The social and economic value of wheelchair user homes

People who use wheelchairs can benefit in many ways from living in homes which are designed to meet their needs. They can enjoy a much greater independence and ability to do everyday tasks such as showering, cooking, using all areas of the house and garden, being able to work, and using all the amenities of their home. This can lead to an overall increase in their confidence and wellbeing, including engagement in social and community life. Accessible homes can also be much safer, reducing risks of accidents or falls at home, and considerably reduce the need for other people to be regularly available to assist with everyday life – including family members, informal carers, or local authority care and support staff. Recent proposals to change planning regulations will mean, once implemented, that all new homes are required to meet an inclusive design standard called the ‘accessible and adaptable design standard’, which is set out in building regulations in ‘Approved Document M’. This has been widely welcomed by many disabled people and others, as it will provide homes that can be adapted to meet many of the changing needs of households over time. But there are still no regulations which require the building of a basic proportion of new homes to a standard which meets the needs of wheelchair users. LSE Housing and Communities were commissioned by Habinteg Housing Association to review the existing evidence around the potential benefits to individual wheelchair users and the public purse of increasing the availability of wheelchair accessible housing to meet current needs, and compare those benefits to the additional costs of building to that accessible standard. We also interviewed 17 wheelchair users about their experiences of living in, or their lack of, accessible housing

Quantitative assessment of cerebella ataxia through automated upper limb functional tests

Neurological disorders typically exhibit movement disabilities and disorders such as cerebellar ataxia (CA) can cause coordination inaccuracies often manifested as disabilities associated with gait, balance and speech. Since the severity assessment of the disorder is based on the expert clinical opinion, it is likely to be subjective. Automated versions of two upper limb tests: Finger to Nose test (FNT) and Diadochokinesia (DDK) test are investigated in this paper. Inertial Measurement Units (IMU) (BioKinTM ) are employed to capture the disability by measuring limb movements. Translational and rotational accelerations considered as kinematic parameters provided the features relevant to characteristic movements intrinsic to the disability. Principal Component Analysis (PCA) and multi-class Linear Discriminant classifier (LDA) were instrumental in dominant features correlating with the clinical scores. The relationship between clinicians assessment and the objective analysis is examined using Pearson Correlation. This study found that although FNT predominantly consist of translational movements, rotation was the dominant feature while for the case of DDK that predominantly consist of rotational movements, acceleration was the dominant feature. The degree of correlation in each test was also enhanced by combining the features in different tests

Bridging the reciprocal gap between sleep and fruit and vegetable consumption: A review of the evidence, potential mechanisms, implications and directions for future work

A substantial burden of disease and mortality globally is attributable to both sleep disruption and low intakes of fruit and vegetable (FV) and there is increasing mechanistic and epidemiological evidence to support a reciprocal relationship between the two. This review provides an overview of experimental and observational studies assessing the relations between sleep and FV consumption from 52 human adult studies. Experimental studies are currently limited and show inconsistent results. Observational studies support a non-linear association with adults sleeping the recommended 7–9 hours/day having the highest intakes of FV. The potential mechanisms linking sleep and FV consumption are highlighted. Disrupted sleep influences FV consumption through homeostatic and non-homeostatic mechanisms. Conversely, FV consumption may influence sleep through polyphenol content via several potential pathways. Few human experimental studies have examined the effects of FV items and their polyphenols on sleep and there is a need for more studies to address this. An appreciation of the relationship between sleep and FV consumption may help optimize sleep and FV consumption and may reduce the burden of chronic diseases. This review provides implications for public health and directions for future work

Nutrition and the circadian system

The human circadian system anticipates and adapts to daily environmental changes to optimise behaviour according to time of day and temporally partitions incompatible physiological processes. At the helm of this system is a master clock in the suprachiasmatic nuclei (SCN) of the anterior hypothalamus. The SCN are primarily synchronised to the 24-h day by the light/dark cycle; however, feeding/fasting cycles are the primary time cues for clocks in peripheral tissues. Aligning feeding/fasting cycles with clock-regulated metabolic changes optimises metabolism, and studies of other animals suggest that feeding at inappropriate times disrupts circadian system organisation, and thereby contributes to adverse metabolic consequences and chronic disease development. ‘High-fat diets’ (HFD) produce particularly deleterious effects on circadian system organisation in rodents by blunting feeding/fasting cycles. Time-of-day-restricted feeding, where food availability is restricted to a period of several hours, offsets many adverse consequences of HFD in these animals; however, further evidence is required to assess whether the same is true in humans. Several nutritional compounds have robust effects on the circadian system. Caffeine, for example, can speed synchronisation to new time zones after jetlag. An appreciation of the circadian system has many implications for nutritional science and may ultimately help reduce the burden of chronic diseases

Using participatory research to co-produce an education and training e-resource to support care home staff to meet the sexuality, intimacy and relationship needs of care home residents with and without dementia

AimTo present the methodological approach and research methods chosen in a research study designed to enable the collaborative creation of an education and training e-resource designed to facilitate and support care home staff to address the sexuality, intimacy and relationship needs of older care home residents.DesignCo-production using community-based participatory approach.MethodsFour participatory workshops with care home staff, residents and their significant others.ResultsWorkshops 1 and 2 identified and developed real-world case scenarios related to sexuality, intimacy and relationship needs and identified care staff training needs in this area. Then workshop 3 provided valuable feedback on the prototype training e-resource, and the final workshop identified care home staff engagement with and implementation of the e-resource in practice.ConclusionThe findings provide evidence that using participatory approaches, such as co-production, to develop education and training resources in a sensitive subject area with care home residents, significant others, carers and care home staff, was a useful approach in engaging a vulnerable population group, in a sensitive area. However, this approach is not without challenges in care home communities

Quantification of axial abnormality due to cerebellar ataxia with inertial measurements

Cerebellar Ataxia (CA) leads to deficiencies in muscle movement and lack of coordination that is often manifested as gait and balance disabilities. Conventional CA clinical assessments are subjective, cumbersome and provide less insight into the functional capabilities of patients. This cross-sectional study investigates the use of wearable inertial sensors strategically positioned on the front-chest and upper-back locations during the Romberg and Trunk tests for objective assessment of human postural balance due to CA. The primary aim of this paper is to quantify the performance of postural stability of 34 patients diagnosed with CA and 22 healthy subjects as controls. Several forms of entropy descriptions were considered to uncover characteristics of movements intrinsic to CA. Indeed, correlation with clinical observation is vital in ascertaining the validity of the inertial measurements in addition to capturing unique features of movements not typically observed by the practicing clinician. Both of these aspects form an integral part of the underlying objective assessment scheme. Uncertainty in the velocity contained a significant level of information with respect to truncal instability and, based on an extensive clustering and discrimination analysis, fuzzy entropy was identified as an effective measure in characterising the underlying disability. Front-chest measurements demonstrated a strong correlation with clinical assessments while the upper-back measurements performed better in classifying the two cohorts, inferring that the standard clinical assessments are relatively influenced by the frontal observations. The Romberg test was confirmed to be an effective test of neurological diagnosis as well as a potential candidate for objective assessment resulting in a significant correlation with the clinical assessments. In contrast, the Trunk test is observed to be relatively less informative

Effect of medication review and cognitive behaviour treatment by community pharmacists of patients discharged from the hospital on drug related problems and compliance: design of a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Drug related problems (DRPs) are common among elderly patients who are discharged from the hospital and are using several drugs for their chronic diseases. Examples of drug related problems are contra-indications, interactions, adverse drug reactions and inefficacy of treatment. Causes of these problems include prescription errors and non-compliance with treatment. The aim of this study is to examine the effect of <it>medication review </it>and <it>cognitive behaviour therapy </it>of discharged patients by community pharmacists to minimize the occurrence of drug related problems.</p> <p>Methods/Design</p> <p>A randomized controlled trial will be performed. Community pharmacists will be randomized into a control group and an intervention group. 342 Patients, aged over 60 years, discharged from general and academic hospitals, using five or more prescription drugs for their chronic disease will be asked by their pharmacy to participate in the study.</p> <p>Patients randomized to the control group will receive usual care according to the Dutch Pharmacy Standard. The medication of patients randomised to the intervention group will be reviewed by the community pharmacist with use of the national guidelines for the treatment of diseases, when patients are discharged from the hospital. The Pharmaceutical Care network Europe Registration form will be used to record drug related problems. Trained pharmacy technicians will counsel patients at home at baseline and at 1,3,6,9 and 12 months, using Cognitive Behaviour Treatment according to the Theory of Planned Behaviour. The patient's attitude towards medication and patient's adherence will be subject of the cognitive behaviour treatment. The counselling methods that will be used are <it>motivational interviewing </it>and <it>problem solving treatment</it>. Patients adherence towards drug use will be determined with use of the Medication Adherence Report Scale Questionnaire. There will be a follow-up of 12 months.</p> <p>The two primary outcome measures are the difference in occurrence of DRPs between intervention and control group and adherence with drug use. Secondary endpoints are attitude towards drug use, incidence of Re-hospitalisations related to medicines, functional status of the patient, quality of life and the cost-effectiveness of this intervention.</p> <p>Discussion</p> <p>Combining both medication review and Cognitive Behaviour Treatment may decrease DRPs and may result in more compliance with drug use among patients discharged from the hospital and using 5 or more chronic drugs.</p> <p>Trial registration</p> <p>Dutch Trial Register NTR1194</p

Vitamin B12 Deficiency Alters the Gut Microbiota in a Murine Model of Colitis

Purpose: Inflammatory bowel disease (IBD) refers to a spectrum of autoimmune diseases, which result in chronic intestinal inflammation. Previous findings suggest a role for diet, nutrition and dysbiosis of the gut microbiota in both the development and progression of the condition. Vitamin B12 is a key cofactor of methionine synthase and is produced solely by microbes. Previous work links increased levels of homocysteine, a substrate of methionine synthase, MetH, to IBD indicating a potential role for vitamin B12 deficiency in intestinal injury and inflammation. This study assessed the role of vitamin B12 in shaping the gut microbiota and determining responses to intestinal injury using a reproducible murine model of colitis. Methods: The effects of vitamin B12 supplementation and deficiency were assessed in vivo; 3-week-old post-weanling C57Bl/6 mice were divided into three dietary treatment groups: (1) sufficient vitamin B12 (50 mg/Kg), (2) deficient vitamin B12 (0 mg/Kg) and (3) supplemented vitamin B12 (200 mg/Kg) for a period of 4 weeks. Intestinal injury was induced with 2% dextran sodium sulphate (DSS) via drinking water for 5 days. The impact of varying levels of dietary vitamin B12 on gut microbiota composition was assessed using 16S rRNA gene sequencing from fecal samples collected at day 0 and day 28 of the dietary intervention, and 7 days following induction of colitis on day 38, when blood and colonic tissues were also collected. Results: No significant alterations were found in the gut microbiota composition of disease-free animals in response to dietary interventions. By contrast, after DSS-induced colitis, >30 genera were significantly altered in vitamin B12 deficient mice. Altered B12 levels produced no significant effect on composite disease-activity scores; however, administration of a B12 deficient diet resulted in reduced DSS-induced epithelial tissue damage. Conclusions: Vitamin B12 supplementation does not alter the gut microbiota composition under healthy conditions, but does contribute to differential microbial responses and intestinal dysbiosis following the induction of experimental colitis

“Because It Kind of Falls in Between, Doesn’t It? Like an Acute Thing and a Chronic”: the Psychological Experience of Anaphylaxis in Adulthood

Anaphylaxis is a serious, rare condition increasing in prevalence. This study explored the psychological experience of adult-onset anaphylaxis from patient, family and staff perspectives. Semi-structured interviews were conducted with twelve participants. Two global themes emerged from thematic analysis: ‘controllability’ (‘an unknown and distressing experience’, ‘the importance of control over triggers’ and ‘responsibility but no control: the impact on others’) and ‘conflict’ (‘rejecting illness identity’, ‘minimisation of risk’, ‘accessing specialist care: running in slow motion’ and ‘patient-centred versus service-centred care’). Findings highlight the importance of perceived control and emphasise the presence of conflict in the experience of this complex, episodic condition

LUCIFER@LBT view of star-forming galaxies in the cluster 7C 1756+6520 at z~1.4

Galaxy clusters are key places to study the contribution of {\it nature} (i.e. mass, morphology) and {\it nurture} (i.e.environment) in the formation and evolution of galaxies. Recently, a number of clusters at z$>$1, i.e. corresponding to the first epochs of the cluster formation, has been discovered and confirmed spectroscopically. We present new observations obtained with the {\sc LUCIFER} spectrograph at Large Binocular Telescope (LBT) of a sample of star-forming galaxies associated with a large scale structure around the radio galaxy 7C1756+6520 at z=1.42. Combining our spectroscopic data and the literature photometric data, we derived some of the properties of these galaxies: star formation rate, metallicity and stellar mass. With the aim of analyzing the effect of the cluster environment on galaxy evolution, we have located the galaxies in the plane of the so-called Fundamental Metallically Relation (FMR), which is known not to evolve with redshift up to z$=2.5$ for field galaxies, but it is still unexplored in rich environments at low and high redshift. We found that the properties of the galaxies in the cluster 7C 1756+6520 are compatible with the FMR which suggests that the effect of the environment on galaxy metallicity at this early epoch of cluster formation is marginal. As a side study, we also report the spectroscopic analysis of a bright AGN, belonging to the cluster, which shows a significant outflow of gas.Comment: Accepted for publication by MNRAS, 10 pages, 6 figures, 3 table