• ActEarly: a City Collaboratory approach to early promotion of good health and wellbeing

      Wright, J.; Hayward, A.; West, J.; Pickett, K.; McEachan, R.M.; Mon-Williams, M.; Christie, N.; Vaughan, L.; Sheringham, J.; Haklay, M.; et al. (2019-10-14)
      Economic, physical, built, cultural, learning, social and service environments have a profound effect on lifelong health. However, policy thinking about health research is dominated by the 'biomedical model' which promotes medicalisation and an emphasis on diagnosis and treatment at the expense of prevention. Prevention research has tended to focus on 'downstream' interventions that rely on individual behaviour change, frequently increasing inequalities. Preventive strategies often focus on isolated leverage points and are scattered across different settings. This paper describes a major new prevention research programme that aims to create City Collaboratory testbeds to support the identification, implementation and evaluation of upstream interventions within a whole system city setting. Prevention of physical and mental ill-health will come from the cumulative effect of multiple system-wide interventions. Rather than scatter these interventions across many settings and evaluate single outcomes, we will test their collective impact across multiple outcomes with the goal of achieving a tipping point for better health. Our focus is on early life (ActEarly) in recognition of childhood and adolescence being such critical periods for influencing lifelong health and wellbeing.
    • Active regulator of SIRT1 is required for cancer cell survival but not for SIRT1 activity

      Knight, J.R.P.; Allison, Simon J.; Milner, J. (2013-11-20)
      The NAD(+)-dependent deacetylase SIRT1 is involved in diverse cellular processes, and has also been linked with multiple disease states. Among these, SIRT1 expression negatively correlates with cancer survival in both laboratory and clinical studies. Active regulator of SIRT1 (AROS) was the first reported post-transcriptional regulator of SIRT1 activity, enhancing SIRT1-mediated deacetylation and downregulation of the SIRT1 target p53. However, little is known regarding the role of AROS in regulation of SIRT1 during disease. Here, we report the cellular and molecular effects of RNAi-mediated AROS suppression, comparing this with the role of SIRT1 in a panel of human cell lines of both cancerous and non-cancerous origins. Unexpectedly, AROS is found to vary in its modulation of p53 acetylation according to cell context. AROS suppresses p53 acetylation only following the application of cell damaging stress, whereas SIRT1 suppresses p53 under all conditions analysed. This supplements the original characterization of AROS but indicates that SIRT1 activity can persist following suppression of AROS. We also demonstrate that knockdown of AROS induces apoptosis in three cancer cell lines, independent of p53 activation. Importantly, AROS is not required for the viability of three non-cancer cell lines indicating a putative role for AROS in specifically promoting cancer cell survival.
    • Adaptive gait changes in long-term wearers of contact lens monovision correction

      Chapman, Graham J.; Vale, Anna; Buckley, John G.; Scally, Andy J.; Elliott, David B. (2010)
      Introduction: The aim of the present study was to determine adaptive gait changes in long-term wearers of monovision correction contact lenses by comparing gait parameters when wearing monovision correction to those observed when wearing binocular distance correction contact lenses. Methods: Gait and toe clearance parameters were measured in eleven participants (53.5 ± 4.6 years, median monovision wearing time 5 years) as they repeatedly walked up to and onto a raised surface with either monovision or distance correction. Results: Compared to distance correction, monovision resulted in a large reduction in stereoacuity from 17¿ to 87¿, a slower walking velocity (p = 0.001), a reduced horizontal toe clearance of the step edge (p = 0.035) and, for trials when monovision correction occurred first, a 33% greater variability in vertical toe clearance (p = 0.021). Variability in some gait data was large due to certain study design features and learning effects. Conclusion: A slower walking velocity with monovision correction suggests participants became more cautious, likely as a result of the significantly reduced stereoacuity. The decreased horizontal toe clearance and increased vertical toe clearance variability suggests that monovision correction may cause a greater likelihood of hitting step edges and tripping during everyday gait. Recommended study design features are suggested for future adaptive gait studies to increase the precision of the data and to attempt to minimize the effects of learning from somatosensory feedback.
    • Adaptive gait changes in older people due to lens magnification

      Chapman, Graham J.; Scally, Andy J.; Elliott, David B. (2011)
      Purpose: Intervention trials that reduce visual impairment in older adults have not produced the expected improvements in reducing falls rate. We hypothesised that this may be caused by adaptation problems in older adults due to changes in magnification provided by new spectacles and cataract surgery. This study assessed the effects of ocular magnification on adaptive gait in young and older adults. Methods: Adaptive gait was measured in 10 young (mean age 22.3 ± 4.6 years) and 10 older adults (mean age 74.2 ± 4.3 years) with the participants' habitual refractive correction (0%) and with size lenses producing ocular magnification of ±1%, ±2%, ±3%, and ±5%. Adaptive gait parameters were measured when participants approached and stepped up onto a raised surface. Results: Adaptive gait changes in the young and older age groups were similar. Increasing amounts of magnification (+1% to +5%) led to an increased distance of the feet from the raised surface, increased vertical toe clearance and reduced distance of the lead heel position on the raised surface (p < 0.0001). Increasing amounts of minification (¿1% to ¿5%) led to the opposite of these changes (p < 0.0001). Adaptation to ocular magnification did not occur in the short term in young or older adults. Conclusion: The observed adaptive gait changes were driven by the magnification changes provided by the size lenses. The raised surface appeared closer and larger with magnification and further away and smaller with minification and gait was adjusted accordingly. Magnification may explain the mobility problems some older adults have with updated spectacles and after cataract surgery.
    • Added Value: The Complementary Role of Care Record Analysis and Key Informant Interviews in Understanding Current UK Nursing Home Care for Older Adults

      Williams, Stephen; Downs, Murna G. (2013)
      Reducing hospital admissions of older adults with ambulatory care sensitive conditions is a government priority. Yet relatively little is known about current health care practice in UK nursing homes. We studied approaches to developing understanding of current health care practices in UK nursing homes using a methodology of data-extraction from retrospective care home records combined with key informant interviews. Older adults with an exacerbation of one of 4 ambulatory sensitive conditions that warranted decision making around admission to hospital or continued primary-care led nursing home care were 178 identified and recruited for participation. Care home records were examined using a proforma for data-extraction. These data were combined with care-plans to construct a brief care narrative. The relevant progress notes/daily record of care-given at the time of the decision making were used to construct a visual time-line of events. For those participants who consented, the key multiple stake holders in care were identified: non-professional carers, care-home workers, caring professionals and care-managers. These data were used to generate supplementary trigger questions and topics for semi-structured interviews. This enabled questions raised by the care record to be identified and explored. Implications of the findings for practice and research will be discussed.
    • Addressing ex-offenders inequity in access to healthcare through the provision of a nurse led intervention

      Eshareturi, Cyril (2015-10)
      The current context of offender health in England and Wales indicates that the health needs of ex-offenders are significantly greater than those of the general population with a lack of equity existing between need and supply. The study presented herein is aimed at mapping the ex-offender health pathway towards identifying “touch points” in the community for the delivery of nurse-led interventions. The study was underpinned by the “Silences Framework” which enabled the study to gain theoretically by situating power with ex-offenders. A total of 26 respondents were ranked on the basis of poor health with those scoring the lowest and confirming their ranking through a confirmation of a health condition selected as cases and interviewed over the course of 6 months. These interview narratives were validated by interviewing individuals in the professional networks of ex-offenders and were analysed using the inductive qualitative thematic approach. The study uncovered that ex-offenders were not prepared in prison for the continuity in access to health care in the community on release. Ex-offender’s on-release preparation did not enquire as a matter of procedure on whether an offender was registered with a General Practitioner (GP) or had the agency to register self with a practice on release. Postrelease, the study uncovered a disparity between services, which address the physical health needs of ex-offenders and those which address their mental and substance misuse health needs. Finally, the study identified the site of postrelease supervision as the “touch point,” where a nurse-led intervention could be delivered.
    • Addressing Inclusion: Developing an innovative technology assisted learning package for educators and students for use in a UK Recovery College

      Williams, Stephen (2016)
      Improving Inclusion: Developing An Innovative Technology Assisted Learning Package for a UK Recovery College for Mental Health Service Users. Recovery Colleges in the UK represent a new initiative in providing support and psycho-educational interventions for people with mental health difficulties as part of the 'Recovery movement' (Williams, 2016; Perkins and Slade, 2012). Multiple barriers exist for people with mental health difficulties, particularly among ethnic minorities) in accessing such services and include (but are not limited to) -financial problems, difficulties with transport, condition-related difficulties - (e.g. poor motivation, organisational difficulties or feeling unwell) (Memon et al.,2015). To overcome this we put together a collaborative research project with a technology business partners service users and service providers to develop a new technology assisted learning project to ease access to the College's taught sessions. This involved developing sophisticated video-recording and streaming software and hardware that could 64 live-broadcast college sessions to users in their own homes via a variety of hardware platforms. Users could participate in the taught sessions by means of the video/sound interactive software on tablets, mobile devices or their home computer. The innovative features of the TAL package are described, and the impact this facility had on user participation in the college programme evaluated. Particular attention is paid to the development and partnership nature of the project development. The implications for Recovery College and mental health service provider practice is discussed with particular reference to the potential future wider application of TAL packages to promoting access across other domains of mental health care.
    • Addressing key issues in the consanguinity-related risk of autosomal recessive disorders in consanguineous communities: lessons from a qualitative study of British Pakistanis

      Darr, Aliya; Small, Neil A.; Ahmad, Waqar I-U.; Atkin, K.; Corry, P.C.; Modell, B. (2016-01)
      Currently there is no consensus regarding services required to help families with consanguineous marriages manage their increased genetic reproductive risk. Genetic services for communities with a preference for consanguineous marriage in the UK remain patchy, often poor. Receiving two disparate explanations of the cause of recessive disorders (cousin marriage and recessive inheritance) leads to confusion among families. Further, the realisation that couples in non-consanguineous relationships have affected children leads to mistrust of professional advice. British Pakistani families at-risk for recessive disorders lack an understanding of recessive disorders and their inheritance. Such an understanding is empowering and can be shared within the extended family to enable informed choice. In a three-site qualitative study of British Pakistanis, we explored family and health professional perspectives on recessively inherited conditions. Our findings suggest, first, that family networks hold strong potential for cascading genetic information, making the adoption of a family centred approach an efficient strategy for this community. However, this is dependent on provision of high quality and timely information from health care providers. Secondly, families’ experience was of ill-coordinated and time-starved services, with few having access to specialist provision from Regional Genetics Services; these perspectives were consistent with health professionals’ views of services. Thirdly, we confirm previous findings that genetic information is difficult to communicate and comprehend, further complicated by the need to communicate the relationship between cousin marriage and recessive disorders. A communication tool we developed and piloted is described and offered as a useful resource for communicating complex genetic information.
    • Addressing obesity in Roma communities: a community readiness approach

      Islam, Shahid; Small, Neil A.; Bryant, M.; Yang, T.; Cronin de Chavez, A.; Saville, F.; Dickerson, J. (2019)
      Participation in community programmes by the Roma community is low whilst this community presents with high risk of poor health and low levels of wellbeing. To improve rates of participation in programmes compatibility must be achieved between implementation efforts and levels of readiness in the community. The Community Readiness Model (CRM) is a widely used toolkit which provides an indication of how prepared and willing a community is to take action on specific issues. We present findings from a CRM assessment for the Eastern European Roma community in Bradford, UK on issues related to nutrition and obesity. We interviewed key respondents identified as knowledgeable about the Roma community using the CRM. This approach applies a mixed methodology incorporating readiness scores and qualitative data. A mean community readiness score was calculated enabling researchers to place the community in one of nine possible stages of readiness. Interview transcripts were analysed using a qualitative framework analysis to generate contextual information. An overall score consistent with vague awareness was achieved, which indicates a low level of community readiness. This score suggests there will be a low likelihood of participation in currently available nutrition and obesity programmes. To our knowledge this is the first study to apply the CRM in the Roma community for any issue. We present the findings for each of the six dimensions that make up the CRM together with salient qualitative findings.
    • Adherence of patients to long-term medication: a cross-sectional study of antihypertensive regimens in Austria

      Lotsch, F.; Auer-Hackenberg, L.; Groger, M.; Rehman, K.; Morrison, V.; Holmes, E.; Parveen, Sahdia; Plumpton, C.; Clyne, W.; de Geest, S.; et al. (2015-05)
      Objective The objective of this study was to evaluate adherence and causes for non-adherence to antihypertensive therapy in Austrian patients. A special focus was placed on social parameters and behavioural theories. Methods Patients were invited via advertisements in community pharmacies in Austria to complete an online survey. Inclusion criteria were an age of 18 years or older, a diagnosis of arterial hypertension and a current prescription of antihypertensive medication. Adherence was measured by the four-item Morisky scale. Non-adherence was defined by at least one point in the Morisky scale. Several demographic, social and behavioural parameters were analysed as potential co-variables associated with adherence. Results A total of 323 patients completed the online survey, of which 109 (33.7 %) met the criteria for nonadherence. In a multivariable model, self-efficacy and age were associated with adherence, whereas intention and barriers were linked to non-adherence; 56 patients (17.3 %) were classified as intentionally non-adherent. Conclusion This study demonstrates that non-adherence affects an important proportion of patients in the treatment of arterial hypertension. Young age was a particularly important risk factor for non-adherence, and this patient population is, therefore, in need of special attention. Modifiable risk factors were identified that could help improving the treatment of arterial hypertension and potentially other chronic conditions.
    • Adopt a care home: an intergenerational initiative bringing children into care homes

      Di Bona, L.; Kennedy, S.; Mountain, Gail (2019-07)
      Dementia friendly communities, in which people living with dementia actively participate and those around them are educated about dementia, may improve the wellbeing of those living with dementia and reduce the associated stigma. The Adopt a Care Home scheme aims to contribute towards this by teaching schoolchildren about dementia and linking them with people living with dementia in a local care home. Forty-one children, ten people living with dementia and eight school / care home staff participated in a mixed methods (questionnaires, observations, interviews and focus groups) evaluation to assess the scheme’s feasibility and impact. Data were analysed statistically and thematically. The scheme was successfully implemented, increased children’s dementia awareness and appeared enjoyable for most participants. Findings, therefore, demonstrate the scheme’s potential to contribute towards dementia friendly communities by increasing children’s knowledge and understanding of dementia and engaging people living with dementia in an enjoyable activity, increasing their social inclusion.
    • Adult human epidermal melanocytes for neurodegeneration research.

      Papageorgiou, Nikolaos; Carpenter, Elizabeth; Scally, Andy J.; Tobin, Desmond J. (2008)
      Neuronal models for Alzheimer's disease research frequently have limitations as a result of their nonhuman origin and/or transformed state. Here we examined the potential of readily accessible neural crest-derived human epidermal melanocytes isolated from elderly individuals as a model system for Alzheimer's disease research. The amyloidogenic isoforms of amyloid precursor protein (APP; isoforms APP751/770) and amyloid beta (A¿)1¿40 were detected in epidermal melanocytes using immunocytochemistry and western blotting. Incubation of epidermal melanocytes with aggregated A¿1¿40 peptide caused a concentration-dependent reduction in cell viability, whereas age-matched dermal fibroblasts remained unaffected. These findings suggest that epidermal melanocytes from elderly donors are capable of amyloidogenesis and are sensitive to A¿1¿40 cytotoxicity. Thus, these cells may provide a readily accessible human cell model for Alzheimer's disease research.
    • Advanced Practice: Research Report

      Hardy, Maryann L.; Snaith, Beverly; Edwards, Lisa; Baxter, John; Millington, Paul; Harris, Martine A. (Health & Care Professions Council, 2021-01)
      The Health Care and Professions Council (HCPC) regulates fifteen different professions; some of these are large groups like Physiotherapists and some are much smaller such as Speech and Language Therapists (SLT). Most of the people registered by the HCPC work within their own areas of clinical expertise and defined professional scope of practice. However, an increasing number of registrants are undertaking new or additional roles beyond the traditional scope of practice for the defined profession. These roles are often shared with other medical or health professionals and persons undertaking these roles are often, but not consistently, referred to as Advanced Practitioners. Advanced Practitioners are employed within the NHS across all four countries of the UK and are also employed by private healthcare providers. The roles they undertake vary from the highly specialised (e.g. an advanced podiatrist might specialise in biomechanics) to more general roles with greater professional autonomy and decision-making (e.g. a paramedic working in a GP Practice assessing patients with undifferentiated acute problems). As a result, there is currently no consistency in role title, scope of advanced practice, necessary underpinning education or professional accreditation across the HCPC registered professions. This study was undertaken to explore these issues and seek opinion on the need for additional regulatory measures for persons working at an advanced practice level. NB: For the purposes of this study, advanced practice was considered to encompass all roles, regardless of role title, where the level of practice undertaken was considered to be advanced. Method Three approaches to data collection were undertaken to ensure the differing opinions across all HCPC registered professions, different stakeholders and the four nations of the UK were collected. Data were collected through: 1. A UK wide survey of HCPC registered healthcare professionals; 2. A UK wide survey of organisations delivering AHP & scientific advanced practice education; 3. A series of focus groups and interviews across a range of stakeholder groups. Findings The concept of advanced level practice was not consistently understood or interpreted across the different stakeholder groups. Those participants identifying as working at an advanced practice level undertook a range of activities both within and out with the traditional scope of practice of the registered profession adding a further layer of complexity. Educational support and availability for advanced level practice varied across professional groups and inequity of accessibility and appropriateness of content were raised as concerns. There is no consensus across participant groups on the need for regulation of advanced level practice. Perceived advantages to additional regulation were the consistent and equal educational and employer governance expectations, particularly where multiple professional groups are undertaking the same role, all be it with a differing professional educational foundation and lens. However, while some voices across the participant groups felt regulation was essential to assure practice standards and reduce risk of role title misuse, there was equally a lack of appetite for regulation that inhibited agility to respond to, and reflect, the rapidly changing healthcare environment and evolving scope of advanced level practice. Importantly, no evidence was presented from any participant group that advanced level practice within HCPC regulated professions presents a risk to the public. Conclusion The study data presented in this report reflect the complexity of the concept of advanced practice within the HCPC regulated professions. Much of this is a consequence of the differing speeds of professional role development across healthcare organisations and professional groups, often related to service capacity gaps and locally developed education to support local initiatives. Despite this, there is no clear evidence, based on the findings of this research, that additional regulation of advanced level practice is needed, or desired, to protect the public. However, as the HCPC is one of the few organisations with a UK wide remit, it may have a central role in achieving unification across the 4 nations in relation to the future role expectations, educational standards, and governance of advanced level practice.
    • Advancing the Understanding of the Role of Responsible AI in the Continued Use of IoMT in Healthcare

      Al-Dhaen, Fatema; Hou, Jiachen; Rana, Nripendra P.; Weerakkody, Vishanth J.P. (Information Systems Frontiers, 2021)
      This paper examines the continuous intention by healthcare professionals to use the Internet of Medical Things (IoMT) in combination with responsible artificial intelligence (AI). Using the theory of Diffusion of Innovation (DOI), a model was developed to determine the continuous intention to use IoMT taking into account the risks and complexity involved in using AI. Data was gathered from 276 healthcare professionals through a survey questionnaire across hospitals in Bahrain. Empirical outcomes reveal nine significant relationships amongst the constructs. The findings show that despite contradictions associated with AI, continuous intention to use behaviour can be predicted during the diffusion of IoMT. This study advances the under- standing of the role of responsible AI in the continued use of IoMT in healthcare and extends DOI to address the diffusion of two innovations concurrently.
    • Adverse events in drug administration: a literature review.

      Armitage, Gerry R.; Knapman, H. (2003)
      Discussions between the children's services manager at an National Health Service trust, and a children's nursing lecturer from the trust's partnering university clarified that there was a need to establish a greater understanding of the local circumstances surrounding adverse events in drug administration - particularly when those events involved nurses. Indeed it is claimed that nurses spend up to 40% of their time administering drugs. It was agreed that a collaborative research study, specifically designed to explore the nature of drug administration errors, could inform future trust policies and procedures around both drug administration and error, as well as the various university curricula concerning drug administration. This study, supported by senior management in the trust, and the chair of the local research ethics committee, has commenced. The first part of this study -- an introductory literature review, is presented here. The work of O'Shea [J Clin Nurs (1999)8:496-504] is significant in structuring the review that bears a number of recurring themes. It is not the intention of this literature review to reappraise O'Shea's original critique but to expand on her work, offer a contemporaneous perspective in the light of studies and reports published since 1999, and reset the topic in the context of clinical governance. This literature review has already provided an underpinning framework for a pilot questionnaire to staff who have been involved in drug administration errors and is also the basis for curricular input to preregistration students on the subject of risk management and drug administration. In conclusion, several recommendations about the shape of future research are offered.
    • Affirmative Action in South Africa

      Archibong, Uduak E.; Adejumo, O. (2013)
      Affirmative action policies in South Africa and other countries have been designed to address inequity and discrimination, and to manage a wide range of diversity in all spheres of life, particularly after the end of apartheid in 1994. Years after implementing affirmative action in South Africa, perceptions of its impact or even benefit seem to vary from person to person. This article presents the findings from a study utilizing different data sources including document review, interviews, and a consensus workshop on the perceptions of the impact of affirmative action in South Africa. It is part of a larger European Commission–funded comparative study of positive action measures across countries in North America, the European Union, and South Africa. Participants were drawn from different public and private organizational sectors, racial groups, genders, age groups, and people with disabilities. The analyzed data provided insight into how society might be perceiving and reacting to the operation of affirmative action in South Africa.
    • Affirmative action measures and gender equality: review of evidence, policies, and practices

      Archibong, Uduak E.; Utam, Kingsley U. (Encyclopedia of the UN Sustainable Development Goals. Springer, Cham, 2020)
      The central aim of this chapter is to describe the policy and practice of affirmative action measures. It synthesizes findings from published studies and highlights the rationale, drivers, benefits, beneficiaries, effectiveness, and impacts of affirmative action policies and practices in different countries. The chapter will discuss the possible lessons from these studies and highlight the link between affirmative action policies and practices and contributions to achieving target 5 of the Sustainable Development Goals (SDG).