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Objective: Through interviews with older adults and professionals in Chongqing, China, this paper explores the challenges and opportunities faced by smart cities that undertake to better support ageing‐in‐place. Methods: We undertook a qualitative multi‐methods approach, engaging 46 professional stakeholders and 64 older people to examine the role of smart cities in enabling older people to age‐in‐place in Chongqing, China. Results: With the development of smart cities, technology has the potential to facilitate ageing‐in‐place by creating opportunities for heathy and active ageing. This study identified specific priorities in delivering age‐friendly smart cities, including the following: shaping smart environments around the everyday lives of older people, designing inclusive and equitable smart cities and ensuring strong forms of institutional governance, trust and relationship building with older people. Conclusions: The age‐friendly city and communities movement (AFCC) and smart city policy instruments have potential for realising active ageing by supporting mobility, access to services and civic participation. However, there exists a disconnect between smart city policy and practice in delivering tangible well‐being outcomes for older people. Addressing this requires greater cross‐sectoral working, reconciling smart city policy priorities with AFCC domains and creating the institutional and governance framework to enable socially sustainable cities to support ageing‐in‐place. [ABSTRACT FROM AUTHOR]

A global ageing population presents opportunities and challenges to designing urban environments that support ageing in place. The World Health Organization's Global Age-Friendly Cities movement has identified the need to develop communities that optimise health, participation and security in order to enhance quality of life as people age. Ensuring that age-friendly urban environments create the conditions for active ageing requires cities and communities to support older adults' rights to access and move around the city ('appropriation') and for them to be actively involved in the transformation ('making and remaking') of the city. These opportunities raise important questions: What are older adults' everyday experiences in exercising their rights to the city? What are the challenges and opportunities in supporting a rights to the city approach? How can the delivery of age-friendly cities support rights to the city for older adults? This paper aims to respond to these questions by examining the lived experiences of older adults across three cities and nine neighbourhoods in the United Kingdom. Drawing on 104 semi-structured interviews with older adults between the ages of 51 and 94, the discussion centres on the themes of: right to use urban space; respect and visibility; and the right to participate in planning and decision-making. These themes are illustrated as areas in which older adults' rights to access and shape urban environments need to be addressed, along with recommendations for age-friendly cities that support a rights-based approach. [ABSTRACT FROM AUTHOR]

The article provides a novel look at the links between salutogenesis, health promotion, and urban design supported by the findings of recent research on local high streets and their benefits for the well-being of older people. Salutogenesis and the related explanatory concept of sense of coherence (SOC) have provided a theoretical framework for developing healthy settings interventions, shifting the focus from exploring barriers and deficits to assets and resources in promoting people's health and well-being. While these concepts have informed policies and programmes at the level of regions and cities, no attempt has been made to establish more direct links with the disciplines devoted to the organization and design of the built environment at the scale of public spaces and streets. This article advances the idea that the main categories of SOC—comprehensibility, manageability and meaningfulness—have found application in urban design theory. Linking these categories with urban design concepts in a comprehensive framework, it is possible to guide interventions aimed at strenghtening well-being resources available in the public realm. This is corroborated by the findings resulting from a study of the well-being experiences of older people (n = 84) across a range of local high streets in the city of Edinburgh (UK) applying an innovative multi-methods approach. The discussion establishes the links between well-being benefits, SOC constructs and urban design concepts, and underscores the potential of the proposed framework to guide a design-oriented salutogenic approach to the built environment. [ABSTRACT FROM AUTHOR]

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Background and Objectives The age-friendly cities and communities (AFCC) agenda has led to a range of policy initiatives aimed at supporting aging in place for older people. While there is case study evidence of how people age across urban contexts, there has been little research exploring cross-national understandings of age-friendly places among older people. The objective of this article is to identify the place experiences of older people living across cities and communities in India, Brazil, and the United Kingdom and to discuss implications for the AFCC agenda. Research Design and Methods A total of 300 semistructured interviews were undertaken with older people across 9 cities and 27 communities in India, Brazil, and the United Kingdom. The data were analyzed using thematic analysis undertaken by each national team and then discussed and revised at collaborative workshops with researchers from each of the 3 country teams. Results The data capture the ways in which place is constructed from the perspective of older people drawing upon social, community, and cultural dimensions of aging across diverse urban environments. We explore how older people negotiate place in the context of their everyday life and identify the relational and interconnected ways in which place attachment, belonging, and identity are constructed. Discussion and Implications Age-friendly interventions need to attend to the changing physical, social and cultural dimensions of aging and place. Integrated place-making practices are required to support older people to age in the right place across rapidly transforming urban contexts globally. [ABSTRACT FROM AUTHOR]

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The age-friendly cities and communities movement has focused on how to better support older adults to age well within urban environments. Central to 'ageing well' and 'active ageing' agendas is ensuring that older adults can participate in meaningful forms of social participation. The benefits of social participation in old age have been well documented, and research amongst community-dwelling older adults has explored some of the neighbourhood qualities that facilitate or impede such forms of engagement. However, understandings of how older adults construct and negotiate social participation within everyday urban environments have been largely unexplored. To address this gap, we present results from 104 interviews conducted with older adults living in three cities and nine neighbourhoods in the United Kingdom (UK). The findings explore three themes generated from the research: 'constructing meaningful social participation in old age', 'negotiating access to social participation' and 'navigating home and community'. Across these themes, the paper describes how experiences of social participation in old age involve a number of inter-connected physical, psychological and social processes experienced by individuals across a range of environmental settings including the home, outdoor spaces and community facilities. The paper concludes by discussing the implications of the findings for practice, specifically in the delivery of age-friendly communities. [ABSTRACT FROM AUTHOR]

Developing urban environments that promote healthy, active living for older adults is at the forefront of global planning policy debates, resulting in concepts and design guidelines to support population ageing. However, current urban planning in India is overlooking the design of age-friendly cities. The share of older adults in India is estimated to increase from 8 per cent in 2015 to 20 per cent in 2050. This demographic shift towards a higher proportion of older adults and the associated health and social care expenditures make healthy ageing a public health priority. Existing studies in gerontology have focused on improving housing environments, but we are now understanding the significance of neighbourhood environments for active ageing. This study contributes to the knowledge on factors shaping active ageing in urban India. We present findings from 55 semi-structured interviews conducted with older adults (age > 60 years) in the metropolitan cities of New Delhi and Chennai in India. The findings explore three themes that emerged from this research: (a) neighbourhood design for active ageing, (b) social participation in community spaces and (c) navigating urban transport and mobility. Across these themes, this study highlights that access to neighbourhood amenities such as transportation, parks and green spaces, and opportunities for leisure and social interaction play a key role in determining older adults' health and quality of life. In drawing on older adults' lived experiences in their communities, this study informs policy efforts to improve neighbourhood supports for active ageing in urban India. [ABSTRACT FROM AUTHOR]

The ageing in place agenda emphasises the importance of supporting older adults to age in their communities surrounded by the personal resources to age well. In exploring the relationship between older people and their environment, the concept of place insideness is seen as central to constructing feelings of identity, belonging and attachment in old age. Yet there has been little research exploring how older adults experience place insideness across different urban, social and cultural contexts which is an impediment to identifying effective interventions for age-friendly cities and communities. This article explores how place insideness is experienced amongst older adults across India, Brazil and the United Kingdom. The article presents qualitative findings from 294 semi-structured interviews collected across 9 cities and 27 neighbourhoods. The findings reveal that older adults cultivate their sense of place insideness in old age through dimensions of physical insideness (i.e., environmental competence in navigating and engaging in the community), social insideness (i.e., knowing others) and autobiographical insideness (i.e., shared place histories). In drawing on older people's understanding of their communities, this article explores the opportunities and challenges in developing a sense of place insideness to support ageing well. We identify implications for policy and practice in terms of how we can better design urban environments as age-friendly communities which support a greater sense of place for older people. [ABSTRACT FROM AUTHOR]

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Background: There is a need to develop innovative solutions to enhance safe and green physical environments, which optimise health, wellbeing and community participation among older adults. To develop solutions that meet the needs of a diverse ageing population, an interdisciplinary approach is needed. Our aim was to identify the needs of older people in relation to ageing well in the environment by bringing together knowledge from different perspectives using Patient and Public Involvement. Methods: An international consortium (Retrofit living For ageing well through Understanding and Redesign of Built environments consortium: ReFURB) was established in April 2018, including ten core members, to (i) explore cutting-edge solutions to safe living for ageing populations and (ii) develop innovative approaches to everyday physical environments, which bring about health benefits. We used a co-design, interdisciplinary framework involving older adults, carers, physiotherapists, geriatricians, engineers, human movement experts, geographers and psychologists from the UK and Australia. This engaged people in a 1 day workshop that comprised a series of presentations from international speakers on urban design, social connectedness, hazards and injury prevention, and the physical environment. Small group discussions (facilitated by consortium members) followed presentations to consider the opportunities, challenges and barriers encountered with ageing, which included the use of creative engagement activities (LEGO® Serious Play, mind maps, poster gallery walk), to help participants share personal stories and reflect on the issues raised. Thematic coding was used to synthesise the outputs of the small group work. Results: Five themes were identified across the workshops: access and transport; involvement of the whole community; restoration rather than redesign; assistive and digital technology; and intergenerational approaches. These dimensions related to the physical, social and nature-based qualities of everyday environments, as they pertain to ageing well. Conclusions: Co-design was a valuable tool that helped understand the perceptions of participants and essential to develop effective interventions and solutions. Participants highlighted several issues affecting people as they age and key environmental considerations to promote wellbeing, activity, and participation. The consortium identified gaps in the existing evidence base and are now planning activities to further develop research ideas in collaboration with our co-design participants. [ABSTRACT FROM AUTHOR]

Although moving from institutional to home-like long-term care (LTC) settings can promote and sustain the health and wellbeing of older adults, there has been little research examining how home is perceived by older adults when moving between care settings. A qualitative study was conducted over a two-year period during the relocation of residents and staff from an institutional LTC home to a purpose-built LTC home in Western Canada. The study explored perceptions of home amongst residents, family members and staff. Accordingly, 210 semi-structured interviews were conducted at five time-points with 35 residents, 23 family members and 81 staff. Thematic analyses generated four superordinate themes that are suggestive of how to create and enhance a sense of home in LTC settings: (a) physical environment features; (b) privacy and personalisation; (c) autonomy, choice and flexibility; and (d) connectedness and togetherness. The findings reveal that the physical environment features are foundational for the emergence of social and personal meanings associated with a sense of home, and highlight the impact of care practices on the sense of home when the workplace becomes a home. In addition, tension that arises between providing care and creating a home-like environment in LTC settings is discussed. [ABSTRACT FROM AUTHOR]

Copyright of PsyEcology is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Pixo: Revista de Arquitetura Cidade e Contemporaneidade is the property of Pixo Revista de Arquitetura Cidade e Contemporaneidade and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose of the Study: Home and community engagement are key contextual factors for aging well, particularly for older adults in vulnerable social positions. A community-based participatory action research project conducted in Western Canada examined how to best use the shared amenity spaces in a low-income seniors' apartment complex in order to connect services and programs with tenants and to provide opportunities for service providers and local stakeholders to build upon and create new relationships toward collaboration and service delivery. Design and Methods: Pre-move deliberative dialogue workshops (n = 4) were conducted with stakeholders (e.g., service providers, developers, and municipal government employees). Workshop participants (n = 24) generated ideas and plans on how physical and social environments can contribute to the social engagement of senior tenants. Results: Shared dialogue led to community investment and asset sharing by integrating the knowledge and experiences of multiple stakeholder groups into the planning process. This article highlights how collaborative planning approaches for the effective use of the social environment (e.g., social programming), within the physical environment (e.g., amenity and community spaces), can generate rich and illuminating data for informing enhancements in the social environment of apartment dwelling low-income seniors. Contextual challenges to service provision are discussed, including the need for communication about and coordination of on-site programming, culturally diverse and responsive programming, and longterm funding. Implications: Prolonging independent community living with the assistance of support services should be a goal to both delay premature relocation into institutional care and meet the preferences of older adults. [ABSTRACT FROM AUTHOR]

Objective: Long-term care (LTC) facilities are increasingly intent on creating a “homelike” atmosphere for residents. Although residential staff are integral to the construction of a home within LTC settings, their perceptions have been relatively absent from the literature. Method: Thirty-two LTC staff participants were interviewed about their experiences and perceptions of the physical environment and conceptualizations of home, and thematic analyses were conducted. Results: An overarching category—interpersonal relationships—emerged from our analyses emphasizing the importance of relationships in creating a homelike environment within institutional settings. Sub-themes that inform our understanding include the following: (a) Staff members’ perceptions of home; (b) “Their second home”: Adjustment to and familiarity in LTC; and (c) “We become family”: Relationality makes a home. Discussion: The study provides evidence to inform current policies and practices in LTC. Specifically, enough time and space should be given to residents and staff to create and maintain personal relationships to make residential care homelike. [ABSTRACT FROM AUTHOR]

Purpose The provision of home and community supports can enable people to successfully age-in-place by improving physical and mental health, supporting social participation and enhancing independence, autonomy and choice. One challenge concerns the integration of place-based supports available as older people transition into affordable housing. Sustainable solutions need to be developed and implemented with the full involvement of communities, service organizations and older people themselves. Partnership building is an important component of this process. The purpose of this paper is to detail the intricacies of developing partnerships with low-income older people, local service providers and nonprofit housing associations in the context of a Canadian housing development.Design/methodology/approach A community-based participatory approach was used to inform the data collection and partnership building process. The partnership building process progressed through a series of democratized committee meetings based on the principles of appreciative inquiry, four collaboration cafés with nonprofit housing providers and four community mapping workshops with low-income older people. Data collection also involved 25 interviews and 15 photovoice sessions with the housing tenants. The common aims of partnership and data collection were to understand the challenges and opportunities experienced by older people, service providers and nonprofit housing providers; identify the perspectives of service providers and nonprofit housing providers for the provision and delivery of senior-friendly services and resources; and determine actions that can be undertaken to better meet the needs of service providers and nonprofit housing providers in order to help them serve older people better.Findings The partnership prioritized the generation of a shared vision together with shared values, interests and the goal of co-creating meaningful housing solutions for older people transitioning into affordable housing. Input from interviews and photovoice sessions with older people provided material to inform decision making in support of ageing well in the right place. Attention to issues of power dynamics and knowledge generation and feedback mechanisms enable all fields of expertise to be taken into account, including the experiential expertise of older residents. This resulted in functional, physical, psychological and social aspects of ageing in place to inform the new build housing complex.Research limitations/implications The time and effort required to conduct democratized partnerships slowed the decision-making process.Originality/value The findings confirm that the drive toward community partnerships is a necessary process in supporting older people to age well in the right place. This requires sound mechanisms to include the voice of older people themselves alongside other relevant stakeholders. Ageing well in a housing complex requires meaningful placemaking to include the functional, physical, psychological and social aspects of older people’s everyday life in respect to both home and community. [ABSTRACT FROM AUTHOR]

Purpose: Falls and their associated injuries represent a significant cost and care burden in long-term care (LTC) settings. The evidence base for how and why falls occur in LTC, and for the design of effective interventions, is weakened by the absence of objective data collected on falls. Design and Methods: In this article, we reflect on the potential utility of video footage in fall investigations. In particular, we report on findings from a Canadian Institute for Health Research-funded research project entitled "Technology for Injury Prevention in Seniors," detailing 4 distinct methodological approaches where video footage of real-life falls was used to assist in identifying the circumstances and contributory factors of fall events in LTC: questionnaire-driven observational group analysis; video-stimulated recall interviews and focus groups; video observations of the resident 24 hr before the fall; and video incorporated within a comprehensive systemic falls investigative method. Results and Implications: We describe various ways in which video footage offers potential for both care providers and researchers to help understand the cause and prevention of falls in LTC. We also discuss the limitations of using video in fall investigations, including the logistical, practical, and ethical concerns arising from such an approach. [ABSTRACT FROM AUTHOR]

There is a long history of surveillance of older adults in institutional settings and it is becoming an increasingly common feature of modern society. New surveillance technologies that include activity monitoring, and ubiquitous computing, which are described as ambient assisted living (AAL), are being developed to provide unobtrusive monitoring and support of activities of daily living and to extend the quality and length of time older people can live in their homes. However, concerns have been raised with how these kinds of technologies may affect user's privacy and autonomy. The objectives of this paper are (a) to describe the development of home-based surveillance technologies; (b) to examine how surveillance is being restructured with the use of this technology; and (c) to explore the potential outcomes associated with the adoption of AAL as a means of surveillance by drawing upon the theoretical work of Foucault and Goffman. The discussion suggests that future research needs to consider two key areas beyond the current discourse on technology and ageing, specifically: (a) how the new technology will encroach upon the private lived space of the individual, and (b) how it will affect formal and informal caring relationships. This is critical to ensure that the introduction of AAL does not contribute to the disempowerment of residents who receive this technology. [ABSTRACT FROM PUBLISHER]

Background Older adults living in long term care (LTC) settings are vulnerable to fall-related injuries. There is a need to develop and implement evidence-based approaches to address fall injury prevention in LTC. Knowledge translation (KT) interventions to support the uptake of evidence-based approaches to fall injury prevention in LTC need to be responsive to the learning needs of LTC staff and use mediums, such as videos, that are accessible and easy-touse. This article describes the development of two unique educational videos to promote fall injury prevention in long-term care (LTC) settings. These videos are unique from other fall prevention videos in that they include video footage of real life falls captured in the LTC setting. Methods Two educational videos were developed (2012-2013) to support the uptake of findings from a study exploring the causes of falls based on video footage captured in LTC facilities. The videos were developed by: (1) conducting learning needs assessment in LTC settings via six focus groups (2) liaising with LTC settings to identify learning priorities through unstructured conversations; and (3) aligning the content with principles of adult learning theory. Results The videos included footage of falls, interviews with older adults and fall injury prevention experts. The videos present evidence-based fall injury prevention recommendations aligned to the needs of LTC staff and: (1) highlight recommendations deemed by LTC staff as most urgent (learner-centered learning); (2) highlight negative impacts of falls on older adults (encourage meaning-making); and, (3) prompt LTC staff to reflect on fall injury prevention practices (encourage critical reflection). Conclusions Educational videos are an important tool available to researchers seeking to translate evidence-based recommendations into LTC settings. Additional research is needed to determine their impact on practice. [ABSTRACT FROM AUTHOR]

Background: Long-term oxygen therapy (LTOT) extends life in patients with chronic obstructive pulmonary disease with severe hypoxaemia. Questionnaire-based studies of the effects of LTOT have not suggested uniformly positive findings. The few qualitative studies suggest that patients report benefits but also concerns about dependency on oxygen therapy. The aim of the study was to explore the views and experiences of COPD patients, their carers and the healthcare professionals who deliver these services, on the long-term use of oxygen therapy.Methods: Focus groups were conducted with 16 patients with from the LTOT service, six carers, and nine healthcare professionals (n = 31). Eleven patients with COPD, four carers and one staff manager (n = 16) participated in semi-structured interviews. Interviews and focus group were digitally recorded and field notes were taken. Data were analysed using the thematic network analysis approach.Results: Patients and carers reported the benefits of LTOT including increased social activity, perceived improvements in health status and self-management in routine daily activities. Concerns were raised regarding stigma, dependency on LTOT and deterioration in health status. Staff accounts included negative perceptions, suggesting that LTOT was often inappropriately prescribed and under-used but recommended active patient management to address this challenge.Conclusions: LTOT has some beneficial effects in improving daily activities and social interaction of patients with COPD but also some limitations. Increased support and monitoring by healthcare professionals would address some concerns, as would better information for patients, carers and the general public. [ABSTRACT FROM AUTHOR]

Purpose – Despite the growing area of research involving falls in the residential care setting, the link between contextual and environmental factors in falls is poorly understood. This paper aims to draw upon existing research being undertaken in long-term care (LTC) in Metro Vancouver, Canada, with a particular focus on identifying contextual factors contributing to fall events. Design/methodology/approach – This paper presents the results of a qualitative observational analysis of video-captured data collected through a network of high-quality video systems in two LTC facilities. The research comprised workshops involving experienced researchers who reviewed six video sequences of fall events. The outcome of the workshops was a written narrative summarizing the discussion and researchers' interpretation of fall sequences. Findings – The analysis indicates that there are a broad range of environmental, behavioral and situational factors that contribute to falls in LTC. This suggests that a limited conceptualization of a fall as an outcome of the person's impairment and environmental hazards fails to convey the complexity of potential contributory factors typical of most fall incidents. Research limitations/implications – Broadening our understanding of falls provides the potential to make recommendations for falls prevention practice across multiple levels, including the individual, social and organizational context. Originality/value – The paper evaluates the potential of video-based data in fall analysis and points to the development of a case study approach to analyzing fall incidents to capture the complex nature of contributory factors beyond research that focuses solely on intrinsic and extrinsic risk factors. [ABSTRACT FROM AUTHOR]

Purpose Policy has identified the need for integrated dementia services for older people. However, the role of the formal cater within an integrated framework of service delivery has not been well articulated in practice. The aim of this paper is to understand the experiences of formal carers working with the context of an integrated dementia service by exploring findings from a research-based evaluation. Design/methodology/approach - The evaluation captured the experiences of formal carers working within the service via observations, semi-structured interviews and focus groups. Findings - Working with an integrated service brings about individual, social and organisational challenges to the role of the formal carer, in terms of: delivering flexibility and responsiveness, providing continuity of care, ensuring cross-organisational working and acquiring skills, knowledge and expertise. Originality/value - To facilitate the successful delivery of integrated care, the emerging role of the formal carer needs to be more clearly articulated and supported within a service context. [ABSTRACT FROM AUTHOR]

Purpose - The concepts of well-being and participation are prevalent in current regeneration policy, being seen as crucial to alleviating disadvantage and marginalisation in deprived communities. However little is understood about how such ambiguous concepts are articulated within urban regeneration practice. This paper seeks to present a reflective case study of research in a New Deal for Communities (NDC) area designed to understand different conceptualisations of well-being and participation in community places and regeneration practices. Design/methodology/approach - The perspectives of regeneration professionals, local residents and academics were revealed through the development of a multi-method and participatory research approach using interviews, observations, video diaries and workshops. An action oriented event aimed at developing overlapping communities of practice was held to engage in active dialogue and develop shared understandings between the resident, professional and academic communities. Findings - Conceptualisations of well-being and participation articulated through regeneration policy and practice between the different stakeholder groups are contradictory. The absence of a shared vision for regeneration and differing expectations of participation can have detrimental effects on both the well-being of local residents and the sustainability of the long-term participation of local residents in the regeneration process. This challenges the recent government approach to creating a Big Society which is underpinned by devolved decision making and the desire for local leadership through realising the potential of communities. Originality/value - The research has helped to create new relationships between residents and professionals organised around joint working and changed practice. [ABSTRACT FROM AUTHOR]

Literature suggests that the successful transformation of inner city areas is dependent upon regeneration professionals closely involving local residents, within a sprit of genuine partnership working. Yet urban regeneration programmes have been largely criticised for the way resident engagement and participation have been conducted, leading to debate on the requisite skillset of the regeneration professional. Undertaking semi-structured interviews with regeneration professionals in an area of the north-west of England with an established urban regeneration company, this paper examines the challenges that professionals encountered facilitating community involvement. The findings identified professional, institutional and organisational barriers that prevented regeneration professionals from mobilising the necessary tools, expertise and knowledge to practise effective engagement, including the absence formal training, limited opportunity for peer-to-peer reflection and the lack of role freedom. Addressing these barriers is fundamental to ensuring that regeneration professionals can share and negotiate meaningful forms of community participation and engagement. [ABSTRACT FROM AUTHOR]

We evaluated a commercially-available monitoring system for older people with dementia living at home. The system was designed to detect problems before they require crisis intervention. Fourteen clients from two healthcare organisations in the Netherlands used the system over a 9-month period. The formal and informal caregivers were interviewed, project group meetings were observed, nurse diaries were analysed and a cost analysis performed. Clients and informal caregivers reported enhanced feelings of safety and security as a result of having the system installed in the home. The system appeared to reduce the burden of care on the informal caregiver and had the potential to allow people to live at home for longer. There were financial savings for clients staying at home with the technology compared with the costs of staying in a nursing home: for 10 clients living at home for 2 months, the savings were 23,665 euro. The study showed that the monitoring system represents a potentially useful early warning system to detect a situation before it requires emergency intervention. [ABSTRACT FROM AUTHOR]

Background: Meningitis is characterized by an inflammation of the meninges, or the membranes surrounding the brain and spinal cord. Early diagnosis and treatment is crucial for a positive outcome, yet identifying meningitis is a complex process involving an array of signs and symptoms and multiple causal factors which require novel solutions to support clinical decision-making. In this work, we explore the potential of fuzzy cognitive map to assist in the modeling of meningitis, as a support tool for physicians in the accurate diagnosis and treatment of the condition.Methods: Fuzzy cognitive mapping (FCM) is a method for analysing and depicting human perception of a given system. FCM facilitates the development of a conceptual model which is not limited by exact values and measurements and thus is well suited to representing relatively unstructured knowledge and associations expressed in imprecise terms. A team of doctors (physicians), comprising four paediatricians, was formed to define the multifarious signs and symptoms associated with meningitis and to identify risk factors integral to its causality, as indicators used by clinicians to identify the presence or absence of meningitis in patients. The FCM model, consisting of 20 concept nodes, has been designed by the team of paediatricians in collaborative dialogue with the research team.Results: The paediatricians were supplied with a form containing various input parameters to be completed at the time of diagnosing meningitis among infants and children. The paediatricians provided information on a total of 56patient cases amongst children whose age ranged from 2 months to 7 years. The physicians' decision to diagnose meningitis was available for each individual case which was used as the outcome measure for evaluating the model.The FCM was trained using 40 cases with an accuracy of 95%, and later 16 test cases were used to analyze the accuracy and reliability of the model. The system produced the results with sensitivity of 83.3% and specificity of 80%.Conclusions: This work suggests that the application and development of a knowledge based system, using the formulization of FCMs for understanding the symptoms and causes of meningitis in children and infants, can provide a reliable front-end decision-making tool to better assist physicians. [ABSTRACT FROM AUTHOR]

Copyright of Community, Work & Family is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose – The purpose of this paper is to offer a critical overview of claims and counter claims around increased expectations that the third sector organisations (TSOs) will compete for contracts to deliver public services. It does this through the lens of contested notions of being "businesslike" and "entrepreneurial" across the public and third sectors. Then it assesses how some of these tensions are currently played out between public sector commissioners and third sector service providers. Design/methodology/approach – This paper is based on a one-year project funded under the ESRC Business Engagement Opportunities scheme (2009-2010) in which the authors are working with NHS Manchester (responsible for commissioning and directing NHS funds into a wide range of services for communities across the city) and local third sector delivery and infrastructure organisations. The project consists of a set of knowledge exchange activities (scoping, workshops, placements and an on-line tool) intended to help NHS Manchester reshape its local provider profile through market making and commissioning new service contracts from TSOs, especially social enterprises. Preliminary findings are reported from the review of academic and policy literature that formed the scoping stage of this project. Findings – Public sector commissioners and TSOs often struggle to make sense of each others' world views and working assumptions. This cannot be easily overcome but ways of improving dialogue are proposed through exploration of third sector outcomes and entrepreneurial language, practices and mindsets. Originality/value – This paper offers a new, grounded reflection on the nexus of public sector contracts, entrepreneurship and third sector values. [ABSTRACT FROM AUTHOR]