Designing assisted living technologies 'in the wild' : preliminary experiences with cultural probe methodology

Background There is growing interest in assisted living technologies to support independence at home. Such technologies should ideally be designed ‘in the wild’ i.e. taking account of how real people live in real homes and communities. The ATHENE (Assistive Technologies for Healthy Living in Elders: Needs Assessment by Ethnography) project seeks to illuminate the living needs of older people and facilitate the co-production with older people of technologies and services. This paper describes the development of a cultural probe tool produced as part of the ATHENE project and how it was used to support home visit interviews with elders with a range of ethnic and social backgrounds, family circumstances, health conditions and assisted living needs. Method Thirty one people aged 60 to 98 were visited in their homes on three occasions. Following an initial interview, participants were given a set of cultural probe materials, including a digital camera and the ‘Home and Life Scrapbook’ to complete in their own time for one week. Activities within the Home and Life Scrapbook included maps (indicating their relationships to people, places and objects), lists (e.g. likes, dislikes, things they were concerned about, things they were comfortable with), wishes (things they wanted to change or improve), body outline (indicating symptoms or impairments), home plan (room layouts of their homes to indicate spaces and objects used) and a diary. After one week, the researcher and participant reviewed any digital photos taken and the content of the Home and Life Scrapbook as part of the home visit interview. Findings The cultural probe facilitated collection of visual, narrative and material data by older people, and appeared to generate high levels of engagement from some participants. However, others used the probe minimally or not at all for various reasons including limited literacy, physical problems (e.g. holding a pen), lack of time or energy, limited emotional or psychological resources, life events, and acute illness. Discussions between researchers and participants about the materials collected (and sometimes about what had prevented them completing the tasks) helped elicit further information relevant to assisted living technology design. The probe materials were particularly helpful when having conversations with non-English speaking participants through an interpreter. Conclusions Cultural probe methods can help build a rich picture of the lives and experiences of older people to facilitate the co-production of assisted living technologies. But their application may be constrained by the participant’s physical, mental and emotional capacity. They are most effective when used as a tool to facilitate communication and development of a deeper understanding of older people’s needs

Accountability for performance in English and Scottish fire and rescue services from 2010 to 2016

Using evidence from English and Scottish fire and rescue services from 2010-2016, this paper aims to show how divergent performance management regimes can affect public accountability. Performance management regimes enable agencies and the public to hold public sector organisations accountable by facilitating evaluation of their accomplishments. However, our findings show that local as opposed to central control over performance management, can have quite differing implications for public accountability

Three-centre cluster structure in 11C and 11B

Studies of the 16O(9Be,alpha 7Be)14C, 7Li(9Be,alpha 7Li)5He and 7Li(9Be,alpha alpha t)5He reactions at E(beam)=70 and 55 MeV have been performed using resonant particle spectroscopy techniques. The 11C excited states decaying into alpha+7Be(gs) are observed between 8.5 and 13.5 MeV. The alpha+7Li(gs), alpha+7Li*(4.652 MeV) and t+8Be(gs) decays of 11B excited states between 9 and 19 MeV are observed. The decay processes are used to indicate the possible three-centre 2alpha+3He (2alpha+3H) cluster structure of observed states. This cluster structure is more prominent in the positive-parity states, where two rotational bands with large deformations are suggested. Excitations of some of the observed T=1/2 resonances coincide with the energies of previously measured T=3/2 isobaric analogs of the 11Be states,indicating that these states may have mixed isospin.Comment: Contribution for the proceedings of the NUSTAR'05: NUclear STructure, Astrophysics and Reactions, University of Surrey, Guildford, UK; accepted for publication in Journal of Physics

A comparative appraisal of recent and proposed changes to the fire and rescue services in England and Scotland

The regimes for developing policy, delivering services and providing assurance to the public for Fire and Rescue Services in Scotland and England have diverged significantly since 2010, facilitated by the devolution of responsibility for local public services to the Scottish Government. This divergence has generated an opportunity to compare two service regimes that for over a hundred and fifty years shared the same antecedents and history. Previous studies have individually explored the antecedents and the first five years of the development in each of the two countries between 2010 and 2015 (Taylor et al 2018, Murphy and Ferry 2018). This chapter presents a comparative appraisal of more recent and proposed changes to the fire and rescue services in England and Scotland and brings the narrative up to 2018. The catalyst for this new appraisal has been the publication of a series of key policy documents in both countries, which suggest it is both timely and opportune to undertake a further comparison of the two countries arrangements

Caring for the patient, caring for the record: an ethnographic study of 'back office' work in upholding quality of care in general practice

© 2015 Swinglehurst and Greenhalgh; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. 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.Additional file 1: Box 1. Field notes on summarising (Clover Surgery). Box 2. Extract of document prepared for GPs by summarisers at Clover Surgery. Box 3. Fieldnotes on coding incoming post, Clover (original notes edited for brevity).This work was funded by a research grant from the UK Medical Research Council (Healthcare Electronic Records in Organisations 07/133) and a National Institute of Health Research doctoral fellowship award for DS (RDA/03/07/076). The funders were not involved in the selection or analysis of data nor did they make any contribution to the content of the final manuscript

The influence of barefoot and barefoot inspired footwear on the kinetics and kinematics of running in comparison to conventional running shoes.

Barefoot running has experienced a resurgence in footwear biomechanics literature, based on the supposition that it serves to reduce the occurrence of overuse injuries in comparison to conventional shoe models. This consensus has lead footwear manufacturers to develop shoes which aim to mimic the mechanics of barefoot locomotion. This study compared the impact kinetics and 3-D joint angular kinematics observed whilst running: barefoot, in conventional cushioned running shoes and in shoes designed to integrate the perceived benefits of barefoot locomotion. The aim of the current investigation was therefore to determine whether differences in impact kinetics exist between the footwear conditions and whether shoes which aim to simulate barefoot movement patterns can closely mimic the 3-D kinematics of barefoot running. Twelve participants ran at 4.0 m.s-1±5% in each footwear condition. Angular joint kinematics from the hip, knee and ankle in the sagittal, coronal and transverse planes were measured using an eight camera motion analysis system. In addition simultaneous tibial acceleration and ground reaction forces were obtained. Impact parameters and joint kinematics were subsequently compared using repeated measures ANOVAs. The kinematic analysis indicates that in comparison to the conventional and barefoot inspired shoes that running barefoot was associated significantly greater plantar-flexion at footstrike and range of motion to peak dorsiflexion. Furthermore, the kinetic analysis revealed that compared to the conventional footwear impact parameters were significantly greater in the barefoot condition. Therefore this study suggests that barefoot running is associated with impact kinetics linked to an increased risk of overuse injury, when compared to conventional shod running. Furthermore, the mechanics of the shoes which aim to simulate barefoot movement patterns do not appear to closely mimic the kinematics of barefoot locomotion

Socio-cultural influences on the behaviour of South Asian women with diabetes in pregnancy: qualitative study using a multi-level theoretical approach

BACKGROUND: Diabetes in pregnancy is common in South Asians, especially those from low-income backgrounds, and leads to short-term morbidity and longer-term metabolic programming in mother and offspring. We sought to understand the multiple influences on behaviour (hence risks to metabolic health) of South Asian mothers and their unborn child, theorise how these influences interact and build over time, and inform the design of culturally congruent, multi-level interventions. METHODS: Our sample for this qualitative study was 45 women of Bangladeshi, Indian, Sri Lankan, or Pakistani origin aged 21-45 years with a history of diabetes in pregnancy, recruited from diabetes and antenatal services in two deprived London boroughs. Overall, 17 women shared their experiences of diabetes, pregnancy, and health services in group discussions and 28 women gave individual narrative interviews, facilitated by multilingual researchers, audiotaped, translated, and transcribed. Data were analysed using the constant comparative method, drawing on sociological and narrative theories. RESULTS: Key storylines (over-arching narratives) recurred across all ethnic groups studied. Short-term storylines depicted the experience of diabetic pregnancy as stressful, difficult to control, and associated with negative symptoms, especially tiredness. Taking exercise and restricting diet often worsened these symptoms and conflicted with advice from relatives and peers. Many women believed that exercise in pregnancy would damage the fetus and drain the mother's strength, and that eating would be strength-giving for mother and fetus. These short-term storylines were nested within medium-term storylines about family life, especially the cultural, practical, and material constraints of the traditional South Asian wife and mother role and past experiences of illness and healthcare, and within longer-term storylines about genetic, cultural, and material heritage - including migration, acculturation, and family memories of food insecurity. While peer advice was familiar, meaningful, and morally resonant, health education advice from clinicians was usually unfamiliar and devoid of cultural meaning. CONCLUSIONS: 'Behaviour change' interventions aimed at preventing and managing diabetes in South Asian women before and during pregnancy are likely to be ineffective if delivered in a socio-cultural vacuum. Individual education should be supplemented with community-level interventions to address the socio-material constraints and cultural frames within which behavioural 'choices' are made

Investigating and learning lessons from early experiences of implementing ePrescribing systems into NHS hospitals:a questionnaire study

Background: ePrescribing systems have significant potential to improve the safety and efficiency of healthcare, but they need to be carefully selected and implemented to maximise benefits. Implementations in English hospitals are in the early stages and there is a lack of standards guiding the procurement, functional specifications, and expected benefits. We sought to provide an updated overview of the current picture in relation to implementation of ePrescribing systems, explore existing strategies, and identify early lessons learned.Methods: a descriptive questionnaire-based study, which included closed and free text questions and involved both quantitative and qualitative analysis of the data generated.Results: we obtained responses from 85 of 108 NHS staff (78.7% response rate). At least 6% (n = 10) of the 168 English NHS Trusts have already implemented ePrescribing systems, 2% (n = 4) have no plans of implementing, and 34% (n = 55) are planning to implement with intended rapid implementation timelines driven by high expectations surrounding improved safety and efficiency of care. The majority are unclear as to which system to choose, but integration with existing systems and sophisticated decision support functionality are important decisive factors. Participants highlighted the need for increased guidance in relation to implementation strategy, system choice and standards, as well as the need for top-level management support to adequately resource the project. Although some early benefits were reported by hospitals that had already implemented, the hoped for benefits relating to improved efficiency and cost-savings remain elusive due to a lack of system maturity.Conclusions: whilst few have begun implementation, there is considerable interest in ePrescribing systems with ambitious timelines amongst those hospitals that are planning implementations. In order to ensure maximum chances of realising benefits, there is a need for increased guidance in relation to implementation strategy, system choice and standards, as well as increased financial resources to fund local activitie