Debating critical costume: negotiating ideologies of appearance, performance and disciplinarity

In this article, I present an argument for a proposed focus of ‘critical costume’. Critical Costume, as a research platform, was founded in 2013 to promote new debate and scholarship on the status of costume in contemporary art and culture. We have now hosted two biennial conferences and exhibitions (Edge Hill University 2013, Aalto University 2015). These events have exposed an international appetite for a renewed look at how costume is studied, practised and theorized. Significantly, Critical Costume is focused on an inclusive remit that is interdisciplinary and supports a range of ‘voices’: from theatre and anthropology scholars to working artists. In that regard, I offer an initial argument for how we might collectively navigate this interdisciplinary field of practice with reference to other self-identified critical approaches to art and design. By focusing on an interdisciplinary perspective on costume, my intention is to invite new readings and connections between popular practices, such as Halloween and cosplay, with the refined crafts of theatrical and film professionals. I argue that costume is a vital element of performance practice – as well as an extra-daily component of our social lives – that affords distinct methods for critiquing how appearance is sustained, disciplined and regulated. I conclude by offering a position on the provocation of critical costume and a word of caution on the argument for disciplinarity

Cellular and molecular changes in calcifying tendinitis

Calcifying tendinitis can be a debilitating disease and occurs when mineral becomes deposited in tendon. The tendons situated in the rotator cuff of the human shoulder are particularly vulnerable. The pathogenetic mechanisms of this disease are unknown, but chondrogenic modulation has been proposed by Uhthoff (1975 et seq.) and this particular theory has been investigated. Cellular, molecular and enzymic features of pathological tendon have been compared and contrasted with normal tendon and articular cartilage, in addition to ossifying muscle. Fresh tissue samples were taken in the operating theatre, sub-divided, then processed by several different methods. Pathological specimens showed a variety of morphological changes. Ultrastructural observations in the regions around the deposited mineral enabled a detailed description of the pathological tissue and the associated calcific deposits. Alkaline phosphatase is frequently associated with calcification but in mineralising tendon, enzyme activity was not evident. Immunocytochemistry used to investigate the possible presence of collagen types II, VI, hyaluronic acid binding region protein and chondroitin- 4 and 6- sulphates, molecules that may be associated with a pathological cellular modulation in the tendon. No collagen type II was observed in the calcifying tendon. Thus, we suggest that a chondrogenic modulation is an unlikely causal mechanism of the pathology. Microanalytical studies compared the calcium to phosphorous ratios of mineral found in individual patients. Statistically significant ratios were obtained from hydroxyapatite crystals found in ossified tendon, compared with the less electron dense crystals of cal-cospherites located in the same tissue section. The ratios were all closer to the expected value for hydroxyapatite rather than pyrophosphate. Although it is not yet possible to provide a specific pathological mechanism for calcifying tendinitis, it appears not to be akin to endochondral ossification or primary bone formation, but may have features unique to tendon mineralisation

On Atmospherics: Staging Stormzy and nonbinary thinking

Taking the UK Grime artist Stormzy’s performance at Glastonbury 2019 as a case study, this article investigates the tactics, technologies and processes revealed through the act of staging atmospheres. Process-based philosophies of experience, such as pluriversal design and worlding, are adopted to examine the ontologically ‘nonbinary’ perspectives that an atmosphere-led stage aesthetics invite. Methodologically, Stormzy’s headlining act produced by TAXBOX and collaborators is analyzed through the geographer Derek McCormack’s approach to speculative devices (such as balloons or stage sets) as ‘doing atmospheric things’. This includes an analysis of stage atmospheres as indeterminate ‘worlding envelopes’ and the role of atmospherics in enacting, projecting, or affirming possible worlds for Black British culture. McCormack’s proposal of atmospheric envelopment is extended into the study of theatre and performance by positioning ‘scenographics’ as a type of atmospherics. Put simply, this article offers an initial argument for considering the tactical affects of scenographics within the production of atmospherics. The article concludes with a challenge to category-based (binary) stage ontologies and argues the benefits of atmospherics as a process-based (nonbinary) approach to stage aesthetics

At the borders of scenography

Foreward for Scenography and Art History introducing how to approach scenography as a crafting of border

Is telephone health coaching a useful population health strategy for supporting older people with multimorbidity? : An evaluation of reach, effectiveness and cost-effectiveness using a 'trial within a cohort'

BACKGROUND: Innovative ways of delivering care are needed to improve outcomes for older people with multimorbidity. Health coaching involves 'a regular series of phone calls between patient and health professional to provide support and encouragement to promote healthy behaviours'. This intervention is promising, but evidence is insufficient to support a wider role in multimorbidity care. We evaluated health coaching in older people with multimorbidity. METHODS: We used the innovative 'Trials within Cohorts' design. A cohort was recruited, and a trial was conducted using a 'patient-centred' consent model. A randomly selected group within the cohort were offered the intervention and were analysed as the intervention group whether they accepted the offer or not. The intervention sought to improve the skills of patients with multimorbidity to deal with a range of long-term conditions, through health coaching, social prescribing and low-intensity support for low mood. RESULTS: We recruited 4377 older people, and 1306 met the eligibility criteria (two or more long-term conditions and moderate 'patient activation'). We selected 504 for health coaching, and 41% consented. More than 80% of consenters received the defined 'dose' of 4+ sessions. In an intention-to-treat analysis, those selected for health coaching did not improve on any outcome (patient activation, quality of life, depression or self-care) compared to usual care. We examined health care utilisation using hospital administrative and self-report data. Patients selected for health coaching demonstrated lower levels of emergency care use, but an increase in the use of planned services and higher overall costs, as well as a quality-adjusted life year (QALY) gain. The incremental cost per QALY was £8049, with a 70-79% probability of being cost-effective at conventional levels of willingness to pay. CONCLUSIONS: Health coaching did not lead to significant benefits on the primary measures of patient-reported outcome. This is likely related to relatively low levels of uptake amongst those selected for the intervention. Demonstrating effectiveness in this design is challenging, as it estimates the effect of being selected for treatment, regardless of whether treatment is adopted. We argue that the treatment effect estimated is appropriate for health coaching, a proactive model relevant to many patients in the community, not just those seeking care. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number ( ISRCTN12286422 )

Feasibility of an Intervention to Support Hearing and Vision in Dementia:The SENSE-Cog Field Trial

OBJECTIVES: People with dementia (PwD) frequently experience hearing and vision impairment that is underrecognized and undertreated, resulting in reduced quality of life. Managing these impairments may be an important strategy to improve outcomes in PwD. Our objective was to field-trial a multifaceted sensory intervention (SI) to enhance hearing and vision in PwD. DESIGN: An international single-arm open-label feasibility, acceptability, and tolerability study. SETTING: Home-based setting in the United Kingdom, France, and Cyprus. PARTICIPANTS: Adults aged 60 years and older with mild-to-moderate dementia and uncorrected or suboptimally corrected hearing and/or vision impairment, and their study partners (n = 19 dyads). INTERVENTION: A sensory intervention (SI), comprising assessment of hearing and vision, fitting of corrective devices (glasses, hearing aids), and home-based support from a sensory support therapist for device adherence and maintenance, communication training, referral to support services, environmental sensory modification, and optimization of social inclusion. MEASUREMENTS: Ratings of study procedure feasibility, and intervention acceptability/tolerability, ascertained through questionnaires, participant diaries, therapist logbooks, and semistructured interviews. RESULTS: We successfully delivered all intervention components, and these were received and enacted as intended in all those who completed the intervention. No serious adverse events were reported. Acceptability (ie, understanding, motivation, sense of achievement) and tolerability (ie, effort, fatigue) ratings of the intervention were within a priori target ranges. We met recruitment and retention (93.8%) targets in two of the three sites. Participants completed more than 95% of diary entries, representing minimal missing data. Delays in the logistics circuit for the assessment and delivery of hearing aids and glasses were identified, requiring modification. The need for minor modifications to some outcome measures and the inclusion criteria were identified. CONCLUSION: This is the first study combining home-based hearing and vision remediation in PwD. The positive feasibility, acceptability, and tolerability findings suggest that a full-scale efficacy trial, with certain modifications, is achievable

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Improving care for older people with long-term conditions and social care needs in Salford : the CLASSIC mixed-methods study, including RCT

BackgroundThe Salford Integrated Care Programme (SICP) was a large-scale transformation project to improve care for older people with long-term conditions and social care needs. We report an evaluation of the ability of the SICP to deliver an enhanced experience of care, improved quality of life, reduced costs of care and improved cost-effectiveness.ObjectivesTo explore the process of implementation of the SICP and the impact on patient outcomes and costs.DesignQualitative methods (interviews and observations) to explore implementation, a cohort multiple randomised controlled trial to assess patient outcomes through quasi-experiments and a formal trial, and an analysis of routine data sets and appropriate comparators using non-randomised methodologies.SettingSalford in the north-west of England.ParticipantsOlder people aged ≥ 65 years, carers, and health and social care professionals.InterventionsA large-scale integrated care project with three core mechanisms of integration (community assets, multidisciplinary groups and an ‘integrated contact centre’).Main outcome measuresPatient self-management, care experience and quality of life, and health-care utilisation and costs.Data sourcesProfessional and patient interviews, patient self-report measures, and routine quantitative data on service utilisation.ResultsThe SICP and subsequent developments have been sustained by strong partnerships between organisations. The SICP achieved ‘functional integration’ through the pooling of health and social care budgets, the development of the Alliance Agreement between four organisations and the development of the shared care record. ‘Service-level’ integration was slow and engagement with general practice was a challenge. We saw only minor changes in patient experience measures over the period of the evaluation (both improvements and reductions), with some increase in the use of community assets and care plans. Compared with other sites, the difference in the rates of admissions showed an increase in emergency admissions. Patient experience of health coaching was largely positive, although the effects of health coaching on activation and depression were not statistically significant. Economic analyses suggested that coaching was likely to be cost-effective, generating improvements in quality of life [mean incremental quality-adjusted life-year gain of 0.019, 95% confidence interval (CI) –0.006 to 0.043] at increased cost (mean incremental total cost increase of £150.58, 95% CI –£470.611 to £711.776).LimitationsThe Comprehensive Longitudinal Assessment of Salford Integrated Care study represents a single site evaluation, with consequent limits on external validity. Patient response rates to the cohort survey were ConclusionsThe SICP has been implemented in a way that is consistent with the original vision. However, there has been more rapid success in establishing new integrated structures (such as a formal integrated care organisation), rather than in delivering mechanisms of integration at sufficient scale to have a large impact on patient outcomes.Future workFurther research could focus on each of the mechanisms of integration. The multidisciplinary groups may require improved targeting of patients or disease subgroups to demonstrate effectiveness. Development of a proven model of health coaching that can be implemented at scale is required, especially one that would provide cost savings for commissioners or providers. Similarly, further exploration is required to assess the longer-term benefits of community assets and whether or not health impacts translate to reductions in care use.Trial registrationCurrent Controlled Trials ISRCTN12286422.FundingThis project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 6, No. 31. See the NIHR Journals Library website for further project information