A Thematic Analysis of Lived Experiences of Falls in Middle-Aged and Older Adults

Objectives: Fall-related injuries occur at a similar prevalence rate in middle-aged and older adults and may increase concerns about falling and future falls. No research to date has examined how experiences of falls and related concerns, differ between middle-aged and older fallers. This study aimed to address this using qualitative interviews. Methods: Ten middle-aged (55-64 years) and ten older adults (68-83 years) were interviewed about their experiences of falls and concerns about falling. Guided by a social constructivist epistemology, reflexive thematic analysis was used to categorise themes within the data. Results: Five overarching themes were identified. Four themes showed distinctions between groups (i) perceptions of age-related decline; (ii) ageism: stigma associated with ‘fallers’; (iii) concerns about loss of independence; and (iv) unravelling perceived control. The fifth theme (v) perceptions of falls risk: concerns and awareness, demonstrated the most similarities. Conclusions: Whilst middle-aged and older fallers showed similar ratings of concern about falling, the behaviours underlying these were qualitatively different. For older adults, concerns led to protective adaptations to reduce their fall risk. Contrastingly, middle-aged adults showed a lack of personal responsibility over their fall risk. The findings highlight the importance of early educational intervention to reduce future falls and frailty

Through each other's eyes: initial results and protocol for the co-design of an observational measure of adolescent-parent interaction using first-person perspective

Background: Current observational methods to understand adolescent-parent interaction are limited in terms of ecological and content validity. We outline initial results and a protocol for future work from a programme of work to: (1) establish a new method for data capture of adolescent-parent interaction at home using wearable cameras and; (2) develop a new relevant and comprehensive observational micro-coding scheme. In Part 1, we report our completed preliminary work, comprised of an initial scoping review, and public engagement work. In Part 2, we present a protocol for the development of the new measure. Methods: Part 1—We searched Pubmed for existing observational measures of adolescent-parent interaction for the scoping review. We also undertook public engagement work utilising a mobile research van, taken to multiple locations around Bristol, UK to engage with a variety of populations through interactive methods. Part 2—Our protocol describes plans for: (1) A systematic review of the psychometric properties of observational measures of adolescent-parent interaction; (2) Focussed public engagement workshops; (3) Harmonisation of information from existing coding schemes and literature with information from public engagement with adolescents and parents; (4) A pilot study to assess the acceptability and feasibility of the method; (5) Development of a coding scheme in consultation with expert and lay panels, and through real-life application to recorded videos from a pilot sample. Results: Scoping review: we identified 21 adolescent-parent observational schemes, of which eight used micro-coding and 13 used globalcoding schemes. The majority of micro-coding schemes were not developed specifically for adolescents. Most studies used conflict or problem-solving tasks, which may not adequately capture positive adolescent-parent interactions. The mobile van event received views from 234 young people and/or parents. Families were positive about taking part in research using headcams. “Trust” and “understanding” were most frequently reported as important adolescent-parent relationship constructs. Conclusions: This work represents the first attempt to truly co-design a method to assess parenting in adolescence. We hope to develop an observational measure using novel technological methods that can be used across a range of research and therapeutic settings

Ecology of Nepenthes on Mount Talang, West Sumatra, Indonesia

Gunung (Mount) Talang is an active volcano in West Sumatra that has a number of Nepenthes species, including the endemic N. talangensis, but their ecology has been little been studied. This study found five species of Nepenthes growing in the protected forest area of Gunung Talang, namely N. bongso, N. inermis, N. pectinata, N. spathulata and N. talangensis. The population of N. talangensis is very small (23 individuals) and it grows sympatrically with N. bongso and N. inermis forming natural hybrids. Lithocarpus conocarpus, Camellia lanceolata, Syzygium acuminatissimum, Adinandra dumosa and Dehaasia sp. are the five most dominant tree species found in the Nepenthes habitat, while L. conocarpus and Podocarpus neriifolius had strong positive associations with N. talangensis. Growth rates of the five Nepenthes species were not significantly different, neither were foliar nitrogen (mean = 1.14%) or phosphorus concentrations (mean = 0.11%). We suggest that N. talangensis should be considered as Critically Endangered and outline some possible conservation actions

Polyphenols in obesity and weight management: are they worth further research? An umbrella review

Polyphenols are widely known for their putative antioxidant and anti-inflammatory effects and their potential protective role in several diseases such as type 2 diabetes, cardiovascular disease and cancer. They have also attracted significant interest as ‘anti-obesity’ agents, although with mechanisms of action that have been exclusively demonstrated in animal and in vitro studies. This umbrella review aims to evaluate current evidence surrounding the role of polyphenols in obesity and weight management and to establish the usefulness of these agents in combatting obesity. A search of systematic reviews and meta-analyses of randomised controlled trials was carried out. Nine systematic reviews (of which eight included a meta-analysis) were included. Evidence of polyphenols' effects on reducing bodyweight is mixed, and where the effects are significant, they are numerically small and unlikely to be of help in reducing bodyweight or preventing weight gain. Future research should focus on establishing the anti-inflammatory and antioxidant effects of polyphenols through well-designed randomised controlled trials. Such research could be more valuable and cost-effective since it has shown potential to improve human health

Investigation of grid-forming and grid-following converter multi-machine interactions under different control architectures

The proliferation of converter-interfaced generation necessitates the investigation of novel small-signal multi-machine interactions. The flexibility and lack of standardisation of converter control approaches results in a plethora of potential implementations, bringing different dynamics that can interact with each other and existing elements of the power system. This paper performs a small-signal analysis of power systems with the inclusion of grid-forming and grid-following converters for varying combinations of common control architectures, in terms of cascaded control loops, within the literature. Investigations are performed for a two-machine system and the WSCC 9-bus (three-machine) system. As well as interaction identification and characterisation, the impact of varying transmission line lengths, system loading, and generation dispatch are investigated

Increased physical activity promotes skin clearance, improves cardiovascular and psychological health, and increases functional capacity in patients with psoriasis

Background: Patients with psoriasis are less physically active compared to age-matched controls, due to psoriasis-specific barriers, which significantly limits their ability to benefit from health-promoting levels of physical activity (PA). In addition, long-term health outcomes for people with psoriasis are poor and include depression, metabolic syndrome and cardiovascular disease (CVD); presenting a significant challenge to healthcare services. Objectives: We designed a PA intervention in partnership with patients with psoriasis hypothesising this may have therapeutic utility in the management of psoriasis. Methods: Participants with chronic plaque psoriasis were recruited to a single-centre, 20-week, prospective cohort study. A wrist-worn accelerometer (GENEActiv Original; Activinsights Ltd) and a hip-worn pedometer (Onwalk 900; Decathlon Group) were used objectively measure levels of PA. Our 10-week PA intervention comprised twice weekly 60-min walks within three different greenspaces in Greater Manchester, each led by a Sports and Exercise Scientist to deliver a pre-specified volume/dose of activity. During weeks-11–20 of the study, participants followed independent activities. Clinical evaluation, including assessment of psoriasis severity, cardiometabolic parameters, psychological wellbeing and functional capacity was made at baseline, week-10 and -20. Results: Sixteen patients with psoriasis completed the study. We observed significantly reduced Psoriasis Area and Severity Index at week-10 (p = 0.01) and -20 (p = 0.001) compared to baseline, with 50% of participants achieving PASI-50 at week-20. Dermatology Life Quality Index (DLQI) was significantly reduced at week-20 (p = 0.04), compared to baseline. Significant reduction in blood pressure at week-10 (systolic: −7.4 mmHg, p = 0.002; diastolic: −4.2 mmHg, p = 0.03) and -20 (systolic: −8.8 mmHg, p = 0.001; diastolic: 4.1 mmHg, p = 0.008) was observed and pulse wave velocity was significantly reduced by week-20 (p = 0.02), suggesting improvement in cardiovascular health. Despite high prevalence of anxiety and depression at baseline, we documented a significant improvement in wellbeing and psychological health. Functional capacity was significantly enhanced following completion of the study. Conclusion: Increasing PA constitutes a promising therapeutic intervention in the management of psoriasis. Evaluation of our intervention in a clinical trial would help determine clinical utility and establish PA guidelines for patients with psoriasis

Exploring the utility of ultrasound to assess disuse atrophy in different muscles of the lower leg

Background Skeletal muscle is a highly plastic tissue crucial for many functions associated with whole-body health across the life course. Magnetic resonance imaging (MRI) is the current gold standard for measuring skeletal muscle size. However, MRI is expensive, and access to facilities is often limited. B-mode ultrasonography (U/S) has been proposed as a potential alternative to MRI for the assessment of muscle size. However, to date, no work has explored the utility of U/S to assess disuse muscle atrophy (DMA) across muscles with different atrophy susceptibility profiles, an omission which may limit the clinical application of previous work. Methods To address this significant knowledge gap, 10 young men (22 ± years, 24.1 ± 2.3 kg/m2) underwent 15-day unilateral leg immobilization using a knee-brace and air boot. Cross-sectional area (CSA) and muscle thickness (MT) of the tibialis anterior (TA) and medial gastrocnemius (MG) were assessed via U/S before and after immobilization, with CSA and muscle volume assessed via MRI. Results With both muscles combined, there were good correlations between each U/S and MRI measure, both before (e.g., CSAMRI vs. MTU/S and CSAU/S: r = 0.88 and 0.94, respectively, both P < 0.0001) and after (e.g., VOLMRI vs. MTU/S and CSAU/S: r = 0.90 and 0.96, respectively, both P < 0.0001) immobilization. The relationship between the methods was notably stronger for MG than TA at each time-point (e.g., CSAMRI vs. MTU/S: MG, r = 0.70, P = 0.0006; TA, r = 0.37, P = 0.10). There was no relationship between the degree of DMA determined by the two methods in either muscle (e.g., TA pre- vs. post-immobilization, VOLMRI: 136 ± 6 vs. 133 ± 5, P = 0.08; CSAU/S: 6.05 ± 0.3 vs. 5.92 ± 0.4, P = 0.70; relationship between methods: r = 0.12, P = 0.75). Conclusions Both MTU/S and CSAU/S provide comparable static measures of lower leg muscle size compared with MRI, albeit with weaker agreement in TA compared to MG. Although both MTU/S and CSAU/S can discern differences in DMA susceptibility between muscles, neither can reliably assess degree of DMA. Based on the growing recognition of heterogeneous atrophy profiles between muscles, and the topical importance of less commonly studied muscles (i.e., TA for falls prevention in older adults), future research should aim to optimize accessible methods to determine muscle losses across the body

Effectiveness of telerehabilitation on quality of life in stroke survivors: a systematic review and meta - analysis

Background: Recent advances in technology have made possible the delivery of health services to patients remotely, and telerehabilitation for stroke survivors has emerged as a promising intervention. This systematic review assessed the clinical effectiveness of telerehabilitation (TR) programmes on quality of life (QoL) of stroke survivor compared to standard care. Methods: MEDLINE, CINAHL, AMED, Web of Science and Scopus databases were searched from inception to 10th of June 2022. Studies were considered eligible for inclusion if they fulfilled the following criteria: assessed the efficacy of different telerehabilitation models in poststroke patients, employed randomised controlled trial, and non-randomised design, stroke survivor adults age ≥ 18 years, health related quality of life outcome, and full text available. Data were extracted by 2 independent researchers. Risk of bias was assessed by the Cochrane Handbook for Systematic Reviews of Interventions. A meta-analysis was performed among trials presenting with similar clinical characteristics. Results: A total of 11 eligible studies that met the inclusion criteria were included in the review. These studies were conducted in Brazil (n=1), Italy (n=2), Netherland (n=1), South Korea (n=1), Taiwan (n=1), United Kingdom (n=1) and United States (n=4) between 2004 and 2020. Except for blinding of participants to study group allocation, all the studies were (> 50%) at low risk of bias to considering adequate sequence generation, allocation concealment, blinding of trial personnel or outcome assessors, evaluation of incomplete outcome data, and lack of selective reporting. The meta-analysis (n = 5) included 306 individuals with duration of follow up ranged between 4 weeks and 12 weeks. We found that there was no statistically significant difference (SMD = 0.089, confidence interval (CI) 95% = -0.184 to 0.362, p = 0.522) for Stroke Impact Scale between the interventions and the control. Conclusion: The review provides evidence for the effectiveness of TR interventions to improve the QoL of stroke survivors in a short-term. Further research studies are required to examine the effectiveness of TR interventions for stroke survivors in a long-term follow-up

Effects of two dentifrices on the surface properties and staining susceptibility of polymer-based materials

This study examined the effect of whitening and abrasive regular dentifrices on the surface characteristics and stain susceptibility of polymer-based CAD-CAM blocks subjected to artificial toothbrushing abrasion (TB). Two resin composite blocks [CeraSmart (CS) and Grandio Blocs (GB)], one polymer-infiltrated ceramic [Vita Enamic (VE)], and one direct resin composite [GrandioSO (RC)] were used to produce 60 specimens. The baseline mass, gloss, roughness, Vickers hardness (Hv), and color were measured after 7 days of water storage. The specimens were then separated into three TB treatment groups (n = 5): water control (C), regular daily dentifrice (R), and whitening dentifrice (W). Measurements were repeated post-TB (20,000 cycles). All specimens were immersed in coffee, and the CIE ΔE00 was measured after 1, 7, and 14 days. Two-way, one-way ANOVA, and Tukey's post hoc tests were performed to determine any significant differences between the materials and TB groups. To determine the stain resistance, repeated measures of ANOVA, one-way ANOVA, and Tukey's post hoc tests were used (α = 0.05). The R and W mass changes were minimal (-3.77 to 3.16 g%). W reduced the gloss of all the materials by 12.6%-65%. All materials in W were slightly rougher (Ra, 0.107-0.144 μm) than those in R (Ra, 0.049-0.072 μm). The ΔE00 ranged from 0.6 to 1.6 in W and 0.4 to 1.4 in R. VE was the hardest material at baseline (Hv = 362), whereas brushing and staining lowered Hv in all TB groups (282.8-300.6). After brushing in W, VE, and RC were more susceptible to coffee stains than were CS and GB. The whitening dentifrice roughened CAD-CAM specimens, reducing gloss, yet lightened some materials. Polymer-infiltrated ceramic and direct resin composite specimens brushed with abrasive regular or whitening dentifrice resulted in more intense staining than the CAD-CAM resin composites

Risk and protective factors in risk assessment: predicting inpatient aggression in adult males detained in a forensic mental health setting

Structured clinical risk assessments represent a preferred means of assessing levels of aggression risk at different times and in different individuals. Increasing attention has been given to capturing protective factors, with sound risk assessment critical to high-secure forensic mental health care. The aim was to assess the predictive value of the HCR-20v3 for aggression risk and the long-term care pilot version of the SAPROF (the SAPROF-LC-pilot) in a high-secure forensic mental health inpatient population and to determine the incremental value of protective over risk factors. Participants were adult males detained in a high secure forensic mental health service, with a primary diagnosis of schizophrenia and/or personality disorder. The focus was on examining hospital based aggression (self- and other-directed) at two time points; up to 6 months (T1) and between 7 and 12 months (T2). The HCR-20V3 and SAPROF-LC-pilot demonstrated good predictive validity but with variability across subscales and aggression types/periods. Historical factors of the HCR-20V3 and External factors of the SAPROF-LC-pilot failed to predict, aside from a medium effect at T1 for verbal aggression and self-harm, for Historical factors. There was evidence for protective factors adding to prediction over risk factors alone, with the integration of protective and risk factors into a risk judgement particularly helpful in improving prediction accuracy. Protective factors contributed to risk estimates and particularly if integrated with risk factors. Combining risk and protective factors has clear predictive advantages, ensuring that protective factors are not supplementary but important to the aggression assessment process