Attitudes of patients and staff to the implementation of an open door policy in a psychiatric unit of a general hospital [Abstract]

OBJECTIVE: To document the changing attitudes of staff and patients to the implementation of an open door policy (ODP) in the custodial psychiatry unit at the University Hospital of the West Indies. METHOD: The implementation of the changing therapeutic activities between October 2000 and January 2001 was followed using qualitative methods. Patients, their relatives and staff were interviewed around the time of implementation of each changing activity, and their attitudes documented. Patients attitudes to the transformed ward were sampled from May 2001 using the Verona Satisfaction Scale. The ODP had five separate components. The first was the opening of the main gate of the ward, which took place in October 2000. This was followed by a rationalization in stages of patients clinical status and their assignment to specific therapeutic activities. The implementation of daily therapeutic community group meetings was followed shortly afterwards by the implementation of an art therapy programme and other occupational activities. The opening of the Occupational Centre was the final phase of the programme in June 2001. RESULTS: The initial response of staff members to the opening of the main gate was angry and hostile with acts of passive resistance. Patient response was cautious but favourable, and they soon took advantage of leaving the ward unacompanied. Demarcation of the patients into groups of clinical severity soon allowed the staff to rationalize therapuetic activities for the patients. Both staff and patients were cooperative to this change. Implementation of the therapuetic community group meetings had a profound resocializing effect on patients and staff. Finally, the implementation of the art and activity therapy was warmly received by the patients, and proudly acclaimed by the staff. Analysis of the Verona Satisfaction Scores indicated a general acceptance and appreciation by the patients. CONCLUSIONS: The general consensus has been that the ward atmosphere was positively transformed by the ODP with patients being more satisfied with their care and being less hostile in their interactions with staff. Staff have cooperated with the changes, and have expressed appreciation of the benefits derived from the process. (AU)

Atmospheric particulate absorption and black carbon measurement.

It is convenient to measure the optical attenuation A of the combination of a layer of atmospheric particulate matter and the quartz fiber filter on which it has been collected. The problem of relating A to the absorption and scattering coefficients k and s of the particulate matter itself is treated as a problem in diffuse reflectance spectroscopy using the KubelkaMunk theory. The results show that although, in general, A is a nonlinear function strongly dependent on both s and k, for a limited range of s and sample thickness d, A can be a practically linear function of k. Fortunately, this range includes that common to atmospheric particulate samples. Furthermore, it is shown that if the filter's reflectance is sufficiently high, A can be nearly independent of s. This is in agreement with experimental and, for the limiting case when the substrate filter reflectance is unity, theoretical results obtained by other researchers. Use of such measurements of A as a means of determining the black carbon mass loading C on a filter is also investigated. It is shown that when the black carbon mass fraction f(c) is high, as it is for samples collected in large urban areas, A is a predictable and practically linear function of C. However, when f(c) is low, as it is for many rural locations, then the slope of the function A(C) is strongly dependent on f(c), leading to possible overestimates of C. This problem can be alleviated by making the measurement of A at near-infrared wavelengths rather than in the visible spectrum.

Nephelometer optical response model for the interpretation of atmospheric aerosol measurements.

A numerical model evaluating the response of a typical integrating nephelometer is described. The model incorporates the actual scattering geometry as well as the effects of a finite light source, detector size, and a nonideal Lambertian diffuser. An angular scattering weighting function is introduced to provide a tractable approach in numerical calculations and easy application. Using established size distribution ensembles associated with a few representative aerosol types, we compare the calculated response of a real nephelometer with that of an ideal, or perfect, nephelometer. The results indicate that, frequently, the nephelometer-produced aerosol-scattering coefficient is of the order of 10-20% too small; but for some naturally occurring aerosols, the difference may be as large as 40-50%. For a multiple-wavelength nephelometer, the response model can be employed to estimate the expected error in the aerosol-scattering coefficients directly from the measurements themselves.

Absorption-coefficient-determination method for particulate materials.

A method is presented for determining the optical absorption coefficient, or the imaginary refractive index, of particulate material that has been collected from aerosols or hydrosols by means of filtration. The method, based on the Kubelka-Munk theory of diffuse reflectance, is nondestructive and requires no other knowledge of the sample than the amount present, the specific gravity, and an estimate of the real index of refraction. The theoretical development of the method is discussed along with an analysis of photometric and gravimetric errors. We test the method by comparing results obtained for powdered didymium glass with measurements made before the glass was crushed. An example of the method's application to the determination of the absorption coefficient of atmospheric dust at UV, visible, and near-IR wavelengths is also presented.

Imaginary refractive index of buckyballs.

The UV, visible, and IR imaginary refractive indexes of C(60) are determined and compared with that of carbon soot.

Carbon and the optical properties of atmospheric dust.

Atmospheric particulate matter was examined to estimate the significance of free carbon as an absorber of near-ultraviolet, visible, and near-infrared radiation. Bulk and size-fractionated samples have been disassembled into acetone-soluble, water-soluble, and insoluble fractions. The absorption coefficients for these fractions, and for the insoluble material after removal of the free carbon by burning, have been measured. The results show that in the visible and near infrared, free carbon, although not a major component by mass, is by far the dominant absorbing material. These measurements in relation to otherresearch suggest that geographic variations in and anthropogenic contributions to the free-carbon content cause much of the variation in the absorption coefficient of atmospheric particulate samples.