Divergence or convergence? Health inequalities and policy in a devolved Britain

Since the advent of political devolution in the UK, it has been widely reported that markedly different health policies have emerged. However, most of these analyses are based on a comparison of health care policies and, as such, only tell part of a complex and evolving story. This paper considers official responses to a shared public health policy aim, the reduction of health inequalities, through an examination of national policy statements produced in England, Scotland and Wales respectively since 1997. The analysis suggests that the relatively consistent manner in which the ‘policy problem’ of health inequalities has been framed combined with the dominance of a medical model of health have constrained policy responses. Our findings differ from existing analyses, raising some important questions about the actuality of, and scope for, policy divergence since devolution

Walking, landscape and visual culture: how walkers engage with and conceive of the landscapes in which they walk

Walking in the countryside is an increasingly popular pursuit in Britain. Much previous research within the social sciences has tended to concentrate on the physiological benefits, barriers or facilitators to walking. This thesis explores particular walkers’ complex motivations for and modes of walking, their individual engagements with certain types of (northern) landscapes and the significance of specific kinds of visual images, traditions and wider practices of looking. Constructions and discourses of landscape are considered in relation to the persistence of certain ideas and aesthetic traditions as well as and in relation to current concerns about individual health and social well-being. The research is multi-disciplinary and engages with studies of art history and visual culture, cultural geography, anthropology and sociology. Visual studies research methods are used to explore individual interpretations and experiences of landscapes, and how the circulation and consumption of particular kinds of images might inform attitudes to walks and walking. Walkers’ views and attitudes have been investigated using an ethnographic approach. In-depth qualitative interviews (including photo elicitation) have been undertaken with walkers who regularly walked five or more miles in the countryside either in organised groups, on their own or with friends and family, in order to capture how walking is perceived, felt, and made sense of. A grounded theory approach has been used for the interviews, building on theories that emerged from systematic comparative analysis, and were grounded in the fieldwork. Overall the thesis observes a marked persistence of and some striking similarities between particular ideas, cultural traditions and interpretations of walking in and ways of looking at types of countryside from the Romantic period to the present day

Older people’s views and experiences of engagement in standardised patient simulation

Background - The last two decades have witnessed initiatives aimed at improving the care of older people, including educating nurses so that they are equipped with the skills to care for older people with frailty and complex multimorbidities. It has been suggested that involvement of older service-users in nurse education can facilitate the development of nurses’ caring skills by promoting understanding of the reality of older people’s situations. One method of involving older service-users is standardised patient simulation. While some recent studies have acknowledged the importance of considering standardised patients’ experiences and perceptions of simulation, to-date few have focused specifically on the experiences of older people. Methods - In this qualitative study, data was collected via focus groups whereby older people were invited to discuss their views and experiences of involvement in SPS. Data were analysed using open coding. Findings - Four themes emerged from the data, demonstrating that involving older people in SPS may be beneficial for their wellbeing. The four themes were: ‘using personal experiences to improve care’, ‘having a sense of purpose’, ‘preparation and support for SPS’, and ‘feeling appreciated’. Discussion - Whilst most participants reported that they enjoyed the SPS activities, engagement appeared to have had a much deeper significance for them. Many participants’ responses suggested that involvement assisted them to ‘make sense’ of their experiences of illness and healthcare, and also gave a sense of purpose, of belonging and of being valued. Conclusion - Findings support the need for nurse educators to consider developing SPS programmes that involve older people

PyZebrascope: An Open-Source Platform for Brain-Wide Neural Activity Imaging in Zebrafish

Understanding how neurons interact across the brain to control animal behaviors is one of the central goals in neuroscience. Recent developments in fluorescent microscopy and genetically-encoded calcium indicators led to the establishment of whole-brain imaging methods in zebrafish, which record neural activity across a brain-wide volume with single-cell resolution. Pioneering studies of whole-brain imaging used custom light-sheet microscopes, and their operation relied on commercially developed and maintained software not available globally. Hence it has been challenging to disseminate and develop the technology in the research community. Here, we present PyZebrascope, an open-source Python platform designed for neural activity imaging in zebrafish using light-sheet microscopy. PyZebrascope has intuitive user interfaces and supports essential features for whole-brain imaging, such as two orthogonal excitation beams and eye damage prevention. Its camera module can handle image data throughput of up to 800 MB/s from camera acquisition to file writing while maintaining stable CPU and memory usage. Its modular architecture allows the inclusion of advanced algorithms for microscope control and image processing. As a proof of concept, we implemented a novel automatic algorithm for maximizing the image resolution in the brain by precisely aligning the excitation beams to the image focal plane. PyZebrascope enables whole-brain neural activity imaging in fish behaving in a virtual reality environment. Thus, PyZebrascope will help disseminate and develop light-sheet microscopy techniques in the neuroscience community and advance our understanding of whole-brain neural dynamics during animal behaviors.Peer Reviewe

Diagnosing malignant melanoma in ambulatory care: a systematic review of clinical prediction rules.

OBJECTIVES: Malignant melanoma has high morbidity and mortality rates. Early diagnosis improves prognosis. Clinical prediction rules (CPRs) can be used to stratify patients with symptoms of suspected malignant melanoma to improve early diagnosis. We conducted a systematic review of CPRs for melanoma diagnosis in ambulatory care. DESIGN: Systematic review. DATA SOURCES: A comprehensive search of PubMed, EMBASE, PROSPERO, CINAHL, the Cochrane Library and SCOPUS was conducted in May 2015, using combinations of keywords and medical subject headings (MeSH) terms. STUDY SELECTION AND DATA EXTRACTION: Studies deriving and validating, validating or assessing the impact of a CPR for predicting melanoma diagnosis in ambulatory care were included. Data extraction and methodological quality assessment were guided by the CHARMS checklist. RESULTS: From 16 334 studies reviewed, 51 were included, validating the performance of 24 unique CPRs. Three impact analysis studies were identified. Five studies were set in primary care. The most commonly evaluated CPRs were the ABCD, more than one or uneven distribution of Colour, or a large (greater than 6 mm) Diameter (ABCD) dermoscopy rule (at a cut-point of \u3e4.75; 8 studies; pooled sensitivity 0.85, 95% CI 0.73 to 0.93, specificity 0.72, 95% CI 0.65 to 0.78) and the 7-point dermoscopy checklist (at a cut-point of ≥1 recommending ruling in melanoma; 11 studies; pooled sensitivity 0.77, 95% CI 0.61 to 0.88, specificity 0.80, 95% CI 0.59 to 0.92). The methodological quality of studies varied. CONCLUSIONS: At their recommended cut-points, the ABCD dermoscopy rule is more useful for ruling out melanoma than the 7-point dermoscopy checklist. A focus on impact analysis will help translate melanoma risk prediction rules into useful tools for clinical practice