An investigation into the impact of computer therapy on people with aphasia.

Use of computers by the general population continues to increase and computers are now an integral part of communication, leisure activities and work. The majority of research into use of computers by people with aphasia has focussed narrowly on evaluating effects of computer therapy on specific language impairments. Little is known about the broader impacts of computer use by people with aphasia, in terms of levels of social activity and social participation and little is known of the views of people with aphasia on using computers. The research in this thesis investigates the outcome of computer therapy from the perspective of people living with aphasia. Outcome was evaluated using the framework of the World Health Organisation International Classification of Functioning, Disability and Health (WHO ICF 2001) to investigate impact not just in terms of impairment but on activity and participation as well. The ICF also provided a framework for investigating contextual factors (environmental and personal) which might effect outcome. The investigation took the form of two complementary but contrasting case series studies: an investigation into the outcome of using computers to target word finding abilities (treatment targeting impairment only); and an investigation into the outcome of training to use voice recognition software as a writing aid (treatment aiming to overcome activity limitations but not targeting impairment itself). Both studies comprised a qualitative investigation of the views of participants on the outcome and process of therapy. Both studies supplemented this qualitative data with complementary quantitative evaluations seeking to quantify key aspects of outcome. Study one findings indicated that all six participants perceived benefits to levels of activity, participation and confidence in addition to benefits to language impairment. Although some of this benefit was attributed to improved language skill, benefits were also attributed to increased confidence associated with acquiring skills. Study two found benefits to levels of activity and participation and confidence for all participants. Benefits were perceived even where there was no measured change to language impairment or quality or quantity of language used. Computer use by people with aphasia can therefore bring much broader benefits than just to language impairment. Benefits include increases in leisure and social activity, social participation and confidence. Previous computer experience is not necessary and benefits can be shown many years post stroke. These broader benefits should be borne in mind when selecting who may be appropriate for computer therapy

Evidence of the Lack of Effectiveness of Low-Income Savings Incentives

In view of the government’s propensity to develop programs to encourage savings, we examine a group of individuals to whom these programs are targeted: low- to moderate-income taxpayers. We show that saving for retirement is not a priority in the lives of these taxpayers. The low priority given to saving is often due to immediate necessary costs such as housing, food, and transportation. However, our study shows that even nonessential items and activities such as cable and internet services or travel are often considered more important than saving. We also show that most of the participants were not even aware of the tax incentives available to them. In light of these results and evidence from other studies showing that individuals will save when given the right opportunities, we support arguments in favor of modifying the current “Saver’s Credit” and adopting the Automatic Individual Retirement Account (IRA) currently proposed in Congress. We also suggest an “opt-out” program offered through direct deposit or small employers along with a government match as an alternative way of packaging incentives for retirement savings. By making the retirement vehicle readily available with a transparent, immediate match, the effectiveness of the incentive should increase dramatically for those qualified

Identifying Informational Sources And Educational Methods For Soil Conservation Information Used By Landowners of Highly Erodible Fields

Inadequate adoption of soil conservation practices is a serious problem since 40 percent of the nation\u27s farmers have some highly erodible land

Exploring the experiences and perceptions of patients awaiting rotator cuff repair surgery: an integrated qualitative study within the POWER pilot and feasibility trial

Background: As waiting times for orthopaedic surgery increase, there have been calls to move from ‘waiting lists’ to ‘preparation lists’, to better prepare patients for surgery. In this context, a pilot randomised controlled trial (POWER) was conducted, comparing physiotherapist-led exercise to waiting-list control (usual care), for patients awaiting rotator cuff repair surgery. This qualitative study was integrated within the pilot trial.Objectives: ●Explore experiences of adults awaiting rotator cuff repair surgery in the NHS●Explore the acceptability of the physiotherapist-led exercise intervention●Explore barriers and enablers to recruitment, retention, and adherence Design: Integrated qualitative study with semi-structured telephone interviewsMethods: Adults awaiting rotator cuff repair, consenting to participate in the trial were eligible. Sampling was purposive regarding age, gender, randomised allocation, and hospital site. Interviews were audio-recorded and transcribed. Data were analysed using Reflexive Thematic Analysis.Results: 20 participants were recruited (age range 49 to 81 years; 12 male, 10 randomised to physiotherapist-led exercise). Many participants were unable to recall their experiences of trial processes; nonetheless, three themes were identified from the data: experience of shoulder pain and pathway to treatment; communication and decision-making in the context of rotator cuff repair surgery; and experiences of the POWER physiotherapist-led exercise intervention and processes. Conclusions: Patients experience significant burden due to shoulder pain. Their journey to surgery can be long, confusing, and associated with perceived abandonment. In a future trial, the intervention should offer opportunity for shared decision-making, optional exit from the surgical pathway, and an individualised exercise programme

Time from diagnosis to surgery and prostate cancer survival: a retrospective cohort study

Background: A diagnosis of prostate cancer leads to emotional distress and anxiety, prompting calls for rapid diagnostic pathways. Nevertheless, it remains unclear what impact time between diagnosis and surgery has upon prostate cancer survival. Methods: Using national databases for England (cancer registries, Hospital Episode Statistics and Office of National Statistics), we identified 17,043 men with prostate cancer, aged 15 years and older, diagnosed in 1996–2009, and who had surgical resection with curative intent within 6 months of diagnosis. We used relative survival to investigate associations between waiting times and five- and ten-year survival. Results: Five- and ten-year relative survival estimates for the total study sample were 1.04 (95% CI: 1.04 to 1.05) and 1.08 (95% CI: 1.06-1.09), respectively. There were no notable differences in survival between patients who had surgery at 0–3 and 4–6 months after diagnosis. Relative survival was higher among the elderly (>65) and those with well and moderately differentiated tumours. Conclusion: The high relative survival in our cohort probably reflects adherence to selection criteria for surgery among men with localised prostate cancer. Among men treated with surgery within 6 months of diagnosis, we found little evidence of an association between time from diagnosis to surgery and survival.6 page(s

USF Jesuit Foundation Grant Application Coversheet

This is a 2-page cover sheet that goes into the budget breakdown for the USF Jesuit Foundation Grant Application

Informed consent in randomised controlled trials:further development and evaluation of the participatory and informed consent (PIC) measure

Background: Informed consent is an accepted ethical and legal prerequisite for trial participation, yet there is no standardised method of assessing patient understanding for informed consent. The participatory and informed consent (PIC) measure was developed for application to recruitment discussions to evaluate recruiter information provision and evidence of patient understanding. Preliminary evaluation of the PIC indicated the need to improve inter-rater and intra-rater reliability ratings and conduct further psychometric evaluation. This paper describes the assessment, revision and evaluation of the PIC within the context of OPTiMISE, a pragmatic primary care-based trial. Methods: This study used multiple methods across two phases. In phase one, one researcher applied the existing PIC measure to 18 audio-recorded recruitment discussions from the OPTiMISE study and made detailed observational notes about any uncertainties in application. Appointments were sampled to be maximally diverse for patient gender, study centre, recruiter and before and after an intervention to optimise information provision. Application uncertainties were reviewed by the study team, revisions made and a coding manual developed and agreed. In phase two, the coding manual was used to develop tailored guidelines for applying the PIC to appointments within the OPTiMISE trial. Two researchers then assessed 27 further appointments, purposively sampled as above, to evaluate inter-rater and intra-rater reliability, content validity and feasibility. Results: Application of the PIC to 18 audio-recorded OPTiMISE recruitment discussions resulted in harmonisation of the scales rating recruiter information provision and evidence of patient understanding, minor amendments to clarify wording and the development of detailed generic coding guidelines for applying the measure within any trial. Application of the revised measure using these guidelines to 27 further recruitment discussions showed good feasibility (time to complete), content validity (completion rate) and reliability (inter- and intra-rater) of the measure. Conclusion: The PIC provides a means to evaluate the content of information provided by recruiters, patient participation in recruitment discussions and, to some extent, evidence of patient understanding. Future work will use the measure to evaluate recruiter information provision and evidence of patient understanding both across and within trials