• Acetaminophen (paracetamol) induces hypothermia during acute cold stress

      Foster, Josh; Mauger, Alexis R.; Govus, Andrew; Hewson, David; Taylor, Lee; University of Bedfordshire; Loughborough University; University of Kent; Mid Sweden University; Qatar Orthopaedic and Sports Medicine Hospital (Springer, 2017-08-01)
      Acetaminophen is an over-the-counter drug used to treat pain and fever, but it has also been shown to reduce core temperature (Tc) in the absence of fever. However, this side effect is not well examined in humans, and it is unknown if the hypothermic response to acetaminophen is exacerbated with cold exposure.
    • The CARESSES randomised controlled trial: exploring the health-related impact of culturally competent artificial intelligence embedded into socially assistive robots and tested in oder adult care homes

      Papadopoulos, Chris; Castro, Nina; Nigath, Abiha; Davidson, Rosemary; Faulkes, Nicholas; Menicatti, Roberto; Khaliq, Ali Abdul; Recchiuto, Carmine Tommaso; Battistuzzi, Linda; Randhawa, Gurch; et al. (Springer, 2021-04-23)
      This trial represents the final stage of the CARESSES project which aimed to develop and evaluate a culturally competent artificial intelligent system embedded into social robots to support older adult wellbeing. A parallel group, single-blind randomised controlled trial was conducted across older adult care homes in England and Japan. Participants randomly allocated to the Experimental Group or Control Group 1 received a Pepper robot for up 18 h across 2 weeks. Two versions of the CARESSES artificial intelligence were tested: a fully culturally competent system (Experimental Group) and a more limited version (Control Group 1). Control Group 2 (Care As Usual) participants did not receive a robot. Quantitative outcomes of interest reported in the current paper were health-related quality of life (SF-36), loneliness (ULS-8), and perceptions of robotic cultural competence (CCATool-Robotics). Thirty-three residents completed all procedures. The difference in SF-36 Emotional Wellbeing scores between Experimental Group and Care As Usual participants over time was significant (F[1] = 6.614, sig = .019, ηp2 = .258), as was the comparison between Any Robot used and Care As Usual (F[1] = 5.128, sig = .031, ηp2 = .146). There were no significant changes in SF-36 physical health subscales. ULS-8 loneliness scores slightly improved among Experimental and Control Group 1 participants compared to Care As Usual participants, but this was not significant. This study brings new evidence which cautiously supports the value of culturally competent socially assistive robots in improving the psychological wellbeing of older adults residing in care settings.
    • Cognitive behaviour therapy versus counselling intervention for anxiety in young people with high-functioning autism spectrum disorders: a pilot randomised controlled trial

      Murphy, Suzanne; Chowdhury, Uttom; White, Susan W.; Reynolds, Laura; Donald, Louisa; Gahan, Hilary; Iqbal, Zeinab; Kulkarni, Mahesh; Scrivener, Louise; Shaker-Naeeni, Hadi; et al. (Springer, 2017-08-02)
      The use of cognitive-behavioural therapy (CBT) as a treatment for children and adolescents with autism spectrum disorder (ASD) has been explored in a number of trials. Whilst CBT appears superior to no treatment or treatment as usual, few studies have assessed CBT against a control group receiving an alternative therapy. Our randomised controlled trial compared use of CBT against person-centred counselling for anxiety in 36 young people with ASD, ages 12–18. Outcome measures included parent- teacher- and self-reports of anxiety and social disability. Whilst each therapy produced improvements inparticipants, neither therapy was superior to the other to a significant degree on any measure. This is consistent with findings for adults.
    • Does the use of a serious game and the grip-ball decrease discomfort in older people when assessing maximal grip-strength?

      Chkeir, Aly; Voilmy, Dimitri; Duchêne, Jacques; Hewson, David; University of Technology of Troyes (Springer, 2016-09-17)
      Grip strength testing is a common tool in healthcare evaluation due its predictive ability for a range of concerns including nutritional status, fall risk, and frailty. With respect to frailty, grip strength is one of the Fried criteria, which is the most widely used frailty assessment tool. One problem with maximal grip strength testing is that values might underestimate maximal force due to problems with motivation or discomfort associated with the maximal test. An innovative serious game using the Grip-ball dynamometer was designed to measure grip strength in comparison to the frailty threshold of Fried. Discomfort levels were assessed using a visual-analogue scale for the Serious Game, the Grip-ball in a standard test, and the Jamar dynamometer, which is the gold standard for grip-strength testing. Discomfort was significantly higher for the Jamar, which had a 95% confidence interval of 6.2-7.5, in comparison to 1.5-2.4 for the Grip-ball and 0.7-1.3 for the Serious Game. The Serious Game was able to identify individuals who were not able to produce sufficient grip force to pass the Fried threshold for frailty, while improving comfort levels for the users when compared to a Jamar dynamometer.
    • Health care providers’ perspectives of disrespect and abuse in maternity care facilities in Nigeria: a qualitative study

      Orpin, Joy; Puthussery, Shuby; Burden, Barbara; University of Bedfordshire (Springer, 2019-10-31)
      Objectives To explore healthcare providers’ perspectives of disrespect and abuse in maternity care and the impact on women’s health and well-being. Methods Qualitative interpretive approach using in-depth semi-structured interviews with sixteen healthcare providers in two public health facilities in Nigeria. Interviews were audio-recorded, transcribed, and analysed thematically. Results Healthcare providers’ accounts revealed awareness of what respectful maternity care encompassed in accordance with the existing guidelines. They considered disrespectful and abusive practices perpetrated or witnessed as violation of human rights, while highlighting women’s expectations of care as the basis for subjectivity of experiences. They perceived some practices as well-intended to ensure safety of mother and baby. Views reflected underlying gender-related notions and societal perceptions of women being considered weaker than men. There was recognition about adverse effects of disrespect and abuse including its impact on women, babies, and providers’ job satisfaction. Conclusions Healthcare providers need training on how to incorporate elements of respectful maternity care into practice including skills for rapport building and counselling. Women and family members should be educated about right to respectful care empowering them to report disrespectful practices.
    • Intrinsic Mode Entropy for postural steadiness analysis

      Amoud, Hassan; Snoussi, Hichem; Hewson, David; Duchêne, Jacques; Université de technologie de Troyes (Springer, 2009-12-31)
      Postural balance during quiet standing is maintained by complex interactions of many sensory systems, including visual, vestibular, and proprioceptive systems. It has been demonstrated that applying vibration to the tibialis anterior tendon when subjects are in a static upright position creates an illusion of body inclination, thus decreasing postural stability. Postural balance was evaluated using centre of pressure (COP) displacements measured using a force plate. Recently, Intrinsic Mode Entropy (IMEn) has been proposed to quantify the degree of regularity and complexity in nonlinear signals. IMEn can be considered as an extension of Sample Entropy (SampEn) to deal with different oscillation levels. The first step of IMEn consists of extracting the Intrinsic Mode Functions (IMFs) of a time-series using Empirical Mode Decomposition (EMD). The IMEn is then obtained by computing the SampEN of the cumulative sums of the IMFs.
    • Modified bathroom scale and balance assessment: a comparison with clinical tests

      Duchêne, Jacques; Hewson, David; Rumeau, Pierre; University of Technology of Troyes; University of Bedfordshire; Gérontopôle (Springer, 2016-04-18)
      Frailty and detection of fall risk are major issues in preventive gerontology. A simple tool frequently used in daily life, a bathroom scale (balance quality tester: BQT), was modified to obtain information on the balance of 84 outpatients consulting at a geriatric clinic. The results computed from the BQT were compared to the values of three geriatric tests that are widely used either to detect a fall risk or frailty (timed get up and go: TUG; 10 m walking speed: WS; walking time: WT; one-leg stand: OS). The BQT calculates four parameters that are then scored and weighted, thus creating an overall indicator of balance quality. Raw data, partial scores and the global score were compared with the results of the three geriatric tests. The WT values had the highest correlation with BQT raw data (r = 0.55), while TUG (r = 0.53) and WS (r = 0.56) had the highest correlation with BQT partial scores. ROC curves for OS cut-off values (4 and 5 s) were produced, with the best results obtained for a 5 s cut-off, both with the partial scores combined using Fisher's combination (specificity 85 %: <0.11, sensitivity 85 %: >0.48), and with the empirical score (specificity 85 %: <7, sensitivity 85 %: >8). A BQT empirical score of less than seven can detect fall risk in a community dwelling population.
    • One-class support vector machine for joint variable selection and detection of postural balance degradation

      Amoud, Hassan; Snoussi, Hichem; Hewson, David; Duchêne, Jacques (Springer, 2009-12-31)
      The study of the static posture is of great interest for the analysis of the deficit of the control of balance. A method of balance analysis is to use a platform of forces which makes it possible to extract displacement of the centre of pressure (COP). The parameters extracted from COP time series prove like variables keys to supervise the degradation of balance. However, the irrelevance and\or the redundancy of some of them make difficult an effective detection of degradation. The objective of this paper is the implementation of a method of detection (SVDD) and of a procedure of selection of the relevant parameters able to detect a degradation of balance. The selected criterion of selection is the maximization of the area AUC under the curve ROC.
    • Organ donation as an 'altruistic gift': Incentives and reciprocity in deceased organ donation from a UK Polish migrant perspective

      Sharp, Chloe; Randhawa, Gurch; University of Bedfordshire (Springer, 2014-01-01)
      Background: Incentives and reciprocity have been widely debated within the literature as an alternative to altruism to motivate the public to register and consent to organ donation. This pilot study was the first to examine the views of the UK Polish migrant community toward these issues. Material and Methods: One-to-one and small group interviews were conducted in English and Polish to collect data. The interviews were recorded and transcribed and interviews in Polish were translated into English. All transcripts were coded, codes were grouped by theme and emergent themes were constantly compared to the new data until saturation. Results: Participants were motivated to donate altruistically but would accept reciprocity for organs once consent was given. Payment for organs was viewed as unfavourable but participants would accept contribution toward funeral expenses. Conclusions: Deceased organ donation was viewed as an ‘altruistic gift’. ‘Altruism’ and ‘gift’ are problematic in deceased organ donation and could explain the challenges that arise in the incentives and reciprocity debate. Mauss’s gift exchange theory could frame incentives as forming the ‘obligation to give’ and could encourage registration but could lead to coercion. Reciprocity could benefit families and be viewed as ‘fair’ and a token of gratitude.
    • The PARAChute project: remote monitoring of posture and gait for fall prevention

      Hewson, David; Duchêne, Jacques; Charpillet, François; Saboune, Jamal; Michel-Pellegrino, Valerie; Amoud, Hassan; Doussot, Michel; Paysant, Jean; Boyer, Anne; Hogrel, Jean-Yves (Springer, 2007-01-01)
      Falls in the elderly are a major public health problem due to both their frequency and their medical and social consequences. In France alone, more than two million people aged over 65 years old fall each year, leading to more than 9 000 deaths, in particular in those over 75 years old (more than 8 000 deaths). This paper describes the PARAChute project, which aims to develop a methodology that will enable the detection of an increased risk of falling in community-dwelling elderly. The methods used for a remote noninvasive assessment for static and dynamic balance assessments and gait analysis are described. The final result of the project has been the development of an algorithm for movement detection during gait and a balance signature extracted from a force plate. A multicentre longitudinal evaluation of balance has commenced in order to validate the methodologies and technologies developed in the project.
    • Point OutWords: protocol for a feasibility randomised controlled trial of a motor skills intervention to promote communicative development in non-verbal children with autism

      McKinney, Ailbhe; Hotson, Kathryn L.; Rybicki, Alicia; Weisblatt, Emma J.L.; Días, Claudia; Foster, Juliet; Villar, Sofia S.; Murphy, Suzanne; Belmonte, Matthew K.; Nottingham Trent University; et al. (Springer, 2020-01-23)
      Background: Point OutWords is a caregiver-delivered, iPad-assisted intervention for non-verbal or minimally verbal children with autism. It aims to develop prerequisite skills for communication such as manual and oral motor skills, sequencing, and symbolic representation. This feasibility trial aims to determine the viability of evaluating the clinical efficacy of Point OutWords. Methodology: We aim to recruit 46 non-verbal or minimally verbal children with autism and their families, approximately 23 per arm. Children in the intervention group will use Point OutWords for half an hour, five times a week, for 8 weeks. Children in the control group will have equal caregiver-led contact time with the iPad using a selection of control apps (e.g. sensory apps, drawing apps). Communication, motor, and daily living skills are assessed at baseline and post-intervention. Parents will keep diaries during the intervention period and will take part in focus groups when the intervention is completed. Discussion: Point OutWords was developed in collaboration with children with autism and their caregivers, to provide an intervention for a subgroup of autism that has been historically underserved. As autism is a heterogeneous condition, it is unlikely that one style of intervention will address all aspects of its symptomatology; the motor skills approach of Point OutWords can complement other therapies that address core autistic symptoms of social cognition and communication more directly. The current feasibility trial can inform the selection of outcome measures and design for future full-scale randomised controlled trials of Point OutWords and of other early interventions in autism. Trial registration: ISRCTN, ISRCTN12808402. Prospectively registered on 12 March 2019. Keywords: Autism spectrum disorder, Minimally verbal, Non-verbal, Motor, Language, Communication, iPad, Feasibility, Randomised controlled trial
    • Public-private partnerships and efficiency in public procurement of primary healthcare infrastructure: a qualitative research in the NHS UK

      Mudyarabikwa, Oliver; Regmi, Krishna; University of Bedfordshire; University of East London (Springer, 2015-12-05)
      Aim There is growing interest in the contribution of public-private partnerships (PPPs) bridging the shortage of financial resources and management expertise in developing public healthcare infrastructure. However, few studies have evidenced PPPs’ ability in increasing efficiency in public procurement of primary healthcare infrastructure. The aim of this study was to assess to what extent PPPs would increase efficiency in public procurement of primary healthcare facilities. Subject and methods A qualitative analysis, adopting a realistic research evaluation method, used data collected from a purposive sample of public (n = 23) and private sector staff (n = 2) directly involved in the UK National Health Service Local Improvement Finance Trust (LIFT). Results We find a positive association of LIFT helping to bridge public sector capital shortages for developing primary care surgeries. LIFT is negatively associated with inefficient procurement because it borrows finance from private banks, leaving public agencies paying high interest rates. The study shows that some contextual factors and mechanisms in LIFT play a major part in obstructing public staff from increasing procurement efficiency. Conclusion PPP’s ability to increase efficiency may be determined by contextual factors and mechanisms that restrict discretion over critical decisions by frontline public sector staff. Developing their capacity in monitoring PPP activities may make partnerships more efficient.
    • Refugee and immigrant community health champions: a qualitative study of perceived barriers to service access and utilisation of the National Health Service (NHS) in the West Midlands, UK

      Mudyarabikwa, Oliver; Regmi, Krishna; Ouillon, Sinead; Simmonds, Raymond; Coventry University; University of Bedfordshire; MiFriendly Cities Refugee and Migrant Centre, Coventry (Springer, 2021-06-18)
      There has been much discussion recently that better healthcare systems lead to increased service access and utilisation. However, there are still concerns raised among the refugee and immigrant communities about barriers to access and utilisation of primary healthcare services in the UK. This study aimed to explore with refugee and immigrant community health champions (CHCs) their perceptions about such barriers based on feedback in their own discussions with fellow refugees, asylum-seekers and immigrants in the West Midlands, UK. A total of 42 refugees and immigrants were recruited. Qualitative design-focused group discussions were conducted among purposively selected participants. These discussions were conducted between May and September 2019, and data were analysed using thematic analysis. The barriers to service access and utilisation are categorised into four themes: (i) knowledge about health issues that most affected refugees and immigrants; (ii) community indications of factors that obstructed service access; (iii) challenges in identifying local teams involved in service provision; and (iv) accurate knowledge about the different teams and their roles in facilitating access. This study highlighted that the levels of service access and utilisation would depend on the competence and effectiveness of the health system. Urgency and seriousness of individuals’ healthcare needs were the factors that were perceived to strongly influence refugees and immigrants to seek and utilise local services. We identified a number of potential barriers and challenges to service access and utilisation that should be overcome if primary healthcare service is to be planned and delivered effectively, efficiently and equitably in the West Midlands.
    • A set of technological tools for physical frailty assessment

      Jaber, Rana; Hewson, David; Duchêne, Jacques; Université de Technologie (Springer, 2012-12-31)
      Early detection of frailty in the elderly is an important issue, to ensure appropriate interventions can be undertaken to improve the outcome for frail elderly. Among the various models proposed for frailty detection, physical criteria described by Fried et al can be fed by very simple and friendly devices usable in any uncontrolled environment. This paper proposes a set of such technological tools providing a measure of these physical and physiological indices of frailty.
    • Shared attention for action selection and action monitoring in goal-directed reaching

      Mahon, Aoife; Bendžiūtė, Solveiga; Hesse, Constanze; Hunt, Amelia R.; University of Bedfordshire; University of Aberdeen (Springer, 2018-08-10)
      Dual-task studies have shown higher sensitivity for stimuli presented at the targets of upcoming actions. We examined whether attention is directed to action targets for the purpose of action selection, or if attention is directed to these locations because they are expected to provide feedback about movement outcomes. In our experiment, endpoint accuracy feedback was spatially separated from the action targets to determine whether attention would be allocated to (a) the action targets, (b) the expected source of feedback, or (c) to both locations. Participants reached towards a location indicated by an arrow while identifying a discrimination target that could appear in any one of eight possible locations. Discrimination target accuracy was used as a measure of attention allocation. Participants were unable to see their hand during reaching and were provided with a small monetary reward for each accurate movement. Discrimination target accuracy was best at action targets but was also enhanced at the spatially separated feedback locations. Separating feedback from the reaching targets did not diminish discrimination accuracy at the movement targets but did result in delayed movement initiation and reduced reaching accuracy, relative to when feedback was presented at the reaching target. The results suggest attention is required for both action planning and monitoring movement outcomes. Dividing attention between these functions negatively impacts action performance.
    • Socially assistive robots, older adults and research ethics: the case for case-based ethics training

      Battistuzzi, Linda; Papadopoulos, Chris; Hill, Tetiana; Castro, Nina; Bruno, Barbara; Sgorbissa, Antonio (Springer, 2020-05-27)
      Most studies on socially assistive robots (SARs) in elder care are conducted in care homes and recruit participants with some degree of cognitive impairment. The ethical dimension in these studies thus requires careful attention, suggesting that the researchers involved should be offered specific research ethics training. To meet this need in CARESSES—an international multidisciplinary project that aims to design and evaluate the first culturally competent SAR for the care of older adults—a research ethics training module for the project researchers was developed. The training module is largely based on case-based learning (CBL), a widely recognized approach to learning and instruction that is regarded as highly effective across multiple disciplines. In this paper, we argue that research ethics training should be offered to robotics investigators involved in research on SARs in elder care, and we provide an overview of the ethical issues involved in conducting research with SARs and older adults in care homes. Finally, we show how CBL can be used for research ethics training in this context.
    • SOLACE: a psychosocial stigma protection intervention to improve the mental health of parents of autistic children: a feasibility randomised controlled trial

      Lodder, Annemarie; Papadopoulos, Chris; Randhawa, Gurch (Springer, 2020-04-22)
      This study presents findings from a feasibility trial, testing an 8-week psychosocial stigma protection intervention (SOLACE) designed to improve the mental health of parents of autistic children. Seventeen parents were stratified then randomly assigned to either SOLACE (n = 9) or control group (n = 8). Retention and adherence rates were excellent with minimal missing data suggesting SOLACE had good acceptability and feasibility. Quantitative analysis revealed that mental health scores had significantly improved for those who took part in SOLACE compared to no significant changes for control group participants. In addition, changes in secondary outcome measures (e.g. stigma, self-esteem and self-compassion) were in favour of SOLACE. Focus group interviews revealed that SOLACE was acceptable to parents. Results suggest that a full randomised controlled trial is warranted.
    • Systematic review of the relationship between autism stigma and informal caregiver mental health

      Papadopoulos, Chris; Lodder, Annemarie; Constantinou, Georgina; Randhawa, Gurch; University of Bedfordshire (Springer, 2018-12-19)
      Families play a crucial role in determining the mental health of the autistic individual(s) they are caring for. However, the stigma associated with autism can impair caregiver health. To investigate this, empirical evidence pertaining to stigma's impact on informal caregivers' mental health was systematically reviewed. All twelve included studies (n = 1442 informal caregivers) consistently reported the impact of autism related stigma upon caregiver mental health to be significant, meaningful and complex. A new theoretical framework describing the relationship between stigma and caregiver mental health is constructed. Moderating variables include those both changeable through intervention (e.g. hopelessness, self-esteem, self-compassion) and not changeable (gender, culture, financial burden and time since diagnosis). Implications and recommendations for professionals, interventions and future research are proposed.
    • Univariate and bivariate empirical mode decomposition for postural stability analysis

      Amoud, Hassan; Snoussi, Hichem; Hewson, David; Duchêne, Jacques; University of Technology of Troyes (Springer, 2008-03-23)
      The aim of this paper was to compare empirical mode decomposition (EMD) and two new extended methods of Open image in new windowEMD named complex empirical mode decomposition (complex-EMD) and bivariate empirical mode decomposition (bivariate-EMD). All methods were used to analyze stabilogram center of pressure (COP) time series. The two new methods are suitable to be applied to complex time series to extract complex intrinsic mode functions (IMFs) before the Hilbert transform is subsequently applied on the IMFs. The trace of the analytic IMF in the complex plane has a circular form, with each IMF having its own rotation frequency. The area of the circle and the average rotation frequency of IMFs represent efficient indicators of the postural stability status of subjects. Experimental results show the effectiveness of these indicators to identify differences in standing posture between groups.
    • Validation of a smartphone gait analysis system

      Hammoud, Ali; Duchêne, Jacques; Abou-Ghaida, Hussein; Mottet, Serge; Goujon, Jean-Marc; Hewson, David; University of Technology of Troyes (Springer, 2015-12-31)
      This paper presents a validation study of a smartphone for detection of heel strike and foot flat during gait, in comparison with a validated in-shoe plantar pressure system. The aim of the study is to produce a smartphone gait analysis system that is able to estimate gait parameters in a non-controlled environment such as the home. The smartphone system using the built-in tri-axial accelerometer of the phone, and provides a reliable estimation of the number of steps and the stride-to-stride interval (ISI). Comparison with the results produced by an F-Scan mobile system showed an excellent relationship (R2=0.97). When Detrended Fluctuation Analysis was applied to the ISI calculated for each system, no significant differences were observed for a paired t-test. These findings open the way for other gait features such as gait velocity, walking distance and step length to be calculated using smartphones. Such a technique could be used to detect the loss of complexity in signals due to advanced age or disease in order to assess frailty and risk of falls in the elderly in ecological conditions.