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Physical inactivity has been identified as a leading risk factor for premature mortality globally, and adolescents, in particular, have low physical activity levels. Schools have been identified as a setting to tackle physical inactivity. Economic evidence of school-based physical activity programmes is limited, and the costs of these programmes are not always collected in full. This paper describes a micro-costing and cost-consequence analysis of the ‘Girls Active’ secondary school-based programme as part of a cluster randomised controlled trial (RCT). Micro-costing and cost-consequence analyses were conducted using bespoke cost diaries and questionnaires to collect programme delivery information. Outcomes for the cost-consequence analysis included health-related quality of life measured by the Child Health Utility-9D (CHU-9D), primary care General Practitioner (GP) and school-based (school nurse and school counsellor) service use as part of a cluster RCT of the ‘Girls Active’ programme. Overall, 1,752 secondary pupils were recruited and a complete case sample of 997 participants (Intervention n = 570, Control n = 427) was used for the cost-consequence analysis. The micro-costing analysis demonstrated that, depending upon how the programme was delivered, ‘Girls Active’ costs ranged from £1,054 (£2 per pupil, per school year) to £3,489 (£7 per pupil, per school year). The least costly option was to absorb ‘Girls Active’ strictly within curriculum hours. The analysis demonstrated no effect for the programme for the three main outcomes of interest (health-related quality of life, physical activity and service use).Micro-costing analyses demonstrated the costs of delivering the ‘Girls Active’ programme, addressing a gap in the United Kingdom (UK) literature regarding economic evidence from school-based physical activity programmes. This paper provides recommendations for those gathering cost and service use data in school settings to supplement validated and objective measures, furthering economic research in this field. Trial registration: -ISRCTN, . [ABSTRACT FROM AUTHOR]

Background: Childhood obesity is a serious public health challenge and schools have been identified as an ideal place to implement prevention interventions. The aim of this study was to measure the cost-effectiveness of a multi-faceted school-based obesity prevention intervention targeting children aged 6–7 years when compared to ‘usual activities’. Methods: A cluster randomised controlled trial in 54 schools across the West Midlands (UK) was conducted. The 12-month intervention aimed to increase physical activity by 30 minutes per day and encourage healthy eating. Costs were captured from a public sector perspective and utility-based health related outcomes measured using the CHU-9D. Multiple imputation using chained equations was used to address missing data. The cost effectiveness was measured at 30 months from baseline using a hierarchical net-benefit regression framework, that controlled for clustering and prespecified covariates. Any uncertainty in the results was characterised using cost-effectiveness acceptability curves. Results: At 30 months, the total adjusted incremental mean cost of the intervention was £155 (95% confidence interval [CI]: £139, £171), and the incremental mean QALYs gained was 0.006 (95% CI: -0.024, 0.036), per child. The incremental cost-effectiveness at 30 months was £26,815 per QALY and using a standard willingness to pay threshold of £30,000 per QALY, there was a 52% chance that the intervention was cost-effective. Conclusions: The cost-effectiveness of the school-based WAVES intervention was subject to substantial uncertainty. We therefore recommend more research to explore obesity prevention within schools as part of a wider systems approach to obesity prevention. Trial registration: This paper uses data collected by the WAVES trial: Controlled trials (registered May 2010). [ABSTRACT FROM AUTHOR]

Background: Patient and public involvement (PPI) is a requirement for UK health and social care research funding. Evidence for how best to implement PPI in research programmes, such as National Institute for Health Research (NIHR) Collaborations for Applied Health Research and Care (CLAHRCs), remains limited. This paper reports findings from an action research (AR) project called IMPRESS, which aims to strengthen PPI within CLAHRC East of England (EoE). IMPRESS combines AR with Normalisation Process Theory (NPT) to explore PPI within diverse case study projects, identifying actions to implement, test and refine to further embed PPI. Methods: We purposively selected CLAHRC EoE case study projects for in-depth analysis of PPI using NPT. Data were generated from project PPI documentation, semi-structured qualitative interviews with researchers and PPI contributors and focus groups. Transcripts and documents were subjected to abductive thematic analysis and triangulation within case. Systematic across case comparison of themes was undertaken with findings and implications refined through stakeholder consultation. Results: We interviewed 24 researchers and 13 PPI contributors and analysed 28 documents from 10 case studies. Three focus groups were held: two with researchers (n = 4 and n = 6) and one with PPI contributors (n = 5). Findings detail to what extent projects made sense of PPI, bought in to PPI, operationalised PPI and appraised it, thus identifying barriers and enablers to fully embedded PPI. Conclusion: Combining NPT with AR allows us to assess the embeddedness of PPI within projects and programme, to inform specific local action and report broader conceptual lessons for PPI knowledge and practice informing the development of an action framework for embedding PPI in research programmes. To embed PPI within similar programmes teams, professionals, disciplines and institutions should be recognised as variably networked into existing PPI support. Further focus and research is needed on sharing PPI learning and supporting innovation in PPI. [ABSTRACT FROM AUTHOR]

Background: Centile curves and standard scores are common in epidemiological research. However, standardised norms and centile growth curves for language disorder that reflect the entire UK local school population do not exist. Methods: Scores on six language indices assessing receptive and expressive functioning of children were obtained from the SCALES population survey. Monolingual English speaking participants were aged between five and nine years. Children who attended special schools at study intake, or who were learning English as an additional language were excluded. We constructed language norms using the LMS method of standardisation which allows for skewed measurements. We made use of probability weights that were produced from a two-step logistic model. Distributions of estimated standard scores from an intensively assessed sub-population and from the full population were contrasted to demonstrate the role of weights. Results: Non-overlapping centile curves and standardised scores at each age were obtained for the six language indices. The use of weights was essential at retrieving the target distribution of the scores. An online calculator that estimates standardised scores for the measures was constructed and made freely available. Conclusions: The findings highlight the usefulness and flexibility of the LMS method at dealing with the standardisation of linguistic and educational measures that are sufficiently continuous. The paper adds to the existing literature by providing population norms for a number of language tests that were calculated from the same group of individuals. [ABSTRACT FROM AUTHOR]

Background: Speech and language therapy provision for aphasia (a language disorder) post stroke has been studied over time through surveys completed by speech and language therapists. This paper revisits provision based on what was received by 278 patients in 21 UK speech and language therapy departments in 2014–2016. Aims: To explore the speech and language therapy received by community dwelling people with post stroke aphasia in the UK. Methods and procedures: A quantitative content analysis was conducted by two speech and language therapist researchers. Therapy goals recorded were coded into categories and subcategories. Descriptive statistics were used to identify the frequency with which goal categories were targeted, average therapy time received, length and frequency of therapy sessions, personnel involved and mode of delivery. Outcomes and results: Forty-five percent of participants were in receipt of therapy in the three month window observed. Six goal categories were identified. Rehabilitation was the most frequent (60%) followed by enabling (17.2%), review (4.3%), assessment (3.6%), supportive (3.5%) and activity to support therapy (2.8%). The median amount of therapy received in three months was 6.3 hours at an average of one 60-minute session every two weeks. Seventy-seven percent of therapy sessions were delivered by qualified speech and language therapists and 23% by assistants. Ninety percent of sessions were one to one, face to face sessions whilst 9.5% were group sessions. Discussion: In line with previous reports, speech and language therapy for community dwelling stroke survivors with aphasia is restricted. Rehabilitation is a large focus of therapy but the intensity and dose with which it is provided is substantially lower than that required for an effective outcome. Despite this, one to one face to face therapy is favoured. More efficient methods to support more therapeutic doses of therapy are not commonly used in routine clinical services. [ABSTRACT FROM AUTHOR]

Personhood discourses in dementia care have gained prominence and current care home standards mandate that care should be “person-centred”. However, it is unclear how the personhood of staff is construed within the care relationship. This paper aims to explore how the personhood of paid carers of people with dementia can be understood by focussing on the views and experiences of care home staff. We undertook a secondary qualitative analysis of interviews with 25 paid care staff in England, conducted as part of the MARQUE (Managing Agitation and Raising QUality of lifE) study. The authors inductively developed themes around the topic of personhood for staff, contrasting management and care staff perspectives. We found that many care staff are not identified as persons in their own right by their employing institutions, and that there is a general lack of acknowledgment of the moral work of caring that occurs within formal care work. This oversight can reduce the complex relationships of care work to a series of care tasks, challenges care workers’ self-worth and self-efficacy, and impede their efforts to deliver person-centred care. We conclude that care staff status as persons in their own right should be explicitly considered in quality standards and supported by employers’ policies and practices, not simply for their role in preserving the personhood of people with dementia but for their own sense of valued personhood. Enhancing staff personhood may also result in improved care. [ABSTRACT FROM AUTHOR]

Purpose: There is a general inquisition regarding the monetary value of a research output, as a substantial amount of funding in modern academia is essentially awarded to good research presented in the form of journal articles, conferences papers, performances, compositions, exhibitions, books and book chapters etc., which, eventually leads to another question if the value varies across different disciplines. Answers to these questions will not only assist academics and researchers, but will also help higher education institutions (HEIs) make informed decisions in their administrative and research policies. Design and methodology: To examine both the questions, we applied the United Kingdom’s recently concluded national research assessment exercise known as the Research Excellence Framework (REF) 2014 as a case study. All the data for this study is sourced from the openly available publications which arose from the digital repositories of REF’s results and HEFCE’s funding allocations. Findings: A world leading output earns between £7504 and £14,639 per year within the REF cycle, whereas an internationally excellent output earns between £1876 and £3659, varying according to their area of research. Secondly, an investigation into the impact rating of 25315 journal articles submitted in five areas of research by UK HEIs and their awarded funding revealed a linear relationship between the percentage of quartile-one journal publications and percentage of 4* outputs in Clinical Medicine, Physics and Psychology/Psychiatry/Neuroscience UoAs, and no relationship was found in the Classics and Anthropology/Development Studies UoAs, due to the fact that most publications in the latter two disciplines are not journal articles. Practical implications: The findings provide an indication of the monetary value of a research output, from the perspectives of government funding for research, and also what makes a good output, i.e. whether a relationship exists between good quality output and the source of its publication. The findings may also influence future REF submission strategies in HEIs and ascertain that the impact rating of the journals is not necessarily a reflection of the quality of research in every discipline, and this may have a significant influence on the future of scholarly communications in general. Originality: According to the author’s knowledge, this is the first time an investigation has estimated the monetary value of a good research output. [ABSTRACT FROM AUTHOR]

In this paper we explore a relational understanding of landscape qualities. We asked three independent groups of human observers to assess the expressive qualities of a range of landscapes in the UK and in Spain, either by means of personal visits or from a projected digital image. We employed a Free Choice Profiling (FCP) methodology, in which observers generated their own descriptive terminologies and then used these to quantify perceived landscape qualities on visual analogue scales. Data were analysed using Generalised Procrustes Analysis, a multivariate statistical technique that does not rely on fixed variables to identify underlying dimensions of assessment. The three observer groups each showed significant agreement, and generated two main consensus dimensions that suggested landscape ‘health’ and ‘development in time’ as common perceived themes of landscape expressivity. We critically discuss these outcomes in context of the landscape assessment literature, and suggest ways forward for further development and research. [ABSTRACT FROM AUTHOR]

Background: Wound-edge protection devices (WEPDs) have been used in surgery for more than 40 years to reduce surgical site infection (SSI). No economic evaluation of WEPDs against any comparator has ever been conducted. The aim of the paper was to assess whether WEPDs are cost-effective in reducing SSI compared to standard care alone in the United Kingdom. Methods and Findings: An economic evaluation was conducted alongside the ROSSINI trial. The study perspective was that of the UK National Health Service and the time horizon was 30 days post-operatively. The study was conducted in 21 UK hospitals. 760 patients undergoing laparotomy were randomised to either WEPD or standard care and 735 were included in the primary analysis. The main economic outcome was cost-effectiveness based on incremental cost (£) per quality adjusted life year (QALY) gained. Patients in the WEPD arm accessed health care worth £5,420 on average and gained 0.02131 QALYs, compared to £5,130 and 0.02133 QALYs gained in the standard care arm. The WEPD strategy was more costly and equally effective compared to standard care, but there was significant uncertainty around incremental costs and QALYs. The findings were robust to a range of sensitivity analyses. Conclusions: There is no evidence to suggest that WEPDs can be considered a cost effective device to reduce SSI. Their continued use is a waste of limited health care resources. [ABSTRACT FROM AUTHOR]