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Kinetic parameters sensitive to cognitive activity during walking for diagnosis of Parkinson's disease.
Full text linkParkinson's disease (PD) is a neurodegenerative disorder that affects both motor and cognitive functions. An objective and easily measurable digital marker is crucial for improving the diagnosis and monitoring of PD. Since gait is a complex activity that requires both motor control and cognitive input, this study assumes that kinetic parameters of the foot sensitive to the cognitive load (dual-tasking) for healthy adults can be used to diagnose PD. In this study, walking with a cognitive task has been conducted on healthy subjects, the kinetic parameters have been calculated with algorithms of inverse dynamics in Opensim. Subsequently, the moment-related variables, including the bend and force of the plantar surface, were collected from 13 patients with PD and 32 healthy controls using the wearable system. Statistical analysis of the focused kinetic parameters indicates that the moment of the metatarsophalangeal joint has a significant difference between dual-task walking and single walking. The experimental results demonstrate that features extracted from the bend and force signal of the plantar surface can diagnose PD with an average accuracy of 95.55% with 5-fold cross validation. It demonstrates that kinetic data from the foot captured by wearable sensors can serve as an objective digital marker for PD. [Abstract copyright: © The Author(s), under exclusive licence to Springer Nature B.V. 2026. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
Assessment and maintenance of normal fluid status in older people living in care homes: a scoping review protocol.
Full text linkIntroductionMaintaining normal fluid status is critical to health and well-being. Older people are vulnerable to abnormal fluid status and associated complications, morbidity and mortality. Care home residents are especially vulnerable due to dependence on care home staff, frailty and multiple comorbidities. However, it is unclear what evidence-based assessments and interventions are available to support effective fluid-status management in care homes.Methods and analysisThis article describes a protocol for a scoping review aiming to explore current evidence on assessment and maintenance of normal fluid status in older people living in care homes. It is written in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Reviews guidelines. The literature search will cover 10 clinical databases and include research registries and grey literature, and reference lists of included articles. Screening of sources will comprise two stages: title and abstract and full-text screening. Articles will be managed in Covidence and data charting will use bespoke data extraction forms used to generate a narrative synthesis of results. Screening and data extraction will be completed by two coauthors, blinded to each other's results, with discrepancies adjudicated by a third author when required.Ethics and disseminationAs a scoping review of existing evidence, rather than conducting new research, ethical approval is not required. Dissemination will comprise a peer-reviewed publication, presentation at a national conference focused on care of older people, and local patient and public involvement and engagement groups. We will explore opportunities to develop care home-facing education materials working with our local Applied Research Collaboration.RegistrationOpen Science Framework: https://doi.org/10.17605/OSF.IO/AVS5B
Advanced Adaptive Protection Scheme for Modern Power Grids Using Data‐Driven Non‐Standard Protection and Clustering Techniques
Full text linkThis work aims to introduce an advanced adaptive protection scheme for modern power networks with renewable energy resources and various operational topologies. These topologies increase the difficulty of protecting the power grid as fault current levels changes, potentially causing delayed tripping, miscoordination or unnecessary outages. This study developed 34 network topologies using the IEEE 33‐bus system, incorporating a photovoltaic system (operated under two controllers), two wind turbines (operated under four types) and three battery energy storage systems. These network topologies are clustered using a new data‐driven approach that utilises the overcurrent relay (OCR) setting to deal with the operation variations of different 34 power grid topologies. The data‐driven clustering approach is compared to different clustering approaches, K‐means, K‐medoids and PSO‐based clustering. Principal component analysis and the water cycle algorithm are utilised to identify optimal relay settings using a non‐standard OCR characteristic that adapts to the actual fault level and topologies to achieve minimum tripping time. Overall, the proposed adaptive non‐standard relay scheme outperformed standard approaches and achieved lower tripping times, with reductions of 10% to 25%
A four-year longitudinal study of once weekly multi-joint resistance training and aerobic training vs. resistance training only
Full text linkBackground: This study investigated the effects of a four-year exercise programme on 49 men aged 60 to 82 years, previously naïve to exercise. Participants chose between a combined resistance and aerobic exercise group or a resistance training only group.Methods: The combined group (n=25, age 66 ± 7 years) engaged in a weekly resistance programme featuring seated chest press, seated pull down, and leg press at 60-70% of one repetition maximum, followed by approximately 30 minutes of aerobic exercise at 70-90% maximum heart rate. The resistance training only group (n=24, age 65 ± 5 years) followed a similar resistance programme but included only multi-joint and single-joint exercises, without an aerobic component. Each session lasted 50-60 minutes.Results: Over four years, both groups exhibited significant increases in strength for chest press and leg press (p<.05) with no group differences. Body fat decreased similarly in both groups (p<.001). The combined group showed an increase in relative maximal oxygen uptake (p<.01), whereas the resistance training group experienced a decline (p<.001). Leg power improved in both groups (p<.05) with no significant differences. Grip strength remained unchanged in either group.Conclusions: The study demonstrated that combined resistance and aerobic training, as well as resistance training alone, are equally effective for enhancing upper and lower body muscle strength in older men. However, the combined training approach is more time-efficient and superior for improving aerobic fitness
Employment Destinations and Professional Registration of Dual-Qualified Nurses and Social Workers in England
No full textPurpose: This study explores the employment destinations and professional registration of dual-qualified nurses and social workers in England.Design/methodology/approach: An exploratory cross-sectional survey design was used. An online survey was conducted between July and August 2024 with graduates of integrated Nursing and Social Work programmes in England. Data were analysed using descriptive statistics and thematic analysis.Findings: Eighty-two participants completed the survey. Most participants (85.4%)had never held a role explicitly requiring a dual-qualification, yet 79.3% reported applying their dual-qualification skills in practice. Dual-qualified nurses and social workers were employed in roles across multiple sectors, particularly within integrated care contexts such as learning disability, mental health, and integrated discharge services. Most current roles required Nursing and Midwifery Council (NMC) professional registration (52.4%), with fewer requiring both (25.6%) or Social Work England (SWE) only (18.3%).Practical implications: The findings suggest that dual-qualified nurses and social workers contribute valuable skills across the health and social care workforce, even when not in formally recognised roles. Findings highlight the need for greater recognition of dual-qualified roles within health and social care organisations, and the development of integrated roles that fully utilise the combined skill set of these professionals.Originality/value: This study offers the first empirical insight into the employment destinations and professional registration of dual-qualified nurses and social workers in England. It strongly supports the case for explicitly recognising and promoting dual-qualification pathways as a strategic component of integrated care workforcedevelopment
Electrochemical sensors for diagnosis and monitoring of acute lymphoblastic leukaemia.
Full text linkAcute Lymphoblastic Leukaemia (ALL) is a deadly form of blood cancer which occurs predominantly in children. It represents one of the most prevalent paediatric cancers. Both the diagnosis and monitoring of ALL presents clinicians with significant challenges. Diagnosis and monitoring of such paediatric conditions can be challenging due to the limitations in the patient's ability to communicate symptoms clearly. Early diagnosis is vital for improving the chances of positive outcomes for patients. Similarly rapid, real-time prognostics allows clinicians to adjust treatment in a timely manner. This enhances survival prospects by both early diagnosis and monitoring of relapse and also helps to avoid damage caused by unnecessary excessive and harsh treatment when the patient is in remission. The latter is especially pertinent to young and vulnerable patients. Unfortunately, current diagnostic and prognostic tests for ALL are cumbersome, slow, and require specialised facilities and trained staff. As a consequence, they are neither rapid - nor can they be widely applied. Electrochemical biosensors have the potential to underpin rapid, self-administered, high-frequency, cost-effective and point-of-care monitoring of relevant (protein and nucleic acid) biomarkers. The development of such technologies has the potential to overcome the shortcomings of current ALL diagnostic and prognostic methods. Herein, we review the literature in electrochemical biosensors for ALL diagnostics and prognostics, identifying trends and suggesting promising avenues for future work. [Abstract copyright: Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.
Advanced multi-layer inverse-time relay scheme for enhanced arc-flash mitigation and coordination in distribution networks
Full text linkThis study presents an advanced multi-layer Overcurrent Relay (OCR) protection scheme designed to enhance relay coordination, reduce tripping times, and minimise arc flash risks in distribution networks. Traditional single-layer protection approaches often face limitations, particularly in modern grids that incorporate Distributed Generation (DG). To address these challenges, the proposed scheme employs a flexible, new multi-layer protection approach that enables relay settings to adapt according to the fault and network scenarios. The effectiveness of the advanced scheme is assessed through simulations on a modified CIGRE 14-bus and meshed power networks with various operation modes. Compared to conventional single-layer methods, total relay tripping times are reduced by up to 45.1 %, and incident energy levels decrease by more than 54 %, resulting in smaller hazardous zone requirements for maintenance personnel. These improvements are consistent across all scenarios, highlighting the scheme’s ability to adapt to various operating conditions and grid configurations, particularly as the share of renewable energy continues to increase
Development of The COMBINED approach: Integrating a brief behaviour change intervention supported by a physiotherapist for people with rotator cuff disorders.
Full text linkModifiable lifestyle factors (smoking, inactivity, overweight) could contribute to the onset and persistence of rotator cuff disorders, yet physiotherapy practice rarely addresses them. Brief interventions (BIs) can support behaviour change but are not routinely embedded in musculoskeletal care. To develop The COMBINED approach: a physiotherapist-supported intervention integrating BI's targeting modifiable health behaviours into routine consultations for people with rotator cuff disorders; and to explore how physiotherapists can be supported to deliver it. A theory-, evidence-, and pragmatic-based development process incorporated stakeholder co-design, behavioural theory, and evidence across three workstreams: (1) narrative review of BIs targeting smoking, inactivity, and weight management; (2) four co-design workshops with 26 stakeholders (physiotherapists, patients, experts) to select and adapt a BI and identify key intervention features; (3) theoretical modelling using COM-B, TDF, and BCTTv1 to map barriers/facilitators, select behaviour change techniques, and develop prototype components. Fourteen BIs were identified; Moving Medicine had greatest utility. Barriers included time constraints, limited skills and confidence, and fear of offending patients, contrasting with patients' acceptability of lifestyle conversations. Recommendations included embedding the BI into routine care, scripts, infographics, patient resources, and training. Twelve TDF domains and 20 BCTs informed prototype development comprising: (1) patient-level intervention: a BI (adapted from Moving Medicine) embedded in routine consultations with tailored resources; (2) clinician-level implementation toolkit. The COMBINED approach is the first formally developed intervention supporting integration of BI's within routine consultations for people with rotator cuff disorders and is now ready for feasibility testing. [Abstract copyright: Copyright © 2026 The Authors. Published by Elsevier Ltd.. All rights reserved.
Purulent Skin and Soft Tissue Abscesses: Knowledge and Innovation Arising from a Ritualistic Practice in General Surgery.
No full textSkin and soft tissue abscesses represent a complex and unpredictable subgroup of infections that necessitate urgent surgical intervention to effectively address the source of infection. The management of this patient population is distinctive, predominantly relying on a singular surgical technique.While the acceptance of this surgical practice is well-established, the theoretical and practical impetus to its rationale has not been recognised.A scoping literature review was conducted to explore and acknowledge the gaps in the contemporary understanding of skin and soft tissue abscesses. Beyond the empirical outcomes of surgical practices, a dearth of patient, nursing, clinical and organisational experiences and opinions on what constitutes successful skin and soft tissue abscess management was identified. This doctoral study aimed to liberate these voices and re-evaluate how the effectiveness of managing skin and soft tissue abscesses should be genuinely defined and evolved.Seven qualitative focus group sessions and one interview were conducted to examine the core values and beliefs surrounding the surgical management of skin and soft tissue abscesses. Thematic analysis unveiled causal mechanisms that reflected and feasibly accounted for the behaviours and events explored.Through a critical realism lens, the sessions engaged patients (n = 3), nurses (n = 5), clinicians (n = 6), and National Health Service organisational stakeholders (n = 5). Four key causal mechanisms were identified: (1) The subjective experience influencing perceptions of success; (2) The perception of choice, a conviction of outcome; (3) An institutional constraint of resources obscures skin and soft tissue abscess practice change; and (4) The perceptions of possibility.The findings demonstrated that healthcare perceptions of skin and soft tissue abscesses have deep ties to historical beliefs, influencing patient experiences and highlighting an urgent need to redefine the condition based on contemporary understandings of diagnosis, severity, and outcomes. Institutional influences often provoked clinical passivity, limiting opportunities for nuanced cognition of patient choice and diversities of referral, assessment, and interventional management.This evidence generated revised clinical terminology for assessing, diagnosing, and managing skin and soft tissue abscesses, challenging clinical ritualism, and addressing institutional biases. A novel severity assessment tool and surgical management pathway contribute new knowledge from this evidence, incorporating objective and subjective paradigms and reflecting contemporary patient, professional, and institutional experiences.Skin and soft tissue abscesses should now be actively managed, recognising a spectrum of patient and pathophysiological presentations to inform a contemporary understanding, re-imagine professional practice and reflect modern demographics. Practice, education, training and policy recommendations generated through this research will further foster improved patient care, diversify surgical practice, and adapt institutional culture
Exploring diagnostic radiographers' experiences and understandings of informed consent and capacity assessment during general radiography imaging examinations of persons living with dementia: A qualitative interview study of UK practice.
Full text linkCapacity to consent is a legal and ethical consideration when undertaking medical imaging on those people living with dementia. Capacity refers to an individual's ability to make informed decisions for themselves, and is a necessary requirement for valid consent. Previous research has not provided enough insight into establishing capacity to consent and how to proceed with imaging when capacity is lacking, to properly inform practice or policy. This study aims to explore diagnostic radiographers' experiences and understandings of gaining valid informed consent during general radiography examinations for persons living with dementia. Qualitative design using semi-structured-interviews and thematic analysis. A total of 18 Diagnostic-Radiographers participated. All had experience of providing general medical imaging to persons living with dementia. Findings identified a lack of accessible and transferable policy guidance and training to support radiographers through consent-seeking and capacity-assessment during general radiography examinations with persons living with dementia. Consequently, radiographers reported a lack of confidence and uncertainty assessing capacity and knowing when to make best-interest decisions or seek informed-consent. Furthermore, pressure from referrers, lack of information on requests and the ability to modify techniques led some radiographers to 'push boundaries' and disregard the principles of the Mental-Capacity-Act. Diagnostic radiographers working in general radiography lacked confidence in being able to assess capacity and to know when to seek informed-consent or make a best interest decision on behalf of a person living with dementia. Future research eliciting data from persons living with dementia and their carers is needed to further inform policy and practice. The evidence-based flowchart (RAD-CHECK) can be used support radiographers through the steps required to assess capacity, gain informed-consent or make a best-interest decision for persons living with dementia. [Abstract copyright: Copyright © 2025 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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