What is going on in public involvement in health research? A qualitative exploration of aims, processes and outcomes

This project aimed to understand what was going on in public involvement in health research based on an investigation of the relationship between the practice of involvement and conceptualisations of involvement in the literature. A qualitative exploration was conducted of two case studies where researchers involved members of the public in the design, planning and conduct of health research. The methodological approach drew on realism, reflexivity and abduction. Data were gathered by observation, interview and collection of documents.The literature review identified that key critiques of involvement practice were based on different understandings of the purpose of involvement, and that normative and substantive rationales valued different kinds of outcomes with significant implications for both the conceptualisation and evaluation of involvement. Key components of involvement were distilled from the literature and not all were addressed by current conceptualisations of involvement in research. Findings suggest that the evaluation of involvement practice based on rationale and key components has potential to improve understanding because the criteria for judging practice are closely related to desired outcomes and address all aspects of involvement agreed as important.The case studies provide a rich picture of involvement in context and additional insights into processes, mechanisms, and impacts of involvement. Consideration of the range of impacts identified, and their connection to the rationale for involvement identified a range of conceptual issues related to the outcomes of involvement.The project’s findings have been used to develop new theory-based tools to support the planning, practice and evaluation of involvement. These include a framework for the evaluation of involvement, identification of potential involvement tasks and roles for involvement in health services research, ideas to support thinking about the context of involvement in research, and ways to improve thinking about the range of experiential expertise needed when recruiting research partners

The early presentation and management of rheumatoid arthritis cases in primary care

Recent NICE guidance has emphasised the importance of early recognition and referral of patients with inflammatory arthritis so that disease modifying treatment can be promptly initiated. The timely identification of such patients, given the large numbers consulting with musculoskeletal complaints, is a considerable challenge and descriptive data from primary care are sparse. Our objective was to examine GP records from three years before to 14 days after the first coded diagnosis of rheumatoid arthritis in order to describe the early course and management of the diseas

Randomised trial of a vibrating bladder stimulator -the time to pee study

This randomised, non-blinded study evaluated a vibrating bladder stimulator to facilitate collection of a urine sample from pre-continent children. The use of a bladder stimulator produced no significant time improvements in any of the analysed parameters (n = 97). We identify a population of patients who may benefit from some form of bladder stimulation

The Effects of Exercise-Induced Muscle Damage on the Human Response to Dynamic Exercise

Exercise-induced muscle damage (EIMD) is a commonly experienced phenomenon, yet its effect on the human response to dynamic exercise is poorly understood. Therefore the intention of this thesis was to provide empirical evidence to advance the scientific knowledge and understanding of the phenomenon of EIMD; principally by investigating the physiological, perceived exertion and metabolic responses to the performance of dynamic exercise with EIMD. The eccentric, muscle-damaging exercise protocol employed for all four studies involved participants completing 100 squats performed as 10 sets of 10 repetitions with the load on the bar corresponding to 70% of the individual’s body mass. Measures of markers of muscle damage were taken before and after the eccentric exercise protocol in each of the four studies. The markers used were plasma creatine kinase activity, isokinetic peak torque and perceived muscle soreness. Cycling rather than running was used as the dynamic exercise mode in studies 1, 2 and 4 in order to avoid the confounding influence of alterations in gait subsequent to EIMD. The dynamic exercise in study 3 was performed inside a whole body scanner and was therefore limited to knee extension and flexion. These four studies have provided novel insights into the influence of eccentric, muscle-damaging exercise on the human response to the performance of dynamic exercise. We have demonstrated for the first time that following EIMD, the enhanced ventilatory response to dynamic exercise is provoked by stimuli unrelated to the blood lactate response, and that this enhanced ventilation may provide an important cue to inform the perception of effort. Furthermore, we have shown that the reduced time to exhaustion observed following EIMD is associated with an elevated perception of exertion and increases in [Pi] during dynamic exercise. Finally, we have demonstrated that the kinetic response is unaltered during the transition to high intensity dynamic exercise. Changes in [HHb] kinetics indicate that compensatory mechanisms act to preserve blood-myocyte O2 flux in the face of microvascular dysfunction, resulting in the unaltered observed across the rest-to-exercise transition

Is investment in Indigenous land and sea management going to the right places to provide multiple co-benefits?

Indigenous land and sea management (ILSM) has been the focus of large government investment in Australia and globally. Beyond environmental benefits, such investments can deliver a suite of social, cultural and economic co-benefits, aligning with the objectives of Indigenous communities and of governments for culturally appropriate socio-economic development. Nevertheless, there have been very few studies done on the spatial distribution of this investment and the extent to which its associated co-benefits address socio-economic disadvantage, which is unevenly distributed across Australia. This study draws on Australian ILSM programmes to examine the spatial and temporal distribution of investment for ILSM between 2002–2012 and considers implications for the distribution of associated co-benefits. Mapping and analysis of 2600 conservation projects revealed that at least $462M of investment in ILSM projects had occurred at 750 discrete sites throughout Australia. More than half of this investment in ILSM has been concentrated in northern Australia, in disadvantaged remote and very remote areas where a high percentage of the population is Indigenous, and Indigenous land ownership extensive. Our research has shown that ILSM investment has successfully been spatially distributed to areas with high needs for multiple social, economic, environmental and health and well-being co-benefit outcomes

Categorization of species as native or nonnative using DNA sequence signatures without a complete reference library.

New genetic diagnostic approaches have greatly aided efforts to document global biodiversity and improve biosecurity. This is especially true for organismal groups in which species diversity has been underestimated historically due to difficulties associated with sampling, the lack of clear morphological characteristics, and/or limited availability of taxonomic expertise. Among these methods, DNA sequence barcoding (also known as "DNA barcoding") and by extension, meta-barcoding for biological communities, has emerged as one of the most frequently utilized methods for DNA-based species identifications. Unfortunately, the use of DNA barcoding is limited by the availability of complete reference libraries (i.e., a collection of DNA sequences from morphologically identified species), and by the fact that the vast majority of species do not have sequences present in reference databases. Such conditions are critical especially in tropical locations that are simultaneously biodiversity rich and suffer from a lack of exploration and DNA characterization by trained taxonomic specialists. To facilitate efforts to document biodiversity in regions lacking complete reference libraries, we developed a novel statistical approach that categorizes unidentified species as being either likely native or likely nonnative based solely on measures of nucleotide diversity. We demonstrate the utility of this approach by categorizing a large sample of specimens of terrestrial insects and spiders (collected as part of the Moorea BioCode project) using a generalized linear mixed model (GLMM). Using a training data set of known endemic (n = 45) and known introduced species (n = 102), we then estimated the likely native/nonnative status for 4,663 specimens representing an estimated 1,288 species (412 identified species), including both those specimens that were either unidentified or whose endemic/introduced status was uncertain. Using this approach, we were able to increase the number of categorized specimens by a factor of 4.4 (from 794 to 3,497), and the number of categorized species by a factor of 4.8 from (147 to 707) at a rate much greater than chance (77.6% accuracy). The study identifies phylogenetic signatures of both native and nonnative species and suggests several practical applications for this approach including monitoring biodiversity and facilitating biosecurity