Singing and COPD: a pilot randomized controlled trial of wellbeing and respiratory outcomes

Aims/objectives To test whether a ten-week regular weekly group singing programme, with guided home practice, leads to improvement in COPD-specific health status, as assessed by the COPD Assessment Test (CAT, primary outcome). To test whether the programme results in changes to health-related quality of life, mental health, breathlessness, lung function, functional exercise performance and breathing patterns (secondary outcomes). Rationale A number of randomized controlled trials (RCTs) exist which suggest that there are potential benefits to health and wellbeing of regular singing for people with COPD (Chronic Obstructive Pulmonary Disease). However, most rely on small samples, and findings across the different outcome measures are inconsistent, while interview studies tend to report consistent positive physical and psychological outcomes. Further research is therefore needed. Approach A single-blind, randomized controlled trial compared a structured, weekly group singing programme plus home practice between sessions over ten weeks, with a usual COPD treatment control. The sample was drawn from a local NHS population of people with COPD. Following baseline assessments, participants were allocated to a 10 week singing programme or a control. Findings Twenty-four individuals completed to follow-up. Measures at 12 weeks showed no significant differences between singing and control groups except for one item on the health status questionnaire (SF-36) which suggested the singers were less limited in their activities of daily living post-singing. Final follow-up, planned for 6 months post intervention, was aborted due to the COVID-19 pandemic. Discussion and conclusion The study failed to recruit to target. There remains a recruitment problem in RCTs of singing for COPD, resulting in inconclusive findings, which conflict with the positive qualitative evidence. A wide variety of reseach methods, as well as RCTs, are suggested to enable a better understanding of the impact of singing on COPD. Trial registration number: ISRCTN42943709

Phase 1 Anglo-French report on the IMPRESS Health 2 (Interreg IVA Channel Programme) project 4282: understanding factors behind the late testing and diagnosis of HIV

This report outlines the combined Anglo-French findings and analysis of data from the phase 1 (research) phase of the Interreg IVA Channel Programme funded IMPRESS Health 2 project examining factors behind the late testing and diagnosis of HIV in Kent, Medway, and Picardy (France)

Tawney and the third way

From the 1920s to the 1950s R. H. Tawney was the most influential socialist thinker in Britain. He articulated an ethical socialism at odds with powerful statist and mechanistic traditions in British socialist thinking. Tawney's work is thus an important antecedent to third way thinking. Tawney's religiously-based critique of the morality of capitalism was combined with a concern for detailed institutional reform, challenging simple dichotomies between public and private ownership. He began a debate about democratizing the enterprise and corporate governance though his efforts fell on stony ground. Conversely, Tawney's moralism informed a whole-hearted condemnation of market forces in tension with both his concern with institutional reform and modern third way thought. Unfortunately, he refused to engage seriously with emergent welfare economics which for many social democrats promised a more nuanced understanding of the limits of market forces. Tawney's legacy is a complex one, whose various elements form a vital part of the intellectual background to current third way thinking

Party finance reform as constitutional engineering? The effectiveness and unintended consequences of party finance reform in France and Britain

In both Britain and France, party funding was traditionally characterized by a laissez faire approach and a conspicuous lack of regulation. In France, this was tantamount to a 'legislative vacuum'. In the last two decades, however, both countries have sought to fundamentally reform their political finance regulation regimes. This prompted, in Britain, the Political Parties, Elections and Referendums Act 2000, and in France a bout of 'legislative incontinence' — profoundly transforming the political finance regime between 1988 and 1995. This article seeks to explore and compare the impacts of the reforms in each country in a bid to explain the unintended consequences of the alternative paths taken and the effectiveness of the new party finance regime in each country. It finds that constitutional engineering through party finance reform is a singularly inexact science, largely due to the imperfect nature of information, the limited predictability of cause and effect, and the constraining influence of non-party actors, such as the Constitutional Council in France, and the Electoral Commission in Britain

Understanding factors behind the late testing and diagnosis of HIV: Findings from phase 1 of the IMPRESS Health 2 (Interreg IVA Channel Programme) Project

Over 100,000 have HIV in the UK. However, while effective treatment exists, there is neither a cure nor a preventive vaccine, so 500+ people die from AIDS every year with many others dying undiagnosed. Health policy focuses on prevention and support, but it is necessary to increase the number of early diagnoses and reduce the rate of spread (Public Health England, 2014). Approximately 25% of HIV positive individuals do not know their status however, and almost half of all UK diagnoses occur late. It is vital therefore, to understand and address barriers to early testing and diagnoses to address this trend. Clinical data for 240 patients diagnosed with HIV in 3 trusts in Kent and Medway over 5 years were analysed in relation to clinical, social, demographic and psychosexual factors likely to affect knowledge of HIV and their decision to seek a test. Fifty-three semi-structured interviews were also conducted with patients and healthcare professionals to elicit experienced and perceptions about barriers to testing and ways to increase uptake. Patients were aged 19-81 (mean 40 years) and 67.5% were men. Women were more likely to be diagnosed late however (67.9% versus 56.8%), and late diagnosis was higher than the national average for both sexes (60.4%) with the highest rates in Medway (66.1%) and Maidstone and Tunbridge Wells (64.6%). Patients diagnosed late were 4 years older than those diagnosed early, and late diagnosis was higher in ethnic minority groups (70.2%) compared to white British (53.0%). Those born outside the UK were also generally diagnosed later (69.8%). The most frequent categories affected were heterosexuals (56.2%), men who have sex with men (36.6%) and intravenous drug users (2.0%). Patients diagnosed during an acute hospital admission were far more likely to be diagnosed late (89.1%) compared to other settings (49.6% - 57.1%). Qualitative data suggested that outmoded notions of HIV as a ‘gay’ disease still prevailed and heterosexuals did not generally consider themselves to be at risk. Healthcare professionals sometimes failed to acknowledge risks in ‘non-traditional’ groups and often overlooked HIV as a likely cause of symptoms until they were seriously unwell. Clearer public health messages should be targeted at the general population and there is a need to better educate healthcare professionals, especially GPs about the clinical indicators of HIV which also needs to be de-stigmatised

Radiological Impacts in Life Cycle Assessment – Part II: Comparison of Methodologies

In a complementary article, an overarching framework was proposed to include radiological impacts in Life Cycle Impact Assessment (LCIA). Two methodologies were derived embodying the framework: the Critical Group Methodology (CGM), adapted from the approach commonly used in Human and Environmental Risk Assessment (HERA), and UCrad, based on the compartment modelling approach commonly used in LCIA. In this paper, characterisation factors obtained by the two methodologies are compared in detail to investigate the consequences of the different approaches to fate modelling and the sensitivity of the characterisation factors to the radionuclides’ half-life. Characterisation factors from the CGM methodology are strongly affected by radioactive decay at low half-life and by dilution at large distances. Conversely, UCrad factors are not affected by dilution and are affected less than CGM by radioactive decay. It is concluded that UCrad is more appropriate than CGM for LCA because it is consistent with the general approach used in LCIA. However, CGM can be used alongside UCrad to make recommendations on the location and scale of specific processes emitting radionuclides

Transcritical flow of a stratified fluid over topography: analysis of the forced Gardner equation

Transcritical flow of a stratified fluid past a broad localised topographic obstacle is studied analytically in the framework of the forced extended Korteweg--de Vries (eKdV), or Gardner, equation. We consider both possible signs for the cubic nonlinear term in the Gardner equation corresponding to different fluid density stratification profiles. We identify the range of the input parameters: the oncoming flow speed (the Froude number) and the topographic amplitude, for which the obstacle supports a stationary localised hydraulic transition from the subcritical flow upstream to the supercritical flow downstream. Such a localised transcritical flow is resolved back into the equilibrium flow state away from the obstacle with the aid of unsteady coherent nonlinear wave structures propagating upstream and downstream. Along with the regular, cnoidal undular bores occurring in the analogous problem for the single-layer flow modeled by the forced KdV equation, the transcritical internal wave flows support a diverse family of upstream and downstream wave structures, including solibores, rarefaction waves, reversed and trigonometric undular bores, which we describe using the recent development of the nonlinear modulation theory for the (unforced) Gardner equation. The predictions of the developed analytic construction are confirmed by direct numerical simulations of the forced Gardner equation for a broad range of input parameters.Comment: 34 pages, 24 figure

Arts on prescription for community‐dwelling older people with a range of health and wellness needs

Published evidence for the role of participatory art in supporting health and well‐being is growing. The Arts on Prescription model is one vehicle by which participatory art can be delivered. Much of the focus of Arts on Prescription has been on the provision of creative activities for people with mental health needs. This Arts on Prescription program, however, targeted community‐dwelling older people with a wide range of health and wellness needs. Older people were referred to the program by their healthcare practitioner. Professional artists led courses in visual arts, photography, dance and movement, drama, singing, or music. Classes were held weekly for 8–10 weeks, with six to eight participants per class, and culminated with a showing of work or a performance. Program evaluation involved pre‐ and postcourse questionnaires, and focus groups and individual interviews. Evaluation data on 127 participants aged 65 years and older were available for analysis. We found that Arts on Prescription had a positive impact on participants. Quantitative findings revealed a statistically significant improvement in the Warwick–Edinburgh Mental Well‐being Scale(WEMWBS) as well as a statistically significant increase in the level of self‐reported creativity and frequency of creative activities. Qualitative findings indicated that the program provided challenging artistic activities which created a sense of purpose and direction, enabled personal growth and achievement, and empowered participants, in a setting which fostered the development of meaningful relationships with others. This evaluation adds to the evidence base in support of Arts on Prescription by expanding the application of the model to older people with a diverse range of health and wellness needs

Data supporting UCrad and CGM, two novel methodologies for radiological impacts in Life Cycle Assessment

Radiological impacts are often disregarded in Life Cycle Assessment (LCA) due to the lack of a standard and comprehensive framework for including the impacts of radionuclides alongside other emissions from industrial processes. This data article is related to the research articles “Radiological Impacts in Life Cycle Assessment. Part I: General framework and two practical methodologies” [1] and “Radiological Impacts in Life Cycle Assessment. Part II: Comparison of Methodologies” [2], which introduced two practical methodologies for assessing the radiological impacts in LCA; these are UCrad and the Critical Group Methodology (CGM). This article reports the characterisation factors, for routine direct discharges and releases from nuclear waste disposed in a geological disposal facility, obtained from both methodologies. The article also reports the underlying data supporting the methodologies and the analysis carried out in the related research articles