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Successful aging can be generally defined as minimizing disabilities, maintaining functional capacity, and supporting an engaged lifestyle. Given world population changes, this concept is of increasing importance. Technologies have become an integral part of daily life across a range of domains and have potential to support older adults. However, for that potential to be met, the technology must be designed with consideration for older adults’ capabilities, limitations, motivations to use technological support, and opinions regarding the role of technology in their lives. In this context, we review the theoretical background relevant to successful aging and technology support. Moreover, the technology should not impose cognitive demands but should augment or enhance cognitive function. We present older adult personas to highlight how current and emerging technologies can assist aging individuals in meeting their diverse needs and reaching their goals. We provide considerations and future research directions to guide technology design and promote successful aging.
A consensus workshop on low-calorie sweeteners (LCS) was held in November 2018 where seventeen experts (the panel) discussed three themes identified as key to the science and policy of LCS: (1) weight management and glucose control; (2) consumption, safety and perception; (3) nutrition policy. The aims were to identify the reliable facts on LCS, suggest research gaps and propose future actions. The panel agreed that the safety of LCS is demonstrated by a substantial body of evidence reviewed by regulatory experts and current levels of consumption, even for high users, are within agreed safety margins. However, better risk communication is needed. More emphasis is required on the role of LCS in helping individuals reduce their sugar and energy intake, which is a public health priority. Based on reviews of clinical evidence to date, the panel concluded that LCS can be beneficial for weight management when they are used to replace sugar in products consumed in the diet (without energy substitution). The available evidence suggests no grounds for concerns about adverse effects of LCS on sweet preference, appetite or glucose control; indeed, LCS may improve diabetic control and dietary compliance. Regarding effects on the human gut microbiota, data are limited and do not provide adequate evidence that LCS affect gut health at doses relevant to human use. The panel identified research priorities, including collation of the totality of evidence on LCS and body weight control, monitoring and modelling of LCS intakes, impacts on sugar reduction and diet quality and developing effective communication strategies to foster informed choice. There is also a need to reconcile policy discrepancies between organisations and reduce regulatory hurdles that impede low-energy product development and reformulation.
Clinical medicine is heavily reliant upon the results of high-quality research, conducted to exacting ethical standards. Efforts to ensure such standards include the development of national and international research ethics guidelines together with the establishment of review systems such as research ethics committees (RECs, also known as institutional review boards or IRBs). A major focus of these efforts has been on protecting the autonomy of participants, primarily through the process of detailed informed consent. Gaining well-informed consent from prospective participants limits the potential for individuals to be subjected unknowingly or unwillingly to experimentation and, when well done, supports individuals to make free choices about their research participation. However, informed consent is not a universal panacea as there are various ethical breaches in research against which informed consent is relatively powerless. My focus is on one such breach – that of data misuse.
Surgery is an important part of contemporary health care, but currently much of surgery lacks a strong evidence base. Uptake of evidence‐based medicine (EBM) methods within surgical research and among practitioners has been slow compared with other areas of medicine. Although this is often viewed as arising from practical and cultural barriers, it also reflects a lack of epistemic fit between EBM research methods and surgical practice. In this paper we discuss some epistemic challenges in surgery relating to this lack of fit, and investigate how resources from feminist epistemology can help to characterize them. We point to ways in which these epistemic challenges may be addressed by gathering and disseminating evidence about what works in surgery using methods that are contextual, pluralistic, and sensitive to hierarchies.
To examine the use of vitamin D supplements during infancy among the participants in an international infant feeding trial.
Information about vitamin D supplementation was collected through a validated FFQ at the age of 2 weeks and monthly between the ages of 1 month and 6 months.
Infants (n 2159) with a biological family member affected by type 1 diabetes and with increased human leucocyte antigen-conferred susceptibility to type 1 diabetes from twelve European countries, the USA, Canada and Australia.
Daily use of vitamin D supplements was common during the first 6 months of life in Northern and Central Europe (>80 % of the infants), with somewhat lower rates observed in Southern Europe (>60 %). In Canada, vitamin D supplementation was more common among exclusively breast-fed than other infants (e.g. 71 % v. 44 % at 6 months of age). Less than 2 % of infants in the USA and Australia received any vitamin D supplementation. Higher gestational age, older maternal age and longer maternal education were study-wide associated with greater use of vitamin D supplements.
Most of the infants received vitamin D supplements during the first 6 months of life in the European countries, whereas in Canada only half and in the USA and Australia very few were given supplementation.
The UK Mental Capacity Act provides an important legislative framework for protecting persons who are vulnerable, by virtue of partial or total lack of capacity, from abuse, coercion, exploitation, disrespect or unwarranted intrusions on their privacy and liberty. In this article we argue, however, that in order to effectively implement the Act's governing principles and promote the autonomy of persons whose capacities are impaired, health and social welfare professionals must go beyond a primarily cognitive approach to capacity assessment and refer to a range of more demanding autonomy conditions relating to authenticity, diachronic coherence and consistency, accountability to others, and affective attitudes towards oneself. We suggest that these conditions are in fact implicit in the guidelines, scenarios and practical advice contained in the Act's accompanying Code of Practice. To ground our analysis, we discuss two cases of end-of-life decision-making, and consider how these cases might have been assessed had the Mental Capacity Act been applied. We also address the question of whether the conditions for autonomy we identify raise the bar too high to be met by persons who are vulnerable because their capacity is partially compromised.
Charcoal-burning has become a common method of attempted suicide in Asia and survivors are often intoxicated with carbon monoxide (CO). Reports of the neuropsychiatric aspects of CO poisoning date back to 1914. This article outlines the neuropsychiatric sequelae that have been described secondary to CO poisoning. The underlying pathophysiology and management strategies, including acute management and cognitive rehabilitation, are discussed as these topics are of relevance to psychiatrists.
Objectives: Many innovative health technologies do not have a sufficient evidence-base to allow for adequate assessment of their benefits. Funders in several countries have been exploring arrangements that allow for temporary or partial coverage of these technologies, but only as part of a further evaluation. The public's support of arrangements that restrict access to innovative technology until sufficient evidence is available is crucial if these arrangements are going to remain viable. The project's other objective is to examine the lay public's views on a case in which patients’ publicly funded access to an innovative health technology is being delayed until there is sufficient evidence to justify a coverage decision. The case considered is the Ontario (Canada) government's decision to restrict access to positron emission tomography (PET) scans until further evidence becomes available.
Methods: The case was deliberated on by twenty-six members of the Toronto Health Policy Citizens' Council, with a follow-up survey administered to individual council members.
Results: The majority of council members agreed that the approach taken by the government was reasonable and in the best interests of its citizens. The council did express concerns regarding certain aspects of the case, including about the length of time it is taking to obtain further evidence.
Conclusions: Public support for arrangements that limit access to new technologies will likely vary depending on the details of the specific arrangement being proposed. Deliberative public dialogue can be effectively used to identify cases the general public is most likely to support.
The feasibility of a templated seedless approach for growing segmented p-i-n nanowires –based diodes based on selective epitaxial growth is demonstrated. Such diodes are the basic structure for a TunnelFET device. This approach has the potential for being easily scalable at a full-wafer processing, and there is no theoretical limitation for control on nanowires growth and properties when scaling down their diameters, as opposed to an unconstrained vapor-liquid-solid growth. Moreover, Si/SixGe1-x hetero-structures are implemented, showing that this can improve the TFET ON current not only thanks to the lowered barrier for the band-to-band source-channel tunneling, but additionally thanks to its lower thermal budget for growth, allowing for better control of the abruptness of the doping profile at the source-channel tunneling interface.
Nurses are increasingly being employed instead of doctors in some areas of work. This article examines this phenomenon in relation to a ‘nurse-led’ Personal Medical Services Primary Care Act pilot scheme. As part of an evaluative project, we examined the way in which patients understood and constructed nursing roles in the context of their use of primary care services in a socially deprived area. Whilst professional roles are established to some extent as the result of negotiation between and within professions and with government policymakers, patients' perceptions also affect whether or not changes are accepted, and the extent to which new roles gain legitimacy. Our evaluation took the form of a case study with questionnaires, in-depth interviews and observations. This particular paper is based mainly on data obtained from interviews with patients who had experienced the nurse-led service. The results showed that some patients attributed high status to the nurse by emphasizing that the nurse leading the practice was highly qualified, and other patients reconstructed the role and thought of the nurse as a doctor. This latter interpretation was derived from the patients' descriptions of core activities such as diagnosis and treatment, and other factors such as an absence of uniform. However, the most important factor that affected whether or not patients accepted a ‘nurse-led service’ related to the way in which the service met their needs. This seemed to be more important than perceptions of professional identity. The nurse-led service continued to provide the social support and continuity of care that the patients valued, and which had been provided by their previous general practitioner. The provision of these aspects of care appeared to be more important than whether or not the service was nurse-led or doctor-led. It is important to consider patients' perceptions of policy innovation when establishing new services.
This chapter describes a motivational enhancement therapy (MET) intervention tailored to reach young people who use cannabis. MET intervention also motivates young people to voluntarily participate in a confidential assessment and evaluation of the impact of cannabis on their lives, and offer support to those who wish to quit or reduce use. A general trend toward increased cannabis use for much of the 1990s was particularly marked among teenagers, possibly due to its ready availability and declining perceptions of risk. Developmental tasks of adolescence include increasing psychological autonomy, expanding social roles, development of the capacity for intimacy, and the formation of value systems and life goals. The Teen Cannabis Check-Up is a two-session assessment and feedback intervention developed to reach cannabis users who are neither self-initiating change nor seeking treatment. The chapter describes the variations of cannabis check-up interventions tailored for adolescents and common issues in implementing the check-up approach.