Embedding patient and public involvement: managing tacit and explicit expectations

Background: Evidencing well-planned and implemented patient and public involvement (PPI) in a research project is increasingly required in funding bids and dissemination activities. There is a tacit expectation that involving people with experience of the condition under study will improve the integrity and quality of the research. This expectation remains largely unproblematised and unchallenged. Objective: To critically evaluate the implementation of PPI activity, including co-research in a programme of research exploring ways to enhance the independence of people with dementia. Design: Using critical cases we make visible and explicate theoretical and moral challenges of PPI. Results: Case 1 explores the challenges of undertaking multiple PPI roles in the same study making explicit different responsibilities of being a co-applicant, PPI advisory member and a co-researcher. Case 2 explores tensions which arose when working with carer co-researchers during data collection; here the co-researcher’s wish to offer support and advice to research participants, a moral imperative, was in conflict with assumptions about the role of the objective interviewer. Case 3 defines and examines co-research data coding and interpretation activities undertaken with people with dementia; reporting the theoretical outputs of the activity and questioning whether this was co-researcher analysis or PPI validation. Conclusion: PPI activity can empower individual PPI volunteers and improve relevance and quality of research but it is a complex activity which is socially constructed in flexible ways with variable outcomes. It cannot be assumed to be simple or universal panacea for increasing the relevance and accessibility of research to the public

Vibration analysis of thin-walled composite beams with I-shaped cross-sections

A general analytical model applicable to the vibration analysis of thin-walled composite I-beams with arbitrary lay-ups is developed. Based on the classical lamination theory, this model has been applied to the investigation of load–frequency interaction curves of thin-walled composite beams under various loads. The governing differential equations are derived from the Hamilton’s principle. A finite element model with seven degrees of freedoms per node is developed to solve the problem. Numerical results are obtained for thin-walled composite I-beams under uniformly distributed load, combined axial force and bending loads. The effects of fiber orientation, location of applied load, and types of loads on the natural frequencies and load–frequency interaction curves as well as vibration mode shapes are parametrically studied

Maintaining social connections in dementia: A qualitative synthesis

The clinical symptoms of dementia include difficulty with speech, poor short-term memory and changes in behavior. These symptoms can affect how the person with dementia understands and performs in social interactions. This qualitative review investigated how people with mild to moderate dementia managed social connections. A systematic search of social science databases retrieved 13 articles; data were synthesized using thematic analysis. Results established the work undertaken by people with dementia to maintain and present a social persona seen as socially acceptable. Interpretations are contextualized within Goffman and Sabat's theories on 'self'. People with dementia were agentic in impression management: undertaking work to maintain recognized social roles, while being aware of when their illness led to others discrediting them. Wider recognition of strategies used to maintain a social self could inform interventions designed to increase capability and confidence in co-managing social connections following dementia diagnosis

On triply coupled vibrations of axially loaded thin-walled composite beams

Free vibration of axially loaded thin-walled composite beams with arbitrary lay-ups is presented. This model is based on the classical lamination theory, and accounts for all the structural coupling coming from material anisotropy. Equations of motion for flexural–torsional coupled vibration are derived from the Hamilton’s principle. The resulting coupling is referred to as triply coupled vibrations. A displacement-based one-dimensional finite element model is developed to solve the problem. Numerical results are obtained for thin-walled composite beams to investigate the effects of axial force, fiber orientation and modulus ratio on the natural frequencies, load–frequency interaction curves and corresponding vibration mode shapes

'The dynamic nature of being a person': An ethnographic study of people living with dementia in their communities

BACKGROUND AND OBJECTIVES: A dementia diagnosis can impact on social interactions. This study aims to understand how people living with dementia act as social beings within everyday interactions in their local communities. RESEARCH DESIGN AND METHODS: Focused ethnography informed by Spradley's approach to data collection and analysis. Observations in community spaces. RESULTS: Twenty-nine observations were undertaken in everyday social settings with 11 people with dementia who were part of a longitudinal interview study. Data consisted of 40 hours of observation, and researcher fieldnotes. The overarching theme 'The dynamic nature of being a person' encapsulates participants' exhibited experiences in negotiating to attain and sustain an acknowledged place in their communities. Two sub-themes characterized contexts and actions: 1 'Being me - not dementia': participants constructed narratives to assert their ontological presence in social settings. They and others used strategies to mediate cognitive changes evidencing dementia. 2 'Resisting or acquiescing to 'being absent in place'': Participants were often able to resist being absent to the gaze of others, but some social structures and behaviors led to a person being 'in place', yet not having their presence confirmed. DISCUSSION AND IMPLICATIONS: People living with dementia can actively draw on personal attributes, familiar rituals, objects, and social roles to continue to present themselves as social beings. Identifying how post-diagnosis people may self-manage cognitive changes to retain their presence as a person can help health and social care practitioners and families collaborate with the person living with dementia enabling them to have a continued social presence

A predictive model of carer resilience in dementia family caregiving: A structural equation modelling approach

Objectives: This study aimed to investigate the mediating effects of quality of the caregiving relationship and other carer and person with dementia variables in predicting carer resilience over time. Method: Carers of people with mild and moderate dementia in community settings completed baseline (n = 176 dyads) and six‐month follow‐up assessments (n = 139 dyads). Causal mediation analysis was conducted using Pearson Correlation and Structural Equation Modelling (SEM) to examine longitudinal predictors of carer resilience, and the effect of several mediating person with dementia, and carer factors on carer resilience over time. Results: At 6‐month follow‐up, higher levels of carer resilience were longitudinally correlated with higher ratings of perceived relationship quality by people with dementia (r = 0.53 p ≤ 0.01), and lower levels of emotional distress symptoms by carer's (r = −0.59 p ≤ 0.01). Mediation analyses showed that people with dementia perspectives of the quality of the caregiving relationship mediated the relationship between carer distress specific to neuropsychiatric symptoms (β = −0.32, p ≤ 0.001) and carer resilience (β = 0.53, p ≤ 0.001) over time. The final SEM provided a good fit for the data (X 2 = 0.12, p = 0.72, CFI = 1.00, NFI = 0.99, and Root Mean Square Error of Approximation = 0.001). Conclusion: Higher ratings of perceived relationship quality by people with dementia, and lower levels of carer emotional distress predicted higher carer resilience at follow‐up. People with dementia perspectives of the quality of the caregiving relationship mediated the relationship between carer distress specific to neuropsychiatric symptoms and carer resilience over time. Our findings indicate that interventions aimed at strengthening the caregiving relationship might have a protective long‐term effect for carer resilience in dementia caregiving

Promoting independence in dementia: protocol for a feasibility trial of the PRIDE intervention for living well with dementia

Background: Dementia can lead to social exclusion, loss of identity and independence, due to deterioration in cognition and activities of daily living. The aim of the study is to investigate the feasibility of the Promoting Independence in Dementia (PRIDE) intervention, designed to facilitate independence in people with mild dementia. Methods and Results: This is a mixed-methods feasibility trial of the PRIDE, in preparation for a future randomised controlled trial. Up to 50 people with dementia will be recruited. Dementia advisors will deliver the three session intervention. Quantitative outcomes will be taken at baseline and up to three months post baseline. Fidelity checklists will assess fidelity to the intervention. Qualitative implementation data will be gathered in a series of post-intervention semi-structured interviews with staff and participants. This will include data to examine participant experiences of and engagement with the intervention, and other aspects of delivery such as recruitment of DAWs, fidelity and experiences of receiving and delivering the intervention. This study aims to: 1) establish and field test the PRIDE intervention; 2) determine the recruitment rate of sites, providers and participants; 3) assess fidelity in delivery of the intervention and engagement with people with dementia; 4) assess the feasibility and acceptability of outcome measure data and 5) assess the acceptability of the intervention by stakeholders. Discussion: There has been increased need for non-pharmacological interventions for mild dementia. The results of this feasibility study will allow us to plan for a definitive RCT of a three session dementia advisor led intervention for mild dementia

Excitation of electronic states in tetrahydrofuran by electron impact

We report on differential and integral cross section measurements for the electron impact excitation of the three lowest lying Rydberg bands of electronic states in tetrahydrofuran. The energy range of the present experiments was 15–50 eV with the angular range of the differential cross section measurements being 15°–90°. The important effects of the long-range target dipole moment and the target dipole polarizability, on the scattering dynamics of this system, are evident from the present results. To the best of our knowledge, there are no other theoretical or experimental data against which we can compare the cross section results from this study

Vibration and buckling of thin-walled composite I-beams with arbitrary lay-ups under axial loads and end moments

A finite element model with seven degrees of freedom per node is developed to study vibration and buckling of thin-walled composite I-beams with arbitrary lay-ups under constant axial loads and equal end moments. This model is based on the classical lamination theory, and accounts for all the structural coupling coming from material anisotropy. The governing differential equations are derived from the Hamilton’s principle. Numerical results are obtained for thin-walled composite I-beams to investigate the effects of axial force, bending moment and fiber orientation on the buckling moments, natural frequencies, and corresponding vibration mode shapes as well as axial-moment-frequency interaction curves

Feasibility and acceptability evaluation of the PRIDE (Promoting Independence in Dementia) intervention for living well with dementia

Objectives: Post-diagnostic psychosocial interventions could play an important role in supporting people with mild dementia remain independent. The PRIDE intervention was developed to address this. Method: The mixed methods non-randomised, pre-post feasibility study occurred across England. Facilitators were recruited from the voluntary sector and memory services. Participants and their supporters took part in the 3-session intervention. Outcome measures were collected at baseline and follow-up. To evaluate acceptability, focus groups and interviews were conducted with a sub-sample of participants and facilitators. Results: Contextual challenges to delivery including national research governance changes, affecting recruitment of study sites. Thirty-four dyads consented, with 14 facilitators providing the intervention. Dyads took part in at least two sessions (79%), and 73% in all three. Outcome measures were completed by 79% without difficulty, with minimal missing data. No significant changes were found on pre and post assessments. Post-hoc analysis found moderate effect size improvements for self-management (SMAS instrument) in people with dementia (d=0 .41) and quality of life (EQ5D measure) in carers (d=0.40). Qualitative data indicated that dyads found PRIDE acceptable, as did intervention facilitators.Conclusions: The 3-session intervention was well accepted by participant-dyads and intervention facilitators. A randomised controlled trial of PRIDE would need to carefully consider recruitment potential across geographically varied settings, and site-stratification according to knowledge of contextual factors, such as the diversity of post-diagnostic services across the country. Letting sites themselves be responsible for identifying suitable intervention facilitators was successful. The self-report measures showed potential to be included in the main trial