This thesis is concerned with play, particularly the role of social play in a co-located context and its ability to bring people together. Participation in social play can have significant effects on an individual, group, community and culture, and thus, through practice-based research, this thesis documents the exploration of the design of “playful interventions” which may be artefacts or events which seek to bring people together through play. In play, individuals form shared meanings, understanding and values, as determined by the rules of the play situation. In the play experience, they become temporary communities, who, through play, can experiment, explore and redefine their relationships with one another, the play context and potentially the world beyond. The experimental nature of play leads it to be naturally imbued with transformative potential for everyone involved; whether that be small in scale, such as forming a new way of looking at a space through playing within it, or on a larger scale, through forming new concepts around a local area or governmental policy. Play is, however, very unpredictable, being led by player interaction, and always pushes up against the rules of the play situation. In play, the particular output (if there is one) is never certain, and no two play experiences will be the same. This unpredictability means that its transformational power is always a potential but never guaranteed. Designers, when working with play as a medium must embrace this unpredictability and explore approaches to design playful experiences which are satisfying in themselves for the participants whilst also trying to find methods to unlock the potential for individual (and group) transformation through play. The thesis is a narrative account of sustained academic research, based upon eight academic publications and practice works, produced between 2013 and 2018. Six of these publications document practical exploration of the creation of playful interventions, in the form of video games, performances and events. Two further publications explore design approaches to enhance participation drawing from expert interview analysis and theoretical engagement with institutional approaches to promotion of participation in the museum and gallery. The body of work thus explores the design of participation from two perspectives: the artist/designer of an artefact and as a “context provider” who designs events and spaces within which play, and participation can take place amongst participants. Within this thesis, the body of publications are contextualised in relation to theories of play, game design and art practice and also drawing from theories around communities of practice and communities of play. A series of expert practitioner interviews underpin both the academic and practical framing of this research, drawing from key practitioners in the UK and Europe working in play, game design, event curation and community work. The thesis formalises the design methods used to create playful interventions by the author and expert practitioners in the field of social play as presented both across the academic publications and within interview content. The formalisation of these design techniques is presented as two social play frameworks, one for designing participation around artefacts and one which focusses upon designing participation around events. Each framework aims to aid a designer and/or context provider in helping participants to unlock the unpredictable yet transformative potential of play as individuals and as communities whilst acknowledging the complex interrelations which occur in designed social contexts.

Many family mediators encounter intimate partner violence (IPV) during the course of child-custody and divorce mediation. By interviewing family mediators in Oregon I have established concrete strategies that mediators use when working with parties who may have a history of IPV. These strategies may be structural, such as building design and intake procedures, or they may be verbal interventions employed during the course of mediation. Mediators employed a wide variety of strategies based on their experience, situations, and intuition. Some strategies, like the use of shuttle mediation, were used by all the mediators I contacted. Other strategies, such as naming problematic behavior, were limited to only a few of the mediators. All the participating family mediators were aware of the possibility of IPV and consciously took measures to limit its influence on the mediation process when it existed.

"This dissertation describes the development of a methodology for implementing robotic systems for interventional procedures under intraoperative Magnetic Resonance Imaging (MRI) guidance. MRI is an ideal imaging modality for surgical guidance of diagnostic and therapeutic procedures, thanks to its ability to perform high resolution, real-time, and high soft tissue contrast imaging without ionizing radiation. However, the strong magnetic field and sensitivity to radio frequency signals, as well as tightly confined scanner bore render great challenges to developing robotic systems within MRI environment. Discussed are potential solutions to address engineering topics related to development of MRI-compatible electro-mechanical systems and modeling of steerable needle interventions. A robotic framework is developed based on a modular design approach, supporting varying MRI-guided interventional procedures, with stereotactic neurosurgery and prostate cancer therapy as two driving exemplary applications. A piezoelectrically actuated electro-mechanical system is designed to provide precise needle placement in the bore of the scanner under interactive MRI-guidance, while overcoming the challenges inherent to MRI-guided procedures. This work presents the development of the robotic system in the aspects of requirements definition, clinical work flow development, mechanism optimization, control system design and experimental evaluation. A steerable needle is beneficial for interventional procedures with its capability to produce curved path, avoiding anatomical obstacles or compensating for needle placement errors. Two kinds of steerable needles are discussed, i.e. asymmetric-tip needle and concentric-tube cannula. A novel Gaussian-based ContinUous Rotation and Variable-curvature (CURV) model is proposed to steer asymmetric-tip needle, which enables variable curvature of the needle trajectory with independent control of needle rotation and insertion. While concentric-tube cannula is suitable for clinical applications where a curved trajectory is needed without relying on tissue interaction force. This dissertation addresses fundamental challenges in developing and deploying MRI-compatible robotic systems, and enables the technologies for MRI-guided needle-based interventions. This study applied and evaluated these techniques to a system for prostate biopsy that is currently in clinical trials, developed a neurosurgery robot prototype for interstitial thermal therapy of brain cancer under MRI guidance, and demonstrated needle steering using both asymmetric tip and pre-bent concentric-tube cannula approaches on a testbed."

BACKGROUND: Preoperative anxiety commonly occurs in young children prior to anesthesia induction. This anxiety is associated with poor post-operative outcomes such as increases in emergence delirium occurrence and post-operative pain. Studies have demonstrated varying effectiveness of interventions such as clowns and video games used to engage and distract children from their anxiety. Anesthesiologists at Lucile Packard Children’s Hospital have designed a new screen-based modality, called the Bedside Entertainment Theatre (BERT), to distract children from their anxiety. OBJECTIVE: The aim of this study is to examine the anxiety-relieving efficacy of BERT against a hand-held electronic tablet, another screen-based form of entertainment used to alleviate preoperative anxiety in children at the hospital. METHODS: Children aged 4-10 undergoing non-emergent outpatient surgery at Lucile Packard Children’s Hospital and their primary caregiver were recruited for the study. Measures were taken at 5 timepoints from children, parents, and clinicians: in the preoperative holding area (T1), at entrance to the OR (T2), at induction (T3), after emergence from anesthesia (T4), and at a 1-week follow up (T5). Primary outcomes were preoperative anxiety, assessed by the modified Yale Preoperative Anxiety Scale (mYPAS) and Child Fear Scale (CFS), and induction compliance, assessed by the Induction Compliance Checklist (ICC). Secondary outcomes were emergence delirium, measured by the Pediatric Anesthesia Emergence Delirium Scale (PAED) and post-operative pain, measured by the Parents’ Post-operative Pain Measure (PPPM) and a Memory Recall Interview. Child covariates were temperament, measured by the Emotionality Activity Sociability Temperament Survey (EAS-TS) and the Children’s Behavior Questionnaire- Very Short Form (CBQ-VSF), and state-trait anxiety, measured by the Child State-Trait Anxiety Inventory (STAIC). Caregiver covariates were state-trait anxiety, measured by the State-Trait Anxiety Inventory (STAI) and caregiver pain catastrophizing about their child, measured by the Pain Catastrophizing Scale- Parent State (PCS-P State). This study is currently ongoing and plans to recruit 60 participants. Parent, child, and clinician satisfaction with usage of either intervention was also assessed. RESULTS: There were no significant differences between mean preoperative anxiety scores of BERT and tablet users at all pre-induction timepoints. There was a significant increase in mean preoperative anxiety scores in BERT users from T1 to T2 and T1 to T3. There was also a significant increase in mean preoperative anxiety scores from T1 to T3 for tablet users. There were no other significant differences in primary and secondary outcomes between interventions. Only post-surgery PCS-P State scores for BERT users correlated with mYPAS scores at T3 (p < 0.05). No other measured covariates correlated with preoperative anxiety scores (p > 0.05). CONCLUSIONS: Although preliminary results do not show differences between the interventions in relieving preoperative anxiety, there may be potential insights gained in how both interventions affect anxiety at different preoperative timepoints. Statistical analysis with the full sample population will be necessary to draw stronger conclusions. / 2018-07-11T00:00:00Z

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Background and Aims: Mental health difficulties during the perinatal period (pregnancy to 1 year postnatal) are commonplace and are associated with significant impacts for mothers and infants. There is an acknowledgement that more needs to be understood about perinatal mental health, particularly during pregnancy, and that service and treatment options need to be improved. Women's lived experience of difficulties during pregnancy, particularly when experiencing moderate to severe mental health difficulties, is a little researched area. A need for wider treatment options than medication alone has been highlighted and Peer Support Interventions (PSIs) are often considered within this area. Despite this, there is yet to be a review of their effectiveness to date that also considers women's views of such interventions. Therefore, this thesis aimed to systematically review literature focused on women's views of PSIs and their effectiveness. In addition, it also aimed to explore the lived experience of women with moderate to severe difficulties with their mental health during pregnancy, with a focus on trying to establish any psychological needs/needs they may have. Methods: A mixed methods systematic review was conducted to meet the aims on PSI interventions. This involved searching electronic databases, quality assessment of included papers and summarising results, including a meta-synthesis for qualitative findings. The empirical project, on women's lived experiences, utilised an Interpretative Phenomenological Analysis approach to explore the lived experience of women experiencing moderate to severe mental health difficulties during pregnancy. Semi-structured interviews were conducted with 11 women recruited via a specialist perinatal mental health service. Results Thirteen studies were included in the review. Results highlighted the heterogeneity of types of PSIs and methodologies employed to evaluate these. Most studies focused on PSIs for the postnatal period and were often aimed at depression. There was a lack of research on PSIs targeted antenatally, or for other types of mental health difficulties. There was tentative evidence for the use of telephone based PSIs in reducing depressive symptomatology postnatally, but less evidence for the use of other types of PSI, or for interventions during pregnancy. The qualitative evidence highlighted the acceptability of PSIs to women and a meta-synthesis of qualitative research identified a number of themes representing women's views of PSIs. From the empirical project, several Superordinate themes were identified: Need for acceptance, Need for awareness, Search for explanations, What helped, Emotional intensity, Societal influences and Service provision. Within these a range of emergent themes were also found. These themes highlighted possible psychological needs and other needs during this time, as well as providing a greater understanding of women's lived experience. Conclusions: There is a need for more research to establish effectiveness of PSIs during pregnancy and of other modes of delivery and to build on existing findings on the effectiveness of telephone based PSIs. Women viewing PSIs as highly acceptable for perinatal mental health difficulties, should cause services to consider their use, or other opportunities for sharing of peer advice/information. Themes identified from the empirical project highlight the need for greater awareness and acceptance of mental health difficulties during pregnancy, as well as the impact of societal influences on women during this time, and the role clinicians and services could play in achieving greater awareness. Small changes within services could help raise awareness levels and help women feel less isolated.

Background: Recent empirical research and theoretical models acknowledge that impulsive processes, can often undermine peoples’ attempts to lose weight despite currently available and effective support (Chapter 2). Aim: To develop, deliver, and evaluate an impulse management intervention to support weight loss in adults. Methods: A systematic review was conducted to identify available impulse management techniques for influencing eating behaviour (Chapter 3). Intervention Mapping was used to develop the intervention (Chapter 4) which drew on various sources including the findings from the systematic review, stakeholder consultations, existing guidance, and qualitative interviews. A two-arm randomised controlled feasibility trial (Chapter 5), with nested mixed-methods process evaluation and two cycles of intervention delivery and data collection (Chapter 6), was conducted. This assessed the feasibility and acceptability of, and informed refinements to, both the intervention and trial procedures in preparation for a full-scale effectiveness evaluation. Weight was measured as the proposed primary outcome for a full-scale trial at baseline, one-month, and three-months of follow-up, app usage data were collected at both follow-up time points, and semi-structured interviews were conducted at one-month with a subsample of intervention group participants only. Results: The systematic review critically appraised and synthesised evidence on 17 identified techniques which were categorised as Impulse-focused or Reflective techniques. Promising changes in eating behaviour and craving were found for the techniques of visuospatial loading, physical activity, and implementation intentions. Intervention Mapping resulted in development of a novel smartphone app-based intervention (ImpulsePal) aimed to reduce unhealthy snacking, overeating, and alcoholic and sugary drink consumption using impulse management techniques identified in the systematic review. Eighty-eight adults with a Body Mass Index of ≥25kg/m2 and wishing to lose weight, were recruited and randomised in a 2:1 ratio to use ImpulsePal (n=58) or to a waiting list control (n=30) group. Data were available for 74 participants (84%) at one-month and 67 (76%) at three months. Exploratory analyses suggest that the ImpulsePal group (n=43) lost 1.03kg (95% CI 0.33 to 1.74) more than controls (n=26) at one-month, and 1.01kg (95% CI -0.45 to 2.47) more at three months. Participants reported high satisfaction with the intervention and trial procedures. The process evaluation suggests that ImpulsePal and the impulse management techniques are feasible to deliver and acceptable to users. Interviews with twenty-two participants suggest that they valued having access to in-the-moment support, felt more aware of their own eating behaviour and influences on it, and felt an increased ability to resist temptations. Conclusions: This work has developed a novel, theory- and evidence-informed, person-centred app which showed potential to improve impulse management, promote healthier eating, and support weight loss. ImpulsePal is acceptable to overweight and obese adults who want to lose weight and is now ready for evaluation in a full-scale trial. The thesis discusses theoretical, methodological, and practical implications for the future development, evaluation, and implementation of digital behaviour change interventions.

Unsurprisingly the National Health Service (NHS) has harnessed the prolific growth in Internet access to alleviate the increasing burden incurred due to rising healthcare costs. Healthcare interventions focus on the promotion of good behaviours; prevention of bad behaviours; provision of support for shared decision making; increasing knowledge and improving monitoring. Healthcare researchers typically rely on professional software developers in the creation of Internet interventions. Although varying in nomenclature Internet interventions typically consist of the same underlying components, such as navigation, logic and response capture. The LifeGuide Authoring Tool provides a potential solution to reduce this reliance of researchers on software developers in the creation of interventions. However the logic creation command line interface provided by LifeGuide is identified as a potential barrier for adoption, by nonprogrammers, due to their lack of experience with the strict programming style syntax it requires. Through the adoption of user-centred design techniques; early and continuous user involvement; rapid prototyping and interface design principles, a Graphical User Interface (GUI) was developed, with the potential to lower this barrier for researchers with no previous programming experience. A jigsaw metaphor was adopted in the design of the interface, utilising templates and pre-populated fields, with the aim of reducing errors and lowering the cognitive load experienced by users. A task-based evaluation compared the existing LifeGuide interface, with the new GUI, in the creation of commonly used logic. Higher results were reported over the five main usability measures: effectiveness; engagement; efficiency; ease of learning and error tolerability in favour of the GUI, in the creation of intervention logic. Continuing requests to the author to develop healthcare Internet Interventions supports the research, that there is still a heavy reliance of researchers on software developers. A further application for this approach was identified in the development of a tool to support healthcare researchers in the creation of mobile phone messaging interventions.

This dissertation, presented in the form of a grant application, intends to deliver a technique for decreasing the pervasive achievement gap between White and Latino students. Specifically, the aim of the proposal is to identify and implement a school-embedded, family-centered intervention designed to address the local values and concerns of a southern Oregon Latino population. Latino students face unique acculturation stressors under the current U.S. system that create academic difficulties, place strain on familial relationships, and put students at greater risk for problem behavior. In addition, barriers in the U.S. school system present challenges for recently immigrated Latino parents to participate within the school. When embedded in schools, family-centered interventions addressing the needs of Latino students will strengthen the parent-child-teacher relationship and create support structures across family and school social systems to help decrease the achievement gap and produce positive academic and behavioral results. The research approach includes both qualitative and quantitative methods. Initially, a systematic process derived from a model of evidence-based practice will be used to determine a locally-appropriate family-centered intervention for implementation in an educational context with a southern Oregon Latino population. After the selection of an appropriate family-centered intervention, a pilot randomized control trial will be employed to gather data on preliminary outcome measures, including intervention feasibility, fidelity, and effects of the intervention on parents and students. Finally, project results will be disseminated to key stakeholders and funding options for larger efficacy studies will be explored. Three outcomes will result from this project: (1) identification and selection of a locally-appropriate, evidence-based, family-centered intervention for use in a southern Oregon educational context with the Latino population; (2) pilot research to determine the feasibility, implementation fidelity, and initial program effects on student and parenting outcomes; and (3) dissemination of project results and exploration of options for funding intervention efficacy research.

yes / This systematic review of reviews aims to investigate how brief interventions (BIs) are defined, whether they increase physical activity, which factors influence their effectiveness, who they are effective for, and whether they are feasible and acceptable. We searched CINAHL, Cochrane database of systematic reviews, DARE, HTA database, EMBASE, MEDLINE, PsycINFO, Science Citation Index-Expanded and Social Sciences Citation Index, and Scottish Intercollegiate Guidelines Network from their inception until May 2015 to identify systematic reviews of the effectiveness of BIs aimed at promoting physical activity in adults, reporting a physical activity outcome and at least one BI that could be delivered in a primary care setting. A narrative synthesis was conducted. We identified three specific BI reviews and thirteen general reviews of physical activity interventions that met the inclusion criteria. The BI reviews reported varying definitions of BIs, only one of which specified a maximum duration of 30 min. BIs can increase self-reported physical activity in the short term, but there is insufficient evidence about their long-term impact, their impact on objectively measured physical activity, and about the factors that influence their effectiveness, feasibility and acceptability. Current definitions include BIs that are too long for primary care consultations. Practitioners, commissioners and policy makers should be aware of this when interpreting evidence about BIs, and future research should develop and evaluate very brief interventions (of 5 min or less) that could be delivered in a primary care consultation. / Citation sent on from Donna. Emailed Laura Lamming for final draft 16/03/2017 -sm