Exploring stroke survivors' and physiotherapists' views of self-management after stroke : a qualitative study in the UK

Objectives Stroke is a sudden-onset condition with long-term consequences. Self-management could help address long-term consequences of stroke. Stroke survivors' and health professionals' views of self-management may vary, limiting the successful introduction of self-management strategies. This paper explores stroke survivors' and physiotherapists' views of self-management, focusing on what self-management means, and factors perceived to enable and hinder self-management after stroke, to draw out implications for policy, practice and future research.Design Qualitative study using semistructured interviews and a thematic analysis approach.Setting Stroke unit and community stroke-rehabilitation services in London, UK.Participants 13 stroke survivors (8 men and 5 women; aged 53–89 years) admitted to a London stroke unit. 13 physiotherapists: 8 working in an inpatient stroke unit and 5 in community rehabilitation.Results Key differences were evident in how self-management was understood between these groups. Stroke survivors were unfamiliar with the term self-management, but most could provide their own definition and relate to the term, and understood it as care of the self: ‘doing things for yourself’ and ‘looking after yourself’. They did not recognise self-management as part of their care, but valued therapists as encouraging experts in supporting their recovery after stroke. Physiotherapists commonly understood self-management as a process in which stroke survivors were expected to take an active role in their rehabilitation and manage their recovery and health, with different understandings of self-management among physiotherapists shaped by the context in which they worked. They reported that individual, social and organisational factors enable and hinder self-management after stroke, with individual and organisational barriers particularly evident in the early stages.Conclusions If self-management support approaches are to be used, further work is required to explore the language and strategies used by professionals to support self-management, and the barriers to supporting self-management at different time points after stroke

Delivering sustainable, resilient and liveable cities via transformed governance

In the context of steadily declining Natural Capital and universal recognition of the imperative to reverse this trend before we get to the point that nature is not able to restore itself, cities have a crucial role to play. The UK Government commissioned a comprehensive study into the value of biodiversity, and by extension nature, reinforcing “why we should change our ways”—yet what is missing is the “how?”. This paper uniquely describes both the “how?” and a conclusive demonstration of the remarkable benefits of implementing it in a city. Critical to this process, it took a UK Parliamentary Inquiry to reveal that nature has become invisible within the economy, yet the ecological ecosystem services nature provides have enormous benefits to both people and the economy. Therefore integration—or seamless weaving—of urban greenspace and nature into people's lives and the places where they live, work, and spend their leisure time is vital. Moreover, what nature does not provide must be provided by engineered systems, and these have an economic cost; put another way, there are enormous cost savings to be made by taking advantage of what nature provides. In addressing these issues, this paper is the definitive paper from a 20-year portfolio of research on how to bring about transformative change in the complex system-of-systems that make up our cities, providing as it does the crucial in-depth research into the many diverse strands of governance—the last link in a chain of the creation, testing and proof of efficacy of methodologies underpinning a theory and practice of change for infrastructure and cities. The impact of this portfolio of research on Birmingham is two-fold: the Star Framework that placed natural environment considerations at the heart of all decision-making in the city, and the successful bid for the largest of the UK Future Parks Accelerator awards. While both are transformative in their different ways, yet mutually supportive, the latter enabled the design of a suite of system interventions from which the value of Birmingham's greenspaces is estimated to rise from £11.0 billion to £14.4 billion—a remarkable return on investment from the research's conceptualization of Birmingham's urban greenspace as a “business” (with its associated business models). In achieving this, the necessary enablers of thinking and practicing systemically, seamlessly working across disciplinary boundaries, an unusually strong focus on both the aspirations of all stakeholders and the context in question to define “the problem,” and the testing of proposed system intervention(s) both now and in the future have been iteratively combined. However, it is the critical enabling steps of identifying the complete range of value-generating opportunities that the interventions offer, formulating them into alternative business models to underpin the case for change and ensuring that they are synergistic with all the dimensions of governance that yielded the profound outcomes sought

Socio-scientific Issues based Teaching and Learning: Hydrofracturing as an Illustrative context of a Framework for Implementation and Research

Global citizens are constantly immersed in issues like hydraulic fracturing or "hydrofracturing" that rely upon scientific knowledge and the ability to negotiate multiple forms of evidence and reasoning to make informed decisions. Historically, Environmental Education and Science Education have been well positioned to provide learning experiences that support the development of important skills like Discourse that are requisite for full participation in our worldwide community. In this article, we explore the confluence of environmental education, science education, and the emergence of an empirical model for socio-scientific Issues (SSI) based teaching and learning. While environmental education and science education have distinct differences, there are significant overlaps in content and process. The emergence of SSI from the field of science education presents opportunities to drive environmental education, and a new framework for guiding SSI based teaching and learning can be useful in terms of informing focus, structure and processes for teaching through issues. Using hydrofracturing as a sample issue, we demonstrate how this recently developed SSI framework can be applied to create learning environments that support development of critical Discourse practices and further the goals of science and environmental education. The core aspects of the framework are 1) design elements, 2) learner experiences, and 3) teacher attributes. We elaborate each of these aspects and demonstrate how to reposition science content and the roles of students and teachers to engage in the issue of hydrofracturing. The SSI framework also highlights the importance of a safe classroom community and an awareness of the broader geo-political context when practicing SSI based teaching and learning.  This work provides a theoretical and practical basis to drive the fields of science and environmental education towards research and teaching that promote engaged global citizenship and social justice

Shaping innovations in long-term care for stroke survivors with multimorbidity through stakeholder engagement

BACKGROUND:Stroke, like many long-term conditions, tends to be managed in isolation of its associated risk factors and multimorbidity. With increasing access to clinical and research data there is the potential to combine data from a variety of sources to inform interventions to improve healthcare. A 'Learning Health System' (LHS) is an innovative model of care which transforms integrated data into knowledge to improve healthcare. The objective of this study is to develop a process of engaging stakeholders in the use of clinical and research data to co-produce potential solutions, informed by a LHS, to improve long-term care for stroke survivors with multimorbidity. METHODS:We used a stakeholder engagement study design informed by co-production principles to engage stakeholders, including service users, carers, general practitioners and other health and social care professionals, service managers, commissioners of services, policy makers, third sector representatives and researchers. Over a 10 month period we used a range of methods including stakeholder group meetings, focus groups, nominal group techniques (priority setting and consensus building) and interviews. Qualitative data were recorded, transcribed and analysed thematically. RESULTS:37 participants took part in the study. The concept of how data might drive intervention development was difficult to convey and understand. The engagement process led to four priority areas for needs for data and information being identified by stakeholders: 1) improving continuity of care; 2) improving management of mental health consequences; 3) better access to health and social care; and 4) targeting multiple risk factors. These priorities informed preliminary design interventions. The final choice of intervention was agreed by consensus, informed by consideration of the gap in evidence and local service provision, and availability of robust data. This shaped a co-produced decision support tool to improve secondary prevention after stroke for further development. CONCLUSIONS:Stakeholder engagement to identify data-driven solutions is feasible but requires resources. While a number of potential interventions were identified, the final choice rested not just on stakeholder priorities but also on data availability. Further work is required to evaluate the impact and implementation of data-driven interventions for long-term stroke survivors

The Australia Telescope 20 GHz (AT20G) Survey: The Bright Source Sample

The Australia Telescope 20 GHz (AT20G) Survey is a blind survey of the whole Southern sky at 20 GHz (with follow-up observations at 4.8 and 8.6 GHz) carried out with the Australia Telescope Compact Array (ATCA) from 2004 to 2007. The Bright Source Sample (BSS) is a complete flux-limited subsample of the AT20G Survey catalogue comprising 320 extragalactic (|b|>1.5 deg) radio sources south of dec = -15 deg with S(20 GHz) > 0.50 Jy. Of these, 218 have near simultaneous observations at 8 and 5 GHz. In this paper we present an analysis of radio spectral properties in total intensity and polarisation, size, optical identifications and redshift distribution of the BSS sources. The analysis of the spectral behaviour shows spectral curvature in most sources with spectral steepening that increases at higher frequencies (the median spectral index \alpha, assuming S\propto \nu^\alpha, decreases from \alpha_{4.8}^{8.6}=0.11 between 4.8 and 8.6 GHz to \alpha_{8.6}^{20}=-0.16 between 8.6 and 20 GHz), even if the sample is dominated by flat spectra sources (85 per cent of the sample has \alpha_{8.6}^{20}>-0.5). The almost simultaneous spectra in total intensity and polarisation allowed us a comparison of the polarised and total intensity spectra: polarised fraction slightly increases with frequency, but the shapes of the spectra have little correlation. Optical identifications provided an estimation of redshift for 186 sources with a median value of 1.20 and 0.13 respectively for QSO and galaxies.Comment: 34 pages, 19 figures, tables of data included, replaced with version published in MNRA

Radio Emission from SN 1994I in NGC 5194 (M 51) - The Best Studied Type Ib/c Radio Supernova

We present the results of detailed monitoring of the radio emission from the Type Ic supernova SN 1994I from 3 days after optical discovery on 1994 March 31 until eight years later at age 2927 days on 2002 April 05. The data were mainly obtained using the Very Large Array at the five wavelengths, 1.3, 2.0, 3.6, 6.2, and 21 cm, and from the Cambridge 5 km Ryle Telescope at 2.0 cm. Two additional measurements were obtained at millimeter wavelengths. This data set represents the most complete, multifrequency radio observations ever obtained for a Type Ib/c supernova. The radio emission evolves regularly in both time and frequency and is well described by established SN emission/absorption models. It is the first radio supernova with sufficient data to show that it is clearly dominated by the effects of synchrotron self-absorption at early times.Comment: 43 pages, 5 figure

Biguanide iridium(III) complexes with potent antimicrobial activity

We have synthesized novel organoiridium(III) antimicrobial complexes containing a chelated biguanide, including the antidiabetic drug metformin. These 16- and 18-electron complexes were characterized by NMR, ESI-MS, elemental analysis, and X-ray crystallography. Several of these complexes exhibit potent activity against Gram-negative bacteria and Gram-positive bacteria (including methicillin-resistant Staphylococcus aureus (MRSA)) and high antifungal potency toward C. albicans and C. neoformans, with minimum inhibitory concentrations (MICs) in the nanomolar range. Importantly, the complexes exhibit low cytotoxicity toward mammalian cells, indicating high selectivity. They are highly stable in broth medium, with a low tendency to generate resistance mutations. On coadministration, they can restore the activity of vancomycin against vancomycin-resistant Enterococci (VRE). Also the complexes can disrupt and eradicate bacteria in mature biofilms. Investigations of reactions with biomolecules suggest that these organometallic complexes deliver active biguanides into microorganisms, whereas the biguanides themselves are inactive when administered alone

Metal ion binding to the amyloid beta monomer studied by native top-down FTICR mass spectrometry

Native top-down mass spectrometry is a fast, robust biophysical technique that can provide molecular-scale information on the interaction between proteins or peptides and ligands, including metal cations. Here we have analyzed complexes of the full-length amyloid β (1-42) monomer with a range of (patho)physiologically relevant metal cations using native Fourier transform ion cyclotron resonance mass spectrometry and three different fragmentation methods—collision-induced dissociation, electron capture dissociation, and infrared multiphoton dissociation—all yielding consistent results. Amyloid β is of particular interest as its oligomerization and aggregation are major events in the etiology of Alzheimer’s disease, and it is known that interactions between the peptide and bioavailable metal cations have the potential to significantly damage neurons. Those metals which exhibited the strongest binding to the peptide (Cu2+, Co2+, Ni2+) all shared a very similar binding region containing two of the histidine residues near the N-terminus (His6, His13). Notably, Fe3+ bound to the peptide only when stabilized toward hydrolysis, aggregation, and precipitation by a chelating ligand, binding in the region between Ser8 and Gly25. We also identified two additional binding regions near the flexible, hydrophobic C-terminus, where other metals (Mg2+, Ca2+, Mn2+, Na+, and K+) bound more weakly—one centered on Leu34, and one on Gly38. Unexpectedly, collisional activation of the complex formed between the peptide and [CoIII(NH3)6]3+ induced gas-phase reduction of the metal to CoII, allowing the peptide to fragment via radical-based dissociation pathways. This work demonstrates how native mass spectrometry can provide new insights into the interactions between amyloid β and metal cations

Development of a mechanism to facilitate the safety stock planning configuration in ERP

Safety stock planning in ERP in general is dependent upon the planner having the experience to simulate planning scenarios. This paper focuses on the development of a mechanism to calculate adequate safety stocks in accordance with required service levels while enabling efficient configuration of the ERP safety stock parameters. The proposed mechanism could be of great benefit to industrial firms as it offers the ability to classify demand patterns, proposes replenishment strategies that are consistent with the demand profile, calculates key parameters and identifies the changes required to the ERP master data. The associated real world application is able to identify potential to save approximately £1.2 M in stock reductions and, more importantly, allows targeted actions to be implemented at material level. These results demonstrated that the proposed mechanism can be considered as a valuable new development for manufacturing industry to gain the competitive advantage