Integration of teaming therapy and mixed-reality simulation as remote learning modality for couple and family therapy graduate training programs.

In response to COVID-19, a couple and family therapy (CFT) graduate training program integrated a teaming therapy model with virtual technology using mixed-reality simulation software. By utilizing teaming therapy--a model with strong roots in systemic theory and practice-- combined with cutting-edge simulation technology, this distance learning modality provides distinctly relational therapy supervision and training for students at a time when their internships sites are struggling to offer remote clinical services due to the pandemic. This integrative framework offers a high degree of both realism and safety, allowing experiential learning to be appropriately scaffolded for optimum creativity and engagement in an online setting. This paper describes the conceptual, systemic basis for the learning modality, steps for implementation, benefits of the model, and the authors plan for further evaluation.

Emergency Room Safer Transfer of Patients (ER-STOP): a quality improvement initiative at a community-based hospital to improve the safety of emergency room patient handovers.

OBJECTIVES: Ensure early identification and timely management of patient deterioration as essential components of safe effective healthcare. Prompted by analyses of incident reports and deterioration events, a multicomponent organisational rescue from danger system was redesigned to decrease unexpected inpatient deterioration. DESIGN: Quality improvement before-after unblinded trial. SETTING: 430-bed Canadian community teaching hospital. PARTICIPANTS: All admitted adult medical-surgical patients in a before-after 12-month interventional study. INTERVENTION: Locally validated checklist (Modified Early Warning Score+urinary catheter in situ+nurse concern) with an intentional pause and explicit management options was deployed as a modification of an existing ward transfer of accountability fax report in the emergency department (ED). RESULTS: Following deployment of Emergency Room Safer Transfer of Patients (ER-STOP), the risk of an unexpected CCRT (critical care response team) response within 24 hours of admission from ED to adult medical and surgical wards was significantly decreased (OR 4.1, 95% CI 2.17 to 7.77). Mean (±SD) ED wait times (5.66±1.54vs 5.74±1.04 hours, p=0.30), intensive care unit admission rate (3.84%, n=233vs 4.61%, n=278, p=0.06) and cardiac care unit admission rate (9.51%, n=577vs 9.60%, n=579, p=0.198) were unchanged. CONCLUSIONS: ER-STOP improvement was out of proportion to the predictive value of the checklist component suggesting that effectiveness of this low-cost sustainable tool was related to increased situational awareness, empowering a culture of patient safety and repurposing of an adjacent ED medical short-stay unit use. Local adaptation within existing processes is essential to successful safety outcomes.

The lived experience of family members of persons who compulsively hoard: a qualitative study.

The current study took an Interpretive Phenomenological Analysis approach to investigate the lived experiences of 12 family members of persons who hoard to better understand family members' cognitions, emotions, perceptions, experiences, and responses in their interactions with their loved ones who hoard. Five overarching themes for the participants' experiences of having a person who hoards in the family emerged: negative feelings toward the persons who hoard; lack of understanding of hoarding behavior; experiences of loss; internal barriers to seeking support; and internal conflicts. Clinical implications and recommendations for future research are discussed, including a proposed application of an ambiguous loss framework for understanding and working with the experiences of family members of persons who hoard.

Brain injury rehabilitation: the lived experience of inpatients and their family caregivers.

Inpatient rehabilitation is an integral part of the continuum of care for people with severe acquired brain injury (ABI), and may extend for weeks or months. However, there is a lack of research describing the experience of inpatient brain injury rehabilitation. The purpose of this study was to describe and interpret the inpatient brain injury rehabilitation experience from the perspective of patients and their caregivers. Qualitative content analysis of semi-structured interviews from a purposeful sample of 20 patients and 18 of their family caregivers generated in-depth descriptions of the inpatient experience. Three themes were identified; "rehabilitation context/environment", "activity/occupation", and "support and adjustment". The findings provide a greater understanding of rehabilitation from an insider perspective and can assist rehabilitation teams to better meet the needs of people with ABI. Specifically, the need for a therapeutic environment, meaningful occupations and family-centredness in inpatient settings were highlighted by this study.

Impacts of gold mining and land use alterations on the water quality of central Mongolian rivers.

Conservation of water quality is inherently tied to watershed management. Efforts to proect Lake Baikal have increasingly focused on the Selenge River, a major tributary, with more than half its watershed area in Mongolia. Placer gold mining in Mongolia has the potential to load total suspended sediment (TSS), and total phosphorus (TP) into Lake Baikal and destroy spawning areas for the endangered Taimen salmon (Hucho taimen taimen). This work describes water quality assessments performed from 2001 to 2003 on Mongolian tributaries to the Selenge River. Of 7 rivers sampled, rivers with proximal mining had the worst water quality. Elevated loading of TSS and TP was observed below mining regions on the Tuul River. Flooding could breach thin strips of land separating dredge pits from river channels, resulting in massive sediment loading. Extensive disturbance of the river terrace was apparent for many square kilometers. In the mountainous headwaters of the Yeroo River, tributary drainages undergoing mining had TP concentrations 8 to 15 times higher than the main stem. TSS was 7 to 12 times higher, and turbidity was 8 times higher. Alternative mining technologies exist that could minimize impact and improve the possibility for reclamation.

Paper on migration issues seminar workshop on social and community development issues - 1990's and beyond, Wednesday 25th January, 1989

Large scale migration is acknowledged to be a natural reaction to harsh conditions of one kind or another in the home country, as against the attraction of better prospects in the destination country. Unemployment, under-employment, the lure of better employment opportunities, deteriorating social services-health, education, housing, deteriorating social environment - crime, drug abuse, vagrancy - these are some of the main causes cited as being behind the mass exodus of citizens of Trinidad and Tobago within recent years. Suggested solutions:- i Incentives (financial and otherwise) for those in critical occupations to remain/return; ii Re-training; job enrichment strategies; iii Improved social services