Vegetation and floristic diversity in Gibraltar Range and part of Washpool National Parks, New South Wales

The vegetation of Gibraltar Range National Park and adjoining parts of eastern Washpool National Park, 65 km east of Glen Innes (29° 31’S 152° 18’E) on the eastern escarpment of New South Wales is described. In total 124, 20m x 50m full vascular plant floristic sites were recorded and information from an additional 53 sites was collated. Thirteen vegetation assemblages are defined based on flexible UPGMA analysis of cover-abundance scores of all vascular plant taxa. Many of the vegetation communities are typical of what is found along the north eastern escarpment of NSW. Three communities are considered to be rare and two vulnerable. A total of 878 vascular plant taxa from 138 families were recorded, of which only 21 (2%) were of introduced origin and 81 (9%) were found to be of conservation significance. Pattern diversity, species density, species accumulation and average geographic range size, along with general measures of richness and diversity, were analysed for all communities. Each of the communities described varied considerably in the diversity attributes measured. Communities with a high number of shrubs had greater constancy between sites compared to those that contained a high number of closed forest species. The community from rock outcrops had the largest average geographical range size

Cost-effectiveness of diagnostic laparoscopy for assessing resectability in pancreatic and periampullary cancer.

Surgical resection is the only curative treatment for pancreatic and periampullary cancer, but many patients undergo unnecessary laparotomy because tumours can be understaged by computerised tomography (CT). A recent Cochrane review found diagnostic laparoscopy can decrease unnecessary laparotomy. We compared the cost-effectiveness of diagnostic laparoscopy prior to laparotomy versus direct laparotomy in patients with pancreatic and periampullary cancer with resectable disease based on CT scanning

Cost-Effectiveness Analysis of Endoscopic Ultrasound versus Magnetic Resonance Cholangiopancreatography in Patients with Suspected Common Bile Duct Stones.

Patients with suspected common bile duct (CBD) stones are often diagnosed using endoscopic retrograde cholangiopancreatography (ERCP), an invasive procedure with risk of significant complications. Using endoscopic ultrasound (EUS) or Magnetic Resonance CholangioPancreatography (MRCP) first to detect CBD stones can reduce the risk of unnecessary procedures, cut complications and may save costs

'Thanks to London and to God': living religion transnationally among Brazilian migrants in London and 'back home' in Brazil

PhDThis thesis explores the role of religion in the everyday, transnational lives of Brazilian migrants in London and on their return to Brazil. It contributes to an emerging body of work that recognises the importance of religion within transnational processes and foregrounds the experiences of Brazilians in London, a growing yet still largely invisible new migrant group in London. While the study explores the role of religious institutions in the transnational lives of Brazilian migrants, it works with the notion of religion as lived experience to give due weight to the perspectives of migrants themselves. It examines the ways in which migrants negotiate their religious beliefs and practices in different places and create new connections between them. The study draws on a qualitative methodological framework, which included 78 in-depth interviews with Brazilian migrants in London and on their return to Brazil, religious leaders, and migrants’ family members. It also involved extended participant observation in one Catholic and one evangelical Protestant church in London, as well as at community events and in migrants’ domestic spaces in London and five ‘sending’ towns in Brazil. Empirically, the project reveals some of the ways in which religion functions transnationally through examining how religious institutions and their leaders adapt to new contexts, and how religion becomes a crucial resource for migrants at all stages of their migration experience, including on their return. With reference to migrants’ own stories, it explores the ways that they draw on religion to cope with particular challenges related to migration, but also how engagement with the spiritual enables migrants to give meaning to their experiences. The thesis develops the concept of transnational religious spaces to highlight the ways in which religion permeates the spaces of transnationalism and functions within and across multiple scales, including the global, the local, the institutional, the individual, the corporeal and the virtual. These spaces incorporate those who migrate, those who return ‘back home’, and migrants’ families who experience the absence of their loved ones. Yet while transnational religious spaces can enable migrants to create alternative spaces of belonging, I argue that they can also be exclusionary, creating new barriers at the same time as opening up existing ones. I also propose a related concept of religious remittances whereby changing religious practices and beliefs are transferred across borders, adapting to new contexts

Writing the Present: Notation in Barthes’s Collège de France lectures

In his lectures at the Collège de France in 1978–1979, Barthes focuses at length on the activity of ‘la notation’ (in English, notation): grabbing a fleeting event or impression as it happens, and registering it in your notebook. This article explores the ramifications of notation, as outlined in the lectures (where it is associated with haiku, Joycean epiphany and Proustian impressionism), linking it to Barthes’s longstanding interest in the ontology of modes of signification. Allied to his concept of the ‘third meaning’, and to later terms such as the incident and the romanesque, notation is seen to be central to the preoccupation with affect, subjectivity and individuality we associate with Barthes’s later work. Linked with the fantasy of writing a novel, notation also chimes with the “fantasmatic pedagogy” of Barthes’s lectures where ideas are explored in a highly personal way through the accumulation of discontinuous traits. Through notation the affect-driven, decentred Barthesian subject finds its voice

Home-city geographies: urban dwelling and mobility

Developing an agenda to conceptualise the connections between the domestic and the urban, this paper focuses on urban domesticities (homemaking in the city), domestic urbanism (the city as home) and the home-city geographies that connect them. Home-city geographies examine the interplay between lived experiences of urban homes and the contested domestication of urban space. Reflecting the ways in which urban homes and the ability to feel at home in the city are shaped by different migrations and mobilities, the paper demonstrates that not only home and the city, but also urban dwelling and mobility, are intertwined rather than separate

The Longitudinal Impact of Social Media Use on UK Adolescents' Mental Health: Longitudinal Observational Study

BACKGROUND: Cross-sectional studies have found a relationship between social media use and depression and anxiety in young people. However, few longitudinal studies using representative data and mediation analysis have been conducted to understand the causal pathways of this relationship. OBJECTIVE: This study aims to examine the longitudinal relationship between social media use and young people's mental health and the role of self-esteem and social connectedness as potential mediators. METHODS: The sample included 3228 participants who were 10- to 15-year-olds from Understanding Society (2009-2019), a UK longitudinal household survey. The number of hours spent on social media was measured on a 5-point scale from "none" to "7 or more hours" at the ages of 12-13 years. Self-esteem and social connectedness (number of friends and happiness with friendships) were measured at the ages of 13-14 years. Mental health problems measured by the Strengths and Difficulties Questionnaire were assessed at the ages of 14-15 years. Covariates included demographic and household variables. Unadjusted and adjusted multilevel linear regression models were used to estimate the association between social media use and mental health. We used path analysis with structural equation modeling to investigate the mediation pathways. RESULTS: In adjusted analysis, there was a nonsignificant linear trend showing that more time spent on social media was related to poorer mental health 2 years later (n=2603, β=.21, 95% CI 0.43 to 0.84; P=.52). In an unadjusted path analysis, 68% of the effect of social media use on mental health was mediated by self-esteem (indirect effect, n=2569, β=.70, 95% CI 0.15-1.30; P=.02). This effect was attenuated in the adjusted analysis, and it was found that self-esteem was no longer a significant mediator (indirect effect, n=2316, β=.24, 95% CI 0.12 to 0.66; P=.22). We did not find evidence that the association between social media and mental health was mediated by social connectedness. Similar results were found in imputed data. CONCLUSIONS: There was little evidence to suggest that more time spent on social media was associated with later mental health problems in UK adolescents. This study shows the importance of longitudinal studies to examine this relationship and suggests that prevention strategies and interventions to improve mental health associated with social media use could consider the role of factors like self-esteem

The longitudinal effect of social media use on adolescent mental health in the UK: findings from the UK Longitudinal Household Study

BACKGROUND: Cross-sectional studies have suggested an association between the use of social media and depression and anxiety in young people. We examined the longitudinal relationship between social media use and young people's mental health, and the role of self-esteem and social connectedness as potential mediators. METHODS: Adolescents (aged 10-15 years) from the UK Longitudinal Household Study (2009-19) were included. Mental health was measured by the Strengths and Difficulties Questionnaire Total Difficulties score. The number of hours spent on social media was measured on a 5-point scale, from zero to ≥7 h. Self-esteem and social connectedness were measured at ages 13-14 years. Covariates included demographic and household variables. Unadjusted and adjusted multilevel linear regression models explored whether social media use at ages 12-13 years predicted mental health at ages 14-15 years (expressed as beta values and 95% CIs). Path analysis with structural equation modelling was used to investigate the mediation pathways. FINDINGS: We included 3228 adolescents (1659 [51·4%] girls and 1569 [48·6%] boys) for whom social media and mental health data at ages 12-13 years and 14-15 years were available. In adjusted analysis, no association between time spent on social media and poorer mental health was identified (n=2603; b=0·21 [95% CI -0·43 to 0·84]; p=0·52). In adjusted path analysis, there was no mediation of self-esteem (indirect effect; n=2316; b=0·24 [95% CI -0·12 to 0·66]; p=0·22) or social connectedness (indirect effect; -0·03 [-0·20 to 0·12]; p=0·74), but in unadjusted analysis, 68% of the effect of social media use on mental health was mediated by self-esteem (indirect effect; n=2569; 0·70 [0·15 to 1·30]; p=0.016) but not by social connectedness. Similar results were found when the analysis was re-run on a multiply imputed dataset that filled in missing values using multiple imputation. INTERPRETATION: Our data show the importance of longitudinal evidence. We found there was little evidence to suggest a causal relationship between the use of social media and mental health issues 2 years later. Interventions that address social media use alone might not improve young people's mental health, and considering factors such as self-esteem might be more effective. FUNDING: UK National Institute for Health Research School for Public Health Research (grant reference PD-SPH-2015). The views expressed are those of the authors and not necessarily those of the National Institute for Health Research or the UK Department of Health and Social Care

Workplace Interventions to Reduce Occupational Stress for Older Workers: A Systematic Review

The working life of individuals is now longer because of increases to state pension age in the United Kingdom. Older workers may be at particular risk in the workplace, compared with younger workers. Successful workplace interventions to reduce occupational stress amongst older workers are essential, but little is known about their effectiveness. The aim is to evaluate current evidence of the effectiveness of interventions for reducing stress in older workers in non-healthcare settings. Four database searches were conducted. The search terms included synonyms of “intervention”, “workplace” and “occupational stress” to identify original studies published since 2011. Dual screening was conducted on the sample to identify studies which met the inclusion criteria. The RoB 2.0 tool for RCTs was used to assess the risk of bias. From 3708 papers retrieved, ten eligible papers were identified. Seven of the papers’ interventions were deemed effective in reducing workplace stress. The sample size for most studies was small, and the effectiveness of interventions were more likely to be reported when studies used self-report measures, rather than biological measures. This review indicates that workplace interventions might be effective for reducing stress in older workers. However, there remains an absence of high-quality evidence in this field

Comparing primary and secondary health-care use between diagnostic routes before a colorectal cancer diagnosis: Cohort study using linked data

BACKGROUND: Survival in cancer patients diagnosed following emergency presentations is poorer than those diagnosed through other routes. To identify points for intervention to improve survival, a better understanding of patients' primary and secondary health-care use before diagnosis is needed. Our aim was to compare colorectal cancer patients' health-care use by diagnostic route. METHODS: Cohort study of colorectal cancers using linked primary and secondary care and cancer registry data (2009-2011) from four London boroughs. The prevalence of all and relevant GP consultations and rates of primary and secondary care use up to 21 months before diagnosis were compared across diagnostic routes (emergency, GP-referred and consultant/other). RESULTS: The data set comprised 943 colorectal cancers with 24% diagnosed through emergency routes. Most (84%) emergency patients saw their GP 6 months before diagnosis but their symptom profile was distinct; fewer had symptoms meeting urgent referral criteria than GP-referred patients. Compared with GP-referred, emergency patients used primary care less (IRR: 0.85 (95% CI 0.78-0.93)) and urgent care more frequently (IRR: 1.56 (95% CI 1.12; 2.17)). CONCLUSIONS: Distinct patterns of health-care use in patients diagnosed through emergency routes were identified in this cohort. Such analyses using linked data can inform strategies for improving early diagnosis of colorectal cancer