Migrating art:A research design to support refugees' recovery from trauma - a pilot study

An international challenge is presented by the unprecedented number of refugees worldwide, many of whom have undergone psychological and social stresses associated with migration and who consequently experience mental health disorders. A growing number of organisations recognize the role of art in supporting refugees to support recovery from trauma, and this pilot study in participatory arts is designed to contribute to the field. The research was undertaken with a charity supporting pre and post-natal women refugees who are victims of rape, trafficking, sexual violence, domestic servitude, and other forms of gender based violence and human rights abuses. The research explores the benefits of painting landscapes through re-imagining places experienced as a ‘safe-haven’, or journey towards safety. The research design is explored with a view to inform a further research study using the approach to evaluate a participatory arts workshop model that support refugees’ recovery and transition

Painting place:re-imagining landscapes for older people's subjective wellbeing

This study provides insights into how a participatory painting activity impacts older people’s subjective wellbeing. The study uses qualitative methods to analyze the findings, and employs qualitative data collection methods to examine how creativity conducted in an environment of relational connectivity is beneficial to wellbeing. The findings demonstrate that processes of re-imagining landscape contribute to participants’ retaining significant places in the mind when physical engagement is limited. The study reveals how the activity of re-imagining landscape provokes emotions and memories that help participants connect the past with the present, and to connect their older and younger-age selves, positively to reaffirm their older age identity. The paper reflects on the intervention as a form of encounter with landscape whose benefits are potentially therapeutic for different groups, particularly those for whom engagement with memories may assist with processes of adaptation or transition

Art as a Strategy for Living with Utopias in Ruins

The term ‘utopia’ is problematic. Originating in the Greek for ‘no place’ or ‘good place’ it suggests an ideal that can only be imagined. To imagine utopias could be seen as an unrealistic orientation to a future in which the local impacts of global change will be severe. However, utopian thinking also includes the pursuit of a transformation, it is about how we might strive towards a better future and find strategies for living with dystopic situations. Anthropologist Anna Tsing suggests that we need imagination to grasp the precariousness and unpredictability of contemporary life. She does this through both a metaphorical use of the Matsuke mushroom to imagine the possibility of life in a ruined landscape, and through detailed observations of the lives of mushroom pickers surviving economically in the ruins of capitalism. This parallel practice of imagination and observation also characterises the works in the Mobile Utopia exhibition. Through the works we see utopian plans and ideas come up against the frictions of physical place; where ideas are not only imagined, but attempted, enacted and grappled with. Although all the art works are distinctly mobile, they are grounded by the frictions that the artists unearth, enact and perform through investigations of situated and spatial practices. We suggest that the processes and journeys that produced the art works can be thought of as strategies for living and making meaning in the ruins of capitalism. We have grouped the works into three themes: an exploration of infrastructures that enable particular kinds of mobilities; the negotiation of identity on the move and in relation to changing geographies; and the questioning of veracity of or within distributed, networked and mediated mobilities. The themes often overlap within the works as the artists navigate between material geographies, mobile lives and distributed networks. The works are not propositions for the future, they are all explicitly grounded in the way that past, present and future are entangled in a complex relation to each other and to the frictions of location. While reminding us of past ideas of utopian planning they also offer new ways to make critical observations

Mobile Utopia:Art and Experiments

The exhibition of 13 international artists, 12 Experiments, a catalogue of essays,and Mobile Utopias conference hosting 180 delegates, launched a new platformfor Art and Mobilities. The exhibition was developed in connection with the world leading Centre for Mobilities Research. In this context, the exhibition aimed to encourage artists, participants and spectators to take a fresh look at experiences of mobility, their connection with each other and space. To consider ways in which the artistic interventions contribute to the reconfiguration of spaces for experimentation, critique, and political communication, creating new organisational forms, and potentially the reformation of mobility regimes. Artworks were selected for the exhibition from an open call, through a rigorous selection process. The artists were from 4 continents: Australia, Brazil, Canada, Austria, Germany, Greece, Italy, Portugal & UK and are established and internationally renowned artists. The exhibition included works in video installation, sound art, data sculpture, walking art, book works, performance, networked art and participation. It included the following artists: Kaya Barry, Tess Baxter, Valentina Bonizzi, Fernanda Duarte, Michael Hieslmair & Michael Zinganel, Vicki Kerr, Clare McCracken, Peter Merrington & Ilana Mitchell, Nikki Pugh, Max Schleser, Gerda Cammaer & Phillip Rubery, Samuel Thulin, Christina Vasilopoulou, and Louise Ann Wilson. Published in conjunction with the exhibition a catalogue of critical essays underpinned the concepts. This included an essay by Southern, J., Rose, E.E., O Keeffe, L., Art as a Strategy for Living with Utopias in Ruins and The Mobile UtopiaE xperiment by Bȕscher, M., alongside images and statements by the artists addressing the Mobilities theme.The project attracted a range of funders and sponsors. Followingthe exhibition, the curatorial team Southern, Rose, O Keeffe with Kai Tan established an international network in Art and Mobilities with a further symposium: The UK Art & Mobilities Network Inaugural Symposium held on 3rd July 2018, with 22delegates

Better pathways for people with aphasia

Integrated care pathways, clinical pathways, patient journeys and care maps are interchangeable terminology to describe tools which promote organised and efficient patient care based on the best available evidence and guidelines (Kwan et al., 2004). A care pathway can further be described as a ‘complex intervention for the mutual decision making and organisation of care processes for a well-defined group of patients during a well-defined period’ (European Pathway Association, 2007). The use of care pathways allows continuous assessment of clinical processes and outcomes against current best practice and guidelines. As evidence-based practice become progressively more important for effective health delivery, increased research use within aphasia rehabilitation is paramount. Currently, stroke clinical guidelines offer very little in the form of aphasia-specific recommendations to inform practice. Our systematic review of clinical practice guidelines revealed a paucity of high-quality aphasia rehabilitation guidelines internationally (Rohde et al, in press). Integrated care pathways are gaining increasing popularity in health care delivery and offer a potential solution to the lack of evidence-based recommendations within aphasia rehabilitation. The AARP aims to improve the overall patient journey for people with aphasia through providing clinicians with access to the best evidence in a dynamic and user-friendly format. In addition to the principles of integrated care pathways, the AARP utilises the theory of evidence-based practice through combining the best available evidence with family/client perspectives and clinical expertise. The AARP is also underpinned by the principles of knowledge transfer and exchange (KTE) which aims to close the research-practice gap in order to realise and maximise the benefits of research within the practice setting. Hence the aims of this paper are to: a) Present results of the systematic review of clinical guidelines in stroke and aphasia b) Describe the consensus document that maps the AARP. c) Describe the translation of a highly complex system to a user-friendly web-based system

Pneumococcal carriage following PCV13 delivered as one primary and one booster dose (1 + 1) compared to two primary doses and a booster (2 + 1) in UK infants

In January 2020 the UK changed from a 2 + 1 schedule for 13-valent pneumococcal conjugate vaccine (PCV13) to a 1 + 1 schedule (doses at 3 and 12 months) based on a randomized immunogenicity trial comparing the two schedules. Carriage prevalence measured at the time of booster and 6 months later in 191 of the 213 study infants was 57 % (109/191) and 60 % (114/190) respectively. There were eight episodes of vaccine-type (VT) or vaccine-related 6C carriage in the 2 + 1 and six in the 1 + 1 group; ≥4-fold rises in serotype-specific IgG in 71 children with paired post-booster and follow up blood samples at 21–33 months of age were found in 20 % (7/35) of the 2 + 1 and 15 % (6/41) of the 1 + 1 group. VTs identified in carriage and inferred from serology were similar comprising 3, 19A and 19F. Dropping a priming dose from the 2 + 1 PCV 13 schedule did not increase VT carriage in the study cohort. Ongoing population level carriage studies will be important to confirm this

XThe psychosocial impact of living with an ocular prosthesis

Objective: Many patients are satisfied with their ocular prosthesis, but some describe problems with social interactions, body image and self-esteem. Although both clinical practice and research suggest that the severity of a disfiguring condition does not predict distress, there has been little research with patients living with an ocular prosthesis. The objective was to explore the psychological impact of living with an artificial eye or cosmetic shell and determine the relationship between psychological well-being and clinical and psychosocial factors. Methods: A cross-sectional study between March and September 2008 at the ocular prosthesis clinic of Moorfields Eye Hospital, UK. The primary outcome measures were mood as measured by the Hospital Anxiety and Depression Scale (HADS) and appearance-related social anxiety and social avoidance, as measured by the Derriford Appearance Scale (DAS24). Results: Mean scores on the HADS and DAS24 were within normal range, but a considerable proportion of participants were experiencing significant levels of distress. Psychosocial adjustment was unrelated to most clinical and demographic variables, but was associated with a series of cognitive processes. Conclusions: Psychological variables, rather than clinical or demographic factors, are associated with how a patient adjusts to wearing an ocular prosthesis. Such factors might be amenable to change through psychosocial intervention

Keeping children safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives

Background: Unintentional injuries among 0- to 4-year-olds are a major public health problem incurring substantial NHS, individual and societal costs. However, evidence on the effectiveness and cost-effectiveness of preventative interventions is lacking. Aim: To increase the evidence base for thermal injury, falls and poisoning prevention for the under-fives. Methods: Six work streams comprising five multicentre case–control studies assessing risk and protective factors, a study measuring quality of life and injury costs, national surveys of children’s centres, interviews with children’s centre staff and parents, a systematic review of barriers to, and facilitators of, prevention and systematic overviews, meta-analyses and decision analyses of home safety interventions. Evidence from these studies informed the design of an injury prevention briefing (IPB) for children’s centres for preventing fire-related injuries and implementation support (training and facilitation). This was evaluated by a three-arm cluster randomised controlled trial comparing IPB and support (IPB+), IPB only (no support) and usual care. The primary outcome was parent-reported possession of a fire escape plan. Evidence from all work streams subsequently informed the design of an IPB for preventing thermal injuries, falls and poisoning. Results: Modifiable risk factors for falls, poisoning and scalds were found. Most injured children and their families incurred small to moderate health-care and non-health-care costs, with a few incurring more substantial costs. Meta-analyses and decision analyses found that home safety interventions increased the use of smoke alarms and stair gates, promoted safe hot tap water temperatures, fire escape planning and storage of medicines and household products, and reduced baby walker use. Generally, more intensive interventions were the most effective, but these were not always the most cost-effective interventions. Children’s centre and parental barriers to, and facilitators of, injury prevention were identified. Children’s centres were interested in preventing injuries, and believed that they could prevent them, but few had an evidence-based strategic approach and they needed support to develop this. The IPB was implemented by children’s centres in both intervention arms, with greater implementation in the IPB+ arm. Compared with usual care, more IPB+ arm families received advice on key safety messages, and more families in each intervention arm attended fire safety sessions. The intervention did not increase the prevalence of fire escape plans [adjusted odds ratio (AOR) IPB only vs. usual care 0.93, 95% confidence interval (CI) 0.58 to 1.49; AOR IPB+ vs. usual care 1.41, 95% CI 0.91 to 2.20] but did increase the proportion of families reporting more fire escape behaviours (AOR IPB only vs. usual care 2.56, 95% CI 1.38 to 4.76; AOR IPB+ vs. usual care 1.78, 95% CI 1.01 to 3.15). IPB-only families were less likely to report match play by children (AOR 0.27, 95% CI 0.08 to 0.94) and reported more bedtime fire safety routines (AOR for a 1-unit increase in the number of routines 1.59, 95% CI 1.09 to 2.31) than usual-care families. The IPB-only intervention was less costly and marginally more effective than usual care. The IPB+ intervention was more costly and marginally more effective than usual care. Limitations: Our case–control studies demonstrate associations between modifiable risk factors and injuries but not causality. Some injury cost estimates are imprecise because of small numbers. Systematic reviews and meta-analyses were limited by the quality of the included studies, the small numbers of studies reporting outcomes and significant heterogeneity, partly explained by differences in interventions. Network meta-analysis (NMA) categorised interventions more finely, but some variation remained. Decision analyses are likely to underestimate cost-effectiveness for a number of reasons. IPB implementation varied between children’s centres. Greater implementation may have resulted in changes in more fire safety behaviours. Conclusions: Our studies provide new evidence about the effectiveness of, as well as economic evaluation of, home safety interventions. Evidence-based resources for preventing thermal injuries, falls and scalds were developed. Providing such resources to children’s centres increases their injury prevention activity and some parental safety behaviours. Future work: Further randomised controlled trials, meta-analyses and NMAs are needed to evaluate the effectiveness and cost-effectiveness of home safety interventions. Further work is required to measure NHS, family and societal costs and utility decrements for childhood home injuries and to evaluate complex multicomponent interventions such as home safety schemes using a single analytical model. Trial registration: Current Controlled Trials ISRCTN65067450 and ClinicalTrials.gov NCT01452191. Funding: The National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 5, No. 14. See the NIHR Journals Library website for further project information

Yolk sac cell atlas reveals multiorgan functions during human early development

The extraembryonic yolk sac (YS) ensures delivery of nutritional support and oxygen to the developing embryo but remains ill-defined in humans. We therefore assembled a comprehensive multiomic reference of the human YS from 3 to 8 postconception weeks by integrating single-cell protein and gene expression data. Beyond its recognized role as a site of hematopoiesis, we highlight roles in metabolism, coagulation, vascular development, and hematopoietic regulation. We reconstructed the emergence and decline of YS hematopoietic stem and progenitor cells from hemogenic endothelium and revealed a YS-specific accelerated route to macrophage production that seeds developing organs. The multiorgan functions of the YS are superseded as intraembryonic organs develop, effecting a multifaceted relay of vital functions as pregnancy proceeds