Professor Fiona Fylan

Abstract

IntroductionDeath and injury from road traffic is a public health problem worldwide and accordingly there is substantial interest and investment in developing interventions to change road user behaviour. Alongside this, there is growing awareness of the need to evaluate interventions and to identify the most effective mechanisms by which behaviour can be changed. Progress has been hindered due to lack of a common taxonomy with which to define specific techniques used in attempts to change behaviour.ObjectiveBehavioural Change Techniques (BCTs) have been successfully deployed to change a range of different health behaviours. This paper defines a series of BCTs that can be applied in the road safety setting and asks which ones are found in road safety interventions for young road users?MethodAbraham and Michie (2008) identified twenty-six techniques used in behavioural change interventions. These BCTs, plus one other adapted from forensic psychology, are classified into nine groupings. Six educational road safety interventions commonly used in the UK with pre-drivers and young, novice drivers are characterised in terms of the BCTs they employ.ResultsOnly a small subset of BCTs are employed in most of the interventions. They concentrate primarily on increasing awareness of the risks associated with a particular behaviour, and the severity of the potential adverse consequences.ConclusionRecommendations are given for improving the effectiveness of road safety interventions for young people including young, novice drivers by increasing the range of BCTs deployed.

The United Kingdom (UK) cervical screening programme has been successful in securing participation of a high proportion of targeted women, and has seen a fall in mortality rates of those suffering from cervical cancer. There remains, however, a significant proportion of unscreened women and, of women in whom an abnormality is detected, many will not attend for colposcopy. The present work reviews the psychological consequences of receiving an abnormal cervical smear result and of secondary screening and treatment, and examines reasons for women's non-participation in the screening programme. Psychological theories of screening behavior are used to elucidate women's reactions and to suggest methods of increasing participation, of improving the quality of the service, and of reducing women's anxiety. A literature search identified studies that examine factors influencing women's participation in the screening programme, their psychological reaction to the receipt of an abnormal cervical smear result, and experiences of colposcopy. Reasons for non-participation include administrative failures, unavailability of a female screener, inconvenient clinic times, lack of awareness of the test's indications and benefits, considering oneself not to be at risk of developing cervical cancer, and fear of embarrassment, pain, or the detection of cancer. The receipt of an abnormal result and referral for colposcopy cause high levels of distress owing to limited understanding of the meaning of the smear test; many women believe the test aims to detect existing cervical cancer. The quality of the cervical screening service can be enhanced by the provision of additional information, by improved quality of communication, and by consideration of women's health beliefs. This may result in increased participation in, and satisfaction with, the service.

Background: Around 3000 people in the UK die in road traffic collisions, which makes driver behaviour a major health risk. We describe the development and evaluation of an intervention for drivers who have been caught driving without due care and attention, or without consideration for other road users. It can be offered to drivers as an alternative to an appearance at court with subsequent fine and penalty points. The one-day course was based on psychological theory of behavioural change and includes classroom and in-car components. Method: A questionnaire study with a repeated measures design at three time points: pre-course; post-course; and at two-month follow-up. Questionnaires measured attitudes, self-efficacy and intentions. Follow-up questionnaires included self-reported change in behaviour. Findings: A principal components analysis of the attitudes scale indicated four sub-scales: engagement with a driver’s safety responsibilities; safety techniques; arrogance; and realistic about driving difficulties. A one-way ANOVA showed a significant effect of time on all four scales. After the course drivers had more positive attitudes towards safe road user behaviour. Self-efficacy and intentions to drive safely also increased significantly. Mean scores dropped at follow-up but were significantly higher than baseline. At follow-up 99 per cent of participants reported they had changed their driving. Discussion: Educational courses developed from the behavioural change evidence base can change attitudes towards safe and responsible driving and so have the potential to reduce the number of people killed and seriously injured on the roads.

Background: If health and social care delivery systems are to achieve net zero targets, fundamental changes are required to how organizations deliver care, how individuals practice clinically, how people access care, and how systems reduce the demand for healthcare. This paper explores how professionals, patients and citizens respond to this need for change. Methods: We conducted a mixed methods study, comprising 12 deliberative workshops (n = 35) and a survey (n = 413) with health and social care staff, patients and citizens in the North of England. Results: We found that while few people were aware of the net zero target, they supported it. Some, however, questioned organizational commitment, highlighting potential conflicts between cost and sustainability. Staff described a lack of agency to make changes to their practice, despite identifying many opportunities to do so. Some believed that healthcare should be exempt from carbon reduction targets. The strongest messages we found to interest, empower, and motivate people to make changes are: that individual actions matter; that we have a responsibility to set a good example of tackling climate change; and that making changes saves lives and should be a priority. We also found that people need to be reassured that the changes will not adversely affect clinical outcomes. Finally, progress towards targets needs to be tracked and publicly available. Conclusion: Our results indicate a need for clear leadership which gives sustainability a higher priority, a need for staff training to enable conversations about the environmental effects of treatment, and support for shifting the focus from treating illness to promoting health.

Pedestrians and cyclists are at significant risk of being killed as a result of a collision with a vehicle at night-time because of their poor conspicuity. Retroreflective strips positioned on the moveable joints, in a biological motion configuration (biomotion), greatly enhance the night-time conspicuity of pedestrians and cyclists, but it is not clear how widely this strategy is adopted among those running and cycling under low light levels (dawn and dusk or at night). This study explored runners’ and cyclists’ beliefs about their own conspicuity, and the strategies they use to increase their conspicuity and safety under low light levels. Nine focus groups involving 50 participants (mean age = 39.5 ± 13.9 years) were held with individuals who ran and/or cycled under low light conditions or at night-time. The strategies that participants used to increase their conspicuity and enhance their personal safety, and the importance they placed on increased conspicuity to other road users at night was explored. Data were analysed thematically, with two main themes identified. Strategies describes the different approaches used to increase conspicuity when running or cycling in low light, some of which are ineffective. Importance describes how conspicuity relates to other considerations that influence cyclists and runners. While they may believe that conspicuity is essential for their safety, they may compromise their own conspicuity by prioritising style or comfort, or because they believe that being more conspicuous is of limited value because it cannot compensate for the behaviour of other road users. In summary, cyclists and runners are largely unaware of effective strategies to increase their night-time conspicuity, particularly the use of biomotion reflective strips. Garment manufacturers should ensure that conspicuity features (with supporting educative product information on labels) are incorporated into cyclists’ and runners’ clothing or accessories to improve wearer conspicuity and hence safety in low light conditions.

Introduction: Death and injury from road traffic is a public health problem worldwide and accordingly there is substantial interest and investment in developing interventions to change road user behaviour. Alongside this, there is growing awareness of the need to evaluate interventions and to identify the most effective mechanisms by which behaviour can be changed. Progress has been hindered due to lack of a common taxonomy with which to define specific techniques used in attempts to change behaviour. Objective: Behavioural Change Techniques (BCTs) have been successfully deployed to change a range of different health behaviours. This paper defines a series of BCTs that can be applied in the road safety setting and asks which ones are found in road safety interventions for young road users? Method: Abraham and Michie (2008) identified twenty-six techniques used in behavioural change interventions. These BCTs, plus one other adapted from forensic psychology, are classified into nine groupings. Six educational road safety interventions commonly used in the UK with pre-drivers and young, novice drivers are characterised in terms of the BCTs they employ. Results: Only a small subset of BCTs are employed in most of the interventions. They concentrate primarily on increasing awareness of the risks associated with a particular behaviour, and the severity of the potential adverse consequences. Conclusion: Recommendations are given for improving the effectiveness of road safety interventions for young people including young, novice drivers by increasing the range of BCTs deployed.

PURPOSE: Most patients report being highly satisfied with the outcome of cataract surgery but there are variable reports regarding the impact of cataract surgery on some real-world activities, such as fall rates. We hypothesised that adaptations to changed refractive correction and visual function may cause difficulties in undertaking everyday activities for some patients and used a series of focus groups to explore this issue. METHOD: Qualitative methods were used to explore patients' experiences of their vision following cataract surgery, including adaptation to vision changes and their post-surgical spectacle prescription. Twenty-six participants took part in five focus groups (Mean age = 68.2 ± 11.4 years), and the data were analysed using thematic analysis. RESULTS: We identified three themes. 'Changes to Vision' explores participants' adaptation following cataract surgery. While several had problems with tasks relying on binocular vision, few found them bothersome and they resolved following second eye surgery. Participants described a trial and error approach to solving these problems rather than applying solutions suggested by their eyecare professionals. 'Prescription Restrictions' describes the long-term vision problems that pre-surgery myopic patients experienced as a consequence of becoming emmetropic following surgery and thus needing spectacles for reading and other close work activities, which they did not need before surgery. Very few reported that they had the information or time to make a decision regarding their post-operative correction. 'Information Needs' describes participant's responses to the post-surgical information they were given, and the unmet information need regarding when they can drive following surgery. CONCLUSION: The findings highlight the need for clinicians to provide information on adaptation effects, assist patients to select the refractive outcome that best suits their lifestyle, and provide clear advice about when patients can start driving again. Patients need to be provided with better guidance from clinicians and prescribing guidelines for clinicians would be beneficial, particularly for the period between first- and second-eye surgery.

BACKGROUND: Optimising the use of patient data has the potential to produce a transformational change in healthcare planning, treatment, condition prevention and understanding disease progression. Establishing how people's trust could be secured and a social licence to share data could be achieved is of paramount importance. METHODS: The study took place across Yorkshire and the Humber, in the North of the England, using a sequential mixed methods approach comprising focus groups, surveys and co-design groups. Twelve focus groups explored people's response to how their health and social care data is, could, and should be used. A survey examined who should be able to see health and care records, acceptable uses of anonymous health and care records, and trust in different organisations. Case study cards addressed willingness for data to be used for different purposes. Co-creation workshops produced a set of guidelines for how data should be used. RESULTS: Focus group participants (n = 80) supported sharing health and care data for direct care and were surprised that this is not already happening. They discussed concerns about the currency and accuracy of their records and possible stigma associated with certain diagnoses, such as mental health conditions. They were less supportive of social care access to their records. They discussed three main concerns about their data being used for research or service planning: being identified; security limitations; and the potential rationing of care on the basis of information in their record such as their lifestyle choices. Survey respondents (n = 1031) agreed that their GP (98 %) and hospital doctors and nurses (93 %) should be able to see their health and care records. There was more limited support for pharmacists (37 %), care staff (36 %), social workers (24 %) and researchers (24 %). Respondents thought their health and social care records should be used to help plan services (88 %), to help people stay healthy (67 %), to help find cures for diseases (67 %), for research for the public good (58 %), but only 16 % for commercial research. Co-creation groups developed a set of principles for a social licence for data sharing based around good governance, effective processes, the type of organisation, and the ability to opt in and out. CONCLUSION: People support their data being shared for a range of purposes and co-designed a set of principles that would secure their trust and consent to data sharing.

PURPOSE: To investigate the prevalence of mental health conditions and burnout among practising optometrists in Australia. METHODS: A cross-sectional survey of registered practising Australian optometrists was undertaken over a three-week period from mid-November 2019. The survey comprised three well-established mental health scales (Kessler Psychological Distress Scale [K10], Depression Anxiety Stress Scales [DASS-21] and Maslach Burnout Inventory [MBI]) and an open-ended question inviting comments. RESULTS: Five hundred and five respondents completed the K10, representing 8.8% of registered optometrists in Australia; 466 completed all three scales. Prevalence of moderate to severe psychological distress (K10 ≥ 25) was 30.7% (95% CI 26.7%-34.7%), with similar findings for depression and anxiety (DASS-21). Prevalence of high burnout, as indicated by MBI-GS exhaustion was 56.1% (95% CI 51.7%-60.4%), cynicism 57.1% (95% CI 52.7%-61.5%) and professional efficacy 23.1% (95% CI 19.4%-26.8%). Optometrists aged ≤ 30 years were 3.5 times more likely to report moderate to severe psychological distress compared to optometrists aged >30 years (OR = 3.54, P < 0.001, 95% CI 2.38-5.25). The most frequently mentioned work-related issues concerned retail pressures, workload and career dissatisfaction. CONCLUSIONS: The rates of mental health conditions and burnout reported by practising Australian optometrists were high compared with the general population and other health professionals. Younger age and burnout were significant risk factors for psychological distress. Interventions are required to address these issues, particularly for younger optometrists, and could include workplace modifications and building resilience to improve personal mental wellbeing and ensure patient safety.

Magnetometry is a relatively new technique that detects the magnetic fields arising from neuronal current flow within the human body. There are several applications for this technique, including examination of the activity of the brain (magnetoencephalography), and the heart (magnetocardiography) in normal subjects and in patients with various disease processes. This article describes the fundamental principles of magnetometry and explores its use as a functional imaging technique, particularly for the human brain.

Summary: Purpose: Photosensitive epilepsy is the most common of the “reflex” epilepsies. Precipitated by television viewing, flickering light, or specific visual patterns, it is the cause of seizures in 10% of young people with epilepsy. Photosensitivity is associated with two types of EEG abnormalities: photoparoxysmal responses (PPRs) and occipital spikes (OSs). It is unclear whether these abnormalities are mediated by different mechanisms, and furthermore, the clinical significance of OS is unknown.

Methods: By using our previously established population of patients with photosensitive epilepsy, all showing EEG abnormalities on intermittent photic stimulation or pattern stimulation, we examined the effects of pattern contrast, spatial and counterphase temporal frequency, and colour on these abnormalities.

Results: PPRs and not OSs show linear contrast dependency and are elicited by stationary stimuli and by non‐colour‐opponent isoluminant stimuli.

Conclusions: PPRs and OSs are generated independently by the parvocellular and magnocellular visual systems, respectively. The results add support to the hypothesis that only PPRs and not OSs are clinically significant.

Summary: Purpose: Seizures provoked by television viewing may be triggered by patterns in the television image or by flicker from the display itself. We examined the incidence of EEG abnormalities elicited by patterns displayed on television sets with two different frame rates to evaluate the likely contribution of photosensitive and pattern‐sensitive mechanisms to television‐ and video‐game epilepsy.

Methods: Televisions with frame rates of 50 and 100 Hz were used to present 35 patients who were photosensitive or pattern‐sensitive with grating patterns. These patterns comprised vertical square‐wave and sine‐wave gratings of 90% contrast, and the spatial frequency was varied between 0.25–7 cycles/degree. EEGs were analysed for laboratory sensitivity to patterned and unpatterned intermittent photic stimulation (IPS).

Results: Significantly fewer EEG abnormalities were elicited by patterns displayed on the 100 Hz frame‐rate television than on the 50‐Hz frame‐rate television. No abnormalities were observed in response to the blank screens of either television. Thirty‐three patients showed abnormalities in response to patterned IPS but only 15 in response to diffuse flash. Two patients showed no laboratory evidence of photosensitivity. Patients who were sensitive to patterned IPS at 50 Hz were significantly more likely to demonstrate abnormalities to patterns displayed on the 100‐Hz frame‐rate television than were patients who were not sensitive to 50‐Hz patterned IPS.

Conclusions: We suggest that for many patients, the combination of high‐contrast patterns and screen flicker may elicit the observed EEG abnormalities. For patients with sensitivity to screen flicker, the use of a high frame‐rate television may be beneficial in reducing the risk of seizures.

Abstract Purpose It is well known that some patients experience difficulties adapting to new glasses. However, little is known about what patients themselves understand of the adaptation process, and how this influences their attitudes and the decisions they make when adapting to a new pair of glasses. Nor is it understood whether these factors affect their wearing habits. Methods We conducted four focus groups. Participants were 22 glasses wearers (mean ± SD age 43 ± 14 years, range 21–71 years) who reported they: (1) wore spectacle correction for distance vision (single vision, bifocal or progressive lenses); (2) had struggled to get used to a new pair of glasses and (3) sometimes chose not to wear their distance correction. Focus groups were audio recorded, transcribed verbatim and analysed thematically. Results We identified three themes. Trust is about how participants' trust in their optometrist and themselves influences the likelihood of them adapting successfully to new glasses. Conflict describes how the advice patients have received about adapting to glasses can conflict with what they have experienced and how this conflict influences their expectations. Part of Me explores how participants' experiences and feelings about their glasses are important to adaptation and this includes physical, visual, emotional and behavioural aspects. Conclusions The traditional optometric perspective of adaptation to glasses is much narrower than that held by patients, and significantly underestimates the physical, behavioural and emotional adaptation that patients must go through in order to feel fully comfortable wearing their glasses. Patients should receive significantly more information about adaptation, including symptoms that may be experienced and why these happen, practical tips to aid adaptation, and when and how to raise concerns. Patients should also receive information about the day-to-day effects of blur adaptation to avoid them not wearing their glasses, including for vision-critical tasks such as driving.

Objectives: In recent times attention has focused more and more on the so-called risky health practices that young women are engaging in and this serves to problematise a range of individual behaviours. The primary objective of this paper is to examine the discursive constructions young women draw upon to make sense of their experiences of risk in relation to health. Design: This was a qualitative study using in-depth interviews. Methods: 22 interviews were carried out with young women aged 18 to 24 years in further education settings. Drawing on a feminist perspective, a post-structuralist type of discourse analysis was used to analyse the data. Results: This paper focuses on two overarching, and closely related, discursive patterns within the data which are central to how the young women present themselves in relation to risk and health. The first one is significantly moralised and, using this, the young women negotiate the territory between what it means to be good and bad. The second discursive pattern draws significantly on representations of a socially constructed feminine ideal and heavily gendered notions of health and risk. Conclusions: Both discursive patterns can be seen as illustrative of the way that young women do health and gender and how they negotiate risky health practices in and through their talk whilst trying to resist a stigmatised identity. A consideration for both current public health policy and future research is that a change is required away from a focus on individual behaviour to exploring the meaning of different health practices and the implications of this.

Background Musculoskeletal problems generate high costs. Of these disorders, patients with knee problems are commonly seen by GPs. Magnetic resonance imaging (MRI) of the knee is an accurate diagnostic test, but there is uncertainty as to whether GP access to MRI for these patients is a cost-effective policy. Aim To investigate the cost-effectiveness of GP referral to early MRI and a provisional orthopaedic appointment, compared with referral to an orthopaedic specialist without prior MRI for patients with continuing knee problems. Design of study Cost-effectiveness analysis alongside a pragmatic randomised trial. Setting Five-hundred and thirty-three patients consulting their GP about a knee problem were recruited from 163 general practices at 11 sites across the UK. Method Two-year costs were estimated from the NHS perspective. Health outcomes were expressed in terms of quality-adjusted life years (QALYs), based on patient responses to the EQ–5D questionnaire administered at baseline, and at 6, 12, and 24 months' follow-up. Results Early MRI is associated with a higher NHS cost, by £294 ($581; €435) per patient (95% confidence interval [CI] = £31 to £573), and a larger number of QALYs, by 0.05 (95% CI = 0.025 to 0.118). Mean differences in cost and QALYs generated an incremental cost per QALY gained of £5840 ($11 538; €8642). At a cost per QALY threshold of £20 000, there is a 0.81 probability that early MRI is a cost-effective use of NHS resources. Conclusion GP access to MRI for patients presenting in primary care with a continuing knee problem represents a cost-effective use of health service resources. Keywords: cost–benefit analysis, family practice, knee injuries, magnetic resonance imaging

BACKGROUND: Hundreds of thousands of volunteers take part in medical research, but many will never hear from researchers about what the study revealed. There is a growing demand for the results of randomised trials to be fed back to research participants both for ethical research practice and for ensuring their co-operation in a trial. This study aims to determine participants' preferences for type of leaflet (short versus long) used to summarise the findings of a randomised trial; and to test whether certain characteristics explained participants' preferences. METHODS: 553 participants in a randomised trial about General Practitioners' access to Magnetic Resonance Imaging for patients presenting with suspected internal derangement of the knee were asked in the final follow-up questionnaire whether they would like to be fed back the results of the trial. Participants who agreed to this were included in a postal questionnaire survey asking about their preference, if any, between a short and a long leaflet and what it was about the leaflet that they preferred. Multinomial logistic regression was used to test whether certain demographics of responding participants along with treatment group explained whether a participant had a preference for type of leaflet or no preference. RESULTS: Of the participants who returned the final follow-up questionnaire, 416 (88%) agreed to receive the results of the trial. Subsequently 132 (32%) participants responded to the survey. Most participants preferred the longer leaflet (55%) and the main reasons for this were the use of technical information (94%) and diagrams (89%). There was weak evidence to suggest that gender might explain whether participants have a preference for type of leaflet or not (P = 0.084). CONCLUSIONS: Trial participants want to receive feed back about the results and appear to prefer a longer leaflet. Males and females might require information to be communicated to them differently and should be the focus of further research. TRIAL REGISTRATION: The trial is registered with http://www.isrctn.org/ and ID is ISRCTN76616358.

Suboptimal diets, sedentary lifestyles, overweight and obesity expose two-thirds of women in England aged over 50 to a heightened risk of lifestyle-related morbidities. The UK's NHS Breast Cancer Screening Programme now reaches 75% of all women aged 53-64 but provides only mammography screening. This cross-sectional survey of 413 women attending two NHS breast screening clinics in North Yorkshire found that the majority of women were interested in having diet and exercise advice at screening clinics and anticipated a neutral or positive effect on their future screening appointments. Interest was highest among older, less educated and overweight women suggesting that this may be a particularly effective medium for reaching higher risk subgroups. Women showed most interest in problem-solving advice, which provided short-term, life-enhancing benefits such as looking and feeling better, having more energy, losing weight and reducing menopausal symptoms, as well as potentially reducing their disease risk. Most appeared to find doing sufficient exercise more problematic than eating healthily and this might be exacerbated by low awareness of exercise guidelines. Given a choice, preferences were to access advice in leaflets or one to one from an expert; however, many younger, professional women were also interested in computer access. Findings indicate the need first for flexible, multi-level access, combining some broad-based information dissemination with pathways to more personalized support and secondly for the relevant 'consumer benefits' associated with better diet and exercise to be promoted as well as longer-term disease prevention. Overall, this study indicates that the UK's NHS Breast Cancer Screening Programme may be uniquely placed to provide health-enhancing advice as well as mammography screening to the majority of women in England, throughout the course of their mid-life. © The Author (2007). Published by Oxford University Press. All rights reserved.

BACKGROUND: Though new technologies like Magnetic Resonance Imaging (MRI) may be accurate, they often diffuse into practice before thorough assessment of their value in diagnosis and management, and of their effects on patient outcome and costs. MRI of the knee is a common investigation despite concern that it is not always appropriate. There is wide variation in general practitioners (GPs) access to, and use of MRI, and in the associated costs. The objective of this study was to resolve uncertainty whether GPs should refer patients with suspected internal derangement of the knee for MRI or to an orthopaedic specialist in secondary care. METHODS/DESIGN: The design consisted of a pragmatic multi-centre randomised trial with two parallel groups and concomitant economic evaluation. Patients presenting in general practice with suspected internal derangement of the knee and for whom their GP was considering referral to an orthopaedic specialist in secondary care were eligible for inclusion. Within practices, GPs or practice nurses randomised eligible and consenting participants to the local radiology department for an MRI examination, or for consultation with an orthopaedic specialist. To ensure that the waiting time from GP consultation to orthopaedic appointment was similar for both trial arms, GPs made a provisional referral to orthopaedics when requesting the MRI examination. Thus we evaluated the more appropriate sequence of events independent of variations in waiting times. Follow up of participants was by postal questionnaires at six, twelve and 24 months after randomisation. This was to ensure that the evaluation covered all events up to and including arthroscopy. DISCUSSION: The DAMASK trial should make a major contribution to the development of evidence-based partnerships between primary and secondary care professionals and inform the debate when MRI should enter the diagnostic pathway.

The partnership approach to health care, in which patients take an active role in decision making, can potentially improve patient satisfaction and adherence to clinician recommendations. However, the process can be impeded by insufficient or poor‐quality information provision. This study explored participants' understanding of, and requirements for, optometric information. Information leaflets were obtained from 12 optometry practices and four internet‐based resources. Sixty‐four patients/clients participated in focus groups that explored: (1) their understanding of diagrams of visual function, (2) perceptions of good information, (3) information requirements and (4) perceptions of the effects of improved information. A theory‐led thematic analysis identified three major themes within each of the four categories. The use of jargon and the inappropriate layout of diagrams and text impeded comprehension of the leaflets. High‐quality information was defined as being written concisely with simple explanations and clear diagrams. There was also a preference for information to be relevant and applicable to the patient's own eye care needs. In addition, participants expressed a desire for both written and verbal information regarding eye examination procedures and interpretation of prescriptions. Advice regarding eye care was also requested. To facilitate a partnership approach and improve patient satisfaction, patients should be provided with jargon‐free concisely written and clearly presented information. In addition to general information, patients would also benefit from personalised information regarding test results and eyecare regimes.

During the period from 1996 to 2003, the number of powered two-wheelers (PTWs) on the UK's roads increased by almost 50 per cent (Christmas et al., 2008). Although this trend has levelled off in recent years, in 2007, 24,381 riders of PTWs were injured in collisions on the UK's roads and 588 were killed, representing 22 per cent of all road traffic deaths in the UK (Department for Transport, 2008). Given that PTWs make up only 1–2 per cent of traffic per 1,000 miles travelled (Sexton et al., 2004), it is estimated that riders of PTWs are 51 times more likely to suffer a road traffic collision than car drivers per mile travelled (Christmas et al., 2008).

Night-time pedestrians, including recreational walkers and runners, remain at significant risk of being killed or seriously injured, because drivers often fail to see them in time to avoid a collision. Clothing incorporating retro-reflective markers on the moveable joints creates a visual perception of biological motion or “biomotion” which has been shown to improve night-time pedestrian conspicuity. This study investigated whether clothing with markings in the biomotion configuration retains its conspicuity if adapted to include thinner or patterned retro-reflective strips making it more acceptable to wear for recreational pedestrians. In a night-time closed road study, the relative conspicuity of pedestrians to 14 young drivers with normal vision (mean age 24.3 ± 3.1 years) was assessed for pedestrians wearing different thicknesses and patterns of biomotion strips and compared with typical clothing worn by night-time pedestrians, including commercially available sports clothing with retro-reflective elements, a fluorescent yellow top, and black clothing. Results showed that all the biomotion configurations resulted in significantly longer recognition distances: around 2 times longer than the sports clothing, 2.5 times longer than the fluorescent top and 4 times longer than the black clothing. Similar trends were found for the distance at which drivers correctly identified pedestrian orientation (towards or sideways to the vehicle), with significantly longer distances for all the biomotion configurations, when compared to the sports, fluorescent top and black clothing. These findings highlight the effectiveness of biomotion clothing, even when using retro-reflective strips as thin as 0.75 cm and have implications for clothing designs for recreational walkers and runners to enhance their night-time safety.

© 2018 Elsevier Ltd Purpose: Refractive blur is associated with decreased hazard perception and impairments in driving performance, but little is known about why people who have spectacles to correct their distance vision drive with uncorrected vision. Methods: We conducted six focus groups. Participants were 30 drivers (mean age 45) who reported having driven uncorrected at least twice in the past six months despite having spectacles to correct their distance vision. Focus groups were audio recorded, transcribed verbatim and analysed thematically. Results: We identified three themes. 1. Responsibility: participants did not feel obliged to drive with optimal vision and believed that others have a responsibility to ensure drivers maintain clear vision. 2. Safe Enough: participants felt safe to drive uncorrected, did not believe they need to wear spectacles to see sufficiently clearly and that they would know if their uncorrected eyesight fails to meet minimum standards. 3. Situations: participants discussed how they would drive uncorrected for short and familiar journeys, when they feel alert, in daylight and in good weather. Conclusions: Beliefs about the importance of driving with clear vision compete with the benefits of not wearing spectacles. Eyecare professionals should provide more direct advice to patients regarding the need to wear their visual correction for driving.

BACKGROUND: A Personal Health Record (PHR) is an electronic record that individuals use to manage and share their health information, e.g. data from their medical records and data collected by apps. However, engagement with their record can be low if people do not find it beneficial to their health, wellbeing or interactions with health and other services. We have explored the beliefs potential users have about a PHR, how it could be made personally relevant, and barriers to its use. METHODS: A qualitative design comprising eight focus groups, each with 6-8 participants. Groups included adults with long-term health conditions, young people, physically active adults, data experts, and members of the voluntary sector. Each group lasted 60-90 min, was audio recorded and transcribed verbatim. We analysed the data using thematic analysis to address the question "What are people's beliefs about making a Personal Health Record have relevance and impact?" RESULTS: We found four themes. Making it work for me is about how to encourage individuals to actively engage with their PHR. I control my information is about individuals deciding what to share and who to share it with. My concerns is about individuals' concerns about information security and if and how their information will be acted upon. Potential impact shows the potential benefits of a PHR such as increasing self-efficacy, uptake of health-protective behaviours, and professionals taking a more holistic approach to providing care and facilitating behaviour change. CONCLUSIONS: Our research shows the functionality that a PHR requires in order for people to engage with it. Interactive functions and integration with lifestyle and health apps are particularly important. A PHR could increase the effectiveness of behaviour change apps by specifying evidence-based behaviour change techniques that apps should incorporate. A PHR has the potential to increase health-protective behaviours and facilitate a more person-driven health and social care system. It could support patients to take responsibility for self-managing their health and treatment regimens, as well as helping patients to play a more active role when care transfers across boundaries of responsibility.

Visual evoked magnetic responses to pattern onset/offset stimuli were recorded in 5 normal subjects. The outgoing and ingoing magnetic currents were seen maximally over the contralateral visual cortex to the half field stimulated in the majority of subjects. The distribution of magnetic currents with half field stimulation would be consistent with a dipole on the midline with the positive and pointing laterally. Quadrantic stimuli produced dipoles which would be consistent with a vector sum of dipoles situated, in the case of upper quarter field stimulation, in the lingual gyri on the floor of the calcarine fissure. Lower quadrantic stimulation produced a vector consistent with dipoles on the cuneal gyrus and on the ceiling of the calcarine fissure producing a resultant vector. The use of paired octant stimuli to improve localisation was demonstrated on both right left and upper and lower half fields. © 1994.

The aim of this study was to determine the response properties of the human visual cortex to chromatic stimuli using magnetoencephalography (MEG). Evoked responses were recorded to isoluminant red/green sinusoidal gratings for a wide range of spatial and temporal frequencies. For each condition the response was dominated by a single major component which was well modeled by an equivalent current dipole. Coregistration of MEG and MRI data provided evidence that the principal evoked cortical activity originated from visual area V1. To investigate the chromatic response properties of this area, the maximum global field power of the evoked response was plotted as a function of stimulus spatial and temporal frequency. The spatial-frequency tuning was lowpass and the temporal-frequency tuning was multimodal, with peaks at 0 and 4 Hz. The results demonstrate the use of MEG as a technique for investigating activity from discrete regions of cortex.

Purpose: To determine whether UK optometrists and ophthalmologists provide target refraction advice to patients prior to cataract surgery, and when this should first be discussed. Methods: Optometrists and ophthalmologists were asked to complete a survey of two clinical vignettes (both older patients with cataract; a pre-operative myope who routinely read without glasses and a patient using a monovision approach), plus multiple choice and short answer questions either using hard copy or online. Results: Responses were obtained from 437 optometrists and 50 ophthalmologists. Optometrists who reported they would provide target refraction advice were more experienced (median 22 years) than those who would leave this to the Hospital Eye Service (median 10 years). The former group reported it was in the patients’ best interest to make an informed decision as they had seen many myopic patients who read uncorrected pre-operatively, and were unhappy that they could no longer do so after surgery. Inexperienced optometrists reported that they did not want to overstep their authority and left the decision to the ophthalmologist. The ophthalmologists estimated their percentage of emmetropic target refractions over the last year to have been 90%. Conclusion: Currently, some long-term myopes become dissatisfied after cataract surgery due to an emmetropic target refraction that leaves them unable to read without glasses as they did prior to surgery. Although experienced optometrists are aware of this and attempt to discuss this issue with patients, less experienced optometrists tend not to. This suggests that target refraction needs greater exposure in university training and continuing professional development. To provide patients with the knowledge to make informed decisions regarding their surgery, we suggest an agreed protocol within funded direct referral schemes of initial target refraction discussions by optometrists to introduce the idea of refractive outcomes and outline options, with further discussion with the ophthalmologist to clarify understanding.

Poor conspicuity increases the risk of cyclists and pedestrians being involved in collisions with vehicles under low light conditions. Retroreflective strips in biomotion configuration significantly increases conspicuity. This study explored how to design biomotion garments that will appeal to cyclists and pedestrians. Nine focus groups involving 50 participants who ran/cycled under low light conditions. Participants discussed their experiences of choosing and wearing garments for cycling/running, and barriers to wearing biomotion garments. Using thematic analysis, we identified three themes. Design describes how biomotion garments should be attractive and practical. Function describes how they should be comfortable and convenient. Promotion describes participant’s beliefs regarding cost and how to best explain the safety benefits of biomotion garments. Our user-centre research identified how to make biomotion garments appealing. Safety should not compromise design and function: users are unlikely to wear poorly designed and uncomfortable biomotion garments regardless of how much they increase conspicuity.

BACKGROUND: Poor response rates to postal questionnaires can introduce bias and reduce the statistical power of a study. To improve response rates in our trial in primary care we tested the effect of introducing an unconditional direct payment of 5 pounds for the completion of postal questionnaires. METHODS: We recruited patients in general practice with knee problems from sites across the United Kingdom. An evidence-based strategy was used to follow-up patients at twelve months with postal questionnaires. This included an unconditional direct payment of 5 pounds to patients for the completion and return of questionnaires. The first 105 patients did not receive the 5 pounds incentive, but the subsequent 442 patients did. We used logistic regression to analyse the effect of introducing a monetary incentive to increase the response to postal questionnaires. RESULTS: The response rate following reminders for the historical controls was 78.1% (82 of 105) compared with 88.0% (389 of 442) for those patients who received the 5 pounds payment (diff = 9.9%, 95% CI 2.3% to 19.1%). Direct payments significantly increased the odds of response (adjusted odds ratio = 2.2, 95% CI 1.2 to 4.0, P = 0.009) with only 12 of 442 patients declining the payment. The incentive did not save costs to the trial--the extra cost per additional respondent was almost 50 pounds. CONCLUSION: The direct payment of 5 pounds significantly increased the completion of postal questionnaires at negligible increase in cost for an adequately powered study.

Many clients in optometry practice have reported that they do not receive sufficient information from practitioners to make informed purchasing decisions for corrective spectacles. The aim of this study was to identify participants' attitudes and beliefs towards visiting an optician and purchasing spectacles, to compare clients' and practitioners' perceptions of purchasing decisions, and to examine clients' preferences for information and decision making. One hundred and fifty-eight presbyopes completed a questionnaire to examine attitudes and behaviours regarding visiting an optician. Thirty-four practitioners completed a questionnaire examining the purchasing recommendations they make to clients, and their perceptions of clients' purchasing decisions and information needs. Participants reported positive attitudes towards visiting an optician but required more information about their eyesight and about purchasing options. A discrepancy was found between client and practitioner perceptions of purchasing decisions and of involvement in the decision making process. Practitioners overestimated the importance of price to clients and underestimated the importance of their own recommendations on purchasing decisions. The findings of this study could be used to guide practitioners in their provision of information to clients. © 2004 Elsevier Ireland Ltd. All rights reserved.

Abstract

Background  Unmet expectations are a major cause of client dissatisfaction, yet very little is known about the expectations and health values that clients in optometry practice hold about having an eye examination and purchasing spectacles. This study identified different attitudes and behaviours held by presbyope clients in optometric practices.

Method  A total of 158 presbyope clients, recruited from 14 practices, completed a questionnaire which was developed from the theory of planned behaviour. The questionnaire examined attitudes towards spectacles and visiting the optician, motivation to visit the optician, perceptions of barriers to attending the opticians, information requirements, and preferences for shared decision‐making. Responses were analysed using principal components analysis.

Results and Conclusions  Four factors were identified, which were labelled style, vision, avoiding and seeking. Style is concerned with the importance of appearing fashionable or stylish, and desiring approval from others. Vision relates to clients’ attitudes towards obtaining clear vision and to maintaining healthy eyesight. Avoiding describes the perceived difficulties associated with visiting the optician and purchasing new spectacles. Seeking corresponds to the desire for information on the technical details of lenses. Practitioners could use these characteristics to tailor information to meet the needs and address the expectations of individual clients. This may make the information provided more personally relevant, and could enhance client satisfaction.

Objective: To test the effect of postal randomization on recruitment of patients into a randomized trial in primary care. Study Design and Setting: General practices used a telephone service to randomize patients in our trial. Delays in the start of recruitment at some sites led us to modify the randomization procedure. When new practices took part patients completed and posted baseline materials to the Trial Secretary in York who performed the randomization and informed those concerned of the allocation. Results: Of the 647 practices who were invited to take part, 130 (45%) of 288 agreed to participate using telephone randomization and 155 (43%) of 359 using the postal method. These practices recruited 553 patients from November 2002 to October 2004 across 11 sites in the United Kingdom. The postal method reduced the number of patients recruited by a factor of 0.86 (95% confidence interval = 0.62-1.20), or 14%. The number of general practitioners working in a practice significantly increased patient recruitment by a factor of 1.12 (1.05-1.20), whereas practice distance from hospital significantly decreased recruitment by a factor of 0.98 (0.97-0.99). Conclusion: Postal randomization had no significant effect on recruitment of patients into our trial. © 2007 Elsevier Inc. All rights reserved.

© 2017 Elsevier Ltd Fewer young adults are choosing to learn to drive and there is a safety argument for encouraging those who do learn to delay doing so. In this study we explore what motivates young people to learn to drive and we uncover their expectations – and the reality – of the difference driving makes to their short- and longer-term futures. We conducted 12 focus groups with 48 young people age 16–24. The discussions explored why they do or don't want to drive, the immediate life changes that driving brings as well as how driving might affect their life in the future. We analysed the data using thematic analysis using the question: what motivates young people to learn to drive? We identified five motivations in the data, organised into two themes. The first theme relates to the benefits of maturity. Young people believe driving provides independence and represents the first stage of becoming an adult. Most rely on their parents for lifts, and therefore parents control and scrutinise their social life. The car as a form of personal space was very important for young people, as they have complete control over this environment, which can be missing in other aspects of their lives. Driving also bestows kudos, particularly for those amongst the first in their peer group to pass their test. Novice drivers enjoy being able to offer lifts to friends and family, although described how this rapidly becomes an imposition. The second theme is about broadening horizons. Young people believe that driving expands their social world, enabling them to travel further afield with their friends for day trips because driving is faster, more convenient and cheaper than public transport. In practice, few of those who drive had used their car in this way, instead using it mainly for commuting and getting fast food. Participants talked about how driving opens up career opportunities, allowing them to travel to more distant cities for work and study. However, driving usually made accessing work and study opportunities more convenient rather than possible. Instead, the main benefit young people actually experienced was having more time to sleep in the morning. The qualitative nature of the study, together with the inclusion of pre-drivers, drivers and non-drivers, has provided insight into motivations for learning to drive and how the reality of driving often does not match expectations. The results could be used to inform the potential content of an intervention to encourage young people to delay learning to drive.

During the period from 1996 to 2003, the number of powered two-wheelers (PTWs) on the UK's roads increased by almost 50 per cent (Christmas et al., 2008). Although this trend has levelled off in recent years, in 2007, 24,381 riders of PTWs were injured in collisions on the UK's roads and 588 were killed, representing 22 per cent of all road traffic deaths in the UK (Department for Transport, 2008). Given that PTWs make up only 1–2 per cent of traffic per 1,000 miles travelled (Sexton et al., 2004), it is estimated that riders of PTWs are 51 times more likely to suffer a road traffic collision than car drivers per mile travelled (Christmas et al., 2008).

OBJECTIVE: To develop a validated measure of professionals' attitudes towards clinical adverse event reporting (CAER). DESIGN: Cross-sectional survey with follow-up. PARTICIPANTS: 201 doctors and nurse/nurse-midwives undergoing postqualification training in Leeds, York and Hull Universities in 2003. MATERIALS: A questionnaire which comprised 73 items extracted from interviews with professionals; a second, statistically reduced version of this questionnaire. RESULTS: The analysis supported a 25-item questionnaire comprising five factors: blame as a consequence of reporting (six items); criteria for reporting (six items); colleagues' expectations (six items); perceived benefits of reporting events (five items); and clarity of reporting procedures (two items). The resulting questionnaire, the Reporting of Clinical Adverse Effects Scale (RoCAES), had satisfactory internal consistency (Cronbach's alpha = 0.83) and external reliability (Spearman's correlation = 0.65). The construct validity hypothesis-doctors have less positive attitudes towards CAER than nurses-was supported (t = 5.495; p<0.0001). CONCLUSION: Initial development of an evidence-based, psychometrically rigorous measure of attitudes towards CAER has been reported. Following additional testing, RoCAES may be used to systematically elicit professionals' views about, and inform interventions to improve, reporting behaviour.

Low vision can have a profound impact on quality of life, affecting mobility, day-to-day visual tasks, social functioning, and psychological wellbeing. Existing quality of life measures used in low vision tend to concentrate on visual function at the expense of psychosocial adjustment. We report the development of a new measure of quality of life in low vision. Focus groups were held with low vision centre staff and clients to explore the areas that affect quality of life in people with low vision. A content analysis was used to develop a 25-item questionnaire and a client priorities form. Questionnaires were posted to a random sample of 200 clients, and completed with 72 consecutive clients in a low vision clinic. Principal component analysis identified three factors: the ability to carry out day-to-day tasks; independence; and motivation. The measure can be analysed as a single scale with scores ranging from 0 to 100 and higher scores indicating better quality of life. Clients had the most difficulty with reading books, newspapers and letters, using public transport, and engaging in hobbies or leisure activities. Clients also reported a lack of confidence, feeling worried about doing something embarrassing, and staying at home because of their eyesight. Focus-QoL is a brief measure of quality of life, and combined with the client priorities form, it could help low vision service providers target resources to best meet individual client needs.

Background Magnetic resonance imaging (MRI) of the knee for meniscus and ligament injuries is an accurate diagnostic test. Early and accurate diagnosis of patients with knee problems may prevent the onset of chronic problems such as osteoarthritis, a common cause of disability in older people consulting their GP. Aim To assess the effect of early access to MRI, compared with referral to an orthopaedic specialist, on GPs' diagnoses and treatment plans for patients with knee problems. Design of study A multicentre, pragmatic, randomised controlled trial. Setting Five hundred and fifty-three patients with knee problems were recruited from 163 general practices across the UK from November 2002 to October 2004. Method Eligible patients were randomised to MRI or consultation with an orthopaedic specialist. GPs made a concomitant provisional referral to orthopaedics for patients who were allocated to imaging. GPs recorded patients' diagnoses, treatment plans, and their confidence in these decisions at trial entry and follow-up. Data were analysed as intention to treat. Results There was no significant difference between MRI and orthopaedic groups for changes in diagnosis (P = 0.79) or treatment plans (P = 0.059). Significant changes in diagnostic and therapeutic confidence were observed for both groups with a greater increase in diagnostic confidence (P<0.001) and therapeutic confidence (P = 0.002) in the MRI group. There was a significant increase in within-group changes in diagnostic and therapeutic confidence. Conclusion Access to MRI did not significantly alter GPs' diagnoses or treatment plans compared with direct referral to an orthopaedic specialist, but access to MRI significantly increased their confidence in these decisions.

This report summarises the results of research undertaken by two independent research groups (Brainbox Research and the University of Leeds) into the components of interventions that are most likely to change speeding driver behaviour (part one). The parallel nature of the work by these two groups has led to partially overlapping conclusions, which are noted in this joint report. Part two reports the discussions and consensus of an expert group meeting of scientists and stakeholders at which the research was presented. The outcome of this meeting was a list of components that national speed awareness schemes should include, and how such schemes should be evaluated.

Health psychology theory, specifically the self-regulatory model (Leventhal et al. 1997), suggests that recent onset presbyopes go through an iterative series of stages in which they interpret their visual symptoms, cope with these symptoms and also their cognitive and emotional correlates, and then appraise the effectiveness of their coping strategy. Coping can be either active, eg information seeking or visiting an optometrist, or avoidant, eg denying there is a problem or avoiding reading-based activities. Cognitive threats can arise from incorrectly attributing presbyopic symptoms to a disease process, or from the negative stereotypes that are widely held about ageing. Emotional threats include anxiety, frustration, anger and depression. The cycle of interpretation, coping and appraisal is repeated with the aim of reducing the cognitive and emotional threats and returning the individual to a state of psychological equilibrium. The optical professional can provide information at each of the three stages.

PURPOSE: We aimed to elucidate the mechanisms underlying video-game epilepsy by comparing the flicker- and spatial-frequency ranges over which photic and pattern stimulation elicited photoparoxysmal responses in two different populations: (a) 25 patients with a history of seizures experienced while playing video games; and (b) 25 age- and medication-matched controls with a history of photosensitive epilepsy, but no history of video-game seizures. METHODS: Abnormality ranges were determined by measuring photoparoxysmal EEG abnormalities as a function of the flicker frequency of patterned and diffuse intermittent photic stimulation (IPS) and the spatial frequency of patterns on a raster display. RESULTS: There was no significant difference between the groups in respect of the abnormality ranges elicited by patterned or diffuse IPS or by spatial patterns. When the groups were compared at one specific IPS frequency (-50 Hz), however, the flicker frequency of European television displays, the video-game patients were significantly more likely to be sensitive. CONCLUSIONS: The results suggest that video-game seizures are a manifestation of photosensitive epilepsy. The increased sensitivity of video-game patients to IPS at 50 Hz indicates that display flicker may underlie video-game seizures. The similarity in photic- and pattern-stimulation ranges over which abnormalities are elicited in video-game patients and controls suggests that all patients with photosensitive epilepsy may be predisposed toward video-game-induced seizures. Photosensitivity screening should therefore include assessment by using both IPS at 50 Hz and patterns displayed on a television or monitor with a 50-Hz frame rate.

PURPOSE: The continued presence of EEG abnormalities in patients with a history of photosensitive seizures is used to signify the persistence of photosensitive epilepsy. The extent to which this approach places patients at risk of seizures is unclear, however. We describe those EEG abnormalities that may be tolerated with low risk of further seizures, and those that are indicative of poor seizure control. METHODS: Fifty patients with EEG evidence of persistent photosensitive epilepsy underwent photosensitivity testing with diffuse and patterned light; 58% of patients continued to experience seizures, and 42% were seizure free. The incidence of EEG abnormalities to diffuse and patterned intermittent photic stimulation (IPS) was analysed as a function of recent seizures. RESULTS: All patients showed EEG abnormalities to patterned IPS; there was no significant association between patterned IPS and poor seizure control. EEG abnormalities to diffuse IPS occurred in 58% of patients, and 76% of these patients had experienced a seizure within the previous year. These patients were more than twice as likely to be poorly controlled than those who showed abnormalities only to patterned IPS. These results were consistent for both medicated and unmedicated patients. CONCLUSIONS: EEG abnormalities to patterned IPS can be used to signify the persistence of photosensitive epilepsy, but abnormalities to diffuse IPS are more likely to indicate the patient is poorly controlled and at risk of further seizures.

SIGNIFICANCE: Work-related stress is common in the optometry profession, yet there is limited research on how optometrists and organizations manage and mitigate these issues. This study explores strategies to reduce work-related stress and provides recommendations for individuals, employers, and the profession, to inform future support and guidance. PURPOSE: To explore how optometrists self-manage work-related stress and to identify potential strategies that employers can implement to minimize stress and foster a supportive and positive work environment. METHODS: This study was a qualitative analysis of 1284 responses from an online cross-sectional survey of optometrists registered with the General Optical Council in the United Kingdom during 2024. Content analysis was applied to responses to three different open questions covering work-related stress: what participants do to minimize stress in the workplace; what employers could do; and which aspects of their role participants find most enjoyable. RESULTS: We identified four themes that describe personal strategies for managing work-related stress: (1) in-work approaches; (2) work–life balance strategies; (3) leisure and social support activities; and (4) personal and professional interventions. Three themes described actions employers could take: (1) clinical efficiency and workload management; (2) clinical-commercial business strategy; and (3) workplace culture and emotional well-being. In terms of their role, clinical and patient-related work was the most enjoyable. Many expressed a strong interest in professional development, with higher clinical qualifications, particularly in independent therapeutic prescribing, being the most aspirational form of self-development. CONCLUSIONS: Addressing work-related stress requires a collaborative approach where individuals adopt personal coping strategies, and employers and the profession implement tailored, multifactorial interventions to mitigate systemic stressors. Such combined efforts are essential to foster supportive work environments, reduce stress across the workforce, and drive the systemic changes necessary to enhance professional well-being and patient care in optometry.

Introduction: As emerging therapies enter clinical trials, functional vision assessments are required by regulatory bodies to show real-world effectiveness. Development of new outcome measures should begin with a thorough understanding of the goals of people with low vision. The study aims to explore the rehabilitation goals of people with low vision by analyzing data collected with the Canadian Occupational Performance Measure (COPM) in an Australian cohort. Methods: We applied thematic analysis to a retrospective dataset of reported goals of people with low vision, obtained using the COPM. The dataset was obtained from a low vision service provider, Vision Australia. We analyzed de-identified COPM data from 190 clients (122 female, 64%). Three main themes were identified (safety and confidence, life skills, and leisure). Results: “Safety and confidence” is about participants being able to access their home, community, and workplace safely and confidently. Most (87%) of the goals related to effective navigation and mobility. The “life skills” theme included goals related to personal care (25%), kitchen skills (25%), and interpersonal skills (5%), and for parents, their child's development (43%). The “leisure” theme is about engaging in leisure activities and socializing with others. More than half (53%) of the participants reported access to media as a rehabilitation goal, and many wanted to improve their information technology skills. Discussion: In conclusion, we identified three main goals: safety and confidence, especially in accessing the wider community and safety around the home environment; life skills, including kitchen work; and leisure activity, such as accessing print and electronic material. Most mobility goals focused on enhancing feelings of safety, confidence, and independence. These findings underscore the crucial role of emotional support in enhancing functional mobility. Implications for Practitioners: The results identify important goals that could be incorporated into vision restoration clinical trials, in order to emphasize clients’ desired visual functioning.

Continuity between waking life and dreaming has typically been studied via the quantitative analysis of dream reports, which has illustrated that dreaming reflects waking-life experiences, thoughts, and emotions. However, there are currently no reliable methods of analyzing dreams for the more subjective aspects of dreams, such as those dreams that are metaphorically related to the dreamer’s waking life, which require dreamer input. We conducted a qualitative study involving in-depth semistructured interviews with 4 participants. The interview schedules were based on Schredl’s (2010) dream group technique. Using thematic analysis we developed 3 themes that describe continuity between waking life and dreams: “experiential continuity” (between waking-life experiences/thoughts and dreams), “emotional continuity” (between waking-life emotions and dreams), and “representative continuity” (metaphorical and generic representations of waking life in dreams). Rather than being dichotomous, participants experienced continuity in gradations. A fourth theme (“attitudes toward continuity”) explored how attitudes toward continuity influenced continuity experiences. (PsycINFO Database Record (c) 2014 APA, all rights reserved)

13% of the UK’s total Carbon dioxide emissions are from domestic buildings. Reducing carbon emissions from domestic buildings is an important societal need, this includes older, solid brick walled houses. Solid wall insulation: either internal or external, is the only option to improve the thermal performance of solid brick walls. however; it is also costly and complex insulation to install, and can have several unintended consequences. This thesis focusses on internally installed solid wall insulation, or internal wall insulation (IWI) IWI retrofit can be prone to discontinuities or breaks in the insulation layer, these can be caused by obstructions such as walls or floors. Areas where the IWI layer is broken act as thermal bridges, allowing greater flow of heat through the wall resulting in heat loss and cooling of surfaces at discontinuities which can be at risk of surface condensation formation, potentially leading to mould growth and damage to the building fabric. There are gaps in the knowledge regarding the impacts of discontinuities of IWI in-situ: research in this field has focussed on the use of simulation to assess this risk. The goal of this thesis is to measure the change in moisture risk at junctions of solid brick walled buildings after IWI retrofit, and the impact that discontinuities have on that risk. A field trial was undertaken in a solid brick walled house in which a selection of junctions featuring discontinuities were measured under quasi-steady state conditions. Three IWI retrofits were undertaken in sequence using different IWI systems. In-situ Surface moisture risk was calculated for each junction estimated. Discontinuities of the IWI layer were found to increase the surface condensation risk relative to pre-retrofit. The addition of insulation to discontinuities eliminated or reduced the risk of surface moisture. Simulations were also undertaken to assess the accuracy of the standard approach of assessing surface condensation risk at junctions. Improved wall thermal conductivity and environmental inputs were used in stages to assess how these improved the accuracy of predictions. Simulations were also used to carry out a sensitivity analysis and a parametric analysis of junctions with and without discontinuities of IWI. The sensitivity analysis examined the sensitivity of surface moisture risk to external wall U-value. The parametric analysis investigated how IWI system properties and environmental conditions affect surface condensation at a junction with and without a discontinuity. The findings of this thesis give guidance for the design of IWI retrofits to reduce surface moisture risks at discontinuities of the IWI layer.

Heat pumps are a key part of the UK Government's decarbonisation strategy to achieve net zero carbon emissions by 2050. Shared-loop ground source heat pumps (GSHPs) offer domestic space and hot water heating at scale in medium-to-high-density areas where standard single-dwelling heat pumps are unsuitable. However, it is unclear whether homeowners would be willing to pay for them. This paper explores public perceptions of three shared-loop GSHP financing models. We used focus groups to understand homeowners' responses to each finance model, refined the models, and tested them in an online survey of UK homeowners. We found that while there is potential interest in joining a shared-loop GSHP network, there was distrust because the financial offers were perceived as unfair, disadvantaging some customers, and not offering long-term financial savings compared with a gas boiler. The standing charge for the shared loop was a major barrier. There was a preference for the shared-loop GSHP to be offered by a utility company, a need for personalised financial projections, and the option to delay joining. Our results suggest that to increase uptake, greater certainty around future decarbonisation incentivisation strategies is needed, along with regulation of financial models.

© 2018, The Author(s) 2018. Objective: Men’s engagement in family planning has become part of the global health agenda; however, little is known about the training manuals health practitioners’ use and how these manuals describe and explain men’s roles within a family planning context. Design: To further understand engagement, this paper examines how training manuals written for health practitioners describe and define men’s participation within family planning. Setting: The training manuals were written for UK health practitioners and covered men’s contributions to family planning. Method: Discourse analysis was used to examine the three training manuals focused upon. Results: Three main discourses were identified: ‘contraception is a woman’s responsibility’, ‘men disengage with health practitioners’ and ‘men are biologically predisposed to avoid sexual responsibility’. Conclusion: Together, these three discourses function to marginalise men in family planning, constructing them as detached accessories that lack the ability to engage.

Thermal retrofits of homes are central to the UK's fuel poverty and net zero carbon policies but there are concerns about poor quality installation and so new standards are to be introduced (PAS2035). We have explored retrofit installers' perceptions of the barriers to installing internal wall insulation (IWI) and of current regulations and standards for retrofits. We conducted four focus groups with retrofit installers. Thematic analysis identified three themes. (1) IWI is viewed as impractical in situations other than new builds, extensions and conversions as it is too time-consuming and expensive. (2) Installing IWI is perceived as an unskilled job with no need for training or referring to standards during installation. (3) Because standards lack credibility, installers can be sceptical of potential problems caused by on-site installation adaptations, for example thermal bridging. Our results show that retrofit standards have not improved retrofit quality. Awareness and credibility of standards is low, and new standards (PAS2035) will introduce additional costs which may reduce the pool of installers willing to engage in the retrofit market. Policies need to address installer training, professional identity and social practices, and reduce barriers to change in order to increase success.

This report presents the findings from part of the Peacock and Verity SHEEPISH Development Stage project, which is funded by the North East and Yorkshire Net Zero Hub’s Energy Project Enabling Fund. The SHEEPISH project aims to develop 15 Silver Street, Masham, North Yorkshire, using bioconstruction materials, particularly sheep’s wool insulation (SWI), become a SWI training site for installers across Yorkshire and the North East, and create a stakeholder cooperative into a robust circular SWI supply chain. Leeds Sustainability Institute has been appointed by Peacock and Verity to consult with stakeholders to find out whether there is support for a Yorkshire-based SWI supply chain, advise on how the performance of SWI at 15 Silver Street could be monitored over time, and perform hygrothermal simulations of building elements at 15 Silver Street to assess whether there are any moisture risks associated with using SWI. Twelve stakeholder interviews were conducted in February 2024 with participants from four stakeholder groups: Yorkshire sheep farmers; general contractors; private and social housing clients; and both SWI suppliers and wool merchants. Participants talked about their current beliefs about SWI, barriers to its use, the potential of developing a Yorkshire SWI market and rationale behind it. Cost was perceived to be the main barrier to increasing use of SWI. Farmers were willing to supply their fleeces if it were financially advantageous to do so, but despite the cost of raw wool making up a fraction of overall manufacturing costs, SWI suppliers and wool merchants thought there would be little opportunity to pay farmers more for their fleeces. There is already a SWI manufacturer based in Yorkshire but for a collaboration to develop, demand for Yorkshire SWI would need to grow. This could be stimulated by promoting the low-carbon, safer-to-install and breathable credentials of SWI to a potential Yorkshire client base, such as private homeowners, prestige commercial organisations, and those with historic assets or a sustainable ethos. Literature on SWI indicates favourable performance for improving air quality, controlling moisture levels and reducing sound transmission. However, most of this data comes from laboratory testing which does not replicate the reality of a product's performance within a construction, highlighting the value of capturing in situ performance data at 15 Silver Street. A range of monitoring options, together with practical considerations, are discussed. We recommend monitoring SWI moisture levels over an extended period and measuring air quality during SWI and conventional insulation installation periods for comparison. Moisture behaviour and breathability of SWI is often considered to be a benefit; however, natural materials can be more vulnerable to decay due to moisture accumulation over time. Hygrothermal simulation models the movement of heat and moisture through materials in a representation of a building element, such as a wall or roof, in response to internal and external climate conditions. Hygrothermal simulation models were used to assess the risk of moisture accumulation over time in selected external elements at 15 Silver Street following a retrofit. Modelling was carried out using the WUFI Pro version 6.7 software for four external wall build ups and three roof build ups, where each case was simulated for a virtual 3 and 10- year period. Overall, hygrothermal simulation indicates that the proposed build ups, including those using SWI, have low moisture risk. In each of the cases modelled, total water content declined over the simulation period or reached an equilibrium state that indicates a low risk of water accumulation in the building fabric. Therefore, the use of SWI appears to be as safe as the wood fibre insulation also specified in the design at 15 Silver Street.

Adopting a fabric first approach and installing thermal insulation in existing buildings is one of the most effective methods of improving energy efficiency. The use of internal wall insulation (IWI) has been shown to offer an effective thermal solution, especially where other methods of insulation are unsuitable. However, fitting internal wall insulation is not without risk as discontinuities (gaps) are often found in the insulation layer for a variety of reasons. This can lead to increased flow of heat from the interior to the exterior causing reduced local surface temperatures, which can lead to condensation or mould growth. Currently there is little or no consistency in the terminology used to discuss such discontinuities in IWI and as such categorising specific types of discontinuities and their relative magnitude and rate of recurrence in practice is difficult. This paper seeks to address the lack of consistency by proposing a taxonomy that practitioners and researchers can use when describing discontinuities in IWI. This paper brings together the findings from building performance research, part of which involved field studies forensically observing IWI installations. Alongside the site visits, a literature review of IWI research was undertaken to identify the types of discontinuities observed and the terminology used to describe the occurrence and characteristics. From this a taxonomy has been developed to standardise and characterise discontinuities. It is hoped this will improve the understanding of and appreciation for the importance and scale of discontinuities in the industry, in so doing setting out a route for reducing their occurrence. It is also proposed that this taxonomy could be adapted for use in discussion of other insulation types.

Internal wall insulation (IWI) is one of the few retrofit approaches to reduce heat loss through solid brick walls. Discontinuities in the insulation layer can result in thermal bridges, leading to reduced surface temperatures and the potential for condensation to form. Party wall junctions retrofitted with IWI act as discontinuities when neighbouring homes do not have IWI, leading to reduced surface temperatures on the neighbouring side. The condensation risk imposed on the uninsulated neighbour by a range of notional IWI systems are simulated, the resulting temperature factors indicate whether each system imposes a risk upon the uninsulated neighbour. Thicker, higher performing IWI systems were found to result in greater risk in the neighbouring property.

Introduction There is increasing focus in the UK on the so-called ‘risky practices’ that young women are engaging in which serves to problematise a range of individual behaviours. The aim of this paper is to explore the way that young women talk about health and risk within this context and to examine the implications for policy and practice in public health. Methods Semi-structured, in-depth interviews were carried out with twenty-two young women aged 18 – 24 years in post-compulsory education settings in the north of England. Data from the interviews was analysed using a post-structuralist type of discourse analysis drawing on a feminist perspective. Findings and Discussion The young women constructed their accounts of health and risk by drawing on idealised feminine constructs and there are three central and closely related discursive patterns in the data. The first one draws on moral constructions of what it means to be healthy; the second draws on representations of a socially constructed westernised feminine ideal; and the final one constructs risk taking in terms of health as resistance to dominant discourse. These three discursive patterns will be explored. We argue that the way in which the young women talk about health and risk has implications in contemporary western society for policy direction and the future of research in this area. A shift in focus is required away from pathologising individual behaviours and towards taking into account a) the meaning that young women attach to their health practices and b) the wider context in which these are carried out and experienced.

This book focuses on the impacts of the built environment, and how to predict and measure the benefits and consequences of changes taking place to address sustainability in the development and building industries.

BACKGROUND: GPs commonly see patients with knee problems. Magnetic resonance imaging (MRI) of the knee is an accurate diagnostic test for meniscus and ligament injuries of the knee, but there is uncertainty about the appropriate use of MRI and when it should enter the diagnostic pathway for patients with these problems. AIM: To assess the effectiveness of GP referral to early MRI and a provisional orthopaedic appointment, compared with referral to an orthopaedic specialist without prior MRI for patients with continuing knee problems. Design of study: Pragmatic multicentre randomised trial with two parallel groups. SETTING: A total of 553 patients consulting their GP about a continuing knee problem were recruited from 163 general practices at 11 sites across the UK. METHOD: Patients were randomised to MRI within 12 weeks of GP referral including a provisional orthopaedic appointment, or orthopaedic appointment without prior MRI within a maximum of 9 months from GP referral. The primary outcome measures were the Short Form 36-item (SF-36) physical functioning scale and the Knee Quality of Life 26-item Questionnaire (KQoL-26) at 6, 12, and 24 months. RESULTS: Patients randomised to MRI improved mean SF-36 physical functioning scores by 2.81 (95% confidence interval [CI] = -0.26 to 5.89) more than those referred to orthopaedics (P = 0.072). Patients randomised to MRI improved mean KQoL-26 physical functioning scores by 3.65 (95% CI = 1.03 to 6.28) more than controls (P = 0.007). There were no other significant differences. CONCLUSION: GP access to MRI yielded small, but statistically significant, benefits in patients' knee-related quality of life but non-significant improvements in physical functioning.

The recent focus in the UK on young women’s ‘risky’ health practices as problematic lends itself to an examination of how they make sense of health and risk themselves. In relation to the conference theme of (dis) embodiment, this paper discusses a central discursive pattern within the data from 22 in-depth interviews with young women aged 18 to 24 years about health and risk. We will present data showing how young women construct risk taking in a more resistant and agentic, rather than problematic, way. Lupton’s (1999) definition of risk as ‘that which threatens the integrity of the body’ will be used to explore the young women’s understandings of the embodiment of risk in health and health practices. This includes risk experienced as both a threat to the integrity of the healthy self as well as embodied feminine identity but also as a means of experiencing being ‘alive’.

Objectives: In recent times attention has focused more and more on the so-called risky health practices that young women are engaging in and this serves to problematise a range of individual behaviours. The primary objective of this paper is to examine the discursive constructions young women draw upon to make sense of their experiences of risk in relation to health. Design: This was a qualitative study using in-depth interviews. Methods: 22 interviews were carried out with young women aged 18 to 24 years in further education settings. Drawing on a feminist perspective, a post-structuralist type of discourse analysis was used to analyse the data. Results: This paper focuses on two overarching, and closely related, discursive patterns within the data which are central to how the young women present themselves in relation to risk and health. The first one is significantly moralised and, using this, the young women negotiate the territory between what it means to be good and bad. The second discursive pattern draws significantly on representations of a socially constructed feminine ideal and heavily gendered notions of health and risk. Conclusions: Both discursive patterns can be seen as illustrative of the way that young women do health and gender and how they negotiate risky health practices in and through their talk whilst trying to resist a stigmatised identity. A consideration for both current public health policy and future research is that a change is required away from a focus on individual behaviour to exploring the meaning of different health practices and the implications of this.

Dr Fiona Fylan

This book tackles the challenges posed by accelerating urbanization, and demystifies Social Sustainability, the least understood of all the different areas of sustainable development.

The whole-life sustainability of a building should be underpinned with a demonstration of functional value and an awareness of the direct environmental impact. While a great deal of energy and resources are consumed in the construction of buildings, this is marginal when compared to the operation costs and associated energy used during a building's life cycle. Many reports identify the build costs and associated resources to be less than 1 % of the whole-life operation costs. The exact energy use of a building can vary widely, depending on the use, energy efficiency of the building and occupant behaviour; thus, a greater deal of attention should be given to understanding the energy used in buildings and how energy efficient operation is achieved.

To meet targets on fuel poverty, energy efficiency and carbon emissions existing homes need to be more energy efficient. We report the results of a participatory action research project to explore the challenges associated with energy efficiency retrofit programmes and ways to better implement future schemes. Six focus groups were held with 48 participants from a range of energy efficiency roles. Data were analysed thematically using the research question “What are the challenges presented by implementing energy efficiency retrofit programmes”. We identified four themes in the data: Funding mechanisms; Predicting performance; Installation; and People. Challenges include funding mechanisms for retrofit programmes resulting in insufficient time to plan, publicise, implement and evaluate a scheme and insufficient flexibility to specify the most appropriate intervention for individual homes. Site workers sometimes need to adapt retrofit designs because of insufficient detail from the designer and can equate quality of installation with quality of finish. Landlords and occupier behaviour can impact on the programme's success and there is a need for greater information on benefits for landlords and for energy behaviour change interventions run alongside retrofit programmes for occupiers. There is a need for outcome evaluations of retrofit schemes with the results shared with stakeholders.

Leeds was designated a core city for trialling the Government’s Green Deal domestic energy efficiency policy. Leeds Beckett University undertook a monitoring and testing program on 65 dwellings to investigate the effectiveness of the insulation measures installed and to understand any underperformance. This report outlines the findings from a series of investigations including; surveys, air tightness tests, co heating tests, in situ U-value tests, hygrothermal and thermal bridging modelling, in use monitoring and occupant interviews. The surveys revealed that the ‘whole house approach’ to retrofit was, more often, missing, and quality assurance around insulation detailing was regularly absent, leading to avoidable errors and potentially embedding problems in the installations. Furthermore, moisture issues were, in the majority of instances, over-looked or made worse despite over half the sample having some form of damp. Despite this, energy savings were observed and the appearance of the dwellings were improved, thus apparent satisfaction was generally high, even though the installs were imperfect and moisture problems were introduced. Hygrothermal modelling of IWI cases suggests that thermal bridging at party walls can increase by more than 60% and that there could be potential for rot to embedded timbers. Insulation was recorded to reduce background ventilation of the dwellings by around 25% (a factor unaccounted for in government energy models), although some dwellings were still left with air tightness levels worse than modern day UK Building Regulations limits and replacing wet plaster with IWI was seen to undermine the performance of the insulation. The heat loss coefficient of three homes were tested and showed improvements of 25% and 56% for full retrofits with IWI, and 8% for a party wall retrofit; ¾ of these savings were achieved by fabric improvements and the final quarter from incidentally making dwellings more air tight. The before and after in use monitoring suggested the average savings in energy consumption from all retrofit types (EWI, IWI or other) were between 20% and 29%, although small sampling periods limits the certainty of the results. More reliably it was observed that comfort conditions improved; before the retrofit, 14 of the homes were experiencing discomfort from cold; the retrofit brought on average 2 /3 of uncomfortable homes into more reasonable comfort bands. Nearly all of the occupants had positive experiences, although no householders had to pay for the retrofit, reporting being warmer, bringing unused rooms back into operation and feeling more pride in their homes and communities. A variety of perceptions and behaviours were observed around set point temperatures, use of heating controls and motivations for using energy, all of which contribute to make a complex policy landscape. There is huge potential for domestic retrofit and although this research suggests the current

The benefits and risks associated with installing internal wall insulation (IWI) and thin internal wall insulation (TIWI) retrofits into solid wall homes are researched and evaluated for BEIS. In order to deliver this, a holistic approach was adopted and the project was split into four main sections, each of which has an accompanying Annex to this summary report: Annex A: Review of existing literature as well as primary investigations using house surveys, householder questionnaires and installer focus groups into the sociotechnical barriers to IWI and TIWI. Annex B: Technical evaluation of the performance of IWI and six novel TIWI retrofits installed in field trial solid wall Test Houses using before and after building performance evaluations. Annex C: Modelling of the impact on annual energy consumption, EPC rating, overheating risk, condensation risk and moisture accumulation made by IWI and TIWI retrofits in a range of UK house archetypes. Annex D: Laboratory testing of test walls using hygrothermal chambers to quantify the change in moisture and thermal performance of solid brick walls when they are insulated with IWI and TIWI to determine how weather

Thermal performance is often assumed to be constant over the service life of insulation. The aim of this project was to establish the existing evidence on the impact of retrofit degradation over time, and what it means for insulation performance. This report summarises current understanding, classifying key mechanisms for degradation and makes recommendations for how to address identified knowledge gaps.