‘Rekindling couplehood’ using a multisensory suitcase of memories:A pilot study of people living with moderate dementia and their partners

Creating individualised activities in partnership with people who have moderate dementia and their partners at home has rarely been achieved, as such interventions are usually pre planned and prepared by researchers or professionals. The academic gap is in the activity design being led by the person who has dementia and their partner and how to pragmatically engage them in a meaningful manner which rekindles positive joint memories and improves the quality of their current relationship. This explores the meaning and significance of recalling holiday memories for people living with moderate dementia and their partners, using multisensory reminiscence. A sensory ethnography research methodology was employed to overcome the challenges of engaging individuals with cognition, decision making and communication difficulties and to enhance co-production of the activity with the person living with dementia and her spouse. This processual and longitudinal methodology allowed individuals, who are often excluded from research, to express themselves and co-design activities over 5 home visits using multisensory reminiscence of shared holiday memories. The co-produced research culminated in the creation of a digital story, the sharing of food and drink and re-enactment through exploration of their holiday memorabilia: which formed their “suitcase of memories” (SOM). The study extends the current academic debate in the subjects of co-produced interventions and identifies the critical themes of Holidays as life; Freedom; View seen, viewpoint heard and Strengthened self-identity with younger self emerged from the research. Such areas of sensory reminiscence have supported positive recollections, discourse, and, when combined, resulted in a beneficial impact on the partners shared relationship. A significant research outcome was the transition from a negative life view dominated by dementia to positively rekindling their relationship as a result of the SOM intervention and sensory methodology. Future research will continue to work with new couples to see if similar results are achieved with more case studies. Key WordsDementia, Couplehood, Reminiscence, Tourism, Sensory, Memories, “Sensory Ethnography

Impact of a physician – critical care practitioner pre‐hospital service in Wales on trauma survival: a retrospective analysis of linked registry data

The Emergency Medical Retrieval and Transfer Service for Wales launched in 2015. This service delivers senior pre-hospital doctors and advanced critical care practitioners to the scene of time-critical life- and limb-threatening incidents to provide advanced decision-making and pre-hospital clinical care. The impact of the service on 30-day mortality was evaluated retrospectively using a data linkage system. The study included patients who sustained moderate-to-severe blunt traumatic injuries (injury severity score ≥ 9) between 27 April 2015 and 30 November 2018. The association between pre-hospital management by the Emergency Medical Retrieval and Transfer Service and 30-day mortality was assessed using multivariable logistic regression. In total, data from 4035 patients were analysed, of which 412 (10%) were treated by the Emergency Medical Retrieval and Transfer Service. A greater proportion of patients treated by the Emergency Medical Retrieval and Transfer Service had an injury severity score ≥ 16 and Glasgow coma scale ≤ 12 (288 (70%) vs. 1435 (40%) and 126 (31%) vs. 325 (9%), respectively). The unadjusted 30-day mortality rate was 11.7% for patients managed by the Emergency Medical Retrieval and Transfer Service compared with 9.6% for patients managed by standard pre-hospital care services. However, after adjustment for differences in case-mix, the 30-day mortality rate for patients treated by the Emergency Medical Retrieval and Transfer Service was 37% lower (adjusted odds ratio 0.63 (95%CI 0.41–0.97); p = 0.037). The introduction of an emergency medical retrieval service was associated with a reduction in 30-day mortality for patients with blunt traumatic injury

The Carnegie Hubble Program: The Distance and Structure of the SMC as Revealed by Mid-infrared Observations of Cepheids

Using Spitzer observations of classical Cepheids we have measured the true average distance modulus of the SMC to be $18.96 \pm 0.01_{stat} \pm 0.03_{sys}$ mag (corresponding to $62 \pm 0.3$ kpc), which is $0.48 \pm 0.01$ mag more distant than the LMC. This is in agreement with previous results from Cepheid observations, as well as with measurements from other indicators such as RR Lyrae stars and the tip of the red giant branch. Utilizing the properties of the mid--infrared Leavitt Law we measured precise distances to individual Cepheids in the SMC, and have confirmed that the galaxy is tilted and elongated such that its eastern side is up to 20 kpc closer than its western side. This is in agreement with the results from red clump stars and dynamical simulations of the Magellanic Clouds and Stream.Comment: Accepted for publication in ApJ. 38 Pages, 11 figures. Figure 9 is interactive. Spitzer photometry for all Cepheids available as online tabl

Cuyahoga County Bail Task Force: Report and Recommendations

Introduction: All Cuyahoga County courts should transition from a bail system based on bond schedules, which vary widely from one court to the next, to a centralized, consistent, and comprehensive system of pretrial services initiated immediately after arrest. For most minor offenses, the presumption should be release on personal recognizance. Money bail should not be used to simply detain defendants. Rather than relying on bond schedules, courts should assess each defendant’s risk of non-appearance and danger to the community using a uniform risk assessment tool. If money bail is considered, courts should evaluate each defendant’s risk of non-appearance and ability to pay, and then tailor money bail accordingly. A more robust and early evaluation of each defendant, using particularized information from a single, uniform database about a defendant’s criminal history and pending cases, as well as a risk assessment tool, would give judges better information upon which to make pretrial release decisions. Prompt centralized bail hearings before a judge, with defense counsel present, for all defendants in common pleas and municipal courts throughout the county would facilitate early and improved access to pretrial processes and services designed to reduce the risk of nonappearance and danger to the community. This system would lessen collateral consequences for the accused, such as loss of employment or housing while waiting in jail, and result in significant cost savings to government by reducing unnecessary detention

"Any lady can do this without much trouble ...": class and gender in The dining room (1878)

Macmillan's "Art at Home" series (1876–83) was a collection of domestic advice manuals. Mentioned in every study of the late-nineteenth-century domestic interior, they have often been interpreted, alongside contemporary publications such as Charles Eastlake's Hints on Household Taste (1868), as indicators of late 1870s home furnishing styles. Mrs Loftie's The Dining Room (1878) was the series' fifth book and it considers one of the home's principal (and traditionally masculine) domestic spaces. Recent research on middle-class cultural practices surrounding food has placed The Dining Room within the tradition of Mrs Beeton's Household Management (1861); however, it is not a cookery book and hardly mentions dinners. Drawing upon unpublished archival sources, this paper charts the production and reception of The Dining Room, aiming to unravel its relationships with other contemporary texts and to highlight the difficulties of using it as historical evidence. While it offers fascinating insights into contemporary taste, class and gender, this paper suggests that, as an example of domestic design advice literature, it reveals far more about the often expedient world of nineteenth-century publishing practices

Trajectories in chronic disease accrual and mortality across the lifespan in Wales, UK (2005–2019), by area deprivation profile: linked electronic health records cohort study on 965,905 individuals

Background: Understanding and quantifying the differences in disease development in different socioeconomic groups of people across the lifespan is important for planning healthcare and preventive services. The study aimed to measure chronic disease accrual, and examine the differences in time to individual morbidities, multimorbidity, and mortality between socioeconomic groups in Wales, UK.Methods: Population-wide electronic linked cohort study, following Welsh residents for up to 20 years (2000-2019). Chronic disease diagnoses were obtained from general practice and hospitalisation records using the CALIBER disease phenotype register. Multi-state models were used to examine trajectories of accrual of 132 diseases and mortality, adjusted for sex, age and area-level deprivation. Restricted mean survival time was calculated to measure time spent free of chronic disease(s) or mortality between socioeconomic groups.Findings: In total, 965,905 individuals aged 5-104 were included, from a possible 2.9 m individuals following a 5-year clearance period, with an average follow-up of 13.2 years (12.7 million person-years). Some 673,189 (69.7%) individuals developed at least one chronic disease or died within the study period. From ages 10 years upwards, the individuals living in the most deprived areas consistently experienced reduced time between health states, demonstrating accelerated transitions to first and subsequent morbidities and death compared to their demographic equivalent living in the least deprived areas. The largest difference were observed in 10 and 20 year old males developing multimorbidity (-0.45 years (99% CI: -0.45, -0.44)) and in 70 year old males dying after developing multimorbidity (-1.98 years (99% CI: -2.01, -1.95)).Interpretation: This study adds to the existing literature on health inequalities by demonstrating that individuals living in more deprived areas consistently experience accelerated time to diagnosis of chronic disease and death across all ages, accounting for competing risks