Journal articles on the topic 'Older people Home care Equipment and supplies'

This article provides a commentary on the costs of obese nursing home patients. We conducted a comprehensive literature search, which found 46 relevant articles on obesity in older adults and effects on nursing home facilities. This review indicated obesity is increasing globally for all age groups and older adults are facing increased challenges with chronic diseases associated with obesity more than ever before. With medical advances comes greater life expectancy, but obese adults often experience more disabilities, which require nursing home care. In the United States, the prevalence of obesity in adults aged 60 years and older increased from 9.9 million (23.6%) to 22.2 million (37.0%) in 2010. Obese older adults are twice as likely to be admitted to a nursing home. Many obese adults have comorbidities such as Type 2 diabetes; patients with diabetes incurred 1 in every 4 nursing home days. Besides the costs of early entrance into nursing facilities, caring for obese residents is different than caring for nonobese residents. Obese residents have more care needs for additional equipment, supplies, and staff costs. Unlike emergency rooms and hospitals, nursing homes do not have federal requirements that require them to serve all patients. Currently, some nursing homes are not prepared to deal with very obese patients. This is a public health concern because there are more obese people than ever in history before and the future appears to have even a heavier generation moving forward. Policymakers need to become aware of this serious gap in nursing home care.

Abstract As healthcare increasingly shifts to home and community-based settings, informal caregiver responsibilities are increasing beyond assistance with activities of daily living to include complex care procedures previously performed by licensed caregivers in clinical settings. With an aging population, increasing numbers of older adults are assuming a caregiving role and these older adult caregivers are performing complex care procedures such as wound care. The negative physical and mental health consequences of caregiving for older adult caregivers are well documented in the literature. However, access to and use of resources are associated with better physical and mental health. Past research on caregiving resources has utilized pre-determined resource variables. Little is known about older adult caregivers’ salient thoughts on resources important to caregiving and performing complex care procedures. This study utilized thematic analysis of qualitative interview data to identify themes and patterns related to resources as described by older adult caregivers. The following seven themes related to resources needed or utilized were identified: 1) expert guidance from healthcare professionals; 2) written instructions; 3) relationships with healthcare professionals for obtaining wound care supplies; 4) additional durable medical equipment; 5) financial resources; 6) coverage for caregiver personal time; and 7) select persons for social and emotional support. Older adult caregivers need and use a variety of resources when providing wound care. As increasing numbers of older adults choose to ‘age in place’, the importance of adequate resources to sustain care recipients and their caregivers in the home setting is critical.

Despite all efforts to contain the COVID-19 pandemic in Brazil, little attention has been paid to homes for the aged, which are the home of thousands of older people and serve as social care facilities. There is no provision in the national regulations for the operation of these long-term care facilities with respect to physical structure, human resources or equipment to offer specific health care services to residents. Thus, homes for the aged are unable to offer proper care to people with COVID-19. These facilities have had difficulty in acquiring and maintaining the stocks of personal protective equipment for residents and staff. This letter is intended to draw attention to this reality and prevent the occurrence of a cruel and inhumane geronticide. Government authorities and the media need to work together and help unveil this reality, which, although present, is hidden and unknown to the majority of the population.

Background: A significant proportion of people with dementia live alone, but little is known about their specific needs. Objective: To understand the profile of people living alone with mild-to-moderate dementia in the UK and identify any systematic differences associated with living situation. Methods: We analyzed cross-sectional data from 1,541 people with mild-to-moderate dementia and 1,277 caregivers participating in the IDEAL cohort at the first wave of assessment. Results: There were 1,256 (81.5%) people with dementia living with others and 285 (18.5%) living alone, of whom 51 (3% of whole sample) reported little or no informal support. There were relatively few differences associated with living situation and odds ratios were generally small. People living alone were older on average, and more likely to be female, than those living with others. Those living alone were more likely to have higher cognitive ability and self-reported functional ability, and more social contact with those from other households. They were also lonelier, expressed less satisfaction with life, and used home care services and equipment more. There were no differences in symptoms, mood, quality of life, or well-being. Conclusion: The findings support the view that it is possible to ‘live well’ with mild-to-moderate dementia while living alone, given appropriate support, including home care and equipment. Nevertheless, it is important to consider how those living alone may be supported to have a more satisfactory experience, and how health and social care services can best respond to their needs.

Purpose Social work involves working directly with people who are experiencing a crisis. An assessment is carried out to establish the best way forward and then reviewed after a period of time to measure success or recalibrate the service. The current pandemic restrictions have all but ruled out meeting with people face-to-face. Now, professionals are usually required to don some form of personal protective equipment (PPE) when meeting with people and their families. Talking to an unknown professional who is behind a mask or on the telephone, about a personal issue is hard for everyone, but it is particularly difficult for people who may be further on in their dementia journey. Design/methodology/approach Critique Findings These impediments impact the social work assessment and review, meaning people may not have the quality of service they need and may end up paying for unnecessary provision. If admission to a care home is deemed necessary, the stakes rise considerably. A care home admission means contributing towards fees with pensions, savings and assets, including housing. Now, it comes with an additional health risk. Originality/value COVID-19 infection has impacted on the older population but residents in care homes with frailer physical health, cognitive impairment and delirium are at particularly high risk of dying.

Abstract Objective This study aimed to examine the urban-rural differences of unmet needs and their expected LTC services among community-dwelling old people. Methods The data comes from the Chinese Longitudinal Health Longevity Survey (CLHLS) in 2014. A total of 1587 community residents aged 65+ with disability of activities of daily life (ADL) were included in this study. Binary logistic regression was used to estimate correlates of unmet need in LTC. And chi-square test was used to examine the differences of expected community-based LTC services between urban and rural area. Results Over half (55.07%) of the participants reported their need were unmet. For both rural and urban residents, poorer economic status and reluctant caregivers (ORs>1, P＜0.01) seriously affected the unmet need. Besides, of urban older adults, people who were male and lonely(ORs>1, P＜0.05) reported more unmet need. While of rural old ones, people who were with severe ADL disability and poorer self-rated health(ORs>1, P＜0.01) reported more unmet need. And people with available medication and home visit services(ORs<1, P＜0.01) reported more met need. However, the supplies for community LTC care services were far below the demands. Conclusion The risk of having unmet need associated with ADL disabilities in LTC is largely determined by their economic status and caregivers’ willingness to provide care for both rural and urban old people. There is a need for an overall improvement in the planning, provision and financing of long-term care services for elderly individuals in China.

Background The population of Europe is aging rapidly. Most community-dwelling older adults (CDOAs) want to remain in their homes, particularly those experiencing functional decline. Politicians and academics repeatedly praise technological instruments for being the preferred solution for helping older adults with deteriorating health to remain at home. Objective This study aimed to understand the perceptions of CDOAs and their informal caregivers (ICs) and professional caregivers (PCs) about technologies that can help keep older adults at home. Methods This qualitative study used personal interviews, focus groups, and photo-elicitation interviews to better understand the perceptions of a convenience sample of 68 CDOAs, 21 ICs, and 32 PCs. Results A fraction of CDOAs did not perceive technological instruments to be a very useful means of helping them remain at home. However, the ICs and PCs were more positive. The CDOAs preferred and were more willing to adopt technologies related to their mobility and safety and those that would help slow down their cognitive decline. The ICs preferred technological aids that assist in the activities of daily living as well as safety-related technologies for detecting falls and helping to locate disoriented older adults. The PCs preferred integrated communication and information systems to improve collaboration between all stakeholders, housing equipped with technologies to manage complex care, high-performance ancillary equipment to transfer people with reduced mobility, and surveillance systems to ensure safety at home. Conclusions Although our study reports that CDOAs have limited interest in innovative technologies to help them remain at home, their technological skills will undoubtedly improve in the future, as will those of ICs and PCs. Technological tools will play an increasingly important role in home health care.

Abstract Supporting older people to live in the community as they experience health and functional changes has become a priority for policy makers, health system leaders and community members, including many older people themselves. Aging-in-place has been promoted as a way to support the sustainability of health care systems and limit health care and societal costs. However, the expenses borne by individuals and caregivers to support older people to age-in-place when experiencing changes in health and functional ability are often not considered in health care literature and policy. We conducted a scoping review using Joanna Briggs Institute methodology to explore the out-of-pocket expenses for people with frailty living in the community. We included research and policy papers on community-dwelling people over 60 and experiencing frailty. Findings about financial out-of-pocket expenses were extracted. A total of 9669 sources were screened by two reviewers and 42 sources were included. The sources were from 17 countries, most from the US, and had various designs, including 14 qualitative designs, 15 cross sectional, 11 other quantitative and 2 policy discussions. The sources most often reported expenses related to home care (16), medication (12), housekeeping (10), transportation (8), and medical equipment (6). Gaps in the body of literature include lack of a consistent measure of out-of-pocket expenses and cost considerations of co-housing programs. The context—including policy, community and personal—was particularly important to the experience of out-of-pocket expenses for people with frailty, and further research is needed to expand on this knowledge.

Urinary incontinence is a common condition that affects both men and women, and with profoundly negative effects. Prevalence figures do show that it is more common in younger women than men, but as people age the difference decreases, with research identifying that one in three older men have continence issues. However, even with this increase, there is little direct best practice guidance on addressing male urinary incontinence compared to that for women. Professionals seem to be unaware that men have known existing barriers to accessing health care and this would be especially true of such an embarrassing condition. There seems to be a lack of education in identifying symptoms and assessing and little thought to appropriate management if required. This can also be true of manufacturers that provide continence management equipment. This article will look at some of these themes and highlight the gender gaps and give guidance on how professionals may address these.

In today’s times, elderly individuals are keeping their natural teeth for longer owing to the rising popularity of fixed dental restorations and dental implants. It is seen that access to oral health care reduces and dental demands rise as people get older and more dependent on medical attention. For a high quality of life in terms of dental health, it is critical to have a functional dentition. A skilled oral health care provider is required for the geriatric population due to complex connections between dental health, some systemic illnesses, and medication side effects. For more than a century, there have been mobile dentistry services available as a way to help the underserved in society. Initially geared towards children, these services are now frequently used by adults and the elderly, particularly those in nursing homes, people with special needs, and those who have disabilities. When treating dependent elderly patients, it has been shown that home dental treatment is more economical than traditional dental care. Four distinct mobile dental service models by which a dental healthcare professional contacts a patient include the mobile dental vehicle model, portable equipment model, fixed equipment model, and the hybrid model. The services provided by the public sector in most countries employ a range of models, including the hybrid model, portable equipment, and fixed equipment, but the private sectors mostly use portable equipment to provide a mobile dental service. Dental care provided by university-based services ranges from routine to complicated procedures, whereas basic, routine care is mostly offered by the commercial sector. Mobile and portable dental models offer a practical substitute for typical dental clinic visits or when the fixed setup is not present. Mobile dental services also have shown utility for data gathering, strategy creation, and investigations on the potential effects of preventative and oral treatment provided by these services.

Objectives: To investigate the effect of the number of cohabitating household members on falls among an disabled aging Korean population. Methods: We used data from the first to the fourth waves of the Korea Longitudinal Study of Aging. Using the first wave at baseline, data included 1414 individuals aged 45 years and older who needed assistance for performance of activities of daily living (ADL) or instrumental activities of daily living (IADL). We classified falls as overall falls, falls requiring medical treatment, and hip fractures caused by falls. The number of cohabitating family members was classified as none (living alone), one, two, or more. A generalized estimating equation with logit link was used to examine the association between the number of cohabitating household members with overall falls and injuries caused by falls. Results: Compared to living with two or more household members, living alone was associated with higher odds of overall falls, falls needing medical treatment, and hip fractures caused by falls (odds ratio (OR) 2.13, 95% confidence interval [CI] 1.36–3.34; OR 2.13, 95% CI 1.28–3.53; OR 1.93, 95% CI 1.01–3.69, respectively). These associations were particularly strong in individuals with cognitive decline. Conclusions Living alone is associated with higher odds of overall falls, falls needing medical treatment, and hip fractures caused by falls, particularly for those with cognitive decline. Conclusions: Intervention programs to prevent falls in disabled, aging adults, especially those living alone and those with declined cognitive function, need to provide home care services and promote the use of safety equipment.

INTRODUCTION: Little is known about management and mitigation of COVID-19 in long-term care facilities (LTCF) for the aged in Latin America. OBJECTIVE: To describe how the management of LTCF in Latin American countries plan and adapt their routines for coping with COVID-19 and whether they have been able to fulfill recommendations published by the World Health Organization (WHO). METHODOLOGY: A cross-sectional study was conducted by online survey of managers of LTCF located in Hispanic American countries. A 46-item questionnaire (adopting the WHO principles) was sent to participants. Descriptive statistics were used to summarize the data. RESULTS: Twenty-three care home managers replied, responsible for a total of 874 older people (range: 5 - 270). One questionnaire was excluded because of missing responses. Fourteen LTCF (63.60%) were private, for-profit facilities. The rate of compliance with WHO recommendations exceeded 70% for the majority of items. Just over half of the institutions had developed a strategic management plan, or had identified strategies for dealing with deaths of suspected cases. Difficulty acquiring personal protective equipment (PPE) was reported by 59.10% of the LTCF surveyed. The homes’ capacity for SARS-Cov-2 testing was limited (36.36% of the institutions did not have any tests). CONCLUSIONS: The rate of compliance with recommendations published by the WHO for dealing with COVID-19 was greater than 70% at the majority of the LTCF surveyed. More than half of the institutions had strategic management plans. Availability of PPE and SARS-Cov-2 testing capacity were very unsatisfactory.

In its most direct interpretation, telemedicine is medical care provided at a distance. Although telemedicine’s use had been steadily increasing, the COVID-19 pandemic prompted an unprecedented interest and urgency among patients, health care professionals, and policymakers to facilitate health care devoid of the need for in-person contact. The growth in personal access to telecommunications technology meant an unprecedented number of people in the United States and around the world had access to the equipment and technology that would make virtual care possible from the home. As the mass implementation of telemedicine unfolded, it became quickly apparent that scaling up the use of telemedicine presented considerable new challenges, some of which worsened disparities. This article describes those challenges by examining the history of telemedicine, its role in both supporting access and creating new barriers to access in trying to get everyone connected, frameworks for thinking about those barriers, and facilitators that may help overcome them, with a particular focus on older adults and patients with cancer in rural communities.

Abstract COVID-19 has had a disproportionate impact on older people, in terms of their susceptibility to the disease and increased fatality rates, while also by creating barriers to health care access, social isolation, psychological and financial burdens. Policy responses provide an opportunity to understand whether the demands of this crisis have led to the development of policy innovations to meet the needs of aging populations. We analyzed an illustrative corpus of policies collected by HelpAge International across Asia in Afghanistan, Bangladesh, India, Iran, Japan, Korea, Myanmar, Pakistan, and Vietnam. We identified different policy types that impacted older persons during the pandemic. We also observed the degree to which these policies support arguments for paradigmatic policy changes by examining different models of intersectoral and multisectoral collaborations, and the kinds of policies where these multiactor arrangements were the most common. From our analysis, we identify two main areas where COVID-19 policies are most likely to lead to more long-lasting innovation in Asia. The first is in the upgrading of infrastructures to ensure access to benefits, and to develop remote and doorstep banking. The second area is well-being and caring support, such as the development of programs to provide increased services to support home-based older persons, including telemedicine, delivery services for medical and other supplies, and remote support for older persons and their carers. These changes, while important, are consistent with “acceleration” models of policy change, where COVID-19 responses sped up, and scaled up, programs consistent with current institutional and organizational structures.

Background/Introduction:In November 2021, a tanker exploded in Freetown, injuring and killing people. The WHO facilitated a seven-week first deployment of the Senegalese military to support the Ministry of Health (MOH) in providing care to the wounded in three referral hospitals.Objectives:Review the deployed team’s processes and outputs of medical care provided to burns patients.Method/Description:This is a cross-sectional After-Action Review (AAR) debrief of the deployment, including the WHO and MOH staff (n =14) in a virtual workshop. Six thematic areas: mobilization, deployment, coordination, case management activities, national capacity, and community acceptance were analyzed.Results/Outcomes:The WHO facilitated the team’s deployment and mobilized medical supplies and equipment whilst the MOH provided accommodation and logistics through collaboration. The team dispensed their functions with professionalism, adapted to the environment and available resources, and augmented the care provided by the available health workers. They offered additional care: reconstructive surgery, pain management, palliative and wound care, rehabilitation, physiotherapy, and psychosocial counselling, which were initially inadequate. 87 out of 155 patients were discharged home at the end, the national clinicians acquired additional skills, and the community appreciated the team. Despite being perceived as a weakness, the language barrier did not hinder the patient-doctor/nurse relationship or the provision of clinical care.Conclusion:This sub-regional response had significant benefits, including speed, political acceptability, and health context experience to support rapid and safe deployment. Mechanisms to facilitate rapid and quality-assured deployment of EMTs at regional and sub-regional levels in collaboration with WHO should be strengthened in region to support future responses.

A rising proportion of older people has more demand on services including hospitals, retirement homes, and assisted living facilities. Regaining control of this population’s expectations will pose new difficulties for lawmakers, medical professionals, and the society at large. Smart technology can help older people to have independent and fulfilling lives while still living safely and securely in the community. In the last several decades, the number of sectors using robots has risen. Comrade robots have made their appearance in old human life, with the most recent notable appearance being in their care. The number of elderly individuals is increasing dramatically throughout the globe. The source of the story is the use of robots to help elderly people with day-to-day activities. Speech data and facial recognition model are done with AI model. Here, with the Comrade robotic model, elder people’s healthcare system is designed with better analysis state. The aim is to put in place a simple robotic buddy to determine the health of the old person via a headband that has been given to them. Comrade robot may do things like senior citizens home automation, home equipment control, safety, and wellbeing sensing, and, in emergency situation, routine duties like navigating in the outside world. The fear that robotics and artificial intelligence would eventually eliminate most of the jobs is increasing. It is anticipated that, in order to survive and stay relevant in the constantly shifting environment of work, workers of the future will need to be creative and versatile and prepared to identify new business possibilities and change industry to meet challenges of the world. According to the research, reflective practice, time management, communicating, and collaboration are important in fostering creativity.

Purpose – The purpose of this paper is to examine the effects of an integration programme on service users from users’ own perspective. Design/methodology/approach – Multi-method approach was used. Both quantitative and qualitative data collection and analysis were employed to uncover and examine service users’ views of the impact of the integration programme. Findings – An improvement in the physical functioning of one in three occupational equipment users; a rise in the level of satisfaction of 85 per cent of occupational health and 82 per cent of physiotherapy users; older people with complex problems and high-level needs were able to be helped to live at home; and waiting times for both assessment and for services within two weeks and four weeks were below the national achievement and ministerial targets. The impact of the integration programme on users was complex. Positive outcomes were achieved for some user groups and individuals but not for others. A lack of change outcomes in social care, and service users’ low level of satisfaction with social care services appears to be associated with the impact of agency work and the predominant aim in social work of achieving maintenance and prevention outcomes. Originality/value – This paper contributes to knowledge on what and how the total integration in Cambridgeshire has benefited users.

Purpose – Approximately 100,000 people in the UK aged 75 and over have concurrent dementia and sight loss, but current understanding of their experiences, needs and preferences is limited. The purpose of this paper is to report on a research project that explored the provision of social care and support for older people with both conditions. Design/methodology/approach – The project was a collaboration between the universities of York, Worcester, Bournemouth and Cambridge, supported by the Thomas Pocklington Trust and the Housing and Dementia Research Consortium. Data for this paper were drawn from focus groups held in 2013 involving 47 professionals across the dementia, sight loss and housing sectors. Findings – Thematic analysis identified five main barriers to providing high-quality, cost-effective social care and support: time constraints; financial limitations; insufficient professional knowledge; a lack of joint working; and inconsistency of services. The requirements of dementia and sight loss often conflict, which can limit the usefulness of equipment, aids and adaptations. Support and information needs to address individual needs and preferences. Research limitations/implications – Unless professionals consider dementia and sight loss together, they are unlikely to think about the impact of both conditions and the potential of their own services to provide effective support for individuals and their informal carers. Failing to consider both conditions together can also limit the availability and accessibility of social care and support services. This paper is based on input from a small sample of self-selecting professionals across three geographical regions of England. More research is needed in this area. Practical implications – There are growing numbers of people living with concurrent dementia and sight loss, many of whom wish to remain living in their own homes. There is limited awareness of the experiences and needs of this group and limited provision of appropriate services aids/adaptations. A range of measures should be implemented in order to support independence and well-being for people living with both conditions and their family carers. These include increased awareness, improved assessment, more training and greater joint working. Social implications – People living with dementia or sight loss are at high risk of social isolation, increasingly so for those with both conditions. Services that take an inclusive approach to both conditions can provide crucial opportunities for social interaction. Extra care housing has the potential to provide a supportive, community-based environment that can help residents to maintain social contact. Originality/value – This paper adds much-needed evidence to the limited existing literature, and reflects the views of diverse professionals across housing, health and social care.

Objective The aim of the present study was to evaluate the effect of a high-speed telemonitoring project for older people with chronic disease in a regional Australian town. Participants’ vital signs were monitored and triaged daily by a telehealth nurse. Methods A prospective, uncontrolled study design evaluated the effect of home-based telemonitoring on older people with chronic disease. Evaluation included surveys (including the Stanford Chronic Disease Self-Efficacy tool and the Self-Rated Health Questionnaire), self-reported health service use and interviews and focus groups exploring client experiences. Results Participants reported an improved understanding of their vital signs monitoring (48%) and consequently better self-management of health (48%) and that they were better informed (44%) and more confident (25%) to discuss health with their doctor. Patients also reported making medication changes (17%), positive dietary changes (34%) and increasing their physical activity (33%). Overall, patients’ self-rated general health improved (mean (± s.d.) improvement 0.30 ± 0.80; 95% confidence interval (CI) 0.16–0.45; 118 d.f.; P < 0.001), with more participants reporting that their health is ‘excellent’ or ‘very good’ at the end of the trial. Patients also reported fewer doctor visits (P < 0.001), fewer visits to the local hospital emergency department (P = 0.021) and fewer non-local hospital admissions (P < 0.001) compared with the preceding year. There was no significant reduction in local hospital admissions (P = 0.171). Conclusions The findings of the present study suggest that telemonitoring with videoconferencing empowers older people to better understand and manage their own health, and is associated with improved health outcomes and reduced service use. Having regular, daily access to a Telehealth nurse reassured participants, and triggered changes to services and behaviour that are likely to have positively affected patient outcomes. What is known about this topic? Telehealth is increasingly being used in the care of older people with chronic conditions and can reduce health service use. Previous research has indicated that telehealth has the potential to provide patients with greater knowledge and understanding of their condition. What this paper adds? Our research demonstrates that older people with limited experience of technology can be taught to successfully use telehealth equipment. We observed regular contact with telehealth nurses enables health promoting behaviour messages to be tailored to patients’ needs. What are the implications for practitioners? Providing older people with tailored health support alongside an understanding of vital signs readings can enhance self-efficacy.

Evacuation/Oxygen Bus The Chicago Fire Department (CFD) identified a need to treat multiple stable fire/inhalation victims who require oxygen, whether due to a previous medical condition or as the result of an acute event, such as evacuation of or fire in any building, hospital, or treatment facility. As a partner with the Chicago Department of Public Health (CDPH) and an active participant in the “Chicago Healthcare System Coalition for Preparedness and Response”, the CFD determined that a bus could be an adjunct in city responses and emergencies. With the support of the Coalition, the CFD approached the Chicago Transit Authority (CTA) to obtain a bus. Once the actual bus was given to the CFD, an operations order was written and the appropriate equipment was purchased. The Evacuation Committee of the Coalition identified equipment and supply needs. Supplies purchased and retrofitted for the bus include modulators for patient oxygen use, oxygen tanks, masks, nebulizers, automated external defibrillators (AEDs), first line advanced life support (ALS) medications, evacuation chairs for moving patients, and special emergency lighting. The bus is able to accommodate thirty five people who require treatment simultaneously. The use of the bus includes but not limited to: (1) hospital evacuation and treatment of stable patients with oxygen and nebulizers prior to transportation to an alternate facility; (2) long-term care facility evacuation and treatment of stable patients with oxygen needs prior to placement and transport to another facility; (3) responding to building fires to treat victims who may need oxygen and nebulizer treatments on site; (4) assisting with the evacuation of home-based, at-risk oxygen dependent patients; and (5) treating evacuated children from specialized treatment facilities who may be oxygen dependent. The outside of the bus has both CFD and CDPH logos to identify that this is a collaborative effort between city agencies and a Healthcare Coalition.

The combination of increasing life spans and low birth rates is accelerating the pace at which the share of older adults in the population worldwide is rising. As people age, their autonomy tends to decrease which leads frequently to the need to use support equipment to perform their daily living activities. Governments, at all levels, are establishing programs to enable this population to live with dignity at home, receive more proper care, and to participate in all life’s activities in a joyful and independent way. Within these programs, we can find the Assistive Technology (AT) organizations that makes available to the population assistive technology equipment as wheelchairs or hospital beds. These organizations collect and store donated products for lend them to needed users. The management of these products’ flow, the location of the access centers, and design of the transportation schemes is not straightforward, due to several complexities, such as a highly uncertain demand and offer, budget limitations, and restricted availability of human resources within the organizations, most of which are volunteers. In this paper, we analyze the AT operations, based on a Circular Economy perspective, and we develop tools that can help the managers of these programs to make better logistics decisions. These tools are based on mathematical models and efficient algorithms that have been developed to solve location, inventory, and routing operational problems in the AT organizations. We have been inspired by the social program of the Barcelona City Council, Banc del Moviment, but the tools can be used and extended to other programs around the world.

Purpose The purpose of this paper is to assess nutritional habits and body composition parameters in the group of Polish pupils and students. Design/methodology/approach The study was conducted by the body composition analysis using the biological impedance method applying TANITA analyzer and diagnostic survey method using standardized direct interview with selected elements of the Sarzynska test. The research was carried out in various regions of Poland on a group of 1,000 pupils and students, using a targeted sample selection in the following subgroups: 250 middle school pupils, 250 high school students, 250 students living in a family home and 250 students living in an academic home. Findings Significantly the worst nutritional habits according to the Sarzynska test are shown by students living in academic home. As many as 21.6 percent of them eat very badly, while only 10.4 percent of students living in a family home eat very badly. This may indicate a lack of conditions, skills and time to prepare healthy meals, but also the lack of parental control in relation to what their child eats. The middle school pupils eat the healthiest meals (64.4 percent). It can be seen the regularity that the older the child is, the smaller the percentage of people in the healthy group. Research limitations/implications A research limitation was the little sample size of the study (1,000 person) and participants might have felt uncomfortable during research. Practical implications People planning class schedules should also plan breaks for a full-value meal. It is necessary to organize affordable courses that would teach simple and fast food preparation that does not require a lot of equipment and little popular ingredients. It would also be necessary to draw parents’ attention to excessive care and the fact that not allowing children to “experiment” in the kitchen may arouse in them the reluctance and fear of cooking. Social implications Among students, one should conduct universal education regarding a healthy lifestyle, which should focus on the subject of proper nutrition and physical activity, because there are no systemic solutions that would include adults. In order to improve nutritional habits, social rooms in academic homes should be adjusted so that students have the conditions to prepare nutritious meals, as well as provide access to canteens, where students would receive a reasonable meal at a reasonable price. The qualifications of the staff working there should also be improved. Originality/value The present study adds to the existing body of literature nutritional habits and body composition parameters in the group of Polish pupils and students. The results are the foundation for providing recommendations to policy makers, universitets, schools, food organizations and parents.

Coronavirus (COVID-19) is an infectious disease whisch split human to human caused by a newly acquired coronavirus. Mostly people infected with COVID-19 will experience moderate respiratory illness and recover without the need for special treatment. Older people, as well as those with less medical problems such as disease,diabetes, chronic respiratory diseases, and cancer are more likely to be seriously ill. The best way to prevent and reduce transmission of COVIT-19Protect yourself and others from infection by washing your hands or using alcohol-based medicine often and without touching your face. The COVID-19 virus is spread mainly through saliva droplets or runny nose when an infected person coughs or sneezes, so it is important that you re-practice the practice of breathing (for example, by coughing on a flexible elbow). At this time, there are no specific drugs or specifications for COVID-19. However, there are many ongoing clinical trials examining possible treatments. We can only protect ourselves from this problem because we currently do not have a cure so in this proposed program we will provide a setup that will enable automatic protection through the installation of equipment and set up electrical equipment. In India, about 200 percent of people lose their lives as a result of disrupted health care systems which means that in many hospitals, the doctor visits patients with a morning shift or in the afternoon shift or on individual shifts. What happens if a patient's health becomes important during this time or when the doctor is not in the market with the patient. The solution is; the patient may lose his or her life. thus avoiding this important situation; we tend to suggest a device that raises the device of an intelligent embedded system that monitors the health of patients indefinitely. This system monitors patients' heart rate, vital signs, and salt water (if any). If any of the above parameters are on the far side of the periphery, this sensible device informs physicians or caregivers and suggests ways to improve the patient's overall health savings. Objects (IoT) sees the way forward to something in any place by anyone at any time. information and communication technology helps to transform digital technologies. The IoT location unit is designed to connect multiple mobile devices to networks. reveals the structural design of an intelligent health care system using the Wireless Sensor Network. Monitoring a patient's health is a common function in health care facilities from home to hospital. In the proposed system, patients carry a set of nerve endings to collect their physical limits. Arduino is attached to the patient's body, assists the deaf and sends sensory information to the server via WiFi. WiFi, which is used in most hospital systems, provides very little interference with the operation of some devices. The server detects unusual cases of patients using the limit value and sends an SMS and email to the doctor with a video-feed. The system allows for the movement of a patient wearing a nerve and the video feed enhances physician communication. Through this program we can improve the quality of treatment for patients who may need ongoing long-term health monitoring.

Photo by Jeremy Wong on Unsplash ABSTRACT In response to the threat of COVID-19, CMS issued unprecedented restrictions severely limiting the liberty of older adults residing in long-term care. Older adults are identified as at a high risk of becoming infected through exposure to SARS-Cov-2 and of suffering the most severe morbidity and mortality. While protecting the individual from disease, the restrictions also had a determinantal effect. The restrictions exacerbated social isolation and loneliness, two pervasive public health concerns within the older adult population. Legally, the restrictions pass constitutional muster. The ethical analysis presents more questions and debates. Initially, the restrictions to protect the older adult were grounded in public health ethics and bioethics principles. However, the ethical lines become blurred as the risk of harm secondary to isolation increased over the time that the restrictions remained in effect. The ethical point of view becomes more divergent considering the restrictions also preserved medical resources for the greater good of society, arguably diverting them to serve younger people. We have a moral obligation to reduce social isolation and recognize the older adult as a valuable member of society with equal worth and dignity. INTRODUCTION In response to the threat of COVID-19, CMS issued unprecedented restrictions severely limiting the liberty of older adults residing in long-term care. Older adults are identified as at a high risk of becoming infected from exposure to SARS-Cov-2 and from suffering the most severe morbidity and mortality. While protecting the individual from disease, the restrictions also had a determinantal effect. The restrictions exacerbated social isolation and loneliness, two pervasive public health concerns within the older adult population. Legally, the restrictions pass Constitutional muster. The ethical analysis presents more questions and debates. Initially, the restrictions to protect the older adult were grounded in public health ethics and bioethics principles. However, the ethical lines become blurred as the risk of harm secondary to isolation increased over the time that the restrictions remained in effect. The devastation of COVID-19 within the older adult population extends beyond the immediate risk and harm of infection. At the beginning of the COVID-19 pandemic, experts determined that older adults, especially those living in long-term care, were at a greater risk of becoming infected and depleting scarce medical resources. Two days after WHO declared the pandemic, the Centers for Medicare & Medicaid Services (CMS) followed the Centers for Disease Control (CDC) recommendations and announced mitigation measures that required long-term care facilities to (1) restrict volunteers and nonessential personnel from entering the facility; (2) cancel all group activities and communal dining; (3) screen residents and health care personnel for fever and respiratory symptoms; and (4) encourage residents to stay in their rooms. The social isolation resulting from the mitigation measures posed a credible threat to five core domains of healthy aging: (1) promoting health; preventing injury and managing chronic conditions; (2) cognitive health; (3) physical health; (4) mental health; and (5) facilitating social engagement.[1] l. Social Isolation and Loneliness COVID-19 highlighted two pervasive public health concerns confronting older adults—social isolation and loneliness. Social isolation is an objective deficit in the number of relationships and the frequency of contact with family, friends, and the community.[2] Social Isolation is a risk factor for loneliness. Loneliness is the subjective perception of a lack of meaningful relationships.[3] Loneliness has three dimensions: (1) absence of a significant person to provide emotional support and affirm one’s value as a person; (2) absence of a small group of people seen regularly, such as a card group; and (3) absence of a larger network group of people who provide support by being together as a group, for example, church services or rotary meetings.[4] COVID-19 restrictions affected all three dimensions. Social isolation can be as dangerous as smoking fifteen cigarettes per day, earning its designation as a public health priority.[5] Isolation increases the risk of cardiovascular disease, obesity, anxiety, and depression. Loneliness can lead to depression, alcoholism, and suicidal thoughts.[6] Some studies found that loneliness is also a factor in cognitive decline. For example, caregivers reported that 63 percent of older adults with cognitive impairment experienced cognitive decline during the COVID-19 pandemic.[7] In 2017, the American Association of Retired Persons (AARP) reported that social isolation accounted for $6.7 billion in additional Medicare spending although only 14 percent of older adults in the US reported being socially isolated.[8] Approximately 24 percent of community-dwelling older adults in the US are socially isolated. Forty-three percent of adults aged 60 and older report feeling lonely. Those living in long-term care report loneliness at a rate of at least double of community-dwelling older adults.[9] WHO defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”[10] A broad definition of health highlights the detriment of social isolation in older adults. There is a moral obligation to mitigate the effect of isolation.[11] The additional Medicare spending costs attributable to the effects of social isolation secondary to COVID-19 will be extraordinary. Providing social support will directly benefit older adults and indirectly benefit society by reducing Medicare spending associated with the effects of social isolation. Combating the pervasiveness of social isolation requires immediate collaborative community action. Many long-term care residents who depend on visits from family and friends to socialize increasingly felt lonely, abandoned, and despondent,[12] increasing the risk of feeling grief and loss, including individual and collective trauma reactions.[13] Also, normally social opportunities, medical, and legal appointments defaulted to telephone or virtual appointments. The cessation of in-person medical appointments interfered with optimal management of chronic conditions and preventive care. Some older adults lack access to the technology, are unfamiliar with technology, or cannot use technology for other reasons. At least one study supports the potential for older adults to benefit from technology and suggests that training could promote long-term benefits in older adults aged 80 years and over.[14] Focusing on technological advances specific to older adults with input from older adults should be a priority. When communal dining abruptly stopped, residents had to eat all their meals alone in their rooms. Older adults often mention the difficulty of eating meals alone, especially if recently divorced, widowed, or otherwise separated from a spouse or partner. Closure of the exercise facilities limited the ability of an older adult to stay physically active. Reduced physical activity creates long-term adverse health effects.[15] ll. Measures to Mitigate Isolation To facilitate some contact, long-term care facilities devised window visits. The resident remained safely inside the locked facility, standing or seated in front of a window. Visitors stood outside in the grass or parking lot. Any conversation took place over the telephone. To simulate physical contact, residents and visitors pressed their palms together, separated by the glass barrier. The window visits recall the prison visits depicted in movies and television. In late June 2020, CMS relaxed the restrictions and advised that long-term care facilities could resume some communal activities and permit outdoor visits. Although CMS eased the restrictions, interpersonal contact remained minimal. Outdoor visits required scheduling an appointment during limited hours of availability. The facilities limited the visits per week and the duration of each visit to thirty minutes. In addition, the staff enforced wearing personal protective equipment and maintaining physical distancing. Several impracticalities diminished the optimism of the relaxed restrictions. Residents could leave their rooms for meals but remained physically separated at a distance that prevented any meaningful interaction. Similarly, the limitations on the in-person visits presented problems. Non-resident spouses with mobility challenges found the outdoor access difficult, if not impossible. Residents or spouses with hearing and vision losses experienced challenges in communicating while sitting outside, six feet apart, and wearing masks.[16] lll. Legal Precedent for Emergency Measures The primary legal issue stems from the conflict between individual liberty and the public good or health. Jacobson v. Massachusetts provides a framework for balancing individual liberty rights and the public good during a pandemic.[17] Jacobson clarified an essential point of law - the rights and liberties secured by the US Constitution are not absolute.[18] Faced with a pandemic, a community has the right to protect members of the community.[19] Jacobson outlines four standards for imposing public health mandates during a pandemic. First, the State overreaches when it uses public health powers unnecessarily.[20] Second, the state must use the least restrictive means to prevent harm.[21] Third, the state must use reasonable means expected to prevent or ameliorate a health threat.[22] Finally, the intervention must not pose an undue risk.[23] The guidelines in Jacobson, established during the smallpox pandemic, apply to COVID-19. In response to the threat of COVID-19, public health authorities enacted mandates to protect the public, especially older adults, against the highly contagious and virulent virus. The CMS restrictions specifically addressed older adults living in long-term care facilities. While the CMS directives obstructed residents’ liberties, they also contradicted the Assisted Living Facility social model, which places autonomy and independence at the forefront. Given the gravity of harm and the uncertainties in the early phases of the pandemic, the restrictions were arguably the least restrictive means to manage the immediate threat. The effectiveness varied from facility to facility, with many deaths throughout the US in long-term care facilities. While valuable early in the pandemic, at some point the continuation of the mitigation measures increased social isolation and its associated risks. In Jew Ho v. Williamson, the Supreme Court overturned a quarantine order to contain the bubonic plague.[24] The officials enforced the order only against a targeted ethnic population which did not present an identified risk.[25] In reaching its decision, the Court determined that the quarantine order was not a reasonable regulation to prevent the spread of the bubonic plague. Rather, it was racially motivated. The Court ruled that the government cannot impose public health orders in a racially invidious manner.[26] There are similarities between Jew Ho and the CMS restrictions. Like the quarantine order in Jew Ho, the restrictions targeted a specific population. But with COVID-19 older adults were an identified high-risk population because of their susceptibility to infection and severe illness. During the early phases of the pandemic, the directives were reasonable to accomplish the purpose of preventing the spread in the identified high-risk population. They were not discriminatory according to the rule of law in Jew Ho. The argument supporting the constitutionality of the CMS restrictions wanes as the length of the safety precautions increased. lV. Ethical Analysis of the Lengthy Social Isolation The CMS restrictions require the ethical analysis of harm, proportionality, reciprocity, and transparency. As well as analysis under the principles of autonomy, beneficence, non-maleficence, and justice. a. Harm and Proportionality As previously discussed, older adult long-term care residents were more susceptible to COVID-19 and to severe physical effects requiring hospitalization. In addition, older adults are more likely to die from COVID-19. Based on a totality of the circumstances and what we knew about the virus in the early phases of the pandemic, the restrictions were the least restrictive means to protect this high-risk population. But the question of proportionality requires ongoing assessment and re-evaluation. While the initial uncertainty and chaos justified the restrictions, as the pandemic continued and the risk of harm from the restrictions increased, the pendulum began to swing. At some point, upon proof or likelihood of safety, less restrictive alternatives should have been adopted. b. Reciprocity The concept of reciprocity is a core principle of public health and requires the balancing of the benefits and burdens of the social cooperation.[27] When individuals sacrifice their liberty for the benefit of others, they should not be penalized as a result of making the sacrifice, and thus society owes a reciprocal obligation to the individuals, such as providing individuals support and not discriminating against them.[28] Residents did not have any input or choice when CMS and the administrators stripped away their autonomy and liberties. While the restrictions protected the individual resident from the direct harm of infection, the restrictions also protected society from the indirect harm of the depletion of scarce medical resources. Public health officials identified long-term care residents as most likely to require significant medical resources. One talking point repeatedly broadcast was the need to prevent the depletion of hospital beds, ventilators, medications, and supplies. Most assisted-living facilities are for-profit, and residents pay for their food, shelter, and personal needs. What does society owe these long-term care residents in return for the liberty they sacrificed for the benefit of society at large? At the very least, I suggest we owe these individuals the commitment to conduct research exploring and addressing the effects of the restrictions. c. Transparency by Government, the Media, and the Long-Term care Facilities The communications from government and public health officials about the pandemic and the restrictions were opaque, leaving unanswered questions, doubts, and speculation. Some facilities provided families with basic information communicated through robocall messaging, with words of encouragement, painting rosy pictures of the residents' sequestered daily lives. Public health officials assert the common good and protecting the public’s safety and health justify paternalism and compulsory powers.[29] One counterargument is that the compulsory interventions or restrictions push paternalism to new levels.[30] The COVID-19 pandemic and the mitigation interventions highlight this tension between libertarian and epidemiological models based on (1) shortages that triggered rationing and prioritization; and (2) measures that safeguarded public health but infringed on individual rights.[31] d. Autonomy, Beneficence, and Non-Maleficence Through a bioethical lens, we immediately see the clash between the CMS restrictions and the long-term care residents’ autonomy. However, autonomy is not absolute. There was a benefit for the individual resident: the protection from a deadly virus. Thus, I argue that the initial restrictions were beneficent. Yet I also point to the deleterious secondary physical and emotional effects of the isolation and assert that the restrictions should have been safely modified as new information on viral spread and safety came about. We can accept the beneficence of protecting the high-risk resident from a deadly disease while acknowledging the associated harm. However, at some point, we must also ask if the harm experienced due to prolonged severe restrictions reached a level that exceeded the boundaries of beneficence and became maleficent. Perceiving the long-term care resident as a passive recipient of care is paternalistic and antithetical to autonomy and a person-centered approach.[32] Instead, society must recognize older adults as essential stakeholders in policymaking. The direct and active involvement of older adults allows the individual to retain agency rather than becoming a passive recipient of care.[33] Prioritization of the older adult as an autonomous active participant counters ageism and promotes autonomy. e. Justice Justice calls for analysis of several discrepancies. First, the special protection of long-term care residents seems justifiable due to their special vulnerability. CMS treated long-term care facilities alike. Most community-dwelling older adults could decide whether to adhere to stay-at-home restrictions and were not subject to the same level of enforcement that existed within long-term care facilities. The restrictions were far more oppressive for long-term care residents. In response to the assertion that selective lockdown discriminates against older adults, the same arguments discussed above demonstrate the morally relevant justification: older adults are more likely to require hospitalization and die from COVID-19.[34] One convincing argument against restrictions on older adults echoing Kant’s categorical imperative argues that selectively restricting older adults for the good of other people amounts to treating older adults as a means to an end for others.[35] While the restrictions imposed on the individual might slow the spread of the disease within the specific long-term care facility, which protects that individual resident, they also impose on the individual resident to serve the greater good: the preservation of scarce medical resources. The second application pushes the restrictive measures closer to violating Kant’s categorical imperative by treating the older adult as a means to the end of others. That is, younger people and those living outside of long-term care would have more hospital resources available to them if long-term care residents were more severely isolated keeping them from needing hospitalization. From a Kantian perspective, the categorical imperative demands respecting the dignity of persons—Kant’s supreme (formal) principle.[36] When we consider the restrictions, I suggest that we must also consider the impact on dignity. It has been suggested that dignity is the “overarching principle of bioethics.”[37] In the context of an analysis of the socially isolating COVID-19 mitigation measures on older adults in long-term care facilities, we should consider the relational aspect of dignity, recognizing the adult as having value and equal worth. The protracted imposed isolation of older adults to preserve medical resources devalues older adults. Ongoing COVID-19 restrictions should be analyzed for their unjustified harms. A second justice concern outside the scope here is that long-term care facilities are resourced differently, and had different results due to quality of care, number of staff, infection control protocols, and previous health infraction records. CONCLUSION The myopic focus on mortality ignores the risks of morbidity secondary to the devastating effects of social isolation on the older adult’s health and quality of life. The paternalistic prevention eclipsed the resident’s autonomy. At some point, the attention and priority must shift. When formulating policies, we must figure out at what point or in which situations the negative impact of restrictions outweighs the protective benefits. Although the restrictions may have slowed the spread of COVID-19, we must not discount the negative consequences, which may be long-term. From an ethical perspective, we must acknowledge the harm that has occurred within this population and accept the responsibility to redress the harm and prevent repeating the mistakes. The prolonged restrictions stretched legal and ethical boundaries. The mixed purpose of the restrictions (protecting the individual resident and preserving healthcare resources) makes the ethical analysis more challenging. Yet doing something for someone’s own good is still paternalistic and problematic. The public health justification includes the collective. We must confront the tough questions about the efficacy of pandemic mitigation measures and the mitigation measures’ adverse consequences. Leaving the doors to long-term care facilities open during the pandemic would have exposed every resident and staff member to a contagion that presented a significant risk of morbidity and mortality. But locking the doors exacerbated social isolation and loneliness, increasing the risk of morbidity and mortality. Julian Savulescu may be correct that there was no desirable solution. We must still work to find better solutions that will reduce social isolation and recognize the older adult as a valuable member of society with equal worth and dignity. [1] Coronavirus Disease 2019 (COVID-19) Nursing Homes & Long-term care Facilities. (n.d.). Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/index.html. [2]Escalante, E., Golden, R. L., & Mason, D. J. (2020). Social Isolation and Loneliness: Imperatives for Health Care in a Post-COVID World. JAMA Health Forum, 1(12),e201597. https://doi.org/10.1001/jamahealthforum.2020.1597. [3] D'cruz, M., & Banerjee, D. (2020). ‘An invisible human rights crisis’: The marginalization of older adults during the COVID-19 pandemic – An advocacy review. Psychiatry Research, 292, 113369. https://doi.org/10.1016/j.psychres.2020.113369. [4] Simard, J., & Volicer, L. (2020). Loneliness and Isolation in Long-term care and the COVID-19 Pandemic. Journal of the American Medical Directors Association, 21(7), 966–967. https://doi.org/10.1016/j.jamda.2020.05.006. [5] Escalante, E., Golden, R. L., & Mason, D. J. (2020). Social Isolation and Loneliness: Imperatives for Health Care in a Post-COVID World. JAMA Health Forum, 1(12). https://doi.org/10.1001/jamahealthforum.2020.1597. [6] Simard, J., & Volicer, L. (2020). Loneliness and Isolation in Long-term care and the COVID-19 Pandemic. Journal of the American Medical Directors Association, 21(7), 966–967. https://doi.org/10.1016/j.jamda.2020.05.006. [7] Batsis, J. A., Daniel, K., Eckstrom, E., Goldlist, K., Kusz, H., Lane, D., … Friedman, S. M. (2021, January 26). Promoting Healthy Aging During COVID‐19. American Geriatrics Society. https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.17035. [8] Escalante, E., Golden, R. L., & Mason, D. J. (2020). Social Isolation and Loneliness: Imperatives for Health Care in a Post-COVID World. JAMA Health Forum, 1(12), e201597. https://doi.org/10.1001/jamahealthforum.2020.1597. [9] Simard, J., & Volicer, L. (2020). Loneliness and Isolation in Long-term care and the COVID-19 Pandemic. Journal of the American Medical Directors Association, 21(7), 966–967. https://doi.org/10.1016/j.jamda.2020.05.006. [10] World Health Organization. Frequently Asked Questions. https://www.who.int/about/frequently-asked-questions. [11] Chu, C. H., Donato‐Woodger, S., & Dainton, C. J. (2020). Competing crises: COVID‐19 countermeasures and social isolation among older adults in long‐term care. Journal of Advanced Nursing, 76(10), 2456–2459. https://doi.org/10.1111/jan.14467. [12] Gardner, W., States, D., & Bagley, N. (n.d.). The Coronavirus and the Risks to the Elderly in Long-term care. Journal of aging & social policy. https://pubmed.ncbi.nlm.nih.gov/32245346/. [13] Campbell, A. D. (2020). Practical Implications of Physical Distancing, Social Isolation, and Reduced Physicality for Older Adults in Response to COVID-19. Journal of Gerontological Social Work, 63(6-7), 668–670. https://doi.org/10.1080/01634372.2020.1772933. [14] Radwan, E., Radwan, A., & Radwan, W. (2020). Challenges Facing Older Adults during the COVID-19 Outbreak. European Journal of Environment and Public Health, 5(1), em0059. https://doi.org/10.29333/ejeph/8457. [15] Plagg, B., Engl, A., Piccoliori, G., & Eisendle, K. (2020). Prolonged social isolation of the elderly during COVID-19: Between benefit and damage. Archives of Gerontology and Geriatrics, 89, 104086. https://doi.org/10.1016/j.archger.2020.104086 . [16] Chu, C. H., Donato‐Woodger, S., & Dainton, C. J. (2020). Competing crises: COVID‐19 countermeasures and social isolation among older adults in long‐term care. Journal of Advanced Nursing, 76(10), 2456–2459. https://doi.org/10.1111/jan.14467. [17] Jacobson v. Massachusetts, 197 U.S. 11 (1905). [18] Jacobson. [19] Jacobson. [20] Jacobson. [21] Jacobson. [22] Jacobson. [23] Jacobson. [24] Jew Ho v. Williamson, 103 F.10 (C.C.N.D. Cal., 1900). [25] Jew Ho v. Williamson . [26] Jew Ho v. Williamson. [27] Viens, A. M. (2008). Public Health, Ethical Behavior and Reciprocity. The American Journal of Bioethics, 8(5), 1–3. https://doi.org/10.1080/15265160802180059. [28] Upshur, R. (2003, November 1). The Ethics of Quarantine. Retrieved from https://journalofethics.ama-assn.org/article/ethics-quarantine/2003-11. [29] Kamweri, J. M. M. (2013). The Ethical Balance Between Individual and Population Health Interests To Effectively Manage Pandemics and Epidemics (dissertation). [30] Argued by Ken Wing Professor Emeritus, Seattle University School of Law. Kamweri, J. M. M. (2013). The Ethical Balance Between Individual and Population Health Interests To Effectively Manage Pandemics and Epidemics (dissertation). [31] Interests To Effectively Manage Pandemics and Epidemics (dissertation). [32] Chu, p. 2457. [33] D'cruz, p.7. [34] Savulescu, J., & Cameron, J. (2020). Why lockdown of the elderly is not ageist and why levelling down equality is wrong. Journal of Medical Ethics, 46(11), 717–721. https://doi.org/10.1136/medethics-2020-106336. [35] Hugh McLachlan, Professor Emeritus of Applied Philosophy, [36] Heinrichs, B. (2010). Single-Principle Versus Multi-Principles Approaches in Bioethics. Journal of Applied Philosophy, 27(1), 72-83. doi:10.1111/j.1468-5930.2009.00474.x. [37] Gedge, E. by impact ethics · in C. E. (2015, July 27). What Is Dignity and Does Bioethics Need to Talk About It? Impact Ethics. https://impactethics.ca/2015/07/27/what-is-dignity-and-does-bioethics-need-to-talk-about-it/, citing, The 2005 UNESCO Declaration of Bioethics and Human Rights https://en.unesco.org/themes/ethics-science-and-technology/bioethics-and-human-rights.

Abstract Background Healthcare services that traditionally have been provided in long-term care institutions in Norway are increasingly being delivered at home to a growing population of older people with chronic conditions and functional limitations. Fostering reablement among older people is therefore important if they are to live safety at home for as long as possible. This study examines how healthcare professionals and managers (staff) in Norwegian municipalities promote reablement among community-dwelling older people. Methods Face-to-face, semi-structured interviews lasting between 21 and 89 min were conducted between November 2018 and March 2019 with healthcare managers (N = 8) and professionals (N = 8 focus groups with 2–5 participants) in six municipalities in Norway. All interviews were audio-recorded, transcribed, and thematically coded inductively and analyzed with the aid of NVivo 12 software. Results Overall, healthcare staff in this study used several strategies to promote reablement, including: carrying out assessments to evaluate older people’s functional status and needs (including for safe home environments), and to identify older people’s wishes and priorities with regard to reablement training. Staff designed care plans informed by the needs assessments, and worked with older people on reablement training at a suitable pace. They promoted among older people and staff (within and across care-units) the principle of ‘showing/doing with’ versus ‘doing for’ the older person so as to not enable disablement. Additionally, they supported older people in the safe and responsible use of welfare technology and equipment. Even so, staff also reported constraints to their efforts to foster reablement, such as: heavy workload, high turnover, insufficient training in reablement care, and poor collaboration across care-units. Conclusion Older people may be supported to live safely at home by meeting them as individuals with agency, identifying and tailoring services to their needs and wishes, and encouraging their functional abilities by ‘showing/doing with’ versus ‘doing for them’ when possible. The healthcare professionals and managers in this study were positive towards reablement care. However, meeting the resource demands of reablement care is a key challenge.

Purpose The purpose of this study is to identify the needs and concerns of older people in Jaipur, Rajasthan, India during the lockdown phase of the Covid-19 crisis. The study also aims to present a viable model for extending needed support through a telephone helpline run by a team of young student volunteers. Design/methodology/approach The study uses a thematic analysis of the interaction between callers (service users) and volunteers. Findings The study shows that the main reasons that motivate the use of the helpline are to seek medical advice and to request medical services and medical supplies free of charge. However, the study also shows that other reasons for calling the helpline are feelings of loneliness and the need for psychological support, especially due to insufficient assistance from families. Practical implications The study shows the benefits of providing this type of service for older people during a time of national health crisis. The service is cost-effective and offers a one-stop assistance point. Social implications The service also constitutes an avenue for building intergenerational solidarity and empathy between younger and older people. This is especially important for citizens who feel socially isolated and disconnected from the rest of society. Originality/value The study offers a model for an easily created resource that could usefully be exported to other geographic settings.

BackgroundVideo-calls have proven to be useful for older care home residents in improving socialization and reducing loneliness. Nonetheless, to facilitate the acceptability and usability of a new technological intervention, especially among people with dementia, there is a need for user-led design improvements. The current study conducted focus groups with an embedded activity with older people to allow for a person-centered design of a video-call intervention.MethodsTwenty-eight residents across four care homes in the South West of England participated in focus groups to aesthetically personalize and ‘dress-up’ the equipment used in a video-call intervention. Each care home was provided with a ‘Skype on Wheels’ (SoW) device, a wheelable ‘chassis’ comprising an iPad or tablet for access to Skype, and a telephone handset. During the focus group, residents were encouraged to participate in an activity using colorful materials to ‘dress-up’ SoW. Comments before, during and after the ‘dress up’ activity were audio recorded. Framework analysis was used to analyze the focus group data.ResultsOlder people, including seven with dementia were able to interact with and implement design changes to SoW through aesthetic personalization. Themes arising from the data included estrangement, anthropomorphism, reminiscence, personalization, need for socialization versus fear of socialization and attitudes toward technology. After this brief exposure to SoW, residents expressed the likelihood of using video-calls for socialization in the future.ConclusionCare home residents enjoy engaging with new technologies when given the opportunity to interact with it, to personalize it and to understand its purpose. Low cost aesthetic personalization of technologies can improve their acceptability, usability, and implementation within complex care environments.

Abstract Background Home care (HC) services are crucial to the health and social wellbeing of older adults, people with disabilities, and the chronically ill. Although the HC sector is growing rapidly in the USA, there is high job turnover among the HC aide workforce. HC provides an important alternative to facility-based care, yet it has often been overlooked within the larger health care system: most recently, in COVID-19 pandemic planning. The objective of the study was to characterize qualitatively the impact of the COVID-19 pandemic on three key HC stakeholders: clients, aides, and agency managers. Methods The study included 37 phone interviews conducted during April – November 2020: HC clients (n = 9), aides (n = 16), and agency managers (n = 12). All interviews were audio recorded and transcribed verbatim. Qualitative analysis of the transcripts followed the grounded theory approach. The interview transcriptions were coded line-by-line into hierarchical themes with NVivo 12 software which allowed weighting of themes based on the number of interviews where they were coded. Results Fear of infection and transmission among HC clients and aides were strong themes. Infection prevention and control became the top priority guiding day-to-day business operations at agencies; sourcing adequate personal protective equipment for staff was the most urgent task. HC aides expressed concerns for their clients who showed signs of depression, due to increased isolation during the pandemic. The disappearance of comforting touch – resulting from physical distancing practices – altered the expression of compassion in the HC aide-client care relationship. Conclusions The findings suggest that the pandemic has further increased psychosocial job demands of HC aides. Increased isolation of clients may be contributing to a wider public health problem of elder loneliness and depression. To support the HC stakeholders during the on-going COVID-19 pandemic, for future pandemic planning or other health emergencies, it is important to improve HC aide job retention. This action could also ease the serious care services shortage among the growing population of older adults.

Abstract Background Home care (HC) services are crucial to the health and social wellbeing of older adults, people with disabilities, and the chronically ill. Although the HC sector is growing rapidly in the USA, there is high job turnover among the HC aide workforce. HC provides an important alternative to facility-based care, yet it has often been overlooked within the larger health care system: most recently, in COVID-19 pandemic planning. The objective of the study was to characterize qualitatively the impact of the COVID-19 pandemic on three key HC stakeholders: clients, aides, and agency managers. Methods The study included 37 phone interviews conducted during April – November 2020: HC clients (n = 9), aides (n = 16), and agency managers (n = 12). All interviews were audio recorded and transcribed verbatim. Qualitative analysis of the transcripts followed the grounded theory approach. The interview transcriptions were coded line-by-line into hierarchical themes with NVivo 12 software which allowed weighting of themes based on the number of interviews where they were coded. Results Fear of infection and transmission among HC clients and aides were strong themes. Infection prevention and control became the top priority guiding day-to-day business operations at agencies; sourcing adequate personal protective equipment for staff was the most urgent task. HC aides expressed concerns for their clients who showed signs of depression, due to increased isolation during the pandemic. The disappearance of comforting touch – resulting from physical distancing practices – altered the expression of compassion in the HC aide-client care relationship. Conclusions The findings suggest that the pandemic has further increased psychosocial job demands of HC aides. Increased isolation of clients may be contributing to a wider public health problem of elder loneliness and depression. To support the HC stakeholders during the on-going COVID-19 pandemic, for future pandemic planning or other health emergencies, it is important to improve HC aide job retention. This action could also ease the serious care services shortage among the growing population of older adults.

Abstract Background mortality in care homes has had a prominent focus during the COVID-19 outbreak. Care homes are particularly vulnerable to the spread of infectious diseases, which may lead to increased mortality risk. Multiple and interconnected challenges face the care home sector in the prevention and management of outbreaks of COVID-19, including adequate supply of personal protective equipment, staff shortages and insufficient or lack of timely COVID-19 testing. Aim to analyse the mortality of older care home residents in Wales during COVID-19 lockdown and compare this across the population of Wales and the previous 4 years. Study Design and Setting we used anonymised electronic health records and administrative data from the secure anonymised information linkage databank to create a cross-sectional cohort study. We anonymously linked data for Welsh residents to mortality data up to the 14th June 2020. Methods we calculated survival curves and adjusted Cox proportional hazards models to estimate hazard ratios (HRs) for the risk of mortality. We adjusted HRs for age, gender, social economic status and prior health conditions. Results survival curves show an increased proportion of deaths between 23rd March and 14th June 2020 in care homes for older people, with an adjusted HR of 1.72 (1.55, 1.90) compared with 2016. Compared with the general population in 2016–2019, adjusted care home mortality HRs for older adults rose from 2.15 (2.11, 2.20) in 2016–2019 to 2.94 (2.81, 3.08) in 2020. Conclusions the survival curves and increased HRs show a significantly increased risk of death in the 2020 study periods.

Abstract Many health and social care services are implementing video remote interpreting (VRI) to deal with supply shortages and high costs of language interpreting for linguistically diverse clients. This qualitative study examines stakeholders’ perspectives on using VRI for home-based cognitive assessments, which are routinely performed with older people during aged care assessments in Australia. We conducted 25 semi-structured interviews with clients, assessors and interpreters in Melbourne and a regional Victorian city. We found that across stakeholder groups participants usually regard VRI as an acceptable alternative to face-to-face interpreting when the latter is not possible. Freelance interpreters said VRI saved on travel time and expenditure and afforded them financial and practical benefits that enabled them to better meet the high demand for their work. However, stakeholders also pointed to the limitations of VRI, including technical challenges, sound and video quality, and difficulties with positioning equipment optimally during interviews. The assessors and interpreters agreed that VRI was inappropriate when clients are known to be cognitively impaired, and that face-to-face interpreting is necessary to support these clients and ensure assessment accuracy. We suggest that plans by health or social care services to replace face-to-face interpreting with VRI should be balanced against the needs of clients and any impacts on professional practice.

Background: Developed countries are facing the challenge of aging societies, a high risk of dependence and high cost of care. Researchers attempted to address these issues by using cost-efficient, innovative technology to promote healthy aging and to regain functionality. After an injury, efficient rehabilitation is crucial to promote returning home and to prevent institutionalization. However, there is often a lack of motivation to carry out physical therapies. Consequently, there is a growing interest in testing new approaches like computer-aided rehabilitation to achieve functional targets and prevent re-hospitalization. Trial design: Pilot multicenter non-inferiority randomized clinical trial. Objectives: To assess the efficacy of a personal mobility device compared with standard of care in the rehabilitation treatment of patient with musculoskeletal issues. Methods: 57 patients aged 67-95 years were randomly assigned to the intervention group (n=35) using the gamified rehabilitation equipment 3 times a week or to a control group (n=22) receiving usual standard care. Outcome measures included SPPB (Short Physical Performance Battery), IHGS (Isometric Hand Grip Strength), FIM (Functional Independence Measure) and number of steps. Results: There were no significant differences between the control and the intervention groups for the primary outcome (SPPB) or any of the secondary outcomes (IHGS, FIM and steps), which demonstrates the non-inferiority effect of the serious game-based intervention. The analysis by mixed-effects regression on SPPB showed no indication of a group x time interaction (SPPB_I_t1=-0.76, p=0.26; SPPB_I_t2=0.21, p=0.74). Although not significant, a positive IHGS improvement of more than 2kg (Right: 2.52kg; Left: 2.43kg) for the patient from the intervention group was observed. In addition, patients who received the intervention exhibited stronger engagement in the rehabilitation process and a higher motivation to being more active. Conclusions: Serious game-based rehabilitation could be an effective alternative for older patients to regain their functional capacities.

Abstract Background A growing number of older people are care dependent and live in nursing homes, which accounts for the majority of long-term-care spending. Specific medical conditions and resident characteristics may serve as risk factors predicting negative health outcomes. We investigated the association between the risk of increasing care need and chronic medical conditions among nursing home residents, allowing for the competing risk of mortality. Methods In this retrospective longitudinal study based on health insurance claims data, we investigated 20,485 older adults (≥65 years) admitted to German nursing homes between April 2007 and March 2014 with care need level 1 or 2 (according to the three level classification of the German long-term care insurance). This classification is based on required daily time needed for assistance. The outcome was care level change. Medical conditions were determined according to 31 Charlson and Elixhauser conditions. Competing risks analyses were applied to identify chronic medical conditions associated with risk of care level change and mortality. Results The probability for care level change and mortality acted in opposite directions. Dementia was associated with increased probability of care level change compared to other conditions. Patients who had cancer, myocardial infarction, congestive heart failure, cardiac arrhythmias, renal failure, chronic pulmonary disease, weight loss, or recent hospitalization were more likely to die, as well as residents with paralysis and obesity when admitted with care level 2. Conclusion This paper identified risk groups of nursing home residents which are particularly prone to increasing care need or mortality. This enables focusing on these risk group to offer prevention or special treatment. Moreover, residents seemed to follow specific trajectories depending on their medical conditions. Some were more prone to increased care need while others had a high risk of mortality instead. Several conditions were neither related to increased care need nor mortality, e.g., valvular, cerebrovascular or liver disease, peripheral vascular disorder, blood loss anemia, depression, drug abuse and psychosis. Knowledge of functional status trajectories of residents over time after nursing home admission can help decision-makers when planning and preparing future care provision strategies (e.g., planning of staffing, physical equipment and financial resources).

Abstract Background Older people living in residential aged care homes experience frequent emergency transfers to hospital. These events are associated with risks of hospital acquired complications and invasive treatments or interventions. Evidence suggests that some hospital transfers may be unnecessary or avoidable. The Early Detection of Deterioration in Elderly residents (EDDIE) program is a multi-component intervention aimed at reducing unnecessary hospital admissions from residential aged care homes by empowering nursing and care staff to detect and manage early signs of resident deterioration. This study aims to implement and evaluate the program in a multi-site randomised study in Queensland, Australia. Methods A stepped-wedge randomised controlled trial will be conducted at 12 residential aged care homes over 58 weeks. The program has four components: education and training, decision support tools, diagnostic equipment, and implementation facilitation with clinical systems support. The integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will be used to guide the program implementation and process evaluation. The primary outcome measure will be the number of hospital bed days used by residents, with secondary outcomes assessing emergency department transfer rates, admission rates, length of stay, family awareness and experience, staff self-efficacy and costs of both implementation and health service use. A process evaluation will assess the extent and fidelity of program implementation, mechanisms of impact and the contextual barriers and enablers. Discussion The intervention is expected to improve outcomes by reducing unnecessary hospital transfers. Fewer hospital transfers and admissions will release resources for other patients with potentially greater needs. Residential aged care home staff might benefit from feelings of empowerment in their ability to proactively manage early signs of resident deterioration. The process evaluation will be useful for supporting wider implementation of this intervention and other similar initiatives. Trial registration The trial is prospectively registered with the Australia New Zealand Clinical Trial Registry (ACTRN12620000507987, registered 23/04/2020).

The article defines that the state is assigned the task of managing changes, especially in the context of the coronavirus pandemic, and this includes the purposeful development, adoption and implementation of organizational, regulatory, coordinating, controlling and motivational influences aimed at updating, innovative content, modernization or large-scale reform of education, as well as appropriate support for the processes of educational transformations that have already begun and are continuing. The essence and purpose of the concept of distance learning is analyzed. It is proved that this is an individualized process of acquiring knowledge, skills, skills and methods of cognitive activity of a person, which occurs through the interaction of remote participants in the educational process in a specialized environment using computer equipment and communication networks. It is noted that among the variety of prospects and advantages of this type of training, there are also significant disadvantages. It is noted that distance learning is based on the principle of flexibility of place, time, and pace of learning, especially during the COVID–19 pandemic. The ability to influence certain aspects of their learning increases students’ internal motivation. Independent responsibility for your own learning activities is formed gradually, so you should increase your autonomy in the learning process. Regarding the consequences of closing schools and switching to distance learning, there are interrupted learning, nutrition problems, stress for teachers, especially older people, parents ‘ lack of preparation for distance home education, deterioration of child care, economic losses, unforeseen burden on the health system, social isolation, difficulties in measuring and checking the assimilation of knowledge. It is determined that the crisis that brought the educational process to remote mode became a motive for revaluing the tools and tools of digital technologies introduced in educational institutions earlier.

Introduction Historically in Australia, there has been a growing movement behind the development of quality Early Childhood Education and Care Centres (termed ‘centres’ for this article). These centres are designed to provide care and education outside of the home for children from birth to five years old. In the mid 1980s, the then Labor Government of Australia promoted and funded the establishment of many centres to provide women who were at home with children the opportunity to move into the workplace. Centre fees were heavily subsidised to make this option viable in the hope that more women would become employed and Australia’s rising unemployment statistics would be reduced. The popularity of this system soon meant that there was a childcare centre shortage and parents were faced with long waiting lists to enrol their child into a centre. To alleviate this situation, independent centres were established that complied with Government rules and regulations. Independent, state, and local government funded centres had a certain degree of autonomy over facilities, staffing, qualifications, quality programmes, and facilities. This movement became part of the global increased focus on the importance of early childhood education. As part of that educational emphasis, the Melbourne Declaration on Educational Goals for Young Australians in 2008 set the direction for schooling for the next 10 years. This formed the basis of Australia’s Education Reforms (Department of Education, Employment and Workplace Relations). The reforms have influenced the management of early childhood education and care centres. All centres must comply with the National Quality Framework that mandates staff qualifications, facility standards, and the ratios of children to adults. From a parent’s perspective centres now look very much the same. All centres have indoor and outdoor playing spaces, separate rooms for differently aged children, playgrounds, play equipment, foyer and office spaces with similarly qualified staff. With these similarities in mind, the dilemma for parents is how to decide on a centre for their child to attend. Does it come down to parents’ taste about a centre? In the education context, how is taste conceptualised? This article will present research that conceptualises taste as being part of a decision-making process (DMP) that is used by parents when choosing a centre for their child and, in doing so, will introduce the term: parental taste. The Determining Factors of Taste A three phase, sequential, mixed methods study was used to determine how parents select one centre over another. Cresswell described this methodology as successive phases of data collection, where each builds on the previous, with the aim of addressing the research question. This process was seen as a method to identify parents’ varying tastes in centres considered for their child to attend. Phase 1 used a survey of 78 participants to gather baseline data to explore the values, expectations, and beliefs of the parents. It also determined the aspects of the centre important to parents, and gauged the importance of the socio-economic status and educational backgrounds of the participants in their decision making. Phase 2 built on the phase 1 data and included interviews with 20 interviewees exploring the details of the decision-making process (DMP). This phase also elaborated on the survey questions and responses, determined the variables that might impact on the DMP, and identified how parents access information about early learning centres. Phase 3 focussed on parental satisfaction with their choice of early learning setting. Again using 20 interviewees, these interviews investigated the DMP that had been undertaken, as well as any that might still be ongoing. This phase focused on parents' reflection on the DMP used and questioned them as to whether the same process would be used again in other areas of decision making. Thematic analysis of the data revealed that it usually fell to the mother to explore centre options and make the decision about enrolment. Along the way, she may have discussions with the father and, to a lesser extent, with the centre staff. Friends, relatives, the child, siblings, and other educational professionals did not rank highly when the decision was being considered. Interestingly, it was found that the mother began to consider childcare options and the need for care twelve months or more before care was required and a decision had to be made. A small number of parents (three from the 20) said that they thought about it while pregnant but felt silly because they “didn’t even have a baby yet.” All mothers said that it took quite a while to get their head around leaving their child with someone else, and this anxiety and concern increased the younger the child was. Two parents had criteria that they did not want their child in care until he/she could talk and walk, so that the child could look after him- or herself to some extent. This indicated some degree of scepticism that their child would be cared for appropriately. Parents who considered enrolling their child into care closer to when it was required generally chose to do this because they had selected a pre-determined age that their child would go into childcare. A small number of parents (two) decided that their child would not attend a centre until three years old, while other parents found employment and had to find care quickly in response. The survey results showed that the aspects of a centre that most influenced parental decision-making were the activities and teaching methods used by staff, centre reputation, play equipment inside and outside the centre, and the playground size and centre buildings. The interview responses added to this by suggesting that the type of playground facilities available were important, with a natural environment being preferred. Interestingly, the lowest aspect of importance reported was whether the child had friends or family already attending the centre. The results of the survey and interview data reflected the parents’ aspirations for their child and included the development of personal competencies of self-awareness, self-regulation, and motivation linking emotions to thoughts and actions (Gendron). The child’s experience in a centre was expected to develop and refine personal traits such as self-confidence, self-awareness, self-management, the ability to interact with others, and the involvement in educational activities to achieve learning goals. With these aspirations in mind, parents felt considerable pressure to choose the environment that would fit their child the best. During the interview stage of data collection, the term “taste” emerged. The term is commonly used in a food, fashion, or style context. In the education context, however, taste was conceptualised as the judgement of likes and dislikes regarding centre attributes. Gladwell writes that “snap judgements are, first of all, enormously quick: they rely on the thinnest slices of experience. But they are also unconscious” (50). The immediacy of determining one's taste refutes the neoliberal construction (Campbell, Proctor, Sherington) of the DMP as a rational decision-making process that systematically compares different options before making a decision. In the education context, taste can be reconceptualised as an alignment between a decision and inherent values and beliefs. A personal “backpack” of experiences, beliefs, values, ideas, and memories all play a part in forming a person’s taste related to their likes and dislikes. In turn, this effects the end decision made. Parents formulated an initial response to a centre linked to the identification of attributes that aligned with personal values, beliefs, expectations, and aspirations. The data analysis indicated that parents formulated their personal taste in centres very quickly after centres were visited. At that point, parents had a clear image of the preferred centre. Further information gathering was used to reinforce that view and confirm this “parental taste.” How Does Parental Taste about a Centre Influence the Decision-Making Process? All parents used a process of decision-making to some degree. As already stated, it was usually the mother who gathered information to inform the final decision, but in two of the 78 cases it was the father who investigated and decided on the childcare centre in which to enrol. All parents used some form of process to guide their decision-making. A heavily planned process sees the parent gather information over a period of time and included participating in centre tours, drive-by viewings, talking with others, web-based searches, and, checking locations in the phone book. Surprisingly, centre advertising was the least used and least effective method of attracting parents, with only one person indicating that advertising had played a part in her DMP. This approach applied to a woman who had just moved to a new town and was not aware of the care options. This method may also be a reflection of the personality of the parent or it may reflect an understanding that there are differences between services in terms of their focus on education and care. A lightly planned process occurred when a relatively swift decision was made with minimal information gathering. It could have been the selection of the closest and most convenient centre, or the one that parents had heard people talk about. These parents were happy to go to the centre and add their name to the waiting list or enrol straight away. Generally, the impression was that all services provide the same education and care. Parents appeared to use different criteria when considering a centre for their child. Aspects here included the physical environment, size of rooms, aesthetic appeal, clean buildings, tidy surrounds, and a homely feel. Other aspects that affected this parental taste included the location of the centre, the availability of places for the child, and the interest the staff showed in parent and child. The interviews revealed that parents placed an importance on emotions when they decided if a centre suited their tastes that in turn affected their DMP. The “vibe,” the atmosphere, and how the staff made the parents feel were the most important aspects of this process. The centre’s reputation was also central to decision making. What Constructs Underpin the Decision? Parental choice decisions can appear to be rational, but are usually emotionally connected to parental aspirations and values. In this way, parental choice and prior parental decision making processes reflect the bounded rationality described by Kahneman, and are based on factors relevant to the individual as supported by Ariely and Lindstrom. Ariely states that choice and the decision making process are emotionally driven and may be irrational-rational decisions. Gladwell supports this notion in that “the task of making sense of ourselves and our behaviour requires that we acknowledge there can be as much value in the blink of an eye as in months of rational analysis” (17). Reay’s research into social, cultural, emotional, and human capital to explain human behaviour was built upon to develop five constructs for decision making in this research. The R.O.P.E.S. constructs are domains that tie together to categorise the interaction of emotional connections that underpin the decision making process based on the parental taste in centres. The constructs emerged from the analysis of the data collected in the three phase approach. They were based on the responses from parents related to both their needs and their child’s needs in terms of having a valuable and happy experience at a centre. The R.O.P.E.S. constructs were key elements in the formation of parental taste in centres and eventual enrolment. The Reputational construct (R) included word of mouth, from friends, the cleaner, other staff from either the focus or another centre, and may or may not have aligned with parental taste and influenced the decision. Other constructs (O) included the location and convenience of the centre, and availability of spaces. Cost was not seen as an issue with the subsidies making each centre similar in fee structure. The Physical construct (P) included the facilities available such as the indoor and outdoor play space, whether these are natural or artificial environments, and the play equipment available. The Social construct (S) included social interactions—sharing, making friends, and building networks. It was found that the Emotional construct (E) was central to the process. It underpinned all the other constructs and was determined by the emotions that were elicited when the parent had the first and subsequent contact with the centre staff. This construct is pivotal in parental taste and decision making. Parents indicated that some centres did not have an abundance of resources but “the lady was really nice” (interview response) and the parent thought that her child would be cared for in that environment. Comments such as “the lady was really friendly and made us feel part of the place even though we were just looking around” (interview response) added to the emotional connection and construct for the DMP. The emotional connection with staff and the willingness of the director to take the time to show the parent the whole centre was a common comment from parents. Parents indicated that if they felt comfortable, and the atmosphere was warm and homelike, then they knew that their child would too. One centre particularly supported parental taste in a homely environment and had lounges, floor rugs, lamps for lighting, and aromatherapy oil burning that contributed to a home-like feel that appealed to parents and children. The professionalism of the staff who displayed an interest in the children, had interesting activities in their room, and were polite and courteous also added to the emotional construct. Staff speaking to the parent and child, rather than just the parent, was also valued. Interestingly, parents did not comment on the qualifications held by staff, indicating that parents assumed that to be employed staff must hold the required qualifications. Is There a Further Application of Taste in Decision Making? The third phase of data collection was related to additional questions being asked of the interviewee that required reflection of the DMP used when choosing a centre for their child to attend. Parents were asked to review the process and comment on any changes that they would make if they were in the same position again. The majority of parents said that they were content with their taste in centres and the subsequent decision made. A quarter of the parents indicated that they would make minor changes to their process. A common comment made was that the process used was indicative of the parent’s personality. A self confessed “worrier” enrolling her first child gathered a great deal of information and visited many centres to enable the most informed decision to be made. In contrast, a more relaxed parent enrolling a second or third child made a quicker decision after visiting or phoning one or two centres. Although parents considered their decision to be rationally considered, the impact of parental taste upon visiting the centre and speaking to staff was a strong indicator of the level of satisfaction. Taste was a precursor to the decision. When asked if the same process would be used if choosing a different service, such as an accountant, parents indicated that a similar process would be used, but perhaps not as in depth. The reasoning here was that parents were aware that the decision of selecting a centre would impact on their child and ultimately themselves in an emotional way. The parent indicated that if they spent time visiting centres and it appealed to their taste then the child would like it too. In turn this made the whole process of attending a centre less stressful and emotional. Parents clarified that not as much personal information gathering would occur if searching for an accountant. The focus would be centred on the accountant’s professional ability. Other instances were offered, such as purchasing a car, or selecting a house, dentist, or a babysitter. All parents suggested that additional information would be collected if their child of family would be directly impacted by the decision. Advertising of services or businesses through various multimedia approaches appeared not to rate highly when parents were in the process of decision making. Television, radio, print, Internet, and social networks were identified as possible modes of communication available for consideration by parents. The generational culture was evident in the responses from different parent age groups. The younger parents indicated that social media, Internet, and print may be used to ascertain the benefits of different services and to access information about the reputation of centres. In comparison, the older parents preferred word-of-mouth recommendations. Neither television nor radio was seen as media approaches that would attract clientele. Conclusion In the education context, the concept of parental taste can be seen to be an integral component to the decision making process. In this case, the attributes of an educational facility align to an individual’s personal “backpack” and form a like or a dislike, known as parental taste. The implications for the Directors of Early Childhood Education and Care Centres indicate that parental taste plays a role in a child’s enrolment into a centre. Parental taste is determined by the attributes of the centre that are aligned to the R.O.P.E.S. constructs with the emotional element as the key component. A less rigorous DMP is used when a generic service is required. Media and cultural ways of looking at our society interpret how important decisions are made. A general assumption is that major decisions are made in a calm, considered and rational manner. This is a neoliberal view and is not supported by the research presented in this article. References Ariely, Dan. Predictably Irrational: The Hidden Forces That Shape Our Decisions. London: Harper, 2009. Australian Children’s Education, Care and Quality Authority (ACECQA). n.d. 14 Jan. 2014. ‹http://www.acecqa.gov.au›. Campbell, Craig, Helen Proctor, and Geoffrey Sherington. School Choice: How Parents Negotiate The New School Market In Australia. Crows Nest, N.S.W.: Allen and Unwin, 2009. Cresswell, John,W. Research Design. Qualitative, Quantitative and Mixed Methods Approaches (2nd ed.). Los Angeles: Sage, 2003. Department of Education. 11 Oct. 2013. 14 Jan. 2014. ‹http://education.gov.au/national-quality-framework-early-childhood-education-and-care›. Department of Employment, Education and Workplace Relations (DEEWR). Education Reforms. Canberra, ACT: Australian Government Publishing Service, 2009. Gendron, Benedicte. “Why Emotional Capital Matters in Education and in Labour?: Toward an Optimal Exploitation of Human Capital and Knowledge Mangement.” Les Cahiers de la Maison des Sciences Economiques 113 (2004): 1–37. Glaswell, Malcolm. “Blink: The power of thinking without thinking.” Harmondsworth, UK: Penguin, 2005. Kahneman, Daniel. Thinking, Fast and Slow. New York: Farrar, Strauss & Giroux, 2011. Lindstrom, Martin. Buy-ology: How Everything We Believe About Why We Buy is Wrong. Great London: Random House Business Books, 2009. Melbourne Declaration on Educational Goals for Young Australians. 14 Jan. 2014. ‹http://www.mceecdya.edu.au/mceecdya/melbourne_declaration,25979.html›. National Quality Framework. 14 Jan. 2014. ‹http://www.acecqa.gov.au. Reay, Diane. A Useful Extension of Bourdieu’s Conceptual Framework?: Emotional Capital as a Way of Understanding Mothers’ Involvement in their Children’s Education? Oxford: Blackwell Publishers, 2000.

Introduction This paper offers a survey of familiar popular music performers and songwriters who reference coffee in their work. It examines three areas of discourse: the psychoactive effects of caffeine, coffee and courtship rituals, and the politics of coffee consumption. I claim that coffee carries a cultural and musicological significance comparable to that of the chemical stimulants and consumer goods more readily associated with popular music. Songs about coffee may not be as potent as those featuring drugs and alcohol (Primack; Schapiro), or as common as those referencing commodities like clothes and cars (Englis; McCracken), but they do feature across a wide range of genres, some of which enjoy archetypal associations with this beverage. m.o.m.m.y. Needs c.o.f.f.e.e.: The Psychoactive Effect of Coffee The act of performing and listening to popular music involves psychological elements comparable to the overwhelming sensory experience of drug taking: altered perceptions, repetitive grooves, improvisation, self-expression, and psychological empathy—such as that between musician and audience (Curry). Most popular music genres are, as a result, culturally and sociologically identified with the consumption of at least one mind-altering substance (Lyttle; Primack; Schapiro). While the analysis of lyrics referring to this theme has hitherto focused on illegal drugs and alcoholic beverages (Cooper), coffee and its psychoactive ingredient caffeine have been almost entirely overlooked (Summer). The most recent study of drugs in popular music, for example, defined substance use as “tobacco, alcohol, marijuana, cocaine and other stimulants, heroin and other opiates, hallucinogens, inhalants, prescription drugs, over-the-counter drugs, and nonspecific substances” (Primack 172), thereby ignoring a chemical stimulant consumed by 90 per cent of adult Americans every day (Lovett). The wide availability of coffee and the comparatively mild effect of caffeine means that its consumption rarely causes harm. One researcher has described it as a ubiquitous and unobtrusive “generalised public activity […] ‘invisible’ to analysts seeking distinctive social events” (Cooper 92). Coffee may provide only a relatively mild “buzz”—but it is now accepted that caffeine is an addictive substance (Juliano) and, due to its universal legality, coffee is also the world’s most extensively traded and enthusiastically consumed psychoactive consumer product (Juliano 1). The musical genre of jazz has a longstanding relationship with marijuana and narcotics (Curry; Singer; Tolson; Winick). Unsurprisingly, given its Round Midnight connotations, jazz standards also celebrate the restorative impact of coffee. Exemplary compositions include Burke/Webster’s insomniac torch song Black Coffee, which provided hits for Sarah Vaughan (1949), Ella Fitzgerald (1953), and Peggy Lee (1960); and Frank Sinatra’s recordings of Hilliard/Dick’s The Coffee Song (1946, 1960), which satirised the coffee surplus in Brazil at a time when this nation enjoyed a near monopoly on production. Sinatra joked that this ubiquitous drink was that country’s only means of liquid refreshment, in a refrain that has since become a headline writer’s phrasal template: “There’s an Awful Lot of Coffee in Vietnam,” “An Awful Lot of Coffee in the Bin,” and “There’s an Awful Lot of Taxes in Brazil.” Ethnographer Aaron Fox has shown how country music gives expression to the lived social experience of blue-collar and agrarian workers (Real 29). Coffee’s role in energising working class America (Cooper) is featured in such recordings as Dolly Parton’s Nine To Five (1980), which describes her morning routine using a memorable “kitchen/cup of ambition” rhyme, and Don't Forget the Coffee Billy Joe (1973) by Tom T. Hall which laments the hardship of unemployment, hunger, cold, and lack of healthcare. Country music’s “tired truck driver” is the most enduring blue-collar trope celebrating coffee’s analeptic powers. Versions include Truck Drivin' Man by Buck Owens (1964), host of the country TV show Hee Haw and pioneer of the Bakersfield sound, and Driving My Life Away from pop-country crossover star Eddie Rabbitt (1980). Both feature characteristically gendered stereotypes of male truck drivers pushing on through the night with the help of a truck stop waitress who has fuelled them with caffeine. Johnny Cash’s A Cup of Coffee (1966), recorded at the nadir of his addiction to pills and alcohol, has an incoherent improvised lyric on this subject; while Jerry Reed even prescribed amphetamines to keep drivers awake in Caffein [sic], Nicotine, Benzedrine (And Wish Me Luck) (1980). Doye O’Dell’s Diesel Smoke, Dangerous Curves (1952) is the archetypal “truck drivin’ country” song and the most exciting track of its type. It subsequently became a hit for the doyen of the subgenre, Red Simpson (1966). An exhausted driver, having spent the night with a woman whose name he cannot now recall, is fighting fatigue and wrestling his hot-rod low-loader around hairpin mountain curves in an attempt to rendezvous with a pretty truck stop waitress. The song’s palpable energy comes from its frenetic guitar picking and the danger implicit in trailing a heavy load downhill while falling asleep at the wheel. Tommy Faile’s Phantom 309, a hit for Red Sovine (1967) that was later covered by Tom Waits (Big Joe and the Phantom 309, 1975), elevates the “tired truck driver” narrative to gothic literary form. Reflecting country music’s moral code of citizenship and its culture of performative storytelling (Fox, Real 23), it tells of a drenched and exhausted young hitchhiker picked up by Big Joe—the driver of a handsome eighteen-wheeler. On arriving at a truck stop, Joe drops the traveller off, giving him money for a restorative coffee. The diner falls silent as the hitchhiker orders up his “cup of mud”. Big Joe, it transpires, is a phantom trucker. After running off the road to avoid a school bus, his distinctive ghost rig now only reappears to rescue stranded travellers. Punk rock, a genre closely associated with recreational amphetamines (McNeil 76, 87), also features a number of caffeine-as-stimulant songs. Californian punk band, Descendents, identified caffeine as their drug of choice in two 1996 releases, Coffee Mug and Kids on Coffee. These songs describe chugging the drink with much the same relish and energy that others might pull at the neck of a beer bottle, and vividly compare the effects of the drug to the intense rush of speed. The host of “New Music News” (a segment of MTV’s 120 Minutes) references this correlation in 1986 while introducing the band’s video—in which they literally bounce off the walls: “You know, while everybody is cracking down on crack, what about that most respectable of toxic substances or stimulants, the good old cup of coffee? That is the preferred high, actually, of California’s own Descendents—it is also the subject of their brand new video” (“New Music News”). Descendents’s Sessions EP (1997) featured an overflowing cup of coffee on the sleeve, while punk’s caffeine-as-amphetamine trope is also promulgated by Hellbender (Caffeinated 1996), Lagwagon (Mr. Coffee 1997), and Regatta 69 (Addicted to Coffee 2005). Coffee in the Morning and Kisses in the Night: Coffee and Courtship Coffee as romantic metaphor in song corroborates the findings of early researchers who examined courtship rituals in popular music. Donald Horton’s 1957 study found that hit songs codified the socially constructed self-image and limited life expectations of young people during the 1950s by depicting conservative, idealised, and traditional relationship scenarios. He summarised these as initial courtship, honeymoon period, uncertainty, and parting (570-4). Eleven years after this landmark analysis, James Carey replicated Horton’s method. His results revealed that pop lyrics had become more realistic and less bound by convention during the 1960s. They incorporated a wider variety of discourse including the temporariness of romantic commitment, the importance of individual autonomy in relationships, more liberal attitudes, and increasingly unconventional courtship behaviours (725). Socially conservative coffee songs include Coffee in the Morning and Kisses in the Night by The Boswell Sisters (1933) in which the protagonist swears fidelity to her partner on condition that this desire is expressed strictly in the appropriate social context of marriage. It encapsulates the restrictions Horton identified on courtship discourse in popular song prior to the arrival of rock and roll. The Henderson/DeSylva/Brown composition You're the Cream in My Coffee, recorded by Annette Hanshaw (1928) and by Nat King Cole (1946), also celebrates the social ideal of monogamous devotion. The persistence of such idealised traditional themes continued into the 1960s. American pop singer Don Cherry had a hit with Then You Can Tell Me Goodbye (1962) that used coffee as a metaphor for undying and everlasting love. Otis Redding’s version of Butler/Thomas/Walker’s Cigarettes and Coffee (1966)—arguably soul music’s exemplary romantic coffee song—carries a similar message as a couple proclaim their devotion in a late night conversation over coffee. Like much of the Stax catalogue, Cigarettes and Coffee, has a distinctly “down home” feel and timbre. The lovers are simply content with each other; they don’t need “cream” or “sugar.” Horton found 1950s blues and R&B lyrics much more sexually explicit than pop songs (567). Dawson (1994) subsequently characterised black popular music as a distinct public sphere, and Squires (2002) argued that it displayed elements of what she defined as “enclave” and “counterpublic” traits. Lawson (2010) has argued that marginalised and/or subversive blues artists offered a form of countercultural resistance against prevailing social norms. Indeed, several blues and R&B coffee songs disregard established courtship ideals and associate the product with non-normative and even transgressive relationship circumstances—including infidelity, divorce, and domestic violence. Lightnin’ Hopkins’s Coffee Blues (1950) references child neglect and spousal abuse, while the narrative of Muddy Waters’s scorching Iodine in my Coffee (1952) tells of an attempted poisoning by his Waters’s partner. In 40 Cups of Coffee (1953) Ella Mae Morse is waiting for her husband to return home, fuelling her anger and anxiety with caffeine. This song does eventually comply with traditional courtship ideals: when her lover eventually returns home at five in the morning, he is greeted with a relieved kiss. In Keep That Coffee Hot (1955), Scatman Crothers supplies a counterpoint to Morse’s late-night-abandonment narrative, asking his partner to keep his favourite drink warm during his adulterous absence. Brook Benton’s Another Cup of Coffee (1964) expresses acute feelings of regret and loneliness after a failed relationship. More obliquely, in Coffee Blues (1966) Mississippi John Hurt sings affectionately about his favourite brand, a “lovin’ spoonful” of Maxwell House. In this, he bequeathed the moniker of folk-rock band The Lovin’ Spoonful, whose hits included Do You Believe in Magic (1965) and Summer in the City (1966). However, an alternative reading of Hurt’s lyric suggests that this particular phrase is a metaphorical device proclaiming the author’s sexual potency. Hurt’s “lovin’ spoonful” may actually be a portion of his seminal emission. In the 1950s, Horton identified country as particularly “doleful” (570), and coffee provides a common metaphor for failed romance in a genre dominated by “metanarratives of loss and desire” (Fox, Jukebox 54). Claude Gray’s I'll Have Another Cup of Coffee (Then I’ll Go) (1961) tells of a protagonist delivering child support payments according to his divorce lawyer’s instructions. The couple share late night coffee as their children sleep through the conversation. This song was subsequently recorded by seventeen-year-old Bob Marley (One Cup of Coffee, 1962) under the pseudonym Bobby Martell, a decade prior to his breakthrough as an international reggae star. Marley’s youngest son Damian has also performed the track while, interestingly in the context of this discussion, his older sibling Rohan co-founded Marley Coffee, an organic farm in the Jamaican Blue Mountains. Following Carey’s demonstration of mainstream pop’s increasingly realistic depiction of courtship behaviours during the 1960s, songwriters continued to draw on coffee as a metaphor for failed romance. In Carly Simon’s You’re So Vain (1972), she dreams of clouds in her coffee while contemplating an ostentatious ex-lover. Squeeze’s Black Coffee In Bed (1982) uses a coffee stain metaphor to describe the end of what appears to be yet another dead-end relationship for the protagonist. Sarah Harmer’s Coffee Stain (1998) expands on this device by reworking the familiar “lipstick on your collar” trope, while Sexsmith & Kerr’s duet Raindrops in my Coffee (2005) superimposes teardrops in coffee and raindrops on the pavement with compelling effect. Kate Bush’s Coffee Homeground (1978) provides the most extreme narrative of relationship breakdown: the true story of Cora Henrietta Crippin’s poisoning. Researchers who replicated Horton’s and Carey’s methodology in the late 1970s (Bridges; Denisoff) were surprised to find their results dominated by traditional courtship ideals. The new liberal values unearthed by Carey in the late 1960s simply failed to materialise in subsequent decades. In this context, it is interesting to observe how romantic coffee songs in contemporary soul and jazz continue to disavow the post-1960s trend towards realistic social narratives, adopting instead a conspicuously consumerist outlook accompanied by smooth musical timbres. This phenomenon possibly betrays the influence of contemporary coffee advertising. From the 1980s, television commercials have sought to establish coffee as a desirable high end product, enjoyed by bohemian lovers in a conspicuously up-market environment (Werder). All Saints’s Black Coffee (2000) and Lebrado’s Coffee (2006) identify strongly with the culture industry’s image of coffee as a luxurious beverage whose consumption signifies prominent social status. All Saints’s promotional video is set in a opulent location (although its visuals emphasise the lyric’s romantic disharmony), while Natalie Cole’s Coffee Time (2008) might have been itself written as a commercial. Busting Up a Starbucks: The Politics of Coffee Politics and coffee meet most palpably at the coffee shop. This conjunction has a well-documented history beginning with the establishment of coffee houses in Europe and the birth of the public sphere (Habermas; Love; Pincus). The first popular songs to reference coffee shops include Jaybird Coleman’s Coffee Grinder Blues (1930), which boasts of skills that precede the contemporary notion of a barista by four decades; and Let's Have Another Cup of Coffee (1932) from Irving Berlin’s depression-era musical Face The Music, where the protagonists decide to stay in a restaurant drinking coffee and eating pie until the economy improves. Coffee in a Cardboard Cup (1971) from the Broadway musical 70 Girls 70 is an unambiguous condemnation of consumerism, however, it was written, recorded and produced a generation before Starbucks’ aggressive expansion and rapid dominance of the coffee house market during the 1990s. The growth of this company caused significant criticism and protest against what seemed to be a ruthless homogenising force that sought to overwhelm local competition (Holt; Thomson). In response, Starbucks has sought to be defined as a more responsive and interactive brand that encourages “glocalisation” (de Larios; Thompson). Koller, however, has characterised glocalisation as the manipulative fabrication of an “imagined community”—whose heterogeneity is in fact maintained by the aesthetics and purchasing choices of consumers who make distinctive and conscious anti-brand statements (114). Neat Capitalism is a more useful concept here, one that intercedes between corporate ideology and postmodern cultural logic, where such notions as community relations and customer satisfaction are deliberately and perhaps somewhat cynically conflated with the goal of profit maximisation (Rojek). As the world’s largest chain of coffee houses with over 19,400 stores in March 2012 (Loxcel), Starbucks is an exemplar of this phenomenon. Their apparent commitment to environmental stewardship, community relations, and ethical sourcing is outlined in the company’s annual “Global Responsibility Report” (Vimac). It is also demonstrated in their engagement with charitable and environmental non-governmental organisations such as Fairtrade and Co-operative for Assistance and Relief Everywhere (CARE). By emphasising this, Starbucks are able to interpellate (that is, “call forth”, “summon”, or “hail” in Althusserian terms) those consumers who value environmental protection, social justice and ethical business practices (Rojek 117). Bob Dylan and Sheryl Crow provide interesting case studies of the persuasive cultural influence evoked by Neat Capitalism. Dylan’s 1962 song Talkin’ New York satirised his formative experiences as an impoverished performer in Greenwich Village’s coffee houses. In 1995, however, his decision to distribute the Bob Dylan: Live At The Gaslight 1962 CD exclusively via Starbucks generated significant media controversy. Prominent commentators expressed their disapproval (Wilson Harris) and HMV Canada withdrew Dylan’s product from their shelves (Lynskey). Despite this, the success of this and other projects resulted in the launch of Starbucks’s in-house record company, Hear Music, which released entirely new recordings from major artists such as Ray Charles, Paul McCartney, Joni Mitchell, Carly Simon and Elvis Costello—although the company has recently announced a restructuring of their involvement in this venture (O’Neil). Sheryl Crow disparaged her former life as a waitress in Coffee Shop (1995), a song recorded for her second album. “Yes, I was a waitress. I was a waitress not so long ago; then I won a Grammy” she affirmed in a YouTube clip of a live performance from the same year. More recently, however, Crow has become an avowed self-proclaimed “Starbucks groupie” (Tickle), releasing an Artist’s Choice (2003) compilation album exclusively via Hear Music and performing at the company’s 2010 Annual Shareholders’s Meeting. Songs voicing more unequivocal dissatisfaction with Starbucks’s particular variant of Neat Capitalism include Busting Up a Starbucks (Mike Doughty, 2005), and Starbucks Takes All My Money (KJ-52, 2008). The most successful of these is undoubtedly Ron Sexsmith’s Jazz at the Bookstore (2006). Sexsmith bemoans the irony of intense original blues artists such as Leadbelly being drowned out by the cacophony of coffee grinding machines while customers queue up to purchase expensive coffees whose names they can’t pronounce. In this, he juxtaposes the progressive patina of corporate culture against the circumstances of African-American labour conditions in the deep South, the shocking incongruity of which eventually cause the old bluesman to turn in his grave. Fredric Jameson may have good reason to lament the depthless a-historical pastiche of postmodern popular culture, but this is no “nostalgia film”: Sexsmith articulates an artfully framed set of subtle, sensitive, and carefully contextualised observations. Songs about coffee also intersect with politics via lyrics that play on the mid-brown colour of the beverage, by employing it as a metaphor for the sociological meta-narratives of acculturation and assimilation. First popularised in Israel Zangwill’s 1905 stage play, The Melting Pot, this term is more commonly associated with Americanisation rather than miscegenation in the United States—a nuanced distinction that British band Blue Mink failed to grasp with their memorable invocation of “coffee-coloured people” in Melting Pot (1969). Re-titled in the US as People Are Together (Mickey Murray, 1970) the song was considered too extreme for mainstream radio airplay (Thompson). Ike and Tina Turner’s Black Coffee (1972) provided a more accomplished articulation of coffee as a signifier of racial identity; first by associating it with the history of slavery and the post-Civil Rights discourse of African-American autonomy, then by celebrating its role as an energising force for African-American workers seeking economic self-determination. Anyone familiar with the re-casting of black popular music in an industry dominated by Caucasian interests and aesthetics (Cashmore; Garofalo) will be unsurprised to find British super-group Humble Pie’s (1973) version of this song more recognisable. Conclusion Coffee-flavoured popular songs celebrate the stimulant effects of caffeine, provide metaphors for courtship rituals, and offer critiques of Neat Capitalism. Harold Love and Guthrie Ramsey have each argued (from different perspectives) that the cultural micro-narratives of small social groups allow us to identify important “ethnographic truths” (Ramsey 22). Aesthetically satisfying and intellectually stimulating coffee songs are found where these micro-narratives intersect with the ethnographic truths of coffee culture. 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