Limaria hians (Mollusca : Limacea): a neglected reef-forming keystone species

1. A key component of physical habitat along braided river systems is the exposed riverine sediment within the active zone. The relatively unmanaged, gravel-bed Fiume Tagliamento, Italy, provides the focus for exploring two ecologically important properties of exposed riverine sediments: their within-patch and between-patch variability in calibre. 2. To characterize between-patch variation in exposed riverine sediments, replicate (within-patch) samples were obtained from three geomorphologically distinct locations along 130 km of the river: bar heads along the margin of the low-flow channel, the heads of major bars across the exposed surface of the active zone, and floodplain surfaces. A photographic technique enabled rapid and consistent field sampling of the coarse sediments at bar heads along the low-flow channel margin and on major bars across the dry bed. 3. A downstream decrease in particle size and an increase in within-patch heterogeneity in sediment size were observed within bar head sediments along the margin of the low-flow channel. Comparisons between major bar and low-flow channel samples revealed greatest within-patch variability in individual sediment size indices (D50, A- and B-axes of the larger particles) at headwater sites, greatest between-patch variability in the three measured indices in the central reaches, and lowest between-patch variability at downstream sites. However, there was a distinct increase in the overall heterogeneity in particle size, which was sustained across all patches, in a downstream direction. 4. There was a clear downstream decrease in the size of floodplain sediments in the headwaters, but thereafter there was no distinct downstream trend in any of the calculated particle size indices. 5. The geomorphological controls on the observed patterns and the potential ecological significance of the patterns, particularly for plant establishment, are discussed in relation to the relative relief of the active zone, and the highly variable hydrological and climatic regime along the river

The Effect of Age, Sex, Area Deprivation, and Living Arrangements on Total Knee Replacement Outcomes: A Study Involving the United Kingdom National Joint Registry Dataset

Background: Total knee replacement (TKR) is a common procedure for the treatment of osteoarthritis that provides a substantial reduction of knee pain and improved function in most patients. We investigated whether sociodemographic factors could explain variations in the benefit resulting from TKR. Methods: Data were collected from 3 sources: the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man; National Health Service (NHS) England Patient Reported Outcome Measures; and Hospital Episode Statistics. These 3 sources were linked for analysis. Pain and function of the knee were measured with use of the Oxford Knee Score (OKS). The risk factors of interest were age group, sex, deprivation, and social support. The outcomes of interest were sociodemographic differences in preoperative scores, 6-month postoperative scores, and change in scores. Results: Ninety-one thousand nine hundred and thirty-six adults underwent primary TKR for the treatment of osteoarthritis in an NHS England unit from 2009 to 2012. Sixty-six thousand seven hundred and sixty-nine of those patients had complete knee score data and were included in the analyses for the present study. The preoperative knee scores were worst in female patients, younger patients, and patients from deprived areas. At 6 months postoperatively, the mean knee score had improved by 15.2 points. There were small sociodemographic differences in the benefit of surgery, with greater area deprivation (−0.71 per quintile of increase in deprivation; 95% confidence interval [CI], −0.76 to −0.66; p < 0.001) and younger age group (−3.51 for ≤50 years compared with 66 to 75 years; 95% CI, −4.00 to −3.02; p < 0.001) associated with less benefit. Cumulatively, sociodemographic factors explained <1% of the total variability in improvement. Conclusions: Sociodemographic factors have a small influence on the benefit resulting from TKR. However, as they are associated with the clinical threshold at which the procedure is performed, they do affect the eventual outcomes of TKR. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of evidence

Quality of relationships as predictors of outcomes in people with dementia: a systematic review protocol

INTRODUCTION: Serious adverse outcomes for people with dementia include institutionalisation, hospitalisation, death, development of behavioural and psychiatric symptoms, and reduced quality of life. The quality of the relationship between the person with dementia and their informal/family carer is thought to affect the risk of these outcomes. However, little is known about which aspects of relationship quality are important, or how they affect outcomes for people with dementia. METHODS AND ANALYSIS: This will be a systematic review of the literature. Electronic databases MEDLINE, EMBASE, Web of Science, PsycInfo, the Cochrane Database, ALOIS and OpenGrey will be searched from inception. 2 independent reviewers will screen results for eligibility with standardised criteria. Data will be extracted for relevant studies, and information on the associations between relationship quality and dementia outcomes will be synthesised. Meta-analysis will be performed if possible to calculate pooled effect sizes. Narrative synthesis will be performed if study heterogeneity rules out meta-analysis. ETHICS AND DISSEMINATION: Ethical review is not necessary as this review summarises data from previous studies. Results will be disseminated via peer-reviewed publication. Results will also be disseminated to a patient and public involvement group and an expert panel for their views on the findings and implications for future work. TRIAL REGISTRATION NUMBER: CRD42015020518

User-Centered Design of Companion Robot Pets Involving Care Home Resident-Robot Interactions and Focus Groups With Residents, Staff, and Family: Qualitative Study

Background: Globally, pressure is increasing on health and social care resources due to the aging population and growing prevalence of dementia. Companion robots, such as Paro, demonstrate strong potential for helping reduce this pressure through reported benefits including reduced agitation, depression, loneliness, care provider burden, and medication use. However, we previously identified that user-centered design of robot pets is both essential and understudied. We observed that commonly used robot pets are poorly matched to end-user requirements, and that end users and developers of robot pets differ significantly in their perception of appropriate design. This may explain some of the contradictory outcome research and variance in results for robot pets, such as Paro. Objective: In response to the literature gap, we aimed to provide user-centered insights into the design of robot pets from key stakeholders to inform future robot development and the choice of robots for real-world implementation and research. We focused on understanding user requirements. Methods: We conducted a qualitative study with 65 participants from 5 care homes (26 care home residents, 29 staff members. and 10 family members). Care home residents formed groups of between 3 and 4 individuals and experienced free interactions with a range of 8 companion robots and toys, including Paro and more affordable alternatives. The robots provided had a range of esthetics, shell types, interactivity levels, and designs for comparison. Care staff and family members observed the interactions. All participants then engaged in focus groups within their stakeholder category to discuss preferences and user requirements in companion robot design. Both free interactions and focus groups were video and audio recorded, transcribed, and subjected to thematic analysis. Results: Care home residents, family members, and staff were open and accepting of the use of companion robot pets, with the majority suggesting that they would keep a device for themselves or the residents. The most preferred device was the Joy for All cat, followed by the Joy for All dog. In discussions, the preferred design features included familiar animal embodiment (domestic pet), soft fur, interactivity, big appealing eyes, simulated breathing, and movements. Unfamiliar devices were more often seen as toy-like and suitable for children, producing some negative responses. Conclusions: This work provides important and user-centered insights into future robot designs for care home residents by means of a comprehensive comparison with key stakeholders. This work strongly supports the use of familiar embodiment in future robot pet designs, with domestic cat and dog morphologies appearing most acceptable. The results have implications for future robot designs and the selection of robot pets for both research and real-world implementations

Implementation of Virtual Reality Motivated Physical Activity via Omnidirectional Treadmill in a Supported Living Facility for Older Adults: A Mixed-Methods Evaluation.: Virtual reality to motivate physical activity for older adults

Virtual reality (VR) can support healthy ageing, but few devices have been trialed with frail older adults to increase physical activity. We conducted a preliminary mixed-methods implementation evaluation of an omnidirectional VR treadmill and a static VR experience with seven older adults over a six-week period in a supported living facility. Frequency of use and pre-post physical functioning measures were collected, mainly to establish technology suitability based on person characteristics. Diary entries following technology use, resident focus group and staff interview revealed technology acceptance and perceived potential for increasing physical activity, health and wellbeing through accessing virtual environments, which motivated continued activity. Results demonstrated technology suitability for a range of older adults with various mobility and physical impairments. However, residents noted interest in a seated treadmill for physical activity without perceived risks of falls with standing treadmills. Staff raised considerations around care home implementations including usability, cost and space

Implementation of Virtual Reality Motivated Physical Activity via Omnidirectional Treadmill in a Supported Living Facility for Older Adults: A Mixed-Methods Evaluation.: Virtual reality to motivate physical activity for older adults

Virtual reality (VR) can support healthy ageing, but few devices have been trialed with frail older adults to increase physical activity. We conducted a preliminary mixed-methods implementation evaluation of an omnidirectional VR treadmill and a static VR experience with seven older adults over a six-week period in a supported living facility. Frequency of use and pre-post physical functioning measures were collected, mainly to establish technology suitability based on person characteristics. Diary entries following technology use, resident focus group and staff interview revealed technology acceptance and perceived potential for increasing physical activity, health and wellbeing through accessing virtual environments, which motivated continued activity. Results demonstrated technology suitability for a range of older adults with various mobility and physical impairments. However, residents noted interest in a seated treadmill for physical activity without perceived risks of falls with standing treadmills. Staff raised considerations around care home implementations including usability, cost and space