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An Automated Approach to Instrumenting the Up-on-the-Toes Test(s)
Get PDFYesNormal ankle function provides a key contribution to everyday activities, particularly step/stair ascent and descent, where many falls occur. The rising to up-on-the-toes (UTT) 30 second test (UTT-30) is used in the clinical assessment of ankle muscle strength/function and endurance and is typically assessed by an observer counting the UTT movement completed. The aims of this study are: (i) to determine whether inertial measurement units (IMUs) provide valid assessment of the UTT-30 by comparing IMU-derived metrics with those from a force-platform (FP), and (ii) to de-scribe how IMUs can be used to provide valid assessment of the movement dynamics/stability when performing a single UTT movement that is held for 5 s (UTT-stand). Twenty adults (26.2 ± 7.7 years) performed a UTT-30 and a UTT-stand on a force-platform with IMUs attached to each foot and the lumbar spine. We evaluate the agreement/association between IMU measures and measures de-termined from the FP. For UTT-30, IMU analysis of peaks in plantarflexion velocity and in FP's centre of pressure (CoP) velocity was used to identify each repeated UTT movement and provided an objective means to discount any UTT movements that were not completed ‘fully'. UTT movements that were deemed to have not been completed ‘fully' were those that yielded peak plantarflexion and CoP velocity values during the period of rising to up-on-the-toes that were below 1 SD of each participant's mean peak rising velocity across their repeated UTT. The number of UTT movements detected by the IMU approach (23.5) agreed with the number determined by the FP (23.6), and each approach determined the same number of ‘fully' completed movements (IMU, 19.9; FP, 19.7). For UTT-stand, IMU-derived movement dynamics/postural stability were moderately-to-strongly correlated with measures derived from the FP. Our findings highlight that the use of IMUs can provide valid assessment of UTT test(s)
Initial insights into the impact and implementation of Creating Active Schools in Bradford, UK
Get PDFYesFew whole-school physical activity programmes integrate implementation science frameworks within the design, delivery, and evaluation. As a result, knowledge of the key factors that support implementation at scale is lacking. The Creating Active Schools (CAS) programme was co-designed and is underpinned by the Capability, Opportunity, Motivation and Behaviour (COM-B) model and the Consolidated Framework for Implementation Research (CFIR). The study aims to understand the initial impact and implementation of CAS in Bradford over 9 months using McKay's et al.'s (2019) implementation evaluation roadmap.
Focus groups and interviews were conducted with school staff (n = 30, schools = 25), CAS Champions (n = 9), and the CAS strategic lead (n = 1). Qualitative data were analysed both inductively and deductively. The deductive analysis involved coding data into a priori themes based on McKay et al's implementation evaluation roadmap, using a codebook approach to thematic analysis. The inductive analysis included producing initial codes and reviewing themes before finalising.
Identified themes aligned into three categories: (i) key ingredients for successful adoption and implementation of CAS, (ii) CAS implementation: challenges and solutions, and (iv) the perceived effectiveness of CAS at the school level. This included the willingness of schools to adopt and implement whole-school approaches when they are perceived as high quality and aligned with current school values. The programme implementation processes were seen as supportive; schools identified and valued the step-change approach to implementing CAS long-term. Formal and informal communities of practice provided "safe spaces" for cross-school support. Conversely, challenges persisted with gaining broader reach within schools, school staff's self-competence and shifting school culture around physical activity. This resulted in varied uptake between and within schools.
This study provides novel insights into the implementation of CAS, with outcomes aligning to the adoption, reach, and sustainability. Successful implementation of CAS was underpinned by determinants including acceptability, intervention complexity, school culture and school stakeholders' perceived self-efficacy. The combination of McKay's evaluation roadmap and CFIR establishes a rigorous approach for evaluating activity promotion programmes underpinned by behavioural and implementation science. Resultantly this study offers originality and progression in understanding the implementation and effectiveness of whole-school approaches to physical activity.Higher Education Innovation Fund (UKRI), Sport England’s Local Delivery Pilot in Bradford, Bradford District Metropolitan Council via the Living Well ProgrammeResearch Development Fund Publication Prize Award winner, Jun 2023
The power of collaboration: managing complex decisions and risks in project environments
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The radiation dose, clinical and anatomical implications of erect lumbar spine radiography: A single centre pre-post implementation evaluation
Get PDFYesLumbar radiographs remain a common imaging examination despite strategies to reduce their use. Many authors have demonstrated benefits in changing from traditional supine and recumbent lateral projections to a prone and/or erect orientation. Despite evidence of clinical and radiation dose optimisation, widespread adoption of these strategies has stalled. This article describes the single-centre implementation and evaluation of erect PA and lateral projections.
This was an observational study pre- and post-implementation of an erect imaging protocol. Patient BMI, image field size, source image and source object distances and DAP were collected together with assessment of radiographic spinal alignment and disc space demonstration. Effective dose was calculated with organ specific doses.
76 (53.5%) patients were imaged in the supine AP and recumbent lateral position, 66 (46.5%) had erect PA and lateral radiographs. Despite the larger BMI of the erect cohort and similar field sizes, effective dose was lower in the PA position by an average of 20% (p
Machine learning based small bowel video capsule endoscopy analysis: Challenges and opportunities
Get PDFYesVideo capsule endoscopy (VCE) is a revolutionary technology for the early diagnosis of gastric disorders. However, owing to the high redundancy and subtle manifestation of anomalies among thousands of frames, the manual construal of VCE videos requires considerable patience, focus, and time. The automatic analysis of these videos using computational methods is a challenge as the capsule is untamed in motion and captures frames inaptly. Several machine learning (ML) methods, including recent deep convolutional neural networks approaches, have been adopted after evaluating their potential of improving the VCE analysis. However, the clinical impact of these methods is yet to be investigated. This survey aimed to highlight the gaps between existing ML-based research methodologies and clinically significant rules recently established by gastroenterologists based on VCE. A framework for interpreting raw frames into contextually relevant frame-level findings and subsequently merging these findings with meta-data to obtain a disease-level diagnosis was formulated. Frame-level findings can be more intelligible for discriminative learning when organized in a taxonomical hierarchy. The proposed taxonomical hierarchy, which is formulated based on pathological and visual similarities, may yield better classification metrics by setting inference classes at a higher level than training classes. Mapping from the frame level to the disease level was structured in the form of a graph based on clinical relevance inspired by the recent international consensus developed by domain experts. Furthermore, existing methods for VCE summarization, classification, segmentation, detection, and localization were critically evaluated and compared based on aspects deemed significant by clinicians. Numerous studies pertain to single anomaly detection instead of a pragmatic approach in a clinical setting. The challenges and opportunities associated with VCE analysis were delineated. A focus on maximizing the discriminative power of features corresponding to various subtle lesions and anomalies may help cope with the diverse and mimicking nature of different VCE frames. Large multicenter datasets must be created to cope with data sparsity, bias, and class imbalance. Explainability, reliability, traceability, and transparency are important for an ML-based diagnostics system in a VCE. Existing ethical and legal bindings narrow the scope of possibilities where ML can potentially be leveraged in healthcare. Despite these limitations, ML based video capsule endoscopy will revolutionize clinical practice, aiding clinicians in rapid and accurate diagnosis
Caring beyond capacity during the COVID-19 pandemic: resilience and family carers of people with dementia from the IDEAL cohort
No full textYesFamily carers of people with dementia have reported increased caring demands during the COVID-19 pandemic. The aim of this qualitative study was to explore seven family carers’ accounts of dementia caregiving one year into the COVID-19 pandemic in England in relation to carer resilience. Themes described the complex challenges of caring during the pandemic, with interviewees burned out and ‘caring beyond capacity’ due to unmet needs within the caring role, therein highlighting the limitations of building individual resilience only. Timely practical support for carers is essential to protect their well-being and to ward against the potential consequences of carer burnout.Economic and Social Research Council (ESRC) grant ES/V004964/1. Economic and Social Research Council (ESRC) and the National Institute for Health and Care Research (NIHR) grant ES/L001853/2. Alzheimer’s Society, grant number 348, AS-PR2-16-001
Reframing physically active learning as movement-centred pedagogy: a European priority action framework
Get PDFYesPhysically active learning (PAL) has emerged as a promising way of eliciting health and education-based outcomes for pupils. Concurrently, research suggests large variability in how PAL is perceived, operationalized, and prioritized in practice across Europe. Therefore, this study aimed to co-develop a framework for action to support the adoption and implementation of PAL.
Adopting a design thinking approach, 40 international stakeholders representing 13 countries engaged in an idea generation workshop during a two-day PAL international conference. Participants included professionals from research (n = 20), practice (n = 4) and policy (n = 1) or a combination (n = 15). Their experience with PAL ranged from none to 19 years (with an average of 3.9 years). Participants were allocated into one of six heterogeneous and multidisciplinary groups and led through interactive tasks to identify: the landscape for PAL across Europe, barriers to the adoption and implementation of PAL, and key objectives for research, policy and practice to improve the adoption and implementation of PAL. All discussions were audio recorded and prioritized objectives were transcribed verbatim and analysed using inductive qualitative content analysis.
Five interlinked and mutually reinforcing themes were identified: (1) Integration of the health and education paradigms (2) Coherent national policy and decision making (3) Building confident and competent teachers (4) Adopting a whole school approach for PAL (5) Strengthening the evidence base for PAL.
The priority action framework identifies five key areas for action to facilitate PAL adoption and implementation across Europe. Central to the success of border uptake of PAL is the integration of the health and education paradigms. To achieve this aim, reframing PAL as movement-centered pedagogy would provide a more holistic and inclusive perspective.The authors of this manuscript were supported and funded by the European Union ERASMUS + Strategic Partnership Fund as part of the Activating Classroom Teachers project, ACTivate (Grant no 2019-1-N001-KA203-063024)
Prevalence and determinants of anxiety among healthcare workers (HCWs) in Europe during Covid-19
Get PDFYesThe COVID-19 pandemic, whose origin was established to be in China, wreaked havoc across the world infecting and killing huge numbers of people. Healthcare workers (HCWs) were affected in many ways especially mentally. The study aims at establishing how anxiety affected HCWs in Europe.
Methodology: A systematic review study was carried out based on the Prefrred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) using five databases. The search period was from September 27th to December 7, 2021, and 2326 articles were yielded. Of these, 22 met the inclusion criteria. All the data was inputted onto a data extraction sheet and thematic analysis was carried out on the study outcomes to identify themes.
Results: It was established that there was a significant increase in anxiety among HCWs in Europe. It was likewise found that there were non-modifiable (sex and age) and modifiable (nature of work, vulnerability, comorbidities, workload, social factors and geographical location) risk factors for anxiety among the workers. Young female HCWs were found to have a higher prevalence of anxiety compared to male health workers. Anxiety is also associated with other mental health issues as well as suicidal thoughts.
Conclusion: There was a marked increase in anxiety among HCWs in Europe during the COVID-19 pandemic. Mental health during disease emergencies should be a priority in terms of policy among healthcare employers. There is a need for further research in this area of mental health to build more evidence that informs policy
The legal response to cyberstalking in Malaysia
No full textNoIn the past two decades, the Internet has been an integral part of our daily lives. The dependency on the Internet and having unlimited access to modern communication systems has brought numerous benefits for users worldwide. However, as a double-edged sword, such systems has also generated a high degree of risk of victimisation from a myriad of cybercrimes, including cyberstalking. Evidence has indicated that cyberstalking has led to more heinous crimes such as cyber fraud and cyber defamation through data mining and social engineering. Moreover, severe repercussion occurs when the crime transcends into the real world which results in rape and even murder. Given the severe impacts of cyberstalking and the nature of such crime in other Western countries, the perception of the law's adequacy remains vague in the current Malaysian legal landscape. Hence, this paper aims at examining the perception of the criminalisation of cyberstalking in Malaysia, the various motives of cyberstalkers in the commission of such crime and the protection afforded to victims of cyberstalking. The paper will also discuss the legal response to cyberstalking in the United Kingdom and European Union focusing on how these countries govern such crime within their jurisdiction. This paper adopts a qualitative methodology, of which the primary data is generated from semi-structured interviews with the relevant stakeholders and victims. The secondary data are the Communications and Multimedia Act 1998, the Penal Code, books, academic journals, online databases, and other library-based sources. The sampling method in this research is purposive sampling and the qualitative data analysis was conducted through thematic and content analysis, in which the observations and the interview transcripts from the semi-structured interviews were examined. The primary data were triangulated with the semi-structured interview data obtained from an officer from the Ministry of Communication and Multimedia and another officer from the Ministry of Women, Family and Community Development. The findings revealed contradictory views on the effective response of the criminal justice system towards cyberstalking, which explains the under-reporting of such crime. Reports has also highlighted that more than 70 per cent of stalking victims are reluctant to lodge a police report due to the belief that enforcement officers would be unhelpful. The findings highlighted that the under-reporting by victim and under-recording by police combined with frequent unresponsiveness of prosecutors and judges leads to significant barriers for effective criminal justice responses to stalking offences. Also, the motivations of cyberstalkers were evident, such as jealousy and obsession. Furthermore, the stalkers may share traits such as envy, a pathological obsession, including professional or sexual fixation, unemployment or failure with their job or life, and a cruel intention to intimidate or cause others to feel inferior Significantly, the findings illustrate that the current Malaysian legal framework on cyberstalking is deficient in protecting cyberstalking victims, which calls for an urgent need for a review in the Malaysian laws
