• A narrative review of family members’ experience of organ donation request after brain death in the critical care setting

      Kentish-Barnes, N.; Siminoff, L.A.; Walker, Wendy; Urbanski, M.; Charpentier, J.; Thuong, M.; Sarti, A.; Shemie, S.D.; Azoulay, E. (Springer, 2019-03-06)
      Introduction Family members of critically ill patients suffer from high levels of anxiety and depression in the ICU, and are at risk of developing post-ICU syndrome following ICU discharge. In the case of brain death, and potential organ donation, the family is at the center of the decision process: within a limited time frame, the family will be informed that the patient is brain-dead and will be approached about potential organ donation. Materials and methods Family experience with organ donation has been the topic of several research papers allowing one to gain knowledge about family members’ experience of organ donation, emphasizing specific needs, adequate support, and pointing out gaps in current delivery of family-centered care. In this narrative review, experts, clinicians, and researchers present the various legal systems regarding family implication in organ donation decisions; describe factors that influence the decision-making process; highlight family perspectives of care and respect for potential donors in the ICU environment; describe the impact of organ donation discussions and decisions on post-ICU syndrome; and suggest communication skills and support to be developed in the future. A research agenda for the next decade is also encouraged. Conclusion Overall, challenges remain and concern all persons involved in the process, ICU doctors and nurses, the organ procurement organization, family members, and, in some cases, the patients themselves. Looking at the big picture will provide opportunities for further improvements.
    • A national education service for adults too

      Tuckett, Alan; Todd, Nigel (Symposium, 2019-07-31)
      The paper highlights the current collapse of adult learning opportunities, the key importance of adult learning to a new public education in a fast changing world, and makes practical proposals for Labour’s National Educational Service.
    • National physical education curriculum: motor and cardiovascular health related fitness in Greek adolescents.

      Koutedakis, Yiannis; Bouziotas, Constantin (BMJ Publishing Group Ltd., 2003)
      Background: State school physical education (PE) programmes are common throughout Greece. However, it is not known if the main objectives of the Greek PE curriculum are achieved. Objective: To assess the current national PE curriculum in relation to selected motor and cardiovascular health related fitness parameters. Methods: A sample of 84 Greek schoolboys (mean (SD) age 13.6 (0.3) years, height 160.7 (8.6) cm, weight 50 (10.8) kg) volunteered. Forty-three indicated participation only in school PE classes and habitual free play (PE group). The remaining 41 were involved in extracurricular organized physical activities in addition to school PE and habitual free play (PE+ group). The subjects underwent anthropometric, motor (flexibility, balance, standing broad jump, hand grip, sit ups, and plate tapping), and cardiovascular health related (percentage body fat, aerobic fitness, and physical activity) fitness assessments. Results: Children in the PE group had inferior motor andcardiovascular health related fitness profiles compared with those in the PE+ group. Body fat (20.3 (8.8) v 13.9 (3.5); p < 0.001), aerobic fitness (34.7 (3.7) v 43.9 (4.2); p < 0.001), and time spent in intensive physical activity (0.2 (0.2) v 0.7 (0.3); p < 0.001) showed the greatest differences between the two groups. In the pupils in the PE group, these were lower than the levels proposed to be necessary to combat future health risks. Adjustments for confounding variables showed a decrease in the significance of motor fitness, but not in cardiovascular health related parameters. Conclusions: The national PE curriculum for Greek secondary schools does not achieve the required levels of motor and cardiovascular health related fitness and should be reconsidered.
    • The need for narrative in clinical education

      Matheson, David; Foss, Alex (University of Wolverhampton, 2020-11-30)
      This article aims to discuss the need for clinical education to embrace the use of narrative. It discusses the split – most evident in Anglophone countries – between the arts and the sciences, before discussing what can and cannot be known from the scientific method, and what can and cannot be known from narrative approaches. It concludes that narrative is the natural way to teach and learn and has the advantage that it can explore hypothetical situations in safety as well as both to learn and to convey values and attitudes while the hypothetico-deductive method can say what does happen but can shed no light on what should happen.
    • The need to redefine age- and gender-specific overweight and obese body mass index (bmi) cut-off points

      Nevill, Alan M; Metsios, George S (Ovid Technologies (Wolters Kluwer Health), 2016-05)
      For convenience, health practitioners and clinicians are inclined to classify people/patients as overweight or obese based on body mass index (BMI) cut-off points of 25 and 30 kg/m^2 respectively, irrespective of age and gender.
    • Negotiating whiteness through brownness: using intersectionality and transactional theory to capture racialised experiences of university campus life

      Ward, Gavin; Richards, Ronnie; Best, Melanie (Routledge, 2021-07-26)
      This paper aims to explore the potential of using dialogue between intersectional and pragmatist theorising of transactional social relations. By considering tensions within intersectional research, a position is developed which utilises a mutual constitution approach to intersectional theory and the dynamic, ongoing, complex social relations captured in pragmatist theorising. It is argued that from this position race and ethnicity become actions in which, for example, Whiteness and Brownness are defined in ongoing relation to each other. Example data from a pilot study, designed to explore experiences of campus life, is analysed using this action sense of race. The ‘Racing’ of experience within the data identifies how Whiteness and Brownness become constituted through a Male, South Asian, Muslim student’s experience of studying sport. Whiteness in this context becomes secular, partying, and sporty-bravado-competitive, while Brownness is supressed Islamic, working not to perpetuate crude Brown-Muslim stereotypes and upset convivial, post-racial discourses. It is envisaged that further data collection from student experiences of studying on the university campus will help to develop deeper insight, and importantly, dialogue about race, ethnicity and privilege.
    • Neonatal Health Psychology [NNHP]: theories and practice.

      Adamson-Macedo, Elvidina N. (National Library of Medicine and National Institutes of Health, 2004)
      By 1994, Health Psychology had been established as a discipline, and defined by Marie Johnston as the scientific study of the psychological processes and behaviour in health, illness and health care. Health Psychology, so far, has mainly related to the adult population, although increasing attention is now being paid to both pediatric and broadly-based child health psychology. It is noteworthy that attention devoted to pediatric and child health psychology has increased dramatically, but the great majority of published work refers to the child and not to the preterm neonate; yet being preterm means being born early, and sometimes too small, and is a stressful life event. In the field of Medicine, Neonatology has appeared as a sub-discipline, and both investigates and cares for at-risk babies, including risk for developmental disabilities. The time is consequently opportune for psychology to make an effective contribution to both the theory and care of the preterm neonate, viewed as a unique, emergent, coactional and hierarchical human being. The formal framework for this is Neonatal Health Psychology (NNHP), which is defined in the article as 'the scientific study of biopsychosocial and behavioural processes in health, illness, and health care of the preterm (and fullterm) neonate during his/her first 28 days of life, and the relationship of such processes with later outcome.' Early work in this category has shown that NNHP has profound interdisciplinary connotations, not least because of the diverse ways in which information has to be derived from the non-verbal neonates. The pathways and scope of NNHP are identified, and many examples of work with preterm neonates are summarised in the article. In making the case for the professional formalization of NNHP, descriptions are given of Neonatal Assessments and very-early interventions; the interdisciplinary character of much of the early work is shown to have been essential. Indication of theoretical frameworks for NNHP is given.
    • Neonatal Psychoneuroimmunology: Emergence, Scope and Perspectives.

      Adamson-Macedo, Elvidina N. (Society of Integrated Sciences, 2000)
      Interdisciplinary Neonatology investigates and cares for at-risk babies, including risk for developmental disabilities. Psychoneuroimmunology seeks to unravel relationships amongst behavioural, neural, endocrine, and immune processes, and their mutual role in maintaining health and treating disease. This article presents an integrative approach to the emergence, scope and perspectives of a new sub-discipline, i.e. Developmental Neonatal Psychoneuroimmunology. The Equilibrium Model (ThEM) proposed by Adamson-Macedo (1991) will be used as a way of representing coactions; within this frame, Gottlieb's experiential canalization (1991b) contributes an explanation of how the psychoneuroimmunological development of the preterm neonate can be facilitated.
    • Networked learning in 2021: a community definition

      Gourlay, Lesley; Rodríguez-Illera, José Luis; Barberà, Elena; Bali, Maha; Gachago, Daniela; Pallitt, Nicola; Jones, Chris; Bayne, Siân; Hansen, Stig Børsen; Hrastinski, Stefan; et al. (Springer Science and Business Media LLC, 2021-03-25)
    • Neurobehavioral assessment predicts differential outcome between VLBW and ELBW preterm infants.

      Constantinou, Janet C.; Adamson-Macedo, Elvidina N.; Mirmiran, Majid; Ariagno, Ronald L.; Fleisher, Barry E. (Nature Publishing Group, 2005)
      OBJECTIVE: To evaluate the impact of birth weight on development of very low birth weight (VLBW) infants using the Neurobehavioral Assessment of the Preterm Infant (NAPI) before hospital discharge, and to show the relation to follow-up outcomes at 12, 18 and 30 months of age. STUDY DESIGN: In total, 113 preterm infants were assessed with the NAPI at 36 weeks postmenstrual age. Later, neurodevelopment was examined using the Bayley Infant Neurodevelopmental Screener (BINS) at 12 months and the Bayley Scales of Infant Development, at 18 and 30 months. The cohort was divided into two groups, based on birth weight, extremely low birth weight (ELBW) (<1000 g) and VLBW (1000 to 1500 g). RESULTS: ELBW infants showed significantly lower NAPI scores compared with VLBW infants at 36 weeks. The predischarge NAPI scores correlated with the 12, 18 and 30 months scores when the ELBW infants continue to have lower performance than the VLBW infants. In all, 14 infants developed cerebral palsy. These infants had significantly lower NAPI, BINS and Bayley scores compared with all other preterm infants. CONCLUSION: NAPI before discharge provides clinically meaningful information related to later neurodevelopmental outcome.
    • Neuromuscular training in pre-professional ballet dancers: A feasibility randomised controlled trial

      Kolokythas, Nico; Metsios, George S.; Galloway, Shaun; Allen, Nick; Wyon, Matthew (J.Michael Ryan Publishing Inc., 2022-06-15)
      Introduction: It is well documented that there is high prevalence of injuries in preprofessional and professional ballet dancers. Current evidence from high in quality and quantity research on injury prevention in sport, indicates that interventions can reduce injury risks by 30 to 50%. Injury prevention research in dance, is limited. The aim of this study was to assess the feasibility (adherence, fidelity, and practicality) of a randomised controlled trial for the utilisation of neuromuscular training in pre-professional ballet dancers. Methods: A convenience sample of 22 pre-professional ballet dancers were randomised into the intervention and the control group. The intervention group took part in a neuromuscular based training workout, five times per week before the ballet class, for ten weeks. The intervention was an adaptation of the FIFA 11+, an injury prevention intervention and is called 11+ Dance. The intervention consisted of low intensity bodyweight exercises, lasted 20-30 minutes and was performed daily. Results: Intervention adherence was 38±8%, with higher participation at the beginning of the study. Attendance for the pre- and post testing was low 45% and 36% for the intervention and control group, respectively, mainly due to injury. There were no adverse effects reported, however, the participants reported delayed onset muscle soreness at the beginning of the intervention, indicating that there may be a potential training effect. Fear of muscle hypertrophy and fatigue were also reported as reasons for attrition. The repeated measures ANOVA revealed statistically non-significant differences for the CMJ F(1,9)= 0.36, p = .564, 𝜂𝜂𝑝𝑝 2 = .04, RSI F(1, 7)= 0.02, p= .885, 𝜂𝜂𝑝𝑝 2= 0.003, and IMTP F(1, 12)= 0.002, p= 0.967, 𝜂𝜂𝑝𝑝 2= .000. Conclusion: The results of the study, together with the feedback from the participants suggest that some protocol modifications are necessary, for the feasibility of a randomised controlled trial in a pre-professional setting. The current trial has produced valuable information for the intervention frequency and load prescription.
    • Neutrality and Workplace Restrictions on Headscarves and Religious Dress: Lessons from Achbita and Bougnaoui

      Hambler, Andrew; University of Wolverhampton (Oxford University Press, 2018-03-15)
      Bans on the wearing of religious symbols, and particularly the Islamic headscarf, in the European public square have been controversial and have been challenged on several occasions on human rights grounds (primarily under Article 9 (Freedom of thought, conscience and religion) of the European Convention on Human Rights (ECHR)).1 However, restrictions on religious dress in the workplace have been fully considered only recently, most significantly before the European Court of Human Rights (ECtHR) in Eweida and Ors v United Kingdom.2 In its judgment, the Court concluded that the right to manifest religion through dress could be restricted,3 in situations where there was a health and safety concern but not in situations where customer image was the justification for any restrictions—regarding the latter, the religious right carried more weight than the employer’s desire for uniformity....
    • New Public Management in an age of austerity: knowledge and experience in further education

      Smith, Rob; O'Leary, Matt (Taylor & Francis, 2013)
      This article originates in a piece of educational research into the experiences of further education (FE) student teachers in the West Midlands region of England. This cohort of students experienced significant upheaval in their college workplaces and placements during the 2010/2011 academic year. Pressures on FE funding were exacerbated by a Comprehensive Spending Review by the coalition government in late 2010 – prompted by the on-going global economic crisis. Some of the repercussions of these funding cuts for staff and students in the sector are discussed in this article, as perceived by this cohort of student teachers working in a range of FE providers across the West Midlands. Many of these repercussions can broadly be seen as an extension of existing managerialist practices, as the justification for an increasing squeeze on local resource allocation continues to be a wider appeal to global market ‘realities’. But we theorise that new public management (NPM) plays an important role in a reductive kind of knowledge production for policy-makers which fuels and legitimises on-going policy intervention, and we see this as an important shaping force in the emerging professional identity of these new teachers
    • New resting energy expenditure prediction equations for patients with rheumatoid arthritis

      Metsios, Giorgos S.; Stavropoulos-Kalinoglou, Antonios; Panoulas, Vasileios F.; Koutedakis, Yiannis; Nevill, Alan M.; Douglas, Karen M. J.; Kita, Marina D.; Kitas, George D. (Oxford University Press, 2008)
      OBJECTIVES: Resting energy expenditure (REE), one of the main components of total energy expenditure, can be measured via indirect calorimetry and/or predicted from equations. The latter may be misleading in RA, as they do not take into account the metabolic alterations occurring in RA. The objectives of this study are to evaluate the accuracy of widely used REE-predictive equations in RA patients against measured REE and to develop RA-specific equations. METHODS: We assessed REE (via indirect calorimetry and several predictive equations), fat-free mass (FFM; via bioelectrical impedance) and disease activity (CRP) in RA patients and healthy controls. Data from 60 RA patients (experimental group) were used to assess the accuracy of existing REE equations and to develop new equations. The new equations were validated in an independent cross-validation group of 22 RA patients. These two groups were merged and two final equations were developed. RESULTS: All equations significantly under-predicted measured REE (from 15% to 18.2%, all at P < 0.001) in the RA experimental group, but not in the control group. After both equations demonstrated a high validity in the cross-validation group, the new final REE prediction equations developed from the total RA sample (n = 82) were: Model 1: REE (kcal/day) = 126.1 x FFM(0.638) x CRP(0.045) (R(2) = 0.70) and Model 2: REE (kcal/day) = 598.8 x weight(0.47) x age(-0.29) x CRP(0.066) (R(2) = 0.62). CONCLUSION: The new equations provide an accurate prediction of REE in RA patients and could be used for clinical monitoring of resting metabolism of these patients without the requirement for specialized personnel.
    • New theory from an old technique: the Rolma matrices.

      Roland, Damian; Matheson, David (Blackwell Publishing, 2012-06)
      Understanding the reasons behind non-adherence to clinical practice guidelines is a complex process. Many explanatory models have been proposed that are grounded in qualitative theory. The 2 × 2 matrix has often been used to condense this potentially complex information into a format understandable to clinicians without educational or qualitative backgrounds.
    • New thrombin and factor Xa inhibitors for primary and secondary prevention of ischaemic stroke

      Winstanley, Lisa; Chen, Ruoling (Bentham Science, 2013-03-01)
      Atrial fibrillation is a major risk factor for first and recurrent ischaemic stroke, and anticoagulation, mainly by use of coumarin medications, is an effective strategy for reducing ischaemic stroke occurrence in these patients. However, the coumarin medications have disadvantages. Over the past decade, important strides have been made towards developing improved anticoagulant medications. This review discusses these new developments and what they mean for the future of primary and secondary ischaemic stroke prevention in patients with atrial fibrillation. Relevant papers were identified with electronic searches of the Medline and EMBASE databases. Ongoing trials were checked using the Trials Results Centre website. The direct thrombin inhibitors, and the factor Xa inhibitors are the two major new anticoagulant drug classes under development at present. In phase III trials, dabigatran and rivaroxaban demonstrated at least as good performance as warfarin at reducing the rate of ischaemic stroke, systemic embolus, and haemorrhagic ischaemic stroke, whilst maintaining a comparable or lower rate of major bleeding events. Drug level monitoring was not required due to stable pharmacodynamics. AZD0837, apixaban, YM-150, edoxaban and betrixaban all showed promising results in phase II trials, as did S35972 in animal, in vitro and ex vivo models. The future of these new anticoagulants looks encouraging, although there are still some significant challenges to overcome. We need to consider the accumulation of long-term safety and efficacy data, and the development of effective means of reversal of anticoagulation for the direct thrombin inhibitors and factor Xa inhibitors.
    • NICE’s recent guidelines on “the size of your waist” unfairly penalizes shorter people

      Nevill, Alan M.; Duncan, Michael J; Myers, Tony (Elsevier, 2022-08-09)
      The National Institute for Clinical Excellence (NICE) has just released its latest guidelines to assess and predict health risk, such as type 2 diabetes, hypertension or cardiovascular disease. Their latest advice is “Keep the size of your waist to less than half of your height”. We believe this advice is flawed and will seriously and unfairly penalize shorter people and lull taller people into a false sense of security. In this short communication, we provide this evidence. We consider this a serious oversight by NICE and feel strongly that this evidence needs to be made available in the public domain.
    • No correlation between circulating ACE activity and VO2max or mechanical efficiency in women.

      Day, Stephen H.; Gohlke, Peter; Dhamrait, Sukhbir S.; Williams, Alun G. (Springer, 2007)
      The insertion (I) variant of the angiotensin-1 converting enzyme (ACE) I/D genetic polymorphism is associated with lower circulating and tissue ACE activity. Some studies have also suggested associations of ACE I/D genotype with endurance phenotypes. This study assessed the relationships between circulating ACE activity, ACE I/D genotype, mechanical efficiency and the maximal rate of oxygen uptake in sedentary individuals. Sixty-two untrained women were tested for mechanical efficiency during submaximal cycle ergometry (delta and gross efficiencies during exercise between 40 and 80 W) and the maximal rate of oxygen uptake during incremental treadmill running. Respiratory variables were measured using indirect calorimetry. Venous blood was obtained for direct assay of circulating ACE activity, allowing for the assessment of correlations between two continuous variables, rather than a categorical analysis of endurance phenotype by genotype alone. ACE I/D genotype was also determined, and was strongly associated with circulating ACE activity (P < 0.0005). Neither circulating ACE activity (27.4 +/- 8.4 nM His-Leu-ml(-1)) nor ACE genotype showed a statistically significant association with any of the endurance phenotypes measured. The weak correlations observed included r = -0.122 (P = 0.229) for the relationship between delta efficiency (23.9 +/- 2.5%) and circulating ACE activity and r = 0.134 (P > 0.6) for the relationship between maximal aerobic power (149.1 +/- 22.9 ml kg(-2/3) min(-1)) and circulating ACE activity. The data do not support a role for systemic ACE activity in the regulation of endurance performance in sedentary individuals, extending this observation to a large female cohort.
    • No room for reflexivity? Critical reflections following a systematic review of qualitative research.

      Newton, Benjamin John; Rothlingova, Zuzana; Gutteridge, Robin; LeMarchand, Karen; Raphael, Jon Howard (Sage, 2012-09)
      We conducted a systematic search of qualitative research into the individual's experience of chronic low back pain. Two reviewers independently read through 740 unique abstracts. Inter-rater reliability was fair. The final sample comprised 19 articles which we critiqued using the Critical Appraisal Skills Programme checklist. This article focuses on the critical appraisal. Limitations include a lack of an adequate rationale for the theoretical framework, a lack of an account for the decisions made across recruitment and data collection, and a lack of reflexivity. Finally we discuss and offer recommendations for reflexivity and the explication of qualitative methodology in research articles.