Frailty: perceptions of occupational therapists in Ireland

Purpose – Ireland’s ageing population has resulted in an increasing number of older adults living with frailty. Despite growing attention towards older adults’ and health professionals’ perspectives of frailty, occupational therapy research is limited. This study aims to explore occupational therapists’ perceptions of frailty and how their perceptions impact their approach to the assessment and management of frailty. Design/methodology/approach – Using qualitative descriptive design, 19 occupational therapists working with older adults participated in online focus groups. Data were analysed using thematic analysis. Findings – Perceptions of occupational therapists were constructed into three main themes: conceptualising frailty; management of frailty; and advancing frailty practice. Findings indicate that occupational therapists perceived frailty as a multidimensional concept but highlight a reluctance to use frailty terminology with patients. Findings also suggest that although occupational therapists are involved in provision of care for older adults living with frailty, the profession’s scope is not optimised in the assessment and management of frailty. Originality/value – Findings provide insight into occupational therapists’ perceptions of frailty. Development of a shared understanding of frailty between clinicians and patients and enhancement of undergraduate frailty education are recommended to progress occupational therapy’s role in frailty management

Altered mitochondrial function and energy metabolism is associated with a radioresistant phenotype in oesophageal adenocarcinoma

Neoadjuvant chemoradiation therapy (CRT) is increasingly the standard of care for locally advanced oesophageal cancer. A complete pathological response to CRT is associated with a favourable outcome. Radiation therapy is important for local tumour control, however, radioresistance remains a substantial clinical problem. We hypothesise that alterations in mitochondrial function and energy metabolism are involved in the radioresistance of oesophageal adenocarcinoma (OAC). To investigate this, we used an established isogenic cell line model of radioresistant OAC. Radioresistant cells (OE33 R) demonstrated significantly increased levels of random mitochondrial mutations, which were coupled with alterations in mitochondrial function, size, morphology and gene expression, supporting a role for mitochondrial dysfunction in the radioresistance of this model. OE33 R cells also demonstrated altered bioenergetics, demonstrating significantly increased intracellular ATP levels, which was attributed to enhanced mitochondrial respiration. Radioresistant cells also demonstrated metabolic plasticity, efficiently switching between the glycolysis and oxidative phosphorylation energy metabolism pathways, which were accompanied by enhanced clonogenic survival. This data was supported in vivo, in pre-treatment OAC tumour tissue. Tumour ATP5B expression, a marker of oxidative phosphorylation, was significantly increased in patients who subsequently had a poor pathological response to neoadjuvant CRT. This suggests for the first time, a role for specific mitochondrial alterations and metabolic remodelling in the radioresistance of OAC

Methodological “Learning-by-Doing” for Action Design Research

This study shares the direct experiences of designing and implementing methodological “learning-by-doing” for Action Design Research (ADR) within a 5-credit module that condenses the realities of completing a full ADR project without compromising the rigour of the approach. The module is described in detail, along with the specifics of its implementation over two years and the key learnings from doing so. Adopting a confessional writing approach, documented experiences from those involved (both designers and students) provide a rich data source, analysed using autonomous and communicative reflexivity. The underlying contribution of this paper is that it provides insights into the learning of ADR, the doing of ADR, and the outcomes of a technique that simultaneously combines both. As a result, ADR educators and researchers can draw on these insights to further their teaching, learning, and research endeavours. Finally, key insights such as forced pragmatism and the challenge of problematisation add to our understanding of conducting ADR while avoiding issues such as methodological slurring

Modelling stellar variability in archival HARPS data: I - rotation and activity properties with multi-dimensional Gaussian processes

Although instruments for measuring the radial velocities (RVs) of stars now routinely reach sub-meter per second accuracy, the detection of low-mass planets is still very challenging. The rotational modulation and evolution of spots and/or faculae can induce variations in the RVs at the level of a few m/s in Sun-like stars. To overcome this, a multi-dimensional Gaussian Process framework has been developed to model the stellar activity signal using spectroscopic activity indicators together with the RVs. A recently published computationally efficient implementation of this framework, S+LEAF 2, enables the rapid analysis of large samples of targets with sizeable data sets. In this work, we apply this framework to HARPS observations of 268 well-observed targets with precisely determined stellar parameters. Our long-term goal is to quantify the effectiveness of this framework to model and mitigate activity signals for stars of different spectral types and activity levels. In this first paper in the series, we initially focus on the activity indicators (S-index and Bisector Inverse Slope), and use them to a) measure rotation periods for 49 slow rotators in our sample, b) explore the impact of these results on the spin-down of middle-aged late F, G & K stars, and c) explore indirectly how the spot to facular ratio varies across our sample. Our results should provide valuable clues for planning future RV planet surveys such as the Terra Hunting Experiment or the PLATO ground-based follow-up observations program, and help fine-tune current stellar structure and evolution models

Visceral Adipose Tissue Modulates Radiosensitivity in Oesophageal Adenocarcinoma

Oesophageal adenocarcinoma (OAC) is an exemplar model of obesity-associated cancer. Response to neoadjuvant chemoradiotherapy (NA CRT) is a clinical challenge. We examined if visceral adipose tissue and obesity status alter radiosensitivity in OAC. The radioresistant (OE33R) and radioresponsive (OE33P) OAC isogenic model was cultured with adipose tissue conditioned media from three patient cohorts: non-cancer patients, surgery only OAC patients and NA CRT OAC patients. Cell survival was characterised by clonogenic assay, metabolomic profiling by nuclear magnetic resonance spectroscopy and adipokine receptor gene expression by qPCR. A retrospective in vivo study compared tumour response to NA CRT in normal weight (n=53) versus overweight/obese patients (n=148). Adipose conditioned media (ACM) from all patient cohorts significantly increased radiosensitivity in radioresistant OE33R cells. ACM from the NA CRT OAC cohort increased radiosensitivity in OE33P cells. Metabolomic profiling demonstrated separation of the non-cancer and surgery only OAC cohorts and between the non-cancer and NA CRT OAC cohorts. Gene expression profiling of OE33P versus OE33R cells demonstrated differential expression of the adiponectin receptor-1 (AR1), adiponectin receptor-2 (AR2), leptin receptor (LepR) and neuropilin receptor-1 (NRP1) genes. In vivo overweight/obese OAC patients achieved an enhanced tumour response following NA CRT compared to normal weight patients. This study demonstrates that visceral adipose tissue modulates the cellular response to radiation in OA

Investigating stellar activity through eight years of Sun-as-a-star observations

Funding: BK, SA, OB, HY, and NKOS acknowledge funding from the European Research Council under the European Union’s Horizon 2020 research and innovation programme (grant agreement no 865624, GPRV). MC acknowledges the SNSF support under grant P500PT_211024. FR is funded by the University of Exeter’s College of Engineering, Maths and Physical Sciences, UK. ACC acknowledges support from STFC consolidated grant number ST/V000861/1, and EPSRC grant number EP/Z000181/1 towards the ERC Synergy project REVEAL.Stellar magnetic activity induces both distortions and Doppler-shifts in the absorption line profiles of Sun-like stars. Those effects produce apparent radial velocity (RV) signals which greatly hamper the search for potentially habitable, Earth-like planets. In this work, we investigate these distortions in the Sun using cross-correlation functions (CCFs), derived from intensive monitoring with the high-precision spectrograph HARPS-N. We show that the RV signal arising from line-shape variations on time-scales associated with the Sun’s rotation and activity cycle can be robustly extracted from the data, reducing the RV dispersion by half. Once these have been corrected, activity-induced Doppler-shifts remain, that are modulated at the solar rotation period, and that are most effectively modelled in the time domain, using Gaussian processes (GPs). Planet signatures are still best retrieved with multidimensonal GPs, when activity is jointly modelled from the raw RVs and indicators of the line width or of the Ca ii H & K emission. After GP modelling, the residual RVs exhibit a dispersion of 0.6–0.8 m s−1, likely to be dominated by signals induced by supergranulation. Finally, we find that the statistical properties of the RVs evolve significantly over time, and that this evolution is primarily driven by sunspots, which control the smoothness of the signal. Such evolution, which reduces the sensitivity to long-period planet signatures, is no longer seen in the activity-induced Doppler-shifts, which is promising for long term RV monitoring surveys such as the Terra Hunting Experiment or the PLATO follow-up campaign.Peer reviewe

Visions for a walking and cycling focussed urban transport system

Walking and cycling can make a considerable contribution to sustainable transport goals, building healthier and more sustainable communities and contributing to traffic and pollution reduction. There have been many national and local initiatives to promote walking and cycling, but without a long term vision and consistent strategy it is difficult to see how a significant change may be achieved. This paper presents three alternative visions for the role of walking and cycling in urban areas for the year 2030: each vision illustrates a ‘desirable’ walking- and cycling-oriented transport system against a different ‘exogenous social background’. These visions have been developed through a process of expert discussion and review and are intended to provide a stimulus for debate on the potential for and desirability of such alternative futures. Each is based on the UK and represents a substantial change to the current situation: in particular, each of the visions presents a view of a society where walking and cycling are considerably more important than is currently the case and where these modes cater for a much higher proportion of urban transport needs than at present. The visions show pictures of urban environments where dependence on motor vehicles has been reduced, in two of the visions to very low levels. The methodological approach for devising visions is informed by work on ‘utopian thinking’: a key concept underlying this approach is one of viewing the future in social constructivist terms (i.e. the future is what ‘we’, as a society, make it) rather than considering the future as something that can be ‘scientifically’ predicted by the extrapolation of current trends