Development of a Complex Intervention to Promote Pulmonary Rehabilitation Uptake Post Hospitalisation for an Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Background: Pulmonary Rehabilitation (PR) uptake rate post-Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is known to be suboptimal. Recent research has advocated for targeting patient care priorities to make PR more appealing to its stakeholders. However, limited data is available about the stakeholders' non-pharmacological patient care priorities and the most bothersome exacerbation impact on the patient. Objectives: To develop a complex intervention based on the stakeholders' patient care priorities to promote PR uptake post-AECOPD. Explore the key stakeholders' non-pharmacological care priorities and the most bothersome impact of exacerbation on the patient during hospitalisation and post-discharge. Lastly, review the effectiveness of interventions developed to promote conventional PR uptake post-AECOPD. Methods: The Medical Research Council framework was utilised to develop the intervention. The following research steps were conducted; I) Consider context by identifying the problem and refine the understanding of it (conducted through qualitative study), II) Engage key stakeholders who will use the intervention (conducted through Survey and Delphi studies), III) Review published evidence to identify the effectiveness of the previously developed interventions (conducted through Systematic review), IV) Draw on existing theories, V) Articulate the aspect of the programme theory, and VI) Design the preliminary version of the intervention. Results:12 participants were recruited in the qualitative study, 50 hospitalised participants were recruited in the patient survey, 46 Healthcare professionals (HCPs) were recruited in round one of the Delphi survey, 45 in round two and eight studies were included in the systematic review. The data synthesis and mapping resulted in a prototype version of the intervention that is set to be delivered in three phases (introduction, preparation, and action) that included a brief educational package, behavioural therapy, and AECOPD PR pathway. Conclusion: The findings generated from the exploratory research steps highlighted a need for a phased approach to introduce PR that initially targets barriers and secondly supports the stakeholder's prioritised care needs to facilitate PR engagement.</p

Deep immunophenotyping of peripheral blood cells in individuals exposed to Mycobacterium tuberculosis

Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), is a worldwide public health issue. To control TB, we need prognostic tests to discriminate subjects infected but unlikely to succumb to disease (LTBI) from subjects developing disease (subclinical TB). To address this, we proposed that immunophenotyping could group LTBI from subclinical TB. We reasoned that in a high incidence, low exposure setting such as Leicester we would have a population of people wherein the immune response reflected the state of infection rather than the state of recent exposure to Mtb antigens. We therefore locally recruited 46 subjects designated as healthy unexposed (HC), active TB patients (ATB) or people with evidence of exposure but no clinical symptoms (latent tuberculosis infection, LTBI). We hypothesized that we could separate HC from ATB and that LTBI would be variable, reflecting the broad nature of the LTBI grouping. We compared the frequencies of specific cell types in peripheral blood mononuclear cells both ex vivo and post antigen-specific stimulation between these groups. We also compared the expression of inflammatory cytokines in plasma from the subjects. We developed an ELISA to determine the level of a novel biomarker of active TB, △TM-IL-12Rβ1. We found some individual characteristics were different for the ATB group compared to the other groups with more regulatory and antigen-specific T cells and fewer naïve CD4 T and NK cells. Principal component analysis showed that HC and ATB subjects could be grouped, while LTBI subjects were spread over the HC and ATB grouping. We have established a set of markers that can be used to group HC and ATB, we can now propose a longer follow up study to see whether any combination of these markers is an indicator of progression from latent to active TB.</p

‘It isn’t just a shove’: Judicial understandings of domestic abuse and the challenges of recognising and responding to ‘coercive control’ in the criminal and family courts

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Dangerous Driving, Deterrence, Disqualification and a missed opportunity to address Destructive Behaviour: the new Sentencing Guidelines for Motoring Offences

[Opening paragraph] On 28 June 2022, sections 86 and 87 of the Police, Crime, Sentencing and Courts Act 2022 came intoforce, raising the maximum sentence for causing death by dangerous driving (CDDD)1 and causingdeath by careless driving whilst under the influence of drink or drugs (CDCDUI)2 from 14 years to lifeimprisonment, and creating a new offence of causing serious injury by careless driving.3 This changefollowed years of campaigning from victim and road safety groups and was welcomed by them, butinitially caused some problems in the Crown Court given that existing guidelines4 provided guidancebased on the previous maximum.5  On 15 June 2023 the Sentencing Council published its newguideline, on which it had consulted up until October 2022, and it came into effect on 1 July 2023.</p

Stochastic Differential Equations In Epidemiology

This thesis is devoted to investigating nonlinear dynamical systems that model infectious diseases. Our primary interest lies in the analysis of stochastic epidemic modelling, particularly on the part that focuses on compartmental stochastic models. These models, with or without time delays, treat the influence of three specific kinds of environmental noise. They are Gaussian white noise, Lévy noise, and telegraph noise. Our aim is to explore the influence these noise process types have on disease dynamics, enhancing our understanding of epidemic modelling. We begin by exploring a deterministic SAIRS epidemic model and identifying two equilibrium states: disease-free and endemic.We derive the basic reproduction number and analyse the global stability of these equilibria. Further, we examine the SAIR model, a special case of the SAIRS model, and establish the global stability of its endemic equilibria using the Lyapunov function method. Next, we analyse a generalised stochastic SEIQR epidemic model perturbed by Gaussian white noise. We explore V -geometric ergodicity of the model. Furthermore, we establish that under certain conditions, the disease either becomes extinct or is stochastically permanent. Moreover, we extend the deterministic SAIRS model discussed earlier into a stochastic model influenced by both Gaussian and Lévy noise. We identify the necessary conditions for the disease’s extinction and for its persistence in mean. Furthermore, we examine a distributed delayed epidemic model incorporating Lévy noise. By employing stochastic Lyapunov functions, we are able to ascertain the conditions under which the disease becomes extinct or persists. Subsequently, we explore a novel stochastic delayed SVIQR epidemic model with Markovian switching. We introduce a stochastic threshold, which we utilise to assess the conditions for disease extinction and persistence. The influence of time delay on the model is also investigated. The thesis concludes with an analysis a triple-delayed stochastic epidemic model with general nonlinear incidence and Lévy noise. We propose a stochastic threshold and use it as a criterion to ascertain whether the disease would vanish or continue to exist within the population.</p

SAR Target Incremental Recognition based on Features with Strong Separability

With the rapid development of deep learning technology, many SAR target recognition algorithms based on convolutional neural networks have achieved exceptional performance on various datasets. However, conventional neural networks are repeatedly iterated on a fixed dataset until convergence, and once they learn new tasks, a large amount of previously learned knowledge is forgotten, leading to a significant decline in performance on old tasks. This paper presents an incremental learning method based on strong separability features (SSF-IL) to address the model’s forgetting of previously learned knowledge. The SSF-IL employs both intra-class and inter-class scatter to compute the feature separability loss, in order to enhance the linear separability of features during incremental learning. In the process of learning new classes, an intra-class clustering loss is proposed to replace the conventional knowledge distillation. This loss function constrains the old class features to cluster around the saved class centers, maintaining the separability among the old class features. Finally, a classifier bias correction method based on boundary features is designed to reinforce the classifier’s decision boundary and reduce classification errors. SAR target incremental recognition experiments are conducted on the MSTAR dataset, and the results are compared with several existing incremental learning algorithms to demonstrate the effectiveness of the proposed algorithm.</p

Alternative binders to simplify the recycling of lithium-ion batteries

Binders are a vital component in the structure and function of battery electrodes. They do, however, have implications for the lifetime and recyclability or lithium ion batteries. This project identified several alternative binders that could simplify battery disassembly during end-of-life processing. Primarily anode binders were investigated, and it was found that water-miscible biopolymers, sodium alginate and gelatin, allowed complete delamination of the electrode active material from the current collector using lowpowered ultrasound with water in 5 seconds. Modification of these polymers, with a deep eutectic solvent made from choline chloride and glycerol, also allowed for the enhancement of key properties such as the thermal stability, adhesive strength and, in the case of sodium alginate, the electrochemical stability of the cells at high cycling rates. Other polymer systems were also tested as binders to try and optimise other key characteristics of the anodes, such as the use of polyaniline and sodium alginate to form a polymer blend. Anodes created using these polymer blends found that the conductivity increased with polyaniline content, but other factors such as a poorer adhesive strength was observed. Alternative extracellular adhesives and pack designs were also discussed, where a novel pack structure using a zigzag conformation of the cells joined together with pressure sensitive adhesives such as glue dots. This was shown to significantly reduce disassembly time and create a simplified dismantling procedure that could be easier to automate, increasing the economic viability of battery disassembly versus conventional end-of-life processes like shredding. This study included an environmental impact study comparing battery disassembly steps when alternative adhesives were used in both electrode binders and extracellular adhesives. These were then compared to commercial standards. This showed a 200% reduction in the global warming potential of the overall recycling process highlighting the importance of design for recycle for LIBs benefits, in terms of performance, economic viability of disassembly and environmental impact.</p

Development of a core outcome set for pharmacist interventions in chronic kidney disease (COSP-KD): a protocol for e-Delphi consensus study

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Macroeconomic Effects of the Exchange Rate : A Non-linear Analysis

The thesis employs non-linear econometric techniques to explore the relationships involving the exchange rate and selected macroeconomic variables, which are subjects of controversy. First, the thesis examines the relationship between globalisation and the exchange rate passthrough to domestic prices, using the panel smooth transition regression model and a sample of 16 African countries. The thesis establishes evidence suggesting a non-linear relationship between globalisation and the pass-through exists, and that globalisation causes a rise in the level of the pass-through. Additional evidence suggests that the influence of globalisation on the pass-through varies with exchange rate regimes, with globalisation causing the pass-through to decrease in fixed regimes and to increase in flexible regimes. Secondly, the thesis investigates non-linearity, asymmetry, and J-curve effects in the relationship between the exchange rate and the trade balance of Zambia with its 17 trading partners. The thesis uses the logistic vector smooth transition regression model and the non-linear panel autoregressive distributed lag model for estimations. Evidence favouring non-linearity and asymmetry effects is established. However, limited evidence of J-curve is found, especially with individual trading partners. Evidence suggests that currency depreciation cannot be relied on to improve trade balance. Third, the thesis examines the relationship between the exchange rate and foreign direct investments, taking into account the role of trade openness, natural resources, and institutional quality. Based on the estimation of the dynamic panel threshold model on a sample of 44 African countries, the thesis establishes evidence of non-linear effects. Specifically, the thesis finds that trade openness, natural resources, and institutional quality induce a non-linear response in foreign direct investments to their determinants. Furthermore, the thesis establishes new evidence suggesting that currency depreciation attracts FDI inflows in countries characterised by greater economic openness, abundant natural resources, and weaker institutions. The findings of the thesis elicit important macroeconomic implications.</p

Utopia, dystopia or reality: Secondary school teachers’ perceptions of the role of research in their professional development

The objective of this research project is to provide deeper understanding of how secondary school teachers comprehend the role of research in their professional development. This study offers theoretical and conceptual insights into novice teachers’ - up to five years of experience – perceptions of research; their viewpoints of their professional development and the links they made between the two. This inquiry used qualitative paradigm, approaching ontological and epistemological questions through the prism of interpretivism. It further employed social constructivism as the philosophical standpoint and adopted methodology of thematic analysis. Eighteen semi-structured in-depth interviews were undertaken with teachers, which came from the seven comprehensive secondary schools in Lincolnshire. The study gave a voice to the secondary teachers whose careers span from one to five years, which resulted in their powerful responses, providing novel insights into participants understanding of the explored subjects, offering its share in addressing a current gap within the literature. Teachers confirmed their agreement with the ‘common accord’ that any engagement with evidence-based practice on their behalf – either as consumers or as producers of research - has the potential to result in enhancing their professional development. However, the original contribution of this inquiry to the body of knowledge - within the scope of its focus - is its uniqueness and originality in the specific context of the schools in rural Lincolnshire. This research project introduces participants’ perceptions towards the significance of the social media platform Twitter, within their professional development, as a free source of timely pedagogy and disciplines related information, as well as contemporary educational research.</p