Making the case for inclusive design.

This paper describes the University of Cambridge, Engineering Design Centre's (EDC) case for inclusive design, based on 10 years of research, promotion and knowledge transfer. In summary, inclusive design applies an understanding of customer diversity to inform decisions throughout the development process, in order to better satisfy the needs of more people. Products that are more inclusive can reach a wider market, improve customer satisfaction and drive business success. The rapidly ageing population increases the importance of this approach. The case presented here has helped to convince BT, Nestlé and others to adopt an inclusive approach.This is the author accepted manuscript. The final version is available from Elsevier via http://dx.doi.org/10.1016/j.apergo.2013.03.01

Handheld portable FTIR spectroscopy for the triage of micro and meso sized plastics in the marine environment incorporating an accelerated weathering study and an aging estimation

Debris in the marine environment can be either natural, such as floating vegetation or volcanic ash deposits, or man-made. The man-made human sources cover the whole gamut of material types, from sewage, glass, mineral, fabric and, of increasing concern, plastic or polymeric. Virtually all plastics absorb IR in a highly selective manner, making their IR spectra a useful qualitative diagnostic. The triage of the visible micro (~1mm-5mm), meso, macro or mega particles with portable and handheld FTIR enables rapid determination of the material on-site, and reduces time wasted on non-polymers on-site or at site. Four most prevalent commodity neustonic plastic types, and their FTIR spectral changes correlated with accelerated weathering, were successfully examined chronologically, detailing significant differences in aging profiles and chemical changes. Subsequently, a small spectroscopically identifiable degraded piece of plastic found in Greenland was correlated to the appropriate aging profile. Finally, a targeted methodology for quantification of sub-millimeter microplastic in dried estuarine sediment was evaluated to ascertain its potential limit of detection

Intermittent fasting interventions for the treatment of overweight and obesity in adults aged 18 years and over:a systematic review and meta-analysis

Objective: To examine the effectiveness of intermittent energy restriction in the treatment for overweight and obesity in adults, when compared to usual care treatment or no treatment. Introduction: Intermittent energy restriction encompasses dietary approaches including intermittent fasting, alternate day fasting, and fasting for two days per week. Despite the recent popularity of intermittent energy restriction and associated weight loss claims, the supporting evidence base is limited. Inclusion criteria: This review included overweight or obese (BMI ≥25 kg/m2) adults (≥18 years). Intermittent energy restriction was defined as consumption of ≤800 kcal on at least one day, but no more than six days per week. Intermittent energy restriction interventions were compared to no treatment (ad libitum diet) or usual care (continuous energy restriction ∼25% of recommended energy intake). Included interventions had a minimum duration of 12 weeks from baseline to post outcome measurements. The types of studies included were randomized and pseudo-randomized controlled trials. The primary outcome of this review was change in body weight. Secondary outcomes included: i) anthropometric outcomes (change in BMI, waist circumference, fat mass, fat free mass); ii) cardio-metabolic outcomes (change in blood glucose and insulin, lipoprotein profiles and blood pressure); and iii) lifestyle outcomes: diet, physical activity, quality of life and adverse events. Methods: A systematic search was conducted from database inception to November 2015. The following electronic databases were searched: MEDLINE, Embase, CINAHL, Cochrane Library, ClinicalTrials.gov, ISRCTN registry, and anzctr.org.au for English language published studies, protocols and trials. Two independent reviewers evaluated the methodological quality of included studies using the standardized critical appraisal instruments from the Joanna Briggs Institute. Data were extracted from papers included in the review by two independent reviewers using the standardized data extraction tool from the Joanna Briggs Institute. Effect sizes were expressed as weighted mean differences and their 95% confidence intervals were calculated for meta-analyses. Results: Six studies were included in this review. The intermittent energy restriction regimens varied across studies and included alternate day fasting, fasting for two days, and up to four days per week. The duration of studies ranged from three to 12 months. Four studies included continuous energy restriction as a comparator intervention and two studies included a no treatment control intervention. Meta-analyses showed that intermittent energy restriction was more effective than no treatment for weight loss (−4.14 kg; 95% CI −6.30 kg to −1.99 kg; p ≤ 0.001). Although both treatment interventions achieved similar changes in body weight (approximately 7 kg), the pooled estimate for studies that investigated the effect of intermittent energy restriction in comparison to continuous energy restriction revealed no significant difference in weight loss (−1.03 kg; 95% CI −2.46 kg to 0.40 kg; p = 0.156). Conclusions: Intermittent energy restriction may be an effective strategy for the treatment of overweight and obesity. Intermittent energy restriction was comparable to continuous energy restriction for short term weight loss in overweight and obese adults. Intermittent energy restriction was shown to be more effective than no treatment, however, this should be interpreted cautiously due to the small number of studies and future research is warranted to confirm the findings of this review

Durrington Walls to West Amesbury by way of Stonehenge: a major transformation of the Holocene landscape

A new sequence of Holocene landscape change has been discovered through an investigation of sediment sequences, palaeosols, pollen and molluscan data discovered during the Stonehenge Riverside Project. The early post-glacial vegetational succession in the Avon valley at Durrington Walls was apparently slow and partial, with intermittent woodland modification and the opening-up of this landscape in the later Mesolithic and earlier Neolithic, though a strong element of pine lingered into the third millennium BC. There appears to have been a major hiatus around 2900 cal BC, coincident with the beginnings of demonstrable human activities at Durrington Walls, but slightly after activity started at Stonehenge. This was reflected in episodic increases in channel sedimentation and tree and shrub clearance, leading to a more open downland, with greater indications of anthropogenic activity, and an increasingly wet floodplain with sedges and alder along the river’s edge. Nonetheless, a localized woodland cover remained in the vicinity of DurringtonWalls throughout the third and second millennia BC, perhaps on the higher parts of the downs, while stable grassland, with rendzina soils, predominated on the downland slopes, and alder–hazel carr woodland and sedges continued to fringe the wet floodplain. This evidence is strongly indicative of a stable and managed landscape in Neolithic and Bronze Age times. It is not until c 800–500 cal BC that this landscape was completely cleared, except for the marshy-sedge fringe of the floodplain, and that colluvial sedimentation began in earnest associated with increased arable agriculture, a situation that continued through Roman and historic times

The MATISSE study: a randomised trial of group art therapy for people with schizophrenia.

RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are.BACKGROUND: Art Therapy has been promoted as a means of helping people who may find it difficult to express themselves verbally engage in psychological treatment. Group Art Therapy has been widely used as an adjunctive treatment for people with schizophrenia but there have been few attempts to examine its effects and cost effectiveness has not been examined. The MATISSE study aims to evaluate the clinical and cost effectiveness of group Art Therapy for people with schizophrenia. METHOD/DESIGN: The MATISSE study is a three-arm, parallel group, pragmatic, randomised, controlled trial of referral to group Art Therapy plus standard care, referral to an attention control 'activity' group plus standard care, or standard care alone. Study participants were recruited from inpatient and community-based mental health and social care services at four centres in England and Northern Ireland. Participants were aged over 18 years with a clinical diagnosis of schizophrenia, confirmed by an examination of case notes using operationalised criteria. Participants were then randomised via an independent and remote telephone randomisation service using permuted stacked blocks, stratified by site. Art Therapy and activity groups were made available to participants once a week for up to 12 months. Outcome measures were assessed by researchers masked to allocation status at 12 and 24 months after randomisation. Participants and care givers were aware which arm of the trial participants were allocated to. The primary outcomes for the study are global functioning (measured using the Global Assessment of Functioning scale) and mental health symptoms (measured using the Positive and Negative Syndrome Scale) assessed at 24 months. Secondary outcomes were assessed at 12 and 24 months and comprise levels of group attendance, social function, satisfaction with care, mental wellbeing, and costs. DISCUSSION: We believe that this is the first large scale pragmatic trial of Art Therapy for people with schizophrenia. TRIAL REGISTRATION: Current Controlled Trials ISRCTN46150447.Published versio

The Effectiveness of Alcohol Screening and Brief Intervention in Emergency Departments: A Multicentre Pragmatic Cluster Randomized Controlled Trial

BACKGROUND: Alcohol misuse is common in people attending emergency departments (EDs) and there is some evidence of efficacy of alcohol screening and brief interventions (SBI). This study investigated the effectiveness of SBI approaches of different intensities delivered by ED staff in nine typical EDs in England: the SIPS ED trial. METHODS AND FINDINGS: Pragmatic multicentre cluster randomized controlled trial of SBI for hazardous and harmful drinkers presenting to ED. Nine EDs were randomized to three conditions: a patient information leaflet (PIL), 5 minutes of brief advice (BA), and referral to an alcohol health worker who provided 20 minutes of brief lifestyle counseling (BLC). The primary outcome measure was the Alcohol Use Disorders Identification Test (AUDIT) status at 6 months. Of 5899 patients aged 18 or more presenting to EDs, 3737 (63·3%) were eligible to participate and 1497 (40·1%) screened positive for hazardous or harmful drinking, of whom 1204 (80·4%) gave consent to participate in the trial. Follow up rates were 72% (n?=?863) at six, and 67% (n?=?810) at 12 months. There was no evidence of any differences between intervention conditions for AUDIT status or any other outcome measures at months 6 or 12 in an intention to treat analysis. At month 6, compared to the PIL group, the odds ratio of being AUDIT negative for brief advice was 1·103 (95% CI 0·328 to 3·715). The odds ratio comparing BLC to PIL was 1·247 (95% CI 0·315 to 4·939). A per protocol analysis confirmed these findings. CONCLUSIONS: SBI is difficult to implement in typical EDs. The results do not support widespread implementation of alcohol SBI in ED beyond screening followed by simple clinical feedback and alcohol information, which is likely to be easier and less expensive to implement than more complex interventions

Integration of Syndromic Surveillance Data into Public Health Practice at State and Local Levels in North Carolina

We sought to describe the integration of syndromic surveillance data into daily surveillance practice at local health departments (LHDs) and make recommendations for the effective integration of syndromic and reportable disease data for public health use

Group art therapy as an adjunctive treatment for people with schizophrenia: multicentre pragmatic randomised trial

Objectives To evaluate the clinical effectiveness of group art therapy for people with schizophrenia and to test whether any benefits exceed those of an active control treatment