Retrofitting the International Space Station.

Crew quarters (CQ) design was key to the habitability design of Skylab, with a specific goal of providing a private space for each crewmember, who might spend 6-8 hours a day there. Despite the privacy afforded by a designated place for each crewmember, Skylab crews reported poor sleep due to noise, light leaks, or disturbances by fellow crewmembers. Adams (1998) noted that Skylab lacked attachment points for relocating sleep restraints, thereby effectively precluding crewmembers from sleeping elsewhere. Generally speaking, Skylab's interior outfitting was not designed for modularity or reconfigurability. In contrast, one of the principal design features of the International Space Station (ISS) is the basic structure of the modules and the rack volumes they accommodate, the International Standard Payload Rack (ISPR). The ISPR is intended to allow interchangeability and reconfiguration. Feedback from expedition crews who have lived onboard the ISS include requests for an improved living environment. Designers can improve the living environment, in part, by learning from the experiences of these crews. By developing solutions that can be retrofitted to the existing basic structures, designers could offer an environment that enriches a crewmember's experience. Crew feedback has cited flexibility of use as a desirable feature during long-duration missions. For such missions, flexibility allows objects or environments to be used in different ways, requiring fewer amenities and less room to house those amenities, thereby reducing transportation demands and costs. Flexibility offers numerous advantages for space applications where the living volume is limited and delivery and maintenance costs are major concerns. A mounting structure and kit of parts system could offer flexibility of use, a benefit for crewmembers who desire visual stimulation and variety in the space station environment. Moreover, this approach is durable; any part would be able to be detached and updated, improved, or replaced. This chapter presents a design solution for a flexible CQ system. The process behind the solution involved a series of self-directed empirical exercises that provided insight and spurred concept generation. Subsequently, a review of relevant ISS specifications served to guide design development. The resulting design is compatible with the basic elements of existing CQ equipment, offers adaptability over time using a proposed kit of parts, and thus an interior strategy that allows crewmembers to tailor the layout and use of their private environment at any time

Design for social innovation and inclusion.

Designing out crime is a strategy that the UK Design Council continues to profile and support, promoting the use of design as an approach for addressing social challenges and combating crime (UK Design Council 2011). This paper considers the strategy and application of design for social innovation to create an inclusive platform for participation in city locations where youth activity isn't otherwise encouraged. Design and diversionary activities can enhance wellness and contribute to healthier urban communities and these are the issues that Streetsport, an innovative diversionary tactics initiative, has sought to address. As a pilot project that grew into an established programme, Streetsport has proved itself as a vehicle of engagement that uses sport and creative activities to divert and distract disaffected young people (who are considered at risk of offending) from the pressures and challenging circumstances within their communities. Measures of the programme's impact are notable with reductions in both incidents of youth crime and complaints of youth anti-social behaviour in some instances down by over 50%. This paper describes the development of the Streetsport programme that began as a key partnership between Gray's School of Art, Grampian Police and RGU:Sport, with Designers playing a pivotal role in establishing and developing the strategy, for placing a mobile sports and activity arena and for making it visible both digitally (through branding and social media) and on location. Likened to a Trojan Horse, the temporary installation is deployed into the community at targeted strategic sites across Aberdeen city which include seven priority neighbourhoods reported by the Scottish Government as being in the 15% most deprived areas of Scotland (Scottish Index of Multiple Deprivation 2009). As a result of this project, the key stakeholders involved now recognise and value the role of design and designers in developing, implementing and communicating youth services. This paper serves as a case study of how design can be applied to facilitate community engagement and how designers can apply their skills specifically to engage disaffected youth through community-based activities

Evidence That the Clinical Impairment Assessment (CIA) Subscales Should Not Be Scored: Bifactor Modelling, Reliability, and Validity in Clinical and Community Samples

Aim: The Clinical Impairment Assessment (CIA 3.0) is the most widely used instrument assessing psychosocial impairment secondary to eating disorder symptoms. However, there is conflicting advice regarding the dimensionality and optimal method of scoring the CIA. We sought to resolve this confusion by conducting a comprehensive factor analytic study of the CIA in a community sample (N = 301) and clinical sample comprising patients with a diagnosed eating disorder (N = 209). Convergent and discriminant validity were also assessed. Method: The CIA and measures of eating disorder symptoms were administered to both samples. Results: Factor analyses indicated there is a general impairment factor underlying all items on the CIA that is reliably measured by the CIA Global score. CIA Global demonstrated good convergent and discriminant validity. Conclusions: CIA Global is a reliable and valid measure of psychosocial impairment secondary to eating disorder symptoms; however, subscale scores should not be computed

Comparative efficacy of pharmacological and non-pharmacological interventions for the acute treatment of adult outpatients with anorexia nervosa: study protocol for the systematic review and network metaanalysis of individual data

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background Outpatient treatment studies of anorexia nervosa (AN) are notoriously hard to conduct given the ambivalence of the patient group and high drop-out rates. It is therefore not surprising that previous meta-analyses of pharmacological and psychological treatments for outpatient treatment of adult AN have proved to be inconclusive. Network meta-analysis (NMA) has the potential to overcome the limitations of pairwise meta-analysis, as this approach can compare multiple treatments using both direct comparisons of interventions within randomized controlled trials (RCTs) and indirect comparisons across trials based on a common comparator. To date there is no published example of this approach with eating disorders and the current study provides a protocol which will use NMA to advance knowledge about what outpatient therapy works best for which patients with AN by conducting both direct and indirect comparisons of different treatments and the moderating variables. Methods Searches of electronic data bases will be supplemented with manual searches for published, unpublished and ongoing RCTs in international registries, and clinical trials registries of regulatory agencies and pharmaceutical companies. Two reviewers will independently extract the data and where possible we will access individual data in order to examine moderators of treatment. Two primary outcomes will be selected: changes to body mass index and changes to global eating disorder psychopathology. The secondary outcome is the total number of patients who, at 12-month post-randomization, attained over the previous 28 day period: (i) BMI > 18.5, and (ii) global eating disorder psychopathology to within 1 SD of community norms. We will also provide a statistical evaluation of consistency, the agreement between direct and indirect evidence. Results Descriptive statistics across all eligible trials will be provided along with a network diagram, where the size of the nodes will reflect the amount of evidence accumulated for each treatment. We will use a contribution matrix that describes the percentage contribution of each direct meta-analysis to the entire body of evidence. Discussion Findings will make a major contribution to the literature by summarising individual data across rapidly accumulating outpatient trials of AN using state of the art NMA methodology

Therapist Adherence in the Strong Without Anorexia Nervosa (SWAN) Study: A Randomized Controlled Trial of Three Treatments for Adults with Anorexia Nervosa

The Authors. International Journal of Eating Disorders Published by Wiley Periodicals, Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.Objective: To develop a psychotherapy rating scale to measure therapist adherence in the Strong Without Anorexia Nervosa (SWAN) study, a multi-center randomized controlled trial comparing three different psychological treatments for adults with anorexia nervosa. The three treatments under investigation were Enhanced Cognitive Behavioural Therapy (CBT-E), the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), and Specialist Supportive Clinical Management (SSCM). Method: The SWAN Psychotherapy Rating Scale (SWAN-PRS) was developed, after consultation with the developers of the treatments, and refined. Using the SWANPRS, two independent raters initially rated 48 audiotapes of treatment sessions to yield inter-rater reliability data. One rater proceeded to rate a total of 98 audiotapes from 64 trial participants. Results: The SWAN-PRS demonstrated sound psychometric properties, and was considered a reliable measure of therapist adherence. The three treatments were highly distinguishable by independent raters, with therapists demonstrating significantly more behaviors consistent with the actual allocated treatment compared to the other two treatment modalities. There were no significant site differences in therapist adherence observed. Discussion: The findings provide support for the internal validity of the SWAN study. The SWAN-PRS was deemed suitable for use in other trials involving CBT-E, MANTRA, or SSCM. VC 2015 The Authors. International Journal of Eating Disorders Published by Wiley Periodicals, Inc

Qualitative analysis of how patients decide that they want risk-reducing mastectomy, and the implications for surgeons in responding to emotionally-motivated patient requests

Objective Contemporary approaches to medical decision-making advise that clinicians should respect patients’ decisions. However, patients’ decisions are often shaped by heuristics, such as being guided by emotion, rather than by objective risk and benefit. Risk-reducing mastectomy (RRM) decisions focus this dilemma sharply. RRM reduces breast cancer (BC) risk, but is invasive and can have iatrogenic consequences. Previous evidence suggests that emotion guides patients’ decision-making about RRM. We interviewed patients to better understand how they made decisions about RRM, using findings to consider how clinicians could ethically respond to their decisions. Methods Qualitative face-to-face interviews with 34 patients listed for RRM surgery and two who had decided against RRM. Results Patients generally did not use objective risk estimates or, indeed, consider risks and benefits of RRM. Instead emotions guided their decisions: they chose RRM because they feared BC and wanted to do ‘all they could’ to prevent it. Most therefore perceived RRM to be the ‘obvious’ option and made the decision easily. However, many recounted extensive post-decisional deliberation, generally directed towards justifying the original decision. A few patients deliberated before the decision because fears of surgery counterbalanced those of BC. Conclusion Patients seeking RRM were motivated by fear of BC, and the need to avoid potential regret for not doing all they could to prevent it. We suggest that choices such as that for RRM, which are made emotionally, can be respected as autonomous decisions, provided patients have considered risks and benefits. Drawing on psychological theory about how people do make decisions, as well as normative views of how they should, we propose that practitioners can guide consideration of risks and benefits even, where necessary, after patients have opted for surgery. This model of practice could be extended to other medical decisions that are influenced by patients’ emotions

Testing a new cognitive behavioural treatment for obesity: A randomized controlled trial with three-year follow-up

It is remarkably difficult for people with obesity to maintain a new lower weight following weight loss. The aim of the present study was to examine the immediate and longer-term effects of a new cognitive behavioural treatment that was explicitly designed to minimise this post-treatment weight regain. One hundred and fifty female participants with obesity were randomized to the new treatment, behaviour therapy (the leading alternative psychological treatment) or guided self-help (a minimal intervention). Both of the main treatments resulted in an average weight loss of about ten percent of initial weight whereas weight loss was more modest with guided self-help. The participants were subsequently followed-up for three years post-treatment. The great majority regained almost all the weight that they had lost with the new treatment being no better than the behavioural treatment in preventing weight regain. These findings lend further support to the notion that obesity is resistant to psychological methods of treatment, if anything other than a short-term perspective is taken. It is suggested that it is ethically questionable to claim that psychological treatments for obesity “work” in the absence of data on their longer-term effects