Human-free offshore lifting solutions

With single elements weighing up to hundreds of tonnes and lifted to heights of 100 meters, offshore wind turbines can pose risks to personnel, assets, and the environment during installation and maintenance interventions. To increase safety during offshore lifts, this study focuses on solutions for human-free lifting operations. Ideas in the categories of logistics, connections, as well as guidance and control, were discussed and ranked by means of a multi-criteria decision analysis. Based upon 38 survey responses weighting 21 predefined decision criteria, the most promising concepts were selected. Logistically, pre-assembled systems would reduce the number of lifts and thus reduce the risk. A MATLAB-based code has been developed to optimise installation time, lifted weight, and number of lifts. Automated bolting and seafastening solutions have high potential to increase safety during the transport of the wind turbine elements and, additionally, speed up the process. Finally, the wind turbine should be lifted on top of the support structure without having personnel being under the load. A multi-directional mechanical guiding element has been designed and tested successfully in combination with visual guidance by cameras in a small-scale experiment

Implications of Synchronous IVR Radio on Syrian Refugee Health and Community Dynamics

With 1,033,513 Syrian refugees adding a strain on the Lebanese healthcare system, innovation is key to improving access to healthcare. Our previous work identified the potential for technology to improve access to antenatal care services and increase refugee agency. Using (1) paper mock ups and a mobile based prototype, (2) process mapping, (3) focus groups and interviews and (4) key informant meetings, we explored the concept of refugee led community radio shows to deliver peer-led healthcare. We observed the influence of community radio shows on Syrian refugee health education, community dynamics and community agency in relationships between healthcare providers and refugees. Refugees were positively impacted through situating the technology within the community. We highlight issues around trust, agency, understanding, sel-forganization and privacy that resulted from running the shows through mock ups and a mobile based prototype. Our findings inform future work in community run radio shows

Designing for digital playing out

We report on a design-led study in the UK that aimed to understand barriers to children (aged 5 to 14 years) 'playing out' in their neighbourhood and explore the potential of the Internet of Things (IoT) for supporting children's free play that extends outdoors. The study forms a design ethnography, combining observational fieldwork with design prototyping and co-creative activities across four linked workshops, where we used BBC micro:bit devices to co-create new IoT designs with the participating children. Our collective account contributes new insights about the physical and interactive features of micro:bits that shaped play, gameplay, and social interaction in the workshops, illuminating an emerging design space for supporting 'digital playing out' that is grounded in empirical instances. We highlight opportunities for designing for digital playing out in ways that promote social negotiation, supports varying participation, allows for integrating cultural influences, and accounts for the weaving together of placemaking and play

Building social capital through breastfeeding peer support: Insights from an evaluation of a voluntary breastfeeding peer support service in North-West England

Background: Peer support is reported to be a key method to help build social capital in communities. To date there are no studies that describe how this can be achieved through a breastfeeding peer support service. In this paper we present findings from an evaluation of a voluntary model of breastfeeding peer support in North-West England to describe how the service was operationalized and embedded into the community. This study was undertaken from May, 2012 to May, 2013. Methods: Interviews (group or individual) were held with 87 participants: 24 breastfeeding women, 13 peer supporters and 50 health and community professionals. The data contained within 23 monthly monitoring reports (January, 2011 to February 2013) compiled by the voluntary peer support service were also extracted and analysed. Results: Thematic analysis was undertaken using social capital concepts as a theoretical lens. Key findings were identified to resonate with ’bonding’, ‘bridging’ and ‘linking’ forms of social capital. These insights illuminate how the peer support service facilitates ‘bonds’ with its members, and within and between women who access the service; how the service ‘bridges’ with individuals from different interests and backgrounds, and how ‘links’ were forged with those in authority to gain access and reach to women and to promote a breastfeeding culture. Some of the tensions highlighted within the social capital literature were also identified. Conclusions: Horizontal and vertical relationships forged between the peer support service and community members enabled peer support to be embedded into care pathways, helped to promote positive attitudes to breastfeeding and to disseminate knowledge and maximise reach for breastfeeding support across the community. Further effort to engage with those of different ethnic backgrounds and to resolve tensions between peer supporters and health professionals is warranted

Designing for Digital Playing Out

We report on a design-led study in the UK that aimed to understand barriers to children (aged 5 to 14 years) ‘playing out’ in their neighbourhood and explore the potential of the Internet of Things (IoT) for supporting children’s free play that extends outdoors. The study forms a design ethnography, combining observational fieldwork with design prototyping and co-creative activities across four linked workshops, where we used BBC micro:bit devices to co-create new IoT designs with the participating children. Our collective account contributes new insights about the physical and interactive features of micro:bits that shaped play, gameplay, and social interaction in the workshops, illuminating an emerging design space for supporting ‘digital playing out’ that is grounded in empirical instances. We highlight opportunities for designing for digital playing out in ways that promote social negotiation, supports varying participation, allows for integrating cultural influences, and accounts for the weaving together of placemaking and play

Wristband accelerometers to motivate arm exercise after stroke (WAVES): study protocol for a pilot randomized controlled trial

BACKGROUND: Loss of upper limb function affects up to 85 % of acute stroke patients. Recovery of upper limb function requires regular intensive practise of specific upper limb tasks. To enhance intensity of practice interventions are being developed to encourage patients to undertake self-directed exercise practice. Most interventions do not translate well into everyday activities and stroke patients continue to find it difficult remembering integration of upper limb movements into daily activities. A wrist-worn device has been developed that monitors and provides ‘live’ upper limb activity feedback to remind patients to use their stroke arm in daily activities (The CueS wristband). The aim of this trial is to assess the feasibility of a multi-centre, observer blind, pilot randomised controlled trial of the CueS wristband in clinical stroke services. METHODS/DESIGN: This pilot randomised controlled feasibility trial aims to recruit 60 participants over 15 months from North East England. Participants will be within 3 months of stroke which has caused new reduced upper limb function and will still be receiving therapy. Each participant will be randomised to an intervention or control group. Intervention participants will wear a CueS wristband (between 8 am and 8 pm) providing “live” feedback towards pre-set movement goals through a simple visual display and vibration prompts whilst undertaking a 4-week upper limb therapy programme (reviewed twice weekly by an occupational/physiotherapist). Control participants will also complete the 4-week upper limb therapy programme but will wear a ‘sham’ CueS wristband that monitors upper limb activity but provides no feedback. Outcomes will determine study feasibility in terms of recruitment, retention, adverse events, adherence and collection of descriptive clinical and accelerometer motor performance data at baseline, 4 weeks and 8 weeks. DISCUSSION: The WAVES study will address an important gap in the evidence base by reporting the feasibility of undertaking an evaluation of emerging and affordable technology to encourage impaired upper limb activity after stroke. The study will establish whether the study protocol can be supported by clinical stroke services, thereby informing the design of a future multi-centre randomised controlled trial of clinical and cost-effectiveness. TRIAL REGISTRATION: ISRCTN:82306027. Registered 12 July 2016. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13063-016-1628-2) contains supplementary material, which is available to authorized users

Immigrant and non-immigrant women's experiences of maternity care: A systematic and comparative review of studies in five countries

Background: Understanding immigrant women’s experiences of maternity care is critical if receiving country care systems are to respond appropriately to increasing global migration. This systematic review aimed to compare what we know about immigrant and non-immigrant women’s experiences of maternity care. Methods: Medline, CINAHL, Health Star, Embase and PsychInfo were searched for the period 1989–2012. First, we retrieved population-based studies of women’s experiences of maternity care (n = 12). For countries with identified population studies, studies focused specifically on immigrant women’s experiences of care were also retrieved (n = 22). For all included studies, we extracted available data on experiences of care and undertook a descriptive comparison. Results: What immigrant and non-immigrant women want from maternity care proved similar: safe, high quality, attentive and individualised care, with adequate information and support. Immigrant women were less positive about their care than non-immigrant women. Communication problems and lack of familiarity with care systems impacted negatively on immigrant women’s experiences, as did perceptions of discrimination and care which was not kind or respectful. Conclusion: Few differences were found in what immigrant and non-immigrant women want from maternity care. The challenge for health systems is to address the barriers immigrant women face by improving communication,increasing women’s understanding of care provision and reducing discrimination

The United Kingdom and the Netherlands maternity care responses to COVID-19: A comparative study

Background The national health care response to coronavirus (COVID-19) has varied between countries. The United Kingdom (UK) and the Netherlands (NL) have comparable maternity and neonatal care systems, and experienced similar numbers of COVID-19 infections, but had different organisational responses to the pandemic. Understanding why and how similarities and differences occurred in these two contexts could inform optimal care in normal circumstances, and during future crises. Aim To compare the UK and Dutch COVID-19 maternity and neonatal care responses in three key domains: choice of birthplace, companionship, and families in vulnerable situations. Method A multi-method study, including documentary analysis of national organisation policy and guidance on COVID-19, and interviews with national and regional stakeholders. Findings Both countries had an infection control focus, with less emphasis on the impact of restrictions, especially for families in vulnerable situations. Differences included care providers’ fear of contracting COVID-19; the extent to which community- and personalised care was embedded in the care system before the pandemic; and how far multidisciplinary collaboration and service-user involvement were prioritised. Conclusion We recommend that countries should 1) make a systematic plan for crisis decision-making before a serious event occurs, and that this must include authentic service-user involvement, multidisciplinary collaboration, and protection of staff wellbeing 2) integrate women’s and families’ values into the maternity and neonatal care system, ensuring equitable inclusion of the most vulnerable and 3) strengthen community provision to ensure system wide resilience to future shocks from pandemics, or other unexpected large-scale events

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Development and calibration of cyclic loading models for monopile foundations in clays

Monopiles are currently the most common foundation for offshore wind turbines. Recent research, such as in the PISA project, have produced new design methods for calculating the ultimate monotonic capacity of monopiles under lateral loading, leading to more efficient designs. However, monopiles are also subject to cyclic lateral loading from wind and waves. This aspect is not yet properly understood or accounted for in design. Better understanding of the cyclic response is important for both serviceability and fatigue design considerations, as cyclic loading can cause permanent foundation rotation, as well as changes to the stiffness and energy dissipation response. A new approach to modelling of cyclic loading, 'Hyperplastic Accelerated Ratcheting Model’ (HARM), can capture pile response to cyclic lateral loading on a cycle by-cycle basis for many cycles. Previous research demonstrates that this approach to modelling compares well to experimental data at a macro-scale, such as the full pile moment-rotation response. However, for design, it would be more appropriate for calibration parameters to be developed for site-specific conditions from laboratory element tests. To facilitate this approach, a database of cyclic laboratory tests in fine-grained soils has been acquired from the literature and private communication. Results of the tests are summarised to establish important features of behaviour and inform the formulation of a 0D, multi-surface, kinematic-hardening, rate-dependent, hyperplasticity model in total stress space which is calibrated to each data set. The model is then applied to more complex cases. Firstly it is used to generate synthetic contour diagrams, well used by the industry, to demonstrate prediction of the development of strain across the full constant-amplitude cyclic stress space. Secondly it is used to predict more realistic, multi-amplitude, element tests undertaken at the Norwegian Geotechnical Institute. Both these exercises serve as tests of the underlying mechanisms of the model. At monopile scale, the PISA project resulted in an extended Winkler model with monotonic reaction curves along the length and at the base of the pile; this approach is subsequently extended to incorporate a total stress, 0D hyperplasticity model in place of each reaction curve. The resulting 1D model is capable of predicting the cyclic response along the pile length, including ratcheting. Cyclic tests at Cowden are modelled, with parameters compared to those at element level to investigate the potential mapping of response at different levels of detail. By exploring mobilisation of lateral pressure down the pile for typical operational loading, an element-testing regime is proposed to better reflect the realistic conditions around the pile. The 0D total-stress model predicts the shear behaviour for fine-grained soils well. However, the possible effects of effective stress changes are modelled by softening of the yield surfaces in the total stress model. A better approach would be to capture realistically effective stress changes due to cyclic loading. A preliminary extension of the 0D model to capture effective stresses, based on Modified Cam-Clay, is presented at development stage.</p