Include Action Plans Research Articles

Lesson Study as a Professional Development Model for Teaching Spatial Ability in Primary STEM

This study explores the efficacy of a professional development (PD) model that employs lesson study to teach spatial ability skills in primary STEM education. The structure of the PD supported the ‘Insights’ mechanism by focusing on visualisation, mental rotation, construction and deconstruction, and spatial orientation, which are vital for nurturing students’ spatial abilities. The ‘Motivation’ mechanism was addressed through goal setting in lesson planning, motivating teachers to integrate spatial tasks into their curricula. Continuous feedback and practical support facilitated the ‘Technique’ mechanism, embedding learned skills into everyday teaching practices. Last, the ‘Embed in Practice’ mechanisms, including action planning and prompts, were effectively translated into classroom practices, evidencing the model’s operational efficacy.

THE POWERING OF GUESSING GAME IN STUDENTS' WRITING DESCRIPTIVE TEXT: EFL CLASSROOM ACTIVITIE

Enhancing writing skills in descriptive text learning by using the guessing method in class VII SMPN 1 Sugio. The benefit of this research is the guessing game method can improve the writing ability of class VII students of SMPN 1 Sugio, this type of research is Class Action Research which is carried out in cycle stages including action planning, implementation of action, observation and evaluation, and reflection. The subject of this class action research is the seventh grade students of SMPN 1 Sugio. The object of this research is the ability to write with the guessing game method. The instruments used in this study were observation sheets and learning outcomes tests. The data from this study were analyzed descriptive qualitative. The results show that the learning activities of grade VII D SMPN 1 Sugio students who used the guessing method are more active and enthusiastic in learning. In the preliminary results, the average student score is 67.1, only one student managed to reach the KKM. In the first cycle of student learning activities with the criteria of failure, with the results achieved 68.1 of 26 students, students who reached the KKM, 6 students while the second cycle of student learning activities with very good criteria, with the results achieved 76.3 of 26 students. Students who managed to reach the KKM 23 students. Based on the results of the study, it can be concluded that the learning outcomes of seventh grade students of SMPN 1 Sugio using the guessing method have increased.

Mitigating and preventing food insecurity: a scoping review of the current EU policies

Abstract Background Food insecurity (FI) is a major public health concern, due to its association with a variety of adverse health outcomes. The aim of this study is to provide a picture of the EU policy response and adherence to the international recommendations in terms of FI mitigation and prevention. Methods A scoping review was carried out based on PRISMA Extension for scoping reviews method. By using specific queries/keywords, Pubmed and Scopus were searched and also institutional databases: EUR-Lex, WHO Global Database on the Implementation of Nutrition. The search was supplemented by a review of a list of organizations’ official websites, including Cordis, Food and Agriculture Organization of the United Nations, United Nations International Children's Emergency Fund and World Food Programme. Results The search on PubMed and Scopus produced a list of 8 articles, 3 concerning agriculture policies in EU, 4 related to intervention on the school lunch and 1 focused on the introduction of a tax on unhealthy drinks. Based on the search on EUR-Lex and WHO Global Database on the Implementation of Nutrition, 4 EU-wide statutory policies were collected covering school meals, food loss reduction, food waste prevention and food crisis and humanitarian aid operations. The institutional website's review returned 18 documents in the form of ‘soft law’ measures, including action plans, action tools and projects. Conclusions Preliminary findings suggest that currently, at EU level, a coherent specific policy framework on FI is lacking. The policy fragmentation is mainly due to the multidimensional nature of FI, which has interconnections with multiple and different areas of food system-food availability, food accessibility, food safety and food quality and healthiness. The outputs also show that to date EU has failed to adhere to the international recommendations (above all, WHO recommendations) on FI mitigation and prevention. This has significant implications in terms of public health. Key messages • Policies design and implementation have the potential to create living environments conducive to good health and to lead to concrete health gains. • Health gains resulting from strategies and policies implementation against FI reduce healthcare costs associated with the treatment of the FI-related diseases.

449 Multidisciplinary deprescribing review for frail older adults in long-term care: Development of a theory informed implementation strategy using a Delphi survey and Roundtable discussion with stakeholders

Abstract Introduction Deprescribing, the systematic process of stopping or altering inappropriate medicines, has been suggested as a safe, effective and appropriate process to optimise prescribing for older adults (1). There is still a lack of understanding of how best to implement sustainable deprescribing in long-term care (LTC). Aim Design a theory-driven implementation strategy, based on consensus from healthcare professionals (HCPs), to facilitate their engagement with deprescribing for frail older adults in LTC. Methods This study consisted of three phases and was designed in conjunction with HCPs working in LTC. Firstly, barriers and enablers to deprescribing in LTC previously identified by the research team were mapped to behaviour change techniques (BCTs) (2). Secondly, a Delphi survey of HCPs (General Practitioners (GPs), Pharmacists, nurses, geriatricians and psychiatrists of old age) was conducted to select feasible BCTs to support deprescribing. HCPs were purposively sampled and recruited via email, divided into HCPs working in Ireland and internationally. Experts were identified from existing professional relationships, engagement with LTC or deprescribing research. Using the results from the Delphi process, the literature on deprescribing interventions and research team knowledge, the BCTs which could form components of an intervention in LTC were shortlisted based on was acceptability, effectiveness, affordability, safety and equity (APEASE). Finally, a roundtable discussion was held with a purposeful, convenience sample of GPs, Pharmacists and nurses working in LTC in Ireland, to prioritise the previously identified barriers/enablers and operationalise the proposed deprescribing strategies created from feasible BCTs and identify the most important strategy to facilitate deprescribing. Results Overall, 34 BCTs were mapped to previously identified barriers/enablers to deprescribing in LTC. For the Delphi survey, 33 HCPs were invited, 20 agreed and it was completed by 16 participants. The Delphi consisted of two rounds. Participants reached consensus that 26 of the BCTs could feasibly be implemented in LTC. Following the APEASE assessment, 21 BCTs were considered eligible for operationalisation. The roundtable discussion, consisting of eight HCPs, identified that lack of resources (time, staffing, technology), was the most important barrier to address. The agreed implementation strategy to enhance engagement with deprescribing processes was an education session prior to a multidisciplinary team (MDT) meeting, led by a nurse from the LTC setting. This was designed from 11 BCTs, including action planning, social support and environmental restructuring addressing the predominant barrier. Incorporating the MDT reduces the burden which would exist if the responsibility was placed on one HCP. Meeting at the LTC site addresses the insufficient technology, as patient information is available. Conclusion This study describes an implementation strategy design process following principles of behavioural and implementation science. Engaging targeted end users throughout the process allows for the creation of a strategy which is intended to address the main perceived barrier to deprescribing of insufficient resources. A limitation of this study is the specificity of the intervention for Irish LTC context, which may have different staffing and organisational structures compared to international healthcare systems.

SURVEY OF KNOWLEDGE ABOUT ANAPHYLAXIS AND GUIDANCE WHEN DISPENSING EPIPEN FOR PHARMACISTS WORKING IN PHARMACIES

Anaphylactic shock is a serious and life-threatening condition, and affected patients should be quickly and effectively treated with an EpiPen. Although the correct use of an EpiPen is greatly affected by a user's proficiency level and the instructions accompanying the EpiPen, there has been almost no investigation into the knowledge of the EpiPen and the actual situation of the accompanying instructions for use. Therefore, we conducted this nationwide survey to elucidate these issues. A questionnaire survey was conducted among pharmacists registered as members of the system of a research company outside the university and working at pharmacies with experience in handling EpiPen prescriptions. Many of the pharmacists surveyed knew that the EpiPen is the first-line treatment for anaphylactic shock. However, they did not have sufficient knowledge of administration routes and candidates for second-line treatment. Both their occasions and experiences of dealing of EpiPen were found to be low. It is desirable to learn at conferences regarding allergology/clinical allergy and seminars for medical professionals including pharmacists in order to acquire the skills and knowledge to consult with patients with allergic diseases, including action plans presented by doctors in preparation for recurrence of anaphylaxis.

A process evaluation, with mediation analysis, of a web-based intervention to augment primary care exercise referral schemes: the e-coachER randomised controlled trial

BackgroundThe e-coachER trial aimed to determine whether adding web-based behavioural support to exercise referral schemes (ERS) increased long-term device-measured physical activity (PA) for patients with chronic conditions, compared to ERS alone, within a randomised controlled trial. This study explores the mechanisms of action of the e-coachER intervention using measures of the behaviour change processes integral to the intervention’s logic model.MethodsFour hundred fifty adults with obesity, diabetes, hypertension, osteoarthritis or history of depression referred to an ERS were recruited in Plymouth, Birmingham and Glasgow. The e-coachER intervention comprising 7-Steps to Health was aligned with Self-Determination Theory and mapped against evidence-based behaviour change techniques (BCTs). Participants completed questionnaires at 0, 4, and 12 months to assess PA and self-reported offline engagement with core BCTs in day-to-day life (including action planning and self-monitoring) and beliefs relating to PA (including perceived importance, confidence, competence, autonomy and support). We compared groups at 4 and 12 months, controlling for baseline measures and other covariates. Mediation analysis using the product of coefficients method was used to determine if changes in process variables mediated intervention effects on moderate to vigorous physical activity (MVPA) recorded by accelerometer and self-report at 4- and 12-months.ResultsThe internal reliability (Cronbach’s alpha) for all multi-item scales was > 0.77. At 4-months, those randomised to e-coachER reported higher levels of PA beliefs relating to importance (1.01, 95% confidence interval (CI): 0.42 to 1.61, p = 0.001), confidence (1.28, 95% CI: 0.57 to 1.98, p < 0.001), competence (1.61, 95% CI: .68 to 2.54, p = 0.001), availability of support (0.77, 95% CI: 0.07 to 1.48, p = 0.031), use of action planning (1.54, 95% CI: 0.23 to 2.85, p = 0.021) and use of self-monitoring (0.76, 95% CI: 0.19 to 1.32, p = 0.009) compared to ERS alone. There were no intervention effects on autonomous beliefs or perceived frequency of support, compared to ERS alone. At the 12-month follow-up, participants belief in the importance of PA was the only process measure to remain significantly higher in the e-coachER group when compared to ERS alone (0.75, 95% CI: 0.05 to 1.45). Intervention effects on perceived importance (2.52, 95% CI: 0.45 to 5.39), action planning (1.56, 95% CI: 0.10 to 3.54) and self-monitoring (1.92, 95% CI: 0.21 to 4.33) at 4-months significantly mediated change in accelerometer measured MVPA at 12-months (recorded in ≥ 10-min bouts).Conclusionse-coachER led to some short-term changes in most process outcomes. Some of these processes also appeared to mediate e-coachER effects on changes in accelerometer measured MVPA. Further work should be carried out to understand how best to design and implement theoretically underpinned web-based physical activity promotion interventions within ERS.Trial registrationISRCTN, ISRCTN15644451. Registered 12 February 2015.

Developing tailored theoretically informed goal-setting interventions for rehabilitation services: a co-design approach

BackgroundSeveral active ingredients contribute to the purposes and mechanisms of goal-setting in rehabilitation. Active ingredients in the goal-setting process include, interdisciplinary teamworking, shared decision-making, having meaningful and specific goals, and including action planning, coping planning, feedback, and review. Clinicians have expressed barriers and enablers to implementing these active ingredients in rehabilitation teams. Interventions designed to improve goal-setting practices need to be tailored to address context specific barriers and enablers. Attempts to understand and enhance goal-setting practices in rehabilitation settings should be supported using theory, process models and determinant frameworks. Few studies have been undertaken to enhance goal-setting practices in varied case-mix rehabilitation settings.MethodsThis study is part of a larger program of research guided by the Knowledge to Action (KTA) framework. A multisite, participatory, codesign approach was used in five sites to address three stages of the KTA. (1) Focus groups were conducted to understand barriers and enablers to implementing goal-setting at each site. Following the focus groups three staff co-design workshops and one consumer workshop were run at each site to (2) adapt knowledge to local context, and to (3) select and tailor interventions to improve goal-setting practices. Focus groups were analysed using the Theoretical Domains Framework (TDF) and informed the selection of behaviour change techniques incorporated into the implementation plan.ResultsBarriers and enablers identified in this study were consistent with previous research. Clinicians lacked knowledge and understanding of the differences between a goal and an action plan often confusing both terms. Clinicians were unable to demonstrate an understanding of the importance of comprehensive action planning and review processes that extended beyond initial goal-setting. Interventions developed across the sites included staff training modules, a client held workbook, educational rehabilitation service flyers, interdisciplinary goal-based case conference templates, communication goal boards and a key worker model. Implementation plans were specifically established for each site.ConclusionsRehabilitation teams continue to struggle to incorporate a truly client-centred, interdisciplinary model of goal-setting in rehabilitation. Whilst clinicians continue to lack understanding of how they can use aspects of goal-setting to enhance client outcomes and autonomy in rehabilitation settings.

Upaya Meningkatkan Nilai Karakter Kedisiplinan dengan Pembiasaan Baris Berbaris Peserta Didik Kelas V SD Negeri Kertosono Kecamatan Banyuurip Kabupaten Purworejo

This study aims to improve students' learning discipline by using the method of lining up habituation for fifth grade students of SD Negeri Kertosono. This type of research is classroom action research (CAR) which is carried out collaboratively, including action planning, action implementation, observation and reflection. The instruments used are non-test instruments in the form of teacher activity observation sheets, student activity observation sheets, teacher interview sheets, student learning discipline checklist sheets and field notes sheets. The data analysis technique used quantitative and qualitative analysis. Descriptive analysis technique of quantitative data is used to determine the percentage of students' learning discipline attitudes. The results of the discipline score using the line-of-sight habituation method showed that the students' learning discipline in each cycle increased after the action for two cycles. The percentage of students' discipline attitude. Based on the research, it shows that using the line-up habituation method can improve students' learning discipline. The percentage of students' learning discipline attitudes from the results of the disciplinary checklist also experienced a significant increase which was included in the very good category. It can be concluded that based on the results of the analysis above, learning using the line-of-sight habituation method can improve student learning discipline.

Socio-economic inequalities in child growth: Identifying orientation and forward-looking layout

Socio-economic inequalities in child growth: Identifying orientation and forward-looking layout

Following Up on Employee Surveys: A Conceptual Framework and Systematic Review.

Employee surveys are often used to support organizational development (OD), and particularly the follow-up process after surveys, including action planning, is important. Nevertheless, this process is oftentimes neglected in practice, and research on it is limited as well. In this article, we first define the employee survey follow-up process and differentiate it from other common feedback practices. Second, we develop a comprehensive conceptual framework that integrates the relevant variables of this process. Third, we describe the methods and results of a systematic review that synthesizes the literature on the follow-up process based on the conceptual framework with the purpose of discussing remaining research gaps. Overall, this paper contributes to a better understanding of the organizational and human factors that affect this process. This is useful for practitioners, as it provides guidance for the successful implementation of this human resource practice. For example, research suggests that it is important to enable managers as change agents and to provide them with sufficient resources.

Tổng quan các biện pháp can thiệp giảm tác động của ô nhiễm không khí đối với sức khỏe

Objective: This study aimed to summarize strategies to reduce impact of air pollution on health. Main findings: There are several strategies including action plan, emission control from fuel-use, traffic-related emission management strategies, industrial emission measures and interventions during important events. Conclusions: Many nations and regions are trying to improve air quality via different measures. Vietnam also need action plans to a long and sustainable air quality management. Keywords: Air Pollution, Health Impact, benefit, intervention, policy

How to Start Up a National Wildlife Health Surveillance Programme.

Simple SummaryA sound understanding of wildlife health is required to inform disease management and mitigation measures in order to help safeguard public, livestock, companion animal and wildlife health. Whilst multiple countries in Europe have schemes for wildlife health surveillance (WHS) in place that monitor the disease conditions that affect free-living wildlife, these vary in scope and scale. In 2018, the Network for WHS of the European Wildlife Disease Association hosted a meeting where representatives from countries with variable levels of current WHS were invited to share knowledge and experience of how their programmes began or were expanded. Through a series of presentations, the events that led to the start-up and expansion of WHS programmes were highlighted, such as the creation of action plans and collaboration through partnership formation. Challenges to development were identified, including limited funding and logistical difficulties around data sharing and the harmonisation of methods. Following a panel discussion, a series of practical recommendations were formulated, offering guidance on how to overcome key challenges for the instigation of national WHS programmes. It is hoped that this resource will provide a useful tool to help support the creation and expansion of WHS programmes in Europe and beyond.Whilst multiple countries in Europe have wildlife health surveillance (WHS) programmes, they vary in scope. In many countries, coordinated general surveillance at a national scale is not conducted and the knowledge of wildlife health status in Europe remains limited. Learning lessons from countries with established systems may help others to effectively implement WHS schemes. In order to facilitate information exchange, the WHS Network of the European Wildlife Disease Association organised a workshop to both collate knowledge and experience from countries that had started or expanded WHS programmes and to translate this information into practical recommendations. Presentations were given by invited representatives of European countries with different WHS levels. Events that led to the start-up and fostered growth spurts of WHS were highlighted, including action plan creation, partnership formation, organisation restructuring and appraisal by external audit. Challenges to programme development, such as a lack of funding, data sharing, infrastructural provision and method harmonisation, were explored. Recommendations to help overcome key challenges were summarised as: understanding and awareness; cross-sectoral scope; national-scale collaboration; harmonisation of methods; government support; academic support; other funding support; staff expertise and capacity; leadership, feedback and engagement; and threat mitigation and wildlife disease management. This resource may enable the development of WHS programmes in Europe and beyond.

The theoretical basis of a nationally implemented type 2 diabetes prevention programme: how is the programme expected to produce changes in behaviour?

BackgroundIt is considered best practice to provide clear theoretical descriptions of how behaviour change interventions should produce changes in behaviour. Commissioners of the National Health Service Diabetes Prevention Programme (NHS-DPP) specified that the four independent provider organisations must explicitly describe the behaviour change theory underpinning their interventions. The nationally implemented programme, launched in 2016, aims to prevent progression to Type 2 diabetes in high-risk adults through changing diet and physical activity behaviours. This study aimed to: (a) develop a logic model describing how the NHS-DPP is expected to work, and (b) document the behaviour change theories underpinning providers’ NHS-DPP interventions.MethodsA logic model detailing how the programme should work in changing diet and activity behaviours was extracted from information in three specification documents underpinning the NHS-DPP. To establish how each of the four providers expected their interventions to produce behavioural changes, information was extracted from their programme plans, staff training materials, and audio-recorded observations of mandatory staff training courses attended in 2018. All materials were coded using Michie and Prestwich’s Theory Coding Scheme.ResultsThe NHS-DPP logic model included information provision to lead to behaviour change intentions, followed by a self-regulatory cycle including action planning and monitoring behaviour. None of the providers described an explicit logic model of how their programme will produce behavioural changes. Two providers stated their programmes were informed by the COM-B (Capability Opportunity Motivation – Behaviour) framework, the other two described targeting factors from multiple theories such as Self-Regulation Theory and Self-Determination Theory. All providers cited examples of proposed links between some theoretical constructs and behaviour change techniques (BCTs), but none linked all BCTs to specified constructs. Some discrepancies were noted between the theory described in providers’ programme plans and theory described in staff training.ConclusionsA variety of behaviour change theories were used by each provider. This may explain the variation between providers in BCTs selected in intervention design, and the mismatch between theory described in providers’ programme plans and staff training. Without a logic model describing how they expect their interventions to work, justification for intervention contents in providers’ programmes is not clear.

Dynamic Assessment of PM2.5 Health Damage Value in China from 2015 to 2018

With the development of industrialization and urbanization in China, there are many environmental problems especially air pollution, which has serious impacts on the sustainable development of economy, ecological environment and public health. Since 2013, a series of environmental protection laws and regulations, and industrial and energy policies have been successively implemented, including Action Plan for Air Pollution Control, and Three-Year Action Plan to Win the Blue Sky Defense War etc. The air quality of the whole country has been improved. In order to evaluate the dynamic changes of environmental health benefits from air pollution control in China, this paper estimates the health effects and health economic losses caused by PM2.5 pollution, and makes a comparative analysis among different regions and cities based on the data of 297 cities at prefecture level and above in China from 2015 to 2018. The results show that, due to sharp decline of ρ(PM2.5), the population exposed to ρ(PM2.5)>35 μg·m-3 decreased year by year, and the proportion of the total population decreased from 80.88% to 62.32%. The total number of all kinds of health endpoints decreased from 33.23 million to 15.91 million, health economic loss decreased from 1579.04 billion yuan to 838.42 billion yuan, the proportion of healthy economic loss in GDP dropped from 2.31% to 0.99%. Among the six regions, the index values of Beijing, Tianjin, Hebei, and surrounding areas, and Chengyu areas have declined year by year. However, Fenwei Plain areas, Yangtze River Delta areas, Pearl River Delta areas, and the middle reaches of the Yangtze River show a complex trend of increasing in some years and decreasing later. However, the situation of Fenwei Plain is still more serious than other areas, and the ρ(PM2.5) is next to Beijing, Tianjin, Hebei and surrounding areas. ρ(PM2.5) of all 11 cities still exceed 35 μg·m-3 in 2018. Compared with 2015, the number of early deaths decreased by 1500, but the total number of all kinds of health endpoints increased by 18900. The health economic loss is 80.711 billion yuan, an increase of 10.714 billion yuan than that in 2015. The proportion of health economic loss in GDP is 3.16%, which is 0.25% lower than that in 2015. The per capita health economic loss is 182.67 yuan higher than that in 2015. In terms of cities, from 2015 to 2018, ρ(PM2.5) in 228 cities decreased with varying degrees. Among which, Dezhou and Baoding dropped the most, only 10 cities saw ρ(PM2.5) rise. 14 cities saw an increase in the number of healthy endpoints, and 11 cities saw an increase in the proportion of healthy economic loss to GDP. Although the index values of Baoding, Xingtai, Handan, and other cities have declined year by year, they still rank top 10 every year. The index value of Xi'an, Xianyang, Linfen, and other cities in 2018 is more than that in 2015. The research shows that the environmental health benefits of air pollution control are significant in China, but it is still necessary to further strengthen regional joint prevention and control, as well as one city one policy.

The Changing Aspects of Motherhood in Face of the COVID-19 Pandemic in Low- and Middle-Income Countries.

PurposeTo advocate perspectives to strengthen existing healthcare systems to prioritize maternal health services amidst and beyond the COVID-19 pandemic in low- and middle income countries.DescriptionCOVID-19 directly affects pregnant women causing more severe disease and adverse pregnancy outcomes. The indirect effects due to the monumental COVID-19 response are much worse, increasing maternal and neonatal mortality.AssessmentAmidst COVID-19, governments must balance effective COVID-19 response measures while continuing delivery of essential health services. Using the World Health Organization’s operational guidelines as a base, countries must conduct contextualized analyses to tailor their operations. Evidence based information on different services and comparative cost-benefits will help decisions on trade-offs. Situational analyses identifying extent and reasons for service disruptions and estimates of impacts using modelling techniques will guide prioritization of services. Ensuring adequate supplies, maintaining core interventions, expanding non-physician workforce and deploying telehealth are some adaptive measures to optimize care. Beyond the COVID-19 pandemic, governments must reinvest in maternal and child health by building more resilient maternal health services supported by political commitment and multisectoral engagement, and with assistance from international partners.ConclusionsMulti-sectoral investments providing high-quality care that ensures continuity and available to all segments of the population are needed. A robust primary healthcare system linked to specialist care and accessible to all segments of the population including marginalized subgroups is of paramount importance. Systematic approaches to digital health care solutions to bridge gaps in service is imperative. Future pandemic preparedness programs must include action plans for resilient maternal health services.

Decoding motor imagery and action planning in the early visual cortex: Overlapping but distinct neural mechanisms

Recent evidence points to a role of the primary visual cortex that goes beyond visual processing into high-level cognitive and motor-related functions, including action planning, even in absence of feedforward visual information. It has been proposed that, at the neural level, motor imagery is a simulation based on motor representations, and neuroimaging studies have shown overlapping and shared activity patterns for motor imagery and action execution in frontal and parietal cortices. Yet, the role of the early visual cortex in motor imagery remains unclear. Here we used multivoxel pattern analyses on functional magnetic resonance imaging (fMRI) data to examine whether the content of motor imagery and action intention can be reliably decoded from the activity patterns in the retinotopic location of the target object in the early visual cortex. Further, we investigated whether the discrimination between specific actions generalizes across imagined and intended movements. Eighteen right-handed human participants (11 females) imagined or performed delayed hand actions towards a centrally located object composed of a small shape attached on a large shape. Actions consisted of grasping the large or small shape, and reaching to the center of the object. We found that despite comparable fMRI signal amplitude for different planned and imagined movements, activity patterns in the early visual cortex, as well as dorsal premotor and anterior intraparietal cortex, accurately represented action plans and action imagery. However, movement content is similar irrespective of whether actions are actively planned or covertly imagined in parietal but not early visual or premotor cortex, suggesting a generalized motor representation only in regions that are highly specialized in object directed grasping actions and movement goals. In sum, action planning and imagery have overlapping but non identical neural mechanisms in the cortical action network.

The impact of a personalised action plan delivered at discharge to patients with COPD on readmissions: a pilot study.

BackgroundSelf‐management interventions in COPD, including action plans, have the potential to increase quality of life and to reduce respiratory‐related hospitalisations. However, knowledge is still sparse of the effectiveness of a personally tailored action plan introduced at or right after discharge from hospital.AimThis pilot study aimed to test whether a personalised, stepwise action plan supported with a short instruction provided at or postdischarge after an acute exacerbation in chronic obstructive pulmonary disease admission as an addition to usual care reduces readmissions and symptom burden, including anxiety and depression levels at 3‐month follow‐up.MethodsThe study was carried out in a randomised controlled design with follow‐up after 3 months. In all, 75 participants were randomly assigned to either an intervention group that received an action plan, including the COPD Assessment Test (CAT), or to a control group that received usual care. The incidence of COPD‐related readmissions was measured as the primary outcome.ResultsCompared to the control group, the action plan group significantly reduced the incidence of readmissions. The action plan group showed a trend towards a significant decrease in HADS‐depression, but none in HADS‐anxiety. Significant improvements in CAT scores were observed for the participants in the intervention group. Only inferior minor differences were found in use of inhalation therapy.ConclusionsA personally tailored action plan introduced at or postdischarge combined with follow‐up support is an effective self‐management tool to support recovery and to reduce unnecessary readmissions. In future follow‐up care, the healthcare professional must initiate the action plan at discharge and immediately after having the opportunity to follow the patient at home. This might require healthcare professionals working across healthcare sectors, who support patients until they have the needed confidence and competence in using the plan.

THE RELATIONSHIP OF DAILY STEPS TO MOOD AND ENERGY: APPLICATION OF STEPMATE (MOBILE APP FOR TRACKING EXERCISE)

Physical activity is one of the most promising and accessible strategies to promote healthy aging. Yet, the majority of middle-aged and older adults do not engage in the recommended amount of exercise despite awareness of its widespread benefits. Smartphone apps have the potential to be valuable tools in tracking and encouraging physical activity; however, few apps incorporate successful behavior change strategies. Drawing from interviews with older adults, we created a new smartphone app to encourage and track daily walking, StepMATE (Mobile App for Tracking Exercise). StepMATE uses behavior change strategies including action planning and social support to help users determine where, when, and with whom they will walk. The app records steps and also uses experience sampling to assess mood and energy levels twice a day. Adults ages 50 and over (N=58) participated in a one-month study where they used the app to set their own walking goals and track their daily walking. Using multilevel modeling, we found that on days in which adults take more steps than their average, they report higher mood and energy. We also found that on days in which participants achieve their step goal, they report higher mood and energy than on days when they do not achieve their goal. Discussion will center on motivational approaches to behavior change among sedentary older adults.

Time to change the paradigm? A mixed method study of the preferred and potential features of an asthma self-management app.

We explored the potential of asthma apps to support self-management and identified preferred features that enable users to live with asthma. We recruited patients from five UK practices and social media; observed their usage of our app, administered a questionnaire and interviewed a purposive sample of patients and professionals to explore preferred features. Thematic analysis of interview was synthesised with quantitative data. A total of 111 patients used our app for 3 months. We interviewed 15 patients and 16 professionals. Participants were interested in a broad range of self-management support strategies, including action plans, monitoring with feedback, allergy/weather warnings and tailor-made running coaching. Professionals wanted to integrate patients' logs with practice records, though were concerned about data overload and risk of patient dependency. We propose a paradigm shift - from apps developed to provide features that are easy to implement technologically, to an approach in which apps are designed to deliver theoretically grounded preferred components.

Can agricultural research and extension be used to challenge the processes of exclusion and marginalisation?

ABSTRACTPurpose: This paper examines if and how agricultural researchers and extension officers can see, understand and change processes that exclude some people and influence marginalisation.Design and methodology: We used participatory action research (PAR) in a programme building sustainable farming practices for nutrition and income in Solomon Islands as our case study. Two qualitative PAR data streams were analysed: (i) documentation of community activities over three years including action planning, learning activities, training workshops, focus group discussions, key informant and informal interviews and (ii) documentation of the research teams’ own learning and reflection sessions.Findings: Agricultural research and learning activities facilitated through PAR can help researchers and extension officers see, understand and challenge processes that cause social exclusion and marginalisation and lead to inequitable access to agricultural opportunities. A combination of (i) starting with a collective vision; (ii) facilitating systematic reflection exercises; and (iii) having locally tuned facilitators creating safe spaces; makes processes of social exclusion tangible, discussable and ultimately actionable, illustrating the potential of the research and extension processes to facilitate social change in real time.Theoretical Implications: The paper makes a contribution to the growing body of theory and literature on innovation systems and people-centred approaches to agricultural development, by highlighting the facilitation challenges and opportunities that can create more learning focused and power-aware agricultural programming.Practical Implications: Our approach, examined in this paper, can improve implementation of policies such as the Solomon Islands Agriculture and Livestock Sector Policy (2015–2019), which aims for active participation of women and youth in agricultural development.Originality: Using a PAR approach to discover how agricultural research and extension activities can help transform the processes that cause social exclusion and create disadvantage and marginalisation.