Experiences of insufficiency: "walking on a ledge in the dark"

During 2009 CARA announced the Iraqi Research Fellowship Programme aiming to enhance research capacity among Iraqi academics. The IRFP allows scholars to conduct and disseminate advanced and modern research projects connecting these to Iraq’s future academic development. This programme takes into consideration fostering and engaging the work of Iraqi academics in exile. One key expectation of the programme is for projects to have a positive impact on development of academia in Iraq in both the short and long term. It also facilitates international academic engagement fostering cooperation with Iraqi counterparts. This account is a reflection from a multidisciplinary team of researcher-practitioners facing these kinds of dilemmas the IRFP is intended to address. The context for the research involves paediatric training in Iraq and the potential extension of curriculum to involve psychosocial approaches to understanding human behaviour. Central to this account is an acknowledgement that in both research and practice, possibly one of the hardest decisions to make is not a choice of whether one possesses sufficient knowledge, but an acceptance that in not knowing we possibly find our way to get to where we want to be. This chapter discusses several challenges faced by an international research team as they embrace uncertainty together.

Perceived neighborhood environmental attributes sssociated with walking and cycling for transport among adult residents of 17 cities in 12 countries: the IPEN study

INTRODUCTION: Prevalence of walking and cycling for transport is low and varies greatly across countries. Few studies have examined neighborhood perceptions related to walking and cycling for transport in different countries. Therefore, it is challenging to prioritize appropriate built-environment interventions. OBJECTIVES: The aim of this study was to examine the strength and shape of the relationship between adults' neighborhood perceptions and walking and cycling for transport across diverse environments. METHODS: As part of the International Physical activity and Environment Network (IPEN) adult project, self-reported data were taken from 13,745 adults (18-65 years) living in physically and socially diverse neighborhoods in 17 cities across 12 countries. Neighborhood perceptions were measured using the Neighborhood Environment Walkability Scale, and walking and cycling for transport were measured using the International Physical Activity Questionnaire-Long Form. Generalized additive mixed models were used to model walking or cycling for transport during the last seven days with neighborhood perceptions. Interactions by city were explored. RESULTS: Walking-for-transport outcomes were significantly associated with perceived residential density, land use mix-access, street connectivity, aesthetics, and safety. Any cycling for transport was significantly related to perceived land use mix-access, street connectivity, infrastructure, aesthetics, safety, and perceived distance to destinations. Between-city differences existed for some attributes in relation to walking or cycling for transport. CONCLUSIONS: Many perceived environmental attributes supported both cycling and walking; however, highly walkable environments may not support cycling for transport. People appear to walk for transport despite safety concerns. These findings can guide the implementation of global health strategies.

Try walking in my shoes: empathy and portrayals of mental illness on screen

How is mental illness represented in film and television? What emotions are elicited from the viewer? How have these portrayals changed over time? And what are the implications of these portrayals for mental health awareness in the community?This interdisciplinary symposium brings together academics, filmmakers, mental health practitioners and consumers to explore these and other questions concerning the portrayal of mental illness on screen. Across two days of screenings, lectures, panels and workshops, we will discuss a range of representations of mental illness, from early cinema to Hollywood studio films, from ethnographic documentaries to television programs. The symposium has a particular focus on women’s mental health and the portrayal of mental illness in Australian films.A key theme of the symposium is the emotion of empathy. If sympathy suggests feeling for someone (that is, feeling sorry for them), empathy is distinguished by feeling with them. This sharing of emotion gives us valuable insight into how things are with another person. This insight can lead to a greater understanding that reduces stigma and discrimination, and helps us to see ‘the other’ as an equal human being. That is why empathy is such an important concept in philosophy, politics, psychology and human rights education.Cinema and television are powerful media that can take the audience on an imaginative journey and tap into our potential to empathise with another human being. Our speakers will examine the ways in which the viewer’s empathy is elicited (or not) by these screen portrayals of mental illness, as well as the benefits and limitations of an empathetic relationship between viewer and character. In this way, the symposium contributes to the broader discussion initiated by the ARC Centre of Excellence for the History of Emotions about the ways in which emotions shape individual, community and national identities.We welcome discussion of these issues from all participants – both speakers and audience members – and we look forward to a dialogue that is open-minded and sensitive to all involved. We hope this will be the start of many more conversations on this important issue that affects us all.

Understanding ageing effects using complexity analysis of foot-ground clearance during walking

Ageing influences gait patterns which in turn can affect the balance control of human locomotion. Entropy-based regularity and complexity measures have been highly effective in analysing a broad range of physiological signals. Minimum toe clearance (MTC) is an event during the swing phase of the gait cycle and is highly sensitive to the spatial balance control properties of the locomotor system. The aim of this research was to investigate the regularity and complexity of the MTC time series due to healthy ageing and locomotors' disorders. MTC data from 30 healthy young (HY), 27 healthy elderly (HE) and 10 falls risk (FR) elderly subjects with balance problems were analysed. Continuous MTC data were collected and using the first 500 data points, MTC mean, standard deviation (SD) and entropy-based complexity analysis were performed using sample entropy (SampEn) for different window lengths (m) and filtering levels (r). The MTC SampEn values were lower in the FR group compared to the HY and HE groups for all m and r. The HY group had a greater mean SampEn value than both HE and FR reflecting higher complexity in their MTC series. The mean SampEn values of HY and FR groups were found significantly different for m = 2, 4, 5 and r = (0.1-0.9) × SD, (0.3-0.9) × SD and (0.3-0.9) × SD, respectively. They were also significant difference between HE and FR groups for m = 4-5 and r = (0.3-0.7) × SD, but no significant differences were seen between HY and HE groups for any m and r. A significant correlation of SampEn with SD of MTC was revealed for the HY and HE groups only, suggesting that locomotor disorders could significantly change the regularity or the complexity of the MTC series while healthy ageing does not. These results can be usefully applied to the early diagnosis of common gait pathologies.

"When I saw walking I just kind of took it as wheeling": interpretations of mobility-related items in generic, preference-based health state instruments in the context of spinal cord injury

Background : In health economic analyses, health states are typically valued using instruments with few items per dimension. Due to the generic (and often reductionist) nature of such instruments, certain groups of respondents may experience challenges in describing their health state. This study is concerned with generic, preference-based health state instruments that provide information for decisions about the allocation of resources in health care. Unlike physical measurement instruments, preference-based health state instruments provide health state values that are dependent on how respondents interpret the items. This study investigates how individuals with spinal cord injury (SCI) interpret mobility-related items contained within six preference-based health state instruments.

Methods : Secondary analysis of focus group transcripts originally collected in Vancouver, Canada, explored individuals’ perceptions and interpretations of mobility-related items contained within the 15D, Assessment of Quality of Life 8-dimension (AQoL-8D), EQ-5D-5L, Health Utilities Index (HUI), Quality of Well-Being Scale Self-Administered (QWB-SA), and the 36-item Short Form health survey version 2 (SF-36v2). Ritchie and Spencer’s ‘Framework Approach’ was used to perform thematic analysis that focused on participants’ comments concerning the mobility-related items only.

Results : Fifteen individuals participated in three focus groups (five per focus group). Four themes emerged: wording of mobility (e.g., ‘getting around’ vs ‘walking’), reference to aids and appliances, lack of suitable response options, and reframing of items (e.g., replacing ‘walking’ with ‘wheeling’). These themes reflected item features that respondents perceived as relevant in enabling them to describe their mobility, and response strategies that respondents could use when faced with inaccessible items.

Conclusion : Investigating perceptions to mobility-related items within the context of SCI highlights substantial variation in item interpretation across six preference-based health state instruments. Studying respondents’ interpretations of items can help to understand discrepancies in the health state descriptions and values obtained from different instruments. This line of research warrants closer attention in the health economics and quality of life literature.