HEALTH, ENVIRONMENT AND THE INSTITUTIONAL CARE OF CHILDREN IN LATE VICTORIAN LONDON

PhDUsing the example of the London-based children's organisation Barnardo's, this thesis examines the influence of contemporary ideas regarding the relationship between environment, health and disease on the organisation and everyday institutional practices of the charity. While autobiographical accounts and historical investigations have written on the 'man himself' as well as the discursive and representational strategies used by Barnardo's to justify child removal, the importance of environmental discourses to the institution remain underexplored. The thesis addresses this lacuna through a detailed analysis of archival materials relating to Barnardo's (committee minutes, pamphlets, reports, Dr Barnardo's personal notebooks) as well as through a textual analysis of Night & Day, the main outlet for publicising the work of the charity and stimulating support for it. The thesis covers the period from 1866, when Barnardo's was founded, to the death of Dr Barnardo in 1905. This is a period when the environmental idea was arguably at its strongest, with a host of social ills (from criminality and prostitution, to human health and vitality and later in the period racial degeneration) linked to the influence of the environment. Like many other social reformers and philanthropists, Dr Barnardo was a firm believer in environmental explanations for such social ills, as well as a committed evangelical Christian, and promoted the rapid removal of young people (not all were orphaned but the vast majority were destitute) from urban and familial environments believed to do harm to their physical, moral and spiritual health. Where the first part of the thesis covers the importance of environment to the Barnardo's justification for his child removal practices, the remainder of it considers the response of the institution to environmental ideas. In addition to examining the influence of environment on institutional design and on the everyday practices of the 'inmates', for example the promotion of light and air in the girl's home at Barkingside, emphasis is also placed on ideas of mobility and movement. Here the thesis explores the paradoxical relationship between the organisation's 'anti-institutional' projection and the institutional realities of constructing and policing 'out of home' care practices (trips to the country- and seaside, boarding-out, emigration). This thesis contributes to extant accounts of Dr Barnardo's; however, its primary contribution lies in its nuanced examination of the role of environmental ideas on shaping institutional design and on its influence on the everyday practices of Barnardo's young inmates.a Collaborative Doctoral Award (CDA) in partnership with the Ragged School Museum, located close to Queen Mary, University of London, in Mile End Park and supported by the Arts and Humanities Research Council as part of its Collaborative Doctoral Award scheme AH/J009466/1

Using a community of practice to evaluate falls prevention activity in a residential aged care organisation: a clinical audit

Objective This study evaluates whether a community of practice (CoP) could conduct a falls prevention clinical audit and identify gaps in falls prevention practice requiring action. Methods Cross-sectional falls prevention clinical audits were conducted in 13 residential aged care (RAC) sites of a not-for-profit organisation providing care to a total of 779 residents. The audits were led by an operationalised CoP assisted by site clinical staff. A CoP is a group of people with a shared interest who get together to innovate for change. The CoP was made up of self-nominated staff representing all RAC sites and comprised of staff from various disciplines with a shared interest in falls prevention. Results All 13 (100%) sites completed the audit. CoP conduct of the audit met identified criteria for an effective clinical audit. The priorities for improvement were identified as increasing the proportion of residents receiving vitamin D supplementation (mean 41.5%, s.d. 23.7) and development of mandatory falls prevention education for staff and a falls prevention policy, as neither was in place at any site. CoP actions undertaken included a letter to visiting GPs requesting support for vitamin D prescription, surveys of care staff and residents to inform falls education development, defining falls and writing a falls prevention policy. Conclusion A CoP was able to effectively conduct an evidence-based falls prevention activity audit and identify gaps in practice. CoP members were well positioned, as site staff, to overcome barriers and facilitate action in falls prevention practice

Deep Learning-Enabled Sleep Staging From Vital Signs and Activity Measured Using a Near-Infrared Video Camera

Conventional sleep monitoring is time-consuming, expensive and uncomfortable, requiring a large number of contact sensors to be attached to the patient. Video data is commonly recorded as part of a sleep laboratory assessment. If accurate sleep staging could be achieved solely from video, this would overcome many of the problems of traditional methods. In this work we use heart rate, breathing rate and activity measures, all derived from a near-infrared video camera, to perform sleep stage classification. We use a deep transfer learning approach to overcome data scarcity, by using an existing contact-sensor dataset to learn effective representations from the heart and breathing rate time series. Using a dataset of 50 healthy volunteers, we achieve an accuracy of 73.4\% and a Cohen's kappa of 0.61 in four-class sleep stage classification, establishing a new state-of-the-art for video-based sleep staging.Comment: Accepted to the 6th International Workshop on Computer Vision for Physiological Measurement (CVPM) at CVPR 2023. 10 pages, 12 figures, 5 table

Altered Innate Immune Responses in Neutrophils from Patients with Well- and Suboptimally Controlled Asthma

© 2015 Francesca S. M. Tang et al. Background. Respiratory infections are a major cause of asthma exacerbations where neutrophilic inflammation dominates and is associated with steroid refractory asthma. Structural airway cells in asthma differ from nonasthmatics; however it is unknown if neutrophils differ. We investigated neutrophil immune responses in patients who have good (AGood) and suboptimal (ASubopt) asthma symptom control. Methods. Peripheral blood neutrophils from AGood (ACQ 0.75, n=7), and healthy controls (HC) (n=9) were stimulated with bacterial (LPS (1 g/mL), fMLF (100 nM)), and viral (imiquimod (3 g/mL), R848 (1.5 g/mL), and poly I:C (10 g/mL)) surrogates or live rhinovirus (RV) 16 (MOI1). Cell-free supernatant was collected after 1 h for neutrophil elastase (NE) and matrix metalloproteinase- (MMP-) 9 measurements or after 24 h for CXCL8 release. Results. Constitutive NE was enhanced in AGood neutrophils compared to HC. fMLF stimulated neutrophils from ASubopt but not AGood produced 50% of HC levels. fMLF induced MMP-9 was impaired in ASubopt and AGood compared to HC. fMLF stimulated CXCL8 but not MMP-9 was positively correlated with FEV1 and FEV1/FVC. ASubopt and AGood responded similarly to other stimuli. Conclusions. Circulating neutrophils are different in asthma; however, this is likely to be related to airflow limitation rather than asthma control