Filtering wireless (Wi-Fi) internet access in public places

This paper discusses selected results from the AHRC-funded ‘Managing Access to the Internet in Public Librarie s' (MAIPLE) project and explores Wi-Fi Internet access in UK public libraries. It investigates how this compares to commercial provision of public Wi-Fi. It discusses security issues, filtering of Wi-Fi access and acceptable use policies. A mixed methods approach was used involving a review of the literature, a questionnaire survey of UK public library authorities and five case studies of selected authorities. A majority of UK public library authorities offer Wi-Fi access to the public at one or more of their libraries and they generally have an authentication system in place for their users. The majority of survey respondents that provide Wi-Fi use filtering software. There are similarities and differences in the ways that public libraries and commercial outlets provide and manage access to their wireless networks. Differences mainly relate to security and privacy: these differences reflect to an extent the underlying purposes of providing public Wi-Fi access as well as legal obligations. In some ways, public library Wi-Fi access is better managed than commercially provided public services. Evidence from the case studies suggests reluctant acceptance of filtering on the part of public library authorities, based on a perceived need to balance providing access to information with providing a safe and trusted public space for all

End-of-life care in UK care homes: a systematic review of the literature

Background The number of people requiring end-of-life care provision in care homes has grown significantly. There is a need for a systematic examination of individual studies to provide more comprehensive information about contemporary care provision. Aim The aim of this study was to systematically review studies that describe end-of-life care in UK care homes. Method A systematic PRISMA review of the literature published between 2008 and April 2017 was carried out. A total of 14 studies were included in the review. Results A number of areas of concern were identified in the literature in relation to the phases of dying during end-of-life care: end-of-life pre-planning processes; understandings of end-of-life care; and interprofessional end-of-life care provision. Conclusions Given that the problems identified in the literature concerning end-of-life care of residents in care homes are similar to those encountered in other healthcare environments, there is logic in considering how generalised solutions that have been proposed could be applied to the specifics of care homes. Further research is necessary to explore how barriers to good end-of-life care can be mitigated, and facilitators strengthened

A cross-sectional study on the deprivation and sex differences in health-related fitness measures in school children

This study aimed to investigate deprivation and sex differences in selected health-relatedfitness measures in 9-12-year-old children. Data were captured on 3,407 children (49.3% boys; aged 10.5 ± 0.6 years). Cardiorespiratory fitness(20 m multistage shuttle run test; 20 m MSRT), muscular strength (handgrip strength) and body mass index (BMI) were measured. Welsh Index of Multiple Deprivation (WIMD) scores were used to make quintile groups. A two-way Analysis of Variance examined differences in BMI z-score by sex and WIMD quintiles. Two-wayAnalysis of Covariances investigated the effect of sex and WIMD quintiles on grip strength and shuttles achieved in 20 m MSRT, adjusting for BMI z-score and maturation, repectively. Independent of sex, children in the middle quintile had a significantly higher mean BMI z-score (p = 0.029) than their least deprived counterparts. There was a significant increase in grip strength (p = 0.005) and20 m MSRT (boys p < 0.001; girls p = 0.028) between most and least deprived quintiles. Significant differences in 20 m MSRT score were more apparent with decreases in deprivation in boys.Overall, inequalities exist in health-related fitness by sex and deprivation. These results can be used to inform focused services to improve current and future health

Systematic critical realist review of interventions designed to improve end-of-life care in care homes.

The demand for high-quality end-of-life care is rising. Frequently evidenced concerns about the provision of end-of-life in care homes relate to inter-disciplinary communication and engagement in advance care planning. A number of interventions employing different mechanisms have been designed to address these issues. Therefore, the aim of this systematic critical realist review was to describe and explain the effectiveness of interventions designed to improve end-of-life care in care homes. Electronic searches were conducted in ScienceDirect, MEDLINE, PubMed, PsychINFO, and CINAHL from January 2000 to August 2018. Forty one studies were included in the review. While most of the evidence identified in this review was not strong, there was evidence to suggest that education and inter-professional collaboration can be effective intervention mechanisms for improving end-of-life care in care homes. High staff turnover was a significant contextual mechanism impacting on the sustainability of interventions. In terms of human agency, it is important to note a consistent finding related to the dedication and enthusiasm of care home staff who deliver end-of-life care

The role of the advanced clinical practitioner in breast diagnosis : a systematic review of the literature

Increasing prevalence in breast cancers, workforce shortages and technological advancements have increased the need to further develop advanced practice in breast diagnosis. The Advanced Clinical Practitioner training programme has been introduced to support this need. The aim of this work was to systematically review studies that explore advanced practice in mammography to assess the potential impact of the introduction of a specific Advanced Clinical Practitioner training programme in breast diagnosis within the UK. A systematic PRISMA review of the literature published between 1999 and January 2020 was carried out. A total of 17 studies were included in the review. Four themes were identified in the literature in relation to advanced practice in breast imaging: multidisciplinary practice; roles and responsibilities associated with advanced practice; development and progression; embedding and sustaining advanced practice. It was evident across all themes that advanced practice is vital in supporting better care for patients attending breast imaging in light of workforce shortages. Although advanced practice and its benefits are well established in breast imaging, persistent barriers were acknowledged such as role ambiguity, recruitment issues, lack of support from some radiologists and poor funding. Findings suggest that introducing a more formalised pathway to advanced practice into breast imaging through the implementation of a specific Advanced Clinical Practitioner apprenticeship training programme may overcome many of the challenges evidenced in this review. The findings of this review will help inform the development of the Advanced Clinical Practitioner apprenticeship programme specific to breast diagnosis. [Abstract copyright: Copyright © 2020 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.

A critical realist evaluation of advance care planning in care homes

Aims: To evaluate care planning in advance of end-of-life care in care homes. Design: A qualitative study. Methods: Qualitative data were collected from January 2018–July 2019 (using focus groups and semi-structured interviews) from three care homes in the South West of England. The data were analysed using thematic analysis followed by Critical Realist Evaluation. Results: Participants comprised of registered nurses (N = 4), care assistants (N = 8), bereaved relatives (N = 7), and domiciliary staff (N = 3). Although the importance of advance care planning was well recognized, the emotional labour of frequently engaging in discussions about death and dying was highlighted as a problem by some care home staff. It was evident that in some cases care home staff's unmet emotional needs led them to rushing and avoiding discussions about death and dying with residents and relatives. A sparsity of mechanisms to support care home staff's emotional needs was noted across all three care homes. Furthermore, a lack of training and knowledge appeared to inhibit care home staff's ability to engage in meaningful care planning conversations with specific groups of residents such as those living with dementia. The lack of training was principally evident amongst non-registered care home staff and those with non-formal caring roles such as housekeeping. Conclusion: There is a need for more focused education to support registered and non-registered care home staff to effectively engage in sensitive discussions about death and dying with residents. Furthermore, greater emotional support is necessary to help build workforce resilience and sustain change. Impact: Knowledge generated from this study can be used to inform the design and development of future advance care planning interventions capable of supporting the delivery of high-quality end-of-life care in care homes

A critical realist evaluation of advance care planning in care homes

Aims: To evaluate care planning in advance of end-of-life care in care homes. Design: A qualitative study. Methods: Qualitative data were collected from January 2018–July 2019 (using focus groups and semi-structured interviews) from three care homes in the South West of England. The data were analysed using thematic analysis followed by Critical Realist Evaluation. Results: Participants comprised of registered nurses (N = 4), care assistants (N = 8), bereaved relatives (N = 7), and domiciliary staff (N = 3). Although the importance of advance care planning was well recognized, the emotional labour of frequently engaging in discussions about death and dying was highlighted as a problem by some care home staff. It was evident that in some cases care home staff's unmet emotional needs led them to rushing and avoiding discussions about death and dying with residents and relatives. A sparsity of mechanisms to support care home staff's emotional needs was noted across all three care homes. Furthermore, a lack of training and knowledge appeared to inhibit care home staff's ability to engage in meaningful care planning conversations with specific groups of residents such as those living with dementia. The lack of training was principally evident amongst non-registered care home staff and those with non-formal caring roles such as housekeeping. Conclusion: There is a need for more focused education to support registered and non-registered care home staff to effectively engage in sensitive discussions about death and dying with residents. Furthermore, greater emotional support is necessary to help build workforce resilience and sustain change. Impact: Knowledge generated from this study can be used to inform the design and development of future advance care planning interventions capable of supporting the delivery of high-quality end-of-life care in care homes

Identification of PRRT2 as the causative gene of paroxysmal kinesigenic dyskinesias

Paroxysmal kinesigenic dyskinesias is a paroxysmal movement disorder characterized by recurrent, brief attacks of abnormal involuntary movements induced by sudden voluntary movements. Although several loci, including the pericentromeric region of chromosome 16, have been linked to paroxysmal kinesigenic dyskinesias, the causative gene has not yet been identified. Here, we identified proline-rich transmembrane protein 2 (PRRT2) as a causative gene of paroxysmal kinesigenic dyskinesias by using a combination of exome sequencing and linkage analysis. Genetic linkage mapping with 11 markers that encompassed the pericentromeric of chromosome 16 was performed in 27 members of two families with autosomal dominant paroxysmal kinesigenic dyskinesias. Then, the whole-exome sequencing was performed in three patients from these two families. By combining the defined linkage region (16p12.1–q12.1) and the results of exome sequencing, we identified an insertion mutation c.649_650InsC (p.P217fsX7) in one family and a nonsense mutation c.487C>T (p.Q163X) in another family. To confirm our findings, we sequenced the exons and flanking introns of PRRT2 in another three families with paroxysmal kinesigenic dyskinesias. The c.649_650InsC (p.P217fsX7) mutation was identified in two of these families, whereas a missense mutation, c.796C>T (R266W), was identified in another family with paroxysmal kinesigenic dyskinesias. All of these mutations completely co-segregated with the phenotype in each family. None of these mutations was identified in 500 normal unaffected individuals of matched geographical ancestry. Thus, we have identified PRRT2 as the first causative gene of paroxysmal kinesigenic dyskinesias, warranting further investigations to understand the pathogenesis of this disorder