Context Accelerometers have been widely used to record physical activity (PA) in studies evalauting effects of exercise on human health. Traditionally, these devices provide a measure related to energy consumption which is ideally suited to studying obesity-related outcomes. More recently, accelerometers have been developed which provide information about exposure to forces of different magnitudes. This may represent a more accurate approach to evaluating PA in the case of physiological systems such as the skeleton, which responds to brief high impacts as opposed to sustained loading. Aims 1. To characterise the extent to which older people are exposed to impact loading of varying magnitudes. 2. To determine whether higher levels of impact loads resulting from everyday PA in older people are related to properties of bone, such as its density and size, whereas little relationship is observed with lower levels of impact. 3. To identify lifestyle, social, psychological and health related factors which affect the exposure of older people to impact loads of different magnitudes. 4. To characterise how relationships between PA and other physiological systems differ according to level of impact load. 5. To explore barriers to participation of older people in PA associated with higher levels of impact. Methods Setting: Relationships between PA and bone will be studied in two well characterised population cohorts of older people, namely the MRC National Survey for Health and Development (NSHD; age 68) and the Hertfordshire Cohort Study (HCS; age 74-82) (n=2000 under active follow up in both cohorts). A cohort of 500 elite athletes over 65 will also be recruited. Study design: Participants from the three cohorts will be asked to wear an accelerometer for seven days, and information about exposure to different levels of impact subsequently extracted using methods developed in our previous studies. A questionnaire asking about factors related to PA will be completed at the same time. Bone measures will include bone density at the hip as measured by a widely used low dose radiation method (DXA), and more detailed measurements of bone size and shape derived from cross sectional images of the lower leg using a different low radiation imaging device (pQCT). Analysis: PA data will be analysed in relation to bone parameters (i) currently being measured in a subgroup of HCS, and (ii) due to be measured in a subgroup of NSHD and elite athletes as part of this project. We also aim to extrapolate information about exposure to impacts from a previous NSHD data collection involving the whole cohort, relating this to hip bone density obtained at the same time. NSHD and HCS provide detailed information for other systems (eg muscle, obesity, metabolic, cardiovascular, respiratory, cognitive), which will also be analysed in relation to different impacts. Potential application Osteoporosis is a common condition predominantly affecting older people, in which weakening of bone leading to an increased risk of fracture. Since decreased PA is thought to contribute to this process, there is a strong need to develop PA interventions to preserve bone strength and reduce fracture risk in older people, particularly in light of emerging safety concerns over conventional pharmacological approaches. However, if successful PA interventions are to be developed for preserving bone, the relationship between PA and bone strength needs to be clearly understood, particularly if only impacts of a certain magnitude are effective in maintaining bone. Likewise, the types of activities which produce desired levels of impact, and the barriers to carrying out these activities, need to be understood if interventions are to be developed which bring about sustained alterations in behaviour required to prevent bone loss in older people.

Since 2001 government policy has created a new set of professionals, Emergency Care Practitioners (ECPs), and a new style of urgent healthcare provision to support the vision of a healthcare service designed around the patient. ECPs are paramedics and nurses with additional training to treat patients at home, in minor injuries units or to stabilise patients for transport to specialist clinical units. Although professional training has been developed for ECPs there has been no research to look at the technologies needed to support this new role. This project is looking at emergency and urgent care work in detail. We propose that supporting technologies can be delivered as Smart Pods with three components: a vehicle/docking system, a treatment (vehicle) unit and a treatment package system (equipment and consumables). The first stage of the project is to model the operational systems to determine the distribution of the vehicle/docking systems for the Smart Pods to deliver the right care at the right time in the right place. At the same time we will be working with clinical partners in the East Midlands and South West to look at 4-6 treatment types (including chest pain, minor head injuries, minor illnesses and falls). These treatment types will be analysed in detail in A&E departments, minor injuries units and ambulance services to look for similarities and differences in clinical practice to provide the framework for the treatment packages and initial data for the layout in the treatment (vehicle) unit. We will propose a standardised pathway for the treatment types and will use a simulation mannequin to test the clinical treatment unit layout in a laboratory with doctors, nurses and ECPs.We will start working on the design of the vehicle by reviewing the current systems and looking at distribution and delivery systems in other industries, e.g. military, car breakdown services, food delivery. We will look at how new emergency care vehicles are ordered, purchased and manufactured and compare this with other low-volume vehicle manufacturing (e.g. Lotus, Maclaren) to help us develop viable solutions. This information will be used to look at both manufacturing and purchasing issues to explore if the Smart Pods concept is viable.Vehicle engineering and associated systems options will be surveyed, in particular chassis/drive chain and intelligent vehicle technologies and we will consider sustainability issues in terms of full life-cycle energy usage. Computer models and animation scenarios covering the full range of proposed SmartPod applications will be developed. The final part of this first phase of the project will start to consider issues of implementation in more depth with patient groups representing people affected by a range of urgent and emergency care conditions. We will also consult members of the lay public, clinicians, and those involved in the planning for, managing, and evaluating urgent and emergency care to investigate views on change in the provision of urgent and emergency care and to identify any unanticipated challenges (e.g. political, organisational, cultural) in implementing change.

Since 2001 government policy has created a new set of professionals, Emergency Care Practitioners (ECPs), and a new style of urgent healthcare provision to support the vision of a healthcare service designed around the patient. ECPs are paramedics and nurses with additional training to treat patients at home, in minor injuries units or to stabilise patients for transport to specialist clinical units. Although professional training has been developed for ECPs there has been no research to look at the technologies needed to support this new role. This project is looking at emergency and urgent care work in detail. We propose that supporting technologies can be delivered as Smart Pods with three components: a vehicle/docking system, a treatment (vehicle) unit and a treatment package system (equipment and consumables). The first stage of the project is to model the operational systems to determine the distribution of the vehicle/docking systems for the Smart Pods to deliver the right care at the right time in the right place. At the same time we will be working with clinical partners in the East Midlands and South West to look at 4-6 treatment types (including chest pain, minor head injuries, minor illnesses and falls). These treatment types will be analysed in detail in A&E departments, minor injuries units and ambulance services to look for similarities and differences in clinical practice to provide the framework for the treatment packages and initial data for the layout in the treatment (vehicle) unit. We will propose a standardised pathway for the treatment types and will use a simulation mannequin to test the clinical treatment unit layout in a laboratory with doctors, nurses and ECPs.We will start working on the design of the vehicle by reviewing the current systems and looking at distribution and delivery systems in other industries, e.g. military, car breakdown services, food delivery. We will look at how new emergency care vehicles are ordered, purchased and manufactured and compare this with other low-volume vehicle manufacturing (e.g. Lotus, Maclaren) to help us develop viable solutions. This information will be used to look at both manufacturing and purchasing issues to explore if the Smart Pods concept is viable.Vehicle engineering and associated systems options will be surveyed, in particular chassis/drive chain and intelligent vehicle technologies and we will consider sustainability issues in terms of full life-cycle energy usage. Computer models and animation scenarios covering the full range of proposed SmartPod applications will be developed. The final part of this first phase of the project will start to consider issues of implementation in more depth with patient groups representing people affected by a range of urgent and emergency care conditions. We will also consult members of the lay public, clinicians, and those involved in the planning for, managing, and evaluating urgent and emergency care to investigate views on change in the provision of urgent and emergency care and to identify any unanticipated challenges (e.g. political, organisational, cultural) in implementing change.