Design sustainability and business. Portfolio submission

This research explores the influence of the early design stage on the environmental impact of products and the roles and interactions of key players in minimising this impact during the new product development cycle. This body of work is unique in that it brings together the findings of two Government funded research initiatives (the Deep RED (Resource Efficient Design) and Retail Lab research initiatives) and a commercial design research commission for a short life retail display system for the Robert Horn Group (all proposed and undertaken by the investigator). It applies design research methodologies, in which the investigator is a leading authority, to utilise practice based design research to inform theory. The Deep RED project incorporates specific environmental design research projects for EON, Travis Perkins, Primarius UK, Scott Bader and Antone; the Antone project being further developed as part of Retail Lab research, eventually becoming a specific commission for the Robert Horn Group and a patent application (GB1216474.5). This research confirms that a products environmental impact is largely established in the concept stages of the new product development (NPD) cycle, it identifies issues concerning the use of environmentally sustainable materials relating to cost and availability and also identifies that there are significant opportunities not only to reduce the environmental impact of products but to reduce costs in so doing. In addition findings from this research highlight issues in supply chain communication and collaboration relating to supply chain management and in particular how this could relate to UK Design Consultancy and the use of Life Cycle Analysis tools. Findings have been disseminated by patent and culminated in two international conference papers and two international journal publications

Researcher access to mental health data: results from an online consultation

This is the final versionMany scientists and researchers use information from hundreds or thousands of people to understand more about health and wellbeing, and to improve treatments and support for those with health problems. This information, or data, is collected in many ways and is kept secure by organisations or individuals known as ‘data controllers’. Their job is to manage the processes that allow bona fide researchers access to these data in a way that respects the privacy and confidentiality of the people the data refers to. Since the new data protection regulations (GDPR) introduced in the UK in 2018, we have heard that researchers and scientists are finding it more difficult to access the health data they need to do important scientific research. In order to collect more information about whether people are having problems with accessing data, and to understand more about what problems people were having, we conducted a short online consultation or survey asking about data access. We advertised the consultation by saying that MQ Mental Health Research (a charity that aims to improve mental health via research) and NHS Digital were interested in hearing about how the data access process could be improved, so it is possible that participants tended to be those who had faced difficulties. Sixty-three people took part in the survey, which was available for just over one month in late 2019. Eleven of them had not yet tried to get access to data, but said they were expecting problems if they were to try. Sixteen people were currently trying to access data, and 36 had successfully accessed data. The 52 people who had tried to, or had accessed, data reported a wide range of problems with their applications. Often each person experienced multiple problems. The application process has lasted between 2 and 70 months (median 12 months), bearing in mind that some of these were not yet completed. There were two common issues. Firstly, the process of application was lengthy and complicated, and not clearly explained. Secondly, researchers reported getting different advice from different people within the same organisation on the same procedures. In addition, some people reported difficulty finding a person who was senior enough in their own institution to sign off the forms. Our recommendations for data controllers, research organisations, and individual researchers following this consultation are shown in Box 1. Our consultation suggests that data access processes need to be clearer and more streamlined and applied in the same way across different data controllers. This would help to ensure that people seeking to access data get consistent advice and consistent responses. We recommend that timelines for the application process, as well as the time between application approval and data provision, are shortened. We need a better balance between data security and privacy on the one hand, and the availability of data to provide evidence for policy and practice in line with the open science movement on the other. This is particularly true where research stands to directly benefit individuals or societies. Those we consulted had a lot of suggestions for specific amendments 4 to parts of the existing process, which were underpinned by frustration and confusion with the process as a whole. Our findings highlight the need for rapid improvement and we recommend actions for all stakeholders within the next 12 months. Given that many other countries routinely publish studies using recent epidemiological data, failure to improve data access processes will clearly result in the UK lagging behind in the international scientific field

The first legal mortgagor: a consumer without adequate protection?

This article contends that the UK government’s attempt to create a well-functioning consumer credit market will be undermined if it fails to reform the private law framework relating to the first legal mortgage. Such agreements are governed by two distinct regulatory regimes that are founded upon very different conceptions of the mortgagor. The first, the regulation of financial services overseen by the Financial Conduct Authority, derives from public law and is founded upon a conception of the mortgagor as “consumer”. The other is land law, private law regulation implemented by the judiciary and underpinned by a conception of the mortgagor as “landowner”. Evidence suggests that the operation of these two regimes prevents mortgagors from receiving fair and consistent treatment. The current reform of financial services regulation therefore will change only one part of this governance regime and will leave mortgagors heavily reliant upon a regulator that still has to prove itself. What this article argues is that reform of the rules of private law must also be undertaken with the aim of initiating a paradigm shift in the conception of the mortgagor from “landowner” to “consumer”. Cultural shifts of this kind take time but the hope is that this conceptual transformation will occur in time to deter the predicted rise in mortgage possessions

High-dose intravenous iron reduces myocardial infarction in patients on haemodialysis

AIMS: To investigate the effect of high-dose iron vs. low-dose intravenous (IV) iron on myocardial infarction (MI) in patients on maintenance haemodialysis. METHODS AND RESULTS: This was a pre-specified analysis of secondary endpoints of the Proactive IV Iron Therapy in Hemodialysis Patients trial (PIVOTAL) randomized, controlled clinical trial. Adults who had started haemodialysis within the previous year, who had a ferritin concentration <400 μg per litre and a transferrin saturation <30% were randomized to high-dose or low-dose IV iron. The main outcome measure for this analysis was fatal or non-fatal MI. Over a median of 2.1 years of follow-up, 8.4% experienced a MI. Rates of type 1 MIs (3.2/100 patient-years) were 2.5 times higher than type 2 MIs (1.3/100 patient-years). Non-ST-elevation MIs (3.3/100 patient-years) were 6 times more common than ST-elevation MIs (0.5/100 patient-years). Mortality was high after non-fatal MI (1- and 2-year mortality of 40% and 60%, respectively). In time-to-first event analyses, proactive high-dose IV iron reduced the composite endpoint of non-fatal and fatal MI [hazard ratio (HR) 0.69, 95% confidence interval (CI) 0.52-0.93, P = 0.01] and non-fatal MI (HR 0.69, 95% CI 0.51-0.93; P = 0.01) when compared with reactive low-dose IV iron. There was less effect of high-dose IV iron on recurrent MI events than on the time-to-first event analysis. CONCLUSION: In total, 8.4% of patients on maintenance haemodialysis had an MI over 2 years. High-dose compared to low-dose IV iron reduced MI in patients receiving haemodialysis. EUDRACT REGISTRATION NUMBER: 2013-002267-25

Heart Failure Hospitalization in Adults Receiving Hemodialysis and the Effect of Intravenous Iron Therapy

OBJECTIVES: This study sought to examine the effect of intravenous iron on heart failure events in hemodialysis patients. BACKGROUND: Heart failure is a common and deadly complication in patients receiving hemodialysis and is difficult to diagnose and treat. METHODS: The study analyzed heart failure events in the PIVOTAL (Proactive IV Iron Therapy in Hemodialysis Patients) trial, which compared intravenous iron administered proactively in a high-dose regimen with a low-dose regimen administered reactively. Heart failure hospitalization was an adjudicated outcome, a component of the primary composite outcome, and a prespecified secondary endpoint in the trial. RESULTS: Overall, 2,141 participants were followed for a median of 2.1 years. A first fatal or nonfatal heart failure event occurred in 51 (4.7%) of 1,093 patients in the high-dose iron group and in 70 (6.7%) of 1,048 patients in the low-dose group (HR: 0.66; 95% CI: 0.46-0.94; P = 0.023). There was a total of 63 heart failure events (including first and recurrent events) in the high-dose iron group and 98 in the low-dose group, giving a rate ratio of 0.59 (95% CI: 0.40-0.87; P = 0.0084). Most patients presented with pulmonary edema and were mainly treated by mechanical removal of fluid. History of heart failure and diabetes were independent predictors of a heart failure event. CONCLUSIONS: Compared with a lower-dose regimen, high-dose intravenous iron decreased the occurrence of first and recurrent heart failure events in patients undergoing hemodialysis, with large relative and absolute risk reductions. (UK Multicentre Open-label Randomised Controlled Trial Of IV Iron Therapy In Incident Haemodialysis Patients; 2013-002267-25)

Get screened: a pragmatic randomized controlled trial to increase mammography and colorectal cancer screening in a large, safety net practice

Abstract Background Most randomized controlled trials of interventions designed to promote cancer screening, particularly those targeting poor and minority patients, enroll selected patients. Relatively little is known about the benefits of these interventions among unselected patients. Methods/Design "Get Screened" is an American Cancer Society-sponsored randomized controlled trial designed to promote mammography and colorectal cancer screening in a primary care practice serving low-income patients. Eligible patients who are past due for mammography or colorectal cancer screening are entered into a tracking registry and randomly assigned to early or delayed intervention. This 6-month intervention is multimodal, involving patient prompts, clinician prompts, and outreach. At the time of the patient visit, eligible patients receive a low-literacy patient education tool. At the same time, clinicians receive a prompt to remind them to order the test and, when appropriate, a tool designed to simplify colorectal cancer screening decision-making. Patient outreach consists of personalized letters, automated telephone reminders, assistance with scheduling, and linkage of uninsured patients to the local National Breast and Cervical Cancer Early Detection program. Interventions are repeated for patients who fail to respond to early interventions. We will compare rates of screening between randomized groups, as well as planned secondary analyses of minority patients and uninsured patients. Data from the pilot phase show that this multimodal intervention triples rates of cancer screening (adjusted odds ratio 3.63; 95% CI 2.35 - 5.61). Discussion This study protocol is designed to assess a multimodal approach to promotion of breast and colorectal cancer screening among underserved patients. We hypothesize that a multimodal approach will significantly improve cancer screening rates. The trial was registered at Clinical Trials.gov NCT00818857http://deepblue.lib.umich.edu/bitstream/2027.42/78264/1/1472-6963-10-280.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78264/2/1472-6963-10-280.pdfPeer Reviewe

Understanding psychiatric institutionalization: a conceptual review

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

A prevalence survey of every-day activities in pregnancy

<p>Abstract</p> <p>Background</p> <p>Research into the effects of common activities during pregnancy is sparse and often contradictory. To examine whether common activities are an acute trigger of pregnancy complications the prevalence of these activities are necessary to determine sample size estimates. The aim of this study is to ascertain the prevalence of selected activities in any seven day period during pregnancy.</p> <p>Methods</p> <p>The study was conducted in the antenatal clinic of a teaching hospital with tertiary obstetric and neonatal care in Sydney, Australia between August 2008 and April 2009. Women who were at least 20 weeks pregnant and able to read English completed a questionnaire to assess whether they had performed a list of activities in the seven days prior to survey completion. Results were analysed using frequency tabulations, contingency table analyses and chi square tests.</p> <p>Results</p> <p>A total of 766 surveys were completed, 29 surveys were excluded as the women completing them were less than 20 weeks pregnant, while 161 women completed the survey more than once. Ninety seven per cent of women completed the survey when approached for the first time, while 87% completed the survey when approached a subsequent time. In the week prior to completing the survey 82.6% of women had consumed a caffeinated beverage, 42.1% had had sexual intercourse, 32.7% had lifted something over 12 kilograms, 21.4% had consumed alcohol and 6.4% had performed vigorous exercise. The weekly prevalence of heavy lifting was higher for multiparous women compared to nulliparous women.</p> <p>Conclusions</p> <p>The results of this study can be used to inform future research into activities as acute triggers of pregnancy complications.</p