Paying your own way: application of the capability approach to explore older people's experiences of self-funding social care

Adult social care policy in England is premised on the concept of person- alisation that purports to place individuals in control of the services they receive through market-based mechanisms of support, such as direct payments and personal budgets. However, the demographic context of an ageing population and the economic and political context of austerity have endorsed further rationing of resources. Increasing numbers of people now pay for their own social care because either they do not meet tight eligibility criteria for access to services and/or their financial means place them above the threshold for local authority-funded care. The majority of self-funders are older people. Older people with complex and changing needs are particularly likely to experience dif- ficulties in fulfilling the role of informed, proactive and skilled navi- gators of the care market. Based on individual interviews with older people funding their own care, this article uses a relational-political interpretation (Deneulin, 2011) of the capability approach (CA) to ana- lyse shortfalls between the policy rhetoric of choice and control and the lived experience of self-funding. Whilst CA, like personalisation, is seen as reflecting neo-liberal values, we argue that, in its relational- political form, it has the potential to expose the fallacious assumptions on which self-funding policies are founded and to offer a more nuanced understanding of older people’s experiences

The work of the audience: visual matrix methodology in museums

Visual matrix methodology has been designed for researching cultural imaginaries. It is an image-led, group-based method that creates a “third space” research setting to observe audience groups re-enacting lived experience of an event or process that takes place in the third space of a cultural setting. In this article the method is described through its use in relation to an art-science exhibition, Human + Future of the species, where three audience groups with investments in technology worked with exhibition material to achieve a complex, ambivalent state of mind regarding technological futures. The visual matrix has been designed to capture the affective and aesthetic quality of audience engagement in third space by showing what audiences do with what is presented to them. We argue that such methodologies are useful for museums as they grapple with their role as sites where citizens not only engage in dialogue with one another but actively re-work their imaginaries of the future

Atmospheric predictability revisited

This article examines the potential to improve numerical weather prediction (NWP) by estimating upper and lower bounds on predictability by re-visiting the original study of Lorenz (1982) but applied to the most recent version of the European Centre for Medium Range Weather Forecasts (ECMWF) forecast system, for both the deterministic and ensemble prediction systems (EPS). These bounds are contrasted with an older version of the same NWP system to see how they have changed with improvements to the NWP system. The computations were performed for the earlier seasons of DJF 1985/1986 and JJA 1986 and the later seasons of DJF 2010/2011 and JJA 2011 using the 500-hPa geopotential height field. Results indicate that for this field, we may be approaching the limit of deterministic forecasting so that further improvements might only be obtained by improving the initial state. The results also show that predictability calculations with earlier versions of the model may overestimate potential forecast skill, which may be due to insufficient internal variability in the model and because recent versions of the model are more realistic in representing the true atmospheric evolution. The same methodology is applied to the EPS to calculate upper and lower bounds of predictability of the ensemble mean forecast in order to explore how ensemble forecasting could extend the limits of the deterministic forecast. The results show that there is a large potential to improve the ensemble predictions, but for the increased predictability of the ensemble mean, there will be a trade-off in information as the forecasts will become increasingly smoothed with time. From around the 10-d forecast time, the ensemble mean begins to converge towards climatology. Until this point, the ensemble mean is able to predict the main features of the large-scale flow accurately and with high consistency from one forecast cycle to the next. By the 15-d forecast time, the ensemble mean has lost information with the anomaly of the flow strongly smoothed out. In contrast, the control forecast is much less consistent from run to run, but provides more detailed (unsmoothed) but less useful information

Feminist geographies of digital work

Feminist thought challenges essentialist and normative categorizations of ‘work’. Therefore, feminism provides a critical lens on ‘working space’ as a theoretical and empirical focus for digital geographies. Digital technologies extend and intensify working activity, rendering the boundaries of the workplace emergent. Such emergence heightens the ambivalence of working experience: the possibilities for affirmation and/or negation through work. A digital geography is put forward through feminist theorizations of the ambivalence of intimacy. The emergent properties of working with digital technologies create space through the intimacies of postwork places where bodies and machines feel the possibilities of being ‘at’ work

STEPWISE - STructured lifestyle Education for People WIth SchizophrEnia : a study protocol for a randomised controlled trial

BACKGROUND: People with schizophrenia are two to three times more likely to be overweight than the general population. The UK National Institute of Health and Care Excellence (NICE) recommends an annual physical health review with signposting to, or provision of, a lifestyle programme to address weight concerns and obesity. The purpose of this randomised controlled trial is to assess whether a group-based structured education programme can help people with schizophrenia to lose weight. METHODS: Design: a randomised controlled trial of a group-based structured education programme. SETTING: 10 UK community mental health trusts. PARTICIPANTS: 396 adults with schizophrenia, schizoaffective, or first-episode psychosis who are prescribed antipsychotic medication will be recruited. Participants will be overweight, obese or be concerned about their weight. INTERVENTION: participants will be randomised to either the intervention or treatment as usual (TAU). The intervention arm will receive TAU plus four 2.5-h weekly sessions of theory-based lifestyle structured group education, with maintenance contact every 2 weeks and 'booster' sessions every 3 months. All participants will receive standardised written information about healthy eating, physical activity, alcohol and smoking. OUTCOMES: the primary outcome is weight (kg) change at 1 year post randomisation. Secondary outcomes, which will be assessed at 3 and 12 months, include: the proportion of participants who maintained or reduced their weight; waist circumference; body mass index; objectively measured physical activity (wrist accelerometer); self-reported diet; blood pressure; fasting plasma glucose, lipid profile and HbA1c (baseline and 1 year only); health-related quality of life (EQ-5D-5L and RAND SF-36); (adapted) brief illness perception questionnaire; the Brief Psychiatric Rating Scale; the Client Service Receipt Inventory; medication use; smoking status; adverse events; depression symptoms (Patient Health Questionnaire-9); use of weight-loss programmes; and session feedback (intervention only). Outcome assessors will be blind to trial group allocation. Qualitative interviews with a subsample of facilitators and invention-arm participants will provide data on intervention feasibility and acceptability. Assessment of intervention fidelity will also be performed. DISCUSSION: The STEPWISE trial will provide evidence for the clinical and cost-effectiveness of a tailored intervention, which, if successful, could be implemented rapidly in the NHS. TRIAL REGISTRATION: ISRCTN19447796 , registered on 20 March 2014

Non-invasive ventilation (NIV) as an aid to rehabilitation in acute respiratory disease

<p>Abstract</p> <p>Background</p> <p>Non-invasive ventilation (NIV) can increase exercise tolerance, reduce exercise induced desaturation and improve the outcome of pulmonary rehabilitation in patients with chronic respiratory disease. It is not known whether it can be applied to increase exercise capacity in patients admitted with non-hypercapnic acute exacerbations of COPD (AECOPD). We investigated the acceptability and feasibility of using NIV for this purpose.</p> <p>Methods</p> <p>On a single occasion, patients admitted with an acute exacerbation of chronic respiratory disease who were unable to cycle for five minutes at 20 watts attempted to cycle using NIV and their endurance time (T_lim) was recorded. To determine feasibility of this approach in clinical practice patients admitted with AECOPD were screened for participation in a trial of regular NIV assisted rehabilitation during their hospital admission.</p> <p>Results</p> <p>In 12 patients tested on a single occasion NIV increased T_limfrom 184(65) seconds to 331(229) seconds (p = 0.04) and patients desaturated less (median difference = 3.5%, p = 0.029). In the second study, 60 patients were admitted to hospital during a three month period of whom only 18(30)% were eligible to participate and of these patients, only four (7%) consented to participate.</p> <p>Conclusion</p> <p>NIV improves exercise tolerance in patients with acute exacerbations of chronic respiratory disease but the applicability of this approach in routine clinical practice may be limited.</p> <p>Trial registration</p> <p><url>http://www.controlled-trials.com/ISRCTN35692743</url></p

Efecto repelente y tiempo de protección de aceites esenciales frente al estadio adulto de Aedes aegypti

The aim of this was to evaluate the repellent effect and protection time of essential oils against the adult Aedes aegypti mosquito. A completely randomized design was used with a factorial arrangement that included 10 essential oils (Minthostachys mollis, Schinus molle, Ruta graveolens, Piper aduncun, Myrica pubescens, Lippia alba, Mentha piperita, Lantana glutinosa, Cymbopogon citratus, Eucalyptus globulus and the DEET control. 10%) and four concentrations of the oils (125, 250, 500 and 1000 mg/ml). Each experimental group consisted of 50 adult female A. aegypti mosquitoes raised in the laboratory and the repellent effect and protection time were evaluated using a sedated animal bait (Rattus rattus) with applications of 0.1 ml of the oils on the legs, tail and face. The rats and mosquitoes were found in two communicating cages of 25x25x40 cm. The oils with the greatest repellent effect and protection time, respectively, were C. citratus (97.4%; 165 minutes), E. globulus (95.8%; 165 minutes), L. glutinosa (93.8%; 180 minutes) and M. piperite (93.5%; 180 minutes) in its highest concentration (1000 mg/l); with differences between oils and between concentrations (p&lt;0.001). Likewise, DEET 10% obtained a repellency of 95.3% and a protection time of 173 minutes. It is concluded that the essential oils of C. citratus, E. globulus, L. glutinosa and M. piperita can be considered as having natural repellent potential for A. aegypti.El estudio tuvo como objetivo evaluar el efecto repelente y tiempo de protección de aceites esenciales frente al mosquito adulto de Aedes aegypti. Se trabajó con un diseño completamente al azar con arreglo factorial que incluyó 10 aceites esenciales (Minthostachys mollis, Schinus molle, Ruta graveolens, Piper aduncun, Myrica pubescens, Lippia alba, Mentha piperita, Lantana glutinosa, Cymbopogon citratus, Eucalyptus globulus y el control DEET 10%) y cuatro concentraciones de los aceites (125, 250, 500 y 1000 mg/ml). Cada grupo experimental se constituyó por 50 mosquitos hembra adultos de A. aegypti criados en laboratorio y el efecto repelente y tiempo de protección se evaluaron usando un cebo animal sedado (Rattus rattus) con aplicaciones de 0.1 ml de los aceites en patas, cola y cara. Las ratas y los mosquitos se encontraron en dos jaulas comunicadas de 25x25x40 cm. Los aceites con mayor efecto repelente y tiempo de protección, respectivamente, fueron: C. citratus (97.4%; 165 minutos), E. globulus (95.8%; 165 minutos), L. glutinosa (93.8%; 180 minutos) y M. piperita (93.5%; 180 minutos) en su concentración mayor concentración (1000 mg/l); con diferencias entre aceites y entre concentraciones (p&lt;0.001). Asimismo, el DEET 10% obtuvo una repelencia de 95.3 % y tiempo de protección de 173 minutos. Se concluye que los aceites esenciales de C. citratus, E. globulus, L. glutinosa y M. piperita pueden considerarse con potencial repelente natural para A. aegypti

Evolution of long-term vaccine-induced and hybrid immunity in healthcare workers after different COVID-19 vaccine regimens

BACKGROUND: Both infection and vaccination, alone or in combination, generate antibody and T cell responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, the maintenance of such responses-and hence protection from disease-requires careful characterization. In a large prospective study of UK healthcare workers (HCWs) (Protective Immunity from T Cells in Healthcare Workers [PITCH], within the larger SARS-CoV-2 Immunity and Reinfection Evaluation [SIREN] study), we previously observed that prior infection strongly affected subsequent cellular and humoral immunity induced after long and short dosing intervals of BNT162b2 (Pfizer/BioNTech) vaccination. METHODS: Here, we report longer follow-up of 684 HCWs in this cohort over 6-9 months following two doses of BNT162b2 or AZD1222 (Oxford/AstraZeneca) vaccination and up to 6 months following a subsequent mRNA booster vaccination. FINDINGS: We make three observations: first, the dynamics of humoral and cellular responses differ; binding and neutralizing antibodies declined, whereas T and memory B cell responses were maintained after the second vaccine dose. Second, vaccine boosting restored immunoglobulin (Ig) G levels; broadened neutralizing activity against variants of concern, including Omicron BA.1, BA.2, and BA.5; and boosted T cell responses above the 6-month level after dose 2. Third, prior infection maintained its impact driving larger and broader T cell responses compared with never-infected people, a feature maintained until 6 months after the third dose. CONCLUSIONS: Broadly cross-reactive T cell responses are well maintained over time-especially in those with combined vaccine and infection-induced immunity ("hybrid" immunity)-and may contribute to continued protection against severe disease

Genome-Wide Association Study in BRCA1 Mutation Carriers Identifies Novel Loci Associated with Breast and Ovarian Cancer Risk

BRCA1-associated breast and ovarian cancer risks can be modified by common genetic variants. To identify further cancer risk-modifying loci, we performed a multi-stage GWAS of 11,705 BRCA1 carriers (of whom 5,920 were diagnosed with breast and 1,839 were diagnosed with ovarian cancer), with a further replication in an additional sample of 2,646 BRCA1 carriers. We identified a novel breast cancer risk modifier locus at 1q32 for BRCA1 carriers (rs2290854, P = 2.7×10-8, HR = 1.14, 95% CI: 1.09-1.20). In addition, we identified two novel ovarian cancer risk modifier loci: 17q21.31 (rs17631303, P = 1.4×10-8, HR = 1.27, 95% CI: 1.17-1.38) and 4q32.3 (rs4691139, P = 3.4×10-8, HR = 1.20, 95% CI: 1.17-1.38). The 4q32.3 locus was not associated with ovarian cancer risk in the general population or BRCA2 carriers, suggesting a BRCA1-specific associat

Identification of a BRCA2-Specific modifier locus at 6p24 related to breast cancer risk

Common genetic variants contribute to the observed variation in breast cancer risk for BRCA2 mutation carriers; those known to date have all been found through population-based genome-wide association studies (GWAS). To comprehensively identify breast cancer risk modifying loci for BRCA2 mutation carriers, we conducted a deep replication of an ongoing GWAS discovery study. Using the ranked P-values of the breast cancer associations with the imputed genotype of 1.4 M SNPs, 19,029 SNPs were selected and designed for inclusion on a custom Illumina array that included a total of 211,155 SNPs as part of a multi-consortial project. DNA samples from 3,881 breast cancer affected and 4,330 unaffected BRCA2 mutation carriers from 47 studies belonging to the Consortium of Investigators of Modifiers of BRCA1/2 were genotyped and available for analysis. We replicated previously reported breast cancer susceptibility alleles in these BRCA2 mutation carriers and for several regions (including FGFR2, MAP3K1, CDKN2A/B, and PTHLH) identified SNPs that have stronger evidence of association than those previously published. We also identified a novel susceptibility allele at 6p24 that was inversely associated with risk in BRCA2 mutation carriers (rs9348512; per allele HR = 0.85, 95% CI 0.80-0.90, P = 3.9×10−8). This SNP was not associated with breast cancer risk either in the general population or in BRCA1 mutation carriers. The locus lies within a region containing TFAP2A, which encodes a transcriptional activation protein that interacts with several tumor suppressor genes. This report identifies the first breast cancer risk locus specific to a BRCA2 mutation background. This comprehensive update of novel and previously reported breast cancer susceptibility loci contributes to the establishment of a panel of SNPs that modify breast cancer risk in BRCA2 mutation carriers. This panel may have clinical utility for women with BRCA2 mutations weighing options for medical prevention of breast cancer