Policy transfer and policy translation : day care for people with dementia in Kerala, India

This thesis explores and explains the development of day care for people with dementia in Kerala, India. The development process is framed within the context of social globalisation. The central aim of the thesis is to further build theory on how and why social policy from one context is transferred and utilised in the development of social policy in another. The theoretical constructs of policy transfer and policy translation are used to explore the development process. Policy transfer is an existing concept within policy and politics literature. Theory on the concept of policy translation is built up within the thesis using theories of literary translation. Exploration of these processes provides an explanation of the development of day care. Policy transfer and policy translation are found to take place between the UK and Kerala. Policy ideas and information from the UK are transferred and then used within the implementation of day care in Kerala. A two-part research design explores firstly policy transfer and then policy translation. Policy transfer is examined within an analytical framework developed from existing models of policy transfer. Policy translation is investigated through a comparative analysis of day care for people with dementia between the UK and Kerala. The differences between day care in the two contexts represent the changes caused by the processes of policy transfer and policy translation. The main findings of the thesis are that policy transfer and policy translation have taken place within the development of day care in Kerala. The two concepts are found to complement each other. The theoretical construct of policy translation provides additional detail and clarity on the process of policy development to that provided by policy transfer. Policy transfer and policy translation can be described as mechanisms by which social globalisation is taking place and in turn globalisation promotes these processes. The thesis concludes that the theoretical constructs of policy transfer and policy translation as developed here could be used within other research to explore the processes of globalisation

Translating Policy and Practice

Global influences and demographic changes are leading policy makers in less developed countries to look to more developed regions for policy and service ideas. Policy and services ideas may then be `borrowed' via processes such as policy transfer (Dolowitz and Marsh, 1996). This article explores the establishment of day care for people with dementia in Kerala, India. During the development of this service policy, information and practice ideas were transferred from different countries, particularly the UK. During the transfer of information and also within the following processes of implementation and enactment of policy, translation processes take place. In order to understand these translation processes, this article describes the development of day care in Kerala and compares its current functioning with that of similar day care centres in the UK. The concept of translation is found to illuminate and explain the process of service development in Kerala and could be used elsewhere to explain examples of policy and practice development

Do factors secreted from synovial fibroblasts affect the differentiation of C2C12 cells?

The Wnt signalling pathway plays a key role within muscle differentiation. Wnt3a, Wnt5a, and DKK1 all have pivotal roles within this pathway. It’s hypothesised that due to their role within the Wnt pathway, Wnt3a, Wnt5a, and DKK1 will affect the differentiation of muscle, demonstrated by the murine C2C12 cell line. Differentiation of the C2C12 cells was induced by adding DMEM differentiation media at day 0. Treatments (Wnt3a, Wnt5a, DKK1, control conditioned media, TNF-α conditioned media, and dexamethasone conditioned media) were added day 0, and mRNA levels of differentiation markers, MyoD, myogenin, α-actinin, and 11βHSD1 were measured using RT-PCR at days 1, 3 and 6. Wnt3a and control conditioned media gave no significant change in differentiation. Wnt5a, DKK1, TNF-α conditioned media and dexamethasone conditioned media gave significant decreases in differentiation. DKK1 inhibitor was tested on cells treated with TNF-α conditioned media, resulting in the decrease in the differentiation no longer being significant. 11βHSD1 enzyme activity assays were carried out to test Wnt3a, Wnt5a, DKK1, and DKK1 inhibitor effects, the results followed the trend of the mRNA data, however were not statistically significant. The results suggest that factors secreted from synovial fibroblasts during inflammation affect muscle differentiation

The role and localisation of PAPSS2a and PAPSS2b within zebrafish

Sulphation is a crucial modification which is required for normal growth and development. Sulphation reactions are mediated through the universal sulphate donor 3’-phosphoadenosinse 5-phosphosulfate (PAPS). PAPS is synthesised in a two step process by the bi-functional enzyme 3'-phosphoadenosine 5'-phosphosulfate synthase (PAPSS), which contains both APS kinase and ATP sulphurylase. There are two forms of PAPSS, PAPSS1 and PAPSS2. PAPSS2 is important for normal skeletal development and has two different isoforms, PAPSS2a and PAPSS2b. It was hypothesised that knock-downs of the PAPSS2a and PAPSS2b genes would lead to alterations in the phenotype of developing zebrafish embryos. In Situ hybridisations were undertaken on zebrafish embryos at days 1, 2 and 3 using anti-sense probes for PAPSS2b. This allowed for confirmation of the expression of PAPSS2b within the zebrafish and also to locate the areas where it is expressed. Once expression of PAPSS2b had been confirmed within the zebrafish morpholino knock-downs were also undertaken for both the PAPSS2a and PAPSS2b genes. Four separate concentrations were used for the morpholino knock-downs (10μM, 30μM, 100μM, and 300μM). Splice site and translational blocking morpholinos were used to induce the gene knock-down and a scramble morpholino control was used. Successful knock-down of PAPSS2b was recorded using PCR when 100μM and 300μM concentrations of the morphlolino were used, the development of the embryo were monitored for the first four days of development and those which had the morpholino knock-down of PAPSS2b had a different phenotype to the controls by which their head was slightly smaller. For PAPSS2a the knock-down of the gene was unable to be confirmed due to the PCR not detecting any gene product in any of the injected zebrafish

Supporting User Participation in Local Policy Development: The Fife Dementia Strategy

This article reviews the consultation process during the development of a local dementia strategy. The processes of involvement by the range of stakeholders involved and how their different views shaped the strategy are considered. Particular attention is paid to the involvement of people with dementia as they are the recipients of the services to be shaped by the strategy and also form the group most difficult to reach. This article demonstrates the value of including a wide range of stakeholders in the development of local policy and the importance of involving people with dementia in policy development

RemoDem: Delivering support for people with dementia in remote areas

RemoDem aimed to develop, test and evaluate services for people with dementia in remote areas of the Faroe Islands, Greenland, Sweden and Scotland. Formative and summative evaluation used a flexible research design including collection of baseline data, interviews and focus groups with key informants and data relating to service users, i.e. people with dementia and their carers. Challenges for service providers included organisational difficulties, lack of clear information about their populations with dementia and lack of knowledge in local communities. Test sites which developed services building on their particular local starting points adopted both specialist and ‘off the shelf’ technologies and found that these were generally helpful for people with significant support needs. The flexible research design was found to be essential in the real world conditions of the service development and evaluation. Services were more successful where more mature and less experimental technologies were used. The new services promised to address effectively challenges of remoteness including distance, communication and workforce deployment issues

Integration: Too Much of a Bad Thing?

Integrated and/or multidisciplinary working has become a central guiding principle of addiction treatment throughout the Western world. Indeed, the notion has become virtually synonymous with good practice in intervening in a complex disorder like addiction. There has been surprisingly little analysis or evaluation of the efficacy of this approach. Rather, it is effectively taken for granted that integrated and/or multidisciplinary working is without question a “good thing.” But for complex interventions such as the therapeutic community, it is equally possible that these developments can threaten the underlying principles of the approach. This short literature review considers three areas of integrated working: integrating professional staff into therapeutic community teams; integrating new treatment approaches into existing therapeutic community frameworks; and the issue of therapeutic communities co-working with other treatment services with different philosophies and working practices. The work originated in an evaluative study of a network of Scottish addiction treatment services and the initial findings are that although there are some advantages to broadening the horizons of the therapeutic community movement, there is equally a danger of undermining some core principles

Altering adipose tissue responses to glucocorticoids through genetic manipulation of the 11B-HSD1 gene

Glucocorticoids (GC) are regulators of permissive and adaptive physiology. GC excess can lead to metabolic complications including type 2 diabetes and metabolic syndrome. Levels are regulated by 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1), which reactivates GC. 11β-HSD1 activity is deregulated in a range metabolic disorders in which GC levels are normal. I hypothesise that 11β-HSD1 is a critical regulator of adipose tissue sensitivity to GC excess, and that through 11β-HSD1 depletion adipose tissue will be desensitised to GCs and resist metabolic deregulation. Using 11β-HSD1 KO mice in a model of GC excess we demonstrate that 11β-HSD1 mediates the adverse metabolic effects of GC excess on a global scale. I further investigated brown adipose tissue (BAT) with GC excess. I demonstrate that 11β-HSD1 regulates BAT activity and mitochondrial function, possibly suppressing BATs thermogenic potential. I extended my studies to examine the potential for white adipose tissue (WAT) to assume markers of thermogneic and mitochondrial function in the context of 11βHSD1 and GC excess. The data suggest 11β-HSD1 may suppress the potential of WAT to assume a ‘BAT-like’ profile. These data show 11β-HSD1 loss of function confers a protective phenotype with GC excess and demonstrates it’s role in mediating the metabolic phenotype associated with GCs. These data support the idea that GCs can influence BAT and WAT thermogenic potential and may increase knowledge of metabolic dysregulation in humans suffering form GC excess. This therefore highlights 11β-HSD1 as an exciting potential target for the treatment for the metabolic disease associated with GC excess

Developing best practice guidelines for designing living environments for people with dementia and sight loss

The paper considers a process of developing evidence-based design guidelines to be used in environments where people with dementia and sight loss are living. The research involved a systematically conducted literature review and a series of consultations with people affected by dementia and/or sight loss who lived or worked in care homes or in domestic settings. Findings from the literature and the consultations were used in an iterative process to develop the guidelines. The process is outlined, providing examples from the guidelines about lighting and colour and contrast. In discussing the research findings and the development process, the authors consider implications of the work including the weakness of the evidence base, the challenges of improving this and the need for innovative approaches to understanding the complexities of design for people with dementia and sight loss. They highlight the emphasis in the literature on independence for people with sight loss and the focus on control of people with dementia, arguing that this falls short of a genuinely person-centred approach, which recognises the active participation of people with dementia and sight loss

Design of residential environments for people with dementia and sight loss: a structured literature review

A structured literature review concerning the design of living environments for people with dementia and sight loss was conducted. Following systematic searching, thirty three items were included and quality assessed. Findings are described covering colour and contrast, lighting, fixtures and fittings, entrances and exits, gardens and outdoors. The discussion highlights the poor quality of evidence, combined nevertheless with useful suggestions for design; the tendency for literature to be fragmented; and the need for improvements in terms of study focus, study quality and an emphasis on independence and individual needs. The review was subsequently used to inform the development of design guidelines