Familiar Setting Research Articles

Creating Inclusive Research Through a Culturally Aware Data Collection Site

AbstractBackgroundEthnic and racial diversity in clinical research is critical for developing generalizable treatments and caregiving strategies. Barriers to participation among persons from underrepresented groups (URG) are systemic in clinical research. To increase URG research participation, we designed a community‐based data collection site where study participants complete full research visits.MethodFor an Alzheimer’s disease study, we established the first community‐based data collection site in Madison, WI, forging connections with Black community leaders and campus outreach staff. The site is proximal to diverse neighborhoods, public transportation, and is a hub for multi‐ethnic businesses. We rent space in the South Madison Partnership Office, an established community outreach center. This has allowed us to cultivate a consistent presence in the Black community, which evolved into a full data‐collection site. Staff include research specialists, community liaisons, nurse practitioners, and clinicians who are culturally‐aware and members of the Black community. The site is decorated with art from local Black and Indigenous artists, and food served is from a local Black‐owned business.ResultWe established proof of concept by successfully launching a fully‐equipped research site in the community, used for memory testing, biometric readings, blood draws, and one‐on‐one conversations with clinicians. Initial comments suggest participants prefer this comfortable, familiar setting over that of a hospital setting.ConclusionResearchers can use culturally‐aware and convenient data collection sites. Our site prioritizes the needs of participants toward the goal of achieving representation of racialized groups in research. This model has potential for broad implementation across aging and biomedical research.

Exploring the Experiences of Community-Dwelling Older Adults Participating in Group Interaction Programs: A Qualitative Meta-Synthesis.

To synthesise evidence from qualitative studies on community-dwelling older adults' experiences of social interactions in group interaction programmes. A systematic review and meta-synthesis based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Two independent researchers screened the titles and abstracts of all retrieved studies based on eligibility criteria. Quality appraisal was conducted based on the comprehensive Critical Appraisal Skills Programme checklist. Data were extracted through an adapted Data Extraction Tool from the Joanna Briggs Institute Qualitative Assessment and Instrument. Findings were synthesised through the JBI meta-aggregation approach. A literature search for peer-reviewed studies was conducted across seven databases from inception to September 2023. Our review included the experiences of 395 community-dwelling older adults across 25 studies, yielding the overarching theme of 'Navigating relationships and facilitating growth in a supportive community'. Five themes were identified: feeling safe in a familiar environment, bringing people together, establishing meaningful relationships, improving personal well-being and facing socialising challenges. Our findings provided not just theoretical insights but also practical implications. They can serve as a solid foundation for formulating or enhancing similar programmes, directly addressing the pervasive issues of loneliness and social isolation among the ageing population worldwide. This review improves our understanding of the social, emotional and personal benefits for older adults upon engaging in group interaction programmes. The insights into the elements of successful group interaction programmes for older adults, include providing a safe and familiar setting and bringing people together for socialisation. Future interventions should incorporate these elements to promote social interactions and community engagement more effectively to mitigate loneliness among older adults. Finally, the diverse range of programmes explored in this review demonstrates that future programmes can be flexibly formulated to suit different interests. The authors have nothing to report. The review protocol has been registered on PROSPERO.

Physicians’ Perspectives on Using Direct Observation to Assess Non-English Language Proficiency for Clinical Practice: A Qualitative Study

BackgroundCommunication barriers are known to adversely affect patient safety. Yet few health systems assess and track physician non-English language proficiency for use in clinical settings. Barriers to current assessments (usually simulated clinician oral proficiency interviews) include time constraints and lack of interactivity. This study's objective was to investigate physician perspectives on using direct clinical observation as an alternative form of assessment of their non-English language skills. MethodsThe authors conducted semistructured interviews with 11 fully and partially bilingual primary care physicians (general internists) from a large academic health system to understand physician perspectives on using direct observation as an alternative form of assessing non-English proficiency for use in clinical practice. Two researchers independently and iteratively coded transcripts using thematic analysis with constant comparison to identify themes. ResultsParticipants, mostly women (n = 9; 81.8%), reported varying levels of proficiency in Cantonese, Mandarin, Russian, or Spanish. Participants expressed three main themes: (1) benefits of direct observation, including familiar setting, relevant content, and convenience; (2) disadvantages, including discomfort, potential embarrassment, and limitations of observing a single encounter; and (3) suggestions to enhance use of direct observation tools, such as observing multiple encounters, and use of remote observation. ConclusionTo ensure high-quality language-concordant care, health systems must assess physicians’ non-English language proficiency. If validated tools can be developed and disseminated in clinical practice, direct observation may be an acceptable option.

Long-lasting pure topographical disorientation due to heading disorientation following left retrosplenial infarction: A report of two cases

Topographical disorientation is linked to lesions in the right hemisphere and typically resolves within a few months post-stroke. Persistent topographical disorientation is uncommon and frequently accompanied by impairments in visual memory, complicating the analysis of the underlying mechanisms. Herein, we report two cases of sustained pure topographical disorientation following cerebral hemorrhages in the left retrosplenial region. The patients exhibited disorientation in both familiar and unfamiliar settings, attributable to heading disorientation, a deficit in determining the directional relationship between one’s current position and a target location or external frames. The patients struggled with reconstructing large-scale spatial frameworks and integrating new egocentric and allocentric perspectives upon changes in body orientation. There were no landmark agnosia, egocentric disorientation, or anterograde disorientation. Although mild verbal memory deficits were observed, no other cognitive impairments, including visual memory deficits, were detected. Our findings imply that lesions confined to the left retrosplenial region can induce enduring heading disorientation and suggest a significant role for this area in processing and integrating spatial information necessary for large-scale navigation. Clarifying the features of topographical disorientation will significantly impact the therapeutic approaches, enhancing the quality of life for affected patients by restoring their independence and mobility.

Patient perspectives on primary care behavioral health integration in an urban mental health professional shortage area: Benefits, facilitators, and barriers.

While studies have described the benefits of integrating behavioral health (BH) into primary care (PC), few have examined patients' perspectives, especially in large, urban health systems. In 2015, the University of Chicago Medicine launched the Primary Care Behavioral Health Integration Program, located in a mental health professional shortage area. In 2021, semistructured interviews were conducted with adult patients who had discussed their depression symptoms with their primary care clinician (PCC). Participants were asked about their experiences of being screened for depression, discussing BH, and being referred to behavioral health clinicians (BHCs). Interviews were analyzed using thematic analysis and constant comparison, and they were conducted until theme saturation was achieved. Fifteen participants were interviewed, the majority of whom were women and African American/Black, with an average age of 52. Participants expressed that PC-BH integration helps patients recognize BH problems and navigate the BH care system, emphasizes the connection between physical and mental health, and eases conversations through familiar setting and established trust. Patients enumerated barriers to integration, including barriers to BH care in the PC setting, barriers to BH conversations with PCCs/BHCs, and barriers to referrals to psychiatry/external therapy. Patients highlighted facilitators of integration, including trust with their PCC, collaboration between PCCs and BHCs, and population-level screening. These perspectives affirm the core strength of PC-BH integration: making BH more accessible and destigmatizing, especially for underserved communities. They also emphasize the importance of collaboration between PCCs and BHCs, shared identities, and actively involving patients in program design and quality improvement interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The identification and treatment of alcohol problems in primary care (iTAPP) study: protocol for a stepped wedge cluster randomized control trial testing the 15-method in a primary care setting

BackgroundThe 15-method is a targeted screening and treatment approach for alcohol problems in primary care. The 15-method used in primary care has proven as effective as specialized treatment for mild to moderate alcohol dependence in Sweden. A feasibility study of the 15-method in Danish primary care found the method acceptable and feasible.AimsTo evaluate the effectiveness of the 15-method in a Danish primary care setting in (1) lowering the proportion of patients exceeding the Danish low-risk alcohol consumption limit of ten standard units per week and a maximum of four standard units on a single day for men and women, and (2) increasing the likelihood of alcohol use being addressed during a consultation in general practice. Further, the rate of prescribed pharmacological treatment for alcohol problems (Disulfiram, Naltrexone, Acamprosate, and Nalmefene) will be measured along with the use of the biomarkers Alanine Transaminase and Gamma-Glutamyl Transferase.MethodsStepped wedge cluster randomized controlled trial in sixteen general practices in the Region of Southern Denmark. Following a three-month baseline, the practices are randomly assigned to launch dates in one of four clusters. General practitioners and nurses receive three hours of training in the 15-method before launch. Patient questionnaires will collect data on alcohol consumption levels among patients affiliated with the practices. The healthcare professionals will register consultations in which alcohol is addressed in their patient filing system. Pharmacological treatment rates and the use of biomarkers will be collected through Danish national registries. The study follows the Medical Research Council’s guidelines for developing and evaluating complex interventions.DiscussionFrom the patient’s perspective, the 15-method may help identify alcohol-related problems at an earlier stage with flexible treatment offers in a familiar setting. For healthcare professionals, it addresses a traditionally challenging topic by equipping them with concrete tools, communication training, and clear treatment directives. From a societal perspective, primary care holds a unique position to identify hazardous and harmful alcohol use across different age groups, with potential public health and economic benefits through early identification and intervention.Trial registrationClinicaltrials.gov NCT05916027. Retrospectively registered 22 June 2023.

Skills, Confidence and Challenges in Speaking English among Indigenous College Students

The study tried to assess the skills, confidence, and challenges in speaking English among indigenous people college students and utilized descriptive research method. 526 indigenous college students from the public and private institutions of the second district of Oriental Mindoro were involved in the study. Results showed that the majority of respondents were female and within the 18-24 age bracket, with the largest proportion of Buhid Mangyan tribe. Most of the respondents demonstrated consistent performance across all speaking skills and often performed the statements in all the indicators in vocabulary, followed by fluency, grammar, and pronunciation. The respondents often showed a prevalent confidence in speaking English, particularly in familiar settings such as home and school, reflecting a positive attitude towards English communication within their community. The respondents often encountered frequent and equally pronounced difficulties in speaking English, spanning academic, personal, and social domains, demanding comprehensive strategies to alleviate these challenges and enhance their English communication skills effectively. It was observed that there was a significant difference in students’ skills, confidence, and challenges in speaking English when grouped according to profile and based on the test conducted, it was found out that females from the Buhid tribe studying in private and belonging to the 3rd level have better assessment than others. English speaking skills of indigenous students are closely related to their English-speaking confidence and challenges. The study revealed that the better the skills and confident in speaking English, the more challenges they experienced. Therefore, a language learning program was put forward to help indigenous college students enhance their English speaking skills to reduce the challenges they might encounter to attain confidence in speaking English.

In “Tone” with dogs: exploring canine musicality

This study investigates the musical perception skills of dogs through playback experiments. Dogs were trained to distinguish between two different target locations based on a sequence of four ascending or descending notes. A total of 16 dogs of different breeds, age, and sex, but all of them with at least basic training, were recruited for the study. Dogs received training from their respective owners in a suitable environment within their familiar home settings. The training sequence consisted of notes [Do-Mi-Sol#-Do (C7-E7-G7#-C8; Hz frequency: 2093, 2639, 3322, 4186)] digitally generated as pure sinusoidal tones. The training protocol comprised 3 sequential training levels, with each level consisting of 4 sessions with a minimum of 10 trials per session. In the test phase, the sequence was transposed to evaluate whether dogs used relative pitch when identifying the sequences. A correct response by the dog was recorded as 1, while an incorrect response, occurring when the dog chose the opposite zone of the bowl, was marked as 0. Statistical analyses were performed using a binomial test. Among 16 dogs, only two consistently performed above the chance level, demonstrating the ability to recognize relative pitch, even with transposed sequences. This study suggests that dogs may have the ability to attend to relative pitch, a critical aspect of human musicality.

A qualitative analysis of post-hoc interviews with multilevel participants of a randomized controlled trial of a community-based intervention.

Community-based health interventions often demonstrate efficacy in clinical trial settings but fail to be implemented in the real-world. We sought to identify the key operational and contextual elements of the Los Angeles Barbershop Blood Pressure Study (LABBPS), an objectively successful community-based health intervention primed for real-world implementation. LABBPS was a cluster randomized control trial that paired the barbers of Black-owned barbershops with clinical pharmacists to manage uncontrolled hypertension in Black male patrons, demonstrating a substantial 21.6 mmHg reduction in systolic blood pressure. Despite this success, the LABBPS intervention has not expanded beyond the original clinical trial setting. The aim of this study was to determine the facilitating and limiting factors to expansion of the LABBPS intervention. We undertook a qualitative assessment of semi-structured interviews with study participants performed after trial completion. Interviews included a total of 31 participants including 20 (6%) of the 319 LABBPS program participants ("patrons"), 10 (19%) barbers, and one (50%) clinical pharmacist. The semi-structured interviews were focused on perceptions of the medical system, study intervention, and influence of social factors on health. Several common themes emerged from thematic analysis of interview responses including: importance of care provided in a convenient and safe environment, individual responsibility for health and health-related behaviors, and engagement of trusted community members. In particular, patrons reported that receiving the intervention from their barber in a familiar environment positively influenced the formation of relationships with clinical pharmacists around shared efforts to improve medication adherence and healthy habits. All interviewee groups identified the trust diad, comprising the familiar environment and respected community member, as instrumental in increasing health-related behaviors to a degree not usually achieved by traditional healthcare providers. In conclusion, participants of an objectively successful community-based intervention trial consistently identified key features that could facilitate wider implementation and efficacy: social trust relationships, soliciting insights of trust bearers, and consistent engagement in a familiar community setting. These findings can help to inform the design and operations of future community-based studies and programs aiming to achieve a broad and sustainable impact.

Farmer experiences with goat raising in Lao PDR: implications for improving husbandry and sustaining viable systems

ABSTRACT Goat raising has increased in Lao People’s Democratic Republic due to meat demand from Vietnam. Goat production is low input using free grazing and minimal husbandry. Technical constraints are well known but socio-cultural contexts are poorly understood. This paper describes qualitative research on farmer’s motivations, experiences and learning pathways, to improve goat husbandry. Semi-structured interviews were conducted with 30 smallholder goat farmers in Lao’s South-Central province of Savannakhet. The interviews revealed that farmers relied on their experiences and observations of goat raising in their communities to make their management decisions. Trial and error was a valued learning strategy. Farmers took guidance from the exchange of goat raising experiences with other goat farmers and preferred participatory learning that fostered discussion in familiar village settings. Lao smallholder goat farming systems are a product of compromise across a number of resources. Project interventions that required low investments of labour, land or capital were most readily implemented and adapted by farmers. This study questions the assumption that project interventions are inherently optimal and beneficial for smallholder farming systems. Recommendations propose how farmer’s experiences, constraints and preferences can be incorporated into development approaches to ensure management system changes reflect the desires of smallholder farmers.

On-site sensory experience boosts acceptance of cultivated chicken

This study set out to assess if presenting cultivated chicken in the context of a familiar meal, in a familiar dining setting, would motivate repeat consumption and recommendation. A survey of 107 diners was conducted at Huber's Butchery and Bistro in Singapore – the world's first butchery to serve cultivated meat – from April to June 2023. The findings showed that eating cultivated chicken significantly boosted post-consumption acceptance levels. In addition, cultivated chicken's tastiness may be a more important factor than its integration into a familiar meal or dish in fostering repeat consumption. Implications for the cultivated meat industry, limitations, and suggestions for future research are addressed.

Community art therapy (CAT): learning from art therapy graduate students’ perceptions

ABSTRACT Background In recent years, therapeutic approaches in the field of art therapy have gone beyond clinical models to include community models that emphasize the potential of art to influence communities in distress and encourage art therapists to expand their therapeutic interventions and extend their professional boundaries. Aims: This qualitative study was designed to better understand the experiences of art therapy graduate students who implemented community art therapy (CAT) projects during their internship after taking courses on CAT. It examined how they experienced the transition from the familiar clinical model to the community model. Results Five main themes emerged from the analysis: the students' perceptions of the differences between CAT and the familiar clinical art therapy setting, the specific role of the community art therapist, the role of the art, a sense of belonging to the community, and the power of the group in CAT. Conclusions The artistic process in CAT contribute to the co-creation of community knowledge through metaphorical expressions of identity and belonging. The students experienced the role of the community art therapist as a continuous dialectic between intervener-joiner who makes an impact and is also affected by the process personally. Engaging in a shared examination of the training of CAT allowed the educators and the students to achieve a deeper understanding of the challenges and the transformation required. Implications for practice CAT should be taught as a separate topic in art therapy programs, and CAT professionals should be trained to support and supervise students and therapists. Plain-language summary In recent years, the field of art therapy has undergone significant changes from traditional clinical to community models that emphasise the potential of art to influence communities in distress and encourage art therapists to expand their therapeutic interventions, extend their professional boundaries, and at times become social activists. This study examined 11 art therapy students’ reports on their experiences as facilitators of a community art therapy (CAT) intervention in communities of their choice. The students wrote a one-page reflection on each community intervention and completed the Helpful Aspects of Therapy (HAT) questionnaire that explores helpful and hindering events in each intervention. Five themes emerged: the students` experiences of the differences between traditional art therapy and the CAT setting in terms of the specific role of the art therapist, the role of the art, a sense of belonging to the community, and the power of the group in CAT. The students indicated that the role of the community art therapist involves a continuous dialectic between participants and the facilitator, who can make an impact but is also affected by the process personally. Overall, CAT should be taught as a separate topic in art therapy programmes and CAT professionals should be trained to support and supervise the work of students and therapists.

What influences the public’s willingness to report health insurance fraud in familiar or unfamiliar healthcare settings? a cross-sectional study of the young and middle-aged people in China

IntroductionYoung and middle-aged people are important participants in the fight against health insurance fraud. The study aims to investigate the differences in their willingness to report health insurance fraud and the factors influencing it when it occurs in familiar or unfamiliar healthcare settings.MethodsData were obtained from a validated questionnaire from 828 young and middle-aged people. McNemar’s test was used to compare the public’s willingness to report under the two scenarios. Chi-square tests and multiple logistic regression analysis were used to analyze the determinants of individuals’ willingness to report health insurance fraud in different scenarios.ResultsYoung and middle-aged people were more likely to report health insurance fraud in a familiar healthcare setting than in an unfamiliar one (McNemar’s χ²=26.51, P < 0.05). Their sense of responsibility for maintaining the security of the health insurance fund, the government’s openness about fraud cases, and the perception of their ability to report had significant positive effects on the public’s willingness to report in both settings (P < 0.05). In a familiar healthcare setting, the more satisfied the public is with government measures to protect whistleblowers, the more likely they are to report (OR = 1.44, P = 0.025). Those who perceive the consequences of health insurance fraud to be serious are more likely to report than those who perceive the consequences to be less serious (OR = 1.61, P = 0.042).ConclusionIndividuals are more likely to report health insurance fraud in familiar healthcare settings than in unfamiliar ones, in which their awareness of the severity of the consequences of health insurance fraud and their perceived risk after reporting it play an important role. The government’s publicizing of fraud cases and enhancing the public’s sense of responsibility and ability to maintain the safety of the health insurance fund may be a way to increase their willingness to report, regardless of whether they are familiar with the healthcare setting or not.

МОБІЛЬНА АРХІТЕКТУРА ЯК СПОСІБ ВИРІШЕННЯ ПРОБЛЕМИ ЗАБЕЗПЕЧЕННЯ ВНУТРІШНЬО ПЕРЕМІЩЕНИХ ОСІБ ДОСТУПНИМ ЖИТЛОМ

The article highlights the problems of the creation and implementation of mobile housing for internally displaced persons in Ukraine, which provides people with a decent and comfortable shelter. In addition to social and cultural problems, refugees who are forced to relocate also deal with physical problems, where shelters are designed to meet the minimum needs of temporary accommodation. Designing emergency housing requires innovative and flexible thinking to ensure that housing is safe, healthy and comfortable. This would help improve the quality of housing for residents and surrounding communities. Portable architecture can help develop an industry-wide strategy that includes new materials, components, and construction methods. As a type of building project that must respond to relatively extreme operating parameters, it more often uses experimental and exploratory logistic and construction methods that may ultimately have more general significance. Portable buildings can do almost anything that permanent ones can, and they are also often able to perform other functions that would not be possible with other means. Portable buildings have a low environmental impact; they can be located in rural or urban areas with minimal long-term consequences. They can use a temporary identified address, which is valuable to both the operator and the visitor, as well-known locations can be used to increase the number of people reached over some time. Unusual forms of buildings that are temporarily placed in familiar settings can also change people's view of the environment and perhaps give them the impetus to recognize more clearly its positive and negative features.

At home in the field, in the field at home? Reflections on power and fieldwork in familiar settings

Critical epistemologies and methodologies have over time challenged the static and mono-dimensional approaches to fieldwork, allowing researchers to contemplate and conduct their research in spaces of in-betweenness. Despite this important shift, the essentialist idea that both ‘the field’ and ‘home’ in a fieldwork setting must be actual places persists. In this article, we challenge the conceptualization and operationalization of ‘home’ not only as the juxtaposition to ‘the field’, but also as the embodiment of a place in a specific temporality. We argue that the postulation of ‘home’ as a constant disregards the non-predetermined and unpredictable nature of fieldwork relationships that are often complicated by implicit and explicit power dynamics, especially in places researchers identify as ‘home’. We demonstrate that unequal power relations, especially (1) between the Global North and Global South, (2) between majority and minoritized groups, (3) among genders, and (4) between elites and non-elites, require us to envisage ‘the field’ and ‘home’ in relative terms. We propose the reconceptualization of fieldwork place as a hybridized space that conjoins ‘the field’ and ‘home’ as ‘field-home’, particularly at a time when research mobility is restricted by the COVID-19 pandemic. In this way, we extend the literature on issues related to power, positionality and reflexivity in qualitative research, and provide practical insights for those preparing for fieldwork.

Higher Order Difference Operators and Associated Relative Reproducing Kernel Hilbert Spaces

We study multiple notions of Hilbert spaces of functions which, via the respective inner products, reproduce function values, or differences of function values. We do this by extending results from the more familiar settings of reproducing kernel Hilbert spaces, RKHSs. Our main results deal with operations on infinite graphs of vertices and edges, and associated Hilbert spaces. For electrical network models, the differences represent voltage differences for pairs of vertices x, y. In these cases, relative RKHSs will depend on choices of conductance functions c, where an appropriate function c is specified as a positive function defined on the edge-set E from G. Our present study of higher order differences, using choices of relative RKHSs, is motivated in part by existing numerical algorithms for discretization of PDEs. Our approach to higher order differences uses both combinatorial operations on graphs, and operator theory for the respective RKHSs. Starting with a graph , we introduce an induced graph such that the vertices in are the edges in E from G, while the edges in are pairs of neighboring edges from G.

Somewhere Between a Stopwatch and a Recording Device: Ethnographic Reflections From the Pool

As has recently been highlighted, despite the prevalence of methodological “confessional tales” in ethnography generally, the challenges of undertaking ethnographic research specifically in institutional sports settings remain underexplored. Drawing on data from a 3-year ethnographic study of competitive swimming in the United Kingdom (UK), here we explore some of the practical challenges of balancing different elements of the researcher’s role when undertaking ethnographic “insider” research in familiar settings. In particular, we consider the difficulties of balancing the role of a doctoral researcher and the chosen research role of a volunteer coach with a competitive swimming program. Employing the anthropological concept of liminality, we also analyze the lived challenges of leaving a highly familiar field and entering a state of liminality, where the researcher was caught on the threshold betwixt and between a return to full-time employment in the former “known” role of coach, and a move forward to embrace a new “unknown” role as a full-time member of academic staff.

Reader's Response to Achebe's Civil Peace

This study aims to explore the personal interpretation of the reader of the short story "Civil Peace" using Norman Holland's Reader's Response vehicle. The study is based on a qualitative method, where the text of the story is subjected to the reader's interpretation to identify personality traits, familiar character traits, familiar plot events, and familiar settings. Findings reveal that the reader's interpretation is highly influenced by the major character of the story, Jonathan Iwegbu. The reader connects himself with Iwegbu at the first stage. In the second stage, Iwegbu's struggle seems similar to that of a person the reader knows, Ahmad. In the third stage, Iwegbu's response at moments of miracles and crises connects the reader with events in his personal life, showing unity with this character. Lastly, the reader appreciates Achebe's use of vernacular language as the best tool to depict real events in a realistic style. This study is a significant contribution to the current literature, providing insights into the reader's experience of "Civil Peace.

Love on the Rocks: Lighthouses in Literature as Gendered Geographies of Love

The lighthouse has long been a familiar setting for stories of love, conflict, and epiphany. That isolated tower on the clifftop brims with symbolic possibility and sometimes cliché, positioning it as a site of gendered love, with popular fiction titles embedding the trope of the contained world revolving, like the lit lamp, around the male authority. But the lighthouse also has an explicit historical situatedness. The nineteenth century British lighthouses, in particular, were seen as outposts of empire. They are immovable inscriptions of the outlines of islands, the edges of continents – the imprint of colonisation on country. And they are often seen as male domains. In the popular imagination, a lighthouse is much more than its function. Does recent historical fiction perpetuate or subvert what we think we know about lighthouses and the people who populated them? How does it portray the officially gendered roles and intense relationships of women characters? How might historical novels set in settler colonies recognise the specific meaning of the lighthouse as a marker of imperial authority? And how do we read the lighthouse and its place in the imagination as a geography of gender and love?

Assessment of innovative living and care arrangements for persons with dementia: a systematic review

BackgroundAlternative forms of housing for persons with dementia have been developed in recent decades. These concepts offer small groups of residents familiar settings combined with efforts to provide normal daily life. The aim of this systematic review is to collate and analyze these more innovative forms of housing regarding residents’ quality of life, behavioral aspects, as well as functional, cognitive and emotional aspects.MethodsSearches were conducted in PubMed, EMBASE and PsycInfo in November 2020. Studies comparing traditional and more innovative living environments for persons with dementia were eligible. Concepts are described based on the results of additional searches. Risk of bias of included studies was assessed using checklists from the Joanna Briggs Institute.ResultsA total of 21 studies corresponding to 11 different concepts were included, namely Green Houses (USA), Group Living (Sweden), Cantou (France), Group Homes (Japan), Small-scale Group Living (Austria), Special Care Facilities (Canada), Shared-housing Arrangements (Germany), Residential Groups (Germany), Residential Care Centers / Woodside Places (USA/Canada), Small-scale Living (Netherlands/ Belgium), and Green Care Farms (Netherlands). The concepts are broadly similar in terms of care concepts, but partly differ in group sizes, staff qualifications and responsibilities. Several studies indicate that innovative forms of housing may encourage social behavior, preserve activity performance and/or positively influence emotional status compared to more traditional settings, while other studies fail to demonstrate these effects. Some studies also show increased behavioral and psychological symptoms of dementia (BPSD) in residents who live in more innovative housing concepts. The effect on cognition remains indistinct.DiscussionThe positive effects may be attributable to the inherent characteristics, including small group sizes, a stimulating design, and altered staff roles and responsibilities. Arguably, some of these characteristics might also be the reason for increased BPSD. Studies had variable methodological quality and results have to be considered with caution. Future research should examine these effects more closely and should investigate populations’ preferences with regards to housing in the event of dementia.