• 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.; et al. (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.
    • 'All the world's a stage': Accounting for the dementia experience - insights from the IDEAL study

      Hillman, A.; Jones, I.R.; Quinn, Catherine; Nelis, S.M.; Lamont, R.A.; Clare, L. (2020-10)
      Qualitative dementia research emphasises the importance of recognising the voice of the person with dementia. However, research imbued with a politics of selfhood, whereby individuals are called upon to give coherence to experience and emotion, jars with representations of dementia as a gradual decline in capacity. Moreover, it reinforces an assumption that there is an essential experience that can be accessed through different methods. Drawing on Atkinson and Silverman, we view the interview not as confessional but rather as an outcome of social interaction. This paper draws on qualitative interviews from the Improving the Experince of Dementia and Enhancing Active Life (IDEAL) study, to focus specifically on the forms of accounting and storytelling of people living with dementia and how these are produced through the course of the interview encounter. Extracts from our interviews highlight key aspects of this interactional process: (a) social conventions and temporality, (b) self presentation and identity work, (c) accounts and wider cultural meanings. To conclude, we suggest that qualitative research with people with dementia requires a reframing of both the interview encounter and interpretive practices.
    • Allura Xper cardiac system implementation of automatic dose rate control

      Gislason-Lee, Amber J.; Hoornaert, B.; Davies, A.G.; Cowen, A.R. (2011)
    • Altered Mental States

      McClelland, Gabrielle T.; Williams, Stephen (2016)
      The aim of this chapter is to provide an overview of ASC arising from varied origins. This chapter includes case studies of altered conscious states which aid in linking theory to clinical practice. In the first section we introduce the concept of consciousness and elaborate further on altered states of consciousness. In the second section physiologically induced ASC will be outlined and discussed with reference to situations that nurses may frequently encounter. The third section will focus on psychosis, hallucinations and delusions. These are considered exemplars of ASC, here we explore and evaluate cognitive psychology’s contribution to accounting for the complex phenomenology of the unusual experiences of psychosis. The final section focuses of ASC that result from intention, i.e. as a consequence of alcohol or drug use. Psychological theories, associated psychological issues, and supportive evidence based interventions will be discussed.
    • Alzheimer Europe's position on involving people with dementia in research through PPI (patient and public involvement)

      Gove, Dianne M.; Diaz-Ponce, A.; Georges, J.; Moniz-Cook, E.; Mountain, Gail; Chattat, R.; Øksnebjerg, L.; The European Working Group of People with Dementia (2017)
      This paper reflects Alzheimer Europe’s position on PPI (patient and public involvement) in the context of dementia research and highlights some of the challenges and potential risks and benefits associated with such meaningful involvement. The paper was drafted by Alzheimer Europe in collaboration with members of INTERDEM and the European Working Group of People with Dementia. It has been formally adopted by the Board of Alzheimer Europe and endorsed by the Board of INTERDEM and by the JPND working group ‘Dementia Outcome Measures - Charting New Territory’. Alzheimer Europe is keen to promote the involvement of people with dementia in research, not only as participants but also in the context of PPI, by generating ideas for research, advising researchers, being involved in consultations and being directly involved in research activities. This position paper is in keeping with this objective. Topics covered include, amongst others, planning involvement, establishing roles and responsibilities, training and support, managing information and input from PPI, recognising the contribution of people with dementia involved in research in this way, promoting and protecting the rights and well-being of people with dementia, training and support, and promoting an inclusive approach and the necessary infrastructure for PPI in dementia research.
    • Ambient air pollution and low birthweight: a European cohort study (ESCAPE)

      Pedersen, M.; Giorgis-Allemand, L.; Bernard, C.; Aguilera, I.; Andersen, A.N.; Ballester, F.; Beelen, R.M.J.; Chatzi, L.; Cirach, M.; Danileviciute, A.; et al. (2013)
      Ambient air pollution has been associated with restricted fetal growth, which is linked with adverse respiratory health in childhood. We assessed the effect of maternal exposure to low concentrations of ambient air pollution on birthweight. We pooled data from 14 population-based mother-child cohort studies in 12 European countries. Overall, the study population included 74-178 women who had singleton deliveries between Feb 11, 1994, and June 2, 2011, and for whom information about infant birthweight, gestational age, and sex was available. The primary outcome of interest was low birthweight at term (weight <2500 g at birth after 37 weeks of gestation). Mean concentrations of particulate matter with an aerodynamic diameter of less than 2·5 μm (PM2·5), less than 10 μm (PM10), and between 2·5 μm and 10 μm during pregnancy were estimated at maternal home addresses with temporally adjusted land-use regression models, as was PM2·5 absorbance and concentrations of nitrogen dioxide (NO2) and nitrogen oxides. We also investigated traffic density on the nearest road and total traffic load. We calculated pooled effect estimates with random-effects models. A 5 μg/m3 increase in concentration of PM2·5 during pregnancy was associated with an increased risk of low birthweight at term (adjusted odds ratio [OR] 1·18, 95% CI 1·06-1·33). An increased risk was also recorded for pregnancy concentrations lower than the present European Union annual PM2·5 limit of 25 μg/m3 (OR for 5 μg/m3 increase in participants exposed to concentrations of less than 20 μg/m3 1·41, 95% CI 1·20-1·65). PM10 (OR for 10 μg/m3 increase 1·16, 95% CI 1·00-1·35), NO2 (OR for 10 μg/m3 increase 1·09, 1·00-1·19), and traffic density on nearest street (OR for increase of 5000 vehicles per day 1·06, 1·01-1·11) were also associated with increased risk of low birthweight at term. The population attributable risk estimated for a reduction in PM2·5 concentration to 10 μg/m3 during pregnancy corresponded to a decrease of 22% (95% CI 8-33%) in cases of low birthweight at term. Exposure to ambient air pollutants and traffic during pregnancy is associated with restricted fetal growth. A substantial proportion of cases of low birthweight at term could be prevented in Europe if urban air pollution was reduced.
    • The ambulance service advanced practitioner's role in supporting care homes: a qualitative study of care staff experiences

      Harvey, C., Froggatt, S., Lightowler, B. and Hodge, A.,; Harvey, C.; Froggatt, S.; Lightowler, Bryan; Hodge, A. (Mark Allen Group, 2021-08-02)
      The demand from care homes on NHS services continues to rise, with little evidence of ambulance service contribution in this area. The Yorkshire Ambulance Service provides an advanced practitioner model to support care homes in Sheffield, as an alternative to calling 999. This study investigated the experiences and needs of the care home staff who use the ambulance service advanced practitioner model. This qualitative study conducted semi-structured, face-to-face interviews with 19 staff members from 10 different care home settings. Thematic analysis using a combination of NVivo and manual coding was undertaken. The three key themes from the interviews were variations in service demand, the service user’s expectations and experience, and benefits to residents. Participants reported that good community services reduced the need to call 999, empowering carers to support residents to remain in the community. Care homes require comprehensive services that meet their needs. The advanced practitioner model provided by the ambulance service supports this, preventing unnecessary 999 calls and fitting with other community service provision.
    • An ecological approach to seeking and utilising the views of young people with intellectual disabilities in transition planning

      Small, Neil A.; Raghavan, R.; Pawson, Nicole (2013)
      Transition planning using a person-centred approach has, in the main, failed to shape service provision. We offer an alternative based on an ecological understanding of human development linked to public health approaches that prioritise whole system planning. A total of 43 young people with intellectual disabilities, in Bradford, England, who were approaching transition from school or college were recruited to a qualitative study. Their ethnic breakdown was as follows: 16 white British, 24 Pakistani, 2 Bangladeshi and 1 Black African. Each young person was interviewed twice, at recruitment and a year later, to observe any changes in their social networks during transition. Interviews were undertaken with a semi-structured interview schedule and with the pictorial approach of Talking Mats. Both the networks the young people live within, and their sense of what the future might hold for them, are described and linked to Bronfenbrenner's ecological model of human development. The importance of the family and school is emphasised, as is the absence of engagement in leisure activities and work. Transition planning needs to start with mapping the systems individuals live within, areas of strength should be supported and parts of the system, which are not fit for purpose for these young people, should be prioritised for interventions.
    • An IndianTragedy, an Indian Solution : Perspective of Managing Service Quality in Emergency Medical Services in India

      McIntosh, Bryan; Sheppy, B.; Rane, S. (2012)
      India, the world’s largest democracy and second most populous country, is in the midst of an economic boom with gross domestic product growth averaging nearly 8% over the past several years despite a worldwide recession. The World Health Organization (WHO) has predicted that trauma case related deaths in India will move from ninth position up to the third position by 2020. The organization structure for an improved national trauma system in India will depend on a national inclusive strategy supported by resources and funding within a service quality framework to win public trust. This must include an integrated nationally coordinated approach to the organization of pre-hospital care facilities, hospital networking and communication systems, and the organization of in-hospital care.
    • An investigation into the validity of effort tests in a working age dementia population

      Rudman, N.; Oyebode, Jan R.; Jones, C.A.; Bentham, P. (2011)
      OBJECTIVES: Performance on neuropsychological tests can be influenced by non-cognitive factors, including deliberate underperformance, stress, the need to fulfil a sick role, depression, un-cooperativeness, fatigue and unhappiness with the evaluative situation. Tests to detect suboptimal effort are becoming widely used in clinical practice and are based on their reported insensitivity to cognitive dysfunction. A diagnosis of dementia has life-changing implications for an individual of working age. It is therefore crucial that clinicians can be confident they have obtained a valid estimate of current cognitive functioning. This study aimed to establish whether mood or cognitive functioning adversely influenced performance on symptom validity tests (SVTs) in individuals with working age dementia, who were judged to be using full effort. METHOD: Forty-two participants with dementia diagnosed before the age of 65 completed measures of emotional and cognitive functioning and six SVTs. RESULTS: There were no significant correlations between emotional functioning and measures of effort. However, cognitive functioning, in particular new learning, was significantly related to SVT performance. Participants with mild dementia performed significantly better on all six SVTs than those with moderate/severe dementia. The results also suggest that the SVTs are not equally sensitive to cognitive dysfunction. Rey's Dot Counting Test (DCT) (times criterion) achieved 100% specificity, and was the only test passed by every participant. CONCLUSION: Rey's DCT is the only SVT that can be recommended for use in those under 65 years with possible dementia at this time until further validation studies are undertaken.
    • Analysis of lower limb movement to determine the effect of manipulating the appearance of stairs to improve safety: a linked series of laboratory-based, repeated measures studies

      Elliott, David B.; Foster, Richard J.; Whitaker, David J.; Scally, Andy J.; Buckley, John G. (2015-07)
      Background: Falls on stairs are a common and dangerous problem for older people. This series of studies evaluated whether or not selected changes to the appearance of stairs could make them safer for older people to negotiate. Objectives: To determine the effect of (1) a step edge highlighter and its position and (2) an optimised horizontal–vertical (H–V) visual illusion placed on a step riser on gait safety during stair descent and ascent. Design: A series of studies using a repeated measures, laboratory-based design, investigating gait control and safety in independently mobile older people. Setting: The University of Bradford Vision and Mobility Laboratory. Participants: Fit and healthy older people aged 60 years of age or more, independently mobile, reasonably active and with normal healthy eyes and corrected vision. Interventions: A step edge highlighter in a variety of offsets from the stair edge and an optimised H–V visual illusion placed on the stair riser. The H–V illusion was provided on a staircase by horizontal step edge highlighters on the tread edges and vertical stripes on the step risers. Main outcome measures: Gait parameters that are important for safe stepping in ascent and descent, particularly toe clearance during stair ascent and heel clearance during stair descent. Results: The step edge highlighter increased the precision of heel clearance during stepping and its positioning relative to the tread edge determined the extent of heel clearance over the tread edge. Positioning the highlighter away from the tread edge, as is not uncommonly provided by friction strips, decreased heel clearance significantly and led to greater heel scuffs. Although psychophysics experiments suggested that higher spatial frequencies of the H–V illusion might provide greater toe clearance on stair ascent, gait trials showed similar increased toe clearances for all spatial frequencies. When a 12 cycle per step spatial frequency H–V illusion was used, toe clearance increases of approximately 1 cm (17.5%) occurred without any accompanying changes in other important gait parameters or stability measures. Conclusions: High-contrast tread edge highlighters present on steps and stairs and positioned flush with the edge of the tread or as near to this as possible should improve stair descent safety in older people. A H–V illusion positioned on the riser of a raised surface/walkway (e.g. kerbs) and/or the top and/or bottom of a stairway is likely to increase foot clearance over the associated step/stair edge, and appears not to lead to any decrement in postural stability. Thus, their use is likely to reduce trip risk and hence improve stair ascent safety. The effect of the step and stair modifications should be assessed in older people with visual impairment. The only other remaining assessment that could be made would be to assess fall prevalence on steps and stairs, perhaps in public buildings, with and without these modifications.
    • Analysis of Multiple-Threshold Queues for Congestion Control of Heterogeneous Traffic Streams

      Awan, Irfan U. (2006)
      The use of queue thresholds is a well known technique for network traffic congestion control. This motivates the study of a single server queue with R(R ¿ 2) distinct priority classes under Head of Line (HoL) service priority discipline, Partial Buffer Sharing (PBS) scheme and a finite capacity vector N, representing a sequence of thresholds (N1, N2, ¿ , NR) for each class jobs. The external traffic is modelled using the compound Poisson process or generalised exponential (GE) distribution which can capture the bursty property of the network traffic. The transmission times have also been modelled using the GE distribution to depict the bulk departures from the system. Using a GE/GE/1/N approximation, a closed form cost-effective analytical solution is obtained using the principle of maximum entropy (ME). The forms of the joint, aggregate and marginal state probabilities, as well as basic performance measures such as utilisation and blocking probabilities are analytically established at equilibrium via appropriate mean value constraints and the generating function approach. Consequently, efficient recursive expressions of low computational cost are determined. Typical numerical experiments are included to illustrate the credibility of the proposed mechanism in the context of different QoS grades for various network traffic classes. This model, therefore, can be used as a powerful tool to provide a required grade of service to a particular class of traffic in any heterogeneous networks.
    • Analysis of the Born in Bradford birth cohort - Authors' reply

      Sheridan, E.; Wright, J.; Corry, P.; Oddie, S.; Small, Neil A.; Parslow, R.C. (2014-01-11)
      Ester Garne and Joan Morris are correct that the Born in Bradford birth cohort data for congenital anomalies do not include pregnancies that terminated before 28 weeks: the data we report refer to liveborn and stillborn infants only. We reported a protective effect of education on anomaly rates but we did not propose any theory to account for the finding because we had no further data that related to this observation.