Providing an e-cigarette starter kit for smoking cessation and reduction as adjunct to usual care to smokers with a mental health condition: findings from the ESCAPE feasibility study

Background: Smoking rates in the UK have declined steadily over the past decades, masking considerable inequalities, as little change has been observed among people with a mental health condition. This trial sought to assess the feasibility and acceptability of supplying an electronic cigarette (e-cigarette) starter kit for smoking cessation as an adjunct to usual care for smoking cessation, to smokers with a mental health condition treated in the community, to inform a future effectiveness trial. Methods: This randomised controlled feasibility trial, conducted March-December 2022, compared the intervention (e-cigarette starter kit with a corresponding information leaflet and demonstration with Very Brief Advice) with a ‘usual care’ control at 1-month follow-up. Participants were ≥ 18 years, receiving treatment for any mental health condition in primary or secondary care in three Mental Health Trusts in Yorkshire and one in London, UK. They were also willing to address their smoking through either cessation or reduction of cigarette consumption. The agreed primary outcome measure was feasibility (consent ~ 15% of eligible participants; attrition rate < 30%). Acceptability, validated sustained abstinence and ≥ 50% cigarette consumption reduction at 1-month, were also evaluated and qualitative interviews conducted to further explore acceptability in this population. Results: Feasibility targets were partially met; of 201 eligible participants, 43 (mean age = 45.2, SD = 12.7; 39.5% female) were recruited (21.4%) and randomised (intervention:48.8%, n = 21; control:51.2%, n = 22). Attrition rate was 37.2% at 1-month follow-up and was higher (45.5%) in the control group. At follow-up (n = 27), 93.3% (n = 14) in the intervention group and 25.0% (n = 3) in the control group reported e-cigarette use. The intervention was well received with minimal negative effects. In intention-to-treat analysis, validated sustained abstinence at 1-month was 2/21 (9.5%) and 0/22 (0%) and at least 50% reduction in cigarette consumption 13/21 (61.9%) and 3/22 (13.6%), for the intervention and control group, respectively. Qualitative analysis of participant interviews (N = 5) showed the intervention was broadly acceptable, but they also highlighted areas of improvements for the intervention and trial delivery. Conclusions: Offering an e-cigarette starter kit to smokers with a mental health condition treated in the community was acceptable and largely feasible, with harm reduction outcomes (i.e. switching from cigarette smoking to e-cigarette use and substantial reduction in cigarette consumption) favouring the intervention. The findings of the study will be used to help inform the design of a main trial. Trial Registration: Registry: ISRCTN. Registration number: ISRCTN17691451. Date of registration: 30/09/202

The culture of 'One belt, One road': a critical review of China's enterprise internationalisation - through the lens of Resource-Based View Theory

China's announcement of “One belt, One road” initiative has encouraged Chinese enterprises to actively engage in international trade. The OBOR strategy was aimed at alleviating its overcapacity of production to further stimulate its economic growth and to reassure the global market that their food products were ‘fit for purpose’ from historic food safety breaches. Utilising the ‘Resourced-based view’ theory, this paper critically explores how Chinese dairy producers have responded to their government’s initiatives to further stimulate the Chinese economy. A qualitative approach was adopted, via 28 business executives and senior management within the dairy sector and governmental organisations. The research identified core barriers in terms of resource capacity, internationally recognised food safety management systems and cultural engagement for corporate international expansion. This paper aims to provide feasible strategic analysis and recommendations for the international expansion of Chinese dairy companies, based on the resource-based view theory and current government policies

Developing an AI algorithm to detect predictors of poor performance in a self‐administered, web‐based digital biomarker for Alzheimer’s Disease: proof of concept

Background: The Visual Short Term Memory Binding (VSTMBT) task is a gold‐standard cognitive assessment for the identification of Alzheimer's Disease and associated risk factors, including during the preclinical stage. Previous work from our group (Butler, Watermeyer, …& Parra 2024) demonstrated in a small number (n=37) of healthy older adults that data collected using a web‐based, self‐administrated version of the task provides data comparable to that collected in laboratory conditions. Here we incorporated a machine learning (ML) approach to explore impacts of risk factors on this task in a larger digital dataset. Method: Using data (n=359) collected from an online study incorporating the VSTMBT and lifestyle, psychological, and health data, we created a Binding Cost score which has shown to approximate AD‐related neuropathology (Parra et al., 2024). This categorised participants as either strong‐binders (SB – indicative of no pathology; 85.9% percent of the sample) or weak‐binders (WB – indicative of pathology; 14.1%). We trained three ML algorithms (Random Forest (RF), K‐Nearest Neighbour (KNN) and Decision Tree (DT) by employing SMOTE technique to overcome the imbalance in group distribution. We applied a 10‐fold cross‐validation with hyper‐parameter tuning to optimise the models based on the selected variables (including age, sex, education, BMI, loneliness, and existing‐morbidities) to predict individual’s risk of cognitive impairment based on the groupings (SB vs WB). Models’ performances were examined on 20% of unseen test set. Result: Aside from existing morbidities, which were higher in weak binders (WB = 0.41 (sd+2=0.79); SB =0.22(sd+2=0.49); t=2.21; p=0.03), other measures did not differ between groups. Regarding performance of the ML models, RF achieved the best performance (accuracy: 91%; recall=91%; precision=91%; AUC=97%) compared to KNN (accuracy: 81%; recall=81%; precision=84%; AUC=91%) and DT (accuracy: 81%; recall=81%; precision=82%; AUC= 85%). Feature importance analysis of the RF model suggests mental health, BMI, and fatigue have the highest impact on the prediction model, while sex and multi‐morbidity score have the least impact. Conclusion: The study underscores the potential of web‐based cognitive assessments and ML for remote monitoring and early identification of AD risk factors, contributing to the advancement of accessible tools for early detection

A-407 Harnessing machine learning to the immuohistochemical expression of AMBRA1 and Loricin to identify non-ulcerated AJCC Stage I/II melanomas at high-risk of metastasis

Background: Precision-based personalised biomarkers able to identify both low-risk and high-risk patient subpopulations with localised cutaneous melanoma are urgently needed to guide clinical follow up and treatment stratification. We recently validated the combined immunohistochemical expression of AMBRA1 and Loricrin (AMBLor) in the epidermis overlying non-ulcerated AJCC stage I/II melanomas as prognostic biomarker able to accurately identify genuinely low-risk patient subpopulations (NPV >96%, clinical sensitivity >95%, Ewen et al Brit J Dermatol. 2024). To further identify distinct subsets of patients with non-ulcerated AJCC stage I/II melanomas ar high risk of metastasis, the present study aimed to develop a machine learning (ML) risk-prediction model combining AMBLor ‘at -risk’ status with specific patient clinical and tumour pathological features. Methods: Using commonly and widely used ML models, ML algorithms were trained and tested using three internationally distinct retrospective-prospective cohorts of AMBLor at-risk non-ulcerated AJCC stage I/II melanomas (n=552). Results: Based on a training: test data split of 50:50, 20% of patients were defined as high-risk, with a 5-year recurrence-free survival (RFS) probability of 56% (Log-rank [Mantel-Cox) P < 0.0001, HR 6.88, 95% CI 3[PL1].03-15.63, clinical specificity 87.2%, PPV 44.4%). Further validation of the ML algorithms in a 4th independent retrospective-prospective cohort of 120 AMBLor at-risk non-ulcerated localised melanomas derived from the UK identified 24% patients as high-risk, with a 5-year RFS of 56.3% (Log-rank [Mantel-Cox) P < 0.0001, HR 7.59, 95% CI 2.94-19.6, clinical specificity 82.1%, PPV 50%). Conclusions: Through the proven negative predictive power of AMBLor with the cumulative power of prognostic clinical and pathological features these novel translationally relevant data provide an improved risk- prediction model to stratify patients with non-ulcerated localised melanomas at low or high risk of tumour recurrence thereby aiding optimal personalised patient management and treatment stratification

The Rise of the Victorian Asylum

Historically before the rise of the asylum system in the UK, terms such as ‘madness’ and ‘lunacy’ were used to refer to people with mental health issues. At this time there was minimal consideration for the appropriate treatment needed to support these individuals. The asylum system was initiated as a safe space for people with mental health conditions, but quickly became a system of vastly oppressive institutions. Thus, creating institutions that housed people with significant mental health conditions as opposed to treating and curing them as it has originally proposed to do. This chapter will contextualise changes to legislation throughout the 18th and 19th centuries that were posed as progressive moves in mental health treatment. But that led to a continuation of the construction of ‘dangerousness’ in people with mental health illnesses. This will be demonstrated through the consideration of the long-standing effects that legislation, such as the Poor Law Amendment Act, held over the use of segregation for people with significant mental health conditions in the asylum system. This chapter will conclude by exploring the medicalization of the asylum system that led to the emergence of medical hospitals in the 20th century

The Evolution of Microfinance

This chapter explores the evolution of microfinance by reviewing existing literature. The chapter reviews the development of microfinance to understand how the concept emerged and the extent to which it has evolved. It specifically explores the history of microfinance and how it evolved in some countries before and after the emergence of Muhammad Yunus's microfinance era. The chapter concludes that the evolution of microfinance is a testament to its adaptability and resilience which started as a tool for poverty alleviation and has since transformed into a multifaceted industry that empowers marginalised individuals and communities while contributing to economic development. However, there are variations in opinions regarding the origins of microfinance as some researchers argue that it started in the 15th century, while others claim it was in the 17th or the 19th century. This analysis provides insights into how microcredit evolved into modern microfinance

Validation and application of a tool to assess self-confidence to do improvement

Introduction: Increasing improvement capability in the workforce is vital within healthcare. The type of quality improvement training to increase capability varies. One way to measure the impact of improvement training is self-confidence to do improvement. Objectives: Our objectives were to validate a tool to assess self-confidence to do improvement and to observe the degree of change before and after improvement training. We aimed to assess the degree of impact on self-confidence associated with varying exposure to quality improvement training. Methods: We used an online 10-item and 4-point scale to assess self-confidence before and after improvement training. Reliability analysis using Cronbach’s alpha was performed. The nature of the underlying construct was investigated using exploratory factor analysis and a full set of pre and post measures were used, and to compare individual question changes, a series of paired Wilcoxon tests were performed with Bonferroni post hoc corrections for multiple comparisons. To assess the differing lengths of programmes, individual results from each programme were combined meta-analytically with course duration added as a moderator. Results: 252 completed questionnaires were analysed at baseline and a full set of pre and post measures were available for 128 participants. Cronbach’s alpha for the tool was satisfactory at 0.93 (0.92–0.94) and measured a single underlying construct with an eigenvalue of 6.17. A significant increase in confidence to improve from before to after intervention was found (t(127) = 14.36, p<0.001, d=1.27 (95% CI 1.03–1.50)). Post-testing differences were significant (F(6,125) = 2.89, p=0.02) with shorter courses having significantly smaller increases in confidence. Conclusions: This manuscript provides a validated self-confidence tool to help assess improvement capability. Our tool offers a way to measure the impact of improvement capability on varying training durations and inform decisions about allocating staff time to this activity

Cyber Eyes Wide Open: Innovation, Art, and Collaborative Practice

This chapter showcases a collaboration between creatives, artists, academics, cyber security professionals and companies to create artworks that increased awareness of cyber security. The aim was to offer creative perspectives and practices into how cyber security might be better understood through creating visualizations, experiences and narratives that could enable communication and insight. Four cyber security businesses each provided a theme resulting in vibrant collaborations between the companies, four academics and eight artists. Eleven projects and forty two pieces of art were developed and exhibited in two exhibitions in the Northeast where over hundred people viewed the works. Evaluation indicated that the artworks had an impact, with people more aware of cyber security

Postneonatal Cerebral Palsy in Europe: Prevalence and Clinical Characteristics According to Contributory Events: An SCPE Study.

Postneonatal cerebral palsy (PNCP) is rare and requires large databases to be studied over time. To study the time trend of prevalence of PNCP overall and by cause, and to describe the clinical characteristics of children with PNCP according to cause and compared with children with pre/peri/neonatal CP (PPNCP). The Surveillance of Cerebral Palsy in Europe (SCPE) database was used. Primary events (the first known chronological event in the causal chain) were classified according to the SCPE classification (six main and 19 sub-categories). Prevalence trends for children born during 1976-2012 were modelled using multilevel generalised linear models. The clinical characteristics of PNCP and PPNCP cases born after 1998 were reported as proportions. The prevalence rates of PNCP were 1.76 (95% confidence interval (CI) 1.37, 2.23) and 0.82 per 10,000 live births (95% CI 0.73, 0.92) in children born during 1976-1980 and 2006-2012, respectively. The models showed a 2% annual decline in overall prevalence (prevalence rate multiplied by 0.98 each year) and a 10% decline for infectious causes for every 5-year change. The prevalence rate in children born during 2006-2012 was 0.26 per 10,000 (95% CI 0.21, 0.32) for infectious causes, which remained the most frequent. No trend emerged for other causes. Unilateral spastic CP, associated impairments and severe gross motor dysfunction were more frequent in PNCP than in PPNCP, and PNCP showed predominantly grey matter injury (55.6%). Seventeen percent were born preterm. PNCP differed by cause, with cerebrovascular accidents presenting the least severe and hypoxic causes the most severe forms. Our study confirms the decrease in the prevalence of PNCP in children born up to 2012, particularly for CP, due to infectious causes, which remain the most frequent. Children with PNCP had more severe presentation overall than those with PPNCP, with severity depending on the cause. [Abstract copyright: © 2024 John Wiley & Sons Ltd.