‘An end to the job as we know it’: how an IT professional has experienced the uncertainty of IT outsourcing.

This article foregrounds the voice of an IT professional who is directly employed by a large British company and who, along with colleagues, is experiencing career uncertainty resulting from a management initiative to replace the established workforce with an alternative labour supply provided by a global IT services company. As an account that reflects the uncertainty of the age, the narrative offers insights into current discussions concerning the contemporary nature and experience of work generally. More specifically it tells of a loss of confidence and status of technical professionals as they are methodically undermined by the confident assertion of a ‘shareholder value’ rhetoric. The suggestion is made that the application of commercial-professional rationality to the outsourcing of IT operations may underestimate the commercial risks associated with the loss of embodied technical knowledge gained across time as IT systems evolve to become complex constructions

Dementia and Imagination: a mixed-methods protocol for arts and science research

Introduction Dementia and Imagination is a multi-disciplinary research collaboration bringing together arts and science to address current evidence limitations around the benefits of art activities in dementia care. It is a large programme of work with a novel combination of methods from health and social sciences together with the arts and humanities to address a key societal challenge – supporting the quality of life of the growing number of people living with dementia. This is examined through the following questions; can art improve quality of life and well-being? If it does make a difference, how does it do this - and why? Does it have wider social and community benefits? Methods and analysis Participants are recruited from residential care homes, NHS wards and communities in three locations in England and Wales. A visual arts intervention is developed and delivered as 1 x 2 hour weekly group session for 3 months to N=100 people living with dementia. Quantitative and qualitative data are collected at three time-points to examine the impact on the quality of life of people living with dementia together with the cost-benefit, and the perceptions of those who care for them (N=100 family and professional carers). Repeated-measures systematic observation of wellbeing is applied during the intervention delivery (intervention versus control condition). Qualitative data is collected from a sub-sample at three time-points (N=35 carers/staff and N=35 people living with dementia) to explore changes in social connectedness. Self-reported outcomes during the intervention delivery are obtained (N=100). Focus groups with intervention participants (N=40) explore perceptions of impact. Social network analysis of quantitative and qualitative data from arts and healthcare professionals (N=100) examine changes in perceptions and practice. Ethics and dissemination The study is approved by North Wales research ethics committee – West. The research findings will be shared through a range of activities. International and national academic conferences and events will be attended to present papers and lead symposia. The project has developed an extensive public engagement and communication strategy. Public engagement projects will target a broad range of stakeholders. There is a regularly maintained project website, which is a resource bank for stakeholders and a continuing legacy from the project. A quarterly newsletter is produced. Policy and practice summaries will be developed from the findings. The visual arts intervention protocol will be developed as a practitioners guide and freely available.Strengths and limitations of this study•Dementia and Imagination is the largest arts and dementia research study in the UK.•The development and delivery of the research involves partnerships between universities, community arts organisations, galleries, the NHS and charities.•It combines methods from health and social sciences together with the arts and humanities to address a key societal challenge – supporting the quality of life of the growing number of people living with dementia.•A limitation is that the study design cannot focus on a more robust test of effectiveness, as this was beyond the remit of the funder

Apathy and Its Response to Antipsychotic Review and Nonpharmacological Interventions in People With Dementia Living in Nursing Homes:WHELD, a Factorial Cluster Randomized Controlled Trial

Objectives: Apathy is common, impactful, and difficult to manage in people with dementia. We evaluated the efficacy of nonpharmacological interventions, exercise, and social interaction, in combination with antipsychotic review, to reduce apathy in people with dementia living in nursing homes in a cluster randomized controlled trial (RCT). Methods:Well-being and health for people with dementia (WHELD) program included a 2 × 2 × 2 factorial cluster RCT involving people with dementia living in 16 nursing homes in the United Kingdom. All homes received training in person-centered care, and were randomized to receive antipsychotic review, social interaction, and exercise, either alone or in combinations. Apathy was one of the secondary outcomes of the WHELD trial, and it was measured by the Neuropsychiatric Inventory–nursing home version at baseline and 9 months (n = 273). We used multilevel mixed effects linear regression models to assess the impact of the interventions on apathy. Results:Prevalence of apathy was 44.0% (n = 120; 95% confidence interval [CI] 38.1%–49.9%) at baseline. Severity of apathy had significant positive correlations with dementia severity, neuropsychiatric symptoms, depressive symptoms, agitation, and the needs of the people with dementia (P < .001). Antipsychotic review reduced antipsychotic use, but it significantly increased apathy (β = 5.37; SE = 0.91; P < .001). However, antipsychotic review in combination with either social interaction (β = −5.84; SE = 1.15; P < .001) or exercise (β = −7.54; SE = 0.93; P < .001) significantly reduced apathy. Conclusions:Antipsychotic review can play a significant role in improving apathy in people with dementia living in nursing homes, when combined with psychosocial interventions such as social interaction and exercise. Guidance must be adapted to reflect this subtlety in care

Impact of person-centred care training and person-centred activities on quality of life, agitation, and antipsychotic use in people with dementia living in nursing homes: a cluster-randomised controlled trial

Background Agitation is a common, challenging symptom affecting large numbers of people with dementia and impacting on quality of life (QoL). There is an urgent need for evidence-based, cost-effective psychosocial interventions to improve these outcomes, particularly in the absence of safe, effective pharmacological therapies. This study aimed to evaluate the efficacy of a person-centred care and psychosocial intervention incorporating an antipsychotic review, WHELD, on QoL, agitation, and antipsychotic use in people with dementia living in nursing homes, and to determine its cost. Methods and findings This was a randomised controlled cluster trial conducted between 1 January 2013 and 30 September 2015 that compared the WHELD intervention with treatment as usual (TAU) in people with dementia living in 69 UK nursing homes, using an intention to treat analysis. All nursing homes allocated to the intervention received staff training in person-centred care and social interaction and education regarding antipsychotic medications (antipsychotic review), followed by ongoing delivery through a care staff champion model. The primary outcome measure was QoL (DEMQOL-Proxy). Secondary outcomes were agitation (Cohen-Mansfield Agitation Inventory [CMAI]), neuropsychiatric symptoms (Neuropsychiatric Inventory–Nursing Home Version [NPI-NH]), antipsychotic use, global deterioration (Clinical Dementia Rating), mood (Cornell Scale for Depression in Dementia), unmet needs (Camberwell Assessment of Need for the Elderly), mortality, quality of interactions (Quality of Interactions Scale [QUIS]), pain (Abbey Pain Scale), and cost. Costs were calculated using cost function figures compared with usual costs. In all, 847 people were randomised to WHELD or TAU, of whom 553 completed the 9-month randomised controlled trial. The intervention conferred a statistically significant improvement in QoL (DEMQOL-Proxy Z score 2.82, p = 0.0042; mean difference 2.54, SEM 0.88; 95% CI 0.81, 4.28; Cohen’s D effect size 0.24). There were also statistically significant benefits in agitation (CMAI Z score 2.68, p = 0.0076; mean difference 4.27, SEM 1.59; 95% CI −7.39, −1.15; Cohen’s D 0.23) and overall neuropsychiatric symptoms (NPI-NH Z score 3.52, p < 0.001; mean difference 4.55, SEM 1.28; 95% CI −7.07,−2.02; Cohen’s D 0.30). Benefits were greatest in people with moderately severe dementia. There was a statistically significant benefit in positive care interactions as measured by QUIS (19.7% increase, SEM 8.94; 95% CI 2.12, 37.16, p = 0.03; Cohen’s D 0.55). There were no statistically significant differences between WHELD and TAU for the other outcomes. A sensitivity analysis using a pre-specified imputation model confirmed statistically significant benefits in DEMQOL-Proxy, CMAI, and NPI-NH outcomes with the WHELD intervention. Antipsychotic drug use was at a low stable level in both treatment groups, and the intervention did not reduce use. The WHELD intervention reduced cost compared to TAU, and the benefits achieved were therefore associated with a cost saving. The main limitation was that antipsychotic review was based on augmenting processes within care homes to trigger medical review and did not in this study involve proactive primary care education. An additional limitation was the inherent challenge of assessing QoL in this patient group. Conclusions These findings suggest that the WHELD intervention confers benefits in terms of QoL, agitation, and neuropsychiatric symptoms, albeit with relatively small effect sizes, as well as cost saving in a model that can readily be implemented in nursing homes. Future work should consider how to facilitate sustainability of the intervention in this setting

The impact of a visual arts program on quality of life, communication, and well-being of people living with dementia: a mixed-methods longitudinal investigation

Background: Research reviews highlight methodological limitations and gaps in the evidence base for the arts in dementia care. In response, we developed a 12-week visual art program and evaluated the impact on people living with dementia through a mixed-methods longitudinal investigation. Methods: One hundred and twenty-five people living with mild to severe dementia were recruited across three research settings in England and Wales (residential care homes, a county hospital, and community venues). Quantitative and qualitative data on quality of life (QoL), communication and perceptions of the program were obtained through interviews and self-reports with participants and their carers. Eight domains of well-being were measured using a standardized observation tool, and data compared to an alternative activity with no art. Results: Across all sites, scores for the well-being domains of interest, attention, pleasure, self-esteem, negative affect, and sadness were significantly better in the art program than the alternative condition. Proxy-reported QoL significantly improved between baseline and 3-month follow-up, but no improvements in QoL were reported by the participants with dementia. This was contrasted by their qualitative accounts, which described a stimulating experience important for social connectedness, well-being, and inner-strength. Communication deteriorated between baseline and follow-up in the hospital setting, but improved in the residential care setting. Conclusions: The findings highlight the potential for creative aging within dementia care, the benefits of art activities and the influence of the environment. We encourage dementia care providers and arts and cultural services to work toward embedding art activities within routine care provision

'Country life'? Rurality, folk music and 'Show of Hands'

This paper examines the contribution of folk music to understanding the dynamic, fluid and multi-experiential nature of the countryside. Drawing from literature on the geographies of music, it examines the work of 'Show of Hands', a contemporary folk band from Devon in England. Three areas are studied. First, the paper examines the musical style of Show of Hands in order to explore how hybridised, yet distinctive, styles of music emerge in particular places. Second, it demonstrates how Show of Hands' hybrid musical style has become closely associated with the Southwest of England. Finally, within these spatial and hybrid contexts, attention is given to the ways in which their music represents the 'everyday lives of the rural'. Taken together these themes assess the relevance of music in the understanding of rurality as hybrid space. © 2008 Elsevier Ltd. All rights reserved

Strombolian eruptions and dynamics of magma degassing at Yasur Volcano (Vanuatu)

Open vent basaltic volcanoes account for a substantial portion of the global atmospheric outgassing flux, largely through passive degassing and mild explosive activity. We present volcanic gas flux and composition data from Yasur Volcano, Vanuatu collected in July 2018. The average volcanic plume chemistry is characterised by a mean molar CO2/SO2 ratio of 2.14, H2O/SO2 of 148 and SO2/HCl of 1.02. The measured mean SO2 flux in the period of 6th to 9th July is 4.9 kg s−1. Therefore, the mean fluxes of the other species are 7.5 kg∙s−1 CO2, 208 kg∙s−1 H2O and 4.8 kg∙s−1 HCl. The degassing regime at Yasur volcano ranges from ‘passive’ to ‘active’ styles, with the latter including Strombolian activity and spattering. Gases emitted during active degassing are enriched in SO2 over HCl and CO2 over SO2 relative to passive degassing, with CO2/SO2 ratios of 2.85 ± 0.17, SO2/HCl of 1.6 ± 0.22, and H2O/SO2 of 315 ± 78.8. Gases emitted during passive degassing have CO2/SO2 ratios of 1.96 ± 0.12, SO2/HCl of 0.50 ± 0.07 and H2O/SO2 of 174 ± 43.5. We use a model of volatile degassing derived from melt inclusion studies (Metrich et al., 2011), combined with our observations of chemical variations in the outgassing bubbles to propose a mechanism for magma degassing in the conduit at Yasur. We envisage a shallow conduit filled with crystal-rich magma, forming a viscous and mobile plug that develops an effective yield strength from the surface to a depth of at least 2000 m, in which bubbles are trapped, grow, ascend towards the surface and burst in a typical Strombolian eruption. Deeper bubbles released during active degassing are enriched in CO2 and SO2 compared to bubbles released during ‘passive degassing’, which are sourced from close to the surface, and are, consequently, HCl-rich

A roadmap to advance dementia research in prevention, diagnosis, intervention, and care by 2025.

OBJECTIVE: National and global dementia plans have focused on the research ambition to develop a cure or disease-modifying therapy by 2025, with the initial focus on investment in drug discovery approaches. We set out to develop complementary research ambitions in the areas of prevention, diagnosis, intervention, and care and strategies for achieving them. METHODS: Alzheimer's Society facilitated a taskforce of leading UK clinicians and researchers in dementia, UK funders of dementia research, people with dementia, and carer representatives to develop, using iterative consensus methodology, goals and recommendations to advance dementia research. RESULTS: The taskforce developed 5 goals and 30 recommendations. The goals focused on preventing future cases of dementia through risk reduction, maximising the benefit of a dementia diagnosis, improving quality of life, enabling the dementia workforce to improve practice, and optimising the quality and inclusivity of health and social care systems. Recommendations addressed gaps in knowledge and limitations in research methodology or infrastructure that would facilitate research in prioritised areas. A 10-point action plan provides strategies for delivering the proposed research agenda. CONCLUSIONS: By creating complementary goals for research that mirror the need to find effective treatments, we provide a framework that enables a focus for new investment and initiatives. This will support a broader and more holistic approach to research on dementia, addressing prevention, surveillance of population changes in risk and expression of dementia, the diagnostic process, diagnosis itself, interventions, social support, and care for people with dementia and their families