Overview and Analysis of Practices with Open Educational Resources in Adult Education in Europe

OER4Adults aimed to provide an overview of Open Educational Practices in adult learning in Europe, identifying enablers and barriers to successful implementation of practices with OER. The project was conducted in 2012-2013 by a team from the Caledonian Academy, Glasgow Caledonian University, funded by The Institute for Prospective Technological Studies (IPTS). The project drew on data from four main sources: • OER4Adults inventory of over 150 OER initiatives relevant to adult learning in Europe • Responses from the leaders of 36 OER initiatives to a detailed SWOT survey • Responses from 89 lifelong learners and adult educators to a short poll • The Vision Papers on Open Education 2030: Lifelong Learning published by IPTS Interpretation was informed by interviews with OER and adult education experts, discussion at the IPTS Foresight Workshop on Open Education and Lifelong Learning 2030, and evaluation of the UKOER programme. Analysis revealed 6 tensions that drive developing practices around OER in adult learning as well 6 summary recommendations for the further development of such practices

Housing Needs of Ageing Veterans Who Have Experienced Limb Loss

Military veterans can experience limb loss as a direct result of conflict, an accident, illness or injury. Whatever the cause, there is a need to recognise the long-term consequences and challenges of limb loss on maintaining independence in one’s home. This study aimed to examine the housing needs of veterans experiencing limb loss, and the impact of limb loss on housing needs and home adaptations of ageing military veterans. Thirty-two military veterans (aged 43–95) participated in this study and up to three life-story interviews were carried out with each participant. Two themes were generated: availability of support and changing housing needs. It is evident from the findings that military veterans are unique in various ways, specifically due to military culture, geographical relocation and the additional support that is available to the Armed Forces Community. This must be considered in long-term support to maintain independence in the home

Lost and Found: The LGBT+ Veteran Community and the Impacts of the Gay Ban

Background: Prior to 12th January 2000, the UK Armed Forces enforced a ban on all LGBT+ service personnel. Known as the ‘gay ban’, there was no distinction made between sexual orientation and gender identity. Under this ban, LGBT+ service personnel had medals, awards, and commissions taken, pensions and gratuities disregarded or degraded and their association with the Armed Forces barred. A significant number of LGBT+ military personnel during the ban experienced traumatic investigations to uncover evidence of homosexuality and subsequent dishonourable discharges, forced resignations, and alienation from the military family without access to social, financial, or mental health support, which reduced overall well-being. Despite over two decades since the gay ban was repealed, little is known of the UK LGBT+ veterans’ community or the long-term impact of serving during the Armed Forces gay ban. Method: A mixed methods approach was carried out over two phases. Phase One consisted of a qualitative exploratory study involving semi-structured interviews with 15 LGBT+ veterans to understand their lived experience of the LGBT+ Armed Forces ban. Findings from the Phase One interviews informed the development of an online survey completed by 101 LGBT+ veterans, the quantitative element to gain a greater understanding of the impact of the ban, social isolation, and loneliness. All participants enlisted before 12th January 2000, self-identified as being LGBT+ and as having been affected by the ban. Findings: Following the analysis of Phase One and Phase Two, the findings were triangulated. Three overarching themes were identified - Emotional Impact; Changing to Adapt and Adapting to Change; and Aftermath: Barriers to Help Seeking. Underpinning the themes is the risk to health and well-being and the resultant social isolation and loneliness as a consequence of decades of employing camouflage techniques to blend into military life and expected cultural norms. Conclusions: This work advances knowledge on the lived experience of LGBT+ veterans by providing an evidence base for the development of effective service provision to enhance and improve the health and well-being of LGBT+ veterans. In addition to recognising the harm and cumulative vulnerability, brought about by discriminatory practice and abuse, there is a need to recognise that the risk of life-limiting social isolation and loneliness. Recommendations from the research and LGBT+ veterans themselves are also presented

Developing an Integrated Model of Care for Veterans with Alcohol Problems

Introduction: Veterans often do not present with alcohol problems in isolation, they may have a wide range of social, physical, and sociological needs. The aim of this study was to facilitate the development of a co-designed integrated model of care for veterans with alcohol problems. Methods: Following the development model by the Agency for Clinical Innovation, a planning symposium was held in North East of England to engage health and social care planners, public health leads, clinical commissioning groups and providers. Service users were empowered in discussions to provide insights and look for solutions (N=43). Results: Using diagramming techniques, three examples of health and social care provision were created demonstrating the current commissioning landscape, one veteran’s experience of accessing services and a proposal for a new integrated model of care for veterans with alcohol problems. Discussion: By engaging stakeholders and service users, the model proposed a potential solution to reducing the number of veterans ‘falling through the gaps’ or disengaging from services. The collaborative approach highlighted the difficulties in navigating the current complex health and social care systems. The co-designed hub and spoke model aims to enable alcohol misuse services to adapt and evolve so that they better fit the needs of veterans

Maintaining Independence: A Study into the Health and Social Wellbeing of Older Limbless Veterans

The main aims of this study were: 1) To explore the physical, psychological and social wellbeing of older, limbless veterans across the life-course; 2) To ascertain the factors that contribute to the ability of limbless veterans to maintain their independence at various stages in their lives. Ultimately, this research aimed to produce recommendations for health and social care policy around the requirements of an ageing veteran population, inform future service design, and shape the interface between NHS and third sector organisations with responsibility to care for limbless veterans. The research used a peer-led approach to successfully identify and engage older limbless veterans. The research team conducted detailed life history interviews. The life histories of 32 limbless veterans, aged between 43 and 95 formed the data for the study. Each of the participants were involved in semistructured life history interviews

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Incidence, aetiology, and sequelae of viral meningitis in UK adults: a multicentre prospective observational cohort study

Background Viral meningitis is increasingly recognised, but little is known about the frequency with which it occurs, or the causes and outcomes in the UK. We aimed to determine the incidence, causes, and sequelae in UK adults to improve the management of patients and assist in health service planning. Methods We did a multicentre prospective observational cohort study of adults with suspected meningitis at 42 hospitals across England. Nested within this study, in the National Health Service (NHS) northwest region (now part of NHS England North), was an epidemiological study. Patients were eligible if they were aged 16 years or older, had clinically suspected meningitis, and either underwent a lumbar puncture or, if lumbar puncture was contraindicated, had clinically suspected meningitis and an appropriate pathogen identified either in blood culture or on blood PCR. Individuals with ventricular devices were excluded. We calculated the incidence of viral meningitis using data from patients from the northwest region only and used these data to estimate the population-standardised number of cases in the UK. Patients self-reported quality-of-life and neuropsychological outcomes, using the EuroQol EQ-5D-3L, the 36-Item Short Form Health Survey (SF-36), and the Aldenkamp and Baker neuropsychological assessment schedule, for 1 year after admission. Findings 1126 patients were enrolled between Sept 30, 2011, and Sept 30, 2014. 638 (57%) patients had meningitis: 231 (36%) cases were viral, 99 (16%) were bacterial, and 267 (42%) had an unknown cause. 41 (6%) cases had other causes. The estimated annual incidence of viral meningitis was 2·73 per 100 000 and that of bacterial meningitis was 1·24 per 100 000. The median length of hospital stay for patients with viral meningitis was 4 days (IQR 3–7), increasing to 9 days (6–12) in those treated with antivirals. Earlier lumbar puncture resulted in more patients having a specific cause identified than did those who had a delayed lumbar puncture. Compared with the age-matched UK population, patients with viral meningitis had a mean loss of 0·2 quality-adjusted life-years (SD 0·04) in that first year. Interpretation Viruses are the most commonly identified cause of meningitis in UK adults, and lead to substantial long-term morbidity. Delays in getting a lumbar puncture and unnecessary treatment with antivirals were associated with longer hospital stays. Rapid diagnostics and rationalising treatments might reduce the burden of meningitis on health services

Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military (POLM) cluster randomized trial

<p>Abstract</p> <p>Background</p> <p>Effective strategies for the primary prevention of low back pain (LBP) remain elusive with few large-scale clinical trials investigating exercise and education approaches. The purpose of this trial was to determine whether core stabilization alone or in combination with psychosocial education prevented incidence of low back pain in comparison to traditional lumbar exercise.</p> <p>Methods</p> <p>The Prevention of Low Back Pain in the Military study was a cluster randomized clinical study with four intervention arms and a two-year follow-up. Participants were recruited from a military training setting from 2007 to 2008. Soldiers in 20 consecutive companies were considered for eligibility (n = 7,616). Of those, 1,741 were ineligible and 1,550 were eligible but refused participation. For the 4,325 Soldiers enrolled with no previous history of LBP average age was 22.0 years (SD = 4.2) and there were 3,082 males (71.3%). Companies were randomly assigned to receive traditional lumbar exercise, traditional lumbar exercise with psychosocial education, core stabilization exercise, or core stabilization with psychosocial education, The psychosocial education session occurred during one session and the exercise programs were done daily for 5 minutes over 12 weeks. The primary outcome for this trial was incidence of low back pain resulting in the seeking of health care.</p> <p>Results</p> <p>There were no adverse events reported. Evaluable patient analysis (4,147/4,325 provided data) indicated no differences in low back incidence resulting in the seeking of health care between those receiving the traditional exercise and core stabilization exercise programs. However, brief psychosocial education prevented low back pain episodes regardless of the assigned exercise approach, resulting in a 3.3% (95% CI: 1.1 to 5.5%) decrease over two years (numbers needed to treat (NNT) = 30.3, 95% CI = 18.2 to 90.9).</p> <p>Conclusions</p> <p>Core stabilization has been advocated as preventative, but offered no such benefit when compared to traditional lumbar exercise in this trial. Instead, a brief psychosocial education program that reduced fear and threat of low back pain decreased incidence of low back pain resulting in the seeking of health care. Since this trial was conducted in a military setting, future studies are necessary to determine if these findings can be translated into civilian populations.</p> <p>Trial Registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT00373009">NCT00373009</a> at ClinicalTrials.gov - <url>http://clinicaltrials.gov/</url></p

Quantification of clinically applicable stimulation parameters for precision near-organ neuromodulation of human splenic nerves

Abstract: Neuromodulation is a new therapeutic pathway to treat inflammatory conditions by modulating the electrical signalling pattern of the autonomic connections to the spleen. However, targeting this sub-division of the nervous system presents specific challenges in translating nerve stimulation parameters. Firstly, autonomic nerves are typically embedded non-uniformly among visceral and connective tissues with complex interfacing requirements. Secondly, these nerves contain axons with populations of varying phenotypes leading to complexities for axon engagement and activation. Thirdly, clinical translational of methodologies attained using preclinical animal models are limited due to heterogeneity of the intra- and inter-species comparative anatomy and physiology. Here we demonstrate how this can be accomplished by the use of in silico modelling of target anatomy, and validation of these estimations through ex vivo human tissue electrophysiology studies. Neuroelectrical models are developed to address the challenges in translation of parameters, which provides strong input criteria for device design and dose selection prior to a first-in-human trial