Performance management: a qualitative study of relational boundaries in personal assistance

Personal assistance (PA) is a model of support where disabled people take control of recruiting, training and managing the people that support them. Personal assistance differs from other forms of care, such as domiciliary or informal care, because the disabled person is in control of how, when and by whom they are supported. With the advent of personal health budgets, PA is no longer limited to social care but is also central to future NHS services and funding arrangements. The aims of this study were to gain a deeper understanding of PA relationships, and to explore how both parties manage interpersonal challenges. We report on data from 58 qualitative interviews with disabled employers and personal assistants. Applying concepts from Goffman's (1959) scheme of impression management, we present an analysis of the relational dynamics that occur when two people cooperate in shared endeavours. Goffman's concepts of team members and non‐persons, in addition to the themes of regions and information control, aid a more fundamental understanding of the relational dynamics that occur between disabled employers and their PAs

Faster and better: a machine learning approach to corner detection

The repeatability and efficiency of a corner detector determines how likely it is to be useful in a real-world application. The repeatability is importand because the same scene viewed from different positions should yield features which correspond to the same real-world 3D locations [Schmid et al 2000]. The efficiency is important because this determines whether the detector combined with further processing can operate at frame rate. Three advances are described in this paper. First, we present a new heuristic for feature detection, and using machine learning we derive a feature detector from this which can fully process live PAL video using less than 5% of the available processing time. By comparison, most other detectors cannot even operate at frame rate (Harris detector 115%, SIFT 195%). Second, we generalize the detector, allowing it to be optimized for repeatability, with little loss of efficiency. Third, we carry out a rigorous comparison of corner detectors based on the above repeatability criterion applied to 3D scenes. We show that despite being principally constructed for speed, on these stringent tests, our heuristic detector significantly outperforms existing feature detectors. Finally, the comparison demonstrates that using machine learning produces significant improvements in repeatability, yielding a detector that is both very fast and very high quality.Comment: 35 pages, 11 figure

Artificial intelligence in health care: accountability and safety

The prospect of patient harm caused by the decisions made by an artificial intelligence-based clinical tool is something to which current practices of accountability and safety worldwide have not yet adjusted. We focus on two aspects of clinical artificial intelligence used for decision-making: moral accountability for harm to patients; and safety assurance to protect patients against such harm. Artificial intelligence-based tools are challenging the standard clinical practices of assigning blame and assuring safety. Human clinicians and safety engineers have weaker control over the decisions reached by artificial intelligence systems and less knowledge and understanding of precisely how the artificial intelligence systems reach their decisions. We illustrate this analysis by applying it to an example of an artificial intelligence-based system developed for use in the treatment of sepsis. The paper ends with practical suggestions for ways forward to mitigate these concerns. We argue for a need to include artificial intelligence developers and systems safety engineers in our assessments of moral accountability for patient harm. Meanwhile, none of the actors in the model robustly fulfil the traditional conditions of moral accountability for the decisions of an artificial intelligence system. We should therefore update our conceptions of moral accountability in this context. We also need to move from a static to a dynamic model of assurance, accepting that considerations of safety are not fully resolvable during the design of the artificial intelligence system before the system has been deployed

A Sociological Study of Social Resources and the Patient Experience of Multiple Chronic Illnesses

The number of people living with multiple chronic illnesses (multimorbidity) is increasing and this trend is set to continue. In recent years, there has been a significant increase in epidemiological and clinically informed research into this patient population. However, the extant literature offers relatively little insight into how lay individuals make sense of multimorbidity. Social resources, or the physical and emotional sustenance provided by others, are recognised increasingly as a means towards affecting health outcomes. Social resources are apparent as a nascent theme at the levels of health and social care policy, service organisation, and increasingly, at the level of primary care delivery. However, the apparent enthusiasm for social resources is not universal, and critics have questioned both the socio-political motives behind this trend as well as its underlying social theory. This study employs in-depth qualitative interviews and applies an interpretive approach to analysis. 15 participants living with (at least) osteoarthritis and cardiovascular disease took part in up to two interviews. In addition, a small number of participants’ spouses (four) were recruited into the study. Findings illustrate the ways in which lay individuals make sense of multimorbidity. This thesis draws attention to certain biomedical assumptions made by clinically informed literature. These assumptions are discussed with regard to the concept of illness prioritisation and the relevance of multimorbidity (in conceptual terms) to lay experience. Findings also illustrate the complexity of social resource exchange during illness. A novel conceptual model is developed to elucidate participants’ accounts of supportive practices. Further, findings highlight the role of morality in shaping the experience of support. These observations are synthesised under the theoretical banner of gift-exchange theory, and implications are identified for the application of social resources in policy and service delivery

Personalisation and the promise of independent living: Where now for cash, care and control for disability organisations across the UK?

Personalisation has dominated social care across OECD countries over the past 20 years. UK policy evolved from the efforts of disabled peoples’ organisations (DPOs) to secure the availability of cash payments as part of a wider drive to enable independent living. Implementation of personalisation across the UK has seen significant divergence in how governments have developed their own responses, but in each country the DPOs’ role and impact has shifted from campaigning and promoting the voices of disabled people to a more muted focus on service provision and limited policy engagement. This article draws on a series of interviews with DPOs and leading disabled activists. It highlights concerns raised related to themes around austerity, changing relationships with local government and the role of co-production in developing policy. We conclude the article by discussing the future directions for personalisation and developments in light of the COVID-19 pandemic

Improving Loss Estimation for Woodframe Buildings. Volume 2: Appendices

This report documents Tasks 4.1 and 4.5 of the CUREE-Caltech Woodframe Project. It presents a theoretical and empirical methodology for creating probabilistic relationships between seismic shaking severity and physical damage and loss for buildings in general, and for woodframe buildings in particular. The methodology, called assembly-based vulnerability (ABV), is illustrated for 19 specific woodframe buildings of varying ages, sizes, configuration, quality of construction, and retrofit and redesign conditions. The study employs variations on four basic floorplans, called index buildings. These include a small house and a large house, a townhouse and an apartment building. The resulting seismic vulnerability functions give the probability distribution of repair cost as a function of instrumental ground-motion severity. These vulnerability functions are useful by themselves, and are also transformed to seismic fragility functions compatible with the HAZUS software. The methods and data employed here use well-accepted structural engineering techniques, laboratory test data and computer programs produced by Element 1 of the CUREE-Caltech Woodframe Project, other recently published research, and standard construction cost-estimating methods. While based on such well established principles, this report represents a substantially new contribution to the field of earthquake loss estimation. Its methodology is notable in that it calculates detailed structural response using nonlinear time-history structural analysis as opposed to the simplifying assumptions required by nonlinear pushover methods. It models physical damage at the level of individual building assemblies such as individual windows, segments of wall, etc., for which detailed laboratory testing is available, as opposed to two or three broad component categories that cannot be directly tested. And it explicitly models uncertainty in ground motion, structural response, component damageability, and contractor costs. Consequently, a very detailed, verifiable, probabilistic picture of physical performance and repair cost is produced, capable of informing a variety of decisions regarding seismic retrofit, code development, code enforcement, performance-based design for above-code applications, and insurance practices

Invadopodia: Proteolytic feet of cancer cells

The leading cause of death in cancer patients is metastasis. Invasion is an integral part of metastasis and is carried out by proteolytic structures called invadopodia at the cellular level. In this introductory review, we start by evaluating the definition of invadopodia. While presenting the upstream signaling events involved, we integrate current models on invadopodia. In addition, we discuss the significance of invadopodia in 2D and 3D and in vivo. We finally point out technical challenges and conclude with open questions in the field. © TÜBİTAK.Scientific and Technological Research Council of Turkey (111T547

The efficacy of exercise in preventing injury in adult male football: a systematic review of randomized controlled trials

BACKGROUND: Injury prevention measures might reduce the impact of injury on footballers and football clubs. Increasing research has evaluated the use of exercise for injury prevention. However, research has focused on adolescent females. No high-quality systematic reviews have evaluated the efficacy of all forms of exercise on preventing injury in adult male football. OBJECTIVE: Our objective was to conduct a systematic review to evaluate the efficacy of exercise in preventing injury in adult male football. DATA SOURCES: Comprehensive searches of electronic databases CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE, Embase, AMED (The Allied and Complementary Medicine Database), the Cochrane Central Register of Controlled Trials, PEDro (The Physiotherapy Evidence Database), SPORTDiscus™, the National Research Register, Current Controlled Trials website (York), and http://www.ClinicalTrials.gov were conducted using predefined search terms to identify relevant studies published up to 1 March 2013. Screening of references, searches of grey literature, and hand searches of relevant journals were also employed. STUDY SELECTION: Included studies were randomized controlled trials using injury incidence as an outcome measure to evaluate the efficacy of an exercise intervention on uninjured male footballers aged 16 years and over. Articles not written in English were excluded. DATA EXTRACTION: Two researchers independently searched data sources, screened studies for eligibility, evaluated risk of bias, and extracted data using predefined criteria. STUDY APPRAISAL AND SYNTHESIS METHODS: Risk of bias of included trials was assessed using the Cochrane Collaboration’s tool for assessing risk of bias. There was insufficient trial comparability (outcome measures, interventions, injury type) for meta-analysis, and a qualitative analysis was performed. RESULTS: Eight trials (n = 3,355) from five countries met the inclusion criteria. All trials were assessed as having a high risk of bias. Two trials reported statistically significant reductions in hamstring injuries with eccentric exercise, and two reported statistically significant reductions in recurrent ankle sprains with proprioceptive exercise. Four trials showed no statistically significant difference in injury incidence with exercise interventions targeting a range of injuries. LIMITATIONS: Notable limitations of included trials included poor reporting and limited blinding. A high risk of bias and insufficient comparability across trials prevented quantitative data synthesis. CONCLUSIONS: Limitations in the context of study quality and heterogeneity resulted in an inability to reach a clear conclusion regarding efficacy of exercise for injury prevention in adult male football. Future low risk of bias, properly powered, and comprehensively reported trials are warranted to evaluate the efficacy of exercise on injury prevention. The use of eccentric hamstring exercise for hamstring injury prevention and proprioceptive training for recurrent ankle sprain prevention might be a good focus for future trials, as existing trials with a high risk of bias suggest an effect

Ariel - Volume 2 Number 7

Editors Richard J. Bonanno Robin A. Edwards Associate Editors Steven Ager Stephen Flynn Shep Dickman Tom Williams Lay-out Editor Eugenia Miller Contributing Editors Michael J. Blecker W. Cherry Light James J. Nocon Lynne Porter Editors Emeritus Delvyn C. Case, Jr. Paul M. Fernhof

Disabled women’s care experiences in Turkey: Intimacy, dependency, independent living

The literature on care relationships and independent living is extensive, although geographically limited, and focuses predominantly on the UK, Scandinavia and the US. This paper explores these themes in the context of Turkey. Through a case study approach, it analyses the experiences of three disabled women with distinctive care arrangements (paid professional, familial informal and an eclectic mix). Cases are discussed in relation to the Turkish context and the existing literature. The paper argues that the experiences of disabled Turkish women need to be understood in relation to the Turkish political economy of care (dependent on family support and undocumented migration), cultural aspects of care (shaped by gendered imagery) and the development of disability rights (characterised by limited independent living). Recognising such universal and locally specific aspects of care and independent living across geographies will contribute to a fuller understanding of disabled people’s experiences and enhance theories of care