Studies of Adrenal Androgens

Imperial Users onl

The aspirations and expectations of young people attending a Welsh-medium and an English-medium school in the South Wales Valley

This qualitative study explores the aspirations and expectations of fifty-two young people attending a Welsh-medium and an English-medium school in the South Wales Valleys (an area which has undergone significant and economic changes as a result of deindustrialisation). These young people were first interviewed at the start of Year 11 when they were considering their futures after compulsory education. Some of these young people were interviewed again approximately a year after to explore whether they were able to achieve their aspirations and to examine whether their long-term aspirations had changed. This study illustrates how wider trends such as the contraction of the youth labour market and increasing participation rates in further and higher education as well as transformations in the local labour market have changed the way in which young people understand their educational and employment prospects. Different to some of the young people in Brown’s (1987) Schooling Ordinary Kids study, all of the young people in this study aspired to stay in some form of education and training after Year 11. This study also identifies three types of students – The Academic Inheritors, the Academic Strivers and Vocational students – which differ in terms of their orientations to education and occupational futures. There are also variations between these types of students in terms of their social background, educational experiences and the character and usage of their social networks. The different types of students highlight the limitations of accounts which present Rational Choice Theory (associated with the work of Boudon (1974) and Goldthorpe (1998)) and Bourdieu’s Cultural Reproduction Theory as opposing/competing explanatory theories. This study also compared and contrasted the aspirations and expectations of young people who attended a Welsh-medium and an English-medium school. This study shows how school choice has an impact on the social composition of Welsh-medium and English-medium schools in South East Wales, with Welsh-medium schools on average having lower proportions of students from poorer households compared to English-medium schools. School choice provides some explanation for the differences between the aspirations of young people attending the Welsh-medium and the English-medium school in this study. This study offers a new analysis of the aspirations and expectations of young people finishing compulsory education, in a context of significant social and economic change. It also makes an original contribution by exploring the aspirations of young people who attend a Welsh-medium and an English-medium school – something which has not been explored in depth before by researchers. In addition, this study contributes towards debates regarding the extent that Rational Choice Theory and Bourdieu’s Cultural Reproduction Theory are able to explain young people’s aspirations and expectations. In attempting to explain differences in student orientations, it also shows that it is extremely difficult to empirically test the relative merits of these theories and as such contributes to existing discussions of educational opportunities and inequalities. This study also has policy implications regarding how key actors such as policymakers and schools can provide support to young people to fulfil and achieve their aspirations

Studies in pianistic sonority, nuance and expression: French performance practices in the piano works of Maurice Ravel

This thesis traces the development of Maurice Ravel’s pianism in relation to sonority, nuance and expression by addressing four main areas of research that have remained largely unexplored within Ravel scholarship: the origins of Ravel’s pianism and influences to which he was exposed during his formative training; his exploration of innovative pianistic techniques with particular reference to thumb deployment; his activities as performer and teacher, and role in defining a performance tradition for his piano works; his place in the French pianistic canon. Identifying the main research questions addressed in this study, an Introduction outlines the dissertation content, explains the criteria and objectives for the performance component (Public Recital) and concludes with a literature review. Chapter 1 explores the pianistic techniques Ravel acquired during his formative training, and considers how his study of specific works from the nineteenth-century piano repertory shaped and influenced his compositional style and pianism. Chapter 2 discusses Ravel’s implementation of his idiosyncratic ‘strangler’ thumbs as articulators of melodic, harmonic, rhythmic and textural material in selected piano works. Ravel’s role in defining a performance tradition for his piano works as disseminated to succeeding generations of pianists is addressed in Chapter 3, while Chapters 4 and 5 evaluate Ravel’s impact upon twentieth-century French pianism through considering how leading French piano pedagogues and performers responded to his trailblazing piano techniques. It will be shown that through his activities as teacher and performer, as well as composer, Ravel took control of every detail pertaining to his piano works with his meticulously notated scores, piano roll recordings and interpretive guidance imparted to other pianists, thus catalysing performance practices that promulgated a distinctively French twentieth-century pianistic tradition

A Case of Treatment Resistance and Complications in a Patient with Stiff Person Syndrome and Cerebellar Ataxia

BACKGROUND: Antibodies against glutamic acid decarboxylase (GAD) are associated with Stiff Person Syndrome (SPS). CASE REPORT: A 50-year-old woman presented with symptoms progressed over 9 years, resulting in a cerebellar ataxia and right upper limb tremor. Investigations revealed elevated serum and CSF anti-GAD antibody titres (98.6 and 53.4 μ/ml, respectively). Treatment included intravenous immunoglobulin and immunomodulation (infliximab and rituximab), improving her stiffness, but with no impact on the ataxia-related symptoms. Subsequent high-dose steroids led to diabetic ketoacidosis and unmasking of an insulin-dependent diabetes mellitus. DISCUSSION: This case illustrates several key features: (1) the combined clinical picture of SPS and cerebellar ataxia is a rare phenotype associated with anti-GAD antibodies; (2) the cerebellar ataxia described was progressive and poorly responsive to immunomodulatory therapy; and (3) the potential for development of further autoimmune sequelae in response to immunosuppression, namely, the development of insulin-dependent diabetes in response to treatment with high-dose oral steroids

Intervention planning for Antibiotic Review Kit (ARK): a digital and behavioural intervention to safely review and reduce antibiotic prescriptions in acute and general medicine

Background Hospital antimicrobial stewardship strategies, such as ‘Start Smart, Then Focus’ in the UK, balance the need for prompt, effective antibiotic treatment with the need to limit antibiotic overuse using ‘review and revise’. However, only a minority of review decisions are to stop antibiotics. Research suggests that this is due to both behavioural and organizational factors. Objectives To develop and optimize the Antibiotic Review Kit (ARK) intervention. ARK is a complex digital, organizational and behavioural intervention that supports implementation of ‘review and revise’ to help healthcare professionals safely stop unnecessary antibiotics. Methods A theory-, evidence- and person-based approach was used to develop and optimize ARK and its implementation. This was done through iterative stakeholder consultation and in-depth qualitative research with doctors, nurses and pharmacists in UK hospitals. Barriers to and facilitators of the intervention and its implementation, and ways to address them, were identified and then used to inform the intervention’s development. Results A key barrier to stopping antibiotics was reportedly a lack of information about the original prescriber’s rationale for and their degree of certainty about the need for antibiotics. An integral component of ARK was the development and optimization of a Decision Aid and its implementation to increase transparency around initial prescribing decisions. Conclusions The key output of this research is a digital and behavioural intervention targeting important barriers to stopping antibiotics at review (see http://bsac-vle.com/ark-the-antibiotic-review-kit/ and http://antibioticreviewkit.org.uk/). ARK will be evaluated in a feasibility study and, if successful, a stepped-wedge cluster-randomized controlled trial at acute hospitals across the NHS

Seabed morphology and bed shear stress predict temperate reef habitats in a high energy marine region

High energy marine regions host ecologically important habitats like temperate reefs, but are less anthropogenically developed and understudied compared to lower energy waters. In the marine environment direct habitat observation is limited to small spatial scales, and high energy waters present additional logistical challenges and constraints. Semi-automated predictive habitat mapping is a cost-effective tool to map benthic habitats across large extents, but performance is context specific. High resolution environmental data used for predictive mapping are often limited to bathymetry, acoustic backscatter and their derivatives. However, hydrodynamic energy at the seabed is a critical habitat structuring factor and likely an important, yet rarely incorporated, predictor of habitat composition and spatial patterning. Here, we used a machine learning classification approach to map temperate reef substrate and biogenic reef habitat in a tidal energy development area, incorporating bathymetric derivatives at multiple scales and simulated tidally induced seabed shear stress. We mapped reef substrate (four classes: sediment (not reef), stony reef (low resemblance), stony reef (medium – high resemblance) and bedrock reef) with overall balanced accuracy of 71.7%. Our model to predict potential biogenic Sabellaria spinulosa reef performed less well with an overall balanced accuracy of 63.4%. Despite low performance metrics for the target class of potential reef in this model, it still provided insight into the importance of different environmental variables for mapping S. spinulosa biogenic reef habitat. Tidally induced mean bed shear stress was one of the most important predictor variables for both reef substrate and biogenic reef models, with ruggedness calculated at multiple scales from 3 m to 140 m also important for the reef substrate model. We identified previously unresolved relationships between temperate reef spatial distribution, hydrodynamic energy and seabed three-dimensional structure in energetic waters. Our findings contribute to a better understanding of the spatial ecology of high energy marine ecosystems and will inform evidence-based decision making for sustainable development, particularly within the growing tidal energy sector