5,731 research outputs found

    The PREVENT Study: Preventing hospital admissions attributable to gout

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    BackgroundGout is the most common form of inflammatory arthritis, affecting 1 in 40 people in the UK. Despite highly effective treatments, hospital admissions for gout flares have doubled in England over the last 20 years. Many of these admissions may have been prevented if optimal gout management had been delivered to patients.Objectives1. Describe the epidemiology of gout management in primary and secondary care in the UK.2. Develop an intervention package for implementation during hospitalisations for gout flares, with the aim of improving care and reducing hospitalisations.3. Implement and evaluate this intervention in people hospitalised for gout.MethodsI used population-level health datasets (CPRD, OpenSAFELY, NHS Digital Hospital Episode Statistics) to evaluate outcomes for people with incident gout diagnoses over a 20-year period. I used multivariable regression and survival modelling to analyse factors associated with outcomes, including: i) initiation of urate-lowering therapies (ULT); ii) attainment of serum urate targets; and iii) hospitalisations for gout flares.With extensive stakeholder input, I developed an evidence-based intervention package to optimise hospital gout care. This incorporated the findings of a systematic literature review and process mapping of the admitted patient journey in a cohort of hospitalised gout patients. My intervention consisted of a care pathway, based upon British (BSR), European (EULAR) and American (ACR) gout management guidelines, which encouraged ULT initiation prior to discharge, followed by a nurse-led, post-discharge review to facilitate handover to primary care. I implemented this intervention in patients hospitalised for gout flares at King’s College Hospital over a 12-month period, and evaluated outcomes including ULT initiation, urate target attainment and re-admission rates.ResultsIn the UK, between 2004 and 2020, I showed that only 29% of patients with gout were initiated on ULT within 12 months of diagnosis, while only 36% attained urate targets. No significant improvements in these outcomes were observed after publication of updated BSR and EULAR gout management guidelines. Comorbidities, including chronic kidney disease, heart failure and obesity, associated with increased odds of ULT initiation but decreased odds of attaining urate targets. For patients who were diagnosed with gout during the COVID-19 pandemic, I showed that ULT initiation improved modestly, relative to before the pandemic, while urate target attainment trends were similar. Underlying these trends was a 31% decrease in incident gout diagnoses in England during the first year of the pandemic.Using linked primary and secondary care data, I showed that the risk of hospitalisations for gout flares is greatest within the first 6 months after diagnosis. ULT initiation is associated with more hospitalisations for flares within the first 6 months of diagnosis, but a reduced risk of hospitalisations beyond 12 months; particularly when urate targets are attained.After process mapping the admitted patient journey and systematically appraising the evidence base, I developed and implemented a multi-faceted intervention at King’s College Hospital, with the aim of improving hospital gout care. Following implementation of this intervention, the proportion of hospitalised gout patients who initiated ULT increased from 49% to 92%; more patients achieved serum urate targets; and there were 38% fewer repeat hospitalisations for gout flares.ConclusionsAt a population level, ULT initiation and urate target attainment remain sub-optimal for people with gout in the UK, despite updated management guidelines. Initiation of ULT is associated with long-term reductions in hospitalisations for flares; however, only a minority of patients hospitalised for gout flares are initiated on ULT. After designing and implementing a strategy to optimise hospital gout care, over 90% of patients were initiated on ULT, urate target attainment improved, and repeat hospitalisations decreased. My findings suggest that improved primary-secondary care integration is essential if we are to reverse the epidemic of gout hospitalisations

    Mapping Critical Practice In A Transdisciplinary Urban Studio

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    Architecture and Planning exist to make positive changes to our environment. Future practitioners in these disciplines will be responsible for how our cities develop and are managed - they will be required to exercise their professional judgement in complex and unpredictable contexts. There is increasing interest in transdisciplinary urbanism, but implementation in academic contexts has to date been relatively limited. This thesis aims to build on these examples, through a detailed account of one academic design studio which operates across architecture and urban planning; in doing so it aims to make the case for transdisciplinary, problem and place-based studio teaching. The study considers how a transdisciplinary studio environment supported students to develop a critical approach to practice through collaborative discourse. It looked at studio methods/practices; what it means to practice ‘critically’ in the context of design; and the role ‘going public’ by sharing ideas in public fora might play in developing critical positions. The study was undertaken in collaboration with nine students, a single cohort undertaking the final year of a hybrid master’s qualification in Architecture with Urban Planning. It adopts socio-material and spatial approaches to follow how the studio environment and the students’ emerging interdisciplinary identities shaped both their individual and their shared work. It mapped how their approach to their practice evolved through observations, interviews, and informal conversations, and through their drawings, models and journals. In carrying out these observations, and their analysis, I have returned to drawing methods common in architecture. This allowed me to explore and record aspects of studio practice which might otherwise be missed and revealed the importance of visual and spatial thinking to my own practice. Observations revealed how material spaces, tools and artefacts acted to structure social relations in the studio, and how these relations shaped individual approaches to critical practice

    Wellbeing Work-0ut: Utilisation and comparison of Green Exercise and Mindfulness-Based Stress Reduction as Workplace Interventions for staff at the University of Essex.

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    Wellbeing Work-0ut was a collaboration between the School of Sport, Rehabilitation and Exercise Sciences and OH at the University of Essex, using 0% of participant’s personal time. It aimed to compare the effects of three 8-week interventions: Circuit Training, Green Exercise and MBSR on stress (Primary Outcome), self-esteem, mood, general wellbeing and quality of life (Secondary Outcomes) in employees at the University of Essex. Employees (n=37; 9 males, 28 females; Mean Age = 42.8 years, SD = 10.7), either referred by Occupational Health for stress related issues (n=32) or responded to adverts to join the Wellbeing Work-0ut course (n=5) were assigned to their choice of intervention groups: Circuit Training (n=6), Green Exercise (n=16) or MBSR (n=15). Interventions were in 8-week blocks and ran twice, each time with a different group to increase sample size and better facilitate the interventions. This study used multi-methods (quantitative and qualitative), and a mixed-model design (between-subjects factor: intervention; within-subjects factor: time). Self-report questionnaires: PSS, POMS, RSE, SWEMWBS and SF-36 were taken Baseline, Mid and Post Intervention. Observational field notes were taken, transcribed, and reflexive thematic analysis was performed. Participants of all interventions experienced improved psychological outcomes over time, but there were no statistically significant interactions although two had large effect sizes (TMD and MCS - mental component of SF-36). Further, at timepoint 3, there were minimal clinically important differences on: PSS, SWEMWBS and PCS (physical component of SF-36) for Circuit Training; PSS, TMD, SWEMWBS and MCS for Green Exercise; PSS, RSE, TMD, SWEMWBS and MCS for MBSR. Reflexive thematic analysis gives deeper meaning and detail of participants’ positive experiences, enablers and barriers. Interventions overall are still relevant methods of reducing negative psychological health outcomes. Implications for more in-depth study and communication within businesses to make mental health services more prevalent, visible and accessible

    Effects of the environmental factors in call centre interiors: a case study

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    Environmental factors in workspaces affect employee productivity and satisfaction, particularly in call centres. One of the most challenging issues in contemporary offices is overcoming the problems of concentration on work, despite adverse effects such as insufficient lighting, inappropriate acoustics, or inadequate ventilation. The challenges increase in open-plan solutions. This paper presents a case study from Turkey that elaborates on strategies to improve environmental performance in call centres. It is inspired by a questionnaire conducted among employees of a call centre, identifying existing design lacks. Based on the results, acoustic quality calculations of the physical workspace follow, and initial computing outcomes reveal that the conditions do not meet the standards for call centres. The authors propose strategies to improve acoustic performance in the workspace and apply them to a virtual model. Results reveal that the proposed solutions allow for meeting the standards. Based on the findings, the authors suggest several other strategies for improving the physical environmental quality of the place, thus forming a guideline for the architectural design of call centres. The study derives information from a specific case and context to propose universally applicable solutions. It fills a gap in the literature as it exemplifies the characteristics of call centres in Turkey, which have not been studied before

    How the Migration Process drives the establishment of a Psychological Home: An Italian mixed methods study in the light of Community Psychology

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    The concept of "home" holds profound significance for individuals, yet its definition becomes complex amid changes in living environments, particularly for migrants. This doctoral project explores how migrants construct their psychological sense of home and its impact on well-being. Defense mechanisms, such as idealization or assimilation, play a pivotal role in shaping migrants' psychological sense of home, evolving over time. Despite recognizing the significance of home in migrants' lives, there is a research gap in understanding their psychological sense of home. The study adopts a community psychology approach to migration research, emphasizing relational aspects, contextual interactions, and intervention development. Italy's social scenario, marked by cultural pluralism, makes this approach particularly relevant. The thesis comprises five chapters, offering a theoretical framework, exploring the concept of home, presenting the research question, describing the Italian context, and detailing the methodology. The main studies include a literature review, qualitative interviews, and a quantitative study, each contributing to a comprehensive understanding of migrants' psychological sense of home. The final chapter integrates findings, elucidating the process of establishing a psychological home for migrants. It explores bridging gaps between individual and community-focused migration studies, highlights study limitations, suggests future research, and outlines practical implications. The study contributes valuable insights into the intricate relationship between migrants' psychological sense of home, well-being, and community interactions

    Occupational health and safety issues in human-robot collaboration: State of the art and open challenges

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    Human-Robot Collaboration (HRC) refers to the interaction of workers and robots in a shared workspace. Owing to the integration of the industrial automation strengths with the inimitable cognitive capabilities of humans, HRC is paramount to move towards advanced and sustainable production systems. Although the overall safety of collaborative robotics has increased over time, further research efforts are needed to allow humans to operate alongside robots, with awareness and trust. Numerous safety concerns are open, and either new or enhanced technical, procedural and organizational measures have to be investigated to design and implement inherently safe and ergonomic automation solutions, aligning the systems performance and the human safety. Therefore, a bibliometric analysis and a literature review are carried out in the present paper to provide a comprehensive overview of Occupational Health and Safety (OHS) issues in HRC. As a result, the most researched topics and application areas, and the possible future lines of research are identified. Reviewed articles stress the central role played by humans during collaboration, underlining the need to integrate the human factor in the hazard analysis and risk assessment. Human-centered design and cognitive engineering principles also require further investigations to increase the worker acceptance and trust during collaboration. Deepened studies are compulsory in the healthcare sector, to investigate the social and ethical implications of HRC. Whatever the application context is, the implementation of more and more advanced technologies is fundamental to overcome the current HRC safety concerns, designing low-risk HRC systems while ensuring the system productivity

    Breaking Virtual Barriers : Investigating Virtual Reality for Enhanced Educational Engagement

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    Virtual reality (VR) is an innovative technology that has regained popularity in recent years. In the field of education, VR has been introduced as a tool to enhance learning experiences. This thesis presents an exploration of how VR is used from the context of educators and learners. The research employed a mixed-methods approach, including surveying and interviewing educators, and conducting empirical studies to examine engagement, usability, and user behaviour within VR. The results revealed educators are interested in using VR for a wide range of scenarios, including thought exercises, virtual field trips, and simulations. However, they face several barriers to incorporating VR into their practice, such as cost, lack of training, and technical challenges. A subsequent study found that virtual reality can no longer be assumed to be more engaging than desktop equivalents. This empirical study showed that engagement levels were similar in both VR and non-VR environments, suggesting that the novelty effect of VR may be less pronounced than previously assumed. A study against a VR mind mapping artifact, VERITAS, demonstrated that complex interactions are possible on low-cost VR devices, making VR accessible to educators and students. The analysis of user behaviour within this VR artifact showed that quantifiable strategies emerge, contributing to the understanding of how to design for collaborative VR experiences. This thesis provides insights into how the end-users in the education space perceive and use VR. The findings suggest that while educators are interested in using VR, they face barriers to adoption. The research highlights the need to design VR experiences, with understanding of existing pedagogy, that are engaging with careful thought applied to complex interactions, particularly for collaborative experiences. This research contributes to the understanding of the potential of VR in education and provides recommendations for educators and designers to enhance learning experiences using VR

    THE RELATIONSHIP BETWEEN INSTRUMENTAL ACTIVITIES OF DAILY LIVING AND NATURALISTIC DRIVING PERFORMANCE: INDICATIONS FOR MILD COGNITIVE IMPAIRMENT DETECTION

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    Rationale: A large body of literature has explored the ability of various assessment tools to determine the cognitive status of older adults, as well as the relationships between cognition and driving skills. However, few studies have linked occupational assessment tools and driving skills. Additionally, only a small selection of recent studies has explored both cognitive and driving skills using naturalistic driving data. Results of these studies suggest that cognitive assessments are not the strongest indicators of a person’s cognitive status prior to clinical presentation. Rather, naturalistic driving performance has been implicated as a tool to predict pre-clinical dementia. Due to the established links between occupation-based assessment and standardized driving performance tests, it is plausible that similar links may exist between functional cognition, as measured by occupational assessment, and naturalistic driving performance, implicating both for application in the early detection of dementia. Purpose: The study sought to determine what trends and/or relationships existed amongst participants’ driving aggression, amount of time driving at night, and frequency of drives based on performance in three clinical assessments (cognitive, occupational, driving). Research questions addressed included: 1) Is there a relationship between naturalistic driving performance and performance of IADLs?, 2) Is there a relationship between naturalistic driving performance and cognitive measures?, and 3) Is there a relationship between naturalistic driving performance and standardized driving assessment? Additional research questions investigated differences between age and gender groups. Design: This descriptive, exploratory study collected data for analysis over the course of one year, with naturalistic data collection lasting 20 weeks for each participant. Participants: Participants included 40 older adult drivers (65+ years). All participants were healthy, community-living adults obtained through convenience sampling. Methods: Instruments included the G2 data-logging chip by Azuga Industries, which tracked participants’ driving locations and velocity inside their personal vehicles. Data was computed into three “behavior� values: aggression, daylight driving, and number of trips. Other instruments included the Modified Driving Habits Questionnaire, the Assessment of Motor and Process Skills,and the Montreal Cognitive Assessment. Participants completed clinical assessment in the research lab within the 20-week driving period. Outcomes examined from the G2 chip included total instances of hard braking, total instances of speeding, weekly ratio of night to daylight driving time, and number of trips driven. Results: Analyses indicated that age, MoCA score, and P-Drive scores had significant relationships with one or more naturalistic driving behaviors. The distribution of aggressive driving behavior trended higher in drivers in their 60s and in drivers with low AMPS performance. Discussion: Naturalistic driving performance, as a single measure, was able to reflect differences in performance in all clinical assessments used. The trends in aggressive driving reflected in AMPS performance provide the only known link in the current literature between naturalistic driving and functional assessment. Therefore, the AMPS as a functional assessment may be implicated in the understanding of pre-clinical dementia

    We, the City

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    Given their unchecked neoliberal restructuring, Berlin and Istanbul have been exposed to various forms of political polarisation and social injustice over the last decade. As a result, the struggle for affordable housing, access to public space, fair working conditions, ecological justice and the right to different ways of life has intensified. Various forms of resistance "from below" have challenged the relationship between local governments and social movements, questioning where and how the city's political problems arise. In a mixture of dialogues, essays and critical reflections, this book explores the ways in which residents of Berlin and Istanbul experience, express and resist the physical, political and normative reorganisation of their cities. It poses the question: Who is the We in We, the City
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