• CAM within a field force of countervailing powers: the case of Portugal

      Almeida, Joana; Gabe, Jonathan; Royal Holloway, University of London (Elsevier, 2016-03-03)
      This paper examines the extent to which the position of the medical profession and the state towards complementary and alternative medicine (CAM) practitioners has changed since the late 1990s, taking Portugal as a case study. Using Light’s concept of countervailing powers we consider the alliances, interests, rhetorics and degrees of control between these three actors over time, focusing particularly on the extent to which CAM practitioners have acted as a countervailing force in their relationship with the medical profession and the state. It also brings to the fore the position of supra-state agencies concerning CAM regulation. A critical discourse analysis was conducted on data derived from a systematic search of information from the late 1990s until 2015. Our analysis suggests that CAM has emerged as an active player and a countervailing power in that it has been a significant influence in shaping state policy-making. The medical profession, in turn, has changed from rejecting to ‘incorporating’ CAM while the state has acted has a ‘broker’, trying to accommodate the demands and preferences of both actors while simultaneously demonstrating its power and autonomy in shaping health policy. In sum, the history of countermoves of CAM, the medical profession and the state in recasting power relations regarding CAM regulation in Portugal has highlighted the explanatory value of Light’s countervailing power theory and the need to move away from a professional dominance and corporatist approach where CAM has simply been seen as subjugated to the power of the medical profession and the state.
    • Can an intervention in general practice increase sign-up rates to the NHS Organ Donor Register? a feasibility randomised controlled trial

      Penn-Jones, Catrin Pedder; Papadopoulos, Chris; Randhawa, Gurch; Asghar, Zeeshan; University of Bedfordshire; NHS Blood and Transplant (2017-09-06)
    • Can distance learning become an affective mode of delivery?

      Beckwith, Philip; Sapsed, Susan; University of Bedfordshire (Chinese American Scholars Association, 2007-01-01)
      The term blended learning is becoming more prevalent in the fields of Health and Social Sciences. Although it tends to be synonymous with e-learning; this should not be the case as blended learning involves an integrated delivery strategy. Rossett et al. (2003) suggest that this could include interaction with a supervisor; participation in an online class; breakfast with colleagues; competency descriptions; reading on the beach; reference to a manual; collegial relationships; and participation in seminars, workshops, and online communities. This paper will attempt to explore whether the integration of the Virtual Learning Environment (VLE) to a traditionally taught masters programme through the development of a blended learning strategy, can facilitate its evolution to distance learning.
    • Capturing debriefing and enhancing reflection within simulated clinical learning environments

      Wareing, Mark; England, Jacqueline A.; Mathew, David; Ball, Carla; Willetts, Amanda; Kemp, Jane; Clifford, Kelly; Thompson, Andrea; Dove, Ian; Adams, Louise; et al. (National Association of Educators in Practice, 2020-05-05)
      This article presents findings from an evaluation of a new A3-size learner notes sheet designed for use by healthcare students engaging in clinical simulation and clinical skills sessions. The notes sheet consists of an adapted form of the SBAR (situation, background, assessment, response) tool, whilst capturing post-simulation oral debriefing provided by a facilitator. Additionally, the Driscoll (2007) model is used to provide students with an opportunity to reflect on their engagement in clinical simulation. Two cohorts of students, who engaged in separate simulation sessions, completed the A3 sheet. The study featured 33 midwifery and 21 operating department practitioner (ODP) students undertaking a simulation. Documentary analysis was undertaken to identify the depth of reflective writing of both groups of students. Midwifery student participants reflected on their experiences of simulation at a slightly deeper level than their ODP counterparts. All students adhered to the structure of the notes sheet when receiving their briefing from the facilitator and when asked to write their reflective accounts. This study has sought to explore an under-researched area of clinical simulation: the extent to which healthcare students can utilise reflection when engaging with a clinical scenario within a simulated learning environment.
    • Care transitions for frail, older people from acute hospital wards within an integrated healthcare system in England: a qualitative case study

      Baillie, Lesley; Gallini, Andrew; Corser, Rachael; Elworthy, Gina; Scotcher, Ann; Barrand, Annabelle; ; London South Bank University; University College London Hospitals; Hospital of St John & St Elizabeth; et al. (Ubiquity Press Ltd, 2014-03-27)
      Introduction: Frail older people experience frequent care transitions and an integrated healthcare system could reduce barriers to transitions between different settings. The study aimed to investigate care transitions of frail older people from acute hospital wards to community healthcare or community hospital wards, within a system that had vertically integrated acute hospital and community healthcare services. Theory and methods: The research design was a multimethod, qualitative case study of one healthcare system in England; four acute hospital wards and two community hospital wards were studied in depth. The data were collected through: interviews with key staff (n = 17); focus groups (n = 9) with ward staff (n = 36); interviews with frail older people (n = 4). The data were analysed using the framework approach. Findings: Three themes are presented: Care transitions within a vertically integrated healthcare system, Interprofessional communication and relationships; Patient and family involvement in care transitions. Discussion and conclusions: A vertically integrated healthcare system supported care transitions from acute hospital wards through removal of organisational boundaries. However, boundaries between staff in different settings remained a barrier to transitions, as did capacity issues in community healthcare and social care. Staff in acute and community settings need opportunities to gain better understanding of each other’s roles and build relationships and trust.
    • The CARESSES EU-Japan project: making assistive robots culturally competent

      Bruno, Barbara; Chong, Nak Young; Kamide, Hiroko; Kanoria, Sanjeev; Lee, Jaeryoung; Lim, Yuto; Pandey, Amit Kumar; Papadopoulos, Chris; Papadopoulos, Irena; Pecora, Federico; et al. (2017-06-05)
      The nursing literature shows that cultural competence is an important requirement for effective healthcare. We claim that personal assistive robots should likewise be culturally competent, that is, they should be aware of general cultural characteristics and of the different forms they take in different individuals, and take these into account while perceiving, reasoning, and acting. The CARESSES project is an Europe-Japan collaborative effort that aims at designing, developing and evaluating culturally competent assistive robots. These robots will be able to adapt the way they behave, speak and interact to the cultural identity of the person they assist. This paper describes the approach taken in the CARESSES project, its initial steps, and its future plans. 
    • 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.
    • The CARESSES study protocol: testing and evaluating culturally competent socially assistive robots among older adults residing in long term care homes through a controlled experimental trial

      Papadopoulos, Chris; Hill, Tetiana; Battistuzzi, Linda; Castro, Nina; Nigath, Abiha; Randhawa, Gurch; Merton, Len; Kanoria, Sanjeev; Kamide, Hiroko; Chong, Nak Young; et al. (BMC (part of Springer Nature), 2020-03-20)
      This article describes the design of an intervention study that focuses on whether and to what degree culturally competent social robots can improve health and well-being related outcomes among older adults residing long-term care homes. The trial forms the final stage of the international, multidisciplinary CARESSES project aimed at designing, developing and evaluating culturally competent robots that can assist older people according to the culture of the individual they are supporting. The importance of cultural competence has been demonstrated in previous nursing literature to be key towards improving health outcomes among patients. = 15 each). Participants were allocated to either the experimental group, control group 1 or control group 2 (all n = 15). Those allocated to the experimental group or control group 1 received a Pepper robot programmed with the CARESSES culturally competent artificial intelligence (experimental group) or a limited version of this software (control group 1) for 18 h across 2 weeks. Participants in control group 2 did not receive a robot and continued to receive care as usual. Participants could also nominate their informal carer(s) to participate. Quantitative data collection occurred at baseline, after 1 week of use, and after 2 weeks of use with the latter time-point also including qualitative semi-structured interviews that explored their experience and perceptions further. Quantitative outcomes of interest included perceptions of robotic cultural competence, health-related quality of life, loneliness, user satisfaction, attitudes towards robots and caregiver burden. This trial adds to the current preliminary and limited pool of evidence regarding the benefits of socially assistive robots for older adults which to date indicates considerable potential for improving outcomes. It is the first to assess whether and to what extent cultural competence carries importance in generating improvements to well-being.
    • CARESSES: the flower that taught robots about culture

      Sgorbissa, Antonio; Saffiotti, Alessandro; Chong, Nak Young; Battistuzzi, Linda; Menicatti, Roberto; Pecora, Federico; Papadopoulos, Irena; Pandey, Amit Kumar; Kamide, Hiroko; Koulouglioti, Christina; et al. (IEEE Computer Society, 2019-03-25)
      The video describes the novel concept of 'culturally competent robotics', which is the main focus of the project CARESSES (Culturally-Aware Robots and Environmental Sensor Systems for Elderly Support). CARESSES a multidisciplinary project whose goal is to design the first socially assistive robots that can adapt to the culture of the older people they are taking care of. Socially assistive robots are required to help the users in many ways including reminding them to take their medication, encouraging them to keep active, helping them keep in touch with family and friends. The video describes a new generation of robots that will perform their actions with attention to the older person's customs, cultural practices and individual preferences.
    • Challenges facing online research: experiences from research concerning cyber-victimisation of people with disabilities

      Alhaboby, Zhraa Azhr; Barnes, Jim; Evans, Hala; Short, Emma; University of Bedfordshire (Masaryk University, 2017-08-10)
      Abstract The victimisation of people living with disabilities and chronic conditions is a documented phenomenon. It ranges from harassment incidents to disability hate crimes, and causes physical, mental and psychosocial consequences. The Internet has further reshaped this phenomenon which lead to “cyber-victimisation” experiences, with no less impact upon victims. This methodology paper focuses mainly on the challenges and implications of using online methods in a UK-based study exploring the impact of cyber-victimisation on people coping with disabilities and chronic conditions. Mixed-method design was adopted via an online-survey followed by in-depth interviewing of victims. Online recruitment was through victim-support groups, patient-support groups, and social media. Out of 80 organisations and charities approached, 51(63.8%) gatekeepers helped to reach participants. Recruitment and data collection process was challenged by four overarching themes: 1) social identity in online support groups, 2) the role of online gatekeepers, 3) the contradictory role of social media, and 4) promoting inclusivity. These challenges were theorised from the perspective of the Social Identity Theory. Representing self as a victim and/or a disabled-person had its implications on virtual groups’ membership, social media use, gatekeepers’ decisions and subsequent participation. Some identity aspects were highlighted as positive points to improve engagement with research. In conclusion, the Internet has aggravated the vulnerability of people with disabilities, but it also has a huge potential in researching sensitive topics with this group. Future research in the cyberspace should acknowledge the challenges of online identities of disabled victimised people, and focus on positive identity aspects to facilitate the research process and encourage collaborative participation at early stages of research. Keywords: cyberstalking; cyberharrasment; disability hate crime; Social Identity Theory; online research; methodological challenges
    • Changes in impedance at the electrode-skin interface of surface EMG electrodes during long-term EMG recordings

      Hewson, David; Duchêne, Jacques; Hogrel, Jean-Yves (IEEE, 2001-12-31)
      Changes in the impedance at the electrode-skin interface of SEMG electrodes on the tibialis anterior were assessed in nine subjects. SEMG signals were recorded using a bipolar electrode configuration that conformed to the SENIAM recommendations for SEMG data collection. Impedance measurements were made between a pair of bipolar electrodes using a custom-built device consisting of a PC and an impedance conversion circuit. The impedance device enabled the simultaneous application and recording of a waveform constructed of a known combination of sinusoids passed between the two electrodes. SEMG recordings at 10% of each subject's maximal voluntary force during ankle dorsiflexion were made for a 30-s period every 15-min over a two hour period. Impedance was measured immediately before and after each SEMG recording. All subjects gave their written informed consent.
    • Childhood maternal school leaving age (level of education) and risk markers of metabolic syndrome in mid-adulthood: results from the 1958 British birth cohort

      Pappas Y; Iwundu, Chukwuma; Pang, Dong; (Dove Press, 2020-10-15)
      Purpose: The aim of this study is to investigate the relationship between childhood maternal level of education (CMLE) and changes in anthropometric and laboratory risk markers of metabolic syndrome (MetS) in mid-adulthood using results from the 1958 British Birth Cohort Study. Design: Cohort study. Participants: A total of 9376 study samples consisting of subjects that participated in the biomedical survey of the national child development study (NCDS) carried out between 2002 and 2004 were used for the analysis. Main Outcome Measures: Five risk markers of MetS: (i) HDL-cholesterol (ii) triglyceride (iii) blood pressure (BP) including systolic (SBP) and diastolic (DBP) (iv) waist circumference (WC) and (v) glycated haemoglobin (HbA1c). Methods: The NCDS or the 1958 British birth cohort data deposited in the UK data service by the centre for longitudinal studies were used for analyses. Ordinary least squares regression was used to determine unit changes in the outcome variables given CMLE. Results: The estimates for unadjusted regression analysis of individual risk markers indicated a significant relationship between CMLE and alterations in the five risk markers of MetS (HDL-cholesterol, triglyceride, WC, HbA1c, and BP) in midlife. After adjustment for birth and lifestyle characteristics/health behaviours, the relationship between CMLE and the risk markers was attenuated for HDL-cholesterol, triglycerides, and HbA1c but remained significant for WC 0.70 (95% confidence interval (CI) 0.065– 1.30, p< 0.001) and SBP 1.48 (95% CI 0.48– 2.47 p< 0.001). Conclusion: There was a positive association between lower CMLE and the risk of MetS using the NCDS data. Lifestyle characteristics may be influential determinants of MetS risk in mid-adulthood.
    • Children's unmet palliative care needs: a scoping review of parents' perspectives

      Constantinou, Georgina; Garcia, Rebecca; Cook, Erica Jane; Randhawa, Gurch; University of Bedfordshire (BMJ Publishing Group, 2019-07-19)
      Background: Children with life-limiting conditions often have complex needs, making it challenging for services to provide satisfactory care. Few studies consider whether services actually meet families' needs by exploring and identifying the parents' perspectives of unmet needs. Aim: To identify what published evidence is available on the unmet needs of children with life-limiting conditions and their families, from the perspective of parents, internationally. Eligibility criteria: Inclusion criteria: papers from the perspective of parents of children aged 0-19 years, who have a life-limiting condition and are receiving palliative care. Exclusion criteria: those papers not written in English, not reporting primary research and discussing children who died from stillbirth, accidental or unexpected circumstance. Charting methods: A scoping review was conducted in accordance with the methods of Arksey and O'Malley. Sources of evidence: The electronic databases PubMed, MEDLINE, CINAHL and PsycINFO were searched. Key terms included: parent, needs, met/unmet/satisfaction, palliative/supportive/end of life care, life-limiting/life-threatening illness, infants/children/young people. Results: Total hit indicated 5975 papers for screening. Fifty-five papers met the scoping review criteria. The majority used mixed-methods approaches inclusive of: questionnaires, self-report measures, in-depth interviews, focus groups, case record analysis and art-based workshops. Unmet needs included: respite care, coordination and organisation of care, psychological support and professional communication skills. Conclusions: The findings suggest many unmet needs from the parent's perspective, across several aspects of the Quality Standards and Children's Palliative Care Frameworks. Further research is needed which explores the parent's unmet needs in palliative care services.
    • Children, organ donation and Islam

      Aktas, Mikail; Randhawa, Gurch; Brierley, Joe; Durham University; University of Bedfordshire; Great Ormond St Hospital (BMJ Publishing Group, 2019-05-17)
      Although Islamic scholars have debated deceased organ donation many Muslims remain unaware of these debates, or of Islamic rulings on the issue.1 Overall, there has been little public debate about child end-of-life issues, including deceased donation, in any faith groups including the Muslim community. This letter reviews relevant Islamic issues with an aim of stimulating discussion within both the donation and Muslim communities. We hope it can start a process to ensure families have supportive, accurate, empowering information when making donation decisions in their child’s end-of-life care, including understanding consequent effects on others.
    • Children, organ donation, and Islam: a report of an engagement day of Islamic scholars, young Muslims and pediatric transplant and donation professionals

      Aktas, Mikail; Randhawa, Gurch; Brierley, Joe; ; University of Newcastle; University of Bedfordshire; Great Ormond St Hospital for Sick Children (Wiley, 2020-03-02)
      Meeting report
    • Classification of elderly as fallers and non-fallers using centre of pressure velocity

      Hewson, David; Singh, Neeraj Kumar; Snoussi, Hichem; Duchêne, Jacques (IEEE, 2010-11-11)
      Falls are a leading cause of death in the elderly. One of the most common methods of predicting falls is to evaluate balance using force plate measurement of the Centre of Pressure (COP) displacement. This signal, known as a stabilogram, can be decomposed into movement in anteroposterior (AP) and mediolateral (ML) directions. It has been suggested that studying the velocity of COP displacement could lead to new insights into fall risk. The aim of this study was to attempt to classify elderly fallers and non-fallers, as well as control subjects based on COP velocity measurements. Three groups of 10 subjects (controls, elderly fallers, and elderly non-fallers) were compared. Discriminant function analysis was able to correctly classify 90% of the subjects based only on COP velocity measurements. Further work is needed to determine whether this parameter might be of use in longitudinal measurement of fall risk in home-dwelling elderly.
    • Classifying NIR spectra of textile products with kernel methods

      Langeron, Yves; Doussot, Michel; Hewson, David; Duchêne, Jacques; Université de technologie de Troyes (Elsevier, 2007-04-30)
      This paper describes the use of kernel methods to classify tissue samples using near-infrared spectra in order to discriminate between samples, either with or without elastane. The aim of this real-world study is to identify an alternative method to classify textile products using near-infrared (NIR) spectroscopy in order to improve quality control, and to aid in the detection of counterfeit garments. The principles behind support vector machines (SVMs), of which the main idea is to linearly separate data, are recalled progressively in order to demonstrate that the decision function obtained is a global optimal solution of a quadratic programming problem. Generally, this solution is found after embedding data in another space F with a higher dimension by the means of a specific non-linear function, the kernel. For a selected kernel, one of the most important and difficult subjects concerning SVM is the determination of tuning parameters. Generally, different combinations of these parameters are tested in order to obtain a machine with adequate classification ability. With the kernel alignment method used in this paper, the most appropriate kernel parameters are identified rapidly. Since in many cases, data are embedded in F, a linear principal component (PC) analysis (PCA) can be considered and studied. The main properties and the algorithm of k-PCA are described here. This paper compares the results obtained in prediction for a linear classifier built in the initial space with the PCs from a PCA and those obtained in F with non-linear PCs from a k-PCA. In the present study, even if there are potentially discriminating wavelengths seen on the NIR spectra, linear discriminant analysis and soft independent modelling of class analogy results show that these wavelengths are not sufficient to build a machine with correct generalisation ability. The use of a non-linear method, such as SVM and its corollary methods, kernel alignment and k-PCA, is then justified.
    • Cloud services for culture aware conversation: socially assistive robots and virtual assistants

      Recchuto, Carmine; Gava, Luna; Grassi, Lucrezia; Grillo, Alberto; Lagomarsino, Marta; Lanza, Davide; Liu, Zijian; Papadopoulos, Chris; Papadopoulos, Irena; Scalmato, Antonello; et al. (Institute of Electrical and Electronics Engineers Inc., 2020-07-21)
      This paper introduces a new Cloud platform providing services for culturally competent interaction, that has been developed to expand the capabilities of Socially Assistive Robots and virtual assistants interacting with older persons. The rationale behind the proposed architecture is discussed, by outlining key principles as well as the functionalities provided, with a specific focus on verbal interaction. Three case studies, the humanoid robot Pepper, a robotic medicine dispenser Pillo, and a custom-built Android-based virtual assistant, are analyzed in detail, by showing how robots and other assistants may easily access culturally competent Cloud services to expand their interaction capabilities. Transcripts of conversations are reported and commented, in order to outline both the positive features and the limitations of the system.
    • ‘Coaching and Peer Assisted Learning’ (C‐PAL) ‐ the mental health nursing student experience: a qualitative evaluation

      Wareing, Mark; Green, Helen; Burden, Barbara; Burns, Sally; Beckwith, Mary A.R.; Mhlanga, Fortune; Mann, Bob; University of Bedfordshire; Oxford Health NHS Foundation Trust (Wiley, 2018-08-08)
      Introduction: This paper presents findings from a study that evaluated mental health nursing students’ experience of a team mentoring model called Coaching and Peer Assisted Learning (C-PAL). At present there are no published research studies into the effectiveness of team mentorship utilised by nursing students within inpatient mental health settings. Aim: The study utilised an interpretist methodology where the focus was on individuals in their social world. Method: Two focus groups were held with fifteen students who had experienced C-PAL in four in-patient wards. Findings: Students’ overall experience of piloting C-PAL was positive. Learning opportunities (Theme 3) appeared to be dependent on the quality of peer support (Theme 5) which in turn, enhanced the learner experience and increased the level of student confidence (Theme 6). Less positive experiences included inadequate preparation (Theme 1), poor understanding of the model and competition for learning experiences. Implications for practice: We tentatively suggest that team mentorship models such as C-PAL may be suitable for acute in-patient mental health settings. The success of C-PAL depends upon the preparation of nursing staff, mentors (Theme 4), coaches and students in relation to role expectations, shift rostering (Theme 2) and the implementation of ‘huddling’ to promote opportunistic learning.