Exploration of barriers and enablers for evidence-based interventions for upper limb rehabilitation following a stroke : use of Constraint Induced Movement Therapy and Robot Assisted Therapy in NHS Scotland

The routine use of evidence-based upper limb rehabilitation interventions after stroke has the potential to improve function and increase independence. Two such interventions are Constraint Induced Movement Therapy and Robot Assisted Therapy. Despite evidence to support both interventions, their use within the National Health Service appears, anecdotally, to be low. We sought to understand user perceptions in order to explain low uptake in clinical practice. Methods A combination of a cross-sectional online survey with therapists and semi-structured interviews with stroke patients was used to explore uptake and user opinions on the benefits, enablers and barriers to each intervention. Findings The therapists surveyed reported low use of Constraint Induced Movement Therapy and Robot Assisted Therapy in clinical practice within the Scottish National Health Service. Barriers identified by therapists were inadequate staffing, and a lack of training and resources. Interviews with stroke patients identified themes that may help us to understand the acceptability of each intervention, such as the impact of motivation. Conclusion Barriers to the uptake of Constraint Induced Movement Therapy and Robot Assisted Therapy within the clinical setting were found to be similar. Further qualitative research should be completed in order to help us understand the role patient motivation plays in uptake

'Giving birth in rural Malawi: perceptions, power and decision- making in a matrilineal community

This anthropological study exammes the relationships, influences and power dynanucs underpinning decisions made around childbearing in a resource-poor subsistence farming community in southern Malawi. Local literature and relevant anthropological and technical sources are exan1ined for childbearing themes, patterns of residence and relatedness, knowledge and power, health perceptions and risk Methodological and ethical issues are analysed, taking a reflective approach toward the author's n1idwifery background. The study is founded in the view that understanding childbearing processes has inherent value for women's wellbeing, but also can contribute insights into wider social themes and contribute to anthropological debates. A strongly matrilineal and matrilocal lifestyle is revealed with substantial power residing with older women. Men are heads of households when resident and responsible for the welfare of their own matrikin. TIus dynamic is exan1ined indicating that cluldbearing women's older female matrikin make most decisions, at least for younger women, and men generally support them. To understand decision-making, perceptions of health and childbearing, and concepts of risk are examined. Biomedical ideas are layered with ethnomedical, and local expressions of morality. Ideas of childbearing risk are grounded in this eclectic view, with biological problems often linked with causation, and resolution congruent ·with local cosmology. These include hot/cold imbalance, maintenance of the life-force, adultery in pregnancy, bewitching and pollution and taboo. The development and legitimacy of knowledge used to make decisions is exan1ined. Older women retain control; most young women remaining too ignorant for independent action, but all ages demonstrate acceptance of the knowledge of the formal health service. The overall scenario is of generally benevolent control of younger women using a power base grounded in matrilineal relatedness and eclectic concepts, knowledge and notions of risk to make childbearing decisions. Choices are however ultimately pragmatic and dependent on circumstance with neither local concepts nor biomedical ideas prevailing

The effectiveness of Advance Care Planning (ACP) training for care home staff: an updated systematic review

Context: Population ageing and projections that more people will die in care homes demand that care home staff are prepared for advance care planning (ACP). This is an update of a prior review, published in 2021, of ACP education interventions for healthcare professionals in care homes. Objective: We sought to address the questions: (1) What ACP education interventions exist for care home staff? and (2) How effective are these interventions? Method: The review adheres to PRISMA; PROSPERO (ID: CRD42022337865). Original research evaluating ACP education for care home staff, reporting any measurable outcome of effectiveness, was included. Extensive literature searches were performed from March 2018 to June 2022. The results were reported by narrative synthesis. Findings: We identified 10 studies (310 care homes), from the UK, Belgium, Norway and Canada. Major sources of heterogeneity between studies include intervention design, target population and outcome measure. More recent interventions target the wider multi-disciplinary team. There is a trend towards the adoption of more resident/family and staff-related outcomes. There was insufficient evidence to draw conclusions about the effectiveness of ACP education interventions. Limitations: Heterogeneity of the primary studies did not allow for meta-analysis. Implications: There is still insufficient data to determine the effectiveness of ACP education interventions for care home staff. Future researchers should aim to agree on outcomes that are specific to ACP education interventions for care home staff and develop standardised, validated outcome measures. Study design should consider an intervention’s ‘theory of change’ when considering outcomes

Outcomes, experiences and palliative care in major stroke:a multicentre, mixed-method, longitudinal study

Background: Case fatality after total anterior circulation stroke is high. Our objective was to describe the experiences and needs of patients and caregivers, and to explore whether, and how, palliative care should be integrated into stroke care. Methods: From 3 stroke services in Scotland, we recruited a purposive sample of people with total anterior circulation stroke, and conducted serial, qualitative interviews with them and their informal and professional caregivers at 6 weeks, 6 months and 1 year. Interviews were transcribed for thematic and narrative analysis. The Palliative Care Outcome Scale, EuroQol-5D-5L and Caregiver Strain Index questionnaires were completed after interviews. We also conducted a data linkage study of all patients with anterior circulation stroke admitted to the 3 services over 6 months, which included case fatality, place of death and readmissions. Results: Data linkage (n = 219) showed that 57% of patients with total anterior circulation stroke died within 6 months. The questionnaires recorded that the patients experienced immediate and persistent emotional distress and poor quality of life. We conducted 99 interviews with 34 patients and their informal and professional careers. We identified several major themes. Patients and caregivers faced death or a life not worth living. Those who survived felt grief for a former life. Professionals focused on physical rehabilitation rather than preparation for death or limited recovery. Future planning was challenging. “Palliative care” had connotations of treatment withdrawal and imminent death. Interpretation: Major stroke brings likelihood of death but little preparation. Realistic planning with patients and informal caregivers should be offered, raising the possibility of death or survival with disability. Practising the principles of palliative care is needed, but the term “palliative care” should be avoided or reframed

Post stroke intervention trial in fatigue (POSITIF):Randomised multicentre feasibility trial

OBJECTIVE: To test the feasibility of a telephone delivered intervention, informed by cognitive behavioural principles, for post-stroke fatigue, and estimated its effect on fatigue and other outcomes. DESIGN: Randomised controlled parallel group trial. SETTING: Three Scottish stroke services. SUBJECTS: Stroke survivors with fatigue three months to two years post-stroke onset. INTERVENTIONS: Seven telephone calls (fortnightly then a ‘booster session’ at 16 weeks) of a manualised intervention, plus information about fatigue, versus information only. MAIN MEASURES: Feasibility of trial methods, and collected outcome measures (fatigue, mood, anxiety, social participation, quality of life, return to work) just before randomisation, at the end of treatment (four months after randomisation) and at six months after randomisation. RESULTS: Between October 2018 and January 2020, we invited 886 stroke survivors to participate in postal screening: 188/886 (21%) returned questionnaires and consented, of whom 76/188 (40%) were eligible and returned baseline forms; 64/76 (84%) returned six month follow-up questionnaires. Of the 39 allocated the intervention, 23 (59%) attended at least four sessions. At six months, there were no significant differences between the groups (adjusted mean differences in Fatigue Assessment Scale −0.619 (95% CI −4.9631, 3.694; p = 0.768), the Generalised Anxiety Disorder 7 −0.178 (95% CI −3.823, 3.467, p = 0.92), and the Patient Health Questionnaire −0.247 (95% CI −2.935, 2.442, p = 0.851). There were no between-group differences in quality of life, social participation or return to work. CONCLUSION: Patients can be recruited to a trial of this design. These data will inform the design of further trials in post-stroke fatigue

Reliability and Validity of the Early Years Physical Activity Questionnaire (EY-PAQ).

Measuring physical activity (PA) and sedentary time (ST) in young children (<5 years) is complex. Objective measures have high validity but require specialist expertise, are expensive, and can be burdensome for participants. A proxy-report instrument for young children that accurately measures PA and ST is needed. The aim of this study was to assess the reliability and validity of the Early Years Physical Activity Questionnaire (EY-PAQ). In a setting where English and Urdu are the predominant languages spoken by parents of young children, a sample of 196 parents and their young children (mean age 3.2 ± 0.8 years) from Bradford, UK took part in the study. A total of 156 (79.6%) questionnaires were completed in English and 40 (20.4%) were completed in transliterated Urdu. A total of 109 parents took part in the reliability aspect of the study, which involved completion of the EY-PAQ on two occasions (7.2 days apart; standard deviation (SD) = 1.1). All 196 participants took part in the validity aspect which involved comparison of EY-PAQ scores against accelerometry. Validty anaylsis used all data and data falling with specific MVPA and ST boundaries. Reliability was assessed using intra-class correlations (ICC) and validity by Bland⁻Altman plots and rank correlation coefficients. The test re-test reliability of the EY-PAQ was moderate for ST (ICC = 0.47) and fair for moderate-to-vigorous physical activity (MVPA)(ICC = 0.35). The EY-PAQ had poor agreement with accelerometer-determined ST (mean difference = -87.5 min·day-1) and good agreement for MVPA (mean difference = 7.1 min·day-1) limits of agreement were wide for all variables. The rank correlation coefficient was non-significant for ST (rho = 0.19) and significant for MVPA (rho = 0.30). The EY-PAQ has comparable validity and reliability to other PA self-report tools and is a promising population-based measure of young children's habitual MVPA but not ST. In situations when objective methods are not possible for measurement of young children's MVPA, the EY-PAQ may be a suitable alternative but only if boundaries are applied

Core outcome measures for palliative and end-of-life research after severe stroke: mixed-method Delphi study

Background and Purpose: Stroke is the second commonest cause of death worldwide and a leading cause of severe disability, yet there are no published trials of palliative care in stroke. To design and evaluate palliative care interventions for people with stroke, researchers need to know what measurable outcomes matter most to patients and families, stroke professionals, and other service providers. Methods: A multidisciplinary steering group of professionals and laypeople managed the study. We synthesized recommendations from respected United Kingdom and international consensus documents to generate a list of outcome domains and then performed a rapid scoping literature review to identify potential outcome measures for use in future trials of palliative care after stroke. We then completed a 3-round, online Delphi survey of professionals, and service users to build consensus about outcome domains and outcome measures. Finally, we held a stakeholder workshop to review and finalize this consensus. Results: We generated a list of 36 different outcome domains from 4 key policy documents. The rapid scoping review identified 43 potential outcome measures that were used to create a shortlist of 16 measures. The 36 outcome domains and 16 measures were presented to a Delphi panel of diverse healthcare professionals and lay service users. Of 48 panelists invited to take part, 28 completed all 3 rounds. Shared decision-making and quality of life were selected as the most important outcome domains for future trials of palliative care in stroke. Additional comments highlighted the need for outcomes to be feasible, measurable, and relevant beyond the initial, acute phase of stroke. The stakeholder workshop endorsed these results. Conclusions: Future trials of palliative care after stroke should include pragmatic outcome measures, applicable to the evolving patient and family experiences after stroke and be inclusive of shared decision-making and quality of life

Caspase-11 regulates the tumour suppressor function of STAT1 in a murine model of colitis-associated carcinogenesis

Murine inflammatory caspase-11 has an important role in intestinal epithelial inflammation and barrier function. Activation of the non-canonical inflammasome, mediated by caspase-11, serves as a regulatory pathway for the production of the proinflammatory cytokines IL-1β and IL-18, and has a key role in pyroptotic cell death. We have previously demonstrated a protective role for caspase-11 during dextran sulphate sodium (DSS)-induced colitis, however the importance of caspase-11 during colorectal tumour development remains unclear. Here, we show that Casp11−/− mice are highly susceptible to the azoxymethane (AOM)-DSS model of colitis-associated cancer (CAC), compared to their wild type (WT) littermates. We show that deficient IL-18 production occurs at initial inflammation stages of disease, and that IL-1β production is more significantly impaired in Casp11−/− colons during established CAC. We identify defective STAT1 activation in Casp11−/− colons during disease progression, and show that IL-1β signalling induces caspase-11 expression and STAT1 activation in primary murine macrophages and intestinal epithelial cells. These findings uncover an anti-tumour role for the caspase-11 and the non-canonical inflammasome during CAC, and suggest a critical role for caspase-11, linking IL-1β and STAT1 signalling pathways

Reliability and validity of the early years physical activity questionnaire (EY-PAQ)

Measuring physical activity (PA) and sedentary time (ST) in young children (<5 years) is complex. Objective measures have high validity but require specialist expertise, are expensive, and can be burdensome for participants. A proxy-report instrument for young children that accurately measures PA and ST is needed. The aim of this study was to assess the reliability and validity of the Early Years Physical Activity Questionnaire (EY-PAQ). In a setting where English and Urdu are the predominant languages spoken by parents of young children, a sample of 196 parents and their young children (mean age 3.2 ± 0.8 years) from Bradford, UK took part in the study. A total of 156 (79.6%) questionnaires were completed in English and 40 (20.4%) were completed in transliterated Urdu. A total of 109 parents took part in the reliability aspect of the study, which involved completion of the EY-PAQ on two occasions (7.2 days apart; standard deviation (SD) = 1.1). All 196 participants took part in the validity aspect which involved comparison of EY-PAQ scores against accelerometry. Validty anaylsis used all data and data falling with specific MVPA and ST boundaries. Reliability was assessed using intra-class correlations (ICC) and validity by Bland–Altman plots and rank correlation coefficients. The test re-test reliability of the EY-PAQ was moderate for ST (ICC = 0.47) and fair for moderate-to-vigorous physical activity (MVPA)(ICC = 0.35). The EY-PAQ had poor agreement with accelerometer-determined ST (mean difference = −87.5 min·day−1) and good agreement for MVPA (mean difference = 7.1 min·day−1) limits of agreement were wide for all variables. The rank correlation coefficient was non-significant for ST (rho = 0.19) and significant for MVPA (rho = 0.30). The EY-PAQ has comparable validity and reliability to other PA self-report tools and is a promising population-based measure of young children’s habitual MVPA but not ST. In situations when objective methods are not possible for measurement of young children’s MVPA, the EY-PAQ may be a suitable alternative but only if boundaries are applied

Citizen Science in Ireland

Ireland has a rich history of public engagement with science and the growing number of national citizen science initiatives is in keeping with developments seen in other European countries. This paper explores several aspects of citizen science in Ireland, in order to assess its development and to better understand potential opportunities for the field. An introduction to the roots of citizen science in Ireland’s past, from the first methodical observations of natural phenomena carried out at monastic settlements up to present day projects monitoring environmental change and biodiversity, is presented along with an overview of the current national citizen science projects running in the country. This cataloging of contemporary citizen science will be compared to the awareness of citizen science in the Irish education system at primary, post-primary, and university level. These measures of progress will be considered in the changing context of international citizen science funding and available support, such as the European Citizen Science Association and the EU-Citizen. Science platform. Citizen science in Ireland is at a critical point. If citizen science is embraced as a truly social and participatory innovation, Ireland has the chance to not only dramatically improve its citizen science output, but to also become a model of best practice for countries at similar stages of citizen science development