Hearing the voices of older adult patients: processes and findings to inform health services research

Background Clinical academic research and service improvement is planned using Patient and Public Involvement and Engagement (PPIE) but older PPIE participants are consulted less often due to the perception that they are vulnerable or hard to engage. Objectives To consult frail older adults about a recently adopted service, discharge to assess (D2A), and to prioritise services improvements and research topics associated with the design and delivery of discharge from hospital. To use successive PPIE processes to enable a permanent PPIE panel to be established. Participants Following guidance from an established hospital PPI panel 27 older adult participants were recruited. Participants from Black, Asian and Minority Ethnic (BAME) communities, affluent and non-affluent areas and varied social circumstances were included. Methods Focus groups and individual interviews were conducted in participants own homes or nearby social venues. Results Priorities for discharge included remaining independent despite often feeling lonely at home; to remain in hospital if needed; and for services to ensure effective communication with families. The main research priority identified was facilitating independence, whilst establishing a permanent PPIE panel involving older adults was viewed favourably. Conclusions Taking a structured approach to PPIE enabled varied older peoples’ voices to express their priorities and concerns into early discharge from hospital, as well as enabling the development of health services research into hospital discharge planning and management. Older people as participants identified research priorities after reflecting on their experiences. Listening and reflection enabled researchers to develop a new “Community PPIE Elders Panel” to create an enduring PPIE infrastructure for frail older housebound people to engage in research design, development and dissemination

Creative haptics: an evaluation of a haptic tool for non-sighted and visually impaired design students, studying at a distance

Design students who are blind or sight-impaired face distinct challenges when studying a visually centric discipline such as design practice. Students who are sighted use computer-aided design (CAD) which is presented via high definition using a PC mouse. However, design students who are blind or sight-impaired are not able to use visual display technology; therefore, this creates a barrier to access for this community. The aim of this study is to present a haptic prototype trial (Haptic Application Prototype Test [HAPT]) designed to assist design students who are blind/sight-impaired to interact with prototype assembly at the Open University (OU). The study specifically assessed the user feedback and the efficacy of access to CAD interface through the affordances of the haptic interface. The experiment included two groups of participants: one group included students who were blind and sight-impaired and the second group students who were classed fully sighted. Both groups were tested in two conditions of haptic engagement – manual and virtual. The parameters examined were (a) time – set at an industry-recognized time taken to assemble a ‘sketch model’ or prototype, and (b) ncollision – the number of collisions created by a collision algorithm which calculated any random collisions with the virtual environment or objects therein. Quantitative results showed that there was little statistical difference between time and a between-group test. From this we can imply that the haptic interface had offered equal access to CAD for people in the trial who were sighted and blind/sight-impaired indiscriminate of their sight acuity. Further future work using HAPT could be developed to a wider audience and a larger more diverse range of sight-impaired users. Future work will focus on new explorations of teaching using of haptics for greater immersion for distance learners at the OU science, technology, engineering and mathematics (STEM) labs

Comparative hydrolysis of P2 receptor agonists by NTPDases 1, 2, 3 and 8

Nucleoside triphosphate diphosphohydrolases 1, 2, 3 and 8 (NTPDases 1, 2, 3 and 8) are the dominant ectonucleotidases and thereby expected to play important roles in nucleotide signaling. Distinct biochemical characteristics of individual NTPDases should allow them to regulate P2 receptor activation differentially. Therefore, the biochemical and kinetic properties of these enzymes were compared. NTPDases 1, 2, 3 and 8 efficiently hydrolyzed ATP and UTP with Km values in the micromolar range, indicating that they should terminate the effects exerted by these nucleotide agonists at P2X1- and P2Y2,4,11 receptors. Since NTPDase1 does not allow accumulation of ADP, it should terminate the activation of P2Y1,12,13 receptors far more efficiently than the other NTPDases. In contrast, NTPDases 2, 3 and 8 are expected to promote the activation of ADP specific receptors, because in the presence of ATP they produce a sustained (NTPDase2) or transient (NTPDases 3 and 8) accumulation of ADP. Interestingly, all plasma membrane NTPDases dephosphorylate UTP with a significant accumulation of UDP, favoring P2Y6 receptor activation. NTPDases differ in divalent cation and pH dependence, although all are active in the pH range of 7.0-.5. Various NTPDases may also distinctly affect formation of extracellular adenosine and therefore adenosine receptor-mediated responses, since they generate different amounts of the substrate (AMP) and inhibitor (ADP) of ecto-5-nucleotidase, the rate limiting enzyme in the production of adenosine. Taken together, these data indicate that plasma membrane NTPDases hydrolyze nucleotides in a distinctive manner and may therefore differentially regulate P2 and adenosine receptor signaling

Large magnetoresistance by Pauli blockade in hydrogenated graphene

We report the observation of a giant positive magnetoresistance in millimetre scale hydrogenated graphene with magnetic field oriented in the plane of the graphene sheet. A positive magnetoresistance in excess of 200\% at a temperature of 300 mK was observed in this configuration, reverting to negative magnetoresistance with the magnetic field oriented normal to the graphene plane. We attribute the observed positive, in-plane, magnetoresistance to Pauli-blockade of hopping conduction induced by spin polarization. Our work shows that spin polarization in concert with electron-electron interaction can play a dominant role in magnetotransport within an atomic monolayer.Comment: 6 pages, 3 figures, and supplemental informatio

Assistive technology needs, access and coverage, and related barriers and facilitators in the WHO European region: a scoping review

Purpose: Globally, assistive technology (AT) is used by over 1 billion people, but the prevalence of needs and access to AT in specific countries or regions is largely unknown. This scoping review summarises the evidence available on the prevalence of needs, access and coverage of AT in the World Health Organisation European Region and the barriers and facilitators to its use. Methods: Relevant publications were identified using a combination of two strategies: 1) a systematic search for AT publications in five scientific literature databases; and 2) consultations with 76 of the Region's AT experts. Result: The search strategies yielded 103 publications, 62 of them identified by the systematic search. The included publications were predominantly from six countries, and 18 countries were unrepresented. Information on AT use for specific functional impairments was present in 57 publications: AT for hearing impairment in 14 publications; vision in 12; mobility, 12; communication, 11; self-care, 6; and cognition, 2. AT needs for vision and hearing impairment were more likely to be met (1–87% and 5–90%, respectively) compared with communication and cognition impairments (10–60% and 58%, respectively). The barriers and facilitators to AT access described were linked to accessibility, affordability and acceptability. Conclusion: Data on AT prevalence and coverage are limited in both quantity and quality. Agreed-upon definitions of functional impairment and assistive product categories and standards for data collection are needed to facilitate data comparisons and to build a more representative picture of AT needs and coverage. Implications for rehabilitation: Comprehensive and disaggregated data concerning the prevalence of needs and coverage of AT is needed to enable the development of responsive policies and actions. The literature available on the prevalence of needs and coverage of AT in the WHO European Region is primarily focussed on a small subset of countries and comparisons between studies are limited due to the use of different data collection strategies. Evidence concerning barriers and facilitators to AT access across countries is more consistent and can be organised across the key themes of accessibility, affordability and acceptability of AT. There is a need for consensus among multiple AT actors on standardised definitions for functional impairment and assistive product categories and standards for data collection to enable a more representative picture to be built of AT needs and coverage across the WHO European Region and globally