The struggle to afford adequate energy:different ways of knowing fuel poverty

This thesis examines the co-existence of three ways of knowing fuel poverty – statistical, procedural and experiential – how they interrelate and interact and the implications that follow for the opportunities and challenges of tackling what has proved a persistent inequality and injustice in UK society. There has been significant policy attention and practical action taken over the last two decades which has involved the development of definitions, categories, processes and procedures through which action can be directed and enacted. All of this has been an attempt to know and act upon the struggles that are experienced by ‘fuel poor’ households. The focus of this thesis will be on different ways in which the phenomenon of fuel poverty can be, and is being, known – through the immediate everyday experiences of households, through the procedures developed and followed by local organisations working to provide help to those ‘in need’ and through the statistical definition and modelling that provides the foundation of government policy. These three ways of knowing are investigated through a research design taking a qualitative approach involving interviews with older householders, ethnographic-style observations with three local organisations in England during the winter of 2012 – 2013, and analysis of policy and related documents on statistical modelling. The thesis found that the statistical and experiential ways of knowing are characterised and understood by fundamentally different forms of knowledge and processes of knowledge production, with the procedural way of knowing needing to directly interact with both the statistical and experiential understandings of fuel poverty. Flows of resources and knowledge show how three different ways of knowing fuel poverty interrelate and interact through policy and action on the ground. These findings have implications for future action against fuel poverty, especially where partnership working and direct interaction with households is concerned

Temporality, vulnerability, and energy justice in household low carbon innovations

Decarbonisation and innovation will change the affordability of different domestic energy services. This has the potential to alleviate vulnerability to fuel poverty, but it could create new injustices unless the risks are preempted and actively mitigated. In this paper, we ask: In what ways can emerging low-carbon innovations at the household scale complement, and complicate, achieving energy justice objectives? Drawing from four empirical case studies in the United Kingdom, the paper highlights different risks that come from different types of innovation required to tackle different decarbonisation challenges. More specifically, it assesses four particular household innovations—energy service contracts, electric vehicles, solar photovoltaic (PV) panels, and low carbon heating—selected for their fit with a typology of incremental vs. radical technology and modest vs. substantial changes in user practices. It shows how in each case, such innovations come with a collection of opportunities but also threats. In doing so, the paper seeks to unveil the “political economy” of low-carbon innovations, identifying particular tensions alongside who wins and who loses, as well as the scope and temporality of those consequences

1000 Norms Project: Protocol of a cross-sectional study cataloging human variation

Background Clinical decision-making regarding diagnosis and management largely depends on comparison with healthy or ‘normal’ values. Physiotherapists and researchers therefore need access to robust patient-centred outcome measures and appropriate reference values. However there is a lack of high-quality reference data for many clinical measures. The aim of the 1000 Norms Project is to generate a freely accessible database of musculoskeletal and neurological reference values representative of the healthy population across the lifespan. Methods/design In 2012 the 1000 Norms Project Consortium defined the concept of ‘normal’, established a sampling strategy and selected measures based on clinical significance, psychometric properties and the need for reference data. Musculoskeletal and neurological items tapping the constructs of dexterity, balance, ambulation, joint range of motion, strength and power, endurance and motor planning will be collected in this cross-sectional study. Standardised questionnaires will evaluate quality of life, physical activity, and musculoskeletal health. Saliva DNA will be analysed for the ACTN3 genotype (‘gene for speed’). A volunteer cohort of 1000 participants aged 3 to 100 years will be recruited according to a set of self-reported health criteria. Descriptive statistics will be generated, creating tables of mean values and standard deviations stratified for age and gender. Quantile regression equations will be used to generate age charts and age-specific centile values. Discussion This project will be a powerful resource to assist physiotherapists and clinicians across all areas of healthcare to diagnose pathology, track disease progression and evaluate treatment response. This reference dataset will also contribute to the development of robust patient-centred clinical trial outcome measures

Hippocampal pyramidal cells: the reemergence of cortical lamination

The increasing resolution of tract-tracing studies has led to the definition of segments along the transverse axis of the hippocampal pyramidal cell layer, which may represent functionally defined elements. This review will summarize evidence for a morphological and functional differentiation of pyramidal cells along the radial (deep to superficial) axis of the cell layer. In many species, deep and superficial sublayers can be identified histologically throughout large parts of the septotemporal extent of the hippocampus. Neurons in these sublayers are generated during different periods of development. During development, deep and superficial cells express genes (Sox5, SatB2) that also specify the phenotypes of superficial and deep cells in the neocortex. Deep and superficial cells differ neurochemically (e.g. calbindin and zinc) and in their adult gene expression patterns. These markers also distinguish sublayers in the septal hippocampus, where they are not readily apparent histologically in rat or mouse. Deep and superficial pyramidal cells differ in septal, striatal, and neocortical efferent connections. Distributions of deep and superficial pyramidal cell dendrites and studies in reeler or sparsely GFP-expressing mice indicate that this also applies to afferent pathways. Histological, neurochemical, and connective differences between deep and superficial neurons may correlate with (patho-) physiological phenomena specific to pyramidal cells at different radial locations. We feel that an appreciation of radial subdivisions in the pyramidal cell layer reminiscent of lamination in other cortical areas may be critical in the interpretation of studies of hippocampal anatomy and function

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Best practice framework for Patient and Public Involvement (PPI) in collaborative data analysis of qualitative mental health research: methodology development and refinement

Background Patient and Public Involvement (PPI) in mental health research is increasing, especially in early (pre-funding) stages. PPI is less consistent in later stages, including in analysing qualitative data. The aims of this study were to develop a methodology for involving PPI co-researchers in collaboratively analysing qualitative mental health research data with academic researchers, to pilot and refine this methodology, and to create a best practice framework for collaborative data analysis (CDA) of qualitative mental health research. Methods In the context of the RECOLLECT Study of Recovery Colleges, a critical literature review of collaborative data analysis studies was conducted, to identify approaches and recommendations for successful CDA. A CDA methodology was developed and then piloted in RECOLLECT, followed by refinement and development of a best practice framework. Results From 10 included publications, four CDA approaches were identified: (1) consultation, (2) development, (3) application and (4) development and application of coding framework. Four characteristics of successful CDA were found: CDA process is co-produced; CDA process is realistic regarding time and resources; demands of the CDA process are manageable for PPI co-researchers; and group expectations and dynamics are effectively managed. A four-meeting CDA process was piloted to o-produce a coding framework based on qualitative data collected in RECOLLECT and to create a mental health service user-defined change model relevant to Recovery Colleges. Formal and informal feedback demonstrated active involvement. The CDA process involved an extra 80 person-days of time (40 from PPI coresearchers, 40 from academic researchers).The process was refined into a best practice framework comprising Preparation, CDA and Application phases. Conclusions This study has developed a typology of approaches to collaborative analysis of qualitative data in mental health research, identified from available evidence the characteristics of successful involvement, and developed, piloted and refined the first best practice framework for collaborative analysis of qualitative data. This framework has the potential to support meaningful PPI in data analysis in the context of qualitative mental health research studies, a previously neglected yet central part of the research cycle

Living with fuel poverty in older age:coping strategies and their problematic implications

Fuel poverty is a problem particularly associated with the lives and living conditions of older people, in part because of their vulnerability to health impacts. This article draws attention to the ways in which older people on low incomes cope with and adapt to problems of affording to keep warm at home. We present findings from interviews with 17 households during the winter of 2012–2013 in England. The importance of keeping warm was recognised across the interviews. Four particular categories of coping strategies were defined and used—responsively adjusting the length of time and parts of the home for which heating is kept on, using secondary heating sources; using additional layers that help to keep bodies warm; and adjusting daily routines. We found that it was rare for people themselves to problematize the ways in which they were coping day to day, they largely just saw this as what they did to get by and to control the size of their energy bills. Coping strategies raise questions about what are acceptable living conditions, how judgments are made and how assistance can be provided when householders do not themselves problematize their situation. Implications for action to tackle fuel poverty are considered