Modern English and American drama as it illustrates the modern social viewpoint

Thesis (Ed.M.)--Boston Universit

Use of physical activity questionnaires in people with dementia: a scoping review

Physical activity questionnaires are an important means to assess habitual physical activity. It remains unclear what questionnaires are used and whether they are appropriate for people with dementia who have impaired information recall but are also often largely sedentary. This scoping review aimed to identify and quantify the use of physical activity questionnaires within a dementia population. Eighteen studies met the inclusion criteria for this review. The majority of studies used questionnaires that were validated for use within an older adult population (e.g., Modified Baecke Questionnaire for the Elderly), though none had specifically been validated for use in people with dementia. Interestingly, just over half of studies (N= 10, 55.6%) adapted the questionnaires from the original validated version by allowing a proxy to provide input into the responses. Future research needs to robustly validate the use of proxy-report measures of physical activity in people with dementia

An exploratory study identifying a possible response shift phenomena of the Glasgow Hearing Aid Benefit Profile (GHABP)

A then-test technique was used to investigate the possibility of a response shift in the Glasgow hearing aid benefit profile (GHABP). Following completion of part 1 of the GHABP, 16 adults were invited for hearing-aid follow up appointments. In accordance with then-test technique, participants were asked to think back to before they had their hearing-aids fitted and the GHABP part 1 was completed again to re-establish the disability and handicap scores. These scores were then compared with the initial GHABP part I scores. Paired T testing and Wilcoxon Rank tests were carried out to investigate the statistical significance of the response shift effect. Statistically significant differences were seen between initial and retrospective GHABP (disability) scores using t test. No significant differences could be seen between the initial and retrospective handicap scores. Results suggest participants may have demonstrated a possible response shift phenomenon with the disability construct of the GHABP questionnaire, related to a possible re-calibration effect or a denial of disability effect. This exploratory study suggests that the GHABP questionnaire may be subject to a response shift phenomena. We suggest that further more robust studies are completed to verify this and recommend that this could have psychological impact on participants when explaining the results of the outcome measure and may affect hearing aid use. There is also potential for this phenomenon to affect global GHABP scores specifically when demonstrating to stakeholders the overall success of an audiology service

Community nurses' perspectives and experiences of the chronic oedema 'on the ground' education programme: a focus group study.

The impact of chronic oedema on community nurses’ work, the NHS and those directly affected by the condition is immense. As chronic oedema prevalence is projected to rise and financial austerity continues, innovative, sustainable solutions which ensure positive outcomes for patients must be found. This paper reports findings from a focus group (n =3) investigation of the effects of an innovative workplace education intervention designed to enhance community nurses’ knowledge for practice in chronic oedema prevention and management in Wales, UK. The main findings indicated that the programme had enhanced community nurses’ awareness, knowledge and understanding of chronic oedema management. By enhancing their knowledge base benefit might be conferred for patients with chronic oedema in terms of improved quality of life; self-efficacy and self-management. However, the magnitude of perceived benefit was variable and contingent on engagement with and support for self-management. Findings indicate the need for a longitudinal study

An analysis of hearing aid use: data logging as an adjunct with the Glasgow Hearing Benefit Profile Questionnaire

Introduction: There is significant variability in the ways in which hearing aid use is reported. In part, this is because there is no agreed method of reporting hearing aid use. A recent review by Perez and Edmonds (2012) concluded that a dual-stage approach using data-logging and self-reported outcome measures is preferable to an approach that uses one method alone. A dual-stage approach may provide a comprehensive understanding of hearing aid use and help further develop a detailed understanding of some of the problems associated with non-use or under-use. Objective: This study aimed to compare the relationship of self-reported hearing aid use using the Glasgow Hearing Aid Benefit Profile questionnaire (GHABP; Gatehouse, 1999) to hearing aid data-logging information, and to establish whether the GHABP can be used to accurately measure hearing aid use. Methods: This was an observational cohort study conducted in Wales, United Kingdom. A total of 119 participants were recruited at their hearing aid follow-up appointments. The length of time between hearing aid fitting and follow-up was variable. With participants’ consent, data were collected using the Glasgow Hearing Aid Benefit Profile part 2 questionnaire and data-logging information stored in the hearing aid. Correlational analyses were used to assess the relationships between the two measures of hearing aid use. Results: Mean data-logging use was 5.87 hours per day (SD=5.15) and the mean GHABP use was 67.34% (SD=32.98). Both “use” variables failed a Shapiro Wilks test of normality. There was a strong positive Pearson rho correlation between data-logging use and GHABP use (rs, = .645, p<0.01). Analysis of the GHABP questionnaire revealed that 53 participants stated that they used their hearing aids between 81% and 100% of the time. There were some low levels of use when examining data-logging in the context of variable GHABP results. Conclusions: In participants who present higher GHABP use scores with lower levels of data-logging use, some plausible reasons include: I) Inadvertent overestimation of their use by patients (recall error), 2) The GHABP questionnaire may not be sufficiently sensitive or structured in such a way to effectively measure use. For example, “listening in a quiet environment” is not captured in a GHABP question, or 3) The reporting of use as a percentage may not be an appropriate measure of use. For this reason, in keeping with Perez and Edmonds (2012), both self-reported measures of use and data-logging should be used together and audiologists are reminded to consider both measures with some level of caution

Small mammal responses to long-term large-scale woodland creation: the influence of local and landscape-level attributes

Habitat loss and fragmentation greatly affect biological diversity. Actions to counteract their negative effects include increasing the quality, amount and connectivity of semi-natural habitats at the landscape scale. However, much of the scientific evidence underpinning landscape restoration comes from studies of habitat loss and fragmentation, and it is unclear whether the ecological principles derived from habitat removal investigations are applicable to habitat creation. In addition, the relative importance of local- (e.g. improving habitat quality) vs. landscape-level (e.g. increasing habitat connectivity) actions to restore species is largely unknown, partly because studying species responses over sufficiently large spatial and temporal scales is challenging. We studied small mammal responses to large scale woodland creation spanning 150 years, and assessed the influence of local- and landscape-level characteristics on three small mammal species of varying woodland affinity. Woodland specialists, generalists and grassland specialists were present in woodlands across a range of ages from 10 to 160 years, demonstrating that these species can quickly colonize newly created woodlands. However, we found evidence that woodlands become gradually better over time for some species. The responses of individual species corresponded to their habitat specificity. A grassland specialist (Microtus agrestis) was influenced only by landscape attributes; a woodland generalist (Apodemus sylvaticus) and specialist (Myodes glareolus) were primarily influenced by local habitat attributes, and partially by landscape characteristics. At the local scale, high structural heterogeneity, large amounts of deadwood and a relatively open understory positively influenced woodland species (both generalists and specialists); livestock grazing had strong negative effects on woodland species abundance. Actions to enhance habitat quality at the patch scale focusing on these attributes would benefit these species. Woodland creation in agricultural landscapes is also likely to benefit larger mammals and birds of prey feeding on small mammals and increase ecosystem processes such as seed dispersal

Treatment Interruption after Pregnancy: Effects on Disease Progression and Laboratory Findings

Objective. To assess clinical progression and inflammatory markers among women stopping or continuing antiretroviral therapy (ART) after pregnancy. Methods. ART-naïve women with CD4+ lymphocyte counts >350 cells/uL initiating ART during pregnancy had clinical events and laboratory markers compared over one year postpartum between those stopping (n = 59) or continuing (n = 147) ART. Results. Slopes in CD4 count and HIV RNA did not differ between groups overall and in subsets of ZDV or combination therapy. The hazard ratio (HR) of a new class B event was 2.09 (95% CI 0.79–5.58) among women stopping ART, 1.24 (0.31–4.95) in those stopping ZDV, and 2.93 (0.64–13.36) among those stopping combination therapy. Women stopping ART had increased immune activation. No significant differences were seen in C-reactive protein, lipids, leptin, or interleukin-6. Conclusions. While changes in CD4 and HIV RNA levels over one year were similar between women stopping or continuing ART postpartum, higher immune activation among women stopping therapy requires further study

The relationship between lipoprotein A and other lipids with prostate cancer risk:A multivariable Mendelian randomisation study

BACKGROUND: Numerous epidemiological studies have investigated the role of blood lipids in prostate cancer (PCa) risk, though findings remain inconclusive to date. The ongoing research has mainly involved observational studies, which are often prone to confounding. This study aimed to identify the relationship between genetically predicted blood lipid concentrations and PCa. METHODS AND FINDINGS: Data for low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides (TG), apolipoprotein A (apoA) and B (apoB), lipoprotein A (Lp(a)), and PCa were acquired from genome-wide association studies in UK Biobank and the PRACTICAL consortium, respectively. We used a two-sample summary-level Mendelian randomisation (MR) approach with both univariable and multivariable (MVMR) models and utilised a variety of robust methods and sensitivity analyses to assess the possibility of MR assumptions violation. No association was observed between genetically predicted concentrations of HDL, TG, apoA and apoB, and PCa risk. Genetically predicted LDL concentration was positively associated with total PCa in the univariable analysis, but adjustment for HDL, TG, and Lp(a) led to a null association. Genetically predicted concentration of Lp(a) was associated with higher total PCa risk in the univariable (OR(weighted median) per standard deviation (SD) = 1.091; 95% CI 1.028 to 1.157; P = 0.004) and MVMR analyses after adjustment for the other lipid traits (OR(IVW) per SD = 1.068; 95% CI 1.005 to 1.134; P = 0.034). Genetically predicted Lp(a) was also associated with advanced (MVMR OR(IVW) per SD = 1.078; 95% CI 0.999 to 1.163; P = 0.055) and early age onset PCa (MVMR OR(IVW) per SD = 1.150; 95% CI 1.015,1.303; P = 0.028). Although multiple estimation methods were utilised to minimise the effect of pleiotropy, the presence of any unmeasured pleiotropy cannot be excluded and may limit our findings. CONCLUSIONS: We observed that genetically predicted Lp(a) concentrations were associated with an increased PCa risk. Future studies are required to understand the underlying biological pathways of this finding, as it may inform PCa prevention through Lp(a)-lowering strategies