Worlds elsewhere: studies in some late nineteenth-century and early twentieth-century romance

Romance as a literary genre, although dominant in medieval Europe, has often been marginalized in later ages. Even when it saw a marked revival in Britain in the later nineteenth century, it still found itself embattled; its practitioners and advocates had to justify their position in an era which tended to regard tales of wonder and adventure as being little more than childish fancies and contrary to prevailing notions about the continuing advancement of the human race and the perceived duty of writers to engage with social issues of the day. However, the phenomenon could not be so easily ignored, or dismissed as belonging merely to the province of lower and undeveloped tastes. This thesis considers the work of several romance writers of the period, of varying background, outlook, and literary ability. These are, principally, Buchan, Chesterton, Conan Doyle, Conrad, Haggard, Kipling, Machen, Stevenson, and Wells. Throughout, the emphasis is upon works which in the past may have been comparatively neglected: for instance, in many cases, such as that of Buchan or Wells, the short stories take precedence over the novels. Adventuring into new realms of possibility often took the form in this period of an actual journey out to far places. Chapter One discusses the colonial romances of Buchan and Haggard in Africa, Kipling in India and Conrad and Stevenson in the Far East and the South Seas - distinct geographical locations in which differing romance elements come to the fore. It is argued that overall in this period there seem to be fewer romantic possibilities abroad than in former ages, but that they are still seen to linger (perhaps unexpectedly) in Conrad. Chapter Two undertakes a special study of Haggard in order to show how he modifies the imperial adventure tale of his day by bringing in elements of other, older, romance traditions - this being an important, and under-recognized, aspect of his fiction

Ultrasonographic evaluation of antenatal umbilical cord coiling index (aUCI) in second trimester of gestation and pregnancy outcome

Background: To evaluate the role of antenatal umbilical cord coiling index (aUCI) obtained during routine second trimester ultrasound as a predictor of perinatal outcome.Methods: Fetal ultrasound of 100 pregnant women was done between 18-24 weeks of gestation. Antenatal UCI was calculated as a reciprocal value of the distance between a pair of coils. Patients were followed up till delivery for perinatal outcome. UCI was correlated with: (1) gestational age (2) mode of delivery, (3) presence of meconium-stained amniotic fluid, (4) APGAR scores and (5) birth weight.Results: aUCI was categorized as hypocoiled, normocoiled or hypercoiled. Hypocoiled cord was associated with LBW (1%), preterm delivery (1%) while hypercoiled cord was associated with LBW (4%). No statistical difference was found for birth weight, gestational age, APGAR scores and MSAF between the groups with normal and abnormal aUCI.Conclusions: In present study, no association was found between abnormal aUCI with higher prevalence of interventional delivery, presence of MSAF, preterm and LBW. Therefore, more specific parameters need to be developed as promising prognostic marker for predicting adverse perinatal outcome and further studies are needed to test this hypothesis

Antecedents of online learning effectiveness and its impact on educational ethics:A comparative study between India and Malaysia

COVID-19 pandemic has forced the implementation of a new normal for all businesses leading to an increase in stress levels for many including educators and students. Ethics in education was questioned by professional bodies due to online exams. The objective of this study is to determine the antecedents of student online learning effectiveness and its impact on educational ethics. The study compares Malaysia and India since some Indian educational institutions had been implementing online teaching prior to the pandemic. Data was collected through a survey method. 571 questionnaires from students across Malaysia and India were analyzed using SPSS and PLS-SEM. It was found that physical, psychological, intellectual, and emotional attributes were significant in predicting learning effectiveness which in turn had an impact on educational ethics. Intellectual attributes were the most important predictor of learning effectiveness. The emotional and psychological attributes had a small impact on learning effectiveness. Furthermore, physical attributes had trivial effects on the learning effectiveness. A T-test comparing mean differences between the two countries revealed that there were no significant differences in learning effectiveness between students of both countries while educational ethics was more evident among Indian students as compared to Malaysian students. The key implication is the need for educational institutions and educators to develop pedagogies to stimulate students’ intellectual abilities during online teaching to preserve educational ethics. HEIs must support the students psychologically, emotionally and encourage themselves to keep physically active during the phase of online classes. Institutions must take ample steps to ensure that educational ethics is not affected as a result of the new normal failing which could prove detrimental in the long run for students and institutions. This will help to curb unethical practices during online examinations and mitigate academic dishonesty. Our findings regarding various attributes of online learning effectiveness add profoundly to literature and help to understand antecedents contributing to successful learning effectiveness which leads to positive educational ethics in both the countries

Patient preferences for different methods of blood pressure measurement: is ethnicity relevant?

This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by the Royal College of General Practitioners.$\textit{Background:}$ Ambulatory and/or home monitoring are recommended in the UK and North America for the diagnosis of hypertension but little is known about acceptability. $\textit{Aim:}$ To determine the acceptability of different methods of measuring blood pressure to people from different ethnic minority groups. $\textit{Design and setting:}$ Cross sectional study with focus groups in primary care. $\textit{Methods:}$ People with and without hypertension of different ethnicities were assessed for acceptability of clinic, home and ambulatory blood pressure measurement using completion rate, questionnaire and focus groups. $\textit{Results:}$ 770 participants were included comprising white British (n=300), South Asian (n=241) and African Caribbean (n=229). White British participants had significantly higher successful completion rates across all monitoring modalities compared to the other ethnic groups, especially for ambulatory monitoring: white British (277 completed, 92%[89-95%]) vs South Asian (171, 71%[65-76%], p<0.001 and African Caribbean (188, 82%[77-87%], p<0.001) respectively. There were significantly lower acceptability scores for minority ethnic participants across all monitoring methods compared to white British. Focus group results highlighted self-monitoring as most acceptable and ambulatory monitoring least without consistent differences by ethnicity. Clinic monitoring was seen as inconvenient and anxiety provoking but with the advantage of immediate professional input. $\textit{Conclusions:}$ Reduced acceptability and completion rates amongst minority ethnic groups raise important questions for the implementation and interpretation of blood pressure monitoring in general and ambulatory monitoring in particular. Selection of method for blood pressure monitoring should take into account clinical need and patient preference as well as consideration of potential cultural barriers to monitoring.National Institute for Health Research (Grant ID: PB-PG-1207-15042

Ethnicity and differences between clinic and ambulatory blood pressure measurements.

BACKGROUND: This study investigated the relationship of ethnicity to the differences between blood pressure (BP) measured in a clinic setting and by ambulatory blood pressure monitoring (ABPM) in individuals with a previous diagnosis of hypertension (HT) and without a previous diagnosis of hypertension (NHT). METHODS: A cross-sectional comparison of BP measurement was performed in 770 participants (white British (WB, 39%), South Asian (SA, 31%), and African Caribbean (AC, 30%)) in 28 primary care clinics in West Midlands, United Kingdom. Mean differences between daytime ABPM, standardized clinic (mean of 3 occasions), casual clinic (first reading on first occasion), and last routine BP taken at the general practitioner practice were compared in HT and NHT individuals. RESULTS: Daytime systolic and diastolic ABPM readings were similar to standardized clinic BP (systolic: 128 (SE 0.9) vs. 125 (SE 0.9) mm Hg (NHT) and 132 (SE 0.7) vs. 131 (SE 0.7) mm Hg (HT)) and were not associated with ethnicity to a clinically important extent. When BP was taken less carefully, differences emerged: casual clinic readings were higher than ABPM, particularly in the HT group where the systolic differences approached clinical relevance (131 (SE 1.2) vs. 129 (SE 1.0) mm Hg (NHT) and 139 (SE 0.9) vs. 133 (SE 0.7) mm Hg (HT)) and were larger in SA and AC hypertensive individuals (136 (SE 1.5) vs. 133 (SE 1.2) mm Hg (WB), 141 (SE 1.7) vs. 133 (SE 1.4) mm Hg (SA), and 142 (SE 1.6) vs. 134 (SE 1.3) mm Hg (AC); mean differences: 3 (0-7), P = 0.03 and 4 (1-7), P = 0.01, respectively). Differences were also observed for the last practice reading in SA and ACs. CONCLUSIONS: BP differences between ethnic groups where BP is carefully measured on multiple occasions are small and unlikely to alter clinical management. When BP is measured casually on a single occasion or in routine care, differences appear that could approach clinical relevance.This report presents independent research funded by the National Institute for Health Research (NIHR).The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of HealthThis is a pre-copyedited, author-produced PDF of an article accepted for publication in American Journal of Hypertension following peer review. The version of record, Am J Hypertens (2014) doi: 10.1093/ajh/hpu211, is available online at: http://ajh.oxfordjournals.org/content/early/2014/11/18/ajh.hpu211.long

Measurement of blood pressure for the diagnosis and management of hypertension in different ethnic groups: one size fits all.

BACKGROUND: Hypertension is a major risk factor for cardiovascular disease and prevalence varies by ethnic group. The diagnosis and management of blood pressure are informed by guidelines largely based on data from white populations. This study addressed whether accuracy of blood pressure measurement in terms of diagnosis of hypertension varies by ethnicity by comparing two measurement modalities (clinic blood pressure and home monitoring) with a reference standard of ambulatory BP monitoring in three ethnic groups. METHODS: Cross-sectional population study (June 2010 - December 2012) with patients (40-75 years) of white British, South Asian and African Caribbean background with and without a previous diagnosis of hypertension recruited from 28 primary care practices. The study compared the test performance of clinic BP (using various protocols) and home-monitoring (1 week) with a reference standard of mean daytime ambulatory measurements using a threshold of 140/90 mmHg for clinic and 135/85 mmHg for out of office measurement. RESULTS: A total of 551 participants had complete data of whom 246 were white British, 147 South Asian and 158 African Caribbean. No consistent difference in accuracy of methods of blood pressure measurement was observed between ethnic groups with or without a prior diagnosis of hypertension: for people without hypertension, clinic measurement using three different methodologies had high specificity (75-97%) but variable sensitivity (33-65%) whereas home monitoring had sensitivity of 68-88% and specificity of 64-80%. For people with hypertension, detection of a raised blood pressure using clinic measurements had sensitivities of 34-69% with specificity of 73-92% and home monitoring had sensitivity (81-88%) and specificity (55-65%). CONCLUSIONS: For people without hypertension, ABPM remains the choice for diagnosing hypertension compared to the other modes of BP measurement regardless of ethnicity. Differences in accuracy of home monitoring and clinic monitoring (higher sensitivity of the former; higher specificity of the latter) were also not affected by ethnicity

Influence of ethnicity on acceptability of method of blood pressure monitoring: a cross-sectional study in primary care.

BACKGROUND: Ambulatory and/or home monitoring are recommended in the UK and the US for the diagnosis of hypertension but little is known about their acceptability. AIM: To determine the acceptability of different methods of measuring blood pressure to people from different minority ethnic groups. DESIGN AND SETTING: Cross-sectional study with focus groups in primary care in the West Midlands. METHOD: People of different ethnicities with and without hypertension were assessed for acceptability of clinic, home, and ambulatory blood pressure measurement using completion rate, questionnaire, and focus groups. RESULTS: A total of 770 participants were included, who were white British (n = 300), South Asian (n = 241), and African Caribbean (n = 229). White British participants had significantly higher successful completion rates across all monitoring modalities compared with the other ethnic groups, especially for ambulatory monitoring: white British (n = 277, 92% [95% confidence interval [CI] = 89% to 95%]) versus South Asian (n = 171, 71% [95% CI = 65% to 76%], P<0.001) and African Caribbean (n = 188, 82% [95% CI = 77% to 87%], P<0.001), respectively. There were significantly lower acceptability scores for minority ethnic participants across all monitoring methods compared with white British participants. Focus group results highlighted self-monitoring as most acceptable and ambulatory monitoring least acceptable without consistent differences by ethnicity. Clinic monitoring was seen as inconvenient and anxiety provoking but with the advantage of immediate professional input. CONCLUSION: Reduced acceptability and completion rates among minority ethnic groups raise important questions for the implementation and interpretation of blood pressure monitoring. Selection of method of blood pressure monitoring should take into account clinical need, patient preference, and potential cultural barriers to monitoring

Interarm Difference in Systolic Blood Pressure in Different Ethnic Groups and Relationship to the "White Coat Effect": A Cross-Sectional Study.

BACKGROUND: Interarm differences (IADs) ≥10 mm Hg in systolic blood pressure (BP) are associated with greater incidence of cardiovascular disease. The effect of ethnicity and the white coat effect (WCE) on significant systolic IADs (ssIADs) are not well understood. METHODS: Differences in BP by ethnicity for different methods of BP measurement were examined in 770 people (300 White British, 241 South Asian, 229 African-Caribbean). Repeated clinic measurements were obtained simultaneously in the right and left arm using 2 BPTru monitors and comparisons made between the first reading, mean of second and third and mean of second to sixth readings for patients with, and without known hypertension. All patients had ambulatory BP monitoring (ABPM). WCE was defined as systolic clinic BP ≥10 mm Hg higher than daytime ABPM. RESULTS: No significant differences were seen in the prevalence of ssIAD between ethnicities whichever combinations of BP measurement were used and regardless of hypertensive status. ssIADs fell between the 1st measurement (161, 22%), 2nd/3rd (113, 16%), and 2nd-6th (78, 11%) (1st vs. 2nd/3rd and 2nd-6th, P < 0.001). Hypertensives with a WCE were more likely to have ssIADs on 1st, (odds ratio [OR] 1.73 (95% confidence interval 1.04-2.86); 2nd/3rd, (OR 3.05 (1.68-5.53); and 2nd-6th measurements, (OR 2.58 (1.22-5.44). Nonhypertensive participants with a WCE were more likely to have a ssIAD on their first measurement (OR 3.82 (1.77 to -8.25) only. CONCLUSIONS: ssIAD prevalence does not vary with ethnicity regardless of hypertensive status but is affected by the number of readings, suggesting the influence of WCE. Multiple readings should be used to confirm ssIADs