Perceived barriers and facilitators to physical activity and functional limitations among older adults

Lower physical function, mobility disability and the possibility of subsequent physical disabilities are major public health issues due to the rapid and continuing growth of the older adult population. In addition, the risk for mobility disability and physical disability increases with age. Longer life expectancy, rapid population growth, and low physical activity participation rates among older adults justify the need for better understanding of perceived barriers to and facilitators of physical activity. However, perceived barriers and facilitators, modifiable intra- and extra-individual mechanisms in the disablement pathway, remain underexplored. This dissertation aimed to provide novel insight into the associations between perceived barriers and facilitators, physical activity and related programs, and functional limitations among older adults. First, there are a range of factors that contribute to engagement in lifestyle programs aimed at mobility disability prevention for sedentary older adults, and these factors may be related to the type of program. Next, barriers may attenuate the effect of a structured physical activity program aimed at reducing major mobility disability. Finally, evidence was provided supporting the importance of considering social support as a specific barrier/facilitator in interventions aimed at improving physical function. Low levels of social support over time may increase the risk for declining physical function and subsequent disability development compared with those reporting moderate or high levels of social support. This research provides novel evidence that perceived barriers and facilitators are important to consider as they play key roles in the ongoing disablement pathway toward physical disability in older adults. This could inform the development and translation of future intervention efforts aimed at mobility disability reduction and physical disability prevention. Dissemination of feasible, sustainable and low cost programs for older adults is an important public health issue currently gaining more attention. This research took steps toward understanding the complexities of the disablement pathway and where we might be able to intervene to reduce the negative impact of these outcomes on the individual, health care system, and society. Ultimately, generating information to assist public health and health care professionals in addressing functional decline and disability

Food Waste to Bio-Products

The goal of this project was to design and evaluate a project for the collection and processing of food waste and spent oil in Philadelphia. The project was designed to handle 5% of the total commercial waste generated in Philadelphia. This amounted to approximately 9,700 tons/year of food waste and 73,000 gallons/year of spent oil. The process was designed to utilize a BIOFerm™ Dry Fermentation Digestion System. Following the digestion, the biogas produced is passed through a Caterpillar CG132-12 Generator Set, producing electricity to be sold back to the local grid. The digestate from the anaerobic digestion is used to produce compost, providing an additional revenue stream. In addition to handling the solid food waste, the project is designed to convert the collected spent oil into biodiesel using prepackaged processing units by Springboard Biodiesel. The facility is anticipated to annually produce 2,541 tons of biogas, 5,184,000 kWh of electricity, 14,756 tons of compost, and 59,616 gallons of biodiesel. A rigorous profitability analysis was conducted in order to project cash flows for fifteen years. The total capital investment of the plant is $5.6MM and the expected NPV of the project is -($682,000). The estimated IRR of the project is 12% and the 3-year ROI is 7%. Given the project’s negative NPV, our recommendation is to adopt such a process solely for environmentally beneficial waste management purposes. A key takeway is that in order for such a project to be profitable it would need to target more than just 5% of the total commercial food waste produced

A multitude of modes: considering ‘blended learning’ in context

Discussions of mode in higher education tend to contrast face-to-face teaching with distance education, while acknowledging that somewhere in between these poles, some students are engaged in a somewhat mysterious practice of ‘blended learning’. Blended learning is generally taken to indicate that a combination of face-to-face time in the classroom with the use of digital/online platforms is in use. While the question of whether blended learning is well-understood or well-defined remains unanswered, it can nonetheless be described as the ‘new normal’. This session considers transformation in educational delivery mode in the context of the results of an institutional review of technology-enhanced learning, undertaken at Birkbeck, University of London in 2018. An overview of the method and results of the review will be discussed, alongside consideration of the extent to which these findings are more widely applicable. Birkbeck’s mission has been to create opportunities to study for groups who are usually excluded by conventional modes of provision. However, where ‘distance’ mode teaching acts to take location out of the equation, Birkbeck has historically opened access through its timetable. Birkbeckstudents give up the semblance of a normal life to dedicate many of their evenings to the classroom. But perhaps this has obscured the extent to which student life is increasingly the life of the computer, as well as of the mind. Evening, face-to-face mode teaching, while seen to a great extent as the college’s ‘USP’, is only one element of the ‘student experience’ and digital practices have quietly gone mainstream. These results have thrown into question whether ‘face-to-face’ mode truly exists at Birkbeck any more. Furthermore, if blended learning has become an umbrella term that covers a multitude of modes, it seems that much closer attention is now due to the nature and diversity of ‘blends’

Unambiguous detection of cardiac Pi using long TM 31P STEAM

Synopsis Inorganic Phosphate is a resonance that holds important information on the metabolic state of tissues. From its resonance frequency, intracellular pH can be derived. The ratio of P to PCr or ATP are also important markers. Unlike in other tissues, myocardial P is frequently hidden underneath blood DPG signals. Using STEAM's T delay to be one cardiac cycle, blood-pool originating signals are gone and the Pi resonance is clearly visible. In 3 subjects, P signal was detected and quantified. The signal was around 4.89±0.02ppm, corresponding to a pH of 7.08±0.02. This is a breakthrough for the investigation of cardiac metabolism.This work was supported by the Austrian Science Fund (FWF) project J 4043 as well as by the Sir Henry Dale Fellowship from the Wellcome Trust and the Royal Society (098436/Z/12/Z)

Metabolic Costs of a 58-minute Multi-Intensity Exercise Session with and Without Music and Cueing

International Journal of Exercise Science 13(2): 358-365, 2020. It is unclear if the presence or absence of music and cueing influence total energy expenditure (TEE) during a multi-intensity exercise program. The purpose of this study was to determine the difference between TEE with or without music and cueing during a 58-minute exercise session using heart rate estimation (HRe) and indirect calorimetry (IC). Using a randomized crossover design, 22 participants (6 males; 16 females; 27.64 ± 10.33 yrs.) were randomized into two groups (Group A = 11; Group B = 11). All participants performed the same 58-minute exercise session under two conditions: with music (WM) and without music and cueing (WOM). TEE was obtained through the Activio heart rate system for all 22 participants. TEE and excess post-exercise oxygen consumption (EPOC) were also obtained in a subset of eight participants (4 males; 4 females; 28.25 ± 5.9 yrs.) via IC through a ParvoMedics metabolic cart. Paired samples t-tests were performed to compare TEE between conditions using HRe and IC. Statistical analysis was performed using IBM Analytics, SPSS v24 with significance set at p\u3c 0.05. A significant difference (p= 0.008) was found between TEE WM and WOM using IC (475.74 ± 98.50 vs. 429.37 ± 121.42), but not between TEE WM and WOM using HRe (p= 2.04; 482.67 ± 151.79 vs. 452.90 ± 164.59). The presence of music and cueing increased TEE when monitored via IC, but not when measured via wearable heart rate technology. Music and cueing does aid in additional caloric expenditure

Implementation of the Joint Duty Program at CIA: Analysis and Recommendations

This report assesses the strengths and weaknesses of the Joint Duty (JD) program as it is currently implemented at the CIA. Over the course of approximately six weeks, the Bush School 2012 Capstone interviewed - in-person and by phone - 160 CIA employees who completed a JD assignment. In assessing the qualitative and quantitative responses reported by personnel, we conclude that employees find value in the program, are well-integrated within their host agency, and achieve the program's mission of increasing employees' knowledge of other Intelligence Community agencies. Weaknesses hindering the program include: a disproportionately high number of employees choosing assignments at the Office of Director of National Intelligence (ODNI) and the National Reconnaissance Agency (NRO); insufficient manager guidance in selecting career-relevant assignments; failure to comply with regulations tasking agencies to maintain contact with their JD employees; employees experiencing significant difficulty returning to the CIA upon completion of their assignment; and inconsistent views regarding whether the program aids promotion potential.The Center for the Study of Intelligenc

Qualitative research to inform hypothesis testing for fidelity-based sub-group analysis in clinical trials : lessons learnt from the process evaluation of a multifaceted podiatry intervention for falls prevention

Background: Ensuring fidelity to complex interventions is a challenge when conducting pragmatic randomised controlled trials. We explore fidelity through a qualitative process evaluation, which was conducted alongside a pragmatic, multicentre, two-arm cohort randomised controlled trial: the REFORM (Reducing Falls with Orthoses and a Multifaceted podiatry intervention) trial. The paper aims, through a qualitative process evaluation, to explore some of the factors that may have affected the delivery of the REFORM intervention and highlight how project-specific fidelity can be assessed using a truly mixed-methods approach when informed by qualitative insights. Design: Semi-structured qualitative interviews carried out as part of a process evaluation. Interviews were analysed thematically. Setting: Seven NHS trusts in the UK and a University podiatry school in Ireland. Interviews were undertaken face-toface or over the telephone. Participants: Twenty-one REFORM trial participants and 14 podiatrists who delivered the REFORM intervention. Results: Factors affecting fidelity included: how similar the intervention was to routine practice; the challenges of delivering a multifaceted intervention to a heterogeneous older population; and practical issues with delivery such as time and training. Trial participants’ views of the intervention, whether falls prevention is a personal priority, their experience of being part of a trial and individual factors such as medical conditions may also have affected intervention fidelity. Conclusions: Our process evaluation highlighted factors that were perceived to have affected the fidelity of the REFORM intervention and in doing so demonstrates the importance of considering fidelity when designing and evaluating pragmatic trials. We propose a number of recommendations of how important project-specific insights from qualitative work can be incorporated into the design of fidelity measurement of future trials, which build on existing conceptual fidelity frameworks. In particular, we encourage adopting a mixed-methods approach whereby qualitative insights can be used to suggest ways to enhance quantitative data collection facilitating integration through hypothesis generation, hypothesis testing and seeking explanation for trial findings. This will provide a framework of enabling measures of fidelity to be incorporated into the understanding of trial results which has been relatively neglected by existing literature. Trial registration: ISRCTN Registry: ISRCTN68240461. Registered on 01/07/2011. Keywords: Process evaluation, Randomised controlled trials, Fidelity, Mixed methods, Falls, Elderly, Ageing, Qualitativ

Impact of the national home safety equipment scheme ‘Safe At Home’ on hospital admissions for unintentional injury in children under 5: a controlled interrupted time series analysis

Background: Unintentional home injuries are a leading cause of preventable death in young children. Safety education and equipment provision improve home safety practices, but their impact on injuries is less clear. Between 2009 and 2011 a national home safety equipment scheme was implemented in England (Safe At Home), targeting high injury rate areas and socio-economically disadvantaged families with children under 5. This provided a ‘natural experiment’ for evaluating the scheme’s impact on hospital admissions for unintentional injuries.Methods: Controlled interrupted time series analysis of unintentional injury hospital admission rates in small areas (Lower layer Super-Output Areas (LSOAs)) in England where the scheme was implemented (intervention areas, n=9,466)) matched with LSOAs in England and Wales where it was not implemented (control areas, n=9,466), with subgroup analyses by density of equipment provision.Results: 57,656 homes receiving safety equipment were included in the analysis. In the two years after the scheme ended, monthly admission rates declined in intervention areas (-0.33% (-0.47% to -0.18%)) but did not decline in control areas (0.04% (-0.11% to 0.19%), p value for difference in trend=0.001)). Greater reductions in admission rates were seen as equipment provision density increased. Effects were not maintained beyond two years after the scheme ended.Conclusions: A national home safety equipment scheme was associated with a reduction in injury-related hospital admissions in children under 5 in the 2-years after the scheme ended. Providing a higher number of items of safety equipment appears to be more effective in reducing injury rates than providing fewer items

Assessing metabolism and function of normothermically perfused ex vivo livers by multinuclear MR imaging and spectroscopy

Synopsis Liver transplantation is the only cure for end-stage liver disease. Unfortunately, 20% of patients die waiting for a donor. New techniques for preserving transplant livers, such as normothermic machine perfusion (NMP), provide an opportunity to utilise ‘marginal’ (currently discarded) donated livers if their viability can be assessed accurately. We present initial results from a CE-marked NMP system that we adapted for use in an MRI scanner. We demonstrate the power of NMP-MRI to assess structure and metabolism in a freshly donated pig liver, dynamically over a 10-hour period. Our protocol includes H imaging, P spectroscopy, and hyperpolarised C spectroscopy.This work was funded by a Sir Henry Dale Fellowship from the Wellcome Trust and the Royal Society (Grant No. 098436/Z/12/Z) and by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC)