Barriers to the growth of artificial intelligence within the NHS

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Trailing Fire: Working in the Woods and the Future of Forests in a Chaotic Climate

Our national conversation about wildfire is shifting. As wildland fires become larger, more frequent, more severe, and more expensive—and as climate change and land-use patterns drive the trend toward more fire—we’re scrambling to find a different paradigm for engaging with fire. Scientists now call this age of increasingly extreme burning the Pyrocene, and we’re just beginning to grapple with its impacts on the way we work, play, and live on the land. As a longtime trail worker for the U.S. Forest Service, I’ve spent hundreds of days clearing trails in burned forests. In Trailing Fire, I draw on these experiences to show how we have yet to reckon with wildfire’s longer-term effects on outdoor recreation, and to explore what that means for how humans connect with wild spaces. As outdoor recreation surges across the country, putting public lands in the spotlight and prompting important conversations about equity, inclusion, and access in the outdoors, federal recreation budgets keep shrinking, forcing smaller crews to keep up with the impacts of exploding use. Meanwhile, more fire means trail-maintenance workloads are growing, as the effects of severe burns persist for years, if not decades. While approaches to preparing for and fighting wildfire are changing at both a policy and community level, federal land managers have no comprehensive strategy for addressing the impacts of fire on recreation and trails. And that’s a problem, because recreation provides a portal through which vast numbers of Americans connect with wild spaces. Extreme fire regimes, by limiting access to the outdoors, threaten opportunities for understanding fire’s historic and future role in our shared landscapes. I illustrate these complexities by sharing vivid stories from my years of restoring burned trails, at the same time tracing my evolving understanding of reciprocity between communities, landscapes, and the fires that shape them. Trailing Fire weaves personal narrative with ecological and political context, offering an intimate and original perspective on living and working in the Pyrocene

Investigating talent attraction: percieved attractiveness of non-financial reward elements by means of an experimental design

Includes bibliographical references.The changing nature of work and an increased global need for organisations to remain competitive in the war for scarce skills and talent has influenced the manner in which organisations manage their talent. Organisations are altering their strategic imperatives to include more effective and highly attractive reward packages that attract top talented employees. As a result this could increase their competitive advantage in the market. Lately however, financial rewards and money is no longer enough to attract, motivate or retain employees. These changes have led organisations to seek out non-financial attraction rewards that are most effective in harnessing top talent. The main objective of this study was to establish which non-financial rewards and what combinations of these rewards were perceived to be most attractive to employees when considering a job offering. A secondary objective was to establish which non-financial rewards were most attractive to various demographic groups namely: gender, race, and age

Experiences of the food environment and the role of the ‘routine’ in producing food practices: an ethnography of Sandwell residents

PhDDespite a sustained academic interest in food environments and their impact upon dietary practices, relatively little is known about the ways in which individuals interact with the food environment. The multiple and complex factors that influence food choices are difficult to investigate, especially in the family setting where individual and collective practices intersect. This thesis investigates how people perform food practices and unpacks how specific contexts shape, promote and constrain food behaviours. The case study through which this is examined is that of the food practices of 26 residents of Sandwell, a uniformly deprived metropolitan borough in the West Midlands. Through ethnographically collecting accounts and observations of how residents performed food practices, both in the home and while shopping for food, highly routinized behaviours were revealed. The notion of routinized decision making, as it appears in social science research, is developed and adapted to incorporate descriptions of general approaches to routine food behaviours. The novel concept of routines-of-practice is employed to characterise these routines in terms of agency, attitudes towards individualism, and reliance on environmental and contextual cues. Food shopping practices are positioned, to an extent, as acts of consumerism performed in the pervasive consumption environment of the supermarket. The home, by contrast, was depicted as a site of both privacy and responsibility. The ways in which responsibility was interpreted and enacted dictated how family meals and routine home food behaviours were structured. By looking at food practices in terms of repetitive, context specific and often uncritical behaviours, this thesis highlights the importance of place in moulding food practices. Understanding how people interact and interpret their environment has been underestimated in diet-related health policy and promotion. This thesis specifically examines the way food practices are influenced by environment and context at the micro level

The Effects of Self-Monitoring on the Disruptive Behavior of Students Identified as Severely Behavior Disordered

The study investigated the effects of self-monitoring on the disruptive behaviors of four male senior high school students who were identified as having severe behavior disorders. Using a multiple baseline across subjects design, the students were randomly assigned to 30, 25, 20, and 15 days, respectively, of intervention conditions. The independent variable consisted of self-monitoring of ten appropriate behaviors that had been cooperatively identified by the students and teacher; each student was required to classify his behavior as appropriate or inappropriate at five intervals during their mathematics class. The dependent variables, measured daily, were the mean frequency of occurrence of appropriate behaviors and the percentage scores on mathematics assignments. Inter-rater reliability checks indicated high reliabilities for both dependent variables. The agreement for each subject was 98%, 96%, 97%, and 93%, respectively. The results showed an increase in the mean number of appropriate behaviors during intervention conditions and a slight decrease during the maintenance phase. The mathematics scores, while variable during intervention, showed a high net increase between baseline and maintenance phase. The author concluded that, for high school students identified as having behavior problems, self- monitoring may have a positived effect on both disruptive behavior and academic achievement

The lost part-timers: The decline of part-time undergraduate higher education in England

Part-time undergraduate study has an important role both in widening participation and in developing skills. Since 2010, the number of part-time undergraduate entrants living in England attending UK universities and English further education colleges has fallen annually. By 2015, the numbers nationally had decreased by 51%, by 63% at the Open University, and by 45% at other UK universities and FE colleges. These numbers continue to fall. This report examines the reasons for this decline and especially the role of the 2012 student funding reforms

Heart failure: re-evaluating causes and definitions and the value of routine cardiac magnetic resonance (CMR) imaging

Objective To differentiate the demographics and imaging characteristics of a heart failure population using a comprehensive echocardiographic protocol and routine CMR imaging, and to assess the clinical value of routine CMR in this population. Methods A novel comprehensive diagnostic pathway for heart failure was prospectively applied to 319 new patients attending the Darlington and Bishop Auckland heart failure clinic between May 2013 and July 2014. All had a full clinical assessment and an initial basic clinical transthoracic echo performed. Those patients given a diagnosis of heart failure went on to have routine CMR imaging as well as a more detailed echo scan incorporating a variety of systolic and diastolic measurements. Retrospectively, a cohort of 116 patients with left ventricular systolic impairment, that had both CMR and invasive coronary angiography, were analysed to determine the ability of late gadolinium enhancement (LGE) CMR to predict prognostic coronary artery disease. Main results 1. Heart failure with reduced ejection fraction (HFREF) accounted for the cause of heart failure in 73% of cases whereas heart failure with preserved ejection fraction (HFPEF) accounted for only 14% of cases. 2. Incorporating CMR into the routine assessment of newly diagnosed heart failure patients changed the diagnosis in 22% of cases (14% of cases for those who had an echo performed on the same day). 3. CMR left ventricular ejection fraction (LVEF) averages 3.9% units higher than Simpson’s Biplane LVEF with echo. 4. Regional wall motion score (RWMS) equations were inferior to a Simpson’s Biplane assessment of LVEF by echo and cannot be advocated for routine clinical use. 5. The presence of subendocardial LGE on CMR demonstrated infarcts in 42% of those with HFREF, 20% of those with HFPEF, and 40% of those with heart failure with no major structural disease (HFNMSD). 6. The absence of subendocardial LGE excluded prognostic coronary disease in 100% of cases. 7. LGE in a non subendocardial distribution was prevalent in both the HFREF and HFPEF community with a greater average burden in the HFPEF group. 8. E/e’ and left atrial volume index (LAVI) were the most helpful echo measures for a positive diagnosis of HFPEF and could be measured in over 90% of cases. 9. Systolic dysfunction out with reduced ejection fraction is present in 76% of the HFPEF cohort. Conclusion Heart failure with preserved ejection fraction (HFPEF) is not the epidemic previous literature would have us believe. It is over-diagnosed in current practice due to lax definitions and inappropriately low left ventricular ejection fraction (LVEF) cut-offs. CMR has a substantial impact on the diagnostic profile of the heart failure population. It revokes the diagnosis of HFREF to a greater extent than is accounted for by the temporal improvement in LVEF, even when taking into account method specific LVEF thresholds. CMR with LGE has additive value for identifying infarcts in a sizeable number of patients for whom there is no suspicion of ischaemic heart disease (IHD), and raising the novel concept that ischaemia may account for symptoms in many of those with HFNMSD. It also demonstrates an impressive ability to exclude prognostic coronary disease. Additionally, LGE in a non subendocardial distribution establishes aetiology including myocarditis and sarcoidosis that would not be detected with echo alone. The diagnosis of heart failure with preserved ejection fraction is not standardised and all current protocols are deficient. The cause and mechanism of this condition remains unclear and this study helped clarify the contribution of systolic versus diastolic dysfunction versus simply the presence of atrial fibrillation. Key diagnostic parameters were identified for routine clinical use and CMR LGE imaging demonstrating a greater average burden of non subendocardial LGE may support the postulated fibrotic infiltrative mechanism of pathology in this group

Barriers to the growth of artificial intelligence within the NHS

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Ethical barriers to artificial intelligence in the national health service, United Kingdom of Great Britain and Northern Ireland

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