Ageing Technologically: Exploring the Motivating Operations of Technology Use by Older Adults

Statistics from the 2011 UK Census revealed that one sixth of the population were over the age of 65, which is the highest recorded ratio in any census history. Although there are discrepancies in the physical, mental and social wellbeing of the older adult population, huge strains have been placed upon the National Health Service, care system and subject population. Previous scholarship has revealed that technology use in various formats can reduce these pressures, however, published work on older adults and technology often focusses on attitudes and intentions rather than motivations of actual use. This thesis addresses this gap in the literature by examining the Motivating Operations (MOs) on post-purchase technology use of older adults. By adopting a radical behaviourist perspective, the present research attempts to introduce the Applied Behaviour Analysis (ABA) term, Motivating Operation, to consumer behaviour by incorporating the proposed MOs into the already established Behavioural Perspective Model (BPM). This approach encourages the measurement of actual technology use as an operant behaviour alongside the MOs, as independent variables, impacting upon the rate-of-response. Consequently, a longitudinal quantitative and qualitative empirical strategy has been devised to produce a rich and complex set of data to explain older adult technology use. Overall, by using principles of behaviourism to interpret the technology use of older adults within a post-purchase environment, this thesis intends to break the dominant trend within technology acceptance and adoption literature of relying on either the Technology Acceptance Model (TAM) or Diffusion of Innovation (DIT) to explain behaviours related to technology use. Alternatively, it produces an imaginative but logical analysis of the subject behaviour, which is not in contention with previous models but intends to enhance and expand the consumer behaviour, technology acceptance and adoption literature

Evaluation of the 'Connecting Residents in Scotland's Care Homes' Programme

This report details the findings from the ‘Connecting Residents in Scotland’s Care Homes’ (hereafter CRSCH) programme evaluation. The evaluation was commissioned by the Scottish Government Technology Enabled Care programme in conjunction with the Digital Health and Care Innovation Centre (DHI). The project looked to evaluate the programme from the perspectives of all stakeholders, including residents, care staff, managers, family and friends of residents, and policymakers. Our goal was to find how far the programme is meeting its goals, the issues influencing its effectiveness, and the individual and organisational factors that will influence its continued scale up and sustainability over the longer term. The evaluation was conducted between December 2021 and July 2022 by a research team from the Faculty of Social Sciences and the Stirling Management School at the University of Stirling

Executive Summary: Evaluation of the ‘Connecting Residents in Scotland’s Care Homes’ Programme

This report details the findings from the ‘Connecting Residents in Scotland’s Care Homes’ (hereafter CRSCH) programme evaluation. The evaluation was commissioned by the Scottish Government Technology Enabled Care programme in conjunction with the Digital Health and Care Innovation Centre (DHI). The project sought to evaluate the programme from the perspectives of all stakeholders, including residents, care staff, managers, family and friends of residents, and policymakers. The evaluation goal was to identify how far the programme is meeting its objectives, the issues influencing its effectiveness and the individual and organisational factors that will influence its continued scale up and sustainability over the longer term

Towards an Evaluation Framework for Inclusive Technological Innovation in Social and Health Care Services

With the COVID-19 pandemic came an influx of digital technologies introduced into the care home sector. Many care homes were not ready for digital changes, and subsequently, the inclusivity of these innovations was variable. We develop a holistic evaluation framework to assess the inclusivity of service innovations, including the well-being of care home residents and employees. We adopt a mixed methods approach using the ‘non-adoption, abandonment, and challenges to scale-up, spread, and sustainability - complexity assessment toolkit’ (NASSS-CAT) to evaluate the introduction of tablet computers into care homes across Scotland and assess the inclusivity of the innovation. The paper offers a theoretical synthesis by indicating how the seven dimensions of the NASSS-CAT can evaluate the six stages of the ladder of inclusive innovation. Results specify how the care home sector could be more inclusive of its residents and staff by co-creating innovation, developing staff training, and supporting the well-being/activities coordinators

Towards an Evaluation Framework for Inclusive Technological Innovation in Social and Health Care Services

With the COVID-19 pandemic came an influx of digital technologies introduced into the care home sector. Many care homes were not ready for digital changes, and subsequently, the inclusivity of these innovations was variable. We develop a holistic evaluation framework to assess the inclusivity of service innovations, including the well-being of care home residents and employees. We adopt a mixed methods approach using the ‘non-adoption, abandonment, and challenges to scale-up, spread, and sustainability - complexity assessment toolkit’ (NASSS-CAT) to evaluate the introduction of tablet computers into care homes across Scotland and assess the inclusivity of the innovation. The paper offers a theoretical synthesis by indicating how the seven dimensions of the NASSS-CAT can evaluate the six stages of the ladder of inclusive innovation. Results specify how the care home sector could be more inclusive of its residents and staff by co-creating innovation, developing staff training, and supporting the well-being/activities coordinators

Seven features of safety in maternity units: a framework based on multisite ethnography and stakeholder consultation

Background: Reducing avoidable harm in maternity services is a priority globally. As well as learning from mistakes, it is important to produce rigorous descriptions of ‘what good looks like’. Objective: We aimed to characterise features of safety in maternity units and to generate a plain language framework that could be used to guide learning and improvement. Methods: We conducted a multisite ethnography involving 401 hours of non-participant observations 33 semistructured interviews with staff across six maternity units, and a stakeholder consultation involving 65 semistructured telephone interviews and one focus group. Results: We identified seven features of safety in maternity units and summarised them into a framework, named For Us (For Unit Safety). The features include: (1) commitment to safety and improvement at all levels, with everyone involved; (2) technical competence, supported by formal training and informal learning; (3) teamwork, cooperation and positive working relationships; (4) constant reinforcing of safe, ethical and respectful behaviours; (5) multiple problem-sensing systems, used as basis of action; (6) systems and processes designed for safety, and regularly reviewed and optimised; (7) effective coordination and ability to mobilise quickly. These features appear to have a synergistic character, such that each feature is necessary but not sufficient on its own: the features operate in concert through multiple forms of feedback and amplification. Conclusions: This large qualitative study has enabled the generation of a new plain language framework—For Us—that identifies the behaviours and practices that appear to be features of safe care in hospital-based maternity units

Mutations in TOP3A Cause a Bloom Syndrome-like Disorder

Bloom syndrome, caused by biallelic mutations in BLM, is characterized by prenatal-onset growth deficiency, short stature, an erythematous photosensitive malar rash, and increased cancer predisposition. Diagnostically, a hallmark feature is the presence of increased sister chromatid exchanges (SCEs) on cytogenetic testing. Here, we describe biallelic mutations in TOP3A in ten individuals with prenatal-onset growth restriction and microcephaly. TOP3A encodes topoisomerase III alpha (TopIIIα), which binds to BLM as part of the BTRR complex, and promotes dissolution of double Holliday junctions arising during homologous recombination. We also identify a homozygous truncating variant in RMI1, which encodes another component of the BTRR complex, in two individuals with microcephalic dwarfism. The TOP3A mutations substantially reduce cellular levels of TopIIIα, and consequently subjects’ cells demonstrate elevated rates of SCE. Unresolved DNA recombination and/or replication intermediates persist into mitosis, leading to chromosome segregation defects and genome instability that most likely explain the growth restriction seen in these subjects and in Bloom syndrome. Clinical features of mitochondrial dysfunction are evident in several individuals with biallelic TOP3A mutations, consistent with the recently reported additional function of TopIIIα in mitochondrial DNA decatenation. In summary, our findings establish TOP3A mutations as an additional cause of prenatal-onset short stature with increased cytogenetic SCEs and implicate the decatenation activity of the BTRR complex in their pathogenesis

Rheumatoid arthritis - clinical aspects: 134. Predictors of Joint Damage in South Africans with Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA) causes progressive joint damage and functional disability. Studies on factors affecting joint damage as clinical outcome are lacking in Africa. The aim of the present study was to identify predictors of joint damage in adult South Africans with established RA. Methods: A cross-sectional study of 100 black patients with RA of >5 years were assessed for joint damage using a validated clinical method, the RA articular damage (RAAD) score. Potential predictors of joint damage that were documented included socio-demographics, smoking, body mass index (BMI), disease duration, delay in disease modifying antirheumatic drug (DMARD) initiation, global disease activity as measured by the disease activity score (DAS28), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), and autoantibody status. The predictive value of variables was assessed by univariate and stepwise multivariate regression analyses. A p value <0.05 was considered significant. Results: The mean (SD) age was 56 (9.8) years, disease duration 17.5 (8.5) years, educational level 7.5 (3.5) years and DMARD lag was 9 (8.8) years. Female to male ratio was 10:1. The mean (SD) DAS28 was 4.9 (1.5) and total RAAD score was 28.3 (12.8). The mean (SD) BMI was 27.2 kg/m2 (6.2) and 93% of patients were rheumatoid factor (RF) positive. More than 90% of patients received between 2 to 3 DMARDs. Significant univariate predictors of a poor RAAD score were increasing age (p = 0.001), lower education level (p = 0.019), longer disease duration (p < 0.001), longer DMARD lag (p = 0.014), lower BMI (p = 0.025), high RF titre (p < 0.001) and high ESR (p = 0.008). The multivariate regression analysis showed that the only independent significant predictors of a higher mean RAAD score were older age at disease onset (p = 0.04), disease duration (p < 0.001) and RF titre (p < 0.001). There was also a negative association between BMI and the mean total RAAD score (p = 0.049). Conclusions: Patients with longstanding established RA have more severe irreversible joint damage as measured by the clinical RAAD score, contrary to other studies in Africa. This is largely reflected by a delay in the initiation of early effective treatment. Independent of disease duration, older age at disease onset and a higher RF titre are strongly associated with more joint damage. The inverse association between BMI and articular damage in RA has been observed in several studies using radiographic damage scores. The mechanisms underlying this paradoxical association are still widely unknown but adipokines have recently been suggested to play a role. Disclosure statement: C.I. has received a research grant from the Connective Tissue Diseases Research Fund, University of the Witwatersrand. All other authors have declared no conflicts of interes

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment