Abstract Background A number of children experience difficulties with social communication and this has long-term deleterious effects on their mental health, social development and education. The E-PLAYS-2 study will test an intervention (‘E-PLAYS’) aimed at supporting such children. E-PLAYS uses a dyadic computer game to develop collaborative and communication skills. Preliminary studies by the authors show that E-PLAYS can produce improvements in children with social communication difficulties on communication test scores and observed collaborative behaviours. The study described here is a definitive trial to test the effectiveness and cost-effectiveness of E-PLAYS delivered by teaching assistants in schools. Methods The aim of the E-PLAYS-2 trial is to establish the effectiveness and cost-effectiveness of care as usual plus the E-PLAYS programme, delivered in primary schools, compared to care as usual. Cluster-randomisation will take place at school level to avoid contamination. The E-PLAYS intervention will be delivered by schools’ teaching assistants. Teachers will select suitable children (ages 5–7 years old) from their schools using guidelines provided by the research team. Assessments will include blinded language measures and observations (conducted by the research team), non-blinded teacher-reported measures of peer relations and classroom behaviour and parent-reported use of resources and quality of life. A process evaluation will also include interviews with parents, children and teaching assistants, observations of intervention delivery and a survey of care as usual. The primary analysis will compare pragmatic language scores for children who received the E-PLAYS intervention versus those who did not at 40 weeks post-randomisation. Secondary analyses will assess cost-effectiveness and a mixed methods process evaluation will provide richer data on the delivery of E-PLAYS. Discussion The aim of this study is to undertake a final, definitive test of the effectiveness of E-PLAYS when delivered by teaching assistants within schools. The use of technology in game form is a novel approach in an area where there are currently few available interventions. Should E-PLAYS prove to be effective at the end of this trial, we believe it is likely to be welcomed by schools, parents and children. Trial registration ISRCTN 17561417, registration date 19th December 2022. Protocol version: v1.1 19th June 2023.
Attempts to secure improved outcomes with persistent medically unexplained physical symptoms (MUS/PPS) are in their early stages of development and effective implementation in the United Kingdom remains inconsistent. There are scant systematically examined process and outcome studies in this field published in peer reviewed journals. Moreover, persistent sexual symptoms no longer appear in listed examples of MUS/PPS in the professional literature and consequently few studies can be found on 'what works' for improved outcomes with this group of sufferers.A systematic evaluation of an NHS Community Psychosexual Counselling Service delivered within an Integrated Contraception and Sexual Health Service for adults with persistent sexual dysfunction is summarised. The findings from the synthesis of evaluated research, professional guidance and a particular practice, at clinic cohort and embedded case levels, revealed common themes of engagement across the therapy divides when addressing “medically unexplained” physical symptoms. This supports future research in this area and calls for the inclusion of persistent sexual symptoms. The extracted themes from the therapy process may be used as tools to enhance skills of engagement with unresolved PPS in similar settings in which the individual seeks help to achieve improved outcomes.
In the UK, there are disparities in the use of urban greenspaces, particularly among low-income, ethnically diverse communities. Determining how populations interact with greenspaces and the barriers and facilitators that influence use remains pertinent to improve access. This study aimed to examine how people who reside in an ethnically diverse community use and engage with urban greenspaces and, drawing on the COM-B model (capability, opportunity, motivation, and behaviour), aimed to assess the potential barriers and facilitators that influence use. A cross-sectional survey, conducted across two ethnically diverse towns in southeast England investigated greenspace usage, including activities and reasons for using greenspaces and included the Brief Measure of Behavior Change (COM-B). The survey was shared online via Qualtrics and widely disseminated in the local community via bilingual fieldworkers and community networks. The sample comprised 906 participants (60.7% female; mean age 38 ±16.37 years). The findings revealed that the use of greenspaces was low with around 33% visiting greenspaces frequently (at least once a week). Older people, those with higher levels of deprivation and/or those from a minority ethnic background were all shown to be the lowest users of greenspaces. The findings also confirmed that the types of activities and reasons for visiting greenspaces were shown to vary by a range of socio-demographic characteristics. The COM-B model was shown to be a useful explanatory framework with physical capability and motivation identified as significant predictors of frequency of greenspace use. We now encourage future research to consider what factors underpin motivation and the opportunities to use greenspaces, and how these vary across the wider population.
Arthroplasty registries are important for the surveillance of joint replacements and the evaluation of outcome. Independent validation of registry data ensures high quality. The ability for orthopaedic implant retrieval centres to validate registry data is not known. We analysed data from the National Joint Registry for England, Wales and Northern Ireland (NJR) for primary metal-on-metal hip arthroplasties performed between 2003 and 2013. Records were linked to the London Implant Retrieval Centre (RC) for validation. A total of 67 045 procedures on the NJR and 782 revised pairs of components from the RC were included. We were able to link 476 procedures (60.9%) recorded with the RC to the NJR successfully. However, 306 procedures (39.1%) could not be linked. The outcome recorded by the NJR (as either revised, unrevised or death) for a primary procedure was incorrect in 79 linked cases (16.6%). The rate of registry-retrieval linkage and correct assignment of outcome code improved over time. The rates of error for component reference numbers on the NJR were as follows: femoral head category number 14/229 (5.0%); femoral head batch number 13/232 (5.3%); acetabular component category number 2/293 (0.7%) and acetabular component batch number 24/347 (6.5%). Registry-retrieval linkage provided a novel means for the validation of data, particularly for component fields. This study suggests that NJR reports may underestimate rates of revision for many types of metal-on-metal hip replacement. This is topical given the increasing scope for NJR data. We recommend a system for continuous independent evaluation of the quality and validity of NJR data. Cite this article: Bone Joint J 2015;97-B:10–18.
There is a political drive in the UK to use assistive technologies such as telehealth and telecare as an innovative and efficient approach to healthcare delivery. However, the success of implementation of such services remains dependent on the ability to engage the wider population to adopt these services. It has been widely acknowledged that low acceptance of technology, forms a key barrier to adoption although findings been mixed. Further, it remains unclear what, if any barriers exist between patients and how these compare to those who have declined or withdrawn from using these technologies. This research aims to address this gap focusing on the UK based Cambridgeshire Community Services Assistive Telehealth and Telecare service, an integrated model of telehealth and telecare. Qualitative semi-structured interviews were conducted between 1st February 2014 and 1st December 2014, to explore the views and experiences of 'users' and 'non-users' using this service. 'Users' were defined as patients who used the service (N = 28) with 'non-users' defined as either referred patients who had declined the service before allocation (N = 3) or had withdrawn after using the ATT service (N = 9). Data were analysed using the Framework Method. This study revealed that there are a range of barriers and facilitators that impact on the decision to adopt and continue to engage with this type of service. Having a positive attitude and a perceived need that could be met by the ATT equipment were influential factors in the decision to adopt and engage in using the service. Engagement of the service centred on 'usability', 'usefulness of equipment', and 'threat to identity and independence'. The paper described the influential role of referrers in decision-making and the need to engage with such agencies on a strategic level. The findings also revealed that reassurance from the onset was paramount to continued engagement, particularly in older patients who appeared to have more negative feelings towards technology. In addition, there is a clear need for continued product development and innovation to not only increase usability and functionality of equipment but also to motivate other sections of the population who could benefit from such services. Uncovering these factors has important policy implications in how services can improve access and patient support through the application of assistive technology which could in turn reduce unnecessary cost and burden on overstretched health services.
BackgroundIn October 2014, Health Education England (HEE) launched a national programme for widening participation the aim of which is to develop a healthcare workforce that can relate to the communities it serves.HEE provided evidence that links increasing diversity to improvements in cost management, quality of care for patients, and outcomes [1].It also identified some groups as being under-represented in the NHS workforce: 16-21 year olds, disengaged young people, males (but not in ambulance, medicine, estates and ancillary), Black, Asian and Minority Ethnic groups (Black groups are under-represented in medical and dental, while Asian/Asian British groups are over-represented), and older adults with numeracy and literacy difficulties.One of the key goals of the strategy was to increase the understanding and evidence on what are the specific needs of under-represented groups as they apply, commence and progress on healthcare education programmes and employment.It is within this context that HEE commissioned the Institute for Health Research (IHR), University of Bedfordshire (UoB) to carry out research 'building evidence for supporting widening participation for South Asian students: a qualitative study of the East of England and Thames Valley regions'(hereafter referred to as the previous widening participation research) [2].The Pakistani, Bangladeshi, Indian and Sri-Lankan ethno/national groups are used to define South Asian in the 2011 Census and these groups were included within the South Asian category for the purposes of this research [3].The term 'home grown' refers to those people born or socialised in Britain.Socialisation is referred to as a key
Abstract The gut microbiome is a plastic phenotype; gut microbial composition is highly variable across an individual host's lifetime and between host social groups, and this variation has consequences for host health. However, we do not yet fully understand how longitudinal microbial dynamics and their social drivers may be influenced by ecological stressors, such as habitat degradation. Answering these questions is difficult in most wild animal systems, as it requires long‐term collections of matched host, microbiome, and environmental trait data. To test if temporal and social influences on microbiome composition differ by the history of human disturbance, we leveraged banked, desiccated fecal samples collected over 5 months in 2004 from two ecologically distinct populations of wild, red‐bellied lemurs ( Eulemur rubriventer ) that are part of a long‐term study system. We found that social group explained more variation in microbiome composition than host population membership did, and that temporal variation in common microbial taxa was similar between populations, despite differences in history of human disturbance. Furthermore, we found that social group membership and collection month were both more important than individual lemur identity. Taken together, our results suggest that synchronized environments use can lead to synchronized microbial dynamics over time, even between habitats of varying quality, and that desiccated samples could become a viable approach for studying primate gut microbiota. Our work opens the door for other projects to utilize historic biological sample data sets to answer novel temporal microbiome questions in an ecological context.
This study utilized data from the NJR dataset on all Corail/Pinnacle total hip replacements (THR) to determine (a) the level of unit variation of the Corail/Pinnacle 36mm Metal On Metal THR within ...
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