A Conceptual Model on Risk Perception Among Older South Asians with Type 2 Diabetes

Research has shown that an underestimation of personal health risk can reduce the motivation to change behaviour and reduce risk factors. This paper describes a conceptual model on risk perception among older South Asian people (representing Bangladesh, India and Pakistan) with type 2 diabetes living in the UK; this model was developed using qualitative research. Risk perception in this study is interpreted in terms of risk awareness and risk engagement. This research indicated that the concordance/empowerment model of diabetes management, which advocates self-management towards long-term risk prevention, needs further exploration in older people from minority ethnic groups with type 2 diabetes

Spatial variation in the sedimentary architecture of a dryland fluvial system

Research Funding Natural Environment Research Council (NERC). Grant Number: NEM00578X/1 British Geological Survey (BGS)Peer reviewedPublisher PD

Tensions in dementia care in China: An interpretative phenomenological study from Shandong province

Aims: The study aims to analyse the tensions and the challenges of dementia care that are experienced by people with dementia and their family caregivers in China. Background: China has the largest dementia population in the world; however, dementia care services and related support services are still developing. Caring for a person with dementia is very challenging, as evidenced by many studies. As the majority of people with dementia are looked after by their family in their homes in China, it is very important to understand what people with dementia and their family caregivers are experiencing in the context of dementia care services that are in the process of developing. Design: Interpretative phenomenological analysis (IPA) was used. Method: Semi‐structured individual interviews with 24 participants (10 people with dementia and 14 unrelated family caregivers) recruited from a mental health centre in Shandong Province. Findings: Three main themes emerged that highlighted unmet need: (a) Lack of support services, (b) Insufficient institutional care and (c) Social attitude and social stigma towards dementia. Conclusions: These themes reveal the challenges that the participants face in the context of dementia care services that are in the process of development in China; and how their lived experiences have been affected by the constraints of social support, public services, healthcare access, long‐term care services and social stigma. Implications for practice: This study highlights the tensions that are identified by people with dementia and family caregivers. The research recommends that more support services would be beneficial for this group and would also enhance family support dementia care in China. Looking after an older family member is a culturally, socially and legally embodied norm in Chinese society, so it is important to address education for dementia awareness and the sustainability of family support care services in China by providing dementia services and resources to support both people with dementia and family caregivers

A nomadic exploration of quality of life in long-term conditions

The nature of quality of life and its consensual definition has eluded researchers and philosophers ever since Aristotle. While social indicators researchers seek to model it in order to inform policy, it is used as an outcome measure of health care. Although studied from a variety of perspectives, the concept has, as yet, been largely untouched by postmodernists. In this thesis, quality of life is studied through the frame of long¬term conditions. Within this, I use the Deleuzo-Guattarian concepts of the body without organs, its territorialisation by societal forces and the emancipatory promise of nomadism. Three health service developments for people with multiple sclerosis, a sample of television programming, a Disney Classic feature and the National Service Framework for long-term conditions form the case material for the study. I take the reader through a deterritorialising textual journey, so that quality of life may be approached differently. Qualitative research chapters are alternated with those analysing the political and cultural background to their making. These texts are woven into a deconstruction of quality of life in the five oppositional pairs of life and death, health and illness, independence and dependence, empowerment and disempowerment and certainty and uncertainty. This deconstructive thread informs and is informed by the texts studied, in a (rhizomatic) dis-order used to blur boundaries between established categories. A temporary reterritorialisation of quality of life emerges, which highlights the construction of the self as an endless process. Powerful discourses, such as medicine, shape a quality of life text for people with long-term conditions. Deterritorialisation, as a process, enables the acknowledgement of such territorialising forces and encourages a different engagement with life. The body as a dys-organ-ised entity with erratically evolving possibilities becomes a territory, and quality of life the potential to engage in a liberating process of deterritorialisation.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Artificial intelligence in digital pathology: a diagnostic test accuracy systematic review and meta-analysis

Ensuring diagnostic performance of AI models before clinical use is key to the safe and successful adoption of these technologies. Studies reporting AI applied to digital pathology images for diagnostic purposes have rapidly increased in number in recent years. The aim of this work is to provide an overview of the diagnostic accuracy of AI in digital pathology images from all areas of pathology. This systematic review and meta-analysis included diagnostic accuracy studies using any type of artificial intelligence applied to whole slide images (WSIs) in any disease type. The reference standard was diagnosis through histopathological assessment and / or immunohistochemistry. Searches were conducted in PubMed, EMBASE and CENTRAL in June 2022. We identified 2976 studies, of which 100 were included in the review and 48 in the full meta-analysis. Risk of bias and concerns of applicability were assessed using the QUADAS-2 tool. Data extraction was conducted by two investigators and meta-analysis was performed using a bivariate random effects model. 100 studies were identified for inclusion, equating to over 152,000 whole slide images (WSIs) and representing many disease types. Of these, 48 studies were included in the meta-analysis. These studies reported a mean sensitivity of 96.3% (CI 94.1-97.7) and mean specificity of 93.3% (CI 90.5-95.4) for AI. There was substantial heterogeneity in study design and all 100 studies identified for inclusion had at least one area at high or unclear risk of bias. This review provides a broad overview of AI performance across applications in whole slide imaging. However, there is huge variability in study design and available performance data, with details around the conduct of the study and make up of the datasets frequently missing. Overall, AI offers good accuracy when applied to WSIs but requires more rigorous evaluation of its performance.Comment: 26 pages, 5 figures, 8 tables + Supplementary material

Consensus workshops on the development of an ADHD medication management protocol using QbTest: developing a clinical trial protocol with multidisciplinary stakeholders

BackgroundThe study design and protocol that underpin a randomised controlled trial (RCT) are critical for the ultimate success of the trial. Although RCTs are considered the gold standard for research, there are multiple threats to their validity such as participant recruitment and retention, identifying a meaningful change, and non-adherence to the protocol. For clinical RCTs, involving patients and clinicians in protocol design provides the opportunity to develop research protocols that are meaningful to their target audience and may help overcome some of the inherent threats in conducting RCTs. However, the majority of protocols do not describe the methodology underpinning their development, limiting the amount of learned experience shared between research groups.MethodWith the purpose of reporting a collaborative approach towards developing a protocol, we present the findings from three sequential workshops that were conducted with the aim of developing a protocol to investigate the feasibility of adding a computerised test of attention, impulsivity and activity (QbTest) to medication management of children and young people with Attention deficit hyperactivity disorder (ADHD). Based on previous qualitative interviews with clinicians and families, each workshop prioritised topics for focused discussion. Information from the workshops was fed back to the participants for reflection in advance of the next workshop.ResultsThe workshops involved 21 multi-disciplinary ADHD experts, including clinicians, patient and public involvement (PPI) members, parents of young people with ADHD and researchers. The consensus workshops addressed key research issues such as: the most relevant outcome measures/ resource drivers; methods and time points for data collection; and the clinical protocol for utilising the QbTest, including when best to use this within the medication management process. The resulting protocol details a feasibility RCT design describing these factors.ConclusionProtocols which are co-developed may help overcome some of the risks associated with RCT completion (e.g. recruitment, retention, protocol adherence) and help prioritise outcomes of greater relevance to the populations under study. The methodology has potential value for researchers and organisations developing clinical guidelines, and offers insights into the valuable impact of PPI upon trial design

Introduction : screen Londons

Our aim, in editing the ‘London Issue’ of this journal, is to contribute to a conversation between scholars of British cinema and television, London historians and scholars of the cinematic city. In 2007, introducing the themed issue on ‘Space and Place in British Cinema and Television’, Steve Chibnall and Julian Petley observed that it would have been possible to fill the whole journal with essays about the representation of London. This issue does just that, responding to the increased interest in cinematic and, to a lesser extent, televisual, Londons, while also demonstrating the continuing fertility of the paradigms of ‘space and place’ for scholars of the moving image1. It includes a wide range of approaches to the topic of London on screen, with varying attention to British institutions of the moving image – such as Channel Four or the British Board of Film Classification – as well as to concepts such as genre, narration and memory. As a whole, the issue, through its juxtapositions of method and approach, shows something of the complexity of encounters between the terms ‘London’, ‘cinema’ and ‘television’ within British film and television studies

Aeolian–lacustrine margins: implications for carbon capture and storage within the Rotliegend Group, Southern North Sea

The Southern North Sea Basins of the United Kingdom were renowned for their hydrocarbon resources and exploited extensively from the 1960s to the 1990s. The Permian Leman Sandstone in particular formed an excellent reservoir due to its extensive clean aeolian sediments and was subsequently explored for decades, resulting in a wealth of subsurface data that are now widely accessible. The strata of the Leman Sandstone comprises mixed continental deposits from aeolian, fluvial and lacustrine environments which interfinger with the saline lake deposits of the Silverpit Formation. With the potential reassessment of depleted gas reservoirs in the North Sea for use as sequestration targets for captured carbon dioxide, there is significant renewed interest in the reservoir geology of the Leman Sandstone. A regional study of the sedimentology and petrophysical properties of the Leman Sandstone and Silverpit formations within quadrants 43, 44, 48 and 49 of the Southern North Sea has been conducted. Multiple interactions between the depositional environments are observed, resulting in a complex interplay between aeolian and lacustrine transgressive/regressive events, and migration and expansion/contraction of the fluvial system. In wireline petrophysical data, each depositional environment, along with their transitional environments, form relatively distinct clusters that can be used as a predictive tool for reservoir interpretation in the absence of core, despite extensive sediment recycling between environments

Rapid climate changes during the Lateglacial and the early Holocene as seen from plant community dynamics in the Polar Urals, Russia

A detailed, well-dated record of pollen and sedimentary ancient DNA (sedaDNA) for the period 15 000–9500 cal a bp describes changes at Lake Bolshoye Shchuchye in the Polar Ural Mountains, located far east of the classical Lateglacial sites in western Europe. Arctic tundra rapidly changed to lusher vegetation, possibly including both dwarf (Betula nana) and tree birch (B. pubescens), dated in our record to take place 14 565 cal a bp, coincident with the onset of the Bølling in western Europe; this was paralleled by increased summer temperatures. A striking feature is an early decline in Betula pollen and sedaDNA reads 300 years before the onset of the Younger Dryas (YD) in western Europe. Given the solid site chronology, this could indicate that the YD cooling started in Siberia and propagated westwards, or that the vegetation reacted to the inter-Allerød cooling at 13 100 cal a bp and did not recover during the late Allerød. During the YD, increases in steppe taxa such as Artemisia and Chenopodiaceae suggest drier conditions. At the onset of the Holocene, the vegetation around the lake reacted fast to the warmer conditions, as seen in the increase of arboreal taxa, especially Betula, and a decrease in herbs such as Artemisia and Cyperaceae.publishedVersio

A 24,000-year ancient DNA and pollen record from the Polar Urals reveals temporal dynamics of arctic and boreal plant communities

A 24,000-year record of plant community dynamics, based on pollen and ancient DNA from the sediments (sedaDNA) of Lake Bolshoye Shchuchye in the Polar Ural Mountains, provides detailed information on the flora of the Last Glacial Maximum (LGM) and also changes in plant community composition and dominance. It greatly improves on incomplete records from short and fragmented stratigraphic sequences found in exposed sedimentary sections in the western Russian Arctic. In total, 162 plant taxa were detected by sedaDNA and 115 by pollen analysis. Several shifts in dominance between and within plant functional groups occurred over the studied period, but most taxa appear to have survived in situ. A diverse arctic-alpine herb flora characterised the interval ca. 24,000–17,000 cal years BP and persisted into the Holocene. Around 17,000 cal years BP, sedges (e.g. Carex) and bryophytes (e.g. Bryum, Aulacomnium) increased. The establishment of shrub-tundra communities of Dryas and Vaccinium sp., with potentially some Betula pubescens trees (influx ∼290 grains cm2 year−1), followed at ca. 15,000 cal years BP. Forest taxa such as Picea and ferns (e.g. Dryopteris fragrans, Gymnocarpium dryopteris) established near the lake from ca. 10,000 cal years BP, followed by the establishment of Larix trees from ca. 9000 cal years BP. Picea began to decline from ca. 7000 cal years BP. A complete withdrawal of forest tree taxa occurred by ca. 4000 cal years BP, presumably due to decreasing growing-season temperatures, allowing the expansion of dwarf-shrub tundra and a diverse herb community similar to the present-day vegetation mosaic. Contrary to some earlier comparative studies, sedaDNA and pollen from Lake Bolshoye Shchuchye showed high similarity in the timing of compositional changes and the occurrence of key plant taxa. The sedaDNA record revealed several features that the pollen stratigraphy and earlier palaeorecords in the region failed to detect; a sustained, long-term increase in floristic richness since the LGM until the early Holocene, turnover in grass and forb genera over the Pleistocene-Holocene transition, persistence of a diverse arctic-alpine flora over the late Quaternary, and a variable bryophyte flora through time. As pollen records are often limited by taxonomic resolution, differential productivity and dispersal, sedaDNA can provide improved estimates of floristic richness and is better able to distinguish between different plant assemblages. However, pollen remains superior at providing quantitative estimates of plant abundance changes and detecting several diverse groups (e.g. Poaceae, Cyperaceae, Asteraceae) which may be underreported in the sedaDNA. Joint use of the two proxies provided unprecedented floristic detail of past plant communities and helped to distinguish between long-distance transport of pollen and local presence, particularly for woody plant taxa