duration and quality, using the Pittsburgh Sleep Quality Index (PSQI), was analysed in 203 patients undergoing bariatric surgery between June 2016 and May 2019 in a single centre. Anthropometric data on all patients were recorded as well as presence of OSA and PAP usage. RESULTS: The bariatric population reported an average (standard deviation) sleep duration of 6.5 (1.6) h, and 67.9% of patients had a documented poor sleep quality (PSQI>5). The presence of OSA did not significantly influence either sleep duration (p=0.23) or sleep quality (p=0.5). On logistic regression, there was no significant relationship between sleep duration or sleep quality and the following variables: age, sex, and AHI. There was however a significant association between BMI and sleep quality (p= 0.007). PSQI was inversely associated with BMI. This equated to 1 kg/m2 weight gain being associated with 0.097 decrease in PSQI score. CONCLUSIONS: The presence of OSA does not influence either sleep duration or sleep quality in the bariatric surgical population. This suggests that clinically severe obesity itself may cause poor sleep.

Exploring Client and Therapist Experiences of Sexual Offender Intervention: Developing a Model of "Significant Events".

This research explored the therapeutic events both clients and therapists from community-based treatment interventions for perpetrators of sexual abuse identify as significant in their experience of psychological therapy. A qualitative design was utilized to address this research objective. The sample for the present research is comprised of three different treatment programs for sexual offending. Twenty-five clients and nine therapists participated in the study. Two qualitative measures were used to elicit client and therapist responses. Significant Aspects of Therapy Form was administered every second treatment session during each intervention program. The Significant Aspects Follow-Up Interview was conducted with a sub-sample of participants at the conclusion of each treatment module. Thematic analysis was used to identify significant themes noted by clients and therapists from forms and interviews. Thematic analysis resulted in a model of significant events in therapy. In this model, significant events were categorized into six domains. The six domains were as follows: (a) the process of therapy, (b) making changes and progress in therapy, (c) content and structure of therapy, (d) therapist contributions, (e) negative contributions to therapy, and (f) other factors Each domain further contained between 6 and 18 themes, which are also reported. This study found much overlap and similarity in the experiences of therapy between clients of sexual offender therapy and general psychotherapy. Furthermore, there is overlap between therapists and clients in the aspects of therapy they identify as significant. The implications of these findings on effective service development and comprehensive service evaluations are discussed.

Manual Skill Acquisition During Transesophageal Echocardiography Simulator Training of Cardiology Fellows: A Kinematic Assessment.

OBJECTIVE: To investigate whether a transesophageal echocardiography (TEE) simulator with motion analysis can be used to impart proficiency in TEE in an integrated curriculum-based model. DESIGN: A prospective cohort study. SETTING: A tertiary-care university hospital. PARTICIPANTS: TEE-naïve cardiology fellows. INTERVENTIONS: Participants underwent an 8-session multimodal TEE training program. Manual skills were assessed at the end of sessions 2 and 8 using motion analysis of the TEE simulator's probe. At the end of the course, participants performed an intraoperative TEE; their examinations were video captured, and a blinded investigator evaluated the total time and image transitions needed for each view. Results are reported as mean±standard deviation, or median (interquartile range) where appropriate. MEASUREMENTS AND MAIN RESULTS: Eleven fellows completed the knowledge and kinematic portions of the study. Five participants were excluded from the evaluation in the clinical setting because of interim exposure to TEE or having participated in a TEE rotation after the training course. An increase of 12.95% in post-test knowledge scores was observed. From the start to the end of the course, there was a significant reduction (p<0.001 for all) in the number of probe. During clinical performance evaluation, trainees were able to obtain all the required echocardiographic views unassisted but required a longer time and had more probe transitions when compared with an expert. CONCLUSION: A curriculum-based approach to TEE training for cardiology fellows can be complemented with kinematic analyses to objectify acquisition of manual skills during simulator-based training.

An historical overview of Australia's largest and oldest provider of vocational rehabilitation--CRS Australia.

CRS Australia, the largest and oldest vocational rehabilitation provider in Australia, is examined over its 60-year history. The Australian government located CRS initially in the Department of Social Security, and subsequently in the Department of Community Services however, its establishment required a complexity of policy and range of skills that were not found in one arm of government alone and required cooperation from many government departments. A disagreement between the government and the medical profession about the purpose and control of rehabilitation features in the early history of CRS Australia. Factors such as greater involvement of people with disabilities and government inquiries led to a move from a centre-based to a community-based approach to vocational rehabilitation in the 1970s. CRS Australia is a large employer of health and human service professionals and has played a significant part in the development of these professions in Australia. In recent years, CRS Australia has provided greater business accountability to government and the broader Australian community. CRS Australia's role as an expert vocational assessment agency and vocational rehabilitation provider is expected to continue as welfare reform progresses in Australia.

Assessment of a glutathione S-transferase and related proteins in the gill and digestive gland of Mytilus edulis (L.), as potential organic pollution biomarkers.

The response of the glutathione S-transferase (GST, EC 2.5.1.18) and related proteins of Mytilus edulis to environmental pollution load was assessed. Mussels were reciprocally transplanted between an industrial estuary (Douglas), a rural estuary (Youghal) and a m arine site (Bantry). In addition, m ussels were sam pled along a pollution gradient in an estuary receiving leather tannery effluent (Colligan). These latter m ussels were previously shown to be subject to oxidative stress resulting from the discharges. GST specific activity of cytosolic extracts from the gill and digestive gland tissues was determ ined for all anim als. Specific activity was shown to vary significantly in anim als from different sites, with highest specific activity always observed in sam ples (local and transplanted) taken from the industrial site. By com parison, the m ussels exposed to tannery discharges displayed no significant alteration in GST specific activity. Total intracellular glutathione (GSH) was also determ ined for sam ples taken from the Douglas and Youghal estuaries but no correlation with pollution load was observed. Using FPLC analysis, we observed no specific effect on the relative levels of the GST and the individual GST related proteins in gill or digestive gland sam ples from local or reciprocally transplanted anim als from Douglas or Youghal. The increase in GST specific activity observed in samples from the industrial estuary are indicative of a possible, specific inductive agent at this site. The results from the tannery site, by com parison, indicate that general oxidative stress does not result in elevated G ST specific activity in M. edulis.