Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
47
result(s) for
"Crabtree, Jason"
Sort by:
Process evaluation of a randomised controlled trial of PBS-based staff training for challenging behaviour in adults with intellectual disability
Positive Behaviour Support (PBS) for challenging behaviour is a complex intervention. Process evaluation is pivotal in fully understanding the mechanisms and contextual factors that impact on participant outcomes.
To conduct a process evaluation of a national clinical trial investigating the impact of PBS-based staff training on the level of challenging behaviour in adults with intellectual disability.
The Medical Research Council guidance for process evaluation of complex interventions was followed. Semi-structured interviews with 62 stakeholders from the intervention arm (service users, family and paid carers, service managers, staff who delivered the intervention and PBS trainers), quantitative data from the study database and an external evaluation of the quality of the PBS plans were used.
Twenty-one health staff volunteered to be trained in delivering PBS. Available log data from 17 therapists revealed that they worked with 63 participants a median of 11.50 hours (IQR 8-32). Only 33 out of 108 reports had included all elements of the intervention. Another 47 reports had some elements of the intervention. All PBS plans were rated weak, indicating insufficient quality to impact challenging behaviour. Stakeholders reported an appreciation of PBS and its potential to impact quality of care and engagement with the participant. However, they also identified important challenges including managing PBS-related caseloads, paid carer turnover and service commitment to the delivery of PBS.
PBS-based staff training was well received, but therapists found it difficult to undertake all the elements of the intervention in routine care. Implementing a workforce training strategy is important to better define the active components of PBS, and resource implications if the intervention is no better than usual care.
Journal Article
Assessing Autism in Adults: An Evaluation of the Developmental, Dimensional and Diagnostic Interview—Adult Version (3Di-Adult)
We developed a brief, informant-report interview for assessing autism spectrum conditions (ASC) in adults, called the Developmental, Dimensional and Diagnostic Interview-Adult Version (3Di-Adult); and completed a preliminary evaluation. Informant reports were collected for participants with ASC (n = 39), a non-clinical comparison group (n = 29) and a clinical comparison group (n = 20) who had non-autistic mental health conditions. Mean administration time was 38 min (50 min for ASC). Internal consistency (αs ≥ 0.93) and inter-rater agreement (ICCs ≥ 0.99) were high. When discriminating ASC from non-ASC, the 3Di-Adult showed excellent sensitivity (95%) and specificity (92%). The 3Di-Adult shows promise as a psychometrically sound and time-efficient interview for collecting standardised informant reports for DSM-5 assessments of ASC in adults, in research and clinical practice.
Journal Article
Staff training in positive behaviour support for behaviour that challenges in people with intellectual disability: cost-utility analysis of a cluster randomised controlled trial
Behaviour that challenges in people with intellectual disability is associated with higher healthcare, social care and societal costs. Although behavioural therapies are widely used, there is limited evidence regarding the cost and quality-adjusted life-years (QALYs).
We aimed to assess the incremental cost per QALY gained of therapist training in positive behaviour support (PBS) and treatment as usual (TAU) compared with TAU using data from a cluster randomised controlled trial (Clinical Trials.gov registration: NCT01680276).
We conducted a cost-utility analysis (cost per QALY gained) of 23 teams randomised to PBS or TAU, with a total of 246 participants followed up over 36 months. The primary analysis was from a healthcare cost perspective with a secondary analysis from a societal cost perspective.
Over 36 months the intervention resulted in an additional 0.175 QALYs (discounted and adjusted 95% CI -0.068 to 0.418). The total cost of training in and delivery of PBS is £1598 per participant plus an additional cost of healthcare of £399 (discounted and adjusted 95% CI -603 to 1724). From a healthcare cost perspective there is an 85% probability that the intervention is cost-effective compared with TAU at a £30 000 willingness to pay for a QALY threshold.
There was a high probability that training in PBS is cost-effective as the cost of training and delivery of PBS is balanced out by modest improvements in quality of life. However, staff training in PBS is not supported given we found no evidence for clinical effectiveness.
Journal Article
Clinical outcomes of staff training in positive behaviour support to reduce challenging behaviour in adults with intellectual disability: cluster randomised controlled trial
Staff training in positive behaviour support (PBS) is a widespread treatment approach for challenging behaviour in adults with intellectual disability. Aims To evaluate whether such training is clinically effective in reducing challenging behaviour during routine care (trial registration: NCT01680276).
We carried out a multicentre, cluster randomised controlled trial involving 23 community intellectual disability services in England, randomly allocated to manual-assisted staff training in PBS (n = 11) or treatment as usual (TAU, n = 12). Data were collected from 246 adult participants.
No treatment effects were found for the primary outcome (challenging behaviour over 12 months, adjusted mean difference = -2.14, 95% CI: -8.79, 4.51) or secondary outcomes.
Staff training in PBS, as applied in this study, did not reduce challenging behaviour. Further research should tackle implementation issues and endeavour to identify other interventions that can reduce challenging behaviour. Declaration of interest None.
Journal Article
Simulating fluid-structure interactions using dynamic meshes that depend on interface projection
The Team for Advancing Flow Simulation and Modeling developed a technique called stabilized space-time fluidstructure interaction (SSTFSI), which has been used to evaluate several 3D examples such arterial fluid mechanics and parachute aerodynamics (TAFSM). We focus in this article on interface projection techniques that have evolved as complementary methods for addressing the computational challenges brought on by the geometric complexities of the fluid-structure interface. The SSTFSI approach and the study of air-fabric interactions inspired the development of these supplemental methods; nevertheless, they are relevant to other types of FSI applications and may be utilized with other moving-mesh techniques, such as the Arbitrary Lagrangian-Eulerian (ALE) technique. The FSI Geometric Smoo- thing Method (FSI-GST), Homogenized Modeling of Geometric Porosity, split nodal values for pressure at fabric edges, and incompatible meshes at air-fabric interfaces are some of the current supplemental approaches (HMGP). The model's membrane might be stabilized by using split nodal values for pressure at the edges and incompatible meshes at the interfaces, both of which would reduce the resulting structural reaction at the edges. To mitigate the impact of the structure's complex shape on the fluid mechanics mesh, the FSI-GST is implemented. By replacing the geometric permeability with a locally variable \"equivalent,\" the HMGP avoids the difficult details of the underlying geometry.
Journal Article
Comparing Intellectual and Memory Abilities of Older Autistic Adults with Typically Developing Older Adults Using WAIS-IV and WMS-IV
This study aimed to compare cognitive and memory abilities between older adults with and without autism over the age of 50. Twenty-eight individuals with autism and 29 typically developing (TD) older adults took part in the current study. Participants’ cognitive and memory abilities were assessed by WAIS-IV and WMS-IV. Older autistic adults were found to have poorer performance in processing speed and visual working memory, but they performed at a similar level as TD controls in all other domains. Poorer processing speed and visual working memory are also often found to be associated with age-related decline in neurotypical adults. Longitudinal studies are warranted to explore how the combination of ageing and autism affects cognitive functioning in older adults.
Journal Article
Interface projection techniques for fluid–structure interaction modeling with moving-mesh methods
The stabilized space–time fluid–structure interaction (SSTFSI) technique developed by the Team for Advanced Flow Simulation and Modeling (T★AFSM) was applied to a number of 3D examples, including arterial fluid mechanics and parachute aerodynamics. Here we focus on the interface projection techniques that were developed as supplementary methods targeting the computational challenges associated with the geometric complexities of the fluid–structure interface. Although these supplementary techniques were developed in conjunction with the SSTFSI method and in the context of air–fabric interactions, they can also be used in conjunction with other moving-mesh methods, such as the Arbitrary Lagrangian–Eulerian (ALE) method, and in the context of other classes of FSI applications. The supplementary techniques currently consist of using split nodal values for pressure at the edges of the fabric and incompatible meshes at the air–fabric interfaces, the FSI Geometric Smoothing Technique (FSI-GST), and the Homogenized Modeling of Geometric Porosity (HMGP). Using split nodal values for pressure at the edges and incompatible meshes at the interfaces stabilizes the structural response at the edges of the membrane used in modeling the fabric. With the FSI-GST, the fluid mechanics mesh is sheltered from the consequences of the geometric complexity of the structure. With the HMGP, we bypass the intractable complexities of the geometric porosity by approximating it with an “equivalent”, locally-varying fabric porosity. As test cases demonstrating how the interface projection techniques work, we compute the air–fabric interactions of windsocks, sails and ringsail parachutes.
Journal Article
Characteristics of Older Autistic Adults: a Systematic Review of Literature
Autism is a neurodevelopmental condition that affects individuals across their lifetime, though the effects of ageing in older adulthood are poorly understood to date. This systematic review assessed six characteristics in older autistic adults (cognitive functioning, co-occurring difficulties, autism symptom severity, social integration, adaptive functioning, language processing). A total of 41 studies met inclusion criteria, 16 of which included autistic adults with intellectual disability, and three were longitudinal in nature. Findings show differing effects of ageing across the six domains. Factors contributing to discrepancies such as age and IQ differences, methodology and healthy survivor effect are discussed. The need for more longitudinal studies to investigate changes across developmental stages alongside other limitations, future directions and clinical implications are discussed.
Journal Article
Fluid–structure interaction modeling of ringsail parachutes
In this paper, we focus on fluid–structure interaction (FSI) modeling of ringsail parachutes, where the geometric complexity created by the “rings” and “sails” used in the construction of the parachute canopy poses a significant computational challenge. It is expected that NASA will be using a cluster of three ringsail parachutes, referred to as the “mains”, during the terminal descent of the Orion space vehicle. Our FSI modeling of ringsail parachutes is based on the stabilized space–time FSI (SSTFSI) technique and the interface projection techniques that address the computational challenges posed by the geometric complexities of the fluid–structure interface. Two of these interface projection techniques are the FSI Geometric Smoothing Technique and the Homogenized Modeling of Geometric Porosity. We describe the details of how we use these two supplementary techniques in FSI modeling of ringsail parachutes. In the simulations we report here, we consider a single main parachute, carrying one third of the total weight of the space vehicle. We present results from FSI modeling of offloading, which includes as a special case dropping the heat shield, and drifting under the influence of side winds.
Journal Article