Effect of Weighted Blanket Versus Traditional Practices on Anxiety and Pain in Patients Undergoing Elective Surgery: A Multicenter Randomized Controlled Trial.

Perioperative anxiety is common in surgical patients and linked to poor outcomes. This multicenter randomized controlled trial assessed the effect of the use of a warm weighted blanket on presurgical anxiety and pain, as well as postsurgical restlessness, nausea, and vomiting. Levels of anxiety and pain were measured in adult patients using a 100-point visual analog scale before elective surgery. Patients received either a warm weighted blanket (n = 74) or a traditional sheet or nonweighted blanket (n = 74). Patients in the intervention group had significantly lower preoperative anxiety scores (mean [SD] = 26.28 [25.75]) compared to the control group (mean [SD] = 38.73 [30.55], P = .008). However, the intervention had no significant effect on presurgical pain or postsurgical nausea, vomiting, or restlessness. These results suggest that weighted blankets reduce preoperative anxiety in adult patients.

Comparative evaluation of the sleep quality metrics between a cardboard bed and a camp cot: a randomized controlled crossover study.

Background: Health-beneficial emergency bedding has become increasingly important for dealing with natural disasters such as the anticipated Nankai Trough earthquake in Japan. When the Great East Japan Earthquake occurred, cardboard beds were provided to evacuees. However, there were concerns about lower back pain and sleep disturbances, as cardboard beds offer insufficient pressure distribution. This study aimed to compare the effects of cardboard beds with those of foldable camp cots on sleep quality. Methods: A randomized controlled crossover study involving 20 healthy participants aged 18-45 years was conducted between June 2022 and January 2023. Participants were asked to sleep for one night on a camp cot and for another night on a cardboard bed, with a minimum three-day washout period between the two nights. Body pressure distribution and sleep metrics obtained from polysomnography (PSG) and questionnaires were compared between the two-bed types (P < 0.05). Results: The camp cot exhibited better body pressure distribution than a cardboard bed, leading to improved sleep satisfaction, bedding comfort, and reduced morning sleepiness. Nevertheless, polysomnography revealed no notable differences in sleep metrics or sleep architecture between the two types of beds. Conclusions: Our findings indicate that cardboard beds have lower pressure dispersion capabilities than camp cots, leading to an increased number of position changes during sleep. Additionally, subjective sleep quality, such as alertness on waking, sleep comfort, and sleep satisfaction, was lower for cardboard beds, suggesting that camp cots might offer a more comfortable bedding option for evacuees. However, there were no discernible differences between the two-bed types in terms of objective sleep metrics derived from PSG. The potential for sleep disturbances caused by lower back pain from a hard mattress has been noted, and it is possible that a single night's experience in healthy individuals might not be enough for sleep issues to manifest.

Access to bedding and outdoor runs for growing-finishing pigs: is it possible to improve welfare without increasing environmental impacts?

Providing bedding or access to an outdoor run are husbandry aspects intended to improve pig welfare, which is currently financially supported through animal welfare schemes in several European countries. However, they may significantly affect the environment through changes in feed efficiency and manure management. Therefore, the aim of this paper was to compare farms differing in animal welfare relevant husbandry aspects regarding (1) the welfare of growing-finishing pigs and (2) environmental impact categories such as global warming (GW), acidification (AC), and freshwater (FE) and marine eutrophication (ME), by employing an attributional Life Cycle Assessment. We collected data on 50 farms with growing-finishing pigs in seven European countries. Ten animal-based welfare indicators were aggregated into three pig welfare indices using principal component analysis. Cluster analysis of farms based on husbandry aspects resulted in three clusters: NOBED (31 farms without bedding or outdoor run), BED (11 farms with bedding only) and BEDOUT (eight farms with bedding and outdoor run). Pigs on farms with bedding (BED and BEDOUT) manipulated enrichment more often (P < 0.001), pen fixtures less frequently (P = 0.003) and showed fewer oral stereotypies (P < 0.001) than pigs on NOBED farms. There were fewer pigs with a short(er) tail on farms with than without bedding (P < 0.001). Acidification of BEDOUT and BED farms was significantly higher (compared to NOBED farms P = 0.002) due to higher ammonia emissions related to farmyard manure. Also, BEDOUT farms had higher ME than NOBED farms (P = 0.035). There were no significant differences regarding GW and FE between husbandry clusters, due to the large variability within clusters regarding feed composition and conversion. Therefore, both husbandry aspects associated with improved animal welfare have a significant influence on some environmental impacts, such as acidification and marine eutrophication. Nevertheless, the large variation within clusters suggests that trade-offs may be minimised through e.g. AC and ME.

The cost of keeping warm: a relationship between a rise in the cost of domestic energy and burn injuries caused by personal heating equipment.

INTRODUCTION: During 2022-2023, the UK found itself in the midst of a domestic energy crisis, with the average domestic gas and electricity bill rising by 75% between 2019 and 2022. As a result, the use of hot water bottles, radiant heaters, and electric blankets increased. An unintended consequence of this may be an increase in burn injuries caused by misfortune, misuse, or the use of items in a state of disrepair. PURPOSE: The aim of this study was to explore any increase in referrals to a single burns centre in England for injuries caused by hot water bottles, radiant heaters, or electric blankets. METHODS: This was a retrospective study of a prospectively maintained database of referrals. All referrals between January 2022 and January 2023 were selected and compared with the same period from 2020-2021 (before the rise in energy prices). Referrals were screened for the terms "hot water bottle," "electric heater," "electric blanket," and "heater." Total referrals in each period, demographic data (age, gender), anatomical location and the mechanism of injury were compared between cohorts. RESULTS: We found a statistically significant increase in the number of burns relating to heating implements between 2020/21 and 2022/23, rising from 54 to 81 (p = 0.03) - a 50% increase in injuries. Injuries in working age adults increased significantly (52% to 69%, p < 0.05). The most frequently injured area was the leg (30%) followed by the hand (18%). The commonest type of injury described was scald (72%). We found a moderately-strong correlation between the number of referrals and the average cost of energy in 2022-23. CONCLUSION: The number of injuries sustained by people using personal heating equipment is significantly increasing, which correlated with the rise in domestic energy prices. The most affected demographic appears to be working age adults, with wider implications around lost work-time yet to be explored. Further prospective, population-based work is indicated to assess the strength of the correlation seen in this study.

Giant honeybees (Apis dorsata) trade off defensiveness against periodic mass flight activity.

The giant honeybee Apis dorsata (Fabricius, 1793) is an evolutionarily ancient species that builds its nests in the open. The nest consists of a single honeycomb covered with the bee curtain which are several layers of worker bees that remain almost motionless with their heads up and abdomens down on the nest surface, except for the mouth area, the hub between inner- and outer-nest activities. A colony may change this semi-quiescence several times a day, depending on its reproductive state and ambient temperature, to enter the state of mass flight activity (MFA), in which nest organisation is restructured and defense ability is likely to be suppressed (predicted by the mass-flight-suspend-defensiveness hypothesis). For this study, three episode of MFA (mfa1-3) of a selected experimental nest were analysed in a case study with sequences of >60 000 images at 50 Hz, each comprise a short pre-MFA session, the MFA and the post-MFA phase of further 10 min. To test colony defensiveness under normative conditions, a dummy wasp was cyclically presented with a standardised motion programme (Pd) with intervening sessions without such a presentation (nPd). Motion activity at five selected surveillance zones (sz1-5) on the nest were analysed. In contrast to mfa1,2, in mfa3 the experimental regime started with the cyclic presentation of the dummy wasp only after the MFA had subsided. As a result, the MFA intensity in mfa3 was significantly lower than in mfa1-2, suggesting that a colony is able to perceive external threats during the MFA. Characteristic ripples appear in the motion profiles, which can be interpreted as a start signal for the transition to MFA. Because they are strongest in the mouth zone and shift to higher frequencies on their way to the nest periphery, it can be concluded that MFA starts earlier in the mouth zone than in the peripheral zones, also suggesting that the mouth zone is a control centre for the scheduling of MFA. In Pd phases of pre- and postMFA, the histogram-based motion spectra are biphasic, suggesting two cohorts in the process, one remaining at quiescence and the other involved in shimmering. Under MFA, nPd and Pd spectra were typically Gaussian, suggesting that the nest mates with a uniform workload shifted to higher motion activity. At the end of the MFA, the spectra shift back to the lower motion activities and the Pd spectra form a biphasic again. This happens a few minutes earlier in the peripheral zones than in the mouth zone. Using time profiles of the skewness of the Pd motion spectra, the mass-flight-suspend-defensiveness hypothesis is confirmed, whereby the inhibition of defense ability was found to increase progressively during the MFA. These sawtooth-like time profiles of skewness during MFA show that defense capability is recovered again quite quickly at the end of MFA. Finally, with the help of the Pd motion spectra, clear indications can be obtained that the giant honeybees engage in a decision in the sense of a tradeoff between MFA and collective defensiveness, especially in the regions in the periphery to the mouth zone.

Conditioner application improves bedding quality and bacterial composition with potential beneficial impacts for dairy cow's health.

Recycled manure solids (RMS) is used as bedding material in cow housing but can be at risk for pathogens development. Cows spend several hours per day lying down, contributing to the transfer of potential mastitis pathogens from the bedding to the udder. The effect of a bacterial conditioner (Manure Pro, MP) application was studied on RMS-bedding and milk qualities and on animal health. MP product was applied on bedding once a week for 3 months. Bedding and teat skin samples were collected from Control and MP groups at D01, D51, and D90 and analyzed through 16S rRNA amplicon sequencing. MP application modified bacterial profiles and diversity. Control bedding was significantly associated with potential mastitis pathogens, while no taxa of potential health risk were significantly detected in MP beddings. Functional prediction identified enrichment of metabolic pathways of agronomic interest in MP beddings. Significant associations with potential mastitis pathogens were mainly observed in Control teat skin samples. Finally, significantly better hygiene and lower Somatic Cell Counts in milk were observed for cows from MP group, while no group impact was observed on milk quality and microbiota. No dissemination of MP strains was observed from bedding to teats or milk. IMPORTANCE: The use of Manure Pro (MP) conditioner improved recycled manure solids-bedding quality and this higher sanitary condition had further impacts on dairy cows' health with less potential mastitis pathogens significantly associated with bedding and teat skin samples of animals from MP group. The animals also presented an improved inflammation status, while milk quality was not modified. The use of MP conditioner on bedding may be of interest in controlling the risk of mastitis onset for dairy cows and further associated costs.

Evaluating the Effectiveness of an Alternating Pressure Overlay in Patients Undergoing Cardiothoracic Surgery.

LOCAL PROBLEM: In 2019 and the first half of 2020, our facility experienced an increase in the number and severity of hospital-acquired pressure injuries (HAPIs) among our cardiothoracic surgery population. Fifty percent of these HAPIs occurred within 72 hours of surgery. A review of the literature revealed that alternating pressure overlays (APOs) have been successfully used to prevent HAPIs in surgical patients. PURPOSE: The primary purpose of our quality improvement (QI) project was to measure perioperative HAPI rates in cardiothoracic surgery patients after the addition of APOs to our HAPI prevention protocol. Our secondary purpose was to identify common factors among those patients who developed HAPIs. METHODS: This QI project collected both pre- and postintervention data and compared the findings. A nurse-led team was responsible for measuring HAPI rates during the intervention-from July through October 2020-which involved placing an APO under cardiothoracic surgery patients during the 72-hour perioperative period. APOs were placed on all operating room (OR) tables and remained with the patients following surgery. Bed linens and skin care products were standardized for consistency. Lifts were used to reduce friction during repositioning. RESULTS: During preintervention data collection, we identified 10 patients who developed HAPIs (seven out of 1,174 cardiothoracic surgery patients in 2019, for a HAPI rate of 0.6%, and three out of 333 patients in the first half of 2020, for a HAPI rate of 0.9%). During the four-month intervention period, in which APOs were used in 331 patients undergoing cardiothoracic surgery, no HAPIs developed. CONCLUSION: Use of an APO in cardiothoracic ORs and critical care units may help reduce HAPI rates.

Assessing the cost efficiency and benefits of sawdust, pinewood, and rubber wood shavings as bedding materials.

This study aimed to evaluate the benefits of using sawdust, pinewood shavings, and rubber wood shavings as horse bedding materials. Nine horses were used in a repeated measure design, where each horse was provided with each of the bedding materials for two consecutive weeks. The weight, cost, mucking out time, ammonia emissions, and urine holding capacity were measured and calculated for each bedding material. Results showed that pinewood shavings had the highest urine-holding capacity, while rubber wood shavings had the lowest absorbency for urine. Pinewood shavings also had lower ammonia emissions compared to sawdust and rubber wood shavings but were significantly more expensive. Sawdust was the cheapest of the three bedding materials, but it was used in greater quantities, which required more time for mucking out. The findings from this study could be used to make informed decisions on bedding materials for stables, taking into consideration the trade-off between cost, maintenance requirements, and labor hours.

Exploring herd-level perinatal calf mortality risk factors in eastern Canadian dairy farms.

This closed cohort study aimed to identify the associations between dairy calf management practices and herd-level perinatal calf mortality risk. From February 2020 to June 2021, predominantly Holstein dairy farms in Québec (n = 1,832) and New Brunswick (n = 52), Canada, that were registered in the dairy herd improvement program were visited once. A questionnaire covering all aspects of precalving, calving, and colostrum management was administered. Data regarding perinatal mortality were retrieved from the dairy herd improvement program database for each farm for 2021. Perinatal mortality was calculated for each farm as the proportion of calves dead at birth or dying within 24 h after birth. A multivariable negative binomial model was used to assess herd-level factors associated with the risk of perinatal mortality. The final model included the lying surface in the calving area, the typical time to first colostrum intake, typical cow-calf contact time, the proportion of males born, the proportion of assisted calvings, and herd size. Herd-level perinatal mortality risk ranged from 0% to 38.1% (mean ± SE = 7.6% ± 0.1%). A greater proportion of males born, a higher proportion of assisted calvings, and delayed colostrum feeding were associated with increased herd-level perinatal mortality. Factors associated with a decreased herd-level perinatal mortality risk were having a typical cow-calf contact time between 7 and 12 h after calving compared with reduced cow-calf contact time, soft lying surfaces in the calving area compared with concrete and mat-lying surfaces, and an increased number of calvings per year. Our results show that although some of the significant risk factors are not well understood (i.e., calving area lying surface, typical cow-calf contact time), Canadian farmers could focus on the factors under their control (i.e., time to first colostrum feeding, proportion of difficult calvings, males born, and calvings per year) to reduce the risk of perinatal mortality. Future work should focus on qualitative research to understand the dairy farmer motivations and limitations to implementing practices identified in this and other studies to reduce perinatal mortality.

Effects of Heated Infiltration Solutions and Forced-Air Heating Blankets on Intraoperative Hypothermia During Liposuction: A Factorial Randomized Controlled Trial.

BACKGROUND: This study was conducted to compare the effects of heat preservation by two recommended methods, heated infiltration solutions and forced-air heating blankets, in patients undergoing liposuction under general anesthesia. METHODS: Forty patients were divided into four groups based on whether heated infiltration solutions or forced-air heating blankets were used. Group A received general anesthesia liposuction plastic surgery routine temperature care. Based on the care measures of group A, heated infiltration solutions were used in group B; forced-air heating blanket was used in group C; and heated infiltration solutions and forced-air heating blankets were both used in group D. The primary end point was intraoperative and perioperative temperature measured with an infrared tympanic membrane thermometer. Secondary end points included surgical outcomes, subjective experience, and adverse events. RESULTS: Compared with group A, the intraoperative body temperatures of groups B, C, and D were significantly higher, indicating that the two intervention methods were helpful on increasing the core body temperature. Pairwise comparisons of these three groups showed that there was no significant difference between group C and group D. However, using forced-air heating blankets had a marked effect compared with using heated infiltration solutions alone at three time points. The same trend could be seen in other surgical outcomes. CONCLUSIONS: Heated infiltration solutions and forced-air heating blankets could reduce the incidence of intraoperative hypothermia and improve patients' prognosis after liposuction under general anesthesia. Compared with the heated infiltration fluid, the forced-air heating blanket may have a better thermal insulation effect. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Ability of unsterilized recycled manure solids bedding to support growth of Klebsiella pneumoniae and Escherichia coli.

Although recycled manure solids (RMS) bedding is used on dairy farms, it could allow bacterial growth when contaminated by feces and thus increase the incidence of clinical mastitis in cows. The objective of this study was to describe bacterial growth in three different types of RMS bedding, as well as in sand, when samples were experimentally inoculated with Escherichia coli and Klebsiella pneumoniae. Two 3-day trials were conducted, during which treatments included inoculating bedding samples with E. coli and K. pneumoniae, as well as no inoculation. The trial was repeated 3 times for each bedding sample on each day. Samples were incubated at 15°C for 3 d and bacterial counts were measured every day. After inoculation, there was no significant K. pneumoniae or E. coli growth phase during the trial in those RMS samples that were prepared either in a container or in a heap. Recycled manure solids and sand samples prepared in a rotary drum, however, showed a similar active growth phase of K. pneumoniae during the first 24 h of the trial. Moreover, a significant E. coli growth phase was observed in the samples of sand bedding in the first 24 h. The 3 different types of RMS bedding samples did not react in a similar manner to coliform inoculation. No active growth phase was observed in bedding samples already containing a high bacterial concentration following inoculation with coliforms.

Bien que la litière de fumier recyclé (LFR) soit utilisée dans les fermes laitières, elle pourrait permettre la croissance bactérienne lorsqu'elle est contaminée par des matières fécales et augmenter ainsi l'incidence de mammite clinique chez les vaches. L'objectif de cette étude était de décrire la croissance bactérienne dans trois types de LFR, ainsi que dans du sable, lorsque des échantillons étaient inoculés expérimentalement avec Escherichia coli et Klebsiella pneumoniae. Deux essais de trois jours ont été réalisés, au cours desquels les échantillons de litière ont été inoculés ou non avec E. coli et K. pneumoniae. L'essai a été répété trois fois pour chaque échantillon de litière, chaque jour. Les échantillons ont été incubés à 15 °C pendant 3 jours et la numération bactérienne a été mesurée chaque jour. Après inoculation, il n'y a pas eu de phase de croissance significative de K. pneumoniae ou d'E. coli au cours de l'essai dans les échantillons de LFR préparés dans un conteneur ou en tas. Les échantillons de sable et de LFR préparés dans un tambour rotatif ont cependant montré une phase de croissance active similaire de K. pneumoniae pendant les premières 24 heures de l'essai. En outre, une phase de croissance significative d'E. coli a été observée dans les échantillons de litière de sable au cours des premières 24 h. Les trois différents types d'échantillons de LFR n'ont pas réagi de la même manière à l'inoculation de coliformes. Aucune phase de croissance active n'a été observée dans les échantillons de litière contenant déjà une concentration bactérienne élevée après l'inoculation de coliformes.(Traduit par Docteur Simon Dufour).

Lipid species profiling of bronchoalveolar lavage fluid cells of horses housed on two different bedding materials.

The lipidome of equine BALF cells has not been described. The objectives of this prospective repeated-measures study were to explore the BALF cells' lipidome in horses and to identify lipids associated with progression or resolution of airway inflammation. BALF cells from 22 horses exposed to two bedding materials (Peat 1-Wood shavings [WS]-Peat 2) were studied by liquid chromatography-tandem mass spectrometry (LC-MS/MS). The effects of bedding on lipid class and species compositions were tested with rmANOVA. Correlations between lipids and cell counts were examined. The BALF cells' lipidome showed bedding-related differences for molar percentage (mol%) of 60 species. Whole phosphatidylcholine (PC) class and its species PC 32:0 (main molecular species 16:0_16:0) had higher mol% after Peat 2 compared with WS. Phosphatidylinositol 38:4 (main molecular species 18:0_20:4) was higher after WS compared with both peat periods. BALF cell count correlated positively with mol% of the lipid classes phosphatidylserine, sphingomyelin, ceramide, hexosylceramide, and triacylglycerol but negatively with PC. BALF cell count correlated positively with phosphatidylinositol 38:4 mol%. In conclusion, equine BALF cells' lipid profiles explored with MS-based lipidomics indicated subclinical inflammatory changes after WS. Inflammatory reactions in the cellular lipid species composition were detected although cytological responses indicating inflammation were weak.

Is bedding material a more effective thermal insulator than trap cover for small mammal trapping? A field experiment.

Live trapping is a key technique for conducting ecological studies on small mammals. All-metal live traps are popular in monitoring schemes owing to their tested performance, lightweight design (aluminium) and foldability. However, capture represents a stressful situation for small mammals, particularly during cold seasons, when individuals are susceptible to cold weather starvation resulting from low temperature and insufficient food to maintain body temperature. Metal live traps provide limited protection against cold temperatures, and it is often recommended to use covers to buffer external temperature fluctuations and prevent entry of moisture. Here, we compared the insulative performance of a PVC cover designed for Sherman traps and of bedding material, using data loggers to record temperature and humidity inside traps. We conducted different experiments simulating field conditions (traps at night with a heat source inside) and different treatments (cover, bedding material) to test the thermal insulation capacity of three models of widely used commercial traps: Longworth, Sherman, and Heslinga. Our findings indicated that Longworth and Sherman traps were better insulated against ambient air temperature fluctuations than Heslinga traps (+2.0 °C warmer on average). Bedding material was paramount in reducing relative humidity and increasing thermal insulation capacity of traps (+3.1 °C), an effect that was strengthened when a PVC cover was additionally used (+4.2 °C). The covered traps prevented the direct entrance of rain and dew (reducing damp bedding), provided camouflage (reducing thefts), and improved thermal and humidity conditions of traps (potentially increasing survival of captive small mammals). Our results suggest that using covers and bedding materials can improve thermal and humidity conditions within live traps, thus reducing the metabolic costs of thermoregulation and increasing survival chances for trapped small mammals during cold seasons.

Development of a perioperative thermal insulation system: Testing comfort properties for different textile sets.

The poorly physical and psychological conditions of the patients make the body thermal protection crucial in the perioperative context, due to the risk of hypothermia. The lack of evidence regarding the effectiveness of textile coverings in protecting patients in the operating room, underscores the recommendation of the forced warming system using non-woven fabric for ensuring the best thermal protection in the perioperative context. This study is part of a development process of a three-layered thermal insulation system, a blanket for use in the perioperative context. After previous selection of two fabrics for the mid and outer layers, in this study three fabric samples for the inner layer with same soft tactile sensation and different textile compositions were tested to find its effect on increasing the thermal insulation of the whole set, using a thermal manikin. The serial method was used to calculate the thermal insulation properties of the sets. The best thermal insulation and thermal comfort performance was obtained by the set using an inner layer composed of polypropylene, polyamide, and elastane whose results were the highest thermal conductivity and thickness and the lowest maximum stationary heat flow density. The results indicated that this fabric influenced positively the values of the whole set once increased its thermal protection effectiveness when compared to the other tested sets. This set is more suitable for future testing in patients during their stay in the perioperative setting.

Assessing Methods for Replacement of Soiled Bedding Sentinels in Cage-level Exhaust IVC Racks.

Soiled bedding sentinel programs have long been the cornerstone of rodent health monitoring surveillance. Many recent studies have evaluated methods to replace live animals in these programs; however, the type of ventilated rack being used greatly influences the detection rate of adventitious pathogens. This study evaluated 4 alternative sampling techniques across 5 distinct vivaria and assessed their accuracy in detecting 5 pathogens. Testing was done in an operational (real-world) setting using IVC racks that vent air at the cage level. The 5 agents surveyed were mouse norovirus, Helicobacter spp., Rodentibacter spp. Entamoeba muris, and Spironucleus muris. Samples were collected for subsequent PCR assays as follows: 1) cages with live sentinels exposed to soiled bedding; 2) filter paper placed on the lid of an unoccupied cage containing soiled bedding; 3) filter paper placed in the bedding of an unoccupied cage that contained soiled bedding; 4) swabs from an unoccupied sentinel cage that contained soiled bedding; and 5) pooled swabs from colony cages admixed with swabs from soiled bedding sentinel mice. Cumulative accuracy for all pathogens of interest was highest with the existing soiled bedding sentinel program, followed by pooled swabs of colony cages mixed with swabs from occupied soiled bedding sentinel cages. Soiled bedding sentinel cages detected mouse norovirus, Helicobacter spp., and S. muris with the highest accuracy; the pooled swabs were best in detecting Rodentibacter spp. and E. muris. The findings suggest that with the type of rack and caging used in our facilities, the soiled bedding sentinel method has highest concurrence with the expected health status of an animal room, and the results from this method can be enhanced with the addition of pooled swabs of colony animals.

What is 'agency' in torture and trauma recovery? An inquiry into the properties and explanations of the concept of agency and it's impacts.

This paper presents learnings from trauma recovery mechanisms and social movements from around the world relating to a survivor's role and as such- their agency. It unpacks various conceptual frameworks as possible alternative, effective and strategic pathways in torture rehabilitation. Ongoing and new challenges such as resourcing, cultural adaptability limitations, lack of access to services and inhumane foreign policies pose barriers to established systems that render some practices inadequate in terms of meaningful service delivery or social impact for torture survivors (Wheildon et al., 2022, p. 1689). It is well documented that "Torture aims to dehumanise survivors through calculated acts of cruelty to remove the survivors' dignity and make them powerless." (Luci and Di Rado, 2020, p. 3). As such this paper deliberately straddles multiple thematic fields, all grappling with relatable notions of restoring power or agency to survivors. At the risk of discursiveness into fields beyond torture rehabilitation then, this paper aims to showcase and learn from other successful movements. It also invites you as the reader into this discourse of inquiry and self-reflection, in order to counter the ten- dency of assuming a prescriptive, blanket (or blank) meaning of survivor engagement activities. Its findings suggest the manifestation of bespoke programming according to context and survivors' needs. It does not suggest a systematic overhaul, but rather a shift of incremental and cumulative changes that are recognised as advantageous. This paper deep dives into theories on agency, looking firstly at the broader archetypes that provide commonality and structure before then exploring particularities from different contexts. Implications for practice are then discussed, with nuances drawn out from the findings.