Interventions to improve the quality of life in patients living with endocrine conditions A

IntroductionPatients living with chronic endocrine conditions experience a burden of disease which affects their quality of life compared to healthy controls. In people living with type 1 and type 2 diabetes, this may be due to micro or macrovascular complications, as well as the negative emotions associated with living with diabetes. In individuals with adrenal insufficiency, the reduced quality of life may be due to failure to mimic the circadian rhythm during glucocorticoid replacement. Interventions to improve the management of these endocrine conditions can have an impact on the specific disease related distress. This would in turn affect the quality of life in these individuals. The first study assessed the impact of intermittently scanned continuous glucose monitoring (isCGM) on glycaemic control and diabetes distress in a predominantly type 1 diabetes population with psychosocial issues. The effect of this technology on diabetes distress in people living with type 2 diabetes but not yet on insulin has been evaluated in the second study. In the final study, we compared the effect of prednisolone to hydrocortisone on the quality of life in patients with adrenal insufficiency.Methods:The first study was a retrospective analysis of baseline and follow-up data from the Association of British Clinical Diabetologists (ABCD) nationwide audit of people with diabetes who initiated the isCGM for psychosocial reasons in the United Kingdom. In the second study, a randomized controlled trial, the effect of use of Free Style Libre 2 over 12 weeks on glycaemic control and diabetes distress in patients with type 2 diabetes was assessed. The final study was an observational study that compared the cardiovascular risk and quality of life of patients with adrenal insufficiency, at the start and 4 months after switching from hydrocortisone to prednisolone.ResultsIn the first study, with the initiation of isCGM, after a mean follow-up period of 6.9 months, there was a significant reduction in Diabetes Distress Scale score; 4 at baseline vs. 2.5 at follow up (P0.05). Data from the modified SF-36 quality of life questionnaire showed significant increase in the energy scores and scores relating to the participants’ general health (p=0.003 and p=0.019 respectively), indicating an improvement in the quality of life.Conclusion:Analysis of real-world data of people with T1DM using isCGM initiated for psychosocial reasons shows a significant improvement in diabetes related distress, glycaemic control and hospital admissions due to hyperglycaemia/diabetic ketoacidosis. The use of isCGM in T2DM patients on non-insulin therapy showed promise in improving glycaemic control, as evidenced by increased time in range. There was, however, no significant reduction in HbA1c or impact on diabetes distress. The use of prednisolone was associated with a significant reduction in systolic blood pressure, weight and BMI. Prednisolone did not affect the lipid profile, signifying no increase in cardiovascular risk. Patients felt more energetic and had higher general health scores. These findings suggest that low dose prednisolone may be a better glucocorticoid option than hydrocortisone. In this thesis, we have shown that the disease specific interventions had an overall positive impact on the management of individuals living with diabetes and adrenal insufficiency. This generally resulted in improvement in the quality of life as evidenced by the disease related distress. Interventions also had an impact on the individuals’ biochemical health as shown by various outcome measures

Parents’ wellbeing: perceptions of happiness and challenges in parenthood in Latin America

Traditional research on parenthood and wellbeing often employs a positivist perspective and focuses on non-LA samples -limiting our knowledge and understanding of the influence that strong components of the LA culture such as Machismo and Marianismo, have in parents’ wellbeing. This study explored how Latin American (LA) parents’ wellbeing is influenced by parenthood in a culture strongly influenced by such gender-based perspectives. An interpretative perspective was employed to explore fifteen LA parents’ lived experiences. An eight-questions interview was developed and data were analysed via Thematic Analysis. The American Psychological Association’s Journal Article Reporting Standards for Qualitative Research (JARS-Qual), was followed to compile this paper. Results showed that socio-economic factors such as crime, violence, and economic inequality, negatively influence parents wellbeing -emotions experienced and life satisfaction. Notably, parents seem to find joy in sharing their own personal experiences with their children and passing on gender-based models. However, parents perceive family pressure as a “burden” since they are expected to follow principles of Machismo/Marianismo. Similar to Asian, but unlike European parents, LA parents experience a mixture of positive and negative emotions throughout the parenting journey although strongly shaped by Machismo and Marianismo. This study makes a unique contribution by uncovering the unique influence of LA socio-economic challenges and cultural impositions and expectations and its influence on parental wellbeing

Sequence Outlier Detection and Application of Gated Recurrent Unit Autoencoder Gaussian Mixture Model Based on Various Loss Optimization

In the era of big data, detecting outliers in time series data is crucial, particularly in fields such as finance and engineering. This article proposes a novel sequence outlier detection method based on the gated recurrent unit autoencoder with Gaussian mixture model (GRU-AE-GMM), which combines gated recurrent unit (GRU), autoencoder (AE), Gaussian mixture model (GMM), and optimization algorithms. The GRU captures long-term dependencies within the sequence, while the AE measures sequence abnormality. Meanwhile, the GMM models the relationship between the original and reconstructed sequences, employing the Expectation–Maximization (EM) algorithm for parameter estimation to calculate the likelihood of each hidden variable belonging to each Gaussian mixture component. In this article, we first train the model with mean-squared error loss (MSEL), and then further enhanced by substituting it with quantile loss (QL), composite quantile loss (CQL), and Huber loss (HL), respectively. Next, we validate the effectiveness and robustness of the proposed model through Monte Carlo experiments conducted under different error terms. Finally, the method is applied to Amazon stock data for 2022, demonstrating its significant potential for application in dynamic and unpredictable market environments

PO369: Introduction to the UK PIVOT-vWD Study: A direct to community, cross-sectional study to capture and quantify the impact, voice and outcomes of VWD

Objectives There is a paucity of new evidence/literature on the clinical outcomes, healthcare resource use (HCRU), cost and the quality-of-life (QoL) impact on those with von Willebrand Disease (VWD). The PIVOT-VWD study aims to collect patient generated health data to quantify the impact, voice and outcomes of VWD in the UK. Specifically, in relation to the management of the condition including treatment preferences, symptomology and the impact upon work and daily activities, as well as QoL outcomes. Methods The study design is a bottom-up, cross-sectional methodology. Two survey questionnaires have been developed, one for adult (18+) respondents who will be self-reporting, and a proxy survey for those parents who answer on behalf of their child (under 18) or as a caregiver. Lived experience experts have provided review and input into the study design and survey questionnaire content. The cross-sectional survey includes questions about the individual with VWD focusing on patient characteristics, VWD background, symptomology, management, work & daily activities, quality of life, and perspectives on novel treatments. In addition, if the survey is completed by proxy, specific variables will be collected about the parent/caregiver. Any HCRU questions are captured retrospectively over the last 12 months to be able to estimate the direct healthcare and societal burden of disease. Results Data collection is currently on-going. Recruitment is supported by The Haemophilia Society who have utilised their network, social media accounts and mailing list to distribute invitations to members of the VWD community. The aim of recruitment will be to gather a target sample of 250 respondents based in the UK. The project may be expanded to other countries in the future. Conclusions Capturing the clinical & quality of life impact upon individuals with VWD is critical to supporting new and emerging therapies, which could provide direct benefits to those affected by the condition. In addition, preference research in health technology assessment (HTA) is becoming more relevant as HTA bodies widen their decision-making perspectives. Gathering the voice of the community leads to greater understanding of the priorities of the community, leading to more informed decision making and relevant treatments

Decoupling the Effects of Temperature, Strain, and Refractive Index in Long-Period Fiber Grating Used for Epoxy Resin Cure Monitoring

Epoxy resins are widely used in the manufacture of composite materials for a wide range of applications. Control of the curing process is an important consideration in ensuring product quality and minimizing production times. The curing of epoxy resin is associated with temperature, strain, and refractive index changes but it is difficult to monitor these quantities individually and hence difficult to achieve accurate control of the curing process. One promising approach for monitoring these quantities is the use of long-period fiber gratings (LPFG). We analyze the spectral response of a LPFG in epoxy resins to temperature, strain, and refractive index. Wavelength shifts and dip amplitudes of cladding mode notches are monitored and are used to decouple temperature, strain, and refractive index for gratings in air, liquid, and hardened resins. The three measurands are found from wavelength shifts and dip amplitudes, employing multiplication by a weighted pseudo-inverse matrix assuming linear dependences between the spectral and external parameters. We propose a new model to describe the influence of fiber parameters and external refractive index, temperature, and strain on the spectral behavior of long-period fiber gratings in epoxy resins during hardening. The results obtained can be utilized for multiparameter cure process monitoring of epoxy resins by using long-period fiber gratings

The impact of impact: an invitation to philosophise

This position paper argues for the introduction of a philosophy of research impact, as an invitation to think deeply about the implications of the impact agenda. It delves into the transformative influence of prioritising the end-product of the research journey over the entire knowledge production process. We argue that the prevalence of research impact assessment in Western research ecosystems has reshaped various facets of research, extending from funding proposals to the overarching goals of research agendas, assessment regimes and promotion structures. Through self-reflective analysis, this position paper critically assesses the consequences of this paradigm shift. Utilising perspectives from the UK, Poland, Sweden, and Finland, we explore tensions, conflicts, opportunities, and viabilities arising from such a shift in the teleological purpose of research. This selection of countries offers a spectrum, ranging from early adopters of impact assessment regimes to those where such evaluation is largely absent as of now, and its intermediaries. Moreover, our examination extends across different disciplinary foci, including allied health, business and management studies, earth science, human geography, and history. Our findings suggest a discernible alteration in the fundamental logic of research, where the focus shifts from checks and balances geared towards the advancement of knowledge, towards other supposedly more important goals. Here research is merely cast as an instrumental means to achieve broader societal, political, economic, environmental (etc.) goals. Additionally, we observe that as the formalisation of research impact evaluation intensifies, there are diminishing degrees of freedom for scholars to challenge contemporary power structures and to think innovatively within their research ecosystem

Forever but not everywhere? Unexpected non‐detection of per‐ and polyfluoroalkyl substances (PFAS) in major Philippines rivers

Recent studies suggest per- and polyfluoroalkyl substances (PFAS) are ubiquitous in rivers worldwide. In the Asia-Pacific region, the frequency of PFAS detection in rivers is increasing. However, the overwhelming majority of studies and data represent high population and urbanized river catchments. In this study, we investigate PFAS occurrence in major Philippines river systems characterized by both high and low population densities. In the Pasig Laguna de Bay River, which drains a major urban conurbation, we detected PFAS at concentrations typical of global rivers. Unexpectedly, we did not detect PFAS in river water or sediments in low population density river catchments, despite our instrument detection limits being lower than the vast majority of river concentrations reported worldwide. We hypothesize that septic tanks, as the dominant wastewater treatment practice in Philippines catchments, may control the release of PFAS into groundwater and rivers in the Philippines. However, no groundwater PFAS data currently exist to validate this supposition. More broadly, our findings highlight the need for more representative PFAS sampling and analysis in rivers to more accurately represent regional and global detection frequencies and trends

Automated identification of hedgerows and hedgerow gaps using deep learning Remote Sensing in Ecology and Conservation

Hedgerows are a key component of the UK landscape that form boundaries, borders and limits of land whilst providing vital landscape-scale ecological connectivity for a range of organisms. They are diverse habitats in the agricultural landscape providing a range of ecosystem services. Poorly managed hedgerows often present with gaps, reducing their ecological connectivity, resulting in fragmented habitats. However, hedgerow gap frequency and spatial distributions are often unquantified at the landscape-scale. Here we present a novel methodology based on deep learning (DL) that is coupled with high-resolution aerial imagery. We demonstrate how this provides a route towards a rapid, adaptable, accurate assessment of hedgerow and gap abundance at such scales, with minimal training data. We present the training and development of a DL model using the U-Net architecture to automatically identify hedgerows across the East Riding of Yorkshire (ERY) in the UK and demonstrate the ability of the model to estimate hedgerow gap types, lengths and their locations. Our method was both time efficient and accurate, processing an area of 2479 km2 in 32 h with an overall accuracy of 92.4%. The substantive results allow us to estimate that in the ERY alone, there were 3982 ± 302 km of hedgerows and 2865 ± 217 km of hedgerow gaps (with 339 km classified as for access). Our approach and study show that hedgerows and gaps can be extracted from true colour aerial imagery without the requirement of elevation data and can produce meaningful results that lead to the identification of prioritisation areas for hedgerow gap infilling, replanting and restoration. Such replanting could significantly contribute towards national tree planting goals and meeting net zero targets in a changing climate