Doing pedagogical research in engineering

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Wellbeing: conceptual issues and implications for interdisciplinary work

Wellbeing is a common term in both policy and academia but it is often used in a conceptually vague way and means different things to different people. These issues may limit its potential to create the positive changes that are intended by those who promote wellbeing. Interdisciplinary research and practice offers great potential to further our understanding of, and ability to enhance, wellbeing. However, this type of research is challenging. The Foundations of Knowledge framework is suggested as one way to develop a common understanding of wellbeing in truly integrated research in this area

Enhancing physical activity knowledge exchange strategies for Canadian long-haul truck drivers

Purpose: Canadian long-haul truck drivers lead sedentary lives, but are receptive to receiving physical activity information to address health risks. This study examined how Canadian long-haul truck drivers would like to receive physical activity information in order to improve their overall health. The purpose of this study was twofold: 1) explore barriers Canadian long-haul truck drivers have to receiving and using physical activity information and 2) understand how physical activity information should be structured and delivered to these drivers to overcome these barriers. Design/methodology/approach: Semi-structured interviews were conducted with 12 Canadian long-haul truck drivers. Drivers had, on average, 14.3 years of professional long-haul driving experience. Findings: Few drivers had received any physical activity information. Drivers discussed a culture where they perceived both employers and drivers to be lacking awareness of the importance of physical activity and its impact on health. Drivers explained they were too busy, stressed or tired to be active or to learn about physical activity. Information received by some drivers on this topic was too general to be helpful in changing physical activity behaviours. Drivers mentioned that personalized and accessible physical activity information should be provided to them through multiple methods by their employers, as an aspect of occupational health and safety. Practical implications: Future physical activity information strategies should use both passive and interactive mediums to promote physical activity to Canadian long-haul truck drivers. Originality/value: This is the first study to assess how Canadian long-haul truck drivers would like to receive trustworthy information that can lead to healthful improvements in physical activity behaviour

Estimating the opportunity costs of bed-days.

Opportunity costs of bed-days are fundamental to understanding the value of healthcare systems. They greatly influence burden of disease estimations and economic evaluations involving stays in healthcare facilities. However, different estimation techniques employ assumptions that differ crucially in whether to consider the value of the second-best alternative use forgone, of any available alternative use, or the value of the actually chosen alternative. Informed by economic theory, this paper provides a taxonomic framework of methodologies for estimating the opportunity costs of resources. This taxonomy is then applied to bed-days by classifying existing approaches accordingly. We highlight differences in valuation between approaches and the perspective adopted, and we use our framework to appraise the assumptions and biases underlying the standard approaches that have been widely adopted mostly unquestioned in the past, such as the conventional use of reference costs and administrative accounting data. Drawing on these findings, we present a novel approach for estimating the opportunity costs of bed-days in terms of health forgone for the second-best patient, but expressed monetarily. This alternative approach effectively re-connects to the concept of choice and explicitly considers net benefits. It is broadly applicable across settings and for other resources besides bed-days

Who provides physical activity support in the workplace? Implications for peer led interventions

Objective: Social support is one mechanism through which peer support physical activity (PA) interventions influence behaviour. The aim of this study was to explore the sources and characteristics of social support for PA among office-based work colleagues. Design: A sequential mixed-methods approach was used. First, social network analysis was utilised to map the sources of social support. Then interviews and focus groups were used to explore the characteristics of this support. Setting: One UK public sector employer in the south of England. Method: Using an online survey, 99 employees (40 men; Mage = 40 ± 12 years) reported their PA and named specific colleagues who provided four forms of social support for PA (emotional, informational, companionship, validation). Social network diagrams for each support network were visualised using UCINET and Netdraw. Individuals identified as most frequently providing support for PA participated in one-to-one interviews (n = 6) to discuss their perspective on social support for PA in the workplace. Three focus groups explored the characteristics of social support for PA among employees identified within the networks as support seekers or disconnected. These qualitative data were analysed thematically. Results: Different patterns of relationships between employees were demonstrated for the four forms of support with informational support provided most frequently and validation least frequently. Qualitative data illustrate how each form of support was provided and received, as well as further perceived characteristics of social support. Conclusion: These findings could help inform the future selection and training of peer PA champions in workplace settings and more widely

Beyond group differences: Exploring the preliminary signals of target engagement of an executive function training for autistic children

DATA AVAILABILITY STATEMENT The data that support the findings for this study are available within the National Database for Autism Research (NDAR) at nda.nih.gov.ACKNOWLEDGMENTS The authors thank the staff and students who assisted with collecting and scoring these measures and who provided coaching. The authors specially thank the children and families who contributed their time to this study and joined in the effort to better understand the executive function of children on the autism spectrum. Additional protocol information is available at ClinicalTrials.gov: NCT02361762. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The research reported in this publication was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award no. R00HD071966. Additional funding to support intervention with the waitlist group was provided by the GoFAR Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.Understanding both for whom and how interventions work is a crucial next step in providing personalized care to children with autism spectrum disorder (ASD). Autistic children present with heterogeneity both within core ASD criteria and with respect to co-occurring mental health challenges, which may affect their ability to benefit from intervention. In a secondary data analysis of a randomized control trial evaluating an executive function (EF) training with 70 7- to 11-year-old autistic children, we explored: (1) whether co-occurring attention-deficit/hyperactivity disorder (ADHD) features or anxiety features at baseline moderated the extent to which children benefited from the EF training. In other words, we asked, “For whom is training effective?” We also explored: (2) the extent to which changes in a brain-based measure of target engagement predicted the clinical outcomes of the EF training. This is a step towards asking, “How is training effective?” We found that EF training improved behavioral inhibition only for children with clinically significant cooccurring ADHD features. Anxiety features, while prevalent, did not moderate EF training efficacy. Finally, for the EF training group only, there was a significant correlation between pre-to-post change in an EEG-based measure of target engagement, N2 incongruent amplitude during a flanker task, and change in repetitive behaviors, a behavioral outcome that was reported in the parent RCT to have improved with training compared to waitlist control. This study provides preliminary evidence that EF training may differentially affect subgroups of autistic children and that changes at the neural level may precede changes in behavior.Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health under Award no. R00HD071966GoFAR Foundatio

Nosocomial transmission of C. difficile in English hospitals from patients with symptomatic infection.

BACKGROUND: Recent evidence suggests that less than one-quarter of patients with symptomatic nosocomial Clostridium difficile infections (CDI) are linked to other in-patients. However, this evidence was limited to one geographic area. We aimed to investigate the level of symptomatic CDI transmission in hospitals located across England from 2008 to 2012. METHODS: A generalized additive mixed-effects Poisson model was fitted to English hospital-surveillance data. After adjusting for seasonal fluctuations and between-hospital variation in reported CDI over time, possible clustering (transmission between symptomatic in-patients) of CDI cases was identified. We hypothesised that a temporal proximity would be reflected in the degree of correlation between in-hospital CDI cases per week. This correlation was modelled through a latent autoregressive structure of order 1 (AR(1)). FINDINGS: Forty-six hospitals (33 general, seven specialist, and six teaching hospitals) located in all English regions met our criteria. In total, 12,717 CDI cases were identified; seventy-five per cent of these occurred >48 hours after admission. There were slight increases in reports during winter months. We found a low, but statistically significant, correlation between successive weekly CDI case incidences (phi = 0.029, 95%CI: 0.009-0.049). This correlation was five times stronger in a subgroup analysis restricted to teaching hospitals (phi = 0.104, 95%CI: 0.048-0.159). CONCLUSIONS: The results suggest that symptomatic patient-to-patient transmission has been a source of CDI-acquisition in English hospitals in recent years, and that this might be a more important transmission route in teaching hospitals. Nonetheless, the weak correlation indicates that, in line with recent evidence, symptomatic cases might not be the primary source of nosocomial CDI in England

Recommendations for dealing with waste contaminated with Ebola virus: a Hazard Analysis of Critical Control Points approach

Objective To assess, within communities experiencing Ebola virus outbreaks, the risks associated with the disposal of human waste and to generate recommendations for mitigating such risks. Methods A team with expertise in the Hazard Analysis of Critical Control Points framework identified waste products from the care of individuals with Ebola virus disease and constructed, tested and confirmed flow diagrams showing the creation of such products. After listing potential hazards associated with each step in each flow diagram, the team conducted a hazard analysis, determined critical control points and made recommendations to mitigate the transmission risks at each control point. Findings The collection, transportation, cleaning and shared use of blood-soiled fomites and the shared use of latrines contaminated with blood or bloodied faeces appeared to be associated with particularly high levels of risk of Ebola virus transmission. More moderate levels of risk were associated with the collection and transportation of material contaminated with bodily fluids other than blood, shared use of latrines soiled with such fluids, the cleaning and shared use of fomites soiled with such fluids, and the contamination of the environment during the collection and transportation of blood-contaminated waste. Conclusion The risk of the waste-related transmission of Ebola virus could be reduced by the use of full personal protective equipment, appropriate hand hygiene and an appropriate disinfectant after careful cleaning. Use of the Hazard Analysis of Critical Control Points framework could facilitate rapid responses to outbreaks of emerging infectious disease

Development and testing of candidate items for inclusion in a new rheumatoid arthritis stiffness patient-reported outcome measure

© The Author 2017. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. Objective. To qualitatively develop and test a set of candidate items for a new RA stiffness patientreported outcome measure (PROM) that capture the patient perspective. This is an essential first step in PROM development, prior to quantitative development, assessment and validation. Methods. Focus groups further examined the previously developed stiffness conceptual model and explored the patient perspective regarding stiffness assessment. Data were analysed using thematic analysis. An iterative process of item development was then performed by the expert study team of researchers, patients and clinicians, based on the two qualitative datasets and informed by measurement theory and guidelines. Finally, these candidate items were tested using formal cognitive interview methodology and subsequently refined. Results. Sixteen RA patients from the UK participated in focus groups. Data confirmed the conceptual model of the RA patient experience of stiffness and provided insight into stiffness assessment, including suggestions regarding patient-relevant stiffness assessment categories such as impact, location and timing. These data informed the development of 77 candidate stiffness PROM items, including multiple formats for some. Eleven RA patients participated in cognitive interviews. Minor changes were made to items to enhance understanding and 32 items were removed, resulting in 45 candidate PROM items. Conclusion. Rigorous qualitative methodology and considerable patient involvement has underpinned items for a new RA stiffness PROM with strong content validity. Crucially, patient involvement broadened assessment beyond early morning stiffness duration, which may address existing PROM limitations. Items are now suitable for quantitative item reduction, structural development of the final PROM and validation

Soft tissue radiodensity parameters mediate the relationship between self-reported physical activity and lower extremity function in AGES-Reykjavík participants.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadAlthough previous studies have highlighted the association between physical activity and lower extremity function (LEF) in elderly individuals, the mechanisms underlying this relationship remain debated. Our recent work has recognized the utility of nonlinear trimodal regression analysis (NTRA) parameters in characterizing changes in soft tissue radiodensity as a quantitative construct for sarcopenia in the longitudinal, population-based cohort of the AGES-Reykjavík study. For the present work, we assembled a series of prospective multivariate regression models to interrogate whether NTRA parameters mediate the 5-year longitudinal relationship between physical activity and LEF in AGES-Reykjavík participants. Healthy elderly volunteers from the AGES-Reykjavík cohort underwent mid-thigh X-ray CT scans along with a four-part battery of LEF tasks: normal gait speed, fastest-comfortable gait speed, isometric leg strength, and timed up-and-go. These data were recorded at two study timepoints which were separated by approximately 5 years: AGES-I (n = 3157) and AGES-II (n = 3098). Participants in AGES-I were likewise administered a survey to approximate their weekly frequency of engaging in moderate-to-vigorous physical activity (PAAGES-I). Using a multivariate mediation analysis framework, linear regression models were assembled to test whether NTRA parameters mediated the longitudinal relationship between PAAGES-I and LEFAGES-II; all models were covariate-adjusted for age, sex, BMI, and baseline LEF, and results were corrected for multiple statistical comparisons. Our first series of models confirmed that all four LEF tasks were significantly related to PAAGES-I; next, modelling the relationship between PAAGES-I and NTRAAGES-II identified muscle amplitude (Nm) and location (μm) as potential mediators of LEF to test. Finally, adding these two parameters into our PAAGES-I → LEFAGES-II models attenuated the prior effect of PAAGES-I; bootstrapping confirmed Nm and μm as significant partial mediators of the PAAGES-I → LEFAGES-II relationship, with the strongest effect found in isometric leg strength. This work describes a novel approach toward clarifying the mechanisms that underly the relationship between physical activity and LEF in aging individuals. Identifying Nm and μm as significant partial mediators of this relationship provides strong evidence that physical activity protects aging mobility through the preservation of both lean tissue quantity and quality.United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute on Aging (NIA