• 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. (2018)
      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.; Dobbels, F.; Vrijens, B.; Kardas, P.; Hughes, D.; Ramharter, M. (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 (2017)
      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.
    • 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.
    • Age-differences in the free vertical moment during step descent

      Buckley, John G.; Jones, Stephen F.; Johnson, Louise (2010-02)
      This study utilises a rarely examined biomechanical parameter – the free vertical moment to determine age-related differences in rotational kinetics of the body about the vertical-axis when stepping down from a stationary position. Ten older and 10 young adults completed step-downs from three heights. Free vertical moment impulse and peak during step-initiation double-support and the subsequent step-execution phase, and vertical-axis pelvis angular displacement and velocity at instant of landing were compared. The free vertical moment during double-support was directed away from the intended leadlimb side, producing a change in vertical-axis rotational momentum that moved the lead-limb in a forwards- medial direction about the stationary support/trailing limb during the subsequent step-execution phase. The free vertical moment during step-execution was directed towards the lead-limb side and acted to slow/halt the body’s vertical-axis rotation away from lead-limb side. Free vertical moment impulse and peak during double-support were similar between groups (P > 0.05), but during step-execution were significantly reduced in older adults (P = 0.002). As a result older adults had greater verticalaxis pelvis angular displacement and velocity at instant of landing (directed away from lead-limb side), with significant (P < 0.001) group-by-step height interactions indicating that differences between groups became more pronounced with increasing step-height. These findings highlight that older adults were unable to exert the same vertical-axis control during single-support as young subjects did. Findings also highlight that the analysis of free vertical moment data can be a useful biomechanical tool to highlight age-related differences in how steps/stairs are negotiated.
    • Ageism and death anxiety.

      Middleton-Green, Laura (2014-05-09)
      Laura Middleton-Green, lecturer and researcher in palliative and end of life care, writes about how attitudes to death influence care of the dying.
    • Agreement between routine and research measurement of infant height and weight.

      Bryant, M.; Santorelli, G.; Fairley, L.; Petherick, E.S.; Bhopal, R.S.; Lawlor, D.A.; Tilling, K.; Howe, L.D.; Farrar, D.; Cameron, N.; Mohammed, Mohammed A.; Wright, J.; Born in Bradford Childhood Obesity Scientific Group (2015)
      In many countries, routine data relating to growth of infants are collected as a means of tracking health and illness up to school age. These have potential to be used in research. For health monitoring and research, data should be accurate and reliable. This study aimed to determine the agreement between length/height and weight measurements from routine infant records and researcher-collected data. Methods Height/length and weight at ages 6, 12 and 24 months from the longitudinal UK birth cohort (born in Bradford; n=836–1280) were compared with routine data collected by health visitors within 2 months of the research data (n=104–573 for different comparisons). Data were age adjusted and compared using Bland Altman plots. Results There was agreement between data sources, albeit weaker for height than for weight. Routine data tended to underestimate length/height at 6 months (0.5 cm (95% CI −4.0 to 4.9)) and overestimate it at 12 (−0.3 cm (95% CI −0.5 to 4.0)) and 24 months (0.3 cm (95% CI −4.0 to 3.4)). Routine data slightly overestimated weight at all three ages (range −0.04 kg (95% CI −1.2 to 0.9) to −0.04 (95% CI −0.7 to 0.6)). Limits of agreement were wide, particularly for height. Differences were generally random, although routine data tended to underestimate length in taller infants and underestimate weight in lighter infants. Conclusions Routine data can provide an accurate and feasible method of data collection for research, though wide limits of agreement between data sources may be observed. Differences could be due to methodological issues; but may relate to variability in clinical practice. Continued provision of appropriate training and assessment is essential for health professionals responsible for collecting routine data.
    • All in it together? Community food aid in multi-ethnic context

      Power, M.; Doherty, B.; Small, Neil A.; Teasdale, S.; Pickett, K.E. (2017)
      This paper derives from a study of community food aid in a multi-ethnic, multi-faith city in the North of England. The paper begins to make sense of the diversity of types of food insecurity assistance, examines the potential exclusion of certain groups from receipt of food aid, and explores the relationship between food aid providers and the state. Faith-based food aid is common in the case study area, particularly among food bank provision to the most ‘destitute’ clients. While food aid is adopting service responsibilities previously borne by the state, this does not imply an extension of the ‘shadow state’. Rather, it appears reflective of a pre-welfare state system of food distribution, supported by religious institutions and individual/ business philanthropy, but adapted to be consistent with elements of the ‘Big Society’ narrative. Most faith-based providers are Christian. There is little Muslim provision of (or utilization of) food aid, despite the local demographic context. This raises concerns as to the unintentional exclusion of ethnic and religious groups which we discuss in the concluding sections.