Phenotyping of 1,200 'healthy' adults from the UK has been performed through the investigation of diverse classes of hydrophilic and lipophilic metabolites present in serum by applying a series of chromatographymass spectrometry platforms. These data were made robust to instrumental drift by numerical correction; this was prerequisite to allow detection of subtle metabolic differences. The variation in observed metabolite relative concentrations between the 1,200 subjects ranged from less than 5 % to more than 200 %. Variations in metabolites could be related to differences in gender, age, BMI, blood pressure, and smoking. Investigations suggest that a sample size of 600 subjects is both necessary and sufficient for robust analysis of these data. Overall, this is a large scale and non-targeted chromatographic MS-based metabolomics study, using samples from over 1,000 individuals, to provide a comprehensive measurement of their serum metabolomes. This work provides an important baseline or reference dataset for understanding the 'normal' relative concentrations and variation in the human serum metabolome. These may be related to our increasing knowledge of Nitin Purandare is now deceased.Electronic supplementary material The online version of this article

BackgroundCare home residents in England have variable access to health care services. There is currently no coherent policy or consensus about the best arrangements to meet these needs. The purpose of this review was to explore the evidence for how different service delivery models for care home residents support and/or improve wellbeing and health-related outcomes in older people living and dying in care homes.MethodsWe conceptualised models of health care provision to care homes as complex interventions. We used a realist review approach to develop a preliminary understanding of what supported good health care provision to care homes. We completed a scoping of the literature and interviewed National Health Service and Local Authority commissioners, providers of services to care homes, representatives from the Regulator, care home managers, residents and their families. We used these data to develop theoretical propositions to be tested in the literature to explain why an intervention may be effective in some situations and not others. We searched electronic databases and related grey literature. Finally the findings were reviewed with an external advisory group.ResultsStrategies that support and sustain relational working between care home staff and visiting health care professionals explained the observed differences in how health care interventions were accepted and embedded into care home practice. Actions that encouraged visiting health care professionals and care home staff jointly to identify, plan and implement care home appropriate protocols for care, when supported by ongoing facilitation from visiting clinicians, were important. Contextual factors such as financial incentives or sanctions, agreed protocols, clinical expertise and structured approaches to assessment and care planning could support relational working to occur, but of themselves appeared insufficient to achieve change.ConclusionHow relational working is structured between health and care home staff is key to whether health service interventions achieve health related outcomes for residents and their respective organisations. The belief that either paying clinicians to do more in care homes and/or investing in training of care home staff is sufficient for better outcomes was not supported.

To improve access for these groups, service users and providers need to be better informed; services need to be more culturally tailored, sometimes employing staff with similar cultural backgrounds; and health professionals can benefit from dementia education and knowledge of local services. These factors are key to the delivery of the National Dementia Strategy in England.

Background: Care homes are the institutional providers of long-term care for older people. The OPTIMAL\ud study argued that it is probable that there are key activities within different models of health-care provision\ud that are important for residents’ health care.

Objectives: To understand ‘what works, for whom, why and in what circumstances?’. Study questions\ud focused on how different mechanisms within the various models of service delivery act as the ‘active\ud ingredients’ associated with positive health-related outcomes for care home residents.

Methods: Using realist methods we focused on five outcomes: (1) medication use and review; (2) use of\ud out-of-hours services; (3) hospital admissions, including emergency department attendances and length of\ud hospital stay; (4) resource use; and (5) user satisfaction. Phase 1: interviewed stakeholders and reviewed\ud the evidence to develop an explanatory theory of what supported good health-care provision for further\ud testing in phase 2. Phase 2 developed a minimum data set of resident characteristics and tracked their care\ud for 12 months. We also interviewed residents, family and staff receiving and providing health care to residents.\ud The 12 study care homes were located on the south coast, the Midlands and the east of England. Health-care\ud provision to care homes was distinctive in each site.

Findings: Phase 1 found that health-care provision to care homes is reactive and inequitable. The realist\ud review argued that incentives or sanctions, agreed protocols, clinical expertise and structured approaches to\ud assessment and care planning could support improved health-related outcomes; however, to achieve change NHS professionals and care home staff needed to work together from the outset to identify, co-design and\ud implement agreed approaches to health care. Phase 2 tested this further and found that, although there\ud were few differences between the sites in residents’ use of resources, the differences in service integration\ud between the NHS and care homes did reflect how these institutions approached activities that supported\ud relational working. Key to this was how much time NHS staff and care home staff had had to learn how to\ud work together and if the work was seen as legitimate, requiring ongoing investment by commissioners\ud and engagement from practitioners. Residents appreciated the general practitioner (GP) input and, when\ud supported by other care home-specific NHS services, GPs reported that it was sustainable and valued work.\ud Access to dementia expertise, ongoing training and support was essential to ensure that both NHS and care\ud home staff were equipped to provide appropriate care.

Limitations: Findings were constrained by the numbers of residents recruited and retained in phase 2 for\ud the 12 months of data collection.

Conclusions: NHS services work well with care homes when payments and role specification endorse the\ud im...

Introductioncare home residents have high healthcare needs not fully met by prevailing healthcare models. This study explored how healthcare configuration influences resource use.Methodsa realist evaluation using qualitative and quantitative data from case studies of three UK health and social care economies selected for differing patterns of healthcare delivery to care homes. Four homes per area (12 in total) were recruited. A total of 239 residents were followed for 12 months to record resource-use. Overall, 181 participants completed 116 interviews and 13 focus groups including residents, relatives, care home staff, community nurses, allied health professionals and General Practitioners.Resultscontext-mechanism-outcome configurations were identified explaining what supported effective working between healthcare services and care home staff: (i) investment in care home-specific work that legitimises and values work with care homes; (ii) relational working which over time builds trust between practitioners; (iii) care which ‘wraps around’ care homes; and (iv) access to specialist care for older people with dementia. Resource use was similar between sites despite differing approaches to healthcare. There was greater utilisation of GP resource where this was specifically commissioned but no difference in costs between sites.Conclusionactivities generating opportunities and an interest in healthcare and care home staff working together are integral to optimal healthcare provision in care homes. Outcomes are likely to be better where: focus and activities legitimise ongoing contact between healthcare staff and care homes at an institutional level; link with a wider system of healthcare; and provide access to dementia-specific expertise.

The organic food market is speedily growing in the current era; organizations in this industry, therefore, need to understand consumer motivations, perceptions, attitudes, and behavioral intentions of purchasing organic food. Based on a survey of 268 respondents, we investigated the relationships between individuals’ food safety concerns and health consciousness with their purchase intentions of organic food. The findings of our study reveal that individuals’ health consciousness and food safety concerns are positively related to their intentions of purchasing organic food products through consumer involvement. In addition, consumers’ ecological motive has been found as a boundary condition on the direct and indirect relationships described above such that the associations are stronger at the higher levels of ecological motive.

This special issue focuses broadly upon questions and themes relating to the current conceptualisations, representations and use of ‘ethnicity’ (and ethnic minority experiences) within the field of social gerontology. An important aim of this special issue is to explore and address the issue of ‘otherness’ within the predominant existing frameworks for researching those who are ageing or considered aged, compounded by the particular constructions of their ethnicity and ethnic ‘difference’. The range of theoretical, methodological and empirical papers included in this collection provide some critical insights into particular facets of the current research agendas, cultural understandings and empirical focus of ethnic minority ageing research. The main emphasis is on highlighting the ways in which ethnic cultural homogeneity and ‘otherness’ is often assumed in research involving older people from ethnic minority backgrounds, and how wider societal inequalities are concomitantly (re)produced, within (and through) research itself – for example, based on narrowly defined research agendas and questions; the assumed age and/or ethnic differences of researchers vis-à-vis their older research participants; the workings of the formalised ethical procedures and frameworks; and the conceptual and theoretical frameworks employed in the formulation of research questions and interpretation of data. We examine and challenge here the simplistic categorisations and distinctions often made in gerontological research based around research participants' ethnicity, age and ageing and assumed cultural differences. The papers presented in this collection reveal instead the actual complexity and fluidity of these concepts as well as the cultural dynamism and diversity of experiences within ethnic groups. Through an exploration of these issues, we address some of the gaps in existing knowledge and understandings as well as contribute to the newly emerging discussions surrounding the use of particular notions of ethnicity and ethnic minority ageing as these are being employed within the field of ageing studies.

In recent years, there has been an increasing interest in researching people growing older in the South Asian ethnic minority communities in the UK. However, these populations have received comparatively little attention in wide-ranging discussions on culturally and socially appropriate research methodologies. In this paper, we draw on the experiences of a young female Pakistani Muslim researcher researching older Pakistani Muslim women and men, to explore the significance of gender, age and ethnicity to fieldwork processes and ‘field’ relationships. In particular, we highlight the significance of dress and specific presentations of the embodied self within the research process. We do so by focusing upon three key issues: (1) Insider/Outsider boundaries and how these boundaries are continuously and actively negotiated in the field through the use of dress and specific presentations of the embodied ‘self’; (2) The links between gender, age and space - more specifically, how the researcher's use of traditional Pakistani dress, and her differing research relationships, are influenced by the older Pakistani Muslim participants’ gendered use of public and private space; and (3) The opportunities and vulnerabilities experienced by the researcher in the field, reinforced by her use (or otherwise) of the traditional and feminine Pakistani Muslim dress. Our research therefore highlights the role of different presentations of the embodied ‘self’ to fieldwork processes and relationships, and illustrates how age, gender and status intersect to produce fluctuating insider/outsider boundaries as well as different opportunities and experiences of power and vulnerability within research relationships.