The Starworks Project: Achievements and Next Steps

Following the announcement in March 2016 of the government’s investment of £1.5 million in child prosthetics, National Institute for Health Research (NIHR) Devices for Dignity MedTech Co-operative were given the role of leading the £750,000 fund created to “incentivise the development of new breakthrough innovative prosthetic products for the NHS.” The agreed approach was to pump-prime the formation of a Child Prosthetics Research Collaboration, which brought together children and their families with key opinion leaders from the NHS, industry, clinical academia and leading national research centres with capabilities in child prosthetics. The aim of this work was to increase research focus across the system to accelerate the translation of new inventions and developments in child prosthetics into everyday use. This initiative is centred on the needs of children, patient and families and the NHS and will ensure there is the ideal balance of ‘clinical pull’ and ‘technical push’ to create an energetic environment in which to innovate.  This talk will give an overview of the approach taken to developing a new, much-needed collaborative research network in the field of child prosthetics, including: • Establishing the network • A multi-stakeholder needs assessment, considering the perspectives of children and families, clinicians, academics and industry experts. • A series of ‘Sandpit’ events, bringing together these key stakeholders to collaboratively explore and innovate in emergent challenge areas • The funding of ten ‘Proof of Concept’ projects that respond to these challenge areas, whilst keeping children and families in the centre of the research focus. As part of this talk, we are also pleased to confirm that Starworks has received further funding from the NIHR to continue to develop the network, reinforcing its current foundations and also extending its reach. We will give an insight into initial plans for ‘Starworks 2’, and hope that this talk will encourage families, clinicians, academics and industry experts to reach out to us, learn more, and help us to grow the network further

Child-led, Creative Exploration of Paediatric Incontinence

This paper describes a novel collaboration between a health science initiative, a MedTech Co-operative and a university design research department alongside a group of children with incontinence, their parents and siblings. This collaboration hoped to inform the development of technological interventions specifically aimed at supporting paediatric incontinence. Together, we used a range of bespoke tools to creatively and collaboratively explore questions of ‘What are your main challenges? How do you currently address them? And how would you like to address them in the future?’ These tools aimed to place the children as the experts in the rooms, reflecting on their wider life (i.e. their hobbies, friends, family) and took an asset-based approach to highlight the skills and resources they already leverage to address their personal challenges. Later, ideation activities were used to empower the families as inventors to highlight and address any unmet health needs. Central to each of the activities was the aim to reframe a traditionally ‘taboo’ topic as something that is safe, and even fun, to explore through creative means. This study concludes that by using context-specific, sensitive and creative tools, children from a range of ages can (and should) be included in setting the agenda for future healthcare technology development, even in topics that are traditionally difficult to discuss

Characterization for index based livestock insurance

Pastoral populations of sub-Saharan Africa are particularly vulnerable to losses in wealth and productive assets via herdmortality shocks. Although conventional insurance mechanisms covering individual losses are not cost effective in low income extensive grazing pastoral communities, index insurance for livestock offers a promising alternative. This paper identifies regions most suitable for an index-based livestock insurance product: areas predicted to have high covariaterisk from drought, high potential demand for a livestock insurance product, and supporting market infrastructure for an insurance product. Our findings support current efforts to implement index insurance in Kenya and Ethiopia, and reveal additional areas for geographic expansion in western and southern Africa

Community Isolation Project

Introduction The authors of this summary are nursing students at Seattle Pacific University, and the project goal is focused on understanding feelings of isolation in elderly communities and whether fostering social activities, such as Bingo, would improve social interaction between residents in this community. For the past two years, the COVID-19 pandemic has altered various aspects of social interaction. From masking to social distancing, societal norms and expectations evolved in a manner that promoted isolation and minimal interaction to inhibit the spread of Covid infection between individuals. Of the general populace, the most vulnerable and at risk for infection are the elderly and those with comorbidities. Subsequently, older individuals are more at risk for rigid social isolation precautions due to the risk of infection, affecting many of the individuals in this group who live in community settings such as nursing homes and long-term care facilities. This project ultimately seeks to understand how older individuals might feel after participating in community activities with one another as well as assess for any feelings of depression and social isolation post pandemic.  Background The population worked with is a subsidized living community for individuals over the age of 62. The 200-plus unit apartment complex is located in North Seattle just off the Aurora business district. Social isolation and loneliness in older adults living in communities such as this is a growing concern especially since the pandemic showing upwards of 29% of the elderly population to report being lonely in the U.S. (Taylor, et al., 2018). Although it is hard to precisely measure social isolation and loneliness, the evidence that does exist shows there is an increased risk for dementia alone, by fifty percent, with links to an increase in cardiovascular disease, stroke, anxiety, depression, and suicide (CDC, 2021). More recent studies in populations of older adults residing in senior housing communities seem to experience higher levels of loneliness due to lower-income, being alone due to the death of a spouse/partner, having fewer confiding relationships, depression, and other significant comorbidities as mentioned, as compared to those living in conventional housing (Taylor, et al., 2018). This is attributed to having less contact with family and friends, social anxiety of meeting neighbors, and altogether feeling of not being supported (Taylor, et al., 2018). The COVID-19 pandemic added more barriers to social isolation and loneliness for the elderly due to early restrictions of in-person gatherings, recreational activities within the community, family gatherings being canceled, spiritual congregations canceled, and many deaths within the community, all adding to the sense of isolation, loneliness, and depression (Webb and Chen, 2021). As far as interventions to combat loneliness and social isolation, there have been many. It is difficult to analyze due to individual experience surrounding the issues (Fakoya et al., 2020). There is not a “one-size-fits all” standardization to address social isolation and loneliness in the elderly, showing that tailoring interventions to specific community and individual needs as being the best approach (Fakoya et al., 2020). Activities with Rationale When discussing what activities or events the project should center around, the team collaborated with the property manager at the senior living community to ensure the provided activity would be both fun and engaging for the residents, as well as beneficial and information-producing for our project and the property manager. After it was determined the project would center around targeting loneliness in elderly communities, an idea was landed on creating an event that would demonstrate the importance of connection and combat isolation. A transtheoretical model of change was used as the basis for this project. This change model states that behavior change takes place through the following stages: precontemplation, contemplation, preparation, action, maintenance, and termination. To measure this, pre- and post- surveys were filled out by residents to gather data to support the health promotion project’s claims. The project at the community included two Bingo days. The specific activity was determined through popular request by the residents who had mentioned playing and enjoying Bingo as a community in the past. A week prior to the first event, pre surveys were distributed asking the residents about their experience of isolation and/or loneliness if they had any. Residents were incentivized to attend the Bingo events with promised coffee, snacks, and small prizes for Bingo winners. Residents were even given a chance to be entered into a randomized drawing for a fifteen-dollar gift card to Sprouts, a local grocery store, which was conducted at the end of each Bingo day. After the events, those who participated in Bingo were then further encouraged to fill out post surveys. These surveys questioned how it felt to engage in the community and if their feelings or loneliness/isolation had changed in order to assess the impact the bingo event had on mood and affect. For the purposes of this project, it was important not only to gather information, but to model what having community events, such as Bingo, could look like and how they would positively impact the community. Outcomes To gain a better understanding of how the community felt regarding loneliness, isolation, and their willingness to participate in group activities, pre- and post-bingo surveys were provided utilizing the Likert scale. In return, 30 pre-surveys were returned from the community. Following the event, 30 post-surveys were filled out by the residents who participated in Bingo. After reviewing the results of the pre-surveys, it was concluded that the overall community often feels a sense of loneliness, but they have an ardent desire to participate in group activities. After 2 days of Bingo, residents who joined us were asked to fill out a post-survey to gauge if the group activity had any effect on them. In almost every single post activity survey received, residents answered that playing Bingo with their community positively impacted their mental health, they would play Bingo or attend another event again, and they found it easier to build relationships with their community members while engaging in Bingo together. The community engagement surveys revealed that group activities such as bingo led to an outcome of decreased loneliness and isolation. According to the data collected, hosting and facilitating social events, specifically for older adult populations, post pandemic, is extremely beneficial to mental health and overall wellness. Conclusion Although Covid has been around for two years now, it has proven to be very difficult to navigate, especially in community settings such as this subsidized living community. This pandemic has been exceptionally problematic as facilities search for a balance betweenl encouraging social activity, and also promoting physical safety from Covid-19. While preventing the spread of the virus is certainly a priority, mental health, arguably, is just as crucial to one\u27s well-being as their physical health. The surveys collected in this project revealed that while many individuals had a strong urge to engage in social activities, a sense of loneliness in the community still exists for many people. As mentioned in other studies, there’s no “correct” way to decrease feelings of isolation as the process of overcoming this sense of remoteness may be very specific to the community. Luckily, the staff at this site are very in tune with their population and they disclosed that Bingo is a popular activity among the residents. It was important that the activity was appropriate and engaging for people of all different backgrounds as the intent of the project was to foster community engagement and improve social interactions among the group. Overall, there was a great turnout of people at both the first and second Bingo events, further exemplifying the enthusiasm many individuals shared about wanting to be more engaged in the community. Because there was such a big turnout, the group had a few challenges to overcome. Firstly, accessibility and navigation within the conference room was a little tight the first time around which the group was able to overcome by rearranging tables to accommodate for walkers and wheelchairs. Secondly, while there was a provided space and Bingo set, the budget for prizes and snacks was also very limited which led to the group contributing personal funds to the project. Lastly, while the post-surveys offered great insight, they provided information on a very small percentage of the population. The results of the surveys are from the perspective of individuals who most likely often attend group activities, which ultimately skews the information as this may not accurately represent the entirety of the population at this senior community. For a more accurate representation of the community, there would need to be a larger sample number. The project proved to be successful as many of the residents answered in their post-surveys that the Bingo event decreased feelings of loneliness and isolation, therefore positively impacting their mental health. Many of the individuals also stated in their questionnaires that they would attend more Bingo events in the future. In addition, residents were also eager to suggest other fun group activities such as painting, gardening, picnics, and dances. Moving forward, it would be beneficial for future groups to try other activities in addition to Bingo. Different events may motivate social interaction from the individuals who don’t enjoy activities such as Bingo and would facilitate a feeling of excitement in anticipation for a communal gathering that is both entertaining and interactive. This health promotion project found Bingo to be a successful event in which participants were able to maintain a safe social distance, and engage together in a fun, community activity. References Fakoya, O., McCorry, N., & Donnelly, M. (2020). Loneliness and social isolation for older adults: A scoping review of reviews. BMC Public Health, 20(129). https://doi.org/10.1186/s12889-020-8251-6 Centers for Disease Control and Prevention (2021). Loneliness and social isolation linked to serious health conditions. (n.d.).  https://www.cdc.gov/aging/publications/features/lonely-older-adults.html#:~:text=A%20report%20from%20the%20National,considered%20to%20be%20socially%20isolated Taylor, H., Wang, Y., & Morrow-Howell, N. (2018). Loneliness in senior housing communities. Journal of Gerontological Social Work, 61(6), 623-639. https://doi.org/10.1080/01634372.2018.1478352 Webb, L., & Chen, C. (2021). The covid-19 pandemic\u27s impact on older adults\u27 mental health: Contributing factors, coping strategies, and opportunities for improvement. Int J Geriatr Psychiatry. https://doi.org:10.1002/gps.564

Starworks: Politics, Power and Expertise in co-producing a research, patient, practice and industry partnership for child prosthetics

Significant advances have been made in the field of adult prosthetic limbs. Conversely, paediatric limbs suffer from a ‘market failure’ situation; market forces are inadequate to stimulate product innovation. Children are left with inadequate limb provision at best aiming to minimize pain and discomfort rather than enable independence and quality of life. In 2017, the UK Exchequer announced £1.5M one-off investment in child prosthetics, as a result of lobbying by charities and a small number of parents of children with lower limb loss. Half this investment was dedicated to the provision of ‘activity limbs’ (eg. running blades) for children, and half dedicated to research and innovation over a period of two years. The authors took a lead in the latter, with the aim to re-structure the market forces, catalysing innovation for more appropriate paediatric prosthetics. NIHR Devices for Dignity MedTech Co-operative (D4D), supported by Lab4Living, established a network of key stakeholders based on principles of co-production (Greenhalgh et al. 2016). Details of the process, outputs and impact can be found elsewhere (Mills et al. 2019). This paper focuses on the politics, power and distinctive contributions defined by differing expertise, by which this collaboration was established, operated and sustained. We discuss the co-design methods that helped to achieve this and draw on evidence from the stakeholders and project outputs to demonstrate success of these methods. We conclude by suggesting meaningful co-production isn’t necessarily about including everyone in all decisions, provide some tips for managing political relationships and power differences, and highlight the importance of valuing stakeholders for their (unique) expertise

Mental disorder and the outcome of HIV/AIDS in low-income and middle-income countries: a systematic review.

OBJECTIVES: To conduct a systematic review of the literature to examine the interrelationship between mental health and treatment outcomes in low-income and middle-income settings; to update the work of Collins et al. (2006). DESIGN: Systematic review of peer-reviewed articles that examined one of the following: the effects of mental disorders (including cognitive impairment) upon engagement with treatment and/or adherence; their influence upon HIV-related clinical outcomes; and the impact of interventions for mental disorder. METHODS: Articles about mental health and HIV/AIDS were included if they were published after 2005 and addressed one of the areas of interest described above. Systematic methods were used for searching, screening, and data extraction. Studies employing quantitative measures of exposures and outcomes wherein all participants had a diagnosis of HIV/AIDS were included. RESULTS: This review found ample and moderately consistent evidence that adverse mental health and alcohol consumption are associated with reduced adherence. Variation in measurement and the relative paucity of work meant that interpretation of studies examining engagement with care and other clinical outcomes was difficult. Evidence on the efficacy and effectiveness of mental health interventions in low-income and middle-income settings was very limited. CONCLUSION: This review suggests that psychosocial factors, namely, depression and alcohol may have adverse effects upon HIV-related outcomes. However, further large, high-quality studies examining outcomes other than adherence are needed. There is also an urgent need for randomized controlled trials of interventions for mental disorder and a need to investigate their impact upon HIV-related outcomes