An examination of the development of standards, protocols and standard operating procedures in forensic radiography

Forensic Radiography has seen a rapid development over the last 20 years with the evolution of new technologies, but perhaps more significantly development of policy and guidelines for radiographers, the adoption of standards and standard operating procedures and changes in education and training. This thesis explores the author’s contribution to the body of knowledge in this discipline through the use of participatory action research which was undertaken through a sequence of iterative cycles over time. The author, as practitioner-researcher, examined the practice of forensic radiography through these cycles of data gathering, studying a number of different operational situations, each of which presented specific organisational issues requiring resolution. Practitioners and service users as members of the organisational system were active participants in the cyclical process of planning, taking action and evaluating the actions. Longitudinal, cross sectional and case study research designs employed observation and reflection, focus groups and multidisciplinary group discussions, questionnaires and semi-structured interviews. These led to collaborative findings and the development of new knowledge that was applied to subsequent situations, which were then further examined and refined within an overarching action research model. The thesis highlights the author’s new contributions to the body of knowledge from the respective studies and resultant publications with specific reference to the development of standards, protocols and standard operating procedures in forensic radiography

Development of fisheries co-management in Cambodia : a case study and its implications

The livelihoods and food security of many Cambodians depend heavily on inland capture fisheries, so the sustainable management of these fisheries is very important. Notwithstanding, the sustainability of Mekong fisheries is threatened by increasing fishing pressure and habitat modifications. Current management is considered insufficiently capable of controlling levels of exploitation and achieving equitable distribution of the resource, and the Cambodian government is promoting co-management initiatives as a way of addressing these issues. Using an institutional analysis approach, the current performance of co-management in a Mekong mainstream fishery was assessed, and factors limiting success identified. Results suggest that performance and sustainability of co-management are currently constrained by a lack of clearly defined property rights and resource boundaries, a mismatch between resource scale and management initiatives, and an absence of enabling legislation. Furthermore, objectives for management differ between stakeholders and are not well defined overall. While enabling legislation due to come into effect shortly is expected to improve performance and sustainability of co-management, boundary and scale issues will continue to pose challenges to co-management in open systems such as the Mekong mainstream. As a result, calls for innovative solutions, such as a federation of co-management schemes, will continue. In addition, increasing dependence on fishing, and external threats to resources need to be addressed if sustainability is to be improvedFishery management, Inland fisheries, Cambodia,

Socioeconomics and values of resources in great Lake-Tonle Sap and Mekong-Bassac area : results from a sample survey in Kampong Chhnang, Siem Reap and Kandal provinces, Cambodia

Socioeconomics aspects, Fishery economics, Cambodia,

Adolescent inpatient activity 1999–2010: analysis of English Hospital Episode Statistics data

Objective: To investigate patterns and trends of adolescent (10–19 years) inpatient activity in England by sex, disease category, and admitting speciality. Data 9 632 844 Finished Consultant Episodes (FCEs) from English patients aged 1–19 between 1999/2000 and 2010/2011 (Hospital Episode Statistics data). Analyses Age trends by sex and major International Classification of Disease 10 (ICD10) chapter; differences in activity rates by age and sex; inpatient activity trends over the past decade, disaggregated by sex, admitting speciality and ICD10 chapter. Results: Adolescent female patients account for more activity than girls aged 1–9 (139.4 vs 107.2 FCEs/1000). Female inpatient activity increases significantly between age 10 (70.9 FCEs/1000) and 19 (281.7 FCES/1000, of which non-obstetric care accounts for 155.9 FCEs/1000). Male activity increases much less during adolescence, with lower overall rates among adolescents than younger children (93.7 vs 142.9 FCEs/1000). Between 1999 and 2010, total adolescent inpatient activity increased faster among adolescents (10–19 years) (+14.2%) than younger children (1–9 years) (+11.0%). Adolescent FCEs/1000 increased by 12.8%, including higher rates admitted under Paediatrics (+47.5%) and Paediatric Surgery (+23.2%). Adolescents were admitted across a range of specialities. Conclusions: These data challenge the belief that adolescents are a healthy group who rarely use inpatient services. In England, use of inpatient services is higher among female patients aged 10–19 years than those aged 1–9 years, while adolescent activity has increased faster than for younger children over the past 11 years. Improving service quality for adolescents will require engagement of the many different teams that care for them

Childhood obesity and device-measured sedentary behaviour: an instrumental variable analysis of 3,864 mother–offspring pairs

Objective: Intergenerational data on mother–offspring pairs were utilized in an instrumental variable analysis to examine the longitudinal association between BMI and sedentary behavior. Methods: The sample included 3,864 mother–offspring pairs from the 1970 British Cohort Study. Height and weight were recorded in mothers (age 31 [5.4] years) and offspring (age 10 years) and repeated in offspring during adulthood. Offspring provided objective data on sedentary behavior (7‐day thigh‐worn activPAL) in adulthood at age 46 to 47 years. Results: Maternal BMI, the instrumental variable, was associated with offspring BMI at age 10 (change per kg/m2, β = 0.11; 95% CI: 0.09 to 0.12), satisfying a key assumption of instrumental variable analyses. Offspring (change per kg/m2, β = 0.010; 95% CI: −0.02 to 0.03 h/d) and maternal BMI (β = 0.017; 95% CI: 0.001 to 0.03 h/d) was related to offspring sedentary time, suggestive of a causal impact of BMI on sedentary behavior (two‐stage least squares analysis, β = 0.18 [SE 0.08], P = 0.015). For moderate‐vigorous physical activity, there were associations with offspring BMI (β = −0.010; 95% CI: −0.017 to −0.004) and maternal BMI (β = −0.007; 95% CI: −0.010 to −0.003), with evidence for causality (two‐stage least squares analysis, β = −0.060 [SE 0.02], P = 0.001). Conclusions: There is strong evidence for a causal pathway linking childhood obesity to greater sedentary behavior

Perceptions of health risk among parents of overweight children: a cross-sectional study within a cohort.

OBJECTIVE: To identify the socio-demographic and behavioural characteristics associated with perceptions of weight-related health risk among the parents of overweight children. METHODS: Baseline data from a cohort of parents of children aged 4-11 years in five areas in England in 2010-2011 were analysed; the sample was restricted to parents of overweight children (body mass index ≥ 91(st) centile of UK 1990 reference; n=579). Associations between respondent characteristics and parental perception of health risk associated with their child's weight were examined using logistic regression analyses. RESULTS: Most parents (79%) did not perceive their child's weight to be a health risk. Perception of a health risk was associated with recognition of the child's overweight status (OR 10.59, 95% CI 5.51 to 20.34), having an obese child (OR 4.21, 95% CI 2.28 to 7.77), and having an older child (OR 2.67, 95% CI 1.32 to 5.41). However, 41% of parents who considered their child to be overweight did not perceive a health risk. CONCLUSIONS: Parents that recognise their child's overweight status, and the parents of obese and older children, are more likely to perceive a risk. However, many parents that acknowledge their child is overweight do not perceive a related health risk

Risk and protective factors for meningococcal disease in adolescents: matched cohort study

Objective: To examine biological and social risk factors for meningococcal disease in adolescents. Design: Prospective, population based, matched cohort study with controls matched for age and sex in 1:1 matching. Controls were sought from the general practitioner. Setting: Six contiguous regions of England, which represent some 65% of the country’s population. Participants: 15-19 year olds with meningococcal disease recruited at hospital admission in six regions (representing 65% of the population of England) from January 1999 to June 2000, and their matched controls. Methods: Blood samples and pernasal and throat swabs were taken from case patients at admission to hospital and from cases and matched controls at interview. Data on potential risk factors were gathered by confidential interview. Data were analysed by using univariate and multivariate conditional logistic regression. Results: 144 case control pairs were recruited (74 male (51%); median age 17.6). 114 cases (79%) were confirmed microbiologically. Significant independent risk factors for meningococcal disease were history of preceding illness (matched odds ratio 2.9, 95% confidence interval 1.4 to 5.9), intimate kissing with multiple partners (3.7, 1.7 to 8.1), being a university student (3.4, 1.2 to 10) and preterm birth (3.7, 1.0 to 13.5). Religious observance (0.09, 0.02 to 0.6) and meningococcal vaccination (0.12, 0.04 to 0.4) were associated with protection. Conclusions: Activities and events increasing risk for meningococcal disease in adolescence are different from in childhood. Students are at higher risk. Altering personal behaviours could moderate the risk. However, the development of further effective meningococcal vaccines remains a key public health priority

Childhood obesity and device-measured sedentary behavior : an instrumental variable analysis of 3,864 mother-offspring pairs

Objective Intergenerational data on mother-offspring pairs were utilized in an instrumental variable analysis to examine the longitudinal association between BMI and sedentary behavior. Methods The sample included 3,864 mother-offspring pairs from the 1970 British Cohort Study. Height and weight were recorded in mothers (age 31 [5.4] years) and offspring (age 10 years) and repeated in offspring during adulthood. Offspring provided objective data on sedentary behavior (7-day thigh-worn activPAL) in adulthood at age 46 to 47 years. Results Maternal BMI, the instrumental variable, was associated with offspring BMI at age 10 (change per kg/m(2), beta = 0.11; 95% CI: 0.09 to 0.12), satisfying a key assumption of instrumental variable analyses. Offspring (change per kg/m(2), beta = 0.010; 95% CI: -0.02 to 0.03 h/d) and maternal BMI (beta = 0.017; 95% CI: 0.001 to 0.03 h/d) was related to offspring sedentary time, suggestive of a causal impact of BMI on sedentary behavior (two-stage least squares analysis, beta = 0.18 [SE 0.08], P = 0.015). For moderate-vigorous physical activity, there were associations with offspring BMI (beta = -0.010; 95% CI: -0.017 to -0.004) and maternal BMI (beta = -0.007; 95% CI: -0.010 to -0.003), with evidence for causality (two-stage least squares analysis, beta = -0.060 [SE 0.02], P = 0.001). Conclusions There is strong evidence for a causal pathway linking childhood obesity to greater sedentary behavior

Estimating the effects of preventive and weight-management interventions on the prevalence of childhood obesity in England: a modelling study

BACKGROUND: The effects of the systematic delivery of treatments for obesity are unknown. We aimed to estimate the potential effects on the prevalence of childhood obesity of systematically offering preventive and treatment interventions to eligible children in England, based on weight or health status. METHODS: For this modelling study, we developed a cross-sectional simulation model of the child and young adult population in England using data from multiple years of the Health Survey of England conducted between Jan 1, 2010, and Dec 31, 2019. Individuals were assessed for eligibility via age, BMI, and medical complications. Weight status was defined based on clinical criteria used by the UK National Institute of Health and Care Excellence. Published systematic reviews were used to estimate effect sizes for treatments, uptake, and completion for each weight-management tier. We used all available evidence, including evidence from studies that showed an unfavourable effect. We estimated the effects of two systematic approaches: a staged approach, in which children and young people were simultaneously given the most intensive treatment for which they were eligible, and a stepped approach, in which each management tier was applied sequentially, with additive effects. The primary outcomes were estimated prevalence of clinical obesity, defined as a BMI ≥98th centile on the UK90 growth chart, and difference in comparison with the estimated baseline prevalence. FINDINGS: 18 080 children and young people were included in the analytical sample. Baseline prevalence of clinical obesity was estimated to be 11·2% (95% CI 10·5 to 11·8) for children and young people aged 2-18 years. In modelling, we estimated absolute decreases in the prevalence of obesity of 0·9% (95% CI 0·1 to 1·8) for universal, preventive interventions; 0·2% (0·1 to 0·4) for interventions within a primary-care setting; 1·0% (0·1 to 2·1) for community and lifestyle interventions; 0·2% (0·0 to 0·4) for pharmaceutical interventions; and 0·4% (0·1 to 0·7) for surgical interventions. Staged care was estimated to result in an absolute decrease in the prevalence of obesity of 1·3% (-0·3 to 2·4) and stepped care was estimated to lead to an absolute decrease of 2·4% (0·1 to 4·8). INTERPRETATION: Although individual effect sizes for prevention and treatment interventions were small, when delivered at scale across England, these interventions have the potential to meaningfully contribute to reducing the prevalence of childhood obesity. FUNDING: UK National Institute for Health and Care Research

Patterns of BMI development between 10-42 years of age and their determinants in the 1970 British Cohort Study

Background Mixture modelling is a useful approach to identify sub-groups in a population who share similar trajectories. We aimed to identify distinct BMI trajectories between 10-42 years and investigate how known early-life risk factors are related to trajectories. Methods Sample: 9,187 participants in the 1970 British Birth Cohort Study, with BMI observations between 10-42 years and data on birth-weight, parental BMI, socioeconomic status (SES), breastfeeding and puberty. Latent growth mixture modelling in Mplus was used to model age-related BMI trajectories and test associations of risk factors with trajectory membership. Results A three latent class model was most credible; 1) Normative: 92%: started normal weight but gradually increased BMI to become overweight in adulthood; 2) Childhood onset persistent obesity (COP): 4%: persistently high BMI from childhood; 3) Adolescent and young adulthood onset obesity (AYAO): 4%: normal weight in childhood but had a steep ascending trajectory. Higher maternal and paternal BMI and early puberty increased the probability of being in either the COP or the AYAO classes compared with the normative class. Conclusion Most individuals gradually increased BMI and became overweight in mid-adulthood. Only 8% demonstrated more severe BMI trajectories. Further research is needed to understand the underlying body composition changes and health risks in the COP and AYAO classes