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

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

Netball: Adapted Teaching Games for Understanding (England)

The Game-based Approaches in Physical Education: International Applications presents 22 chapters, including 18 teaching units to be applied in physical education or youth sport, divided into four categories of games and an additional category of performance activities. This book combines the pedagogical, academic, and practical knowledge of a team of experts in the global game-based approaches community. Sharing some common universal principles about game-based physical education teaching, this book innovates by offering unique cultural perspectives and diversity in the pedagogical interpretations made in different continents and countries of the original Teaching Games for Understanding (TGfU) approach. Each unit includes a framework of tactical content of increasing complexity, a teaching unit outline (between 9 and 20 lessons), and the respective game-based activities and learning tasks. By covering key themes in contemporary sports pedagogy and physical education, including lesson content, tactical questioning, task design, assessment, and game modifications, this book is essential reading both for all prospective and in-service physical education teachers and sports coaches working with children and youth and their teacher and coach educators. Chapter 4 Abstract: Teaching Games for Understanding (Bunker and Thorpe, 1982) is a game-based approach to physical education, which prioritizes the problem-solving and decision-making aspects of games. The learner is placed in the center of a sequential process of introducing games requiring increasing levels of tactical understanding. The Teaching Games for Understanding approach incorporates the Curriculum Model with four pedagogical principles (Thorpe, Bunker & Almond, 1986), supported by the games classification system (Almond, 1986) which categorizes games based on their fundamental tactical aims of play. Through contextual gameplay the player firstly learns ‘what to do’ and ‘when to do it’, and only learning ‘how to do it’ at the point when the skill is required for the game. The pedagogical principles provide a framework for game modification, so they are developmentally appropriate for the players. This can challenge the commonly held misconception about Teaching Games for Understanding as only suitable for higher ability or older pupils. This chapter describes the teaching of games in schools in England with particular reference to introducing less experienced pupils to the tactics required for the invasion game, netball

Cognition in virtual reality: assessing user acceptability and feasibility of virtual reality cognitive screening for older adults

Abstract Introduction: The global demographic shift towards an older population necessitates innovative methods to assess cognitive abilities, particularly spatial working memory, which is crucial for daily living and early detection of neurocognitive conditions like Alzheimer's disease. Methods: This qualitative study utilised the Virtual Reality Working Memory Task (VRWMT), a semi-immersive VR activity using keyboard navigation, to assess spatial working memory in older adults. Participants were recruited from community centres and categorised by age and technological familiarity. Focus groups evaluated user perceptions based on the Technology Acceptance Model constructs: Perceived Usefulness, Perceived Ease of Use, Attitude Toward Usage, and Behavioural Intention to Use. The study aimed to assess the acceptability and feasibility of VRWMT across diverse populations, examining its navigational simplicity, emotional engagement, and willingness to endorse VRWMT for routine cognitive assessments. Results: Findings indicated significant variations in perceived usefulness, ease of use, attitude toward using, and behavioural intention to use across different age groups and socio-demographic characteristics. High-technology-familiarity participants found VRWMT easy to use and engaging, while those with low familiarity struggled with navigation and engagement. Socio-demographic factors such as limited digital literacy and lack of standby support impact technology adoption. Higher technological familiarity leads to better acceptance and feasibility of VRWMT. Discussion: VRWMT can enhance cognitive health monitoring and therapeutic interventions. The results highlighted that personalised pathways and user-friendly interfaces can improve accessibility and engagement, making VRWMT a valuable tool for cognitive assessments, as part of Occupational Therapy, in diverse populations. Keywords: feasibility and acceptance; gamified assessment; spatial-working memory; technology acceptance model; virtual reality. Copyright © 2025 Lai, Yee, Wang, Butler, Graham, Hai, Darling, Whittington and Lowe

“It’s just men taking an interest’: Obscuring understanding and recognition of coercive control

This article, grounded in feminist empirical research, explores women’s perceptions of domestic violence and their routes to help-seeking, irrespective of personal experiences with domestic violence and abuse. It highlights how societal norms reinforce women’s subjugation through seemingly harmless ideas like "men just taking an interest" or a "woman’s desire to please." In line with Kirkwood’s (1993) concept of the "distortion of a woman’s subjective reality," the study reveals how women often unknowingly adapt their lives through unrecognised elements of coercive control. Deeply ingrained gendered norms perpetuate this control by subtly manipulating women's daily routines, obscuring abusive behaviour in intimate heterosexual relationships. The article argues that this manipulation starts early, making coercive control harder to recognise and resist. Ultimately, the study concludes that despite feminist efforts, societal norms continue to reinforce traditional gender roles, limiting women’s autonomy and sustaining patriarchal dominance. Concluding that unless there is a shift in these norms women's independence in such relationships will remain constraint

Performing social work: Young fathers’ reflections on social work

Young fathers are marginalized by parenting discourses which focus on women and negative discourses about young people as parents. In this study, young fathers explored their discursive constructions of their own and social workers’ identities and considered their perceptions of social workers as professionals involved in their children’s lives, as well as their thoughts about how they felt social workers view their role as fathers. The study applied Butler’s performativity and gender performances with young fathers to explore how they think social workers perform social work and used critical discourse analysis to examine data from an online focus group of young fathers. While the fathers demonstrated capacity to recognize their own parenting and how this has evolved, they explained social workers expect them to reproduce negative parenting stereotypes and inhabit a role less deserving of support than mothers. This study highlights how young dads experience intersectional discrimination as young people and fathers and concludes by recommending that safe spaces are needed for relationships of trust to be developed between social workers and young dads where their own needs for support can be voiced. Meeting these needs is critical if fathers are to be encouraged and recognized as involved parents

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

Cleaner air, healthier hospitals: Implementing the UK's Clean Air Hospital Framework

National healthcare services significantly contribute to ambient air pollution and greenhouse gases, particularly through transport and energy generation. Hospitals bring together vulnerable patients in high-traffic settings often in urban areas where there are significant baseline concentrations of ambient pollutants. Therefore, there is a requirement for hospitals to look at ways of reducing their emissions of airborne pollutants, ideally within the framework of achieving net zero goals. This study details the initial implementation of the UK's Clean Air Hospital Framework (CAHF) at two major UK hospitals. CAHF is a proactive self-assessment tool designed to reduce the generation of air pollution from hospital activities. It comprises 215 compliance actions across seven key categories: travel, procurement, design & construction, energy generation, communication & training, outreach & leadership and local air quality. CAHF implementation has focused on sustainable travel options, parking policy, energy efficiency improvements, staff training, education, the adoption of green procurement policies and the incorporation of sustainable travel considerations into new infrastructure designs. Currently, the hospitals are more than half-way towards achieving their implementation goal. To monitor the future overall effectiveness of CAHF, a network of 32 NO2 diffusion tubes was set up across the hospital sites, together with continuous monitors for NO2, PM10 and PM2.5 measurement, and four indoor particulate matter monitors at each hospital. The monitoring programme was supplemented with the development of an ADMS-Urban dispersion model for the site, focussing on emissions from significant adjacent road networks. This study provides an evidence-based exemplar for the CAHF approach and provides a blueprint to support other hospitals to engage in this process

A cluster randomised feasibility trial assessing an interactive film intervention to improve the well-being of young people in school settings in the North of England

Background Adolescence is a critical period for the onset of mental illness. A partnership of a health and care network and filmmakers developed an interactive film for youth wellbeing. While such films have potential as a cost-effective preventative tool, their effectiveness remains unproven. This study aimed to assess the feasibility and acceptability of a randomised controlled trial of the interactive film intervention to improve wellbeing in school-aged youth. Methods In a mixed-methods cluster randomised feasibility trial in North East England (2021-2022), students in Years 10 (14-15 years) and 12 (16-17 years) from three schools were recruited and randomised to the following conditions: 1) watching the film in class, 2) watching the film in class with support from youth workers or 3) regular class activities. Feasibility outcomes included willingness of schools to participate, participant recruitment, and retention, which was accessed quantitatively and qualitatively. Data were analysed descriptively and with the use of thematic analysis. Results School recruitment targets were met, although this was challenging due to resource constraints and the COVID-19 pandemic. Questionnaires were completed before watching the film by 172 students (48% of the recruitment target). Follow-up targets for retention were met at 3-months (n=138) and 6-months (n=136). Retention of Year 10 students was high (96%), but Year 12 students had lower retention (60%). Qualitative findings showed students and teachers supported the intervention and trial and measurements however, consent-taking required more time. Communication and resource issues within schools were challenging and need addressing before moving to a larger trial. Conclusion Although some trial aspects were feasible and acceptable, particularly the intervention, others, such as recruitment, retention and school communication, posed challenges. We recommend future feasibility studies should address barriers such as randomisation, communication with schools, recruitment of older students (16-18 years), consent and measurement alignment before moving to a larger-scale trial

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