Search

The short communication reports on the methodologies and societal implications of a research project based on learning, development and changing identity for participants (students and 'service users') within a BSc(Hons) Physiotherapy programme module of study. Focus is placed upon co-production within a participatory approach based on the processes of creativity and open dialogue proposed by the theoretical physicist, David Bohm.

Mathew Kavanagh and co-authors discuss law reform in the global tuberculosis response.

This paper examines the cryptocurrency bitcoin to determine if there is evidence of the weekday effects, such as the Monday effect, during the period between January 2, 2011 and September 10, 2019. The study shows that Bitcoin exhibits a Monday effect at the 10% level of significance and a Tuesday and Sunday effect at the 5% significance level. The S&P500 stock index also showed a Monday effect but did not exhibit a Tuesday or Sunday effect. The study also examined if there was a Month of the Year effect and found that Bitcoin exhibited a May and November effect at the 10% significance level.

BackgroundHIV and TB programs have rapidly scaled-up over the past decade in Sub-Saharan Africa and uninterrupted supplies of those medicines are critical to their success. However, estimates of stock-outs are largely unknown. This survey aimed to estimate the extent of stock-outs of antiretroviral and TB medicines in public health facilities across South Africa, which has the world's largest antiretroviral treatment (ART) program and a rising multidrug-resistant TB epidemic.MethodsWe conducted a cross-sectional telephonic survey (October-December 2015) of public health facilities. Facilities were asked about the prevalence of stock-outs on the day of the survey and in the preceding three months, their duration and impact.ResultsNationwide, of 3547 eligible health facilities, 79% (2804) could be reached telephonically. 88% (2463) participated and 4% (93) were excluded as they did not provide ART or TB treatment. Of the 2370 included facilities, 20% (485) reported a stock-out of at least 1 ARV and/or TB-related medicine on the day of contact and 36% (864) during the three months prior to contact, ranging from 74% (163/220) of health facilities in Mpumalanga to 12% (32/261) in the Western Cape province. These 864 facilities reported 1475 individual stock-outs, with one to fourteen different medicines out of stock per facility. Information on impact was provided in 98% (1449/1475) of stock-outs: 25% (366) resulted in a high impact outcome, where patients left the facility without medicine or were provided with an incomplete regimen. Of the 757 stock-outs that were resolved 70% (527) lasted longer than one month.InterpretationThere was a high prevalence of stock-outs nationwide. Large interprovincial differences in stock-out occurrence, duration, and impact suggest differences in provincial ability to prevent, mitigate and cope within the same framework. End-user monitoring of the supply chain by patients and civil society has the potential to increase transparency and complement public sector monitoring systems.

Although grounded theory (GT) has emerged as a popular research approach across multiple areas of social science, it has been less widely taken up by researchers working in the fields of urban planning and design. The application of GT enables uniquely innovative insights to be gained from qualitative data, but it has attracted criticism and brings its own challenges. This paper proposes a methodology that could be applied by other researchers in the field of urban research. Utilising constructivist GT as a qualitative approach, this research investigates how cultural memory impacts the psychosocial well-being and quality of life (QoL) of users of, and visitors to, historic urban landscapes (HULs). Based on the findings, it can be posited that the application of GT yields a rich and nuanced understanding of how users of HULs experience the settings in which they live, and the impact and significance on human psychosocial well-being of the cultural memories incarnated within such settings. The current paper also contends that GT enables researchers studying the built environment to construct inductively based theories. Lastly, the practical implications of developing GT for application to HUL management are discussed, both in regard to how users experience the contexts in which they live and the impact of such contexts on well-being and quality of life.

A crucial element in the human search for well-being is achieving a sense of identity within, and belonging to, the landscape in which we live. Landscape should be understood as not only the visible environment but the affective values we attach to it and how we shape it in our mind’s eye. These inner reflections of our landscapes constitute one of our richest archives, in particular, in terms of creating and passing down to future generations our cultural memories. The current paper is a review of literature on the concepts of urban heritage conservation, and, in particular, the development of the historic urban landscape (HUL) approach, with reference to the role and contribution of cultural memory and its presence in the urban landscape. We also investigate how the notions of place attachment and identity interrelate with cultural memory to elucidate how such interrelations can contribute to human psychosocial well-being and quality of life (QOL). This review points to the neglected role of cultural memory in the maintenance of psychosocial well-being in HULs, a topic which requires further research to deepen our understanding about its importance in urban environments.

Historic urban landscapes (HULs) are composed of layers of history and memories that are embedded in physical monuments, buildings, and memorials. Physical built fabric stores both personal and cultural memory through long association with communities. Rapid changes due to demolition and redevelopment change the nature of these places and, in turn, affect these memory storages. This paper investigates whether historical city inhabitants consider cultural memories important when managing their HULs. It further explores the effectiveness of cultural memory in creating a sense of place and enhancing the quality of life for inhabitants. The context of the demolished theatre ‘Masrah Al Salam’ in Alexandria, Egypt, was studied after city inhabitants angrily protested the theatre’s removal, indicating a strong community attachment to this lost place. A qualitative methodological approach to this study was applied by conducting on-site, semi-structured, face-to-face interviews supplemented by comments gathered from the Facebook group ‘Alexandria’s Spirit’. The QSR NVivo12 program was used as a qualitative tool for data management, analysis, and mapping intangible elements contributing to an assembly of cultural memories of this place. The study demonstrated the importance of cultural memory associated with urban elements such as iconic heritage buildings that create a sense of place and enhance the identity of our urban environments.

Globalization is associated with significant transformations in city forms and cultural and social performances. Governments and cultural heritage organisations increasingly appreciate the importance of preserving diverse physical cultural heritage through rehabilitation and the implementation of conservation plans. Nevertheless, there is a need to evaluate whether these plans understand the importance of cultural memory in societies, as well as how it affects the human psyche. Utilizing Orabi Square, which is one of the richest Historic Urban Landscapes (HUL) in the metropolitan city of Alexandria in Egypt, this study aims to answer the question; to what extent does Historic Urban Landscape (HUL) management present a situation that maintains cultural memory and achieve psychosocial well-being? The research explored the site’s old and new conditions and place experience, applying a qualitative approach through onsite face-to-face semi-structured interviews combined with data from a Facebook group—Alexandria’s Spirit. The QSR Nvivo12 analysis program was used for the data interpretation and for charting the intangible values accompanying cultural memory such as emotions and behaviour. The study indicated that cultural memory is an affective catalyst for emotional attachment to place and is an important factor informing sense of place. Based on our study, inclusion of cultural memories should be an integral element in the future management plans of Orabi Square to enhance place experience and psychosocial well-being.

The concept of sacrifice plays a significant role in commemorative ritual because it aids collective amnesia and the forgetting of war trauma. Collective amnesia is the product of several processes, both official and individual, which work to disguise aspects of war trauma represented in war memorial design and in the rituals accompanying war commemoration in memorial landscapes. Although many aspects of remembering and forgetting at war memorials exist in the present age, sacrifice is a concept still invoked to attach meaning to death in war. Although the major conflicts of the twentieth century have become more distant in time, trauma induced by war through the agency of postmemory is still disguised by the notion of sacrifice for the nation. As latter-day war memorials attempt to render different and more difficult aspects of war experience to those of the past, the concept of sacrifice continues to be evoked as a cover for the uncomfortable aspects of war remembrance.

Nature Communications 6:6961 doi: (2015); Published 24 April 2015; Updated 15 June 2016 The original version of this Article failed to fully credit the use of the Ocean Data View software in figure 3, which appears below: Schlitzer, R., Ocean Data View, http://odv.awi.de, 2016.

Gliotoxin, and other related molecules, are encoded by multi-gene clusters and biosynthesized by fungi using non-ribosomal biosynthetic mechanisms. Almost universally described in terms of its toxicity towards mammalian cells, gliotoxin has come to be considered as a component of the virulence arsenal of Aspergillus fumigatus. Here we show that deletion of a single gene, gliT, in the gliotoxin biosynthetic cluster of two A. fumigatus strains, rendered the organism highly sensitive to exogenous gliotoxin and completely disrupted gliotoxin secretion. Addition of glutathione to both A. fumigatus Delta gliT strains relieved gliotoxin inhibition. Moreover, expression of gliT appears to be independently regulated compared to all other cluster components and is up-regulated by exogenous gliotoxin presence, at both the transcript and protein level. Upon gliotoxin exposure, gliT is also expressed in A. fumigatus Delta gliZ, which cannot express any other genes in the gliotoxin biosynthetic cluster, indicating that gliT is primarily responsible for protecting this strain against exogenous gliotoxin. GliT exhibits a gliotoxin reductase activity up to 9 microM gliotoxin and appears to prevent irreversible depletion of intracellular glutathione stores by reduction of the oxidized form of gliotoxin. Cross-species resistance to exogenous gliotoxin is acquired by A. nidulans and Saccharomyces cerevisiae, respectively, when transformed with gliT. We hypothesise that the primary role of gliotoxin may be as an antioxidant and that in addition to GliT functionality, gliotoxin secretion may be a component of an auto-protective mechanism, deployed by A. fumigatus to protect itself against this potent biomolecule.

Early psychosocial support for parents/legal guardians who have children with variations of sex characteristics (VSCs) is crucial in helping avoid potentially harmful medical procedures. Psychosocial support, including peer support, can help parents/legal guardians choose the best care path for their child, and it remains important throughout childhood. However, there is a lack of data on the provision of psychosocial support for families with a child who has VSCs. We sought knowledge about the timing and types of psychosocial support, and the level of implementation of psychosocial support amongst health and psychosocial care professionals and peer supporters. A survey was conducted using a purposive sample of healthcare professionals and members of peer support groups across Europe. A total of 301 responses were received and analysed using descriptive and inferential methods. The survey results showed that psychosocial support primarily addresses diagnostic procedures, medical treatment, and medical interventions. Whilst the majority of healthcare professionals aspired to have psychosocial support provided at the point where a diagnosis of VSCs was suspected, this was only reported as current practice by a minority of respondents. Overall, the survey indicates that there is a need for greater implementation of psychosocial support, and more collaboration between healthcare professionals and peer support groups in caring for children with VSCs and their families.

The aim of this study was to explore the associations between diet quality, socio-demographic measures, smoking, and weight status in a large, cross-sectional cohort of adults living in Yorkshire and Humber, UK. Data from 43, 023 participants aged over 16 years in the Yorkshire Health Survey, 2nd wave (2013–2015) were collected on diet quality, socio-demographic measures, smoking, and weight status. Diet quality was assessed using a brief, validated tool. Associations between these variables were assessed using multiple regression methods. Split-sample cross-validation was utilised to establish model portability. Observed patterns in the sample showed that the greatest substantive differences in diet quality were between females and males (3.94 points; P < 0.001) and non-smokers vs smokers (4.24 points; P < 0.001), with higher diet quality scores observed in females and non-smokers. Deprivation, employment status, age, and weight status categories were also associated with diet quality. Greater diet quality scores were observed in those with lower levels of deprivation, those engaged in sedentary occupations, older people, and those in a healthy weight category. Cross-validation procedures revealed that the model exhibited good transferability properties. Inequalities in patterns of diet quality in the cohort were consistent with those indicated by the findings of other observational studies. The findings indicate population subgroups that are at higher risk of dietary-related ill health due to poor quality diet and provide evidence for the design of targeted national policy and interventions to prevent dietary-related ill health in these groups. The findings support further research exploring inequalities in diet quality in the population.

Background: Nursing deficits are growing, and healthcare providers in developed countries must address the challenges of ethically building a sustainable workforce without a continued excessive reliance on overseas recruitment. To secure this, a focus on long-term retention of international recruits is paramount. Objective: To explore the migration motivations and experiences of initial integration for internationally recruited nurses within the healthcare system (England). Design: A mixed methods survey. Setting(s) and participants: 655 internationally recruited nurses who had recently commenced work in England completed the survey. Methods: qualitative and quantitative data was gathered to explore internationally recruited nurses’ demographics and professional backgrounds, migration motivations, application processes, arrival and settlement and initial experiences of integration into the workforce alongside their support and future aspirations. Results: The quantitative results revealed a population of international nurses that were highly educated and vastly experienced, with career development and desires to improve quality of life being the primary motivations for migration. Participants indicated a perception of being well supported during initial application and arrival stage, however, did experience some degree of challenge during workplace integration involving fluctuating levels of support and appointments into positions that did not match their years of experience and previous qualifications. This data was reinforced further detailed by the qualitative feedback that illuminated the difficulties nurses can face during initial arrival and integration and the apparent impact on mental well-being. Conclusion: This paper, contextualised with an international literature base verifying the experiences of internationally recruited nurses, argues that it is the consistent responsibility of employers in developed countries to protect the experiences of international recruits. This can be done by investing in solutions as a key retention strategy.

As the uniquely Christian form of worship, the Eucharist is studied by ‘systematic’ theologians in terms of its coherence with revelation as a whole, and by ‘dogmatic’ theologians in light of historic definitions that still impact the churches of today. Examination of ‘eucharistic sacrifice’ thus presents scholars and students with a cross section of systematic and dogmatic theology as practised within the church at large and among the still separated churches that comprise present-day Christianity. While few would deny connection between ‘Eucharist’ and ‘sacrifice’, historic language of ‘sacrifice’ concerning the central act of Christian worship has often been tantalisingly imprecise. This article explores the relation between the multifaceted phenomenon of sacrifice in Old Testament religion and its development in Jesus’ own understanding of his ministry and death, and in the New Testament church’s practice of the Eucharist. Having identified three distinct motifs of ‘eucharistic sacrifice’ (thanksgiving, sacrificial banquet, propitiatory sacrifice), the article examines their roots in the text of the New Testament and the ways in which they have taken form in the worship and theology of the church. The historical review that forms a major part of the article builds up to the sixteenth-century clash between Martin Luther (joined by all other contemporary Protestants) and the Roman Catholic Church. Moving back into ‘systematic’/’dogmatic’ gear, the question is raised whether the Orthodox account of the relation of Eucharist to sacrifice might supply a path towards overcoming sixteenth-century antinomies, leading to an examination of the treatment of this topic in historic and recent Roman Catholic, Anglican, and Lutheran theology. As the article deliberately adopts an eirenic approach to a long-controversial area of theology, its author admits that the material covered here still ignites strong passions within divided Christianity.

Abstract Background Clinical gait analysis is widely used to aid the assessment and diagnosis of symptomatic pathologies. Foot function pressure systems such as F‐scan and analysis of the spatial–temporal parameters of gait using GAITRite® can provide clinicians with a more comprehensive assessment. There are systems however, such as Strideway™ that can measure these parameters simultaneously but can be expensive. F‐Scan in‐shoe pressure data is normally collected whilst the person is walking on a hard floor surface. The effects of the softer Gaitrite® mat upon the F‐Scan in‐shoe sensor pressure data is unknown. This study therefore aimed to assess the agreement between F‐Scan pressure measurements taken from a standard walkway (normal hard floor), and those from a GAITRite® walkway to establish whether these two pieces of equipment (in‐shoe F‐Scan and GAITRite®) can be used simultaneously, as a cost‐effective alternative. Method Twenty‐three participants first walked on a standard floor and then on a GAITRite® walkway wearing F‐Scan pressure sensor insoles with same footwear. They repeated these walks three times on each surface. Mid gait protocols were utilised by analysing the contact pressure of the first and second metatarsophalangeal joint of the third, fifth and seventh step from each walk. For both joints, 95% Bland–Altman Limits of Agreement was used to determine a level of agreement between the two surfaces, using mean values from pressure data collected from participants who successfully completed all required walks. The intraclass correlation coefficient (ICC) and Lin's concordance correlation coefficient were calculated as indices of reliability. Findings ICC results for the hard surface and the GAITRrite® walkway at the first and second metatarsophalangeal joints were 0.806 and 0.991 respectively. Lin's concordance correlation coefficient for the first and second metatarsophalangeal joints were calculated to be 0.899 and 0.956 respectively. Both sets of statistics indicate very good reproducibility. Bland–Altman plots revealed good repeatability of data at both joints. Conclusion The level of agreement in F‐Scan plantar pressures observed between walking on a normal hard floor and on a GAITRite® walkway was very high, suggesting that it is feasible to use F‐Scan with GAITRite® together in a clinical setting, as an alternative to other less cost‐effective standalone systems. Although it is assumed combining F‐Scan with GAITRite® does not affect spatiotemporal analysis, this was not validated in this study.

Abstract Background: To explore the long‐term impact of a UK specialist service providing intensive weight management support for patients with severe and complex obesity. An interview‐based study of former patients about their contact with the service and how it had affected their subsequent weight management. The questions covered areas of difference between those who had received lifestyle change support and those who had also had weight loss surgery. Methods: This qualitative study took place with former patients of a community‐based weight management service for people with severe or morbid obesity who had been discharged for at least 2 years. Nineteen interviews took place with patients initially contacted by questionnaire about their experiences of involvement with the service. Participants interviewed all had support to change their lifestyle, and some also had bariatric surgery. A narrative interview approach was employed to explore participants’ weight management after involvement with the service. Results: Most participants maintained their weight loss. The self‐esteem of some participants had significantly improved. For some, the weight loss came with significant problems in terms of dietary restrictions and loose skin. Participants said they would like more open‐ended contact, particularly for those who had bariatric surgery. Conclusions: The study supported current research findings that both those who had bariatric surgery or who just had lifestyle change support experienced a significant reduction in their weight. In this respect, participants thought it was a success. However, for a number, it was at a price in terms of the amount and type of food they could eat. The study adds to the understanding of the impact of bariatric surgery and weight management support from the patients’ perspective and of the support needs of patients having lifestyle support and surgery to help them manage the long‐term impact of obesity and treatment side‐effects.

Abstract Background Over the past 20 years, Nepal has seen major improvements in childhood and maternal survival. In 2015, the Nepalese government introduced a new federal political structure. It is unclear how this has affected the health system, and particularly, maternal and child health care. Hence, this study aims to describe and analyse health facility preparedness in the light of the federalization process with regards to providing appropriate and timely maternal and neonatal health services. Methods A descriptive cross-sectional study was conducted in Jumla district, Nepal in 2019 covering all 31 state health facilities (HF) to assess the availability of maternal and neonatal health services including appropriate workforce and access to essential medicines. Tests of association between demographic factors and the probability of a facility experiencing a shortage of essential medicine within the last 3 months were also conducted as exploratory procedures. Results Out ot 31 HFs, more than 90% of them had all their staff positions filled. Most facilities (n = 21) had experienced shortages of essential medicines within the past 3 months. The most common out of stock medicine were: Amoxicillin (n = 10); paracetamol (n = 10); Vitamin A (n = 7); and Metronidazole (n = 5). Twenty-two HFs had referred maternal and newborn cases to a higher centre within the past 12 months. However, more worryingly, twenty HFs or their catchment communities did not have emergency ambulance transport for women and newborns. Conclusion HFs reported better staffing levels than levels of available drugs. HFs should be supported to meet required minimal standards such as availability of essential medicines and the provision of emergency ambulance transport for women and newborns.

Abstract Background Research has consistently demonstrated that preventive cardiology programs have limited success, and healthy practices among high-risk individuals remain suboptimal. Furthermore, there are no current programmes in Malta that offer support to first-degree relatives of patients with premature coronary heart disease. This internal pilot study will determine the feasibility, acceptability, and potential effectiveness of a preventative intervention. Methods/design We are conducting a 12-month single-centre, two-armed group randomised controlled trial (RCT), recruiting a sample of 100 asymptomatic first-degree relatives of patients with premature coronary heart disease (CHD). The study seeks to test an evidence-based intervention to reduce modifiable risk and determine its feasibility and acceptability. The Intervention will be delivered at an outpatient office based in a large acute academic hospital. It will comprise risk communication using an online risk calculator, a counselling style adapted from motivational interviewing, and 12 weekly telephone goal reinforcement calls (3 months). Control subjects will receive verbal lifestyle advice only. Feasibility will be assessed through recruitment and retention. Qualitative evaluation interviews will be conducted with a subsample of 24 purposefully selected participants at 12 months. Assessment for risk factor changes will be measured at pre-intervention and 6 and 12 months. Associations between variables will also be assessed descriptively. Discussion Preventive cardiology guidelines highlighted the importance of lifestyle interventions, and lifestyle intervention adherence was proven to reduce atherosclerotic cardiovascular disease (ASCVD) risk, regardless of the individual's genetic risk. Preventive cardiology programmes may fail to adequately support persons in modifying risky behaviours, and research demonstrates that healthy practices among high-risk individuals can remain suboptimal. Siblings and offspring of patients with premature CHD are at increased risk of ASCVD. Despite this, there is no process in place for routine screening and support to modify risk. It is hypothesised that participants assigned to the intervention arm will show more cardio-protective lifestyle-related improvement from the baseline than those in the control group. To date, this is the first trial being conducted amongst Maltese first-degree relatives. This study addresses the needed research, and the results will inform a definitive trial. The funding institution is the University of Malta. Trial registration ISRCTN, ISRCTN21559170 ; Registered 06/08/2020,

Introduction Many essential interventions are required to ensure in-patients receive safe and effective care with a good experience. In addition, healthcare organisations are assessed on numerous performance indicators, including the aforementioned interventions, where underperformance can lead to lower publicly reported ratings, loss of income and reputational damage. Most importantly, underperformance can lead to compromised patient experience and outcomes. We created a prompt card as a service improvement tool to be used on the daily ward rounds at the bedside of every patient, entitled ‘every patient, every day’ to improve documentation, antibiotic prescribing, venous thromboembolism (VTE) prophylaxis, coding and patient communication.Method Preimplementation data around these interventions and patient experience factors were collected by shadowing ward rounds. The ‘every patient, every day’ tool was then implemented. The ward rounds were shadowed by the same individual to collect post-implementation data. Effect of implementation was assessed via Poisson regression models conducted on the documentation, antibiotics and VTE measures, and logistic regression models conducted on the communication and coding measures.Results The corresponding rate ratios for the effect of the implementation of the service improvement tool were found to be 1.53 (95% CI 1.38 to 1.69) for improved documentation. Antibiotics prescribing improved by 1.44 (95% CI 1.06 to 1.94). VTE prescribing and documentation improved by a rate ratio 1.25 (95% 1.04 to 1.50). For communication, the effect of the implementation was significant at the 5% significance level (p

Abstract Background and Aims This study evaluates a specialist weight management service and compares outcomes in participants referred to the service undergoing either surgery or non‐surgical routes to support weight loss. Methods Four hundred and forty eight participants were assessed on various weight‐related outcomes (body mass index [BMI], psychological distress, quality of life, nutrition, weight‐related symptoms, physical activity) on referral to the service and on discharge. The effect of group (surgery or non‐surgery) and time in the service were facilitated by doubly multivariate analyses of variance models. Results Between referral and discharge, participants improved significantly on a combination of outcomes (P

Abstract Introduction Intermittent claudication (IC) is the most common symptom of peripheral arterial disease. Previous research has suggested that cycloidal vibration therapy (CVT) may induce angiogenesis and improvements in circulation. The objective of this feasibility study was to explore trial design and acceptability of the protocol to provide data to estimate the parameters required to design a definitive randomised control trial. This feasibility study specifically aimed to assess recruitment rate; attendance rates at baseline and follow-up; and safety, tolerability, and compliance with therapy device and additionally, to consider the potential efficacy of CVT as a novel treatment for intermittent claudication. Methods Patients with intermittent claudication (IC) were recruited and CVT was applied at home for 30 min twice a day for a period of 12 weeks. Primary outcomes were pain-free walking time (PFWT) and maximum walking time (MWT) after 12 weeks of treatment. Secondary outcomes included the ankle-brachial index and ankle systolic blood pressure. Participants were assessed during active therapy phase at baseline, week 4, week 8, and week 12. Results Thirty-four participants with IC were recruited: 30 (88%) male and 4 (12%) female. The rate of recruitment was 2.4 participants per month from a standard-size district general hospital. No participants left the study during the activity therapy stage, and no participant failed to attend their follow-up appointment. The general compliance with CVT was high. No participants dropped out during the treatment phase. The mean age of all participants was 68 years (IQR 60–75 years). Substantive improvements were seen in a comparison of differences in times to PFWT and MWT, in ABPI, and in systolic leg pressure in the treated leg. There was no evidence of a substantive difference from baseline in systolic leg pressure in the untreated leg. There were no immediate or delated treatment safety concerns of documented adverse effects with the treatment, all patients completed the required 12-week course indicated a high degree of patient acceptability. Conclusion The statistically significant and substantive improvements from baseline after 12 weeks observed in PFWT and MWT in participants experiencing IC are comparable to improvements seen from other treatment options such as supervised exercise as reported by Stewart et al. (N Engl J Med 347:1941–1951, 2002). The substantive improvement in systolic leg pressure in the treated leg and the concurrent absence of a substantive change in systolic leg pressure in the untreated leg over the same period suggests a causative effect. This study has provided novel information relating to the number of potential eligible participants for a further research trial and potential association between CVT and improved symptoms. Additionally, it has established that CVT treatment is highly acceptable, as indicated by no participant drop-out in the treatment phase, and may potentially offer an alternative treatment option for patients experiencing IC. Furthermore, this study has assessed the variability of the primary outcome measure which provides vital information needed to calculate sample sizes for any future studies. In conclusion, this study has established the feasibility of using CVT to improve patients’ symptoms of IC and provides essential information which will contribute to the design of future research investigating whether the improvements seen are directly related to CVT.

Abstract Background Prophylactic antibiotics are commonly prescribed intra-operatively after caesarean section birth, often at high doses. Even so, wound infections are not uncommon and obesity increases the risk. Currently, no independent wound assessment technology is available to stratify women to low or high risk of surgical site infection (SSI). Study Aim: to investigate the potential of non-invasive infrared thermography (IRT), performed at short times after surgery, to predict later SSI. Methods IRT was undertaken in hospital on day 2 with community follow up (days 7, 15, 30) after surgery. Thermal maps of wound site and abdomen were accompanied by digital photographs, the latter used for wound assessment by six experienced healthcare professionals. Confirmatory diagnosis of SSI was made on the basis of antibiotic prescribing by the woman’s community physician with logistic regression models derived to model dichotomous outcomes. Results Fifty-three women aged 21–44 years with BMI 30.1–43.9 Kg.m− 2 were recruited. SSI rate (within 30 days) was 28%. Inter-rater variability for ‘professional’ opinion of wound appearance showed poor levels of agreement. Two regions of interest were interrogated; wound site and abdomen. Wound site temperature was consistently elevated (1.5 °C) above abdominal temperature with similar values at days 2,7,15 in those who did and did not, develop SSI. Mean abdominal temperature was lower in women who subsequently developed SSI; significantly so at day 7. A unit (1 °C) reduction in abdominal temperature was associated with a 3-fold raised odds of infection. The difference between the sites (wound minus abdomen temperature) was significantly associated with odds of infection; with a 1 °C widening in temperature associated with an odds ratio for SSI of 2.25 (day 2) and 2.5 (day 7). Correct predictions for wound outcome using logistic regression models ranged from 70 to 79%; Conclusions IRT imaging of wound and abdomen in obese women undergoing c-section improves upon visual (subjective) wound assessment. The proportion of cases correctly classified using the wound-abdominal temperature differences holds promise for precision and performance of IRT as an independent SSI prognostic tool and future technology to aid decision making in antibiotic prescribing.

BackgroundProgrammes using motivational interviewing show potential in facilitating lifestyle change, however this has not been well established and explored in individuals at risk of, yet without symptomatic pre-existent cardiovascular disease. The objective of this systematic review and meta-analysis was to determine the effectiveness of motivational interviewing in supporting modifiable risk factor change in individuals at an increased risk of cardiovascular disease.MethodsSystematic review and meta-analysis with results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Health-related databases were searched for randomised controlled trials from 1980 to March 2020. Criteria for inclusion included; preventive programmes, motivational interviewing principles, modification of cardiovascular risk factors in adults of both genders, different ethnicities and employment status, and having at least 1 or more modifiable cardiovascular risk factor/s. Two reviewers independently extracted data and conducted a quality appraisal of eligible studies using an adapted Cochrane framework. The Cochrane framework supports to systematically identify, appraise and synthesize all the empirical evidence that meets the pre-specified eligibility criteria to answer a specific question.FindingsA total of 12 studies met the inclusion criteria. While completeness of intervention reporting was found to be adequate, the application of motivational interviewing was found to be insufficiently reported across all studies (mean overall reporting rate; 68%, 26% respectively). No statistical difference between groups in smoking status and physical activity was reported. A random effects analysis from 4 studies was conducted, this determined a synthesized estimate for standardised mean difference in weight of -2.00kg (95% CI -3.31 to -0.69 kg; p = 0.003), with high statistical heterogeneity. Pooled results from 4 studies determined a mean difference in LDL-c of -0.14mmol/l (5.414mg/dl), which was non-significant. The characteristics of interventions more likely to be effective were identified as: use of a blended approach delivered by a nurse expert in motivational interviewing from an outpatient-clinic. The application of affirmation, compassion and evocation, use of open questions, summarising, listening, supporting and raising ambivalence, combining education and barrier change identification with goal setting are also important intervention characteristics.ConclusionsWhile motivational interviewing may support individuals to modify their cardiovascular risk through lifestyle change, the effectiveness of this approach remains uncertain. The strengths and limitations of motivational interviewing need to be further explored through robust studies.

Abstract Background Peripheral arterial disease affects the lower limb and is associated with diabetes, high cholesterol, smoking and obesity. It increases the risk of cardiovascular morbidity and mortality. It can be symptomatic causing intermittent claudication, but often there are few clinical signs. Podiatrists are able to detect the presence of peripheral arterial disease as part of their lower limb assessment and are well placed to give advice on lifestyle changes to help reduce disease progression. This is important to improve health outcomes and is offered as a prevention/public health intervention. Method We describe the clinical and patient-centred outcomes of patients attending a podiatry-led integrated care pathway in a multi-use clinic situated in a venue supported by the National Centre for Sports and Exercise Medicine in the UK. At the baseline appointment, patients were given a full assessment where symptoms of intermittent claudication using the Edinburgh Intermittent Claudication Questionnaire, foot pulses, Doppler sounds, Ankle Brachial Pressure Indices, glycated haemoglobin (HbA1c) and cholesterol levels, and smoking status were recorded. A tailored treatment plan was devised, including referral to an exercise referral service, smoking cessation programmes (if applicable) and each participant was also seen by a dietician for nutritional advice. Participants were followed up at 3 and 6 months to assess any improvement in vascular status and with each completing the EQ-5D quality of life questionnaire and a simple satisfaction questionnaire at the end of the study. As this was a complex intervention a pilot study design was adopted to evaluate if the method and outcomes were suitable and acceptable to participants the results of which will then inform the design of a larger study. Results Data was collected on 21 individuals; 15 men (71.4%) and 6 women (28.6%) across the 6-month study period. Eleven participants were referred onto the exercise referral service; 16 participants saw the dietician for nutritional advice at baseline and had one-to-one or telephone follow-up at 3 months. Five out of 14 participants had reduced scores from baseline of intermittent claudication during the study period. No evidence for substantive changes in Doppler sounds or ABPI measurements was revealed. Quality of life scores with the EQ-5D improved in 15 participants; this was statistically significant (p = 0.007) with 14 participants who completed the simple satisfaction questionnaire expressing a positive view of the programme. Of the four people who were smokers, two stopped smoking cigarettes and moved to e-cigarettes as part of smoking cessation advice. Conclusion As this was a pilot study the sample size was low, but some statistically significant improvements with some measures were observed over the 6-month study. Podiatrists are able to provide a comprehensive vascular assessment of the lower limb and accompanying tailored advice on lifestyle changes including smoking cessation and exercise. Locating clinics in National Centres for Sports and Exercise Medicine enables easy access to exercise facilities to encourage the adoption of increased activity levels, though the long term sustainability of exercise programmes still requires evaluation. This study was reviewed and approved by London Brent Ethics Committee IRAS ID 204611 and received research governance approval from the sponsor, Sheffield Teaching Hospitals NHS Foundation Trust Research and Innovation Office STH19410.

This article reports on an evaluation of a prescribing workshop to increase ‘shared learning’ between registered practitioners undertaking a non-medical prescribing (NMP) course (midwifery, nursing, physiotherapy, and podiatry) and undergraduate pharmacy students to increase awareness of, and understanding of the roles. The focus was on three domains of safe prescribing: Knowledge (of commonly prescribed medicines and their suitability for individual patients); Process (of legal requirements and supply of medicines and associated patient information); and Relationships (between prescribers and pharmacists). A cross-sectional evaluation was utilized with6-point Likert-style items and a free text section, completed by 337participants. Participants reported positively about the workshop content and their learning experience, although some differences between pharmacy and NMP participants were noted in the knowledge domain. Quantitative analysis revealed significant differences (p

Without the benefit of cognitive or evolutionary theory, late Roman villa patrons and designers intuited their way toward houses that engaged and strongly affected the emotions of inhabitants and visitor participants. Through the lens of their unique cultural moment, they discovered and deployed strategies that respond to certain innate and universal human needs. These were the aspects of a formal language of design that arose from a competitive ‘architectural arms race’ among a newly minted elite in the era of the late empire, which left a heritage that echoes through the history of architecture. Through the application of methods in cognitive science we can recover some of those strategies and understand their effects with a new specificity. Cognitive science confirms, continues, and elucidates earlier discoveries in phenomenology and psychology, placing the embodied and active human agent into the center of the experience of ancient architecture.

Dysphagia is a debilitating condition with significant consequences in terms of physical and mental health. This study demonstrates that it is feasible to provide an intensive therapy program combining neuromuscular electrical stimulation (NMES) with exercise against resistance in the treatment of dysphagia in a public healthcare setting. Thirty-one patients (17 stroke, 14 non-stroke) who experienced dysphagia with reduced laryngeal elevation completed the therapy program. After checking the data sets for comparability, it was deemed appropriate for the outcome data from these patients to be combined with that of 12 stroke patients previously reported to enable statistical analysis on a larger data set (n = 43). A repeated-measures ANOVA revealed a statistically significant increase in amount and variety of food a patient was able to take orally (FOIS) following completion of treatment (p < 0.001). There was no significant between-subject effect of stroke status (p = 0.43), or interaction between treatment and stroke status (p = 0.68). There was a significant improvement in secondary outcome measures of swallow safety with fluids (PAS) (p < 0.001) and swallow-related quality of life (Swal-Qol (p < 0.001). These findings indicate that the therapy program may be associated with reduced impairment in a subset of patients with dysphagia resulting from stroke and non-stroke atiologies, and the data will inform the design of future research to address unanswered questions.

"Interprofessional Education occurs when two or more professionals learn with, from and about each other to improve collaboration and the quality of care" (CAIPE 2002). Interprofessional education forms part of the Standards for the Initial Education and Training of Pharmacists. Working with and understanding the role of another profession has been shown to positively impact on the quality of care of the patient. Following positive pharmacy student feedback from visits to podiatry clinics an interprofessional learning workshop with case - based scenarios was developed. These were based on patients with high risk medical conditions that would impact on the work of both professions. Data from the feedback forms was evaluated and analysed to determine whether the workshop increased knowledge of the British National Formulary (BNF), the prescribing process and gave an insight in to the role of other healthcare professionals. We discuss how the student’s learning has been enhanced by the contribution of another professional group. The workshop was positively received. Students were observed working together discussing the patients’ conditions and issues relating to their care. This initially revolved around the students’ area of knowledge; however, as the session progressed it became apparent that the students were learning with, from and about each other for the benefit of patient care.

Abstract Background Corns are a common foot problem affecting a large proportion of the population. This study describes the characteristics of corns experienced by 201 participants taking part in a randomised controlled trial to investigate associations between demographic and corn parameters on pain, foot related disability and quality of life (QoL). Methods Pain from the main (index) corn was measured using a visual analogue scale (VAS); foot related disability was assessed with the Foot Disability Questionnaire (now known as the Manchester Foot Pain and Disability Index) and quality of life was recorded with the EQ‐5D questionnaire. The effect of demographic and corn parameters on the pain and quality of life outcomes was assessed with analysis of variance (ANOVA) methods. The effect of the same factors on a linear combination of the foot‐related disability outcome measures was assessed using multivariate ANOVA methods. Pain was also tested for its mediating properties on the causal pathway between the independent variables and quality of life. Results The mean pain score was 5.29 points on a 10 cm VAS, with females reporting substantively higher pain levels than males. Age affected foot‐related disability, with lower levels on all domains of the MFPDI reported in older participants; each year of advancing age was associated with falls of: 0.009 points on the Concern about Appearance (CA) domain; 0.047 points on the Functional Limitation (FL) domain and 0.048 points on the Pain Intensity (PI) domain. Sex and corn type also affected disability, with higher scores reported by females and participants with plantar corns. Conclusions The effect of pain was shown to mediate the relationship between sex and foot‐related disability. The presence of plantar corns has a more detrimental effect on QoL than dorsal/inter‐digital corns. Trial registration ISRCTN 13166839