Design for Belonging: The correlation between belonging, identity shifts and mismatches in inclusive systems

With the increased involvement of designers in matters of public discourse, local communities and policy making [1-3] – parameters of inclusive design have moved more prominently into the roles of leading frameworks utilised by practitioners [4-6]. Following on from the Social Turn [7] the imperative to challenge values and attitudes to design [8] and its societal contribution was further demonstrated, resulting in a push for communities to take part in the creative process to produce positive engagement and environments for all [9]. Inclusive design aims to generate solutions to disaggregate and remove barriers to involvement and eliminate separation [10-11]. The term accessibility is often mentioned as a descriptor or enabler of a design becoming inclusive, yet accessibility alone does not generate cultures of participation, relatability, or true inclusion. The preposition that accessibility points in a system’s periphery count towards the design being deemed inclusive, is one of the main issues within enquiries of system imbalances [8-11]. Whilst designers focus on generating accessibility points catered to as many needs as possible, what remains is a vast neglect of what happens to the people once they are inside the system. Lacking relatability and processes of active exclusion push people’s established and shifting identities into places of othering. Far beyond just inclusion, a design that considers one’s intrinsic need to belong, could generate the acceptance of an individual as a part of the system and affirms their full identity to produce greater motivation to progress [11-12] This emerging awareness of cultivating belonging within inclusive design raises considerations for solutions that target urban, migrant communities, where matters of identity are accentuated [12]. This paper will present propositions towards a Design for Belonging, operating on systems thinking practice and explicated through visual data mapping, which in the context of this particular study - focusing on experiences of people with complicated migration/immigration or refugee background

Offenders’ perceptions of the UK prison smoking ban

Purpose Despite overall reductions in levels of smoking in the UK, rates of offender smoking remain high. In 2016, it was announced that prisons in England and Wales would gradually introduce a smoking ban. The purpose of this paper is to explore offenders’ perceptions around the upcoming smoking ban. Design/methodology/approach A total of eight focus groups were conducted in four prisons across the North of England. Both smoking and non-smoking offenders participated in the focus groups, and thematic analysis was used to explore the findings. Findings Themes generated from the data were “freedom and rights”, “the prison environment” and “guiding support”. Participants discussed how the smoking ban was viewed as a punishment and restricted their freedom, with perceptions as to why the ban was being implemented centring around others trying to control them. Participants expressed concerns around the financial implications of the smoking ban on already stretched prison resources. Participants also recommended improving the nicotine replacement therapy on offer, and increasing the range of leisure activities within the prison to prepare for the smoking ban. Originality/value Overall, it was apparent that participants’ awareness of the smoking ban was generally poor. It is recommended that offenders need to be made more aware of the smoking cessation support they will receive and given the opportunity to ask questions about the smoking ban. Increasing offenders’ awareness of the ban may reduce stress associated with a perceived lack of choice around their smoking behaviours

Physiological and psychological health effects of Nordic walking on sedentary adults

To investigate the effects of an eight week Nordic Walking programme on health outcomes in sedentary yet healthy adults. Thirty-nine participants (mean age = 54.6 ± 9.3 years) were randomised to a Nordic (N=20) or standard walking group (N=19) and completed three 55-minute supervised walking sessions per week. Blood pressure, aerobic capacity, lipid profile and anthropometry were assessed and participants completed measures of health-related quality of life, self-esteem, depression and mood pre- and post intervention. There was a significant group interaction for diastolic blood pressure with a trend for lower values in the Nordic Walking group post intervention. There was a significant decrease in waist, hip and upper arm circumference and a significant increase in total distance and averaging exercising heart rate in both walking groups post intervention. There were no significant differences within or between groups for total cholesterol, high and low density lipoprotein however a significant intervention effect was observed for triglycerides. The findings point towards a non-significant improvement in health-related quality of life, selfesteem, depression and mood in both walking groups over time. In line with previous research, an eight-week walking intervention significantly improved aspects of physical and mental health in a sedentary population, although Nordic Walking did not enhance these health benefits compared to standard walking. Further research needs to focus on increasing intervention duration, ensuring mastery of correct technique and monitoring intensity during the intervention period

CLOI: A Shape Classification Benchmark Dataset for Industrial Facilities

Generation of digital models of existing industrial facilities is labor intensive and expensive. The use of state-of-the-art deep learning algorithms can assist to reduce the modelling time and cost. However large databases of labelled, laser-scanned industrial facilities do not exist to date, henceforth training of deep learning models is not possible. Our paper solves this problem by proposing a new benchmark dataset, which consists of five labelled industrial plants. The labelling schema that we followed for the generation of this dataset is based on the frequency of appearance of industrial object types. We labelled the ten most frequent industrial object shapes as identified in previous work. We present CLOI (Channels, L-shapes, circular sections, I-shapes): a richly annotated large-scale repository of shapes represented by labelled point clusters. CLOI has more than 140 million hand labelled points and serves as the foundation for researchers who are interested in automated modelling of industrial assets using deep learning algorithms

Protocol for a randomized controlled trial of the Breaking Free Online Health and Justice program for substance misuse in prison settings

Background Substance misuse, including problematic drug and alcohol use, are significant issues in society that can have multiple detrimental effects. Many people access support for their substance misuse during prison sentences, due to the associations between substance misuse and offending, and the high proportion of the prison population who have drug and alcohol issues. Breaking Free Online Health and Justice is a computer-assisted therapy program that has been developed to support substance-involved offenders to address their substance misuse and associated offending within prison settings. Methods This will be a parallel-group randomized controlled trial of 4-week Breaking Free Online Health and Justice program as an adjunct to standard treatment for substance misuse, in comparison to standard treatment only, in a male Category D open prison. Interventional and control groups will be compared in terms of the changes in their scores on multiple measures from baseline to post-treatment assessment at 4-weeks, and then 3- and 6-months follow-up. Participants will be adult male offenders serving sentences in prison in England who have demonstrable difficulties with drugs and/or alcohol for at least the past 12-months. The primary outcome measure will be self-reported substance misuse, with secondary outcomes being standardized psychometric assessments of substance dependence, mental health, biopsychosocial functioning, quality of life and post-release offending. Other secondary measures will include frequency of completion of specific intervention strategies in the program. Discussion This study will examine whether Breaking Free Online Health and Justice as an adjunct to standard substance misuse interventions in prisons, improves outcomes for substance-involved offenders receiving interventions in custodial settings. Findings from the study will be used to inform further developments of the program and potential improvements to custodial treatment

Repeated misclassifications of tachycardia by an implantable cardiac defibrillator

This case describes repeated misclassifications of SVT due to AV node reentry as VT by an ICD. This case illustrates the limitations of SVT-VT discrimination algorithm. Careful analysis of the stored tracings is of critical importance to reach the correct diagnosis

Pharmacological interventions for treatment-resistant depression in adults

BACKGROUND: Although antidepressants are often a first-line treatment for adults with moderate to severe depression, many people do not respond adequately to medication, and are said to have treatment-resistant depression (TRD). Little evidence exists to inform the most appropriate 'next step' treatment for these people. OBJECTIVES: To assess the effectiveness of standard pharmacological treatments for adults with TRD. SEARCH METHODS: We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) (March 2016), CENTRAL, MEDLINE, Embase, PsycINFO and Web of Science (31 December 2018), the World Health Organization trials portal and ClinicalTrials.gov for unpublished and ongoing studies, and screened bibliographies of included studies and relevant systematic reviews without date or language restrictions. SELECTION CRITERIA: Randomised controlled trials (RCTs) with participants aged 18 to 74 years with unipolar depression (based on criteria from DSM-IV-TR or earlier versions, International Classification of Diseases (ICD)-10, Feighner criteria or Research Diagnostic Criteria) who had not responded to a minimum of four weeks of antidepressant treatment at a recommended dose. Interventions were: (1) increasing the dose of antidepressant monotherapy; (2) switching to a different antidepressant monotherapy; (3) augmenting treatment with another antidepressant; (4) augmenting treatment with a non-antidepressant. All were compared with continuing antidepressant monotherapy. We excluded studies of non-standard pharmacological treatments (e.g. sex hormones, vitamins, herbal medicines and food supplements). DATA COLLECTION AND ANALYSIS: Two reviewers used standard Cochrane methods to extract data, assess risk of bias, and resolve disagreements. We analysed continuous outcomes with mean difference (MD) or standardised mean difference (SMD) and 95% confidence interval (CI). For dichotomous outcomes, we calculated a relative risk (RR) and 95% CI. Where sufficient data existed, we conducted meta-analyses using random-effects models. MAIN RESULTS: We included 10 RCTs (2731 participants). Nine were conducted in outpatient settings and one in both in- and outpatients. Mean age of participants ranged from 42 - 50.2 years, and most were female. One study investigated switching to, or augmenting current antidepressant treatment with, another antidepressant (mianserin). Another augmented current antidepressant treatment with the antidepressant mirtazapine. Eight studies augmented current antidepressant treatment with a non-antidepressant (either an anxiolytic (buspirone) or an antipsychotic (cariprazine; olanzapine; quetiapine (3 studies); or ziprasidone (2 studies)). We judged most studies to be at a low or unclear risk of bias. Only one of the included studies was not industry-sponsored. There was no evidence of a difference in depression severity when current treatment was switched to mianserin (MD on Hamilton Rating Scale for Depression (HAM-D) = -1.8, 95% CI -5.22 to 1.62, low-quality evidence)) compared with continuing on antidepressant monotherapy. Nor was there evidence of a difference in numbers dropping out of treatment (RR 2.08, 95% CI 0.94 to 4.59, low-quality evidence; dropouts 38% in the mianserin switch group; 18% in the control). Augmenting current antidepressant treatment with mianserin was associated with an improvement in depression symptoms severity scores from baseline (MD on HAM-D -4.8, 95% CI -8.18 to -1.42; moderate-quality evidence). There was no evidence of a difference in numbers dropping out (RR 1.02, 95% CI 0.38 to 2.72; low-quality evidence; 19% dropouts in the mianserin-augmented group; 38% in the control). When current antidepressant treatment was augmented with mirtazapine, there was little difference in depressive symptoms (MD on Beck Depression Inventory (BDI-II) -1.7, 95% CI -4.03 to 0.63; high-quality evidence) and no evidence of a difference in dropout numbers (RR 0.50, 95% CI 0.15 to 1.62; dropouts 2% in mirtazapine-augmented group; 3% in the control). Augmentation with buspirone provided no evidence of a benefit in terms of a reduction in depressive symptoms (MD on Montgomery and Asberg Depression Rating Scale (MADRS) -0.30, 95% CI -9.48 to 8.88; low-quality evidence) or numbers of drop-outs (RR 0.60, 95% CI 0.23 to 1.53; low-quality evidence; dropouts 11% in buspirone-augmented group; 19% in the control). Severity of depressive symptoms reduced when current treatment was augmented with cariprazine (MD on MADRS -1.50, 95% CI -2.74 to -0.25; high-quality evidence), olanzapine (MD on HAM-D -7.9, 95% CI -16.76 to 0.96; low-quality evidence; MD on MADRS -12.4, 95% CI -22.44 to -2.36; low-quality evidence), quetiapine (SMD -0.32, 95% CI -0.46 to -0.18; I2 = 6%, high-quality evidence), or ziprasidone (MD on HAM-D -2.73, 95% CI -4.53 to -0.93; I2 = 0, moderate-quality evidence) compared with continuing on antidepressant monotherapy. However, a greater number of participants dropped out when antidepressant monotherapy was augmented with an antipsychotic (cariprazine RR 1.68, 95% CI 1.16 to 2.41; quetiapine RR 1.57, 95% CI: 1.14 to 2.17; ziprasidone RR 1.60, 95% CI 1.01 to 2.55) compared with antidepressant monotherapy, although estimates for olanzapine augmentation were imprecise (RR 0.33, 95% CI 0.04 to 2.69). Dropout rates ranged from 10% to 39% in the groups augmented with an antipsychotic, and from 12% to 23% in the comparison groups. The most common reasons for dropping out were side effects or adverse events. We also summarised data about response and remission rates (based on changes in depressive symptoms) for included studies, along with data on social adjustment and social functioning, quality of life, economic outcomes and adverse events. AUTHORS' CONCLUSIONS: A small body of evidence shows that augmenting current antidepressant therapy with mianserin or with an antipsychotic (cariprazine, olanzapine, quetiapine or ziprasidone) improves depressive symptoms over the short-term (8 to 12 weeks). However, this evidence is mostly of low or moderate quality due to imprecision of the estimates of effects. Improvements with antipsychotics need to be balanced against the increased likelihood of dropping out of treatment or experiencing an adverse event. Augmentation of current antidepressant therapy with a second antidepressant, mirtazapine, does not produce a clinically important benefit in reduction of depressive symptoms (high-quality evidence). The evidence regarding the effects of augmenting current antidepressant therapy with buspirone or switching current antidepressant treatment to mianserin is currently insufficient. Further trials are needed to increase the certainty of these findings and to examine long-term effects of treatment, as well as the effectiveness of other pharmacological treatment strategies

Insights from semi-oriented EPR spectroscopy studies into the interaction of lytic polysaccharide monooxygenases with cellulose

Probing the detailed interaction between lytic polysaccharide monooxygenases (LPMOs) and their polysaccharide substrates is key to revealing further insights into the mechanism of action of this class of enzymes on recalcitrant biomass. This investigation is somewhat hindered, however, by the insoluble nature of the substrates, which precludes the use of most optical spectroscopic techniques. Herein, we report a new semi-oriented EPR method which evaluates directly the binding of cellulose-active LPMOs to crystalline cellulose. We make use of the intrinsic order of cellulose fibres in Apium graveolens (celery) to orient the LPMO with respect to the magnetic field of an EPR spectrometer. The subsequent angle-dependent changes observed in the EPR spectra can then be related to the orientation of the g matrix principal directions with respect to the magnetic field of the spectrometer and, hence, to the binding of the enzyme onto the cellulose fibres. This method, which does not require specific modification of standard CW-EPR equipment, can be used as a general procedure to investigate LPMO–cellulose interactions