Exploring the relationship between age stereotypes and older adults' physical performance

There is a wealth of research exploring the biological, physical and physiological changes that occur with age to subsequently impact on older adults' physical ability and performance. In contrast, there is much less research exploring psychological determinants of older adults' physical ability and performance, despite some compelling evidence that age stereotypes can have an impact. This thesis explores the potential impact of age stereotypes further taking a mixed methods approach. Using an experimental design, Studies 1 and 2 aimed to replicate and extend age-based stereotype threat (ABST) theory. ABST is the concern that someone has for confirming a negative stereotype of their age-group, when they are required to perform in the stigmatized task domain and evidence suggests it has a detrimental impact on cognitive tasks (Lamont, Swift, & Abrams, 2015), as well physical tasks such as hand-grip (Swift, Lamont, & Abrams, 2012). Study 1 extends Swift et al (2012) by using more precise physical and physiological measures. Study 2 extends ABST understanding by exploring the impact on a new physical performance task measuring balance. These studies find partial support for ABST. Study 3 used existing survey data (ELSA) to test the hypothesis that internalised negative age stereotypes are associated with physical performance outcomes and subsequently puts older adults at increased risk of a fall. Studies 4 and 5 explore the associations between negative age stereotypes and physical performance in applied settings, including a dance group (Study 4) and a care home (Study 5). The studies reveal that physical activity can be an effective intervention for improving older adults' attitudes to age. The findings are discussed in relation to psychological theories, ABST and stereotype embodiment theory, as well as proposing the integration of findings with biological models of age related change. Limitations and future recommendations are also discussed

Developing a quality-of-life measure for autistic children and young people in schools

Aim: To develop a quality-of-life measure to be used by both school staff and autistic children and young people (CYP) in schools, in which public and community involvement (PCIE) is at the heart of the research.  Method: A prevalence questionnaire survey will be conducted with 20 primary and secondary schools across Kent, Surrey, and Sussex (KSS). 10 semi-structured interviews will be conducted with autistic CYP. This will inform development of a quality-of-life measure for autistic CYP. Results: Work so far has included PCIE in the early stages of the project, in which young people, school staff and collaborators have contributed to the study set up and designing study materials. Conclusion: With PCIE included in the planning of the project, the research team is confident that this will be useful further along in the project with dissemination and validating and implementing a quality-of-life measure for autistic CYP in schools

A Harmonised Approach to Curating Research-Ready Datasets for Asthma, Chronic Obstructive Pulmonary Disease (COPD) and Interstitial Lung Disease (ILD) in England, Wales and Scotland Using Clinical Practice Research Datalink (CPRD), Secure Anonymised Information Linkage (SAIL) Databank and DataLoch

Background: Electronic healthcare records (EHRs) are an important resource for health research that can be used to improve patient outcomes in chronic respiratory diseases. However, consistent approaches in the analysis of these datasets are needed for coherent messaging, and when undertaking comparative studies across different populations.Methods and results: We developed a harmonised curation approach to generate comparable patient cohorts for asthma, chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) using datasets from within Clinical Practice Research Datalink (CPRD; for England), Secure Anonymised Information Linkage (SAIL; for Wales) and DataLoch (for Scotland) by defining commonly derived variables consistently between the datasets. By working in parallel on the curation methodology used for CPRD, SAIL and DataLoch for asthma, COPD and ILD, we were able to highlight key differences in coding and recording between the databases and identify solutions to enable valid comparisons.Conclusion: Codelists and metadata generated have been made available to help re-create the asthma, COPD and ILD cohorts in CPRD, SAIL and DataLoch for different time periods, and provide a starting point for the curation of respiratory datasets in other EHR databases, expediting further comparable respiratory research

Health service use of infants involved in family justice care and supervision proceedings in Wales: a data linkage study

IntroductionWhen a child has suffered, or is at risk of suffering, significant harm from parents or caregivers, the local authority may issue Section 31 (s.31) Care and Supervision proceedings under the Children Act (1989).ObjectivesWe compared the healthcare use of infants less than one year old subject to s.31 proceedings in Wales (n = 1,332),to that of a comparison group of infants not subject to s.31 proceedings (n = 204,417), between January 2011 and February 2020.MethodsPopulation-based e-cohort study utilising data held in the Secure Anonymised Information Linkage (SAIL) Databank. Infants in s.31 proceedings were identified using the Children and Family Court Advisory and Support Service dataset. This was linked to demographic and healthcare datasets, to identify General Practice (GP) visits, emergency department (ED) attendances, and hospital admissions (emergency and elective); before the study end date or the child's first birthday for the comparison group, orbefore the s.31 application date.Regression analysis calculated event rate ratios [RR] and incidence rate ratios [IRR] for healthcare events, adjusting for widerdeterminants of health (e.g. perinatal factors, maternal mental health, deprivation), and investigated reasons for healthcare use.ResultsInfants in s.31 proceedings had ahigher number and incidence of healthcare events compared with the comparison group, across all healthcare settings. Differences were greatest for emergency hospital admissions (IRR = 4.03, 95% confidence interval [CI] = 3.53 - 4.59; RR = 4.60, CI = 3.90 - 5.41). "Injury and poisoning" was the main reason for emergency admissions amongst infants in s.31 proceedings. For ED presentations, emergency hospital admissions, and GP visits, there were proportionally more events for these infants across all top ten reasons for healthcare.ConclusionsFindings highlight greater healthcare utilisation for infants involved in s.31 proceedings in Wales, helping to build a better understanding of their needs and vulnerabilities

A Realist Evaluation of Autism ServiCe Delivery (RE-ASCeD): Which diagnostic pathways work best, for whom and in what context? Protocol for a rapid realist review

Introduction The National Health Service (NHS) Long-Term Plan (2019) acknowledges that children and young people with suspected autism wait too long for diagnostic assessment and sets out to reduce waiting times. However, diagnostic pathways vary with limited evidence on what model works best, for whom and in what circumstances. The National Autism Plan for Children (2003) recommended that assessment should be completed within 13 weeks but referral to diagnosis can take as long as 799 days. This Rapid Realist Review (RRR) is the first work package in a national programme of research: a Realist Evaluation of Autism ServiCe Delivery (RE-ASCeD). We explore how particular approaches may deliver high-quality and timely autism diagnostic services for children with possible autism; high quality is defined as compliant with National Institute for Heath and Care Excellence (2011) guidelines, and timely as a pathway lasting no more than one calendar year, based on previous work. Methods and analysis RRR is a well-established approach to synthesising evidence within a compressed timeframe to identify models of service delivery leading to desired outcomes. RRR works backwards from intended outcomes, identified by NICE guidelines and the NHS England Long-Term Plan. The focus is a clearly defined intervention (the diagnostic pathway), associated with specific outcomes (high quality and timely), within a particular set of parameters (Autism and Child & Adolescent Mental Health services in the UK). Our Expert Stakeholder Group consists of policymakers, content experts and knowledge users with a wide range of experience to supplement, tailor and expedite the process. The RRR is consistent with Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) and includes identifying the research question, searching for information, quality appraisal, data extraction, synthesising the evidence, validation of findings with experts and dissemination. Ethics and dissemination Ethical approval not required. Findings will inform the wider RE-ASCeD evaluation and be reported to NHS England

An observational study of individual child journeys through autism diagnostic pathways, and associated costs, in the UK National Health Service

BackgroundDemand for diagnostic assessment in children with possible autism has recently increased significantly. Services are under pressure to deliver timely and high-quality diagnosis, following National Institute and Care Excellence multidisciplinary assessment guidelines. This UK National Health Service study aimed to answer: how many hours of health professional time are required to deliver autism diagnostic assessment, and how much does this cost?.MethodCase notes of 20 children (1–16 yrs.) from 27 NHS trusts, assessed through an autism diagnostic pathway in the previous year, were examined retrospectively. Data included: hours of professional time, diagnostic outcome. Assessment costs calculated using standardised NHS tariffs.Results488 children (aged 21–195 months, mean 82.9 months, SD 39.36) from 22 Child Development Services (CDS), four Child and Adolescent Mental Health Services (CAMHS) and one tertiary centre; 87% were either under 5 (36%) or 5 to 11 years (51%). Children seen by CDS were younger than CAMHS (mean (SD) 6.10 (2.72) vs. 10.39 (2.97) years, p < 0.001). Mean days to diagnosis were 375 (SD 235), with large variation (range 41–1553 days). Mean hours of professional time per child was 11.50 (SD 7.03) and varied substantially between services and individuals. Mean cost of assessment was £846.00 (SD 536.31). 339 (70.0%) children received autism diagnosis with or without comorbidity; 54 (11%) received no neurodevelopmental diagnosis; 91 (19%) received alternative neurodevelopmental diagnoses. Children with one or more coexisting conditions took longer to diagnose, and assessment was more costly, on average 117 days longer, costing £180 more than a child with no neurodevelopmental diagnosis. Age did not predict days to diagnosis or assessment costs.ConclusionTypical assessment took 11 h of professional time and over 12-months to complete, costing GB£850 per child. Variation between centres and children reflect differences in practice and complexity of diagnostic presentation. These results give information to those delivering/planning autism assessments using multi-disciplinary team approach, in publicly funded health systems. Planning of future diagnostic services needs to consider growing demand, the need for streamlining, enabling context appropriate services, and child/family complexity

Methods for improving the accuracy of automated NDE systems

Automated inspection systems using twin six-axis industrial robots have been available for a number of years, including the IntACom system at TWI Wales. Utilising phased array ultrasonic probes to quickly inspect complex geometries, the IntACom system is now routinely used in various inspections of composite components. In the present work we introduce a number of methods for improving and quantifying the accuracy of an automated inspection system. The key challenges are identified and addressed through a number of methods including calibration procedures and interfacing multiple sensors with industrial robots for Non Destructive Evaluation (NDE) purposes. The authors also introduce a novel method for improving the Tool Centre Point (TCP) calibration of an industrial robot when the tool is an ultrasonic phased array probe. Experimental trials show that the average positioning error is less than 0.5mm using this new method

Methodological issues of using placebos in interventions based on digital technology

Background/Aims: Use of placebo is the ideal for comparison in clinical trials to reduce biases. With digital technology being used more frequently in healthcare interventions, how do we determine the placebo effect where interventions exploit technology? If placebo in medicine is traditionally defined by a lack of pharmacological agents, how might we begin to move towards controlling for effects of digital technology? Method: This paper explores the traditional placebo effect and discusses its impact in healthcare contexts with digital technology with reference to a particular trial. Different meanings of placebo in the context of evaluating technology suggest new challenges and positive consequences. Results: Methodological considerations are discussed, which enabled the development of a placebo-controlled evaluation of a digital technology in healthcare and rehabilitation. Conclusion: Digital placebo was controlled in our trial by employing technology across all groups in the absence of evidence-based practice and shows how to control for unknown and hidden effects of technology