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Murky waters: the ongoing evolution of vulnerability under section 189 of the Housing Act 1996
Get PDFIn the latest instalment of a long line of Pt VII Housing Act 1996 "vulnerability" cases, Mrs Justice Rose observes—seemingly in jest—that perhaps "old Pereira habits die hard". We agree. In the wake of Hotak and Panayiotou, the judgment in Rother demonstrates the continuing challenge of what HH Judge Luba QC described in the course of oral argument in Johnson 5 as "drinking from the pure waters" of s.189(1)(c) of the Housing Act 1996; avoiding the "dangerous … glossing" of the "primacy of the statutory words" that has characterised the interpretation of "vulnerability" in priority need homelessness assessments. Many of those key problems that characterised the "steady stream" of case law in the Pereira test live on with reference to this new Hotak formulation, albeit in a diluted form. In trying to get back to "those plain words" of s.189(1)(c), the pure waters still look decidedly murky.
In this case comment, we outline the facts and key focus of the court’s decision in Rother, before reflecting on three further issues:
1) the use of external medical advisors;
2) the lack of consideration of s.149 of the Equality Act 2010; and
3) the position in Wales following the Housing (Wales) Act 2014
Analyzing the effect of an arch support functional insole on walking and jogging in young, healthy females
Get PDFBACKGROUND AND OBJECTIVE: The aim of this study was to explore the effectiveness of arch support functional insoles to prevent metatarsalgia. METHOD: Twenty-five healthy females participated in the study. A Vicon motion capture system was used to collect kinematics data of the lower limb. An AMTI force plate was used to record the vertical ground reaction force (GRF), and the Novel Pedar-X System was used to measure foot pressure while subjects wore normal insoles or functional insoles with an arch support during walking and jogging. RESULTS: With the arch support functional insoles, the first metatarsal (FM) region’s contact area was increased and the peak pressure and time-pressure integral of the FM and second and third metatarsal (SATM) were areas decreased. This suggests a lower risk of longitude stress injuries in these areas. The ankle dorsiflexion angle of jogging with the ‘arch support functional insoles’ (RF) and walking with the ‘arch support functional insoles’ (WF) were significantly increased at initial contact and the knee and hip flexion angle of RF and WF were reduced. The peak hip extension angle of WF and RF also declined. The vertical loading rate of RF was lower, which would be beneficial in reducing the risk of lower limb injuries during jogging. CONCLUSIONS: The results demonstrate that arch support functional insoles can be used effectively to prevent and decrease pain and promote a suitable weight-bearing pattern in the foot for promoting the health of young females
A novel behaviour change learning activity for pharmacy undergraduate students
Get PDFObjectives: To engage students in a ‘behaviour change’ learning activity, applying health psychology theory to pharmacy practice in order to help students appreciate the challenges of behaviour change.
Methods: Year 2 pharmacy students selected one behaviour to change and kept a diary for one-week before making changes. Students then received a health psychology lecture on behaviour change models. They instigated their behaviour change and continued to document this in the diary over a further one-week. Diaries were collected after the two-week activity for thematic analysis.
Results: Of the 99 students, 61 (62%) submitted their completed diary, of whom 55 (90%) successfully implemented their behaviour change. These were categorised into four areas: diet, exercise, liquid consumption, and other. The remaining 10% provided reasons for not changing. Ten students (16%) described their behaviour using a psychological theory.
Conclusions: Students engaged well with this novel learning activity, indicated by a high percentage diary completion. They demonstrated a clear appreciation of behaviour change within a real life context and its perceived relevance to pharmacy practice
Natural Perspective: Mapping Visual Space with Art and Science
Get PDFFollowing its discovery in fifteenth-century Italy, linear perspective has often been hailed as the most accurate method of projecting three-dimensional visual space onto a two-dimensional picture plane. However, when we survey the history of European art it is evident that few artists fully complied with its mathematical rules, despite many of them being rigorously trained in its procedures. In this paper, we will consider how artists have actually depicted visual space, and present evidence that images created according to a “natural” perspective (NP) used by artists are judged as better representations of visual space than those created using standard linear (LP) and curvilinear fisheye (FP) projective geometries. In this study, we built a real three-dimensional scene and produced photographs of the scene in three different perspectives (NP, LP and FP). An online experiment in which we asked people to rank the perspectives in order of preference showed a clear preference for NP compared to the FP and LP. In a second experiment, participants were asked to view the real scene and rate each perspective on a range of psychological variables. Results showed that NP was the most preferred and the most effective in depicting the physical space naturally. We discuss the implications of these results and the advantages and limitations of our approach for studying the global metric and geometrical structure of visual space
Frailty: A global measure of the multisystem impact of COPD
Get PDFChronic obstructive pulmonary disease (COPD) is a multisystem disease that resembles the accumulation of multiple impairments seen in aging. A comprehensive geriatric assessment (CGA) captures multisystem deficits, from which a frailty index (FI) can be derived. We hypothesized that patients with COPD would be frailer than a comparator group free from respiratory disease. In this cross-sectional analysis, the CGA questionnaire was completed and used to derive an FI in 520 patients diagnosed with COPD and 150 comparators. All subjects were assessed for lung function, body composition, 6-minute walking distance (6MWD), and handgrip strength. Patients completed validated questionnaires on health-related quality of life and respiratory symptoms. Patients and comparators were similar in age, gender, and body mass index, but patients had a greater mean ± SD FI 0.16 ± 0.08 than comparators 0.05 ± 0.03. In patients, a stepwise linear regression 6MWD (β = −0.43), number of comorbidities (β = −0.38), handgrip (β = −0.11), and number of exacerbations (β = 0.11) were predictors of frailty (all p < 0.01). This large study suggests patients with COPD are frailer than comparators. The FI derived from the CGA captures the deterioration of multiple systems in COPD and provides an overview of impairments, which may identify individuals at increased risk of morbidity and mortality in COPD
Illiquidity and volatility spillover effects in equity markets during and after the global financial crisis: An MEM approach
Get PDFEven though the volatility spillover effects in global equity markets have been documented extensively, the transmission of illiquidity across national borders has not. In this paper, we propose a multiplicative error model (MEM) for the dynamics of illiquidity. We empirically study the illiquidity and volatility spillover effects in eight developed equity markets during and after the recent financial crisis. We find that equity markets are interdependent, both in terms of volatility and illiquidity. Most markets show an increase in volatility and illiquidity spillover effects during the crisis. Furthermore, we find volatility and illiquidity transmission are highly relevant. Illiquidity is a more important channel than volatility in propagating the shocks in equity markets. Our results show an overall crucial role for illiquidity in US markets in influencing other equity markets' illiquidity and volatility. These findings are of importance for policy makers as well as institutional and private investors
Early initiation of post-sternotomy cardiac rehabilitation exercise training (SCAR): study protocol for a randomised controlled trial and economic evaluation
Get PDFIntroduction: Current guidelines recommend abstinence from supervised cardiac rehabilitation (CR) exercise training for 6 weeks post-sternotomy. This practice is not based on empirical evidence, thus imposing potentially unnecessary activity restrictions. Delayed participation in CR exercise training promotes muscle atrophy, reduces cardiovascular fitness and prolongs recovery. Limited data suggest no detrimental effect of beginning CR exercise training as early as 2 weeks post-surgery, but randomised controlled trials are yet to confirm this. The purpose of this trial is to compare CR exercise training commenced early (2 weeks post-surgery) with current usual care (6 weeks post-surgery) with a view to informing future CR guidelines for patients recovering from sternotomy.
Methods and analysis: In this assessor-blind randomised controlled trial, 140 cardiac surgery patients, recovering from sternotomy, will be assigned to 8 weeks of twice-weekly supervised CR exercise training commencing at either 2 weeks (early CR) or 6 weeks (usual care CR) post-surgery. Usual care exercise training will adhere to current UK recommendations. Participants in the early CR group will undertake a highly individualised 2–3 week programme of functional mobility, strength and cardiovascular exercise before progressing to a usual care CR programme. Outcomes will be assessed at baseline (inpatient), pre-CR (2 or 6 weeks post-surgery), post-CR (10 or 14 weeks post-surgery) and 12 months. The primary outcome will be change in 6 min walk distance. Secondary outcomes will include measures of functional fitness, quality of life and cost-effectiveness.
Ethics and dissemination: Recruitment commenced on July 2017 and will complete by December 2019. Results will be disseminated via national governing bodies, scientific meetings and peer-reviewed journals.
Trial registration number: NCT03223558; Pre-results
Cardiovascular response to prescribed detraining among recreational athletes
Get PDFExercise-induced cardiac remodeling (EICR) and the attendant myocardial adaptations characteristic of the athlete's heart may regress during periods of exercise reduction or abstinence. The time course and mechanisms underlying this reverse remodeling, specifically the impact of concomitant plasma volume (PV) contraction on cardiac chamber size, remain incompletely understood. We therefore studied recreational runners (n=21, aged 34 {plus minus} 7 years; 48% male) who completed an 18-week training program (~7 h.w-1) culminating in the 2016 Boston Marathon after which total exercise exposure was confined to 1 hour) for 8 weeks. Cardiac structure and function, exercise capacity, and PV were assessed at peak fitness (10-14 days before) and at 4- and 8-weeks post marathon. Mixed linear modeling adjusting for age, sex, VO2peak and marathon finish time was used to compare data across time points. Physiologic detraining was evidenced by serial reductions in treadmill performance. Two distinct phases of myocardial remodeling and hematologic adaptation were observed. After 4 weeks of detraining, there were significant reductions in PV (Δ -6.0%, P<0.01), left ventricular (LV) wall thickness (Δ -8.1%, <0.05), LV mass (Δ -10.3%, P<0.001), and right atrial area (Δ -8.2%, P<0.001). After 8 weeks of detraining, there was a significant reduction in right ventricle chamber size (end-diastolic area Δ = -8.0%, P <0.05) without further concomitant reductions in PV or LV wall thickness. Abrupt reductions in exercise training stimulus result in a structure-specific time course of reverse cardiac remodeling that occurs largely independently of PV contraction
Development and initial validation of a rock climbing craving questionnaire (RCCQ)
Get PDFConceptual similarities have been identified between experiences of extreme sports athletes and those with drug and behavioural addictions. Evidence suggests rock climbers experience craving and other withdrawal-like states when abstinent from their sport. However, no studies have attempted to quantitatively measure the craving experienced by participants of any extreme sports. Such a measure could allow a greater understanding of the craving experienced by extreme sports athletes and a comparison of these across sports (e.g., surfing) and activities (e.g., drug-use). Therefore, using validated craving measures as a template, the aim of the two studies outlined here was to design and preliminarily validate a subjective multidimensional inventory that could be used to measure craving in the sports of rock-climbing and mountaineering (“RCCQ”). The aim of the first study was to investigate the factor structure of a preliminary measure of craving. Climbers (n = 407) completed the RCCQ. A 3-factor model explained 53.65% of the total variance in item scores. All 3 factors comprised 5 items each, which were conceptually labelled as “urge to climb” “negative reinforcement” and “positive reinforcement”. The aim of the second study was to validate the 15-item 3-factor RCCQ resulting from study one using confirmatory factor analysis. Climbers (n = 254) completed the questionnaire under a climbing-related cue condition or a cue-neutral condition. Confirmatory factor analysis (CFA) revealed a good model fit and that all individual parameter estimates were significant and standard errors were within reasonable limits once item 13 was removed from Factor 1. Study one supports the multi-dimensional nature of rock climbing craving and shows parallels with substance-related craving in reflecting intention and positive (desire) and negative (withdrawal) reinforcement. Study two confirms this factor structure and gives initial validation to the measure with evidence that these factors are sensitive to cue exposure. Given the preliminary nature of the data, any practical implications are tentative. However, if as shown here, craving for climbing (and potentially other extreme sports) is similar to that experienced by drug-users and addicts, there is the potential that climbing and other extreme sports could be used as a replacement therapy for drug users
Reliability of Sprint Acceleration Performance and Three Repetition Maximum Back Squat Strength in Hurling Players
Get PDFThe purpose of this study was to estimate the inter-day reliability of 5, 10 and 20-meter sprint time and three repetition maximum back squat strength in male hurling players. Eighteen male hurling players volunteered to participate and performed 20- meter sprint trials and a three repetition maximum back squat strength test at each test session, on three separate occasions, a minimum of 48 hours apart. Participants performed three sprints over 20-meters, including split times at 5 and 10-meters. The three repetition back squat strength test was performed after the sprint test. The results displayed acceptable levels of reliability for sprint performance times (Intra class correlation coefficient single measure range: 0.76-0.89; Coefficient of variance range: 1.0 – 2.0%) and absolute and relative three repetition maximum back squat strength (Intra class correlation coefficient single measure: 0.98; CV 0.8%). Furthermore, sprint performance times and three repetition maximum back squat strength measures estimated feasible minimum a priori sample sizes from limits of agreement (5-meter:0.01 ± 0.08 s; 10-meter:-0.01 ± 0.12; 20-meter:-0.007 ± 0.15s; three repetition maximum (kg): 1.11 ± 4.19kg; three repetition maximum (kg/BW): 0.01 ± 0.06) random error therefore showing acceptable reliability. Sprint performance over 5, 10 and 20-meters and three repetition maximum back squat strength are reliable measures in male hurling players and can be used to estimate feasible minimum a priori sample sizes for sport science research