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Zhang C, Liu Y, Corner L, Gao Q, Kang YT, Shi H, Li JW, Shen J. Interaction between handgrip strength and vitamin D deficiency on all-cause mortality in community-dwelling older adults: a prospective cohort study. Public Health 2024; 227:1-8. [PMID: 38096620 DOI: 10.1016/j.puhe.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Muscle strength decline and vitamin D deficiency are coexisting conditions associated with multiple adverse health outcomes. This prospective study aimed to investigate the multiplicative and additive interactions between handgrip strength (HS) and serum 25-hydroxyvitamin D [25(OH)D] on all-cause mortality in Chinese community-dwelling older adults. STUDY DESIGN This is a population-based cohort study. METHODS 2635 older adults (85.15 ± 12.01 years) were recruited from the Chinese Longitudinal Healthy Longevity Survey (2012-2018). Low HS was defined according to the Asian Working Group for Sarcopenia 2019 updated consensus (<28 kg for men and <18 kg for women). Serum 25(OH)D < 50 nmol/L were defined as vitamin D deficiency. Cox proportional hazard models were used to examine the association of HS and 25(OH)D with all-cause mortality. Socio-demographics, health status, and clinical characteristics were included as covariates. RESULTS 1715 (65.09 %) and 1885 (71.54 %) participants had low HS and vitamin D deficiency, respectively. During a median follow-up of 3.52 years, 1107 older people died. After multivariable adjustment, both HS and 25(OH)D levels were inversely associated with all-cause mortality risk (Ps < 0.001). The hazard ratios (HRs) of low HS and vitamin D deficiency for all-cause mortality were 1.73 (95 % CI: 1.41-2.13) and 1.61 (95 % CI: 1.32-1.93), respectively. Although significant multiplicative interactions were not found, the association between low HS and all-cause mortality was attenuated in the higher 25(OH)D subgroup than in the lower 25(OH)D subgroup (stratified by 50 nmol/L). The multiple-adjusted HR of mortality for combined low HS and vitamin D deficiency was 2.18 (95 % CI: 1.73-2.56), which was higher than that for these two conditions alone. Significant additive interactions between low HS and vitamin D deficiency on mortality were observed (relative excess risk due to interaction: 0.71, 95 % CI: 0.37-1.05). CONCLUSIONS Low HS and low 25(OH)D levels synergistically increased the risk of all-cause mortality. Our results added new insights to the priority of early detection for older adults with comorbid muscle strength decline and vitamin D deficiency.
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Affiliation(s)
- C Zhang
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, Beijing 100730, China
| | - Y Liu
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, Beijing 100730, China
| | - L Corner
- UK National Innovation Centre for Ageing, Newcastle University, Newcastle upon Tyne NE4 5TG, UK
| | - Q Gao
- Department of Science Research, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Y T Kang
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - H Shi
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J W Li
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology of National Health Commission, Beijing 100730, China.
| | - J Shen
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China.
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Jonnerby J, von Boetticher A, Holloway J, Corner L, Picksley A, Ross AJ, Shalloo RJ, Thornton C, Bourgeois N, Walczak R, Hooker SM. Measurement of the decay of laser-driven linear plasma wakefields. Phys Rev E 2023; 108:055211. [PMID: 38115527 DOI: 10.1103/physreve.108.055211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/10/2023] [Indexed: 12/21/2023]
Abstract
We present measurements of the temporal decay rate of one-dimensional (1D), linear Langmuir waves excited by an ultrashort laser pulse. Langmuir waves with relative amplitudes of approximately 6% were driven by 1.7J, 50fs laser pulses in hydrogen and deuterium plasmas of density n_{e0}=8.4×10^{17}cm^{-3}. The wakefield lifetimes were measured to be τ_{wf}^{H_{2}}=(9±2) ps and τ_{wf}^{D_{2}}=(16±8) ps, respectively, for hydrogen and deuterium. The experimental results were found to be in good agreement with 2D particle-in-cell simulations. In addition to being of fundamental interest, these results are particularly relevant to the development of laser wakefield accelerators and wakefield acceleration schemes using multiple pulses, such as multipulse laser wakefield accelerators.
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Affiliation(s)
- J Jonnerby
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - A von Boetticher
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - J Holloway
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - L Corner
- Cockcroft Institute of Accelerator Science, University of Liverpool, Liverpool WA4 4AD, United Kingdom
| | - A Picksley
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - A J Ross
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - R J Shalloo
- John Adams Institute for Accelerator Science, Imperial College London, London SW7 2AZ, United Kingdom
| | - C Thornton
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Didcot OX11 0QX, United Kingdom
| | - N Bourgeois
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Didcot OX11 0QX, United Kingdom
| | - R Walczak
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - S M Hooker
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
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Li S, Milligan K, Blythe P, Zhang Y, Edwards S, Palmarini N, Corner L, Ji Y, Zhang F, Namdeo A. Exploring the role of human-following robots in supporting the mobility and wellbeing of older people. Sci Rep 2023; 13:6512. [PMID: 37081106 PMCID: PMC10119299 DOI: 10.1038/s41598-023-33837-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/19/2023] [Indexed: 04/22/2023] Open
Abstract
With the ever-pressing challenges of societal ageing, robotic technologies for older people are increasingly portrayed as a solution for better independent living for longer. However, the application of human-following robots for elderly citizens has not yet been considered, and any prospective benefits offered by the technology for active ageing have previously been overlooked. This qualitative research aimed to explore older people's needs and requirements towards the human-following robot through the reflexive thematic analysis of semi-structured interview data from 17 independent older adults, supported by a video-based demonstration of the robot. The results indicate that older people believed that human-following robot has the potential to provide social benefits to an independent older adult by encouraging walking trips and prompting social interaction with others in the community. Practical limitations and cost of the robot are barriers to adoption at present. The findings indicate that there is potential for human-following robots to support active ageing, through increasing opportunities for the social participation of an older adult, but further development of the robot is needed for this potential to be realised.
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Affiliation(s)
- Shuo Li
- School of Engineering, Newcastle University, Cassie Building, Claremont Road, Newcastle Upon Tyne, NE1 7RU, UK.
| | - Kirsty Milligan
- School of Engineering, Newcastle University, Cassie Building, Claremont Road, Newcastle Upon Tyne, NE1 7RU, UK
| | - Phil Blythe
- School of Engineering, Newcastle University, Cassie Building, Claremont Road, Newcastle Upon Tyne, NE1 7RU, UK
| | - Yanghanzi Zhang
- School of Engineering, Newcastle University, Cassie Building, Claremont Road, Newcastle Upon Tyne, NE1 7RU, UK
| | - Simon Edwards
- School of Engineering, Newcastle University, Cassie Building, Claremont Road, Newcastle Upon Tyne, NE1 7RU, UK
| | - Nic Palmarini
- UK's National Innovation Centre for Ageing, The Catalyst, 3 Science Square, Newcastle Upon Tyne, NE4 5TG, UK
| | - Lynne Corner
- UK's National Innovation Centre for Ageing, The Catalyst, 3 Science Square, Newcastle Upon Tyne, NE4 5TG, UK
| | - Yanjie Ji
- Jiangsu Key Laboratory of Urban ITS, Jiangsu Province Collaborative Innovation Centre of Modern Urban Traffic Technologies, School of Transportation, Southeast University, Southeast University Road 2, Nanjing, 211189, China
| | - Fan Zhang
- Jiangsu Key Laboratory of Urban ITS, Jiangsu Province Collaborative Innovation Centre of Modern Urban Traffic Technologies, School of Transportation, Southeast University, Southeast University Road 2, Nanjing, 211189, China
| | - Anil Namdeo
- Department of Geography and Environmental Sciences, Northumbria University, Ellison Place, Newcastle Upon Tyne, NE1 8ST, UK
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Woods T, Palmarini N, Corner L, Barzilai N, Bethell LJ, Cox LS, Eyre H, Ferrucci L, Fried L, Furman D, Kennedy B, Roddam A, Scott A, Siow RC. Quantum Healthy Longevity for healthy people, planet, and growth. Lancet Healthy Longev 2022; 3:e811-e813. [PMID: 36384162 DOI: 10.1016/s2666-7568(22)00267-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Tina Woods
- Collider Health, London, UK; British Society for Research on Ageing, Durham, UK.
| | - Nic Palmarini
- National Innovation Centre for Ageing, Newcastle, UK
| | - Lynne Corner
- National Innovation Centre for Ageing, Newcastle, UK; VOICE Network, Newcastle, UK
| | - Nir Barzilai
- Institute for Aging Research, Albert Einstein College of Medicine, New York, NY, USA; Paul F Glenn Center for the Biology of Human Aging Research, Harvard Medical School, Boston, MA, USA; National Institutes of Health's Nathan Shock Centers of Excellence in the Basic Biology of Aging, New York, NY, USA
| | - Lord James Bethell
- former Parliamentary Under Secretary of State for Technology, Innovation and Life Sciences, London, UK
| | - Lynne S Cox
- Lab of Ageing and Cell Senescence, University of Oxford, Oxford, UK; UK Ageing Networks, Oxford, UK
| | - Harris Eyre
- Brain Capital Alliance, San Francisco, CA, USA; Rice University's Baker Institute for Public Policy, Houston, TX, USA; Meadows Mental Health Policy Institute, Dallas, TX, USA; OECD Neuroscience-inspired Policy Initiative, Paris, France
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
| | - Linda Fried
- Mailman School of Public Health, Public Health Practice, and Department of Epidemiology and Medicine, Columbia University Medical Center, New York, NY, USA
| | - David Furman
- Stanford 1000 Immunomes Project, Stanford School of Medicine, Stanford, CA, USA; Buck AI Platform, The Buck Institute for Research on Aging, Novato, CA, USA
| | - Brian Kennedy
- Centre for Healthy Longevity, National University Health System, and Department of Biochemistry and Department of Physiology, National University of Singapore, Singapore
| | | | - Andrew Scott
- Department of Economics, London Business School, London, UK
| | - Richard C Siow
- Department of Ageing Research, Kings College London, London, UK
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Bennett HQ, Kingston A, Lourida I, Robinson L, Corner L, Brayne C, Matthews FE, Jagger C. A comparison over 2 decades of disability-free life expectancy at age 65 years for those with long-term conditions in England: Analysis of the 2 longitudinal Cognitive Function and Ageing Studies. PLoS Med 2022; 19:e1003936. [PMID: 35290368 PMCID: PMC8923437 DOI: 10.1371/journal.pmed.1003936] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 02/03/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous research has examined the improvements in healthy years if different health conditions are eliminated, but often with cross-sectional data, or for a limited number of conditions. We used longitudinal data to estimate disability-free life expectancy (DFLE) trends for older people with a broad number of health conditions, identify the conditions that would result in the greatest improvement in DFLE, and describe the contribution of the underlying transitions. METHODS AND FINDINGS The Cognitive Function and Ageing Studies (CFAS I and II) are both large population-based studies of those aged 65 years or over in England with identical sampling strategies (CFAS I response 81.7%, N = 7,635; CFAS II response 54.7%, N = 7,762). CFAS I baseline interviews were conducted in 1991 to 1993 and CFAS II baseline interviews in 2008 to 2011, both with 2 years of follow-up. Disability was measured using the modified Townsend activities of daily living scale. Long-term conditions (LTCs-arthritis, cognitive impairment, coronary heart disease (CHD), diabetes, hearing difficulties, peripheral vascular disease (PVD), respiratory difficulties, stroke, and vision impairment) were self-reported. Multistate models estimated life expectancy (LE) and DFLE, stratified by sex and study and adjusted for age. DFLE was estimated from the transitions between disability-free and disability states at the baseline and 2-year follow-up interviews, and LE was estimated from mortality transitions up to 4.5 years after baseline. In CFAS I, 60.8% were women and average age was 75.6 years; in CFAS II, 56.1% were women and average age was 76.4 years. Cognitive impairment was the only LTC whose prevalence decreased over time (odds ratio: 0.6, 95% confidence interval (CI): 0.5 to 0.6, p < 0.001), and where the percentage of remaining years at age 65 years spent disability-free decreased for men (difference CFAS II-CFAS I: -3.6%, 95% CI: -8.2 to 1.0, p = 0.12) and women (difference CFAS II-CFAS I: -3.9%, 95% CI: -7.6 to 0.0, p = 0.04) with the LTC. For men and women with any other LTC, DFLE improved or remained similar. For women with CHD, years with disability decreased (-0.8 years, 95% CI: -3.1 to 1.6, p = 0.50) and DFLE increased (2.7 years, 95% CI: 0.7 to 4.7, p = 0.008), stemming from a reduction in the risk of incident disability (relative risk ratio: 0.6, 95% CI: 0.4 to 0.8, p = 0.004). The main limitations of the study were the self-report of health conditions and the response rate. However, inverse probability weights for baseline nonresponse and longitudinal attrition were used to ensure population representativeness. CONCLUSIONS In this study, we observed improvements to DFLE between 1991 and 2011 despite the presence of most health conditions we considered. Attention needs to be paid to support and care for people with cognitive impairment who had different outcomes to those with physical health conditions.
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Affiliation(s)
- Holly Q. Bennett
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
- * E-mail:
| | - Andrew Kingston
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Ilianna Lourida
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Lynne Corner
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Fiona E. Matthews
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
| | - Carol Jagger
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, United Kingdom
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Spiers G, Boulton E, Corner L, Craig D, Parker S, Todd C, Hanratty B. What matters to people with multiple long-term conditions and their carers? Postgrad Med J 2021:7126599. [PMID: 37068780 DOI: 10.1136/postmj/postgradmedj-2021-140825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/01/2021] [Indexed: 04/19/2023]
Abstract
BACKGROUND The number of people living with multiple long-term conditions is increasing worldwide. This presents challenges for health and care systems, which must adapt to meet the needs of this population. This study drew on existing data to understand what matters to people living with multiple long-term conditions and identify priorities for future research. METHODS Two studies were conducted. (1) A secondary thematic analysis of interview, survey and workshop data collected from the 2017 James Lind Alliance Priority Setting Partnership for Older People with Multiple Conditions, and patient and public involvement workshops; (2) a review of ongoing research and published research priorities, relating to older people (80+) living with multiple long-term conditions. FINDINGS Older people with multiple long-term conditions identified a number of key concerns: access to care, support for both the patient and their carer, physical and mental health and well-being and identifying opportunities for early prevention. The review identified no published research priorities or ongoing research focusing specifically on populations aged over 80 years with multiple long-term conditions. CONCLUSION Older people living with multiple long-term conditions experience care that is inadequate for their needs. A holistic approach to care that extends beyond treating single conditions will ensure wide-ranging needs are met. As multimorbidity rises worldwide, this is a critical message for practitioners across health and care settings. We also recommend key areas that should be given greater focus in future research and policy to inform effective and meaningful forms of support for people living with multiple long-term conditions.
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Affiliation(s)
- Gemma Spiers
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Elisabeth Boulton
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Lynne Corner
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Stuart Parker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Chris Todd
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Barbara Hanratty
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Spiers G, Boulton E, Corner L, Craig D, Parker S, Todd C, Hanratty B. What matters to people with multiple long-term conditions and their carers? Postgrad Med J 2021; 99:postgradmedj-2021-140825. [PMID: 34921067 DOI: 10.1136/postgradmedj-2021-140825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/01/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The number of people living with multiple long-term conditions is increasing worldwide. This presents challenges for health and care systems, which must adapt to meet the needs of this population. This study drew on existing data to understand what matters to people living with multiple long-term conditions and identify priorities for future research. METHODS Two studies were conducted. (1) A secondary thematic analysis of interview, survey and workshop data collected from the 2017 James Lind Alliance Priority Setting Partnership for Older People with Multiple Conditions, and patient and public involvement workshops; (2) a review of ongoing research and published research priorities, relating to older people (80+) living with multiple long-term conditions. FINDINGS Older people with multiple long-term conditions identified a number of key concerns: access to care, support for both the patient and their carer, physical and mental health and well-being and identifying opportunities for early prevention. The review identified no published research priorities or ongoing research focusing specifically on populations aged over 80 years with multiple long-term conditions. CONCLUSION Older people living with multiple long-term conditions experience care that is inadequate for their needs. A holistic approach to care that extends beyond treating single conditions will ensure wide-ranging needs are met. As multimorbidity rises worldwide, this is a critical message for practitioners across health and care settings. We also recommend key areas that should be given greater focus in future research and policy to inform effective and meaningful forms of support for people living with multiple long-term conditions.
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Affiliation(s)
- Gemma Spiers
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Elisabeth Boulton
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Lynne Corner
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Stuart Parker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Chris Todd
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Barbara Hanratty
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Bennett HQ, Kingston A, Lourida I, Robinson L, Corner L, Brayne CEG, Matthews FE, Jagger C. The contribution of multiple long-term conditions to widening inequalities in disability-free life expectancy over two decades: Longitudinal analysis of two cohorts using the Cognitive Function and Ageing Studies. EClinicalMedicine 2021; 39:101041. [PMID: 34386756 PMCID: PMC8342913 DOI: 10.1016/j.eclinm.2021.101041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND : Disability-free life expectancy (DFLE) inequalities by socioeconomic deprivation are widening, alongside rising prevalence of multiple long-term conditions (MLTCs). We use longitudinal data to assess whether MLTCs contribute to the widening DFLE inequalities by socioeconomic deprivation. METHODS : The Cognitive Function and Ageing Studies (CFAS I and II) are large population-based studies of those ≥65 years, conducted in three areas in England. Baseline occurred in 1991 (CFAS I, n=7635) and 2011 (CFAS II, n=7762) with two-year follow-up. We defined disability as difficulty in activities of daily living, MLTCs as the presence of at least two of nine health conditions, and socioeconomic deprivation by area-level deprivation tertiles. DFLE and transitions between disability states and death were estimated from multistate models. FINDINGS : For people with MLTCs, inequalities in DFLE at age 65 between the most and least affluent widened to around 2.5 years (men:2.4 years, 95% confidence interval (95%CI) 0.4-4.4; women:2.6 years, 95%CI 0.7-4.5) by 2011. Incident disability reduced for the most affluent women (Relative Risk Ratio (RRR):0.6, 95%CI 0.4-0.9), and mortality with disability reduced for least affluent men (RRR:0.6, 95%CI 0.5-0.8). MLTCs prevalence increased only for least affluent men (1991: 58.8%, 2011: 66.9%) and women (1991: 60.9%, 2011: 69.1%). However, DFLE inequalities were as large in people without MLTCs (men:2.4 years, 95%CI 0.3-4.5; women:3.1 years, 95% CI 0.8-5.4). INTERPRETATION : Widening DFLE inequalities were not solely due to MLTCs. Reduced disability incidence with MLTCs is possible but was only achieved in the most affluent.
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Affiliation(s)
- Holly Q Bennett
- Population Health Sciences Institute, Faculty of Medical Sciences, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Andrew Kingston
- Population Health Sciences Institute, Faculty of Medical Sciences, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Ilianna Lourida
- Population Health Sciences Institute, Faculty of Medical Sciences, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Lynne Corner
- Population Health Sciences Institute, Faculty of Medical Sciences, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Carol EG Brayne
- Cambridge Institute of Public Health, Forvie site, University of Cambridge School of Clinical Medicine, Cambridge Biomedical campus, Cambridge CB2 0SR, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Faculty of Medical Sciences, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Carol Jagger
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Edwardson Building, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
- Corresponding author.
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Bennett HQ, Kingston A, Spiers G, Robinson L, Corner L, Bambra C, Brayne C, Matthews FE, Jagger C. Healthy ageing for all? Comparisons of socioeconomic inequalities in health expectancies over two decades in the Cognitive Function and Ageing Studies I and II. Int J Epidemiol 2021; 50:841-851. [PMID: 33421052 PMCID: PMC8271204 DOI: 10.1093/ije/dyaa271] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 01/21/2023] Open
Abstract
Background Despite increasing life expectancy (LE), cross-sectional data show widening inequalities in disability-free LE (DFLE) by socioeconomic status (SES) in many countries. We use longitudinal data to better understand trends in DFLE and years independent (IndLE) by SES, and how underlying transitions contribute. Methods The Cognitive Function and Ageing Studies (CFAS I and II) are large population-based studies of those aged ≥65 years in three English centres (Newcastle, Nottingham, Cambridgeshire), with baseline around 1991 (CFAS I, n = 7635) and 2011 (CFAS II, n = 7762) and 2-year follow-up. We defined disability as difficulty in activities of daily living (ADL), dependency by combining ADLs and cognition reflecting care required, and SES by area-level deprivation. Transitions between disability or dependency states and death were estimated from multistate models. Results Between 1991 and 2011, gains in DFLE at age 65 were greatest for the most advantaged men and women [men: 4.7 years, 95% confidence interval (95% CI) 3.3–6.2; women: 2.8 years, 95% CI 1.3–4.3]. Gains were due to the most advantaged women having a reduced risk of incident disability [relative risk ratio (RRR):0.7, 95% CI 0.5–0.8], whereas the most advantaged men had a greater likelihood of recovery (RRR: 1.8, 95% CI 1.0–3.2) and reduced disability-free mortality risk (RRR: 0.4, 95% CI 0.3–0.6]. Risk of death from disability decreased for least advantaged men (RRR: 0.7, 95% CI 0.6–0.9); least advantaged women showed little improvement in transitions. IndLE patterns across time were similar. Conclusions Prevention should target the most disadvantaged areas, to narrow inequalities, with clear indication from the most advantaged that reduction in poor transitions is achievable.
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Affiliation(s)
- Holly Q Bennett
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Andrew Kingston
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Gemma Spiers
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Louise Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Lynne Corner
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Clare Bambra
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Fiona E Matthews
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Carol Jagger
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
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Picksley A, Alejo A, Shalloo RJ, Arran C, von Boetticher A, Corner L, Holloway JA, Jonnerby J, Jakobsson O, Thornton C, Walczak R, Hooker SM. Meter-scale conditioned hydrodynamic optical-field-ionized plasma channels. Phys Rev E 2020; 102:053201. [PMID: 33327141 DOI: 10.1103/physreve.102.053201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/09/2020] [Indexed: 11/07/2022]
Abstract
We demonstrate through experiments and numerical simulations that low-density, low-loss, meter-scale plasma channels can be generated by employing a conditioning laser pulse to ionize the neutral gas collar surrounding a hydrodynamic optical-field-ionized (HOFI) plasma channel. We use particle-in-cell simulations to show that the leading edge of the conditioning pulse ionizes the neutral gas collar to generate a deep, low-loss plasma channel which guides the bulk of the conditioning pulse itself as well as any subsequently injected pulses. In proof-of-principle experiments, we generate conditioned HOFI (CHOFI) waveguides with axial electron densities of n_{e0}≈1×10^{17}cm^{-3} and a matched spot size of 26μm. The power attenuation length of these CHOFI channels was calculated to be L_{att}=(21±3)m, more than two orders of magnitude longer than achieved by HOFI channels. Hydrodynamic and particle-in-cell simulations demonstrate that meter-scale CHOFI waveguides with attenuation lengths exceeding 1 m could be generated with a total laser pulse energy of only 1.2 J per meter of channel. The properties of CHOFI channels are ideally suited to many applications in high-intensity light-matter interactions, including multi-GeV plasma accelerator stages operating at high pulse repetition rates.
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Affiliation(s)
- A Picksley
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - A Alejo
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - R J Shalloo
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - C Arran
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - A von Boetticher
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - L Corner
- Cockcroft Institute for Accelerator Science and Technology, School of Engineering, The Quadrangle, University of Liverpool, Brownlow Hill, Liverpool L69 3GH, United Kingdom
| | - J A Holloway
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - J Jonnerby
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - O Jakobsson
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - C Thornton
- Central Laser Facility, STFC Rutherford Appleton Laboratory, Didcot OX11 0QX, United Kingdom
| | - R Walczak
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - S M Hooker
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
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Kingston A, Bennett H, Robinson L, Corner L, Brayne C, Matthews F, Jagger C. Multimorbidity, Disadvantage, and Trends in Disability-Free Life Expectancy: The CFAS Studies. Innov Aging 2020. [PMCID: PMC7742613 DOI: 10.1093/geroni/igaa057.2200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The combined contribution of multi-morbidity and socio-economic position (SEP) to trends in disability free life expectancy (DFLE) is unknown. We use longitudinal data from the Cognitive Function and Ageing Studies (CFAS I: 1991; CFAS II: 2011), with two year follow up. Disability was defined as difficulty in activities of daily living, and SEP as area-level deprivation. Multi-morbidity was constructed from nine self-reported health conditions and categorised as 0-1, 2-3, 4+ diseases. In 1991 and 2011, shorter total and disability-free years were associated with greater multi-morbidity. Between 1991 and 2011, gains in life expectancy and DFLE were observed at all levels of multi-morbidity, the greatest gain in DFLE being 4 years for men with 0-1 diseases. As multi-morbidity is more prevalent in more disadvantaged groups, further analyses will investigate whether SEP differences remain at all levels of multi-morbidity.
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Affiliation(s)
- Andrew Kingston
- Newcastle University, Newcastle upon Tyne, England, United Kingdom
| | - Holly Bennett
- Newcastle University, Newcastle upon Tyne, England, United Kingdom
| | - Louise Robinson
- Newcastle University, Newcastle upon Tyne, England, United Kingdom
| | - Lynne Corner
- Newcastle University, Newcastle upon Tyne, England, United Kingdom
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, England, United Kingdom
| | - Fiona Matthews
- Newcastle University, Newcastle upon Tyne, England, United Kingdom
| | - Carol Jagger
- Newcastle University, Newcastle upon Tyne, England, United Kingdom
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12
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Allan LM, Wheatley A, Smith A, Flynn E, Homer T, Robalino S, Beyer FR, Fox C, Howel D, Barber R, Connolly JA, Robinson L, Parry SW, Rochester L, Corner L, Bamford C. An intervention to improve outcomes of falls in dementia: the DIFRID mixed-methods feasibility study. Health Technol Assess 2020; 23:1-208. [PMID: 31661058 DOI: 10.3310/hta23590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Fall-related injuries are a significant cause of morbidity and mortality in people with dementia. There is presently little evidence to guide the management of such injuries, and yet there are potentially substantial benefits to be gained if the outcomes of these injuries could be improved. This study aimed to design an appropriate new health-care intervention for people with dementia following a fall and to assess the feasibility of its delivery in the UK NHS. OBJECTIVES To determine whether or not it is possible to design an intervention to improve outcomes of falls in dementia, to investigate the feasibility and acceptability of the DIFRID (Developing an Intervention for Fall related Injuries in Dementia) intervention and to investigate the feasibility of a future randomised controlled trial and the data collection tools needed to evaluate both the effectiveness and the cost-effectiveness of the DIFRID intervention. DESIGN This was a mixed-methods feasibility study. A systematic review (using Cochrane methodology) and realist review [using Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) methodology] explored the existing evidence base and developed programme theories. Searches were carried out in November 2015 (updated in January 2018) for effectiveness studies and in August 2016 for economic studies. A prospective observational study identified service use via participant diary completion. Qualitative methods (semistructured interviews, focus groups and observation) were used to explore current practice, stakeholder perspectives of the health and social care needs of people with dementia following a fall, ideas for intervention and barriers to and facilitators of change. Each of the resulting data sets informed intervention development via Delphi consensus methods. Finally, a single-arm feasibility study with embedded process evaluation was conducted. SETTING This study was set in the community. PARTICIPANTS The participants were (1) people with dementia presenting with falls necessitating health-care attention in each setting (primary care, the community and secondary care) at three sites and their carers, (2) professionals delivering the intervention, who were responsible for training and supervision and who were members of the intervention team, (3) professionals responsible for approaching and recruiting participants and (4) carers of participants with dementia. INTERVENTIONS This was a complex multidisciplinary therapy intervention. Physiotherapists, occupational therapists and support workers delivered up to 22 sessions of tailored activities in the home or local area of the person with dementia over a period of 12 weeks. MAIN OUTCOME MEASURES (1) Assessment of feasibility of study procedures; (2) assessment of the acceptability, feasibility and fidelity of intervention components; and (3) assessment of the suitability and acceptability of outcome measures for people with dementia and their carers (number of falls, quality of life, fear of falling, activities of daily living, goal-setting, health-care utilisation and carer burden). RESULTS A multidisciplinary intervention delivered in the homes of people with dementia was designed based on qualitative work, realist review and recommendations of the consensus panel. The intervention was delivered to 11 people with dementia. The study suggested that the intervention is both feasible and acceptable to stakeholders. A number of modifications were recommended to address some of the issues arising during feasibility testing. The measurement of outcome measures was successful. CONCLUSIONS The study has highlighted the feasibility of delivering a creative, tailored, individual approach to intervention for people with dementia following a fall. Although the intervention required greater investment of time than usual practice, many staff valued the opportunity to work more closely with people with dementia and their carers. We conclude that further research is now needed to refine this intervention in the context of a pilot randomised controlled trial. TRIAL REGISTRATION Current Controlled Trials ISRCTN41760734 and PROSPERO CRD42016029565. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 59. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Louise M Allan
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Alison Wheatley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Amy Smith
- Department of Occupational Therapy, Tees, Esk and Wear Valleys NHS Foundation Trust, Stockton-on-Tees, UK
| | - Elizabeth Flynn
- Department of Physiotherapy, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tara Homer
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Shannon Robalino
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona R Beyer
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Fox
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Denise Howel
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Robert Barber
- Department of Old Age Psychiatry, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jim Anthony Connolly
- Department of Emergency Medicine, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Steve Wayne Parry
- Falls and Syncope Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lynn Rochester
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Lynne Corner
- VOICE, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Bennett HQ, Matthews FE, Robinson L, Corner L, Kingston A, Jagger C. HEALTHY AGEING FOR ALL? SOCIOECONOMIC CHANGES OVER TIME IN DISABILITY-FREE AND INDEPENDENT LIFE EXPECTANCIES. Innov Aging 2019. [PMCID: PMC6845638 DOI: 10.1093/geroni/igz038.3295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Previous research using cross-sectional data shows widening inequalities in disability-free life expectancy (DFLE) by socioeconomic status (SES) in the UK. We aimed to understand the underlying transitions of DFLE and years dependency free (DepFLE) using longitudinal data from the Cognitive Function and Ageing Studies (CFAS I and CFAS II). Methods: Two large population based studies of those aged 65+ in three centres (Newcastle, Nottingham, Cambridgeshire) interviewed at baseline in 1991 (CFAS I) and 2011 (CFAS II) with follow up two years later. Disability was measured using difficulty in activities of daily living (ADL), and dependency by time between help required for ADLs. SES was based on area deprivation categorised into study specific tertiles. Transitions between disability or dependency states and death were modelled using Interpolated Markov Chain software. Results: Between 1991 and 2011, DFLE and disabled life expectancy (DLE) at age 65 increased for men in every SES group, with men being less likely to become disabled or die, and more likely to recover, in 2011 than 1991 across SES groups. For the most disadvantaged women, DFLE was similar, and DLE increased, whilst for the remaining women DFLE increased and DLE was similar. For women probability of recovery increased and probability of death from disability decreased but probability of becoming disabled decreased only for the most advantaged. DepFLE patterns across time were similar but more pronounced. Conclusion: Preventive measures should focus on reducing the disability and dependency onset in the most disadvantaged to ensure inequalities do not widen further.
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Affiliation(s)
| | | | | | - Lynne Corner
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - A Kingston
- Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Carol Jagger
- Newcastle University, Newcastle upon Tyne, United Kingdom
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Parker SG, Corner L, Laing K, Nestor G, Craig D, Collerton J, Frith J, Roberts HC, Sayer AA, Allan LM, Robinson L, Cowan K. Priorities for research in multiple conditions in later life (multi-morbidity): findings from a James Lind Alliance Priority Setting Partnership. Age Ageing 2019; 48:401-406. [PMID: 30892604 DOI: 10.1093/ageing/afz014] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/26/2018] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION multiple conditions in later life (multi-morbidity) is a major challenge for health and care systems worldwide, is of particular relevance for older people, but has not (until recently) received high priority as a topic for research. We have identified the top 10 research priorities from the perspective of older people, their carers, and health and social care professionals using the methods of a James Lind Alliance Priority Setting Partnership. METHODS in total, 354 participants (162 older people and carers, 192 health professionals) completed a survey and 15 older people and carers were interviewed to produce 96 'unanswered questions'. These were further refined by survey and interviews to a shortlist of 21 topics, and a mix of people aged 80+ living with three or more conditions, carers and health and social care providers to prioritised the top 10. RESULTS the key priorities were about the prevention of social isolation, the promotion of independence and physical and emotional well-being. In addition to these broad topics, the process also identified detailed priorities including the role of exercise therapy, the importance of falls (particularly fear of falling), the recognition and management of frailty and Comprehensive Geriatric Assessment. CONCLUSION these topics provide a unique perspective on research priorities on multiple conditions in later life and complement existing UK and International recommendations about the optimisation of health and social care systems to deliver essential holistic models of care and the prevention and treatment of multiple co-existing conditions.
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Affiliation(s)
- S G Parker
- Institute for Health and Society, Newcastle University, UK
- Newcastle University Institute for Ageing, Newcastle University, UK
| | - L Corner
- National Innovation Centre for Ageing, Newcastle University, UK
| | - K Laing
- Institute for Health and Society, Newcastle University, UK
| | - G Nestor
- NIHR Clinical Research Network, Faculty of Medical Sciences, Newcastle University, UK
| | - D Craig
- Institute for Health and Society, Newcastle University, UK
| | - J Collerton
- Academic Health Science Network for the North East and North Cumbria, UK
| | - J Frith
- Institute of Cellular Medicine, Newcastle University, UK
| | - H C Roberts
- Academic Geriatric Medicine, University of Southampton, UK
| | - A A Sayer
- Newcastle University Institute for Ageing, Newcastle University, UK
- NIHR Biomedical Research Centre, Faculty of Medical Sciences, Newcastle University, UK
- Age Research Group, Newcastle University, UK
| | - L M Allan
- Centre for Research in Ageing and Cognitive Health, Medical School, University of Exeter
| | - L Robinson
- Institute for Health and Society, Newcastle University, UK
- Newcastle University Institute for Ageing, Newcastle University, UK
| | - K Cowan
- James Lind Alliance, University of Southampton, UK
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Allan LM, Wheatley A, Flynn E, Smith A, Fox C, Howel D, Barber R, Homer TM, Robinson L, Parry SW, Corner L, Connolly JA, Rochester L, Bamford C. Is it feasible to deliver a complex intervention to improve the outcome of falls in people with dementia? A protocol for the DIFRID feasibility study. Pilot Feasibility Stud 2018; 4:170. [PMID: 30455976 PMCID: PMC6230281 DOI: 10.1186/s40814-018-0364-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 10/29/2018] [Indexed: 11/25/2022] Open
Abstract
Background People with dementia (PWD) experience ten times as many incident falls as people without dementia. Little is known about how best to deliver services to people with dementia following a fall. We used an integrated, mixed-methods approach to develop a new intervention which combines theory generated via a realist synthesis and data on current provision and pathways, gathered through a prospective observational study as well as qualitative interviews, focus groups and ethnographic observation. This intervention is to be tested in a feasibility study in the UK National Health Service. Methods People living with dementia in one of three geographical areas will be eligible for the study if they experience a fall requiring healthcare attention and have an informal carer. Potential participants will be identified by community services (primary care, paramedics, telecare), secondary care (ED, facilitated discharge services, rehabilitation outreach teams) and research case registers. Participants will receive a complex multidisciplinary intervention focused on their goals and interests for up to 12 weeks. The intervention will be delivered by occupational therapists, physiotherapists and rehabilitation support workers. Feasibility outcomes will include recruitment and retention, suitability and acceptability of outcome measures and acceptability, feasibility and fidelity of intervention components. PWD outcome measures will include number of falls, Montreal Cognitive Assessment (MOCA), European Quality of Life Instrument (EQ-5D-5L), Quality of Life–Alzheimer’s Disease Scale (QOL-AD), Modified Falls Efficacy Scale (MFES) and Goal Attainment Scaling (GAS). PWD outcome measures completed by an informal carer will include Disability Assessment for Dementia (DAD), EQ-5D-5L Proxy, QoL-AD Proxy and a Health Utilisation Questionnaire (HUQ). The carer outcome measure will be the Zarit Burden Interview (ZBI). An embedded process evaluation will explore barriers and facilitators to recruitment and intervention delivery. Discussion The study results will inform whether and how a larger multicentre RCT should be undertaken. A full RCT would have the potential to show how outcomes can be improved for people with dementia who have fallen. Ethics and dissemination The National Research Ethics Service Committee Newcastle and North Tyneside 2 approved the feasibility study. Trial registration International Standard Randomised Controlled Trial Registry. Registration number: ISRCTN41760734. Date of registration: 16/11/2015. Electronic supplementary material The online version of this article (10.1186/s40814-018-0364-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Louise M Allan
- 1Institute of Health Research, University of Exeter, South Cloisters, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU UK
| | - Alison Wheatley
- 2Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Elizabeth Flynn
- 3The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Amy Smith
- 4Tees, Esk and Wear Valleys NHS Foundation Trust, Stockton-on-Tees, UK
| | - Chris Fox
- 5University of East Anglia, Norwich, UK
| | - Denise Howel
- 2Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Robert Barber
- 6Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Tara Marie Homer
- 2Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Robinson
- 2Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Jim Anthony Connolly
- 3The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lynn Rochester
- 8Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- 2Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Shalloo RJ, Arran C, Corner L, Holloway J, Jonnerby J, Walczak R, Milchberg HM, Hooker SM. Hydrodynamic optical-field-ionized plasma channels. Phys Rev E 2018; 97:053203. [PMID: 29906935 DOI: 10.1103/physreve.97.053203] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Indexed: 11/07/2022]
Abstract
We present experiments and numerical simulations which demonstrate that fully ionized, low-density plasma channels could be formed by hydrodynamic expansion of plasma columns produced by optical field ionization. Simulations of the hydrodynamic expansion of plasma columns formed in hydrogen by an axicon lens show the generation of 200 mm long plasma channels with axial densities of order n_{e}(0)=1×10^{17}cm^{-3} and lowest-order modes of spot size W_{M}≈40μm. These simulations show that the laser energy required to generate the channels is modest: of order 1 mJ per centimeter of channel. The simulations are confirmed by experiments with a spherical lens which show the formation of short plasma channels with 1.5×10^{17}cm^{-3}≲n_{e}(0)≲1×10^{18}cm^{-3} and 61μm≳W_{M}≳33μm. Low-density plasma channels of this type would appear to be well suited as multi-GeV laser-plasma accelerator stages capable of long-term operation at high pulse repetition rates.
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Affiliation(s)
- R J Shalloo
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - C Arran
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - L Corner
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - J Holloway
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - J Jonnerby
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - R Walczak
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - H M Milchberg
- Institute for Research in Electronics and Applied Physics, University of Maryland, College Park, Maryland 20742, USA
| | - S M Hooker
- John Adams Institute for Accelerator Science and Department of Physics, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
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Pickett J, Bird C, Ballard C, Banerjee S, Brayne C, Cowan K, Clare L, Comas‐Herrera A, Corner L, Daley S, Knapp M, Lafortune L, Livingston G, Manthorpe J, Marchant N, Moriarty J, Robinson L, van Lynden C, Windle G, Woods B, Gray K, Walton C. A roadmap to advance dementia research in prevention, diagnosis, intervention, and care by 2025. Int J Geriatr Psychiatry 2018; 33:900-906. [PMID: 29468724 PMCID: PMC6033035 DOI: 10.1002/gps.4868] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/22/2018] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
| | - Cathy Bird
- Alzheimer's Society Research Network VolunteerAlzheimer's SocietyLondonUK
| | - Clive Ballard
- University of Exeter Medical SchoolUniversity of ExeterExeterUK
| | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical SchoolUniversity of SussexSussexUK
| | - Carol Brayne
- Cambridge Institute of Public Health, School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | | | - Linda Clare
- Centre for Research in Ageing and Cognitive HealthUniversity of ExeterExeterUK
| | | | - Lynne Corner
- Institute for AgeingNewcastle UniversityNewcastle upon TyneUK,Institute for Health & SocietyNewcastle UniversityNewcastle upon TyneUK
| | - Stephanie Daley
- Centre for Dementia Studies, Brighton and Sussex Medical SchoolUniversity of SussexSussexUK
| | - Martin Knapp
- PSSRULondon School of Economics and Political ScienceLondonUK
| | - Louise Lafortune
- Cambridge Institute of Public Health, School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | | | - Jill Manthorpe
- Social Care Workforce Research UnitKing's College LondonLondonUK
| | | | - Jo Moriarty
- Social Care Workforce Research UnitKing's College LondonLondonUK
| | - Louise Robinson
- Institute for AgeingNewcastle UniversityNewcastle upon TyneUK,Institute for Health & SocietyNewcastle UniversityNewcastle upon TyneUK
| | | | - Gill Windle
- Dementia Services Development CentreBangor UniversityBangorGwynedd, WalesUK
| | - Bob Woods
- Dementia Services Development CentreBangor UniversityBangorGwynedd, WalesUK
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Muir D, Vat LE, Keller M, Bell T, Jørgensen CR, Eskildsen NB, Johnsen AT, Pandya-Wood R, Blackburn S, Day R, Ingram C, Hapeshi J, Khan S, Muir D, Baird W, Pavitt SH, Boards R, Briggs J, Loughhead E, Patel M, Khalil R, Cooper D, Day P, Boards J, Wu J, Zoltie T, Barber S, Thompson W, Kenny K, Owen J, Ramsdale M, Grey-Borrows K, Townsend N, Johnston J, Maddison K, Duff-Walker H, Mahon K, Craig L, Collins R, O’Grady A, Wadd S, Kelly A, Dutton M, McCann M, Jones R, Mathie E, Wythe H, Munday D, Millac P, Rhodes G, Roberts N, Simpson J, Barden N, Vicary P, Wellings A, Poland F, Jones J, Miah J, Bamforth H, Charalambous A, Dawes P, Edwards S, Leroi I, Manera V, Parsons S, Sayers R, Pinfold V, Dawson P, Gibbons B, Gibson J, Hobson-Merrett C, McCabe C, Rawcliffe T, Frith L, Gudgin B, Wellings A, Horobin A, Ewart C, Higton F, Vanhegan S, Pandya-Wood R, Stewart J, Wragg A, Wray P, Widdowson K, Brighton LJ, Pask S, Benalia H, Bailey S, Sumerfield M, Etkind S, Murtagh FEM, Koffman J, Evans CJ, Hrisos S, Marshall J, Yarde L, Riley B, Whitlock P, Jobson J, Ahmed S, Rankin J, Michie L, Scott J, Barker CR, Barlow-Pay M, Kekere-Ekun A, Mazumder A, Nishat A, Petley R, Brady LM, Templeton L, Walker E, Moore D, Shaw L, Nunns M, Thompson Coon J, Blomquist P, Cochrane S, Edelman N, Calliste J, Cassell J, Mader LB, Kläger S, Wilkinson IB, Hiemstra TF, Hughes M, Warren A, Atkins P, Eaton H, Keenan J, Poland F, Wythe H, Wellings A, Vicary P, Rhodes C, Skrybrant M, Blackburn S, Chatwin L, Darby MA, Entwistle A, Hull D, Quann N, Hickey G, Dziedzic K, Eltringham SA, Gordon J, Franklin S, Jackson J, Leggett N, Davies P, Nugawela M, Scott L, Leach V, Richards A, Blacker A, Abrams P, Sharma J, Donovan J, Whiting P, Stones SR, Wright C, Boddy K, Irvine J, Harris J, Joseph N, Kok M, Gibson A, Evans D, Grier S, MacGowan A, Matthews R, Papoulias C, Augustine C, Hoffman M, Doughty M, Surridge H, Tembo D, Roberts A, Chambers E, Beever D, Wildman M, Davies RL, Staniszewska S, Stephens R, Schroter S, Price A, Richards T, Demaine A, Harmston R, Elliot J, Flemyng E, Sproson L, Pryde L, Reed H, Squire G, Stanton A, Langley J, Briggs M, Brindle P, Sanders R, McDermott C, David C, Nicola H, Simon D, Martin W, Coldham T, Ballinger C, Kerridge L, Mullee M, Eyles C, Barlow-Pay M, Hickey G, Johns T, Paylor J, Turner K, Whiting L, Roberts S, Petty J, Meager G, Grinbergs-Saull A, Morgan N, Turner K, Collins F, Gibson S, Passmore S, Evans L, Green SA, Trite J, Matthews R, Hrisos S, Thomson R, Green D, Atkinson H, Mitchell A, Corner L, AM AMK, Nguyen R, Frank B, McNeil N, Harrison H. Abstracts from the NIHR INVOLVE Conference 2017. Res Involv Engagem 2017; 3:27. [PMCID: PMC5773864 DOI: 10.1186/s40900-017-0075-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Delia Muir
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Lidewij Eva Vat
- Newfoundland and Labrador’s Support for People and Patient-Oriented Research and Trials Unit, Memorial University Newfoundland, St. Johns, Newfoundland and Labrador Canada
| | - Malori Keller
- Saskatchewan Centre for Patient-Oriented Research, Health Quality Council, Saskatoon, Saskatchewan Canada
| | - Tim Bell
- Canadian Institutes of Health Research, Ottawa, Ontario Canada
| | - Clara R. Jørgensen
- Department of Disability, Inclusion and Special Needs, School of Education, University of Birmingham, Birmingham, UK
| | - Nanna B. Eskildsen
- Department of Palliative Medicine, Bispebjerg Hospital, DK-2400 Copenhagen, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Anna T. Johnsen
- Department of Palliative Medicine, Bispebjerg Hospital, DK-2400 Copenhagen, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Raksha Pandya-Wood
- National Institute for Health Research, Research Design Service East Midlands, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Steven Blackburn
- National Institute for Health Research, Research Design Service West Midlands, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
| | - Ruth Day
- National Institute for Health Research, Research Design Service East Midlands, Department of Health Sciences, University of Leicester, Leicester, UK
- Public contributor involved with the National Institute for Health Research, Research Design Service Public Involvement Community, Derby, UK
| | - Carol Ingram
- National Institute for Health Research, Research Design Service West Midlands, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
- Public contributor involved with the National Institute for Health Research, Research Design Service Public Involvement Community, Derby, UK
| | - Julie Hapeshi
- National Institute for Health Research, Research Design Service South West, Gloucestershire Royal Hospital, Gloucester, UK
| | - Samaira Khan
- National Institute for Health Research, Research Design Service Yorkshire and Humber, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Delia Muir
- National Institute for Health Research, Research Design Service Yorkshire and Humber, Leeds Institute for Clinical Trials Research, University of Leeds, Leeds, UK
| | - Wendy Baird
- National Institute for Health Research, Research Design Service Yorkshire and Humber, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sue H. Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
| | - Richard Boards
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
| | - Janet Briggs
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
| | - Ellen Loughhead
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
- Batley Girls High School, Batley, UK
| | - Mariya Patel
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
- Batley Girls High School, Batley, UK
| | - Rameesa Khalil
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
- Batley Girls High School, Batley, UK
| | | | - Peter Day
- School of Dentistry, University of Leeds, Leeds, UK
| | - Jenny Boards
- School of Dentistry, University of Leeds, Leeds, UK
- The SMILE AIDERS Patient Public Involvement & Engagement Forum School of Dentistry, University of Leeds, Leeds, UK
| | - Jianhua Wu
- School of Dentistry, University of Leeds, Leeds, UK
| | | | - Sophy Barber
- School of Dentistry, University of Leeds, Leeds, UK
| | | | - Kate Kenny
- School of Dentistry, University of Leeds, Leeds, UK
| | - Jenny Owen
- School of Dentistry, University of Leeds, Leeds, UK
| | | | | | | | | | - Katie Maddison
- School of Performance & Cultural Industries, University of Leeds, Leeds, UK
| | - Harry Duff-Walker
- School of Performance & Cultural Industries, University of Leeds, Leeds, UK
| | - Katie Mahon
- School of Performance & Cultural Industries, University of Leeds, Leeds, UK
| | - Lily Craig
- School of Performance & Cultural Industries, University of Leeds, Leeds, UK
| | - Rebecca Collins
- School of Performance & Cultural Industries, University of Leeds, Leeds, UK
| | - Alice O’Grady
- School of Performance & Cultural Industries, University of Leeds, Leeds, UK
| | - Sarah Wadd
- Substance Misuse and Ageing Research Team (SMART), Institute of Applied Social Research, University of Bedfordshire, Luton, UK
| | - Adrian Kelly
- Substance Misuse and Ageing Research Team (SMART), Institute of Applied Social Research, University of Bedfordshire, Luton, UK
| | - Maureen Dutton
- Substance Misuse and Ageing Research Team (SMART), Institute of Applied Social Research, University of Bedfordshire, Luton, UK
| | - Michelle McCann
- Substance Misuse and Ageing Research Team (SMART), Institute of Applied Social Research, University of Bedfordshire, Luton, UK
| | - Rebecca Jones
- Substance Misuse and Ageing Research Team (SMART), Institute of Applied Social Research, University of Bedfordshire, Luton, UK
| | - Elspeth Mathie
- CRIPACC, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Helena Wythe
- CRIPACC, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Diane Munday
- Public Involvement in Research Group, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Paul Millac
- Public Involvement in Research Group, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Graham Rhodes
- INsPIRE PPI Group, Cambridgeshire Community Services NHS Trust, Ely, Cambridgeshire, UK
| | - Nick Roberts
- INsPIRE PPI Group, Cambridgeshire Community Services NHS Trust, Ely, Cambridgeshire, UK
| | - Jean Simpson
- Cambridge University Hospital (CUH) Patient and Public Involvement Panel, Cambridgeshire, UK
| | - Nat Barden
- Service User and Research Group, Cambridge and Peterborough Foundation Trust, Cambridgeshire, UK
| | - Penny Vicary
- Public & Patient Involvement in Research (PPIRes), Norfolk and Suffolk, UK
| | - Amander Wellings
- Public & Patient Involvement in Research (PPIRes), Norfolk and Suffolk, UK
| | | | - Julia Jones
- CRIPACC, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Jahanara Miah
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
- Public Programmes Team, Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Howard Bamforth
- SENSE-Cog Research User Group, Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Anna Charalambous
- Department of Health Sciences, European University Cyprus, Nicosia, Cyprus
| | - Piers Dawes
- Manchester Centre for Audiology and Deafness (ManCAD), Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Steven Edwards
- Public Programmes Team, Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Iracema Leroi
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Valeria Manera
- CoBTeK COgnition Behaviour Technology, Universite de Nice Sophia Antipolis, Nice, France
| | - Suzanne Parsons
- Public Programmes Team, Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | | | - Paul Dawson
- Lancashire Care NHS Foundation Trust, Preston, UK
| | | | | | | | | | | | - Lucy Frith
- National Institute for Health Research (NIHR), Research Design Service North West, University of Liverpool, Liverpool, UK
| | | | | | - Adele Horobin
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
| | | | | | | | - Raksha Pandya-Wood
- National Institute for Health Research (NIHR) East Midlands Research Design Service, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Jane Stewart
- National Institute for Health Research (NIHR) East Midlands Research Design Service, School of Medicine, University of Nottingham, Nottingham Health Science Partners, Queen’s Medical Centre, Nottingham, UK
| | - Andy Wragg
- Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Queen’s Medical Centre, Nottingham, UK
| | - Paula Wray
- INVOLVE Coordinating Centre, University of Southampton, Southampton, UK
| | - Kirsty Widdowson
- Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
| | - Lisa Jane Brighton
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Sophie Pask
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Hamid Benalia
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Sylvia Bailey
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Marion Sumerfield
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Simon Etkind
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Fliss E. M. Murtagh
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Jonathan Koffman
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
| | - Catherine J. Evans
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King’s College London, London, UK
- Department of Palliative Medicine, Sussex Community NHS Foundation Trust, Brighton, UK
| | - Susan Hrisos
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Bren Riley
- Riverside Project, Newcastle upon Tyne, UK
| | | | | | - Safia Ahmed
- Health and Race Equality Forum, Newcastle upon Tyne, UK
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Lydia Michie
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jason Scott
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Caroline R. Barker
- National Institute for Health Research Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, Hampshire, UK
| | - Megan Barlow-Pay
- National Institute for Health Research Design Service South Central, University of Southampton, Southampton, Hampshire, UK
| | - Aisha Kekere-Ekun
- Young Adult Patient and Public Involvement Group member, Southampton, Hampshire, UK
| | - Aniqa Mazumder
- Young Adult Patient and Public Involvement Group member, Southampton, Hampshire, UK
| | - Aniqa Nishat
- Young Adult Patient and Public Involvement Group member, Southampton, Hampshire, UK
| | - Rebecca Petley
- Young Adult Patient and Public Involvement Group member, Southampton, Hampshire, UK
| | - Louca-Mai Brady
- Kingston and St George’s Joint Faculty and Independent Research Consultant, London, UK
| | | | - Erin Walker
- Centre for Outcomes and Experiences Research in Child Health, Illness and Disease, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Darren Moore
- National Institute of Health Research Peninsula Collaboration for Leadership in Applied Health Research & Care, University of Exeter Medical School, Exeter, UK
| | - Liz Shaw
- National Institute of Health Research Peninsula Collaboration for Leadership in Applied Health Research & Care, University of Exeter Medical School, Exeter, UK
| | - Michael Nunns
- National Institute of Health Research Peninsula Collaboration for Leadership in Applied Health Research & Care, University of Exeter Medical School, Exeter, UK
| | - Jo Thompson Coon
- National Institute of Health Research Peninsula Collaboration for Leadership in Applied Health Research & Care, University of Exeter Medical School, Exeter, UK
| | - Paula Blomquist
- Public Health England, London, UK
- National Institute for Health Research (NIHR) Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at UCL, London, UK
| | - Sarah Cochrane
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Natalie Edelman
- Brighton & Sussex Medical School, Brighton, UK
- University of Brighton, Brighton, UK
| | - Josina Calliste
- National Institute for Health Research (NIHR) Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at UCL, London, UK
| | - Jackie Cassell
- National Institute for Health Research (NIHR) Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at UCL, London, UK
- Brighton & Sussex Medical School, Brighton, UK
| | - Laura B. Mader
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Sabine Kläger
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ian B. Wilkinson
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Thomas F. Hiemstra
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mel Hughes
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Angela Warren
- PIER (Public Involvement in Education and Research) partnership, Bournemouth University, Bournemouth, UK
| | - Peter Atkins
- PIER (Public Involvement in Education and Research) partnership, Bournemouth University, Bournemouth, UK
| | - Hazel Eaton
- Research and Development, Dorset Healthcare University NHS Foundation Trust, Dorset, UK
| | | | | | - Helena Wythe
- University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Amander Wellings
- Members of the Patient and Public in Research Group (PPIRes), NHS South Norfolk Clinical Commissioning Group, Norwich, Norfolk, UK
| | - Penny Vicary
- Members of the Patient and Public in Research Group (PPIRes), NHS South Norfolk Clinical Commissioning Group, Norwich, Norfolk, UK
| | - Carol Rhodes
- NIHR Research Design Service West Midlands, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK
| | - Magdalena Skrybrant
- NIHR Collaboration for Leadership in Health Research and Care West Midlands, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Steven Blackburn
- NIHR Research Design Service West Midlands, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK
| | - Lucy Chatwin
- Academic Health Science Network West Midlands, Institute of Translational Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Mary-Anne Darby
- NIHR Clinical Research Network West Midlands, Greyfriars Business Park, Stafford, UK
| | - Andrew Entwistle
- NIHR Clinical Research Network West Midlands, Greyfriars Business Park, Stafford, UK
| | - Diana Hull
- NIHR/Wellcome Trust Birmingham Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Naimh Quann
- NIHR/Wellcome Trust Birmingham Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gary Hickey
- INVOLVE, University of Southampton Science Park, Southampton, UK
| | - Krysia Dziedzic
- NIHR Research Design Service West Midlands, Research Institute for Primary Care & Health Sciences, Keele University, Staffordshire, UK
| | - Sabrina A. Eltringham
- Directorate of Therapeutics and Palliative, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jim Gordon
- Directorate of Therapeutics and Palliative, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Sue Franklin
- Directorate of Therapeutics and Palliative, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Joni Jackson
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Nick Leggett
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Philippa Davies
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Manjula Nugawela
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lauren Scott
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Verity Leach
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alison Richards
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anthony Blacker
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | | | - Jitin Sharma
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Jenny Donovan
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Penny Whiting
- The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West) at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Simon R. Stones
- NIHR: CRN Children/Arthritis Research UK Paediatric Rheumatology Clinical Studies Group, Liverpool, UK
| | - Catherine Wright
- NIHR: CRN Children/Arthritis Research UK Paediatric Rheumatology Clinical Studies Group, Liverpool, UK
| | - Kate Boddy
- NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Jenny Irvine
- NIHR CLAHRC North West Coast (CLAHRC NWC), Based at Division of Health Research, Lancaster University, Lancaster, UK
| | - Jim Harris
- Peninsula Public Involvement Group (PenPIG), PenCLAHRC, South West Peninsula, Exeter, UK
| | - Neil Joseph
- Public Reference Panel (PRP), CLAHRC NWC, North West Coast area, Liverpool, UK
| | - Michele Kok
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Andy Gibson
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - David Evans
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Sally Grier
- Department of Medical Microbiology, North Bristol NHS Trust, Bristol, UK
| | - Alasdair MacGowan
- Department of Medical Microbiology, North Bristol NHS Trust, Bristol, UK
| | - Rachel Matthews
- NIHR CLAHRC Northwest London, Imperial College London/Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - Cherelle Augustine
- NIHR CLAHRC Northwest London, Imperial College London/Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Maurice Hoffman
- NIHR CLAHRC Northwest London, Imperial College London/Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - Heidi Surridge
- NIHR Evaluation Trials and Studies Coordinating Centre (NETSCC), Southampton, UK
| | - Doreen Tembo
- NIHR Evaluation Trials and Studies Coordinating Centre (NETSCC), Southampton, UK
| | - Amanda Roberts
- Public member, NETSCC Public Involvement Virtual Network and Public member of a Trial Steering Committee, Southampton, UK
| | - Eleni Chambers
- Public member, NETSCC PPI Reference Group, Southampton, UK
| | - Daniel Beever
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, South Yorkshire UK
| | - Martin Wildman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire UK
| | - Rosemary L. Davies
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
- National Institute for Health Research, Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sophie Staniszewska
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Warwick, UK
| | | | | | - Amy Price
- The BMJ, London, UK
- Department of Continuing Education, University of Oxford, Oxford, UK
| | | | | | | | | | | | - Lise Sproson
- NIHR Devices for Dignity Health Technology Co-operative, Sheffield, UK
| | - Liz Pryde
- NIHR Devices for Dignity Health Technology Co-operative, Sheffield, UK
| | - Heath Reed
- Lab4Living, Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Gill Squire
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Andy Stanton
- Lab4Living, Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Joe Langley
- Lab4Living, Art and Design Research Centre, Sheffield Hallam University, Sheffield, UK
| | - Moya Briggs
- NIHR Devices for Dignity Health Technology Co-operative, Sheffield, UK
| | - Philip Brindle
- NIHR Devices for Dignity Health Technology Co-operative, Sheffield, UK
| | - Rod Sanders
- NIHR Devices for Dignity Health Technology Co-operative, Sheffield, UK
| | - Christopher McDermott
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
| | - Coyle David
- NIHR Devices for Dignity Healthcare Technology Co-operative at Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF UK
- Renal Medicine, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Heron Nicola
- NIHR Devices for Dignity Healthcare Technology Co-operative at Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF UK
| | - Davies Simon
- Institute for Applied Clinical Sciences, Keele University, Keele, Staffordshire UK
- University Hospital of North Midlands, Newcastle Rd, Stoke-on-Trent, Staffordshire, ST46QG UK
| | - Wilkie Martin
- University Hospital of North Midlands, Newcastle Rd, Stoke-on-Trent, Staffordshire, ST46QG UK
| | | | | | | | - Mark Mullee
- Research Design Service South Central, Southampton General Hospital, Southampton, UK
| | - Caroline Eyles
- Research Design Service South Central, Southampton General Hospital, Southampton, UK
| | - Megan Barlow-Pay
- Research Design Service South Central, Southampton General Hospital, Southampton, UK
| | - Gary Hickey
- NIHR INVOLVE, University of Southampton, Southampton, UK
| | - Tracey Johns
- NIHR Research Design Service East of England, University of Essex, Essex, UK
| | - Jon Paylor
- NIHR Research Design Service London, Kings College London, London, UK
| | - Katie Turner
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Lisa Whiting
- Department of Nursing and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, England
| | - Sheila Roberts
- Department of Nursing and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, England
| | - Julia Petty
- Department of Nursing and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, England
| | - Gary Meager
- Department of Nursing and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, England
| | | | | | - Kati Turner
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Flavia Collins
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Sarah Gibson
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Siobhan Passmore
- Population Health Research Institute, St George’s, University of London, London, UK
| | - Liz Evans
- NIHR CLAHRC Northwest London, Imperial College London/Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Stuart A. Green
- NIHR CLAHRC Northwest London, Imperial College London/Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Jenny Trite
- Central and Northwest London NHS Foundation Trust, London, UK
| | - Rachel Matthews
- NIHR CLAHRC Northwest London, Imperial College London/Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Susan Hrisos
- Institute of Health & Society, Newcastle University, Newcastle, UK
| | - Richard Thomson
- Institute of Health & Society, Newcastle University, Newcastle, UK
| | - Dave Green
- Institute of Health & Society, Newcastle University, Newcastle, UK
| | - Helen Atkinson
- Faculty of Medical Sciences Engage, Newcastle University, Newcastle, UK
| | - Alex Mitchell
- Faculty of Medical Sciences Engage, Newcastle University, Newcastle, UK
| | - Lynne Corner
- Faculty of Medical Sciences Engage, Newcastle University, Newcastle, UK
| | | | - Rebecca Nguyen
- Consumer and Community Health Research Network, Perth, Australia
- Telethon Kids Institute, Perth, Australia
| | - Belinda Frank
- Consumer and Community Health Research Network, Perth, Australia
| | - Ngaire McNeil
- Consumer and Community Health Research Network, Perth, Australia
| | - Hayley Harrison
- Consumer and Community Health Research Network, Perth, Australia
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Cowley J, Thornton C, Arran C, Shalloo RJ, Corner L, Cheung G, Gregory CD, Mangles SPD, Matlis NH, Symes DR, Walczak R, Hooker SM. Excitation and Control of Plasma Wakefields by Multiple Laser Pulses. Phys Rev Lett 2017; 119:044802. [PMID: 29341755 DOI: 10.1103/physrevlett.119.044802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Indexed: 06/07/2023]
Abstract
We demonstrate experimentally the resonant excitation of plasma waves by trains of laser pulses. We also take an important first step to achieving an energy recovery plasma accelerator by showing that a plasma wave can be damped by an out-of-resonance trailing laser pulse. The measured laser wakefields are found to be in excellent agreement with analytical and numerical models of wakefield excitation in the linear regime. Our results indicate a promising direction for achieving highly controlled, GeV-scale laser-plasma accelerators operating at multikilohertz repetition rates.
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Affiliation(s)
- J Cowley
- John Adams Institute for Accelerator Science, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - C Thornton
- John Adams Institute for Accelerator Science, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - C Arran
- John Adams Institute for Accelerator Science, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - R J Shalloo
- John Adams Institute for Accelerator Science, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - L Corner
- John Adams Institute for Accelerator Science, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - G Cheung
- John Adams Institute for Accelerator Science, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - C D Gregory
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot OX11 0QX, United Kingdom
| | - S P D Mangles
- John Adams Institute for Accelerator Science, Blackett Laboratory, Imperial College London, London SW7 2AZ, United Kingdom
| | - N H Matlis
- Deutsches Elektronen-Synchrotron (DESY), Notkestraße 85, Hamburg 22607, Germany
| | - D R Symes
- Central Laser Facility, Rutherford Appleton Laboratory, Didcot OX11 0QX, United Kingdom
| | - R Walczak
- John Adams Institute for Accelerator Science, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - S M Hooker
- John Adams Institute for Accelerator Science, University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
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Shalloo RJ, Corner L. Secondary wavelength stabilization of unbalanced Michelson interferometers for the generation of low-jitter pulse trains. Opt Lett 2016; 41:4068-4070. [PMID: 27607974 DOI: 10.1364/ol.41.004068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We present a double unbalanced Michelson interferometer producing up to four output pulses from a single input pulse. The interferometer is stabilized with the Hänsch-Couillaud method using an auxiliary low power continuous wave laser injected into the interferometer, allowing the stabilization of the temporal jitter of the output pulses to 0.02 fs. Such stabilized pulse trains would be suitable for driving multi-pulse laser wakefield accelerators, and the technique could be extended to include amplification in the arms of the interferometer.
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Abstract
Lack of insight or impaired awareness of deficits in people with Alzheimer’s disease or other dementias (AD) is a relatively neglected area of study. The terms are widely used in professional and everyday life without a shared understanding of what lack of insight means to health professionals, informal caregivers or people with dementia. Content analysis of 49 psychiatry or psychology texts, in which insight or a synonym is mentioned, found lack of clarity in definitions and their operationalization. In general, insight is defined as the ability to understand one’s own problems. Lack of insight therefore is a professional judgement grounded in the medicalization of dementia. People labelled as lacking insight of their dementia will consequently experience more acutely depersonalization, loss of independence, loss of social and political rights and they will have their behaviour individualized. Caregivers’ understanding of the loss of insight may influence the way they deal with risk during caregiving.
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Affiliation(s)
- John Bond
- Centre for Health Services Research and Institute for Ageing and Health, University of Newcastle upon Tyne
| | - Lynne Corner
- Centre for Health Services Research and Institute for Ageing and Health, University of Newcastle upon Tyne
| | - Anna Lilley
- Centre for Health Services Research and Institute for Ageing and Health, University of Newcastle upon Tyne
| | - Catherine Ellwood
- Centre for Health Services Research and Institute for Ageing and Health, University of Newcastle upon Tyne
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Clarke CL, Keyes SE, Wilkinson H, Alexjuk J, Wilcockson J, Robinson L, Corner L, Cattan M. Organisational space for partnership and sustainability: lessons from the implementation of the National Dementia Strategy for England. Health Soc Care Community 2014; 22:634-645. [PMID: 25243927 DOI: 10.1111/hsc.12134] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2014] [Indexed: 06/03/2023]
Abstract
National policy initiatives are faced with challenges in their partnership development and sustainability. The National Dementia Strategy for England recommended Dementia Adviser (DA) and Peer Support Network (PSN) services and 40 demonstration sites were established. In this paper, we report on the national evaluation of these demonstration sites, with specific reference to aspects of organisational development. The research used a mixed-methods design with three main strands: (i) activity and outcome monitoring; (ii) organisational surveys and collaborative discussion; (iii) in-depth case studies in eight of the 40 sites. This paper focuses primarily on three rounds of organisational surveys distributed to all 40 demonstration sites over a period of 21 months and interviews in the case studies. Data identify the significance of infrastructure within immediate services as well as the position of services within the external infrastructure of the wider health and social care landscape. Partnership - both internally and externally - was key to establishing and sustaining services that flourished. When working well, DAs and PSNs acted as a link between services and people with dementia at the same time as filling gaps in existing support, providing information, advice and interpersonal support that was tailored to individual needs and circumstances. In conclusion, to achieve the full potential and sustainability of services requires them to be in an organisational space that allows them to work in partnership and collaboration with other services, and that values their distinct knowledge of their communities.
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Keyes SE, Clarke CL, Wilkinson H, Alexjuk EJ, Wilcockson J, Robinson L, Reynolds J, McClelland S, Corner L, Cattan M. “We’re all thrown in the same boat … ”: A qualitative analysis of peer support in dementia care. Dementia 2014; 15:560-77. [DOI: 10.1177/1471301214529575] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Peer support is well established in fields such as the disability movement and mental health and is increasingly recognised as one way of enabling support by and for people with a diagnosis of dementia and their immediate carers. It was central to the implementation of the National Dementia Strategy (NDS) for England, when 40 demonstration sites were established. This mixed-methods study included in-depth qualitative interviews with people living with dementia ( n = 101) and staff/stakeholders ( n = 82) at 8 of the 40 sites. Data analysis was a five-stage process: coding framework developed (using 25 transcripts); further development of the framework (using a further 70 transcripts); development of emerging themes; modelling of themes and verification of models based on the entire data set. Peer support had positive emotional and social impact that was rooted in identification with others, a commonality of experience and reciprocity of support. There was also a contrast between the quality of peer support and support from professionals. This emphasises the significance of lived experience and promoting a strength-based approach to interpersonal support that is enabling and challenges a deficit approach to understanding dementia.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Mima Cattan
- University of Northumbria, Newcastle, United Kingdom
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24
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White GR, Ainsworth R, Akagi T, Alabau-Gonzalvo J, Angal-Kalinin D, Araki S, Aryshev A, Bai S, Bambade P, Bett DR, Blair G, Blanch C, Blanco O, Blaskovic-Kraljevic N, Bolzon B, Boogert S, Burrows PN, Christian G, Corner L, Davis MR, Faus-Golfe A, Fukuda M, Gao J, García-Morales H, Geffroy N, Hayano H, Heo AY, Hildreth M, Honda Y, Huang JY, Hwang WH, Iwashita Y, Jang S, Jeremie A, Kamiya Y, Karataev P, Kim ES, Kim HS, Kim SH, Kim YI, Komamiya S, Kubo K, Kume T, Kuroda S, Lam B, Lekomtsev K, Liu S, Lyapin A, Marin E, Masuzawa M, McCormick D, Naito T, Nelson J, Nevay LJ, Okugi T, Omori T, Oroku M, Park H, Park YJ, Perry C, Pfingstner J, Phinney N, Rawankar A, Renier Y, Resta-López J, Ross M, Sanuki T, Schulte D, Seryi A, Shevelev M, Shimizu H, Snuverink J, Spencer C, Suehara T, Sugahara R, Takahashi T, Tanaka R, Tauchi T, Terunuma N, Tomás R, Urakawa J, Wang D, Warden M, Wendt M, Wolski A, Woodley M, Yamaguchi Y, Yamanaka T, Yan J, Yokoya K, Zimmermann F. Experimental validation of a novel compact focusing scheme for future energy-frontier linear lepton colliders. Phys Rev Lett 2014; 112:034802. [PMID: 24484144 DOI: 10.1103/physrevlett.112.034802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Indexed: 06/03/2023]
Abstract
A novel scheme for the focusing of high-energy leptons in future linear colliders was proposed in 2001 [P. Raimondi and A. Seryi, Phys. Rev. Lett. 86, 3779 (2001)]. This scheme has many advantageous properties over previously studied focusing schemes, including being significantly shorter for a given energy and having a significantly better energy bandwidth. Experimental results from the ATF2 accelerator at KEK are presented that validate the operating principle of such a scheme by demonstrating the demagnification of a 1.3 GeV electron beam down to below 65 nm in height using an energy-scaled version of the compact focusing optics designed for the ILC collider.
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Affiliation(s)
- G R White
- SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025-7090, USA
| | - R Ainsworth
- John Adams Institute for Accelerator Science at Royal Holloway University of London, Egham Hill, Egham, Surrey TW20 0EX, United Kingdom
| | - T Akagi
- Department of Physics, Hiroshima University, 1-3-1 Kagamiyama, Higashi-Hiroshima 739-8526, Japan
| | - J Alabau-Gonzalvo
- European Organization for Nuclear Research (CERN), CH-1211 Geneva 23, Switzerland
| | - D Angal-Kalinin
- CLRC: Daresbury Laboratory, Daresbury, Warrington, Cheshire WA4 4AD, United Kingdom
| | - S Araki
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - A Aryshev
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - S Bai
- Institute of High Energy Physics (IHEP), Chinese Academy of Sciences (CAS), Beijing, China
| | - P Bambade
- LAL, Universite Paris-Sud, CNRS/IN2P3, Orsay, France
| | - D R Bett
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - G Blair
- John Adams Institute for Accelerator Science at Royal Holloway University of London, Egham Hill, Egham, Surrey TW20 0EX, United Kingdom and Science and Technology Facilities Council, Polaris House, North Star Avenue, Swindon SN2 1SZ, United Kingdom
| | - C Blanch
- Universidad de Valencia - Instituto de Física Corpuscular (IFC), Edificio Institutos de Investigación, c/ Catedrático José Beltrán, 2, E-46980 Paterna, Spain
| | - O Blanco
- European Organization for Nuclear Research (CERN), CH-1211 Geneva 23, Switzerland and LAL, Universite Paris-Sud, CNRS/IN2P3, Orsay, France
| | - N Blaskovic-Kraljevic
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - B Bolzon
- European Organization for Nuclear Research (CERN), CH-1211 Geneva 23, Switzerland and CLRC: Daresbury Laboratory, Daresbury, Warrington, Cheshire WA4 4AD, United Kingdom and Department of Physics, Oliver Lodge Laboratory, University of Liverpool, Oxford St., Liverpool L69 3BX, United Kingdom
| | - S Boogert
- John Adams Institute for Accelerator Science at Royal Holloway University of London, Egham Hill, Egham, Surrey TW20 0EX, United Kingdom
| | - P N Burrows
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - G Christian
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - L Corner
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - M R Davis
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - A Faus-Golfe
- Universidad de Valencia - Instituto de Física Corpuscular (IFC), Edificio Institutos de Investigación, c/ Catedrático José Beltrán, 2, E-46980 Paterna, Spain
| | - M Fukuda
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - J Gao
- Institute of High Energy Physics (IHEP), Chinese Academy of Sciences (CAS), Beijing, China
| | - H García-Morales
- European Organization for Nuclear Research (CERN), CH-1211 Geneva 23, Switzerland and Universitat Politécnica de Catalunya, BarcelonaTech, C. Jordi Girona, 31. 08034 Barcelona, Spain
| | - N Geffroy
- LAPP-Universite de Savoie-CNRS/IN2P3, Annecy-le-Vieux, France
| | - H Hayano
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - A Y Heo
- Department of Physics, Kyungpook National University, 1370 San Kyuk-dong, Puk ku, Taegu 635, South Korea
| | - M Hildreth
- University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - Y Honda
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - J Y Huang
- Pohang Accelerator Laboratory, POSTECH (Pohang University of Science and Technology), San-31 Hyoja-dong, Pohang 790-784, South Korea
| | - W H Hwang
- Pohang Accelerator Laboratory, POSTECH (Pohang University of Science and Technology), San-31 Hyoja-dong, Pohang 790-784, South Korea
| | - Y Iwashita
- Institute for Chemical Research (ICR), Nuclear Science Research Facility, Kyoto University, Gokasho, Uji, Kyoto 611-0011, Japan
| | - S Jang
- Department of Physics, Kyungpook National University, 1370 San Kyuk-dong, Puk ku, Taegu 635, South Korea
| | - A Jeremie
- LAPP-Universite de Savoie-CNRS/IN2P3, Annecy-le-Vieux, France
| | - Y Kamiya
- Department of Physics, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan
| | - P Karataev
- John Adams Institute for Accelerator Science at Royal Holloway University of London, Egham Hill, Egham, Surrey TW20 0EX, United Kingdom
| | - E S Kim
- Department of Physics, Kyungpook National University, 1370 San Kyuk-dong, Puk ku, Taegu 635, South Korea
| | - H S Kim
- Department of Physics, Kyungpook National University, 1370 San Kyuk-dong, Puk ku, Taegu 635, South Korea
| | - S H Kim
- Pohang Accelerator Laboratory, POSTECH (Pohang University of Science and Technology), San-31 Hyoja-dong, Pohang 790-784, South Korea
| | - Y I Kim
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - S Komamiya
- Department of Physics, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan
| | - K Kubo
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - T Kume
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - S Kuroda
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - B Lam
- SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025-7090, USA
| | - K Lekomtsev
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - S Liu
- LAL, Universite Paris-Sud, CNRS/IN2P3, Orsay, France
| | - A Lyapin
- John Adams Institute for Accelerator Science at Royal Holloway University of London, Egham Hill, Egham, Surrey TW20 0EX, United Kingdom
| | - E Marin
- SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025-7090, USA
| | - M Masuzawa
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - D McCormick
- SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025-7090, USA
| | - T Naito
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - J Nelson
- SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025-7090, USA
| | - L J Nevay
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom and John Adams Institute for Accelerator Science at Royal Holloway University of London, Egham Hill, Egham, Surrey TW20 0EX, United Kingdom
| | - T Okugi
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - T Omori
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - M Oroku
- Department of Physics, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan
| | - H Park
- Department of Physics, Kyungpook National University, 1370 San Kyuk-dong, Puk ku, Taegu 635, South Korea
| | - Y J Park
- Pohang Accelerator Laboratory, POSTECH (Pohang University of Science and Technology), San-31 Hyoja-dong, Pohang 790-784, South Korea
| | - C Perry
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - J Pfingstner
- European Organization for Nuclear Research (CERN), CH-1211 Geneva 23, Switzerland
| | - N Phinney
- SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025-7090, USA
| | - A Rawankar
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - Y Renier
- European Organization for Nuclear Research (CERN), CH-1211 Geneva 23, Switzerland
| | - J Resta-López
- Universidad de Valencia - Instituto de Física Corpuscular (IFC), Edificio Institutos de Investigación, c/ Catedrático José Beltrán, 2, E-46980 Paterna, Spain
| | - M Ross
- SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025-7090, USA
| | - T Sanuki
- Tohoku University, 28 Kawauchi, Aoba-ku, Sendai, 980-8576 Japan
| | - D Schulte
- European Organization for Nuclear Research (CERN), CH-1211 Geneva 23, Switzerland
| | - A Seryi
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - M Shevelev
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - H Shimizu
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - J Snuverink
- John Adams Institute for Accelerator Science at Royal Holloway University of London, Egham Hill, Egham, Surrey TW20 0EX, United Kingdom
| | - C Spencer
- SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025-7090, USA
| | - T Suehara
- Department of Physics, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan
| | - R Sugahara
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - T Takahashi
- Department of Physics, Hiroshima University, 1-3-1 Kagamiyama, Higashi-Hiroshima 739-8526, Japan
| | - R Tanaka
- Department of Physics, Hiroshima University, 1-3-1 Kagamiyama, Higashi-Hiroshima 739-8526, Japan
| | - T Tauchi
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - N Terunuma
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - R Tomás
- European Organization for Nuclear Research (CERN), CH-1211 Geneva 23, Switzerland
| | - J Urakawa
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - D Wang
- Institute of High Energy Physics (IHEP), Chinese Academy of Sciences (CAS), Beijing, China
| | - M Warden
- John Adams Institute for Accelerator Science at University of Oxford, Denys Wilkinson Building, Keble Road, Oxford OX1 3RH, United Kingdom
| | - M Wendt
- European Organization for Nuclear Research (CERN), CH-1211 Geneva 23, Switzerland
| | - A Wolski
- Department of Physics, Oliver Lodge Laboratory, University of Liverpool, Oxford St., Liverpool L69 3BX, United Kingdom
| | - M Woodley
- SLAC National Accelerator Laboratory, 2575 Sand Hill Road, Menlo Park, California 94025-7090, USA
| | - Y Yamaguchi
- Department of Physics, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan
| | - T Yamanaka
- Department of Physics, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan
| | - J Yan
- Department of Physics, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113, Japan
| | - K Yokoya
- High Energy Accelerator Research Organization (KEK), 1-1 Oho, Tsukuba, Ibaraki 305-0801, Japan
| | - F Zimmermann
- European Organization for Nuclear Research (CERN), CH-1211 Geneva 23, Switzerland
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Salguero F, Lesellier S, Nuñez A, Corner L, Crawshaw T, Chambers M. Intramuscular BCG Vaccination Reduces Significantly the Pathology Induced by Mycobacterium bovis in Badgers (Meles meles). J Comp Pathol 2010. [DOI: 10.1016/j.jcpa.2010.09.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Brittain K, Corner L, Robinson L, Bond J. Ageing in place and technologies of place: the lived experience of people with dementia in changing social, physical and technological environments. Sociol Health Illn 2010; 32:272-287. [PMID: 20003041 DOI: 10.1111/j.1467-9566.2009.01203.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Abstract This paper explores the varied meanings and lived experiences of older people with dementia, in relation to everyday technologies in public spaces outside the home, through re-analysis of qualitative data generated from research that focused on the use of technology in supporting people with dementia to carry on with their everyday outside activities. The data have been re-analysed to critically examine how people with memory loss manage being outside in both familiar and unfamiliar public environments. In doing so the authors explore how technologies mediate between the physical and social environment in which people with dementia live. This paper highlights the importance of a neglected space within dementia research, namely the outside public environment. Although the outside environment and activities that take place in that space, for some, are curtailed, for others the physical and social security of familiar environments enables them to carry on with everyday activities in this public realm. Outside space can be both therapeutic and frightening and this paper demonstrates that people with dementia can sometimes feel out of place in public space. It however also shows the variety of ways people with dementia use everyday technologies to manage 'feeling out of place'.
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Robinson L, Hutchings D, Corner L, Finch T, Hughes J, Brittain K, Bond J. Balancing rights and risks: Conflicting perspectives in the management of wandering in dementia. Health, Risk & Society 2007. [DOI: 10.1080/13698570701612774] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Robinson L, Hutchings D, Dickinson HO, Corner L, Beyer F, Finch T, Hughes J, Vanoli A, Ballard C, Bond J. Effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia: a systematic review. Int J Geriatr Psychiatry 2007; 22:9-22. [PMID: 17096455 DOI: 10.1002/gps.1643] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Wandering occurs in 15-60% of people with dementia. Psychosocial interventions rather than pharmacological methods are recommended, but evidence for their effectiveness is limited and there are ethical concerns associated with some non-pharmacological approaches, such as electronic tracking devices. OBJECTIVE To determine the clinical and cost effectiveness and acceptability of non-pharmacological interventions to reduce wandering in dementia. DESIGN A systematic review to evaluate effectiveness of the interventions and to assess acceptability and ethical issues associated with their use. The search and review strategy, data extraction and analysis followed recommended guidance. Papers of relevance to effectiveness, acceptability and ethical issues were sought. RESULTS (i) Clinical effectiveness. Eleven studies, including eight randomised controlled trials, of a variety of interventions, met the inclusion criteria. There was no robust evidence to recommend any intervention, although there was some weak evidence for exercise. No relevant studies to determine cost effectiveness met the inclusion criteria. (ii) Acceptability/ethical issues. None of the acceptability papers reported directly the views of people with dementia. Exercise and music therapy were the most acceptable interventions and raised no ethical concerns. Tracking and tagging devices were acceptable to carers but generated considerable ethical debate. Physical restraints were considered unacceptable. CONCLUSIONS In order to reduce unsafe wandering high quality research is needed to determine the effectiveness of non-pharmacological interventions that are practically and ethically acceptable to users. It is important to establish the views of people with dementia on the acceptability of such interventions prior to evaluating their effectiveness through complex randomised controlled trials.
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Affiliation(s)
- L Robinson
- Centre for Health Services Research, University of Newcastle, School of Population & Health Sciences, Newcastle upon Tyne, UK.
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Robinson L, Hutchings D, Corner L, Beyer F, Dickinson H, Vanoli A, Finch T, Hughes J, Ballard C, May C, Bond J. A systematic literature review of the effectiveness of non-pharmacological interventions to prevent wandering in dementia and evaluation of the ethical implications and acceptability of their use. Health Technol Assess 2006; 10:iii, ix-108. [PMID: 16849002 DOI: 10.3310/hta10260] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To determine the effectiveness and cost-effectiveness of non-pharmacological interventions (excluding subjective barriers) in the prevention of wandering in people with dementia, in comparison with usual care, and to evaluate through the review and a qualitative study the acceptability to stakeholders of such interventions and identify ethical issues associated with their use. DATA SOURCES Major electronic databases were searched up until 31 March 2005. Specialists in the field. REVIEW METHODS Selected studies were assessed and analysed. The results of two of the efficacy studies that used similar interventions, designs and outcome measures were pooled in a meta-analysis; results for other studies which reported standard deviations were presented in a forest plot. Owing to a lack of cost-effectiveness data, a modelling exercise could not be performed. Four focus groups were carried out with relevant stakeholders (n = 19) including people with dementia and formal and lay carers to explore ethical and acceptability issues in greater depth. Transcripts were coded independently by two reviewers to develop a coding frame. Analysis was via a thematic framework approach. RESULTS Ten studies met the inclusion criteria (multi-sensory environment, three; music therapy, one; exercise, one; special care units, two; aromatherapy, two; behavioural intervention, one). There was no robust evidence to recommend any non-pharmacological intervention to reduce wandering in dementia. There was some evidence, albeit of poor quality, for the effectiveness of exercise and multi-sensory environment. There were no relevant studies to determine the cost-effectiveness of the interventions. Findings from the narrative review and focus groups on acceptability and ethical issues were comparable. Exercise and distraction therapies were the most acceptable interventions and raised no ethical concerns. All other interventions were considered acceptable except for physical restraints, which were considered unacceptable. Considerable ethical concerns exist with the use of electronic tagging and tracking devices and physical barriers. Existing literature ignores the perspectives of people with dementia. The small number of participants with dementia expressed caution regarding the use of unfamiliar technology. Balancing risk and risk assessment was an important theme for all carers in the management of wandering. CONCLUSIONS There is no robust evidence so far to recommend the use of any non-pharmacological intervention to reduce or prevent wandering in people with dementia. High-quality studies, preferably randomised controlled trials, are needed to determine the clinical and cost-effectiveness of non-pharmacological interventions that allow safe wandering and are considered practically and ethically acceptable by carers and people with dementia. Large-scale, long-term cohort studies are needed to evaluate the morbidity and mortality associated with wandering in dementia for people both in the community and in residential care. Such data would inform future long-term cost-effectiveness studies.
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Affiliation(s)
- L Robinson
- Centre for Health Services Research, University of Newcastle upon Tyne, UK
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Clark H, Corner L, Denzer W, Hancock G, Hutchinson A, Islam M, Peverall R, Ritchie G. Difference frequency generation in periodically poled lithium niobate and its use in the detection of atmospheric methane. Chem Phys Lett 2004. [DOI: 10.1016/j.cplett.2004.09.146] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Corner L, Curless R, Parker SG, Eccles M, Gregson B, Bond J, James OFW. Developing Guidelines for Day Hospitals for Older People. Age Ageing 1998. [DOI: 10.1093/ageing/27.suppl_1.p18-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Corner L, Curless R, Parker S, Eccles M, Gregson B, Bond J, James O. Developing guidelines for day hospitals for older people: adaptation of national guidelines for local use. ACTA ACUST UNITED AC 1998. [DOI: 10.1108/eb020873] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Corner L, Bond J, Curless R, Gregson B, Parker S, James O. The Variability of Day Hospitals in the Northern and Yorkshire Region. Age Ageing 1997. [DOI: 10.1093/ageing/26.suppl_1.p36-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pépin M, Seow HF, Corner L, Rothel JS, Hodgson AL, Wood PR. Cytokine gene expression in sheep following experimental infection with various strains of Corynebacterium pseudotuberculosis differing in virulence. Vet Res 1997; 28:149-63. [PMID: 9112737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Corynebacterium pseudotuberculosis is the causative agent of caseous lymphadenitis in sheep and goats. This disease is characterized by the development of pyogranulomas in the lymph nodes and lung tissue. To measure the cytokine gene expression in C pseudotuberculosis lesions, sheep were inoculated with two attenuated strains (Tox- and PLD-t) and a wild-type (WT) strain of C pseudotuberculosis and were necropsied at 7 or 28 days post-inoculation. The Tox- strain showed a strong reduction in virulence as assessed by the absence of disseminating lesions in the lymph nodes draining the inoculation site in contrast with the WT strain. The PLD-t strain showed an intermediate reduction in virulence. The two attenuated strains, however, induced the same amount of antibodies and IFN-gamma production as the WT strain. Using a semi-quantitative RT-PCR technique, the expression of inflammatory cytokines was found to be higher in the inoculation site, whereas expression of T-cell associated cytokines was more intense in the draining lymph node. On the whole, the infected sheep produced high levels of cytokines in at least one organ on days 7 or 28 post-inoculation. No significant differences in cytokine gene expression were shown between sheep infected with strains differing in virulence. Higher cytokine expression was measured in sheep with pyogranulomas in the draining lymph nodes as compared to those without, especially for interleukin-1 beta and interleukin-8. Overall, these results taken together confirmed the attenuation of virulence in Tox- and PLD-t strains of C pseudotuberculosis and showed the important role of PLD in disseminating the bacteria from the inoculation site to the draining lymph nodes. The pathogenesis of ovine caseious lymphadenitis was shown to be associated with production of cytokines at the pyogranuloma level, but the local cytokine patterns associated with different courses of infection were not distinguished.
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Affiliation(s)
- M Pépin
- Laboratoire de pathologie des petits ruminants et des abeilles, CNEVA Sophia-Antipolis, France.
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Corner L. Summer safety. Prof Care Mother Child 1997; 7:40. [PMID: 9220828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- L Corner
- Child Safety Week, Child Accident Prevention Trust, London
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Corner L, Melville L, McCubbin K, Small KJ, McCormick BS, Wood PR, Rothel JS. Efficiency of inspection procedures for the detection of tuberculous lesions in cattle. Aust Vet J 1990; 67:389-92. [PMID: 2085291 DOI: 10.1111/j.1751-0813.1990.tb03020.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The sensitivity of the abattoir inspection procedure introduced for Australian export beef in 1976 was compared to a detailed necropsy procedure for the detection of tuberculous lesions in cattle. In a sample of cattle that were reactors to the tuberculin test, abattoir inspection failed to detect an estimated 47% of cattle with lesions. The detailed necropsy examination of cattle with lesions of tuberculosis identified 21 sites of infection compared with 13 to 18 in cattle examined by routine meat inspection procedures. Of the lesions detected during detailed necropsy, 15.9% did not involve the thoracic cavity or the medial retropharyngeal lymph nodes. The failure to detect lesions during abattoir inspection has its greatest significance in an animal with a single lesion. If the 245 cattle found with single lesions during detailed necropsy had been examined by abattoir inspection using the 1976 or the 1986 procedures, 0.8 and 8.9%, respectively, of these animals would not have been detected because the diseased tissues would not have been examined. If meat inspection is to provide an effective means of monitoring the level of bovine tuberculosis during the final stages of eradication, a procedure no less sensitive than that introduced in 1976 should be used.
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Affiliation(s)
- L Corner
- CSIRO, Division of Animal Health, Parkville, Victoria
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