The Effect of Different Decline Angles on the Biomechanics of Double Limb Squats and the Implications to Clinical and Training Practice

Bilateral decline squatting has been well documented as a rehabilitation exercise, however, little information exists on the optimum angle of decline. The aim of this study was to determine the ankle and knee angle, moments, the patellofemoral joint load, patellar tendon load and associated muscle activity while performing a double limb squat at different decline angles and the implications to rehabilitation. Eighteen healthy subjects performed double limb squats at 6 angles of declination: 0, 5, 10, 15, 20 and 25 degrees. The range of motion of the knee and ankle joints, external moments, the patellofemoral/patellar tendon load and integrated EMG of gastrocnemius, tibialis anterior, rectus femoris and biceps femoris were evaluated. As the decline angle increased up to 20 degrees, the range of motion possible at the ankle and knee increased. The joint moments showed a decrease at the ankle up to 15 degrees and an increase at the knee up to 25 degrees, indicating a progressive reduction in loading around the ankle with a corresponding increase of the load in the patellar tendon and patellofemoral joint. These trends were supported by a decrease in tibialis anterior activity and an increase in the rectus femoris activity up to 15 degrees declination. However, gastrocnemius and biceps femoris activity increased as the decline angle increased above 15 degrees. The action of gastrocnemius and biceps femoris stabilises the knee against an anterior displacement of the femur on the tibia. These findings would suggest that there is little benefit in using a decline angle greater than 15-20 degrees unless the purpose is to offer an additional stability challenge to the knee joint

Why is it difficult to implement e-health initiatives? A qualitative study

<b>Background</b> The use of information and communication technologies in healthcare is seen as essential for high quality and cost-effective healthcare. However, implementation of e-health initiatives has often been problematic, with many failing to demonstrate predicted benefits. This study aimed to explore and understand the experiences of implementers - the senior managers and other staff charged with implementing e-health initiatives and their assessment of factors which promote or inhibit the successful implementation, embedding, and integration of e-health initiatives.<p></p> <b>Methods</b> We used a case study methodology, using semi-structured interviews with implementers for data collection. Case studies were selected to provide a range of healthcare contexts (primary, secondary, community care), e-health initiatives, and degrees of normalization. The initiatives studied were Picture Archiving and Communication System (PACS) in secondary care, a Community Nurse Information System (CNIS) in community care, and Choose and Book (C&B) across the primary-secondary care interface. Implementers were selected to provide a range of seniority, including chief executive officers, middle managers, and staff with 'on the ground' experience. Interview data were analyzed using a framework derived from Normalization Process Theory (NPT).<p></p> <b>Results</b> Twenty-three interviews were completed across the three case studies. There were wide differences in experiences of implementation and embedding across these case studies; these differences were well explained by collective action components of NPT. New technology was most likely to 'normalize' where implementers perceived that it had a positive impact on interactions between professionals and patients and between different professional groups, and fit well with the organisational goals and skill sets of existing staff. However, where implementers perceived problems in one or more of these areas, they also perceived a lower level of normalization.<p></p> <b>Conclusions</b> Implementers had rich understandings of barriers and facilitators to successful implementation of e-health initiatives, and their views should continue to be sought in future research. NPT can be used to explain observed variations in implementation processes, and may be useful in drawing planners' attention to potential problems with a view to addressing them during implementation planning

Barriers and facilitators to smoking cessation in pregnancy and postpartum : the healthcare professionals

Objectives: Healthcare professionals and the healthcare environment play a central role in protecting pregnant and postpartum women and their infants from smoking-related harms. This study aimed to better understand the health professional’s perspective on how interactions between women, healthcare professionals and the environment influence how smoking is managed. Design: Semi-structured interviews and focus groups. Methods: Data were from 48 healthcare staff involved in antenatal or postpartum care at two UK sites, including midwives, obstetricians, health visitors, GPs, pharmacists, service commissioners and Stop Smoking Service (SSS) advisors and managers. Thematic analysis was guided by a Social-Ecological Framework (SEF). Results: Themes were divided across three SEF levels and represented factors connected to the management of smoking in the healthcare context and the beliefs and behaviour of pregnant or postpartum smokers. Organisational level: service reconfigurations, 'last resort' nicotine replacement therapy prescribing policies, and non-mandatory training were largely negative factors. There were mixed views on opt-out referral pathways and positive views on carbon monoxide monitoring. Inter-personal level: protection of client-professional relationships often inhibited frank discussions about smoking, and weak inter-service relationships affected SSS referral motivation and quality. Individual level: professionals felt community midwives had primary responsibility for managing smoking, though midwives felt under-skilled doing this. Midwives’ perceived priority for addressing smoking was influenced by the demands from unrelated organisational initiatives. Conclusions: Opportunities to improve clinical support for pregnant smokers exist at organisational, inter-service and healthcare professional levels. Interactions between levels reflect the importance of simultaneously addressing different level-specific barriers to smoking cessation in pregnancy

The functional response of a generalist predator

Peer reviewedPublisher PD

Social support and high resilient coping in carers of people with dementia

High resilience is associated improved carer outcomes. Both individual factors and the availability of social support have been linked with resilience. This study was conducted to compare socio-demographic characteristics and the availability of social support for carers with low and high resilient coping, and identify if any domain of social support predicted high resilient coping in informal carers of people with dementia. The participants in this cross sectional survey included 108 informal carers of people with dementia. Findings showed the availability of emotional/informational support was most likely to predict resilient coping and tangible support the least likely. However, when controlling for all covariates, only gender predicted high resilient coping, individual social support domains were no longer significant. Therefore, as no single domain of social support has a significantly greater influence on resilient coping, therefore service providers should enable carers to build a wide, multi-function support network

Governing the world at a distance : the practice of global benchmarking

Benchmarking practices have rapidly diffused throughout the globe in recent years. This can be traced to their popularity amongst non-state actors, such as civil society organisations and corporate actors, as well as states and international organisations (IOs). Benchmarks serve to both ‘neutralise’ and ‘universalise’ a range of overlapping normative values and agendas, including freedom of speech, democracy, human development, environmental protection, poverty alleviation, ‘modern’ statehood, and ‘free’ markets. The proliferation of global benchmarks in these key areas amounts to a comprehensive normative vision regarding what various types of transnational actors should look like, what they should value, and how they should behave. While individual benchmarks routinely differ in terms of scope and application, they all share a common foundation, with normative values and agendas being translated into numerical representations through simplification and extrapolation, commensuration, reification, and symbolic judgements. We argue that the power of benchmarks chiefly stems from their capacity to create the appearance of authoritative expertise on the basis of forms of quantification and numerical representation. This politics of numbers paves the way for the exercise of various forms of indirect power, or ‘governance at a distance’, for the purposes of either status quo legitimation or political reform