Systematic scoping review of frameworks used to develop rehabilitation interventions for older adults

Objectives: Rehabilitation interventions for older adults are complex as they involve a number of interacting components, have multiple outcomes of interest and are influenced by a number of contextual factors. The importance of rigorous intervention development prior to formal evaluation has been acknowledged and a number of frameworks have been developed. This review explored which frameworks have been used to guide the development of rehabilitation interventions for older adults.Design: Systematic scoping review.Setting: Studies were not limited for inclusion based on setting.Participants: Studies were included that featured older adults (>65 years of age).Interventions: Studies were included that reported the development of a rehabilitation intervention.Primary and secondary outcome measures: Data was extracted on study population, setting, type of intervention developed and frameworks used. The primary outcome of interest was the type of intervention development framework.Results: Thirty-five studies were included. There was a range of underlying medical conditions including mild cognitive impairment and dementia (n=5), cardiac (n=4), stroke (n=3), falls (n=3), hip fracture (n=2), diabetes (n=2), breast cancer (n=1), Parkinson’s disease (n=1), depression (n=1), chronic health problems (n=1), osteoarthritis (n=1), leg ulcer (n=1), neck pain (n=1) and foot problems (n=1). The intervention types being developed included multicomponent, support-based, cognitive, physical activities, nursing-led, falls prevention and occupational therapy-led. Twelve studies (34%) did not report using a framework. Five frameworks were reported with the Medical Research Council (MRC) Framework for Developing and Evaluating Complex Interventions being the most frequently cited(77%, n=17).Conclusion: At present the MRC Framework is the most popular for developing rehabilitation interventions for older adults. Many studies do not report using a framework. Further, specific guidance to assist this complex field of rehabilitation research is required

Effects of Classroom-Based Resistance Training With and Without Cognitive Training on Adolescents’ Cognitive Function, On-task Behavior, and Muscular Fitness

Aim: Participation in classroom physical activity breaks may improve children’s cognition, but few studies have involved adolescents. The primary aim of this study was to examine the effects of classroom-based resistance training with and without cognitive training on adolescents’ cognitive function. Methods: Participants were 97 secondary school students (45.4% females, mean age 15.78 ± 0.44). Four-year 10 classes from one school were included in this four-arm cluster randomized controlled trial. Classes were randomly assigned to the following groups: sedentary control with no cognitive training, sedentary with cognitive training, resistance training without cognitive training, and resistance training with cognitive training. Sessions varied in levels of both cognitive demand and resistance training (i.e., high vs. low) and were administered three times per week for 4 weeks (12 sessions). Inhibition, cognitive flexibility, episodic memory, on-task behavior, and muscular fitness were assessed at baseline and post-test. Linear mixed models were used to examine changes within and between groups. Results: In comparison with the control group, episodic memory improved significantly in the resistance training without cognitive training group (−9.87 units, 95% CI: −17.71 to −2.03, p = 0.014, d = 0.72). There were no group-by-time effects for inhibition or cognitive flexibility. Classroom activity breaks both with and without cognitive demand improved participants’ on-task behavior in comparison with the control and sedentary group. The resistance training programs did not lead to improvements in muscular fitness. Conclusion: Participation in body weight resistance training without cognitive training led to selective improvements in episodic memory. No training effects were found for inhibition or cognitive flexibility. A longer study period may be necessary to induce improvements in muscular fitness and associated changes in inhibition and cognitive flexibilit

Sept8/SEPTIN8 involvement in cellular structure and kidney damage is identified by genetic mapping and a novel human tubule hypoxic model.

Chronic kidney disease (CKD), which can ultimately progress to kidney failure, is influenced by genetics and the environment. Genes identified in human genome wide association studies (GWAS) explain only a small proportion of the heritable variation and lack functional validation, indicating the need for additional model systems. Outbred heterogeneous stock (HS) rats have been used for genetic fine-mapping of complex traits, but have not previously been used for CKD traits. We performed GWAS for urinary protein excretion (UPE) and CKD related serum biochemistries in 245 male HS rats. Quantitative trait loci (QTL) were identified using a linear mixed effect model that tested for association with imputed genotypes. Candidate genes were identified using bioinformatics tools and targeted RNAseq followed by testing in a novel in vitro model of human tubule, hypoxia-induced damage. We identified two QTL for UPE and five for serum biochemistries. Protein modeling identified a missense variant within Septin 8 (Sept8) as a candidate for UPE. Sept8/SEPTIN8 expression increased in HS rats with elevated UPE and tubulointerstitial injury and in the in vitro hypoxia model. SEPTIN8 is detected within proximal tubule cells in human kidney samples and localizes with acetyl-alpha tubulin in the culture system. After hypoxia, SEPTIN8 staining becomes diffuse and appears to relocalize with actin. These data suggest a role of SEPTIN8 in cellular organization and structure in response to environmental stress. This study demonstrates that integration of a rat genetic model with an environmentally induced tubule damage system identifies Sept8/SEPTIN8 and informs novel aspects of the complex gene by environmental interactions contributing to CKD risk

Satellite-based emergency mapping using optical imagery: experience and reflections from the 2015 Nepal earthquakes

Landslides triggered by large earthquakes in mountainous regions contribute significantly to overall earthquake losses and pose a major secondary hazard that can persist for months or years. While scientific investigations of coseismic landsliding are increasingly common, there is no protocol for rapid (hours-to-days) humanitarian-facing landslide assessment and no published recognition of what is possible and what is useful to compile immediately after the event. Drawing on the 2015 Mw 7.8 Gorkha earthquake in Nepal, we consider how quickly a landslide assessment based upon manual satellite-based emergency mapping (SEM) can be realistically achieved and review the decisions taken by analysts to ascertain the timeliness and type of useful information that can be generated. We find that, at present, many forms of landslide assessment are too slow to generate relative to the speed of a humanitarian response, despite increasingly rapid access to high-quality imagery. Importantly, the value of information on landslides evolves rapidly as a disaster response develops, so identifying the purpose, timescales, and end users of a post-earthquake landslide assessment is essential to inform the approach taken. It is clear that discussions are needed on the form and timing of landslide assessments, and how best to present and share this information, before rather than after an earthquake strikes. In this paper, we share the lessons learned from the Gorkha earthquake, with the aim of informing the approach taken by scientists to understand the evolving landslide hazard in future events and the expectations of the humanitarian community involved in disaster response. Please read the corrigendum first before accessing the articl

East Midlands Research into Ageing Network (EMRAN) Discussion Paper Series

Academic geriatric medicine in Leicester . There has never been a better time to consider joining us. We have recently appointed a Professor in Geriatric Medicine, alongside Tom Robinson in stroke and Victoria Haunton, who has just joined as a Senior Lecturer in Geriatric Medicine. We have fantastic opportunities to support students in their academic pursuits through a well-established intercalated BSc programme, and routes on through such as ACF posts, and a successful track-record in delivering higher degrees leading to ACL post. We collaborate strongly with Health Sciences, including academic primary care. See below for more detail on our existing academic set-up. Leicester Academy for the Study of Ageing We are also collaborating on a grander scale, through a joint academic venture focusing on ageing, the ‘Leicester Academy for the Study of Ageing’ (LASA), which involves the local health service providers (acute and community), De Montfort University; University of Leicester; Leicester City Council; Leicestershire County Council and Leicester Age UK. Professors Jayne Brown and Simon Conroy jointly Chair LASA and have recently been joined by two further Chairs, Professors Kay de Vries and Bertha Ochieng. Karen Harrison Dening has also recently been appointed an Honorary Chair. LASA aims to improve outcomes for older people and those that care for them that takes a person-centred, whole system perspective. Our research will take a global perspective, but will seek to maximise benefits for the people of Leicester, Leicestershire and Rutland, including building capacity. We are undertaking applied, translational, interdisciplinary research, focused on older people, which will deliver research outcomes that address domains from: physical/medical; functional ability, cognitive/psychological; social or environmental factors. LASA also seeks to support commissioners and providers alike for advice on how to improve care for older people, whether by research, education or service delivery. Examples of recent research projects include: ‘Local History Café’ project specifically undertaking an evaluation on loneliness and social isolation; ‘Better Visits’ project focused on improving visiting for family members of people with dementia resident in care homes; and a study on health issues for older LGBT people in Leicester. Clinical Geriatric Medicine in Leicester We have developed a service which recognises the complexity of managing frail older people at the interface (acute care, emergency care and links with community services). There are presently 17 consultant geriatricians supported by existing multidisciplinary teams, including the largest complement of Advance Nurse Practitioners in the country. Together we deliver Comprehensive Geriatric Assessment to frail older people with urgent care needs in acute and community settings. The acute and emergency frailty units – Leicester Royal Infirmary This development aims at delivering Comprehensive Geriatric Assessment to frail older people in the acute setting. Patients are screened for frailty in the Emergency Department and then undergo a multidisciplinary assessment including a consultant geriatrician, before being triaged to the most appropriate setting. This might include admission to in-patient care in the acute or community setting, intermediate care (residential or home based), or occasionally other specialist care (e.g. cardiorespiratory). Our new emergency department is the county’s first frail friendly build and includes fantastic facilities aimed at promoting early recovering and reducing the risk of hospital associated harms. There is also a daily liaison service jointly run with the psychogeriatricians (FOPAL); we have been examining geriatric outreach to oncology and surgery as part of an NIHR funded study. We are home to the Acute Frailty Network, and those interested in service developments at the national scale would be welcome to get involved. Orthogeriatrics There are now dedicated hip fracture wards and joint care with anaesthetists, orthopaedic surgeons and geriatricians. There are also consultants in metabolic bone disease that run clinics. Community work Community work will consist of reviewing patients in clinic who have been triaged to return to the community setting following an acute assessment described above. Additionally, primary care colleagues refer to outpatients for sub-acute reviews. You will work closely with local GPs with support from consultants to deliver post-acute, subacute, intermediate and rehabilitation care services. Stroke Medicine 24/7 thrombolysis and TIA services. The latter is considered one of the best in the UK and along with the high standard of vascular surgery locally means one of the best performances regarding carotid intervention

Evaluating a model of best practice in primary care led post-diagnostic dementia care: feasibility and acceptability findings from the PriDem study

Objectives: To evaluate the feasibility and acceptability of a primary care-based intervention for improving post-diagnostic dementia care and support (PriDem), and implementation study procedures.// Design: A non-randomised, mixed methods, feasibility study.// Setting: Seven general practices from four primary care networks (PCNs) in the Northeast and Southeast of England.// Participants: We aimed to recruit 80 people with dementia (PWD) and 66 carers.// Intervention: Clinical Dementia Leads delivered a 12-month intervention in participating PCNs, to develop care systems, build staff capacity and capability, and deliver tailored care and support to PWD and carers.// Outcomes: Recruitment and retention rates were measured. A mixed methods process evaluation evaluated feasibility and acceptability of the intervention and study procedures. Using electronic care records, researchers extracted service use data and undertook a dementia care plan audit, preintervention and postintervention, assessing feasibility of measuring the primary implementation outcome: adoption of personalised care planning by participating general practices. Participants completed quality of life, and service use measures at baseline, 4 and 9 months.// Results: 60 PWD (75% of recruitment target) and 51 carers (77% of recruitment target) were recruited from seven general practices across four PCNs. Retention rate at 9 months was 70.0% of PWD and 76.5% of carers. The recruitment approach showed potential for including under-represented groups within dementia. Despite implementation challenges, the intervention was feasible and acceptable, and showed early signs of sustainability. Study procedures were feasible and accessible, although researcher capacity was crucial. Participants needed time and support to engage with the study. Care plan audit procedures were feasible and acceptable.// Conclusions: The PriDem model is an acceptable and feasible intervention. A definitive study is warranted to fully inform dementia care policy and personalised dementia care planning guidance. Successful strategies to support inclusion of PWD and their carers in future research were developed.// Trial registration number: ISRCTN11677384

Application of Multidisciplinary Community Resilience Modeling to Reduce Disaster Risk: Building Back Better

From december 10 to december 11, 2021, a deadly tornado outbreak struck across several states in the us, including arkansas, illinois, kentucky, and tennessee. This tornado outbreak resulted in at least $3.9 Billion in damage, more than 90 fatalities, and hundreds of injuries. Mayfield, kentucky, a small city in the eastern united states, was hit by a long-track tornado rated as an enhanced fujita 4 (ef4) scale and was one of the communities most heavily damaged during the tornado outbreak. Following the 2021 tornado event, an analysis was performed in the interdependent networked community resilience modeling environment (in-core) for the city of mayfield to investigate a design code change for residential structures and its effect on communitywide metrics related to functionality and dislocation. Specifically, the in-core modeling environment was used to hindcast the community-level building damage and forecast the community-level building recovery in mayfield for residential buildings. This required the development of a mayfield test bed for in-core with a focus on buildings. The generalization of multidisciplinary community resilience modeling from a test bed community to a real community impacted by a recent major tornado event is intended to benchmark that in-core has a strong potential and capability to forecast/hindcast community resilience and provide what-if scenarios for decision makers, city planners, and stakeholders in communities with similar sizes

Developing the Principles of Falls Management in Care Homes: An expert Consensus Process

Context: Managing falls in care homes requires an individualised approach for each resident with involvement of staff from care homes and the wider health and social care system. A large randomised controlled trial evaluating an individualised falls management programme (Action FALLS) demonstrated positive findings. However, the delivery of the key components of such programmes is still unclear. Greater understanding of the core components of falls management programmes is needed to support future implementation research.Objective: To establish expert consensus on the core components of falls management for older care home residents.Methods: A modified Nominal Group Technique included the development of a draft set of principles through a scoping review of the grey literature (published elsewhere) and a one-off online nominal group with care home staff and clinicians. Following the group, a single online survey was circulated to gain agreement on the final principles.Findings: 10 participants (including healthcare professionals, care home managers, and care home staff) took part in the online nominal group. Thirty-five core principles of falls management were developed within the domains of theoretical approach, assessments, interventions, training, time points, wider systems, and governance and reporting.Limitations: Since a small number of experts took part in this consensus process from a large and diverse care home sector, it is important to consider the principles as providing support for future implementation work.Implications: These core principles provide a foundation to guide care homes in managing falls in care home residents. Further research is needed to develop implementation strategies and test the feasibility of embedding the principles in routine practice

Satellite-based emergency mapping using optical imagery: experience and reflections from the 2015 Nepal earthquakes

Landslides triggered by large earthquakes in mountainous regions contribute significantly to overall earthquake losses and pose a major secondary hazard that can persist for months or years. While scientific investigations of coseismic landsliding are increasingly common, there is no protocol for rapid (hours-to-days) humanitarian-facing landslide assessment and no published recognition of what is possible and what is useful to compile immediately after the event. Drawing on the 2015 Mw 7.8 Gorkha earthquake in Nepal, we consider how quickly a landslide assessment based upon manual satellite-based emergency mapping (SEM) can be realistically achieved and review the decisions taken by analysts to ascertain the timeliness and type of useful information that can be generated. We find that, at present, many forms of landslide assessment are too slow to generate relative to the speed of a humanitarian response, despite increasingly rapid access to high-quality imagery. Importantly, the value of information on landslides evolves rapidly as a disaster response develops, so identifying the purpose, timescales, and end users of a post-earthquake landslide assessment is essential to inform the approach taken. It is clear that discussions are needed on the form and timing of landslide assessments, and how best to present and share this information, before rather than after an earthquake strikes. In this paper, we share the lessons learned from the Gorkha earthquake, with the aim of informing the approach taken by scientists to understand the evolving landslide hazard in future events and the expectations of the humanitarian community involved in disaster response

Lockdown labs : pivoting to remote learning in forensic science higher education

Forensic Science training and education is reliant on the application of knowledge to casework scenarios and the development of key practical skills that provide a platform for career development in the field. The COVID-19 pandemic introduced a number of challenges to effectively deliver practical content online and remotely, whilst still meeting intended learning outcomes, accreditation requirements, and attaining a high level of student engagement and experience. The MSc Forensic Science programme featured in this study is a one-year degree programme with a strong emphasis on the practical elements of forensic science, and a diverse international student cohort. Therefore, the restrictions associated with the pandemic made it very difficult not only to plan the delivery of material but also to adapt the content itself for effective online and remote learning. By focusing on the intended learning outcomes, a number of innovative teaching practices were developed to successfully transition from face-to-face teaching to online and remote delivery. A range of online and practical resources were developed, including a laboratory home kit, demonstration videos, online practical technique simulations (produced by Learning Science), data analysis tasks, and interactive workshops and activities, all designed to consolidate student learning and build confidence, in preparation for such a time that on campus practical teaching could resume. The initial feedback received from these activities from both staff and students was extremely positive and the transition from classroom to online teaching was a success, as reflected in student attainment and later student feedback. Students reported that they had a better understanding of what was expected of them, including knowledge of protocols and techniques, and felt much more confident moving into the next stage of their learning development. Even though the practical laboratory sessions were the most significantly affected by the restrictions associated with the pandemic, and resulted in reduced interaction for the students, this was counteracted by virtual sessions and workshops, which gave students the opportunity to engage with each other and communicate their thoughts and opinions, ultimately building key presentation and group working skills. This case study will detail the pivot to remote learning, as well as critically evaluating the feedback from students and discussing the changes that are likely to be retained as longer-term teaching practices, versus those that were a necessary temporary addition or adjustment in response to the pandemic