Navigating the food environment: lived experiences of managing type 2 diabetes mellitus through dietary change

This thesis portfolio aimed to understand the lived experiences of individuals with T2DM who make changes to their diet and lifestyle, to lose weight as a way to manage their T2DM condition. The first chapter is a systematic review, using a thematic synthesis methodology to explore individual’s experiences of proposed dietary modifications with a weight loss focus. Four themes were identified that helped us to understand the commonalities and differences in people’s experiences of this approach. We learned that providing tailored nutritional information that is comprehensible and culturally appropriate needed to be prioritised. We also identified a number of additional avenues for research exploration, and consideration from a policy perspective, given the variability in guidance offered for individuals. The second chapter built upon what was learned from this review, and specifically focused on one weight loss focused intervention delivered in NHS Lothian, Scotland. An interpretive phenomenological approach was employed, which allowed the researchers to explore patients' experiences on a case-by-case basis, and in depth. The research provides two vantage perspectives by participants of the programme showcasing the experience of those beginning and ending the weight management intervention. The findings allow a greater depth of understanding of the emotional voyage of being diagnosed with T2DM and undertaking this programme to make health behaviour change. There are a number of insights that provide scope for future research avenues and clinical considerations

Evaluation ofthe Middle East and North Africa Land Data Assimilation System

The Middle East and North Africa (MENA) region is dominated by dry, warm deserts, areas of dense population, and inefficient use of fresh water resources. Due to the scarcity, high intensity, and short duration of rainfall in the MENA, the region is prone to hydro climatic extremes that are realized by devastating floods and times of drought. However, given its widespread water stress and the considerable demand for water, the MENA remains relatively poorly monitored. This is due in part to the shortage of meteorological observations and the lack of data sharing between nations. As a result, the accurate monitoring of the dynamics of the water cycle in the MENA is difficult. The Land Data Assimilation System for the MENA region (MENA LDAS) has been developed to provide regional, gridded fields of hydrological states and fluxes relevant for water resources assessments. As an extension of the Global Land Data Assimilation System (GLDAS), the MENA LDAS was designed to aid in the identification and evaluation of regional hydrological anomalies by synergistically combining the physically-based Catchment Land Surface Model (CLSM) with observations from several independent data products including soil-water storage variations from the Gravity Recovery and Climate Experiment (GRACE) and irrigation intensity derived from the Moderate Resolution Imaging Spectroradiometer (MODIS). In this fashion, we estimate the mean and seasonal cycle of the water budget components across the MENA

Organising design in the wild: locating multidisciplinarity as a way of working

The workplace ecology for a multidisciplinary design team is studied to examine the ways that design is organised in the wild. Detailed is an ethnographic account of the events and practices that were seen in patterned and subtle ways to organise the design work for a project. Design events and activities were distributed in nested contexts throughout the office setting. The design work was seen to be planned, self-organised and coordinated through a series of practical actions and events that occurred in different locations. There was no single, identifiable event, interaction or communicative medium in which the coordination of the design work occurred. From these insights, multidisciplinarity is proposed as a way of organising design work that cuts across some design interfaces. This way of procuring design services is contingent on the appointment of a design firm with multi-disciplinary expertise, in an arrangement where the design work is undertaken collaboratively in a co-located setting with underpinning information systems

Epidemiology and outcomes from out-of-hospital cardiac arrests in England

Introduction This study reports the epidemiology and outcomes from out-of-hospital cardiac arrest (OHCA) in England during 2014. Methods Prospective observational study from the national OHCA registry. The incidence, demographic and outcomes of patients who were treated for an OHCA between 1st January 2014 and 31st December 2014 in 10 English ambulance service (EMS) regions, serving a population of almost 54 million, are reported in accordance with Utstein recommendations. Results 28,729 OHCA cases of EMS treated cardiac arrests were reported (53 per 100,000 of resident population). The mean age was 68.6 (SD = 19.6) years and 41.3% were female. Most (83%) occurred in a place of residence, 52.7% were witnessed by either the EMS or a bystander. In non-EMS witnessed cases, 55.2% received bystander CPR whilst public access defibrillation was used rarely (2.3%). Cardiac aetiology was the leading cause of cardiac arrest (60.9%). The initial rhythm was asystole in 42.4% of all cases and was shockable (VF or pVT) in 20.6%. Return of spontaneous circulation at hospital transfer was evident in 25.8% (n = 6302) and survival to hospital discharge was 7.9%. Conclusion Cardiac arrest is an important cause of death in England. With less than one in ten patients surviving, there is scope to improve outcomes. Survival rates were highest amongst those who received bystander CPR and public access defibrillation