Exercise facilities for neurologically disabled populations : perceptions from the fitness industry

BACKGROUND: People with neurological disabilities (pwND) face many barriers to undertaking physical activity. One option for exercise alongside formal physiotherapy is local fitness facilities but accessibility is often found wanting and gyms are seen as unwelcoming to pwND. OBJECTIVE: The objective of this exploratory study was to investigate the perceptions of fitness facility managers with respect to exercise for pwND in a gym environment. The aim was to identify potential barriers to provision by the fitness industry for pwND. METHODS: The participants included those who were in a position to influence provision at a policy level and those working at management level within fitness providers. A mixed methods approach was used: a quantitative questionnaire and 4 qualitative interviews. Descriptive and correlational analysis, thematic content analysis and concurrent triangulation analysis was undertaken. RESULTS: Specially trained staff is perceived to be necessary to make fitness facilities accessible for pwND. CONCLUSIONS: Ensuring the provision of specially trained staff to support pwND to exercise in gyms may be the main barrier to provision for this population. Investigation into the standard training of fitness professionals combining the expertise of neurological physiotherapists with that of fitness professionals to meet the needs of pwND would be advantageous

Scaling-up an evidence-based intervention for osteoarthritis in real-world settings : a pragmatic evaluation using the RE-AIM framework

Scaling-up and sustaining effective healthcare interventions is essential for improving healthcare; however, relatively little is known about these processes. In addition to quantitative experimental designs, we need approaches that use embedded, observational studies on practice-led, naturally occurring scale-up processes. There are also tensions between having adequately rigorous systems to monitor and evaluate scale-up well that are proportionate and pragmatic in practice. The study investigated the scale-up of an evidence-based complex intervention for knee and hip osteoarthritis (ESCAPE-pain) within 'real-world' settings by England's 15 Academic Health Science Networks (AHSNs). A pragmatic evaluation of the scale-up of ESCAPE-pain using the RE-AIM framework to measure Reach, Effectiveness, Adoption, Implementation and Maintenance. The evaluation used routine monitoring data collected from April 2014 to December 2018 as part of a national scale-up programme. Between 2014 and 2018, ESCAPE-pain was adopted by over 110 clinical and non-clinical sites reaching over 9000 people with osteoarthritis. The programme showed sustained clinical effectiveness (pain, function and quality of life) and high levels of adherence (78.5% completing 75% of the programme) within a range of real-world settings. Seven hundred seventy people (physiotherapists and exercise professionals) have been trained to deliver ESCAPE-pain, and 84.1% of sites have continued to deliver the programme post-implementation. ESCAPE-pain successfully moved from being an efficacious "research intervention" into an effective intervention within 'real-world' clinical and non-clinical community settings. However, scale-up has been a gradual process requiring on-going, dedicated resources over 5 years by a national network of Academic Health Science Networks (AHSNs). Whilst the collection of monitoring and evaluation data is critical in understanding implementation and scale-up, there remain significant challenges in developing systems sufficiently rigorous, proportionate and locally acceptable

Influence of commissioning arrangements on implementing and sustaining a complex healthcare intervention (ESCAPE-pain) for osteoarthritis : a qualitative case study

Funding in health care has a critical impact on the implementation and sustainability of evidence-based interventions. This study explored the perspectives of physiotherapists on the influence of commissioning arrangements on the implementation and sustainability of a group rehabilitation programme for osteoarthritis (ESCAPE-pain). A qualitative case study approach using in-depth interviews. National Health Service (NHS) musculoskeletal (MSK) outpatient departments in England. Thirty physiotherapists in clinical and senior management roles from 11 NHS MSK providers. Five themes were identified: (1) clinical perspectives of ESCAPE-pain - MSK services wanted to implement and sustain ESCAPE-pain because it provided evidence-based, quality care; (2) focusing on clinical activity over outcomes - commissioners were perceived as prioritising activity-based performance over delivering clinical outcomes; (3) rationing availability - patient access to ESCAPE-pain could be limited due to rationing resources; (4) absorbing costs - contracts did not always cover the activities associated with delivering ESCAPE-pain meaning that providers bore the costs; and (5) relationship between commissioners and providers - physiotherapists perceived a disconnect with commissioners and had little power to influence decisions. Commissioning arrangements for MSK physiotherapy services can impede providers from implementing and sustaining a clinically and cost-effective intervention. To be implemented and sustained, an intervention needs to integrate into clinical practice and the wider healthcare system. Commissioning arrangements for MSK physiotherapy need to allow providers the flexibility to deliver interventions that best meet the needs of their patients. The move to more strategic, integrated, outcome-based commissioning has the potential to facilitate the spread and sustainability of interventions. [Abstract copyright: Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

The role of leadership in implementing and sustaining an evidence-based intervention for osteoarthritis (ESCAPE-pain) in NHS physiotherapy services : a qualitative case study

To explore the role of leadership by physiotherapists in implementing and sustaining an evidence-based complex intervention (ESCAPE-pain) for osteoarthritis. A qualitative case study approach using in-depth interviews with 23 clinicians and managers from 4 National Health Service (NHS) physiotherapy providers in England between 2016 and 2017. Data were analysed using thematic analysis. Different leadership roles and actions were characterised with four themes: (1) Clinical champions - clinicians driving the sustainability of ESCAPE-pain; (2) Supporters - junior clinicians directly supporting clinical champions' efforts to sustain ESCAPE-pain; (3) Senior Manager - clinical champions' senior managers influence on sustainability; (4) Decision-making - (in)formal processes underpinning decisions to (not) sustain the programme. The study characterises the role of leadership in physiotherapy to sustain an evidence-based intervention for osteoarthritis (OA) within the NHS. Sustaining the intervention required on-going leadership, it did not stop at implementation. Senior specialist physiotherapists (as Champions) had a critical leadership role in driving sustainability. Their structural position (bridging the operational and strategic) and personal attributes allowed them to integrate different levels of leadership (i.e., senior managers and operational staff) to mobilise the collective, on-going work required for sustaining the programme. IMPLICATIONS FOR REHABILITATION Senior managers and clinicians in practice settings need to be aware that sustaining an intervention is an on-going, collective effort that continues post-implementation. Senior managers need to enable senior clinicians (who straddle strategic and operational functions) to have sufficient autonomy to access and mobilise resources and scope to restructure local systems and practice to support intervention sustainability. Operational staff need to be supported to have the practical know-how to deliver evidence-based intervention, which includes instilling the value of and a commitment for the interventions. Managers need to utilise dispersed leadership to empower and enthuse frontline clinicians to participate fully in the work to refine and sustain interventions, because it cannot be achieved by lone individuals

The White Dwarf Cooling Sequence of NGC6397

We present the results of a deep Hubble Space Telescope (HST) exposure of the nearby globular cluster NGC6397, focussing attention on the cluster's white dwarf cooling sequence. This sequence is shown to extend over 5 magnitudes in depth, with an apparent cutoff at magnitude F814W=27.6. We demonstrate, using both artificial star tests and the detectability of background galaxies at fainter magnitudes, that the cutoff is real and represents the truncation of the white dwarf luminosity function in this cluster. We perform a detailed comparison between cooling models and the observed distribution of white dwarfs in colour and magnitude, taking into account uncertainties in distance, extinction, white dwarf mass, progenitor lifetimes, binarity and cooling model uncertainties. After marginalising over these variables, we obtain values for the cluster distance modulus and age of \mu_0 = 12.02 \pm 0.06 and T_c = 11.47 \pm 0.47Gyr (95% confidence limits). Our inferred distance and white dwarf initial-final mass relations are in good agreement with other independent determinations, and the cluster age is consistent with, but more precise than, prior determinations made using the main sequence turnoff method. In particular, within the context of the currently accepted \Lambda CDM cosmological model, this age places the formation of NGC6397 at a redshift z=3, at a time when the cosmological star formation rate was approaching its peak.Comment: 56 pages, 30 figure

Leading the spread and adoption of innovation at scale : an Academic Health Science Network's perspective

Background: There is virtually no limit to the number of innovations being developed, tested and piloted at any one time to improve the quality and safety of care. The perennial problem is spreading innovations that are proven to be effective on a smaller scale or under controlled conditions. Much of the literature on spread refers to the important role played by external agencies in supporting the spread of innovations. Academic Health Science Networks and the spread of innovation: External agencies can provide additional capacity and capabilities to adopter organisations, such as technical expertise, resources and tools to assist with operational issues. In England, the National Health Service (NHS) established 15 Academic Health Science Networks (AHSNs) to help accelerate the spread and adoption of innovation in healthcare. However, formal clinical-academic networks (such as AHSNs) themselves will not deliver positive, tangible outcomes on the ground (ie, evidence-based innovations embedded at scale across a system). This begs the question of how do AHSNs practically go about achieving this change successfully? We provide an AHSN’s perspective on how we conceptualise and undertake our work in leading implementation of innovation at scale. An AHSN's perspective: Our approach is a collaborative process of widening understanding of the innovation and its implementation. At its core, the implementation and spread of innovation into practice is a collective social process. Healthcare comprises complex adaptive systems, where contexts need to be negotiated for implementation to be successful. As AHSNs, we aim to lead this negotiation through facilitating knowledge exchange and production across the system to mobilise the resources and collective action necessary for achieving spread

SIV Vpx Is Essential for Macrophage Infection but Not for Development of AIDS

Analysis of rhesus macaques infected with a vpx deletion mutant virus of simian immunodeficiency virus mac239 (SIVΔvpx) demonstrates that Vpx is essential for efficient monocyte/macrophage infection in vivo but is not necessary for development of AIDS. To compare myeloid-lineage cell infection in monkeys infected with SIVΔvpx compared to SIVmac239, we analyzed lymphoid and gastrointestinal tissues from SIVΔvpx-infected rhesus (n = 5), SIVmac239-infected rhesus with SIV encephalitis (7 SIV239E), those without encephalitis (4 SIV239noE), and other SIV mutant viruses with low viral loads (4 SIVΔnef, 2 SIVΔ3). SIV+ macrophages and the percentage of total SIV+ cells that were macrophages in spleen and lymph nodes were significantly lower in rhesus infected with SIVΔvpx (2.2%) compared to those infected with SIV239E (22.7%), SIV239noE (8.2%), and SIV mutant viruses (10.1%). In colon, SIVΔvpx monkeys had fewer SIV+ cells, no SIV+ macrophages, and lower percentage of SIV+ cells that were macrophages than the other 3 groups. Only 2 SIVΔvpx monkeys exhibited detectable virus in the colon. We demonstrate that Vpx is essential for efficient macrophage infection in vivo and that simian AIDS and death can occur in the absence of detectable macrophage infection

Growth of 1T ' MoTe2 by thermally assisted conversion of electrodeposited tellurium films

Molybdenum ditelluride (MoTe2) is a transition metal dichalcogenide (TMD) which has two phases stable under ambient conditions, a semiconducting (2H) and semimetallic (1T') phase. Despite a host of interesting properties and potential applications, MoTe2 is one of the less-studied TMDs, perhaps due its relatively low abundance in nature or challenges associated with its synthesis, such as the toxicity of most precursors. In this report, we describe the fabrication of thin films of phase-pure IT' MoTe2 using predeposited molybdenum and electrodeposited tellurium layers, at the relatively low temperature of 450 C. This method allows control over film geometry and over the tellurium concentration during the conversion. The MoTe2 films are characterized by Raman spectroscopy, X-ray photoelectron spectroscopy, X-ray diffraction, atomic force microscopy, and electron microscopies. When applied as a catalyst for the hydrogen evolution reaction, the films display promising initial results. The MoTe2 films have a Tafel slope of below 70 mV dec(-1) and compare favorably with other MoTe2 catalysts reported in the literature, especially considering the inherently scalable fabrication method. The variation in electrocatalytic behavior with thickness and morphology of the films is also investigated

Radio continuum observations of Class I protostellar disks in Taurus: constraining the greybody tail at centimetre wavelengths

We present deep 1.8 cm (16 GHz) radio continuum imaging of seven young stellar objects in the Taurus molecular cloud. These objects have previously been extensively studied in the sub-mm to NIR range and their SEDs modelled to provide reliable physical and geometrical parametres.We use this new data to constrain the properties of the long-wavelength tail of the greybody spectrum, which is expected to be dominated by emission from large dust grains in the protostellar disk. We find spectra consistent with the opacity indices expected for such a population, with an average opacity index of beta = 0.26+/-0.22 indicating grain growth within the disks. We use spectra fitted jointly to radio and sub-mm data to separate the contributions from thermal dust and radio emission at 1.8 cm and derive disk masses directly from the cm-wave dust contribution. We find that disk masses derived from these flux densities under assumptions consistent with the literature are systematically higher than those calculated from sub-mm data, and meet the criteria for giant planet formation in a number of cases.Comment: submitted MNRA

The feasibility of increasing physical activity in care home residents : Active Residents in Care Homes (ARCH) programme

Objectives: Maintaining physical activity for older residents in care homes maximises their physical and mental health and wellbeing, independence, dignity and quality of life. Unfortunately, most residents do not participate in regular physical activity. Active Residents in Care Homes, ARCH, was designed to increase physical activity by facilitating whole-system change in a care home. We evaluated whether ARCH can be delivered, its effects on resident’s physical activity, wellbeing and costs. Design: Feasibility study. Setting: Three residential care homes. Participants: Care home residents and staff. Intervention: Occupational and physiotherapists implemented ARCH over 4 months with an 8-month follow-up. Main outcome measures: Assessment of Physical Activity, Pool Activity Level, EQ5D-5 L, Dementia Care Mapping, cost of implementing ARCH, health and social care utilisation. Results: After implementing ARCH, residents displayed more positive behaviours, better mood and engagement and higher physical activity levels, but these improvements were not sustained at 8-month follow-up. The cost (2016 prices) of implementing ARCH was £61,037, which equates to £1,650/resident. Healthcare utilisation was £295/resident (SD320) in the 4 months prior to ARCH, £308/resident (SD406) during the 4-month implementation and £676/resident (SD438) in the 8-month follow-up. Conclusions: The ARCH programme can be delivered, it may have some short-term benefits and is affordable. Rather than have unrealistic increases in the health and longevity of older care home residents, ARCH may slow the decline in physical, mental and emotional well-being usually seen in older people in care homes, return some dignity and improve their quality of life in their last months or years