To send content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
There is international interest in the training of psychological therapists to deliver evidence-based treatment for common mental health problems. The UK Improving Access to Psychological Therapies (IAPT) programme, one of the largest training initiatives, relies on competent therapists to successfully deliver cognitive behaviour therapy (CBT) and promote good patient outcome.
To evaluate an IAPT CBT training course by assessing if trainees’ clinical skills improve during training and reach competency standards, and to report patient outcome for submitted training cases. To investigate a possible relationship between trainee competence and patient outcome. To explore professional differences during training.
CBT trainee (n = 252) competence was assessed via audio recordings of therapy sessions at the beginning, middle and end of training. Patient pre- to post-treatment outcomes were extracted from submitted training cases (n = 1927). Differences in professional background were examined across competence, academic final grade and tutorial support.
CBT trainees attained competence by the end of the course with 77% (anxiety recordings) and 72% (depression recordings) improving reliably. Training cases reported pre- to post-treatment effect sizes of 1.08–2.26 across disorders. CBT competence predicted a small variance in clinical outcome for depression cases. Differences in professional background emerged, with clinical psychologists demonstrating greater competence and higher academic grades. Trainees without a core professional background required more additional support to achieve competence.
Part of a new CBT therapist workforce was successfully trained to deliver relatively brief treatment effectively. Trainees without a core profession can be successfully trained to competence, but may need additional support. This has implications for workforce training.
After five positive randomized controlled trials showed benefit of mechanical thrombectomy in the management of acute ischemic stroke with emergent large-vessel occlusion, a multi-society meeting was organized during the 17th Congress of the World Federation of Interventional and Therapeutic Neuroradiology in October 2017 in Budapest, Hungary. This multi-society meeting was dedicated to establish standards of practice in acute ischemic stroke intervention aiming for a consensus on the minimum requirements for centers providing such treatment. In an ideal situation, all patients would be treated at a center offering a full spectrum of neuroendovascular care (a level 1 center). However, for geographical reasons, some patients are unable to reach such a center in a reasonable period of time. With this in mind, the group paid special attention to define recommendations on the prerequisites of organizing stroke centers providing medical thrombectomy for acute ischemic stroke, but not for other neurovascular diseases (level 2 centers). Finally, some centers will have a stroke unit and offer intravenous thrombolysis, but not any endovascular stroke therapy (level 3 centers). Together, these level 1, 2, and 3 centers form a complete stroke system of care. The multi-society group provides recommendations and a framework for the development of medical thrombectomy services worldwide.
Patients are frequently discharged with central venous catheters (CVCs) for home infusion therapy.
To study a prospective cohort of patients receiving home infusion therapy to identify environmental and other risk factors for complications.
Prospective cohort study between March and December 2015.
Home infusion therapy after discharge from academic medical centers.
Of 368 eligible patients discharged from 2 academic hospitals to home with peripherally inserted central catheters and tunneled CVCs, 222 consented. Patients remained in the study until 30 days after CVC removal.
Patients underwent chart abstraction and monthly telephone surveys while the CVC was in place, focusing on complications and environmental exposures. Multivariable analyses estimated adjusted odds ratios and adjusted incident rate ratios between clinical, demographic, and environmental risk factors and 30-day readmissions or CVC complications.
Of 222 patients, total parenteral nutrition was associated with increased 30-day readmissions (adjusted odds ratio, 4.80 [95% CI, 1.51–15.21) and CVC complications (adjusted odds ratio, 2.41 [95% CI, 1.09–5.33]). Exposure to soil through gardening or yard work was associated with a decreased likelihood of readmissions (adjusted odds ratio, 0.09 [95% CI, 0.01–0.74]). Other environmental exposures were not associated with CVC complications.
complications and readmissions were common and associated with the use of total parenteral nutrition. Common environmental exposures (well water, cooking with raw meat, or pets) did not increase the rate of CVC complications, whereas soil exposures were associated with decreased readmissions. Interventions to decrease home CVC complications should focus on total parenteral nutrition patients.
Large volumes of data and multiple computing platforms are now universal components of paediatric cardiovascular medicine, but are in a constant state of evolution. Often, multiple sets of related data reside in disconnected “silos”, resulting in clinical, administrative, and research activities that may be duplicative, inefficient, and at times inaccurate. Comprehensive and integrated data solutions are needed to facilitate these activities across congenital heart centres. We describe methodology, key considerations, successful use cases, and lessons learnt in developing an integrated data platform across our congenital heart centre.
The Midwest after-school center occupies a building that housed a bank for many years. It is the smallest of the three clubs, particularly in the size of the gym. The former bank lobby, which has been converted to a gym, has less space and lower ceilings than gyms in the other clubs. The center is located in a community that used to be predominantly Latino, but has recently witnessed the arrival of increasing numbers of African American families. As is true of the neighborhoods near all of the centers we studied, there are a number of gangs in the area. Violence and drugs are major concerns. The crime rate in the area surrounding Midwest is higher than that found in 90 percent of neighborhoods in the city.
Our initial survey questionnaire provides a good sense of those youth who came to the center who were at least ten years old. The survey was completed by 62 youth ages 10–16, with a mean (average) age of 12.16 (of the clubs we studied, Midwest has the fewest youth). The sample was 66 percent Hispanic, 34 percent African American, 8 percent white, and 2 percent Asian American (figures sum to more than 100%, as some youth checked more than one box). It was a high-poverty sample, as 83 percent reported receiving free or reduced-price lunch. It was also a high-attendance sample, as most of the young people had been coming to Midwest for several years and came almost every weekday for at least two to four hours daily. At the beginning of the year, there were five full-time and two part-time staff (which includes a full-time administrator); by the end of the year, two additional full-time staff had joined the center.
Ethnographic Observations: Trained members of the research team visited each club to conduct ethnographic observations, typically two times a week, beginning in September and continuing through the end of the school year in June. Observers recorded detailed field notes after each visit (see Field Note Template later in this appendix). Each field note included the team member’s observations and reflections as well as an account of any conversations with youth or staff. The principal investigator (Hirsch) reviewed the field notes on an ongoing basis. Developments or issues that might benefit from additional investigation were highlighted for follow-up during subsequent visits to the club.
Social Climate Ratings: Following each visit to a club, the research team member involved completed ratings of the social climate of the club on several different dimensions, such as cooperation and conflict among staff and youth enjoyment and participation in decision making (see Field Note Template later in this appendix).
All Youth Attending Each Center
Youth Background Questionnaire: This questionnaire was completed at the start of the year by all youth at each of the clubs who were ten years of age or older. The survey included questions that asked youth for basic demographic information, their levels and history of participation in the club, how safe they felt in their neighborhoods, and whether they experienced the club setting as a “second home.” Each youth also was asked on the survey to identify the staff person at the center with whom he or she had the closest relationship.
Youth programs can be found in abundance throughout our communities. Nowhere, however, are they more prevalent than in the after-school arena. The past decade has witnessed explosive growth in after-school programs. The federal government launched a billion-dollar initiative, the 21st Century Community Learning Centers. California’s Proposition 49 channeled more than 400 million additional dollars to after-school programs. Several major foundations have put after-school programs at the core of their concerns. And city after city is scaling up its after-school programs. Much of this growth has involved after-school centers that typically are home to a wide array of programs and services. These include the Boys & Girls Clubs of America, which more than doubled the number of its clubs, from 1,800 in 1997 to 4,000 in 2008. Clearly there is a push to make after-school programs part of the educational and youth services infrastructure. We believe in the promise of after-school programs but also are concerned about the pitfalls. We have seen both good programs and bad programs, strong centers and weak centers. It is critical to understand the factors that lead to quality and to positive youth outcomes if the after-school movement is to be built on a solid foundation.
It is easy to appreciate the push for more after-school programming. This is especially true for the school-age adolescents in low-income urban communities who we studied in this research. These young people need to cope with violence and poor schools on a daily basis. Job opportunities are often few and far between. Adult role models can be in short supply as the middle class has largely abandoned these neighborhoods, many men are in prison, and parents often have work shifts that leave little time for guidance and support. After-school programs hope to step into these gaps and supplement what youth receive from family and school.
This research project has gone through some interesting transformations. Our original grant application to the William T. Grant Foundation proposed a year of qualitative research followed by a year of quantitative research. We were very grateful when the foundation’s then senior vice president, Robert Granger, encouraged us to focus on the qualitative portion only.
We hadn’t expected to be taken by surprise by the nature of the three after-school centers that we were going to study, but we were. A few years earlier, we had studied six Boys and Girls Clubs and had written two books based on that experience: Hirsch’s A Place to Call Home: After–School Programs for Urban Youth, and Deutsch’s Pride in the Projects: Teens Building Identities in Urban Contexts. We had thought that the clubs in the current research would be reasonably similar to the six we had studied earlier, but that was not the case. With one of the clubs (referred to as North River), it was clear from the very beginning that it was a lot worse than any of the clubs we had come to know previously. Nothing during the rest of our year of data collection served to change our mind about this. Indeed, as time went on, we became more sharply aware of differences across all three of the clubs. We became convinced that to do justice to this situation, we needed to expand our research focus. Our initial objective was to conduct an intensive study of youth-staff relationships, as such relationships had emerged as an important factor in our prior studies. We have done that. But we also added an organizational level of analysis to capture the different cultures and operations at the three sites. The varying perspectives are reported via case studies of each club and of two youth at each club. The book that grew out of this more comprehensive effort is richer, and it is both more theoretical and more applied as a result.
This book examines after-school programs in light of their explosive growth in recent years. In the rush to mount programs, there is a danger of promoting weak ones of little value and failing to implement strong ones adequately. But what is quality and how can it be achieved? This book presents findings from an intensive study of three after-school centers that differed dramatically in quality. Drawing from 233 site visits, the authors examine how – and why – young people thrive in good programs and suffer in weak ones. The book features engaging, in-depth case studies of each of the three centers and of six youths, two from each center. Written in a highly accessible style for academics, youth workers, after-school program leaders and policy makers, the study breaks new ground in highlighting the importance of factors such as collective mentoring, synergies among different programs and activities, and organizational culture and practices.