Study protocol for the translating research in elder care (TREC): Building context through case studies in long-term care project (project two)

Background: The organizational context in which healthcare is delivered is thought to play an important role in mediating the use of knowledge in practice. Additionally, a number of potentially modifiable contextual factors have been shown to make an organizational context more amenable to change. However, understanding of how these factors operate to influence organizational context and knowledge use remains limited. In particular, research to understand knowledge translation in the long-term care setting is scarce. Further research is therefore required to provide robust explanations of the characteristics of organizational context in relation to knowledge use.
Aim: To develop a robust explanation of the way organizational context mediates the use of knowledge in practice in long-term care facilities.
Design: This is longitudinal, in-depth qualitative case study research using exploratory and interpretive methods to explore the role of organizational context in influencing knowledge translation. The study will be conducted in two phases. In phase one, comprehensive case studies will be conducted in three facilities. Following data analysis and proposition development, phase two will continue with focused case studies to elaborate emerging themes and theory. Study sites will be purposively selected. In both phases, data will be collected using a variety of approaches, including non-participant observation, key informant interviews, family perspectives, focus groups, and documentary evidence (including, but not limited to, policies, notices, and photographs of physical resources). Data analysis will comprise an iterative process of identifying convergent evidence within each case study and then examining and comparing the evidence across multiple case studies to draw conclusions from the study as a whole. Additionally, findings that emerge through this project will be compared and considered alongside those that are emerging from project one. In this way, pattern matching based on explanation building will be used to frame the analysis and develop an explanation of organizational context and knowledge use over time. An improved understanding of the contextual factors that mediate knowledge use will inform future development and testing of interventions to enhance knowledge use, with the ultimate aim of improving the outcomes for residents in long-term care settings.

Long-term effects of a playground markings and physical structures on children's recess physical activity levels

Objective : The aim of the study was to investigate the impact of a playground redesign intervention across time on children's recess physical activity levels using combined physical activity measures and to evaluate the potential influence of covariates on the intervention effect.

Method : Fifteen schools located in areas of high deprivation in one large city in England each received £20,000 through a national £10 million Sporting Playgrounds Initiative to redesign the playground environment based on a multicolored zonal design. Eleven schools served as matched socioeconomic controls. Physical activity levels during recess were quantified using heart rate telemetry and accelerometry at baseline, 6 weeks and 6 months following the playground redesign intervention. Data were collected between July 2003 and January 2005 and analyzed using multilevel modeling.

Results : Statistically significant intervention effects were found across time for moderate-to-vigorous and vigorous physical activity assessed using both heart rate and accelerometry.

Conclusions : The results suggest that a playground redesign, which utilizes multicolor playground markings and physical structures, is a suitable stimulus for increasing children's school recess physical activity levels.

Comparison of pQCT parameters between ulna and radius in retired elite gymnasts : the skeletal benefits associated with long-term gymnastics are bone- and site-specific

Objectives: To compare the skeletal benefits associated with gymnastics between ulna and radius.
Methods: 19 retired artistic gymnasts, aged 18-36 years, were compared to 24 sedentary women. Bone mineral content (BMC), total and cortical bone area (ToA, CoA), trabecular and cortical volumetric density (TrD, CoD) and cortical thickness (CoTh) were measured by pQCT at the 4% and 66% forearm.
Results: At the 4% site, BMC and ToA were more than twice greater at the radius than ulna whereas at the 66% site, BMC, ToA, CoA, CoTh and SSIpol were 20 to 51% greater at the ulna than radius in both groups (p<0.0001). At the 4% site, the skeletal benefits in BMC of the retired gymnasts over the non-gymnasts were 1.9 times greater at the radius than ulna (p<0.001), with enlarged bone size at the distal radius only. In contrast, the skeletal benefits at the 66% site were twice greater at the ulna than radius for BMC and CoA (p<0.01).
Conclusion: Whereas the skeletal benefits associated with long-term gymnastics were greater at the radius than ulna in the distal forearm, the reverse was found in the proximal forearm, suggesting both bones should be analysed when investigating forearm strength.

Skeletal benefits after long-term retirement in former elite female gymnasts

Bone strength benefits after long-term retirement from elite gymnastics in terms of bone geometry and volumetric BMD were studied by comparing retired female gymnasts to moderately active age-matched women. In a cross-sectional study, 30 retired female gymnasts were compared with 30 age-matched moderately active controls. Bone geometric and densitometric parameters were measured by pQCT at the distal epiphyses and shafts of the tibia, femur, radius, and humerus. Muscle cross-sectional areas were assessed from the shaft scans. Independent t-tests were conducted on bone and muscle variables to detect differences between the two groups. The gymnasts had retired for a mean of 6.1 ± 0.4 yr and were engaged in ≤2 h of exercise per week since retirement. At the radial and humeral shafts, cortical cross-sectional area (CSA), total CSA, BMC, and strength strain index (SSIpol) were significantly greater (13–38%, p ≤ 0.01) in the retired gymnasts; likewise, BMC and total CSA were significantly greater at the distal radius (22–25%, p ≤ 0.0001). In the lower limbs, total CSA and BMC at the femur and tibia shaft were greater by 8–11%, and trabecular BMD and BMC were only greater at the tibia (7–8%). Muscle CSA at the forearm and upper arm was greater by 15–17.6% (p ≤ 0.001) but was not different at the upper and lower leg. Past gymnastics training is associated with greater bone mass and bone size in women 6 yr after retirement. Skeletal benefits were site specific, with greater geometric adaptations (greater bone size) in the upper compared with the lower limbs.

Reintegration services for long-term dangerous offenders : a case study and discussion

Successfully reintegrating long-term prisoners back into the community often presents significant challenges for service providers. Ex-prisoners typically experience high levels of social stigma; present with multiple needs; and can struggle to find meaningful employment, stable accommodation, and to maintain supportive relationships. There have, however, been relatively few published evaluations of the outcomes achieved by postrelease services on managing the risk of reoffending and, as such, it is difficult for service providers to meet these multiple and complex levels of need in ways that might be considered to be evidence based. In this article we describe a specialized prerelease support, reentry, and reintegration service that is offered to long-term prisoners, many of whom have been legally labelled as ‘‘dangerous.’’ The current model of service delivery is reviewed and discussed in the context of current theories of offender rehabilitation and reintegration. These are then used to discuss the way in which services for this group of offenders might best be conceptualized.

Three dimensional stability charts for slopes based on limit analysis methods

This paper uses finite element upper and lower bound limit analysis to produce chart solutions for three-dimensional (3D) natural slopes for both short- and long-term stability. The presented chart solutions are convenient tools that can be used for preliminary design purposes. The rigorous limit analysis results in this paper were found to bracket the true factor of safety within ±10% or better, which can be used as a benchmark for the solutions from other methods. The depth of the slip surfaces is observed to be generally shallow for most analyzed cases, particularly for the long-term slope stability problem. In addition, it was found that using a two-dimensional (2D) analysis may lead to significant differences in estimating safety factors, which can differ by 2%–60% depending on the slope geometry and soil properties. Therefore, great care and judgement are required when applying 2D analyses to 3D slope problems.