Using choice modelling to inform service sustainability for dementia Meeting Centres for people living with dementia in the UK.

OBJECTIVES: This study explores the preferences and willingness-to-pay (WTP) of carers for Meeting Centres (MCs) attributes in assisting individuals with mild to moderate dementia. METHOD: Preferences from 108 carers, gathered through UK-wide MC networks, were collected using a Discrete Choice Experiment survey. The survey incorporated attributes derived from evidence synthesis and lay consultation. A regression model estimated preference weights and marginal WTP for a change in attributes one a time within the MC support 'package.' RESULTS: Carers preferred MCs offering a balanced mix of practical activities and emotional support, along with flexibility without booking requirements and low costs. Social opportunities and the frequency of the meeting were not prioritised. Respondents expressed a WTP of £43 to stay with 'My MC,' the preferred option, compared to transitioning to an alternative in-person MC, all else being equal. Various factors, including attendance modality, the relationship with the supported person, age, and gender, influenced carers' choices. CONCLUSION: These findings offer valuable insights into carers' preferences, priorities, and WTP within MC support for those with mild to moderate dementia. Understanding these factors can guide the implementation and sustainability of MCs, ensuring alignment with carers' needs and preferences and, ultimately, enhancing support for individuals with dementia.

Strategic and operational issues in sustaining community-based dementia support groups: the Get Real with Meeting Centres realist evaluation part 2.

OBJECTIVES: Support for people with dementia in their communities is neither robust nor consistent in the UK, often bolstered by third sector/grass-roots initiatives facing formidable challenges in sustaining long-term. The Get Real with Meeting Centres project explored factors involved in sustaining one such form of community-based support. This is the second of two linked articles outlining learning from this realist evaluation of Meeting Centres (MCs) for people with dementia and carers, which focusses on findings regarding their operational and strategic running. METHOD: Semi-structured interviews and focus group discussions were conducted with 77 participants across three MC sites in England and Wales, including people living with dementia, informal carers, staff, volunteers, trustees, and supporting professionals/practitioners. Data were themed, then analysed using soft systems methodology and realist logic of analysis. RESULTS: Forty-two 'context-mechanism-outcome' statements were generated, explaining how background circumstances might trigger responses/processes to produce wanted or unwanted outcomes regarding three key areas for MC sustainability: External relationships and collaboration; Internal relationships and practices; and Finances and funding. CONCLUSION: Collaboration is essential to sustaining community-based initiatives such as MCs, particularly between local community and regional level. MCs need to be vigilant in mitigating pressures that create 'mission drift', as targeting a gap in the care pathway and maintaining a person-centred ethos are central to MCs' appeal. Stable, ongoing funding is needed for stable, ongoing community dementia support. More formal recognition of the value of social model community-based initiatives, helped by improved data collection, would encourage more robust and consistent community dementia support.

Solidarity with whom? Minority perspectives on allyship in Danish queer spaces.

Social psychological research has witnessed a burgeoning interest in advantaged group allies acting in solidarity with disadvantaged groups to challenge systems of inequality. While solidarity from advantaged group members is often deemed critical for social change, the perceptions of disadvantaged group members regarding ally participation are seldom addressed. This research delved into how LGBTQIA+ individuals in Denmark conceptualize allyship. Through 26 semi-structured interviews with participants and organizers of queer pride events, a thematic analysis identified three themes addressing how allyship materializes, what risks it bears and who it involves. Specifically, we present a three-levelled framework of allyship, which captures practices of allyship on a personal, relational and structural level. Our analysis also reveals the risk of allyship when it is not perceived as genuine and complexities of group boundaries when discussing allyship, shedding light on intersectional challenges within minority communities. These findings illustrate the nuances involved in providing and receiving allyship within and across various social (sub)groups.

Reaching people and managing membership in community-based dementia support groups: the Get Real with Meeting Centres realist evaluation part 1.

OBJECTIVES: There is a need to improve the provision and reach of community services for people living with dementia, a goal in which community-based support groups can play a key role. The Get Real with Meeting Centres project aimed to explore factors involved in the success and sustainability of Meeting Centres (MCs) a form of community-based support proliferating in the UK. This is the first of two linked articles outlining learning from this realist evaluation of MCs, which focusses on findings around reach and membership. METHOD: Semi-structured interviews and focus group discussions were conducted with 77 participants across three case study MC sites in England and Wales, including people living with dementia, informal carers, staff, volunteers, trustees, and supporting professionals/practitioners. Data were themed, then analysed using both soft systems methodology and realist logic of analysis. RESULTS: Fifty-two 'context-mechanism-outcome' statements were generated, explaining how background circumstances might trigger responses/processes to produce wanted or unwanted outcomes regarding four key areas for MC sustainability: Referrals and the dementia care pathway; Reaching people and membership; Carer engagement and benefit; and Venue and location. CONCLUSION: Strong links with formal services and a well-functioning dementia care pathway are essential to sustaining community-based group support such as MCs; group support is also well-placed to assist work to improve pathway issues. Clarity of offer (including benefit to carers), and a wide range of activities, are key to appeal and reach; transport to, and use of, venue are challenges, as are pressures to support people with more advanced dementia.

You've Got E-Mail: A Pilot Study Examining the Feasibility and Impact of a Group-Based Technology-Training Intervention Among Older Adults Living in Residential Care.

Older adults living in residential care often experience challenges in sustaining meaningful social relationships, which can result in compromised health and well-being. Online social networking has the potential to mitigate this problem, but few studies have investigated its implementation and its effectiveness in maintaining or enhancing well-being. This pilot study used a cluster-randomized pre-post design to examine the feasibility of implementing a 12-week group-based technology-training intervention for older adults (n = 48) living in residential care by exploring how cognitive health, mental health, and confidence in technology were impacted. Analysis of variance revealed significant increases in life satisfaction, positive attitudes toward computer use, and self-perceived competence among participants who received the intervention, but increased depressive symptoms for the control group. These findings suggest that, despite challenges in implementing the intervention in residential care, group-based technology training may enhance confidence among older adults while maintaining or enhancing mental health.

An investigation of politicians' responses to urban diversity and disadvantage: The case of the Danish 'parallel societies'.

We examine how Danish politicians articulate views on the 'parallel society agreement' (aka, the 'ghetto-laws'), a controversial legislative intervention aiming to manage urban migration-related diversity. Through nationwide urban redevelopment aimed at facilitating residential 'mixing', the goal of the legislation is to eliminate so-called 'parallel societies'-socio-economically deprived neighbourhoods characterized by high concentrations of ethnic minorities. In-depth interviews with Danish politicians (n = 11) explored how this proposal was supported, contested or rejected in situated discourse. Following social representations theory, we focus on how 'parallel societies' were constructed in relation to differing ideas about 'mainstream society' and value-laden oppositional meaning-categories (i.e. themata). In particular, we highlight processes of socio-ethical reasoning that occurred through thematization of a shared oppositional meaning-category: 'freedom-constraint'. Views on the intervention were articulated around this oppositional meaning-category. Moreover, a connection was observed between the views articulated by individual politicians and sets of congruent ideas and images mobilized to represent 'parallel societies'. We discuss the theoretical value of taking a social representations approach to urban policy debates, and the practical limitations of dominant representations for successfully promoting intercultural dialogue and engagement-the stated goal of this intervention.

Why trust? A mixed-method investigation of the origins and meaning of trust during the COVID-19 lockdown in Denmark.

Trust is highlighted as central to effective disease management. During the COVID-19 pandemic, Denmark seemed to embody this understanding. Characterizing the Danish response were high levels of public compliance with government regulations and restrictions coupled with high trust in the government and other members of society. In this article, we first revisit prior claims about the importance of trust in securing compliant citizen behaviour based on a weekly time-use survey that we conducted during the first weeks of the COVID-19 pandemic (2 April-18 May 2020). Analysis of activity episodes, rather than merely self-reported compliance, both reconfirms the importance of institutional trust and nuances prior suggestions of detrimental effects of trust in other citizens. These survey-based results are further augmented through thematic analysis of 21 in-depth interviews with respondents sampled from the survey participants. The qualitative analysis reveals two themes, the first focusing on trust in others in Danish society and the second on the history of trust in Denmark. Both themes are based on narratives layered in cultural, institutional and inter-personal levels and further underline that institutional and social trust are complementary and not countervailing. We conclude by discussing how our analysis suggests pathways towards an increased social contract between governments, institutions and individuals that might be of use during future global emergencies and to the overall functioning of democracies.

User perspectives on long-term remote active electronic self-monitoring of mood symptoms in bipolar spectrum disorders.

BACKGROUND: User feedback is crucial in the development of electronic self-monitoring tools for bipolar spectrum disorders (BSD). Previous studies have examined user experiences in small samples self-monitoring over relatively short time periods. We aimed to explore the experiences of a large sample of individuals with BSD engaged in long-term remote active electronic self-monitoring. METHODS: An online survey, containing closed and open questions, was sent to participants with BSD enrolled on the Bipolar Disorder Research Network (BDRN) True Colours mood-monitoring system. Questions related to experiences of using True Colours, including viewing mood graphs, and sharing data with healthcare professionals (HCPs) and/or family/friends. RESULTS: Response rate was 62.7 % (n = 362). 88.4 % reported finding using True Colours helpful. Commonly reported benefits were having a visual record of mood changes, patterns/triggers and identifying early warning signs. Limitations included questions not being comprehensive or revealing anything new. One third had shared their graphs, with 89.9 % finding it helpful to share with HCPs and 78.7 % helpful to share with family/friends. Perceived benefits included aiding communication and limitations included lack of interest/understanding from others. LIMITATIONS: Responder bias may be present. Findings may not be generalisable to all research cohorts. CONCLUSIONS: The majority of participants valued long-term self-monitoring. Personalisation and ease of use were important. A potential challenge is continued use when mood is long-term stable, highlighting the need for measures to be sensitive to small changes. Sharing self-monitoring data with HCPs may enhance communication of the lived experience of those with BSD. Future research should examine HCPs' perspectives.

A randomized trial testing the effectiveness of virtual reality as a tool for pro-environmental dietary change.

This study investigates the impact of an efficacy-focused virtual reality (VR) intervention designed according to instructional design principles on eating behavior. In the preregistered intervention study, psychology students were randomly assigned to nine seminar blocks. Employing parallel design, they were allocated to either a VR intervention to experience the environmental impact of food behavior (1) and alter the future by revising food choices (2) or to a passive control condition. The data from 123 participants (78% female, mean age 25.03, SD = 6.4) were analyzed to investigate the effect of the VR intervention on dietary footprint measured from 1 week before to 1 week after the intervention. The VR intervention decreased individual dietary footprints (d = 0.4) significantly more than the control condition. Similarly, the VR condition increased response efficacy and knowledge to a larger extent compared to the control. For knowledge, the effect persisted for 1 week. The VR intervention had no impact on intentions, self-efficacy, or psychological distance. Additional manipulation of normative feedback enhanced self-efficacy; however, manipulation of geographical framing did not influence psychological distance. This research received no financial support from any funding agency and was registered on 15/09/2021 at Open Science Foundation with the number https://doi.org/10.17605/OSF.IO/2AXF3 .

Sustainability of locally driven centres for those affected by dementia: a protocol for the get real with meeting centres realist evaluation.

INTRODUCTION: Improving support for people with early to moderate dementia to live at home in their communities is a global public health goal. Community adult social care is not robust in many parts of the UK, however, with the pandemic increasing pressure on services for this population. Community-led interventions can play a key role in supporting people postdiagnosis, helping delay decline, but many interventions struggle to sustain beyond 1-2 years. Meeting Centres (MCs) are one such intervention, which many UK community groups find attractive and achievable. However, it is not understood how these communities can ensure they are putting in place strategies that will help them sustain in the longer term, beyond start-up phase. METHODS AND ANALYSIS: This realist evaluation aims to understand the factors affecting sustainability of MCs in rural areas and learn lessons from MCs that have sustained beyond 3 years. Data will be collected using mixed methods: interviews and group discussions with stakeholders involved at every level in three case study locations in England and Wales, analysed with Soft Systems modelling; a Discrete Choice Experiment exploring what people across the UK value and are willing to pay for MCs, analysed with regression modelling. All data will be synthesised using a Realist logic of analysis to build a theoretical model of how, why, for whom, in what contexts and to what extent MCs can be successfully implemented for the long term. ETHICS AND DISSEMINATION: As participants may lack capacity for informed consent, favourable ethical opinion was received from a Health Research Authority research ethics committee. Resulting recommendations will be of interest to stakeholders including those commissioning, planning, running, supporting or attending MCs, as well as policy-makers and healthcare professionals. Knowledge will be shared with emerging MCs to help accelerate scale up of this intervention.

Coming together after standing apart: What predicts felt safety in the post-coronavirus crowd?

RATIONALE: Over a year after the outbreak of SARS-CoV-2, and the ensuing COVID-19 pandemic with its lockdowns and social distancing requirements, being together with others again seems possible. Against this backdrop, important questions arise about how to safely manage gatherings of large numbers of unrelated people - like festivals, concerts and sporting matches - and how individuals contemplating involvement in such events feel about the risks presented. METHODS: To begin answering these questions, the current research surveyed would-be attendees at one of Europe's largest outdoor music festivals (n = 18353). Drawing on social psychological theories of crowd behavior and risk perception, we explored the identity processes that contributed to individual feelings of safety within the planned event. RESULTS: The results show that shared identity with other festival goers and the perception of collectivistic (versus individualistic) values as defining of that festival, contributed to more trust in relevant others, stronger expectations that others would behave with safety rather than risk, and through these increased comfort with, and acceptance of the risks presented by, the planned festival. CONCLUSION: These results highlight identity forces that might be leveraged for crowd management in the context of disease risk.

Identity-Related Factors Protect Well-Being Against Stigma for Transgender and Gender Non-Conforming People.

Relatively little is known about identity-related resilience factors associated with well-being among transgender and gender non-conforming (TGNC) people. Drawing upon theory on stigma-related stress and resilience and work examining group identification as a buffer against discrimination, the aim of the current study was to model perceived discrimination, transgender identification, and gender identity affirmation as predictors of well-being for TGNC people. We also tested whether the positive association between gender identity affirmation and well-being might be explained by the benefits affirmation has for individual self-concept clarity. Participants were 105 TGNC individuals (42% transgender male, 39% transgender female, 19% other gender non-conforming [e.g., non-binary]) recruited through online forums and support groups in the UK and North America who completed an online survey including self-report measures of key constructs. Results from structural equation models demonstrated that: (1) experiences of discrimination were associated with lower well-being overall, but having a stronger transgender identity moderated this association; (2) after adjustment for discrimination and transgender identification, experiences of gender identity affirmation were independently associated with greater well-being for TGNC people. Secondary analyses demonstrated that gender identity affirmation was linked to well-being through reinforcing a strong, internalized sense of clarity about individual self-concept. Results are discussed in terms of the implications for TGNC health and well-being, particularly with regard to the need for supportive, identity-affirming social environments.

Sustaining community-based interventions for people affected by dementia long term: the SCI-Dem realist review.

OBJECTIVES: Community-based support for people with earlier-stage dementia and their care partners, such as regularly meeting groups and activities, can play an important part in postdiagnostic care. Typically delivered piecemeal in the UK, by a variety of agencies with inconsistent funding, provision is fragmented and many such interventions struggle to continue after only a short start-up period. This realist review investigates what can promote or hinder such interventions in being able to sustain long term. METHODS: Key sources of evidence were gathered using formal searches of electronic databases and grey literature, together with informal search methods such as citation tracking. No restrictions were made on article type or study design; only data pertaining to regularly meeting, ongoing, community-based interventions were included. Data were extracted, assessed, organised and synthesised and a realist logic of analysis applied to trace context-mechanism-outcome configurations as part an overall programme theory. Consultation with stakeholders, involved with a variety of such interventions, informed this process throughout. RESULTS: Ability to continually get and keep members; staff and volunteers; the support of other services and organisations; and funding/income were found to be critical, with multiple mechanisms feeding into these suboutcomes, sensitive to context. These included an emphasis on socialising and person-centredness; lowering stigma and logistical barriers; providing support and recognition for personnel; networking, raising awareness and sharing with other organisations, while avoiding conflict; and skilled financial planning and management. CONCLUSIONS: This review presents a theoretical model of what is involved in the long-term sustainability of community-based interventions. Alongside the need for longer-term funding and skilled financial management, key factors include the need for stigma-free, person-centred provision, sensitive to members' diversity and social needs, as well as the need for a robust support network including the local community, health and care services. Challenges were especially acute for small scale and rural groups.

Relative deprivation and revolt: current and future directions.

We review research applying relative deprivation theory to comprehend social, economic, and political phenomena relating to social change. We highlight areas illuminated by relative deprivation and limitations of this contemporary research. Next, we outline four theoretical elaborations of relative deprivation theory to advance understanding of complex socio-economic and political processes of underlying rallies, riots, and revolutions. We end by suggesting methodological approaches and research agendas to understand psychological processes of social change.

"Our Country Needs a Strong Leader Right Now": Economic Inequality Enhances the Wish for a Strong Leader.

Societal inequality has been found to harm the mental and physical health of its members and undermine overall social cohesion. Here, we tested the hypothesis that economic inequality is associated with a wish for a strong leader in a study involving 28 countries from five continents (Study 1, N = 6,112), a study involving an Australian community sample (Study 2, N = 515), and two experiments (Study 3a, N = 96; Study 3b, N = 296). We found correlational (Studies 1 and 2) and experimental (Studies 3a and 3b) evidence for our prediction that higher inequality enhances the wish for a strong leader. We also found that this relationship is mediated by perceptions of anomie, except in the case of objective inequality in Study 1. This suggests that societal inequality enhances the perception that society is breaking down (anomie) and that a strong leader is needed to restore order (even when that leader is willing to challenge democratic values).

High correlation between radiation dose estimates for 256-slice CT obtained by highly parallelized hybrid Monte Carlo computation and solid-state metal-oxide semiconductor field-effect transistor measurements in physical anthropomorphic phantoms.

PURPOSE: Accurate, patient-specific radiation dosimetry for CT scanning is critical to optimize radiation doses and balance dose against image quality. While Monte Carlo (MC) simulation is often used to estimate doses from CT, comparison of estimates to experimentally measured values is lacking for advanced CT scanners incorporating novel design features. We aimed to compare radiation dose estimates from MC simulation to doses measured in physical anthropomorphic phantoms using metal-oxide semiconductor field-effect transistors (MOSFETs) in a 256-slice CT scanner. METHODS: Fifty MOSFETs were placed in organs within tissue-equivalent anthropomorphic adult and pediatric radiographic phantoms, which were scanned using a variety of chest, cardiac, abdomen, brain, and whole-body protocols on a 256-slice system. MC computations were performed on voxelized CT reconstructions of the phantoms using a highly parallel MC tool developed specifically for diagnostic X-ray energies and rapid computation. Doses were compared between MC estimates and physical measurements. RESULTS: The average ratio of MOSFET to MC dose in the in-field region was close to 1 (range, 0.96-1.12; mean ± SD, 1.01 ± 0.04), indicating outstanding agreement between measured and simulated doses. The difference between measured and simulated doses tended to increase with distance from the in-field region. The error in the MC simulations due to the limited number of simulated photons was less than 1%. The errors in the MOSFET dose determinations in the in-field region for a single scan were mainly due to the calibration method and were typically about 6% (8% if the error in the reading of the ionization chamber that was used for the MOSFET calibration was included). CONCLUSIONS: Radiation dose estimation using a highly parallelized MC method is strongly correlated with experimental measurements in physical adult and infant anthropomorphic phantoms for a wide range of scans performed on a 256-slice CT scanner. Incorporation into CT scanners of radiation-dose distribution estimation, employing the scanner's reconstructed images of the patient, may offer the potential for accurate patient-specific CT dosimetry.

Sustainability of community-based interventions for people affected by dementia: a protocol for the SCI-Dem realist review.

INTRODUCTION: With numbers set to increase globally, finding ways to better support people with dementia and their families is a matter of growing concern. Community-based interventions can play a key role in supporting people with early to moderate stage dementia postdiagnosis, helping delay decline and hospitalisation. However, provision of such interventions is fragmented, with significant gaps and no reliable funding model, hence innovative groups and schemes catering for a genuine need can struggle long term and frequently fold. METHODS AND ANALYSIS: This realist review aims to expand our understanding of how best to implement and facilitate community-based interventions to run sustainably, focusing on contextually relevant explanations. We will gather and synthesise literature using a realist approach designed to accommodate and account for the complexity of 'real life' programmes, as implemented under different conditions in different settings, aiming to draw transferable conclusions about their sustainability that explain how and why context can influence outcomes. Our review will iteratively progress through five steps: (1) locate existing theories; (2) search for evidence (using Academic Search, AMED, CINAHL, EMBASE, MEDLINE, ProQuest, PsycINFO, PubMed, Scopus and Social Care Online, between May and September 2019); (3) article selection; (4) extracting and organising data; (5) synthesising the evidence and drawing conclusions. Data analysis will use a realist logic to explain what works, for whom, in what circumstances, in what respects, how and why. A stakeholder group will provide guidance and feedback throughout. ETHICS AND DISSEMINATION: Ethical approval was not required. Recommendations drawn from results are likely to be of interest to a range of stakeholders including those commissioning, planning, running, supporting or attending such interventions, as well as policymakers, healthcare professionals and researchers. We will draw on the expertise of our stakeholder group regarding tailoring dissemination to each audience using a variety of materials, formats and channels.

Stereospecificity of the Hofmann elimination in the gas phase.

The Hofmann elimination of ammonium ions having a single positive charge is demonstrated to exhibit stereospecificity with regard to expulsion of neutral alkene. For the 3-hexyl series of threo and erythro 4-monodeuterated ions (3-hexylammonium ion; N,N,N-trimethyl- d3-3-hexylammonium ion; N-ethyl-3-hexylammonium ion; N-methyl, N-ethyl-3-hexylammonium ion; N,N-dimethyl, N-ethyl-3-hexylammonium ion), the upper limit of the E:Z ratio of the expelled alkene (r) approaches 2 (the stereospecificity) with a deuterium isotope effect close to 2.0, although the effects of isotopic substitution diminish the E:Z ratio somewhat. Two fragmentations compete with that reaction: hydride shift (which gives the same products but with hydrogen scrambling) and loss of a neutral amine to give an alkyl cation. These competing reactions render our calculation approximate, but the results suggest a value not too far from the upper limit.

Activating and Guiding the Engagement of Seniors With Online Social Networking: Experimental Findings From the AGES 2.0 Project.

OBJECTIVE: Guided by theoretical and empirical work attesting to the health benefits of social connections, we tested whether Internet connectivity, and training in its use for social purposes, can support the well-being of older adults receiving care. METHOD: Participants ( N = 76) were randomly assigned to receive 3 months training versus care-as-usual. Cognitive and mental health were assessed before and after the intervention. RESULTS: Results show significant cognitive improvements across time in the training, but not control, group. This effect was mediated through a combination of increased social activity, improved self-competence, and maintained personal identity strength. Indirect effects on mental health outcomes via these processes were also observed. DISCUSSION: These findings suggest that Internet access and training can support the self and social connectedness of vulnerable older adults and contribute positively to well-being.

Hydrogen Liberation from Gaseous 2-Bora-1,3-diazacycloalkanium Cations.

Evidence is presented for cyclization to yield 2-bora-1,3-diazacycloalkanium cations in the gas phase. While the neutral compounds in solution and solid phase are known to possess an acyclic structure (as revealed by X-ray diffraction), the gaseous cations (from which borohydride BH4- ion has been expelled) have a cyclic structure, as revealed by InfraRed Multiple Photon Dissociation (IRMPD) spectroscopy and collisionally activated decomposition (CAD). The IRMPD decomposition of the monocyclic ions proceeds principally via H2 expulsion, although CAD experiments show additional pathways. Pyrolyses of solid monomeric salts and small oligomers produce higher polymers that are consistent with H2 expulsion as the major pathway. Deuterium labeling experiments show that scrambling occurs prior to IRMPD or CAD decomposition in the gas phase.