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Recipient perspectives on the impact of home adaptations in later life in England
Get PDFThe ability for adults to make changes to their home environments as they age to better suit their needs is of increasing importance. It is crucial that the full gamut of impacts from adaptations is understood in order to facilitate comprehensive evaluations which can fully capture their utility. Most previous studies in the field have used a quantitative methodology. Drawing on qualitative interviews, with some informed by wearable camera data, we explore perspectives on the impact of home adaptations from recipients aged 65 and over (n = 30). These are discussed around five themes: restorative outcomes; preventative outcomes; social outcomes; impacts on others; and home perceptions. The research emphasises several under-explored outcomes from adaptations including impacts related to social participation, care provision, relocation, perceptions of the home, service awareness and other household members. We argue that any future evaluation framework needs to comprehensively capture potential outcomes based on the lived experience of recipients in order to fully appreciate both negative and positive impacts from home adaptations
Free-living Monitoring of Ambulatory Activity after Treatments for Lower Extremity Musculoskeletal Cancers using an Accelerometer-based Wearable – A New Paradigm to Outcome Assessment in Musculoskeletal Oncology?
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Ambulatory activity (walking) is affected after sarcoma surgery yet is not routinely assessed. Small inexpensive accelerometers could bridge the gap. Study objectives investigated, whether in patients with lower extremity musculoskeletal tumours: (A) it was feasible to conduct ambulatory activity assessments in patient’s homes using an accelerometer-based wearable (AX3, Axivity). (B) AX3 assessments produced clinically useful data, distinguished tumour sub-groups and related to existing measures.
Methods
In a prospective cross-sectional pilot, 34 patients with musculoskeletal tumours in the femur/thigh (19), pelvis/hip (3), tibia/leg (9), or ankle/foot (3) participated. Twenty-seven had limb-sparing surgery and seven amputation. Patients were assessed using a thigh-worn monitor. Summary measures of volume (total steps/day, total ambulatory bouts/day, mean bout length), pattern (alpha), and variability (S2) of ambulatory activity were derived.
Results
AX3 was well-tolerated and feasible to use. Outcomes compared to literature but did not distinguish tumour sub-groups. Alpha negatively correlated with disability (walking outside (r=–418, p = 0.042*), social life (r=–0.512, p = 0.010*)). Disability negatively predicted alpha (unstandardised co-efficient= −0.001, R2=0.186, p = 0.039*).
Conclusions
A wearable can assess novel attributes of walking; volume, pattern, and variability after sarcoma surgery. Such outcomes provide valuable information about people’s physical performance in their homes, which can guide rehabilitation.
Implications for rehabilitation
Routine capture of ambulatory activity by sarcoma services in peoples’ homes can provide important information about individuals “actual” physical activity levels and limitations after sarcoma surgery to inform personalised rehabilitation and care needs, including timely referral for support.
Routine remote ambulatory monitoring about out of hospital activity can support personalised care for patients, including identifying high risk patients who need rapid intervention and care closer to home.
Use of routine remote ambulatory monitoring could enhance delivery of evidence-based care closer to peoples’ homes without disrupting their daily routine and therefore reducing patient and carer burden.
Collection of data close to home using questionnaires and objective community assessment could be more cost effective and comprehensive than in-hospital assessment and could reduce the need for hospital attendance, which is of importance to vulnerable patients, particularly during the Covid-19 pandemic
Exploring how a disability sport charity utilises exchange relationships with external organisations to sustain operations in times of lockdown
Get PDFNational lockdowns exacerbated the inequalities that many disabled people faced in accessing and engaging in sport and physical activity. Like many organizations, disability sport and physical recreation-focused charities were constrained in their ability to deliver and sustain their services during such periods. This study explored the exchange relationships between a disability sport charity and its existing and prospective business clients as the former rolled key elements of its provision online. Resource mobilization theory was employed as a framework by which to identify key resource types and mechanisms underpinning the exchanges between the businesses and the charity. Semi-structured interviews with participants from eight businesses were conducted to understand the dynamics of such resource exchange. Moral resources featured prominently in participants’ accounts, particularly in relation to the legitimacy of the charity and authenticity of its delivery, with human resources also receiving much attention due to facilitators’ engaging delivery styles. Overall, the charity was able to extend its organizational mission of increasing inclusion in physical activity beyond its own programs via businesses through which it shares exchange relationships, emphasising the importance of such relationships both during and beyond lockdown periods
Visible Policing: Uniforms and the (Re)Construction of Police Occupational Identity
Get PDFThis article contributes to contemporary criminological debates on police visibility by exploring the relationship between police uniforms, artefacts and occupational identity. The article is influenced by visual criminology and semiotics and draws on elicitation interviews with officers and staff from four English police services. Participants were asked to bring with them an object or image that they identified as being an important expression of their occupational identity, which was then discussed. Most often objects or images were associated with their uniform. Findings are presented in relation to the visual symbolism, iconography and performativity of uniforms and related material artefacts. Participants drew upon visual representations in making sense of positive and negative aspects of their role and in defending their occupational identity in the light of perceived external challenges, such as reductions in police numbers and threats of violence and danger. It is argued that the communicative properties of this material culture play an important symbolic role in the self-legitimation and professional identity of police work
How do looking patterns, anti-fat bias, and causal weight attributions relate to adults’ judgements of child weight?
Get PDFPrevailing weight-normative approaches to health pressure adults to visually categorise children’s weight, despite little understanding of how such judgements are made. There is no evidence this strategy improves child health, and it may harm children with higher weights. To understand decision-making processes and identify potential mechanisms of harm we examined perceptual and attitudinal factors involved in adults’ child weight category judgements. Eye movements of 42 adults were tracked while categorizing the weight of 40 computer-generated images of children (aged 4–5 & 10–11 years) varying in size. Questionnaires assessed child-focused weight bias and causal attributions for child weight. Participants’ eye movement patterns resembled those previously reported for adult bodies. Categorisation data showed a perceptual bias towards the ‘mid-range’ category. For higher weight stimuli, participants whose category judgements most closely matched the stimulus’s objective weight had higher child-focused anti-fat bias and weaker genetic attributions for child weight – i.e,. adults who ‘label’ higher weight in children in line with BMI categories report more stigmatising beliefs about such children, suggesting a possible mechanism of harm. Overall, adults’ judgements reflect both unalterable perceptual biases and potentially harmful attitudinal factors, calling into question the feasibility and appropriateness of public health efforts to promote visual child weight categorisation
Nonlinear damping in micromachined bridge resonators
Get PDFThis study presents a thorough theoretical and experimental investigation on the nonlinear damping of in-plane micromachined electromechanical resonators. More specifically, experiments are conducted on an electrically actuated bridge resonator and the primary resonance response of the system is obtained at various AC and DC voltages. A nonlinear theoretical model is developed using the Euler-Bernoulli beam theory while accounting for the geometric, electrostatic (including fringing field effect), and damping nonlinearities. Two damping models are considered in the theoretical model; the Kelvin-Voigt model, which for this system is a nonlinear damping model due to the presence of geometric nonlinearities. The second damping model consists of linear, quadratic, and cubic damping terms. A high-dimensional discretisation is performed, and the nonlinear dynamics of the resonator are examined in detail in the primary resonance regime by constructing the frequency response diagrams at various AC and DC voltages. Thorough comparisons are conducted between the experimental data and the theoretical results for different damping conditions. It is shown that the micro resonator displays strong nonlinear damping. Detailed calibration procedures for the nonlinear damping models are proposed and the advantages and disadvantages of each nonlinear damping model are discussed
Randomized controlled trials of mental health nurse-delivered interventions: A systematic review
Get PDFAccessible Summary: What is known on the subject?: Well conducted randomized controlled trials provide the highest level of evidence of effectiveness of healthcare interventions, including those delivered by mental health nurses. Trials have been conducted over the years but there has not been a comprehensive review since 2005, and never one including studies conducted outside the UK. What the paper adds to existing knowledge?: The paper provides a comprehensive overview of results from randomized controlled trials of mental health nurse‐delivered interventions conducted in the UK, Ireland, US, Australia, New Zealand, or Canada and reported 2005 to 2020. It highlights that the trial evidence is limited and offers only partial evidence for interventions that are central to mental health nursing practice. What are the implications for practice?: Much mental health nursing practice is not supported by the highest level trial evidence. Mental health nurses need to carefully select evidence on which to base their practice both from the mental health nursing literature and beyond. Mental health nurses and other stakeholders should demand greater investment in trials to strengthen the evidence base. Abstract: Introduction: Nurses are the largest professional disciplinary group working in mental health services and have been involved in numerous trials of nursing‐specific and multidisciplinary interventions. Systematic appraisal of relevant research findings is rare. Aim: To review trials from the core Anglosphere (UK, US, Canada, Ireland, Australia, New Zealand) published from 2005 to 2020. Method: A systematic review reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta‐Analyses. Comprehensive electronic database searches were conducted. Eligible studies were randomized controlled trials of mental health nurse‐delivered interventions conducted in relevant countries. The risk of bias was independently assessed. Synthesis involved integration of descriptive statistics of standardized metrics and study bias. Results: Outcomes from 348 between‐group comparisons were extracted from K = 51 studies (N = 11,266 participants), Standardized effect sizes for 68 (39 very small/small, 29 moderate/large) statistically significant outcomes from 30 studies were calculable. All moderate/large effect sizes were at risk of bias. Discussion: Trial evidence of effective mental health nurse‐delivered interventions is limited. Many studies produced few or no measurable benefits; none demonstrated improvements related to personal recovery. Implications for Practice: Mental health nurses should look beyond gold standard RCT evidence, and to evidence‐based interventions that have not been trialled with mental health nurse delivery
Autoethnography: a personal reflection on the work of the family bar in the North of England
Get PDFThis study offers a personal reflection on 18 months at the Family Bar. It provides a unique perspective on a family justice system, which despite acute pressure has retained some of the most compassionate professionals who despite severe cuts to funding, and lack of resources, continue to work efficiently and effectively and with good humour, under stress. The authors are experienced practising lawyers who have published extensively in the area of family law relating to children and family justice. This experience, coupled with the methodological approach of autoethnography, provides a distinct perspective to which academics and practitioners may relate. The aim of this paper is to reflect upon the impact of recent changes in family justice on barristers working in both private and public law family cases
Finding Generative Rules in Settlements and Houses by Means of an Ideographic Language
Get PDFThis research revisits an early space syntax method of ideographic representation which was proposed by Hillier and his colleagues in the 1970s. The method provided an effective way of capturing syntactic relations of enclosure in settlements and houses in its compact format but has not gained the attention it deserves in the field of morphological research. Taking advantage of its power of compressed description, we analyse architectural plans of Korean vernacular houses from the fifteenth to the twentieth century. Tracing the 600-years transformation process by means of a series of ideographic formulae, we investigate the changing patterns of their layout and reveal the genotypical elements shared by a wide variety of housing types. By translating spatial relations to simple linguistic descriptions, the ideographic method enables not only an economic way of representing built environment but also a deductive way of finding generative rules in it
Nutritional Modulation of Sleep Latency, Duration, and Efficiency: A Randomized, Repeated-Measures, Double-Blind Deception Study
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This study aimed to test the hypothesis that a novel nutritional blend composed of tryptophan, glycine, magnesium, tart cherry powder, and l-theanine enhances subjective and objective measures of sleep during free living conditions.
Methods
In a randomized, repeated-measures crossover and double-blind deception design, participants (n = 9 males and 7 females, age = 24 ± 3 yr, body mass = 69.8 ± 11.6 kg, stature = 170.8 ± 9.1 cm) completed a 3-d familiarization period, followed by 3-d intervention and placebo trials. Subjective Pittsburgh Quality Sleep Index, Core Consensus Sleep Diary, and Karolinska Sleepiness Scale survey tools, alongside objective actigraphy measures of sleep, were assessed, with daily nutritional intake, activity, and light exposure standardized between trials. Participants provided daily urine samples for assessment of targeted and untargeted metabolomes.
Results
The intervention trial reduced sleep onset latency (−24 ± 25 min; P = 0.002), increased total sleep time (22 ± 32 min; P = 0.01), and increased sleep efficiency (2.4% ± 3.9%; P = 0.03), while also reducing morning sleepiness (P = 0.02). Throughout the study, 75% of participants remained blinded to sleep assessment as a primary outcome measure, with 56% subjectively indicating improved sleep during the intervention trial. Metabolomic analysis highlighted several significantly altered metabolomes related to sleep regulation between trials, inclusive of 6-sulfatoxymelatonin, d-serine, and l-glutamic acid.
Conclusions
Data demonstrate that using the proposed blend of novel nutritional ingredients during free living conditions reduced sleep onset latency, increased total sleep duration, and increased sleep efficiency, leading to reduced perceptions of morning sleepiness. These effects may be mediated by the upregulation of key metabolites involved in the neurophysiological modulation of the sleep/wake cycle