Objectives: Healthcare services for people living with dementia (PLWD) are stretched, and government promises of increased funding remain undelivered. With the UK dementia population to surpass 1 million by 2024, and dementia care costs predicted to almost treble by 2040, it is essential we understand differences in healthcare use among PLWD. This study aimed to explore social and spatial variations in healthcare use among people diagnosed with dementia (2002-2016). Methods: Data were derived from Electronic Health Records of Clinical Practice Research Datalink GP patients in England (n = 142,302). To standardise healthcare contacts, rates of healthcare contacts per year were calculated for three primary (GP observations and medications) and three secondary healthcare types [Accident & Emergency (A&E) attendances and, emergency and elective hospital admissions]. Fully-adjusted generalised linear regression models were used to identify healthcare use variation by social and spatial groups. Twelve models were generated, one for each healthcare type in early- and late-onset populations separately. Results: This study highlights numerous social and spatial variations in healthcare use among PLWD. Among PLWD, several groups tended to have healthcare service use more closely associated with negative outcomes, including a greater likelihood of A&E attendances and emergency and elective hospital admissions. These groups include: men, people from White ethnicity groups and people from more deprived and rural areas. Conclusions: Systemic and social measures are needed to reduce variations in healthcare use inequalities in PWLD. These include greater healthcare continuity, health checks and medicines reviews, culturally appropriate services, better and more accessible treatment and improved infrastructure.
Climate change impacts are an increasing threat to forests and current approaches to management. In 2020, Climate-smart Forestry (CSF) definition and set of indicators was published. This study further developed this work by testing the definition and indicators through a forest manager survey across fifteen member European countries. The survey covered topic areas of demographics, climate change impacts, definition and indicators assessment, as well as knowledge and communication. Overall, forest managers considered the threat of climate change to their forests as high or critical and 62% found the CSF definition clear and concise; however, the minority suggested greater simplification or nuance. Indicators were viewed as comprehensive but too numerous to integrate into management activities. Two highest ranking indicators were ‘Trees species composition’, and ‘Erosion protection and maintenance of soil condition’. Many managers were aware of suitable alternative species, but also stressed that greater resources should focus on exploring adaptable provenances. Demonstration sites and interactive guides were ranked highest for communication and dissemination; however, online multimedia tools and workshops were also ranked highly. Local perspectives on providing more relevant CSF ranged from silviculture systems, finance and funding, education and training, and social awareness, to tree species mixes and development of protective functions. In summary, forest managers were generally open to CSF, but required greater guidance and proof of application.
It became clear at the onset of the pandemic that radiography could play an important role in diagnosing and staging COVID-19. The key modality would be mobile chest radiography. However, at the onset of the pandemic, no literature existed to indicate whether or not chest X-ray imaging could be used effectively to diagnose or exclude COVID-19. This article explains how a website was created, at speed, during the initial phase of the COVID-19 pandemic. Containing holistic information, the website helped enable rapid redeployment of radiographers onto the frontline where chest X-ray imaging was needed. It aimed to help train radiographers take (and interpret) chest radiographs in high-risk areas that contained large numbers of COVID-19 patients. Within one year, the website had been used in 157 countries. This article documents the approach taken to create the website and suggestions are made about how, in the future, a rapid approach could be achieved to create other websites – should an international crisis occur again. This paper also outlines how stakeholders and content authors from across the world were brought together and supported to create the website. It goes on to explain the leadership style that was adopted to create the website and why that style was selected. An explanation is offered about the project management approach and how its ingredients relate to a published model. Aside from simply providing a historical account of how the website was created, we hope the narrative offers food for thought on how to respond rapidly during an international crisis to formulate and implement a unified international-level solution which addresses an urgent need.
• Background and aim: Wherever sunlight reaches litter, there is potential for photodegradation to contribute to decomposition. Although recent studies have weighed the contribution of short wavelength visible and ultraviolet (UV) radiation as drivers of photodegradation, the relative importance of each spectral region across biomes and plant communities remains uncertain. • Methods: We performed a systematic meta-analysis of studies that assessed photodegradation through spectrally selective attenuation of solar radiation, by synthesizing 30 published studies using field incubations of leaf litter from 110 plant species under ambient sunlight. • Results: Globally, the full spectrum of sunlight significantly increased litter mass loss by 15.3% ± 1% across all studies compared to darkness. Blue light alone was responsible for most of this increase in mass loss (13.8% ± 1%), whereas neither UV radiation nor its individual constituents UV-B and UV-A radiation had significant effects at the global scale, being only important in specific environments. These waveband-dependent effects were modulated by climate and ecosystem type. Among initial litter traits, carbon content, lignin content, lignin to nitrogen ratio and SLA positively correlated with the rate of photodegradation. Global coverage of biomes and spectral regions was uneven across the meta-analysis potentially biasing the results, but also indicating where research in lacking. • Conclusions: Across studies attenuating spectral regions of sunlight, our meta-analysis confirms that photodegradation is a significant driver of decomposition, but this effect is highly dependent on the spectral region considered. Blue light was the predominant driver of photodegradation across biomes rather than UV radiation.
The Ionising Radiations Regulations 2017 require employers to restrict radiation doses to their employees and the public to be As Low As Reasonably Practicable (ALARP). This article looks at the boundary between what might be considered to be reasonable and unreasonable in protecting staff and the general public in the field of hospital-based diagnostic radiology. A simple test for locating this boundary based on a cost-benefit approach is devised and its use illustrated using hospital-based radiation protection examples. It is concluded that a cost-benefit calculation based on the legal definition of ALARP may have some use in the support of radiation protection decision-making in the hospital environment, but only within the context of existing legal, practical and ethical considerations.
Natural sediment flocs are fragile and highly heterogeneous aggregates of biogenic and minerogenic material typically with high porosity and low density. In aquatic environments dominated by fine, cohesive or mixed sediments they can dominate suspended sediment flux. Consequently, monitoring and modelling the behaviour, transport and distribution of flocs is very important for many aquatic industries, maintenance of waterways and conservation and management of aquatic waterbodies. Mathematical models that predict the behaviour of flocs rely on the accurate assessments of the size, shape, density, porosity and fractal dimension of flocs. These inherently 3-dimensional (3D) characteristics are typically derived from 2-dimensional (2D) data, largely due to the challenges associated with sampling, capturing, imaging and quantifying these fragile aggregates. We have developed new volumetric microscopy techniques which can quantify 3D internal and external structures and characteristics of sediment flocs. Here, these techniques were applied to quantify the 3D size (volume), shape and fractal dimension of natural and artificial sediment flocs and compare them to standard 2D approaches. Our study demonstrates that 2D approaches are under-estimating shape complexity and over-estimating the size and mass settling flux of flocs by up to two orders of magnitude, and the discrepancy between 2D and 3D is most marked for natural, organic rich macroflocs. Our study has significant implications for estimations of sediment flux at local to global scales within in aquatic environments. These new data and approaches offer the potential to improve the current parameterisation of sediment transport models and to improve the accuracy of current field-monitoring techniques.
The intense footwork required in flamenco dance may result in pain and injury. This study aimed to quantify the external load of the flamenco Zapateado-3 (Zap-3) footwork via triaxial accelerometry in the form of PlayerLoad (PL), comparing the difference in external loads at the fifth lumbar vertebra (L5), the seventh cervical vertebra (C7) and the dominant ankle (DA), and to explore whether the speed, position, axis and proficiency level of the flamenco dancer affected the external load. Twelve flamenco dancers, divided into professional and amateur groups, completed a 15-s Zap-3 footwork routine at different speeds. Triaxial accelerometry sensors were positioned at the DA, L5 and C7 and were utilized to calculate the total PlayerLoad (PLTOTAL), uniaxial PlayerLoad (PLUNI) and uniaxial contributions (PL%). For both PLTOTAL and PLUNI, this study identified significant effects of speed and position (p < 0.001), as well as the interaction between speed and position (p ≤ 0.001), and at the DA, values were significantly higher (p < 0.001) than those at C7 and L5. Significant single axis and group effects (p < 0.001) and effects of the interactions between the position and a single axis and the group and speed (p ≤ 0.001) were also identified for PLUNI. Medial-lateral PL% represented a larger contribution compared with anterior-posterior PL% and vertical PL% (p < 0.001). A significant interaction effect of position and PL% (p < 0.001) also existed. In conclusion, the Zap-3 footwork produced a significant external load at different positions, and it was affected by speed, axis and the proficiency level of the flamenco dancer. Although the ankle bears the most external load when dancing the flamenco, some external load caused by significant vibrations is also borne by the lumbar and cervical vertebrae.
Improving public engagement in ecological research improves the visibility of science and educates a wider audience about the value of ecology and its study. To this end, we assess the success of two simple activities, designed to track forest cover and understorey conditions, implemented at Lammi Biological Station Science Trail, Finland, in terms of effective public participation and useability of the data generated. We consider how best to engage participants in the activities, and we validate the data obtained by comparison of its reliability and useability against standard ecological approaches. It is also increasingly timely for researchers to utilise the large datasets that can be generated through effective public engagement. If experiments are effectively designed, these data can provide information at a larger scale than is attainable with the resources typically available to individual research projects. Consequently, given high enough uptake, such activities hold the potential for upscaling or generalisation from their findings. Both activities proved useful to collect more intensive data than would otherwise have been feasible. The quadrat vegetation survey (Activity 1) provided useable data to determine species phenology but not species composition. The canopy disk observations (Activity 2) reliably tracked seasonal changes in canopy cover when calibrated against baseline data. Training in these activities fostered engagement in how climate change affects forest ecology, improving the quality of data collected, and engaging participants eager to learn about and contribute to research into these processes.
Understanding the factors that influence the decisions made by victims of domestic violence and abuse (DVA) has, for some time, been a key area of focus for professionals working within the Criminal Justice System and academic researchers alike. Using female victims’ reported decision-making around incidences of DVA as an illustrative case study, this article analyses N=120 police victim statements (PVSs), collected by officers in one force in Northwest England. The usefulness of a PVS as a form of qualitative research data to better understand DVA is examined by means of a deductive content analysis. Drawing on the literature addressing decision-making by victims in DVA, a simple coding frame was developed to provide a structure for the initial investigation of the PVSs to examine the type of data contained in these legal documents. Findings suggest that, while they have some limitations, PVSs are a valuable and currently under-utilised form of qualitative data to research and understand victim decision-making in DVA.
Purpose: The introduction of whole slide imaging and digital pathology has enabled greater scrutiny of visual search behaviors among pathologists. We aim to investigate zooming and panning behaviors, external markers of visual processing capabilities, and the changes with experience. Approaches: Twenty digitized breast core needle biopsy histopathology slides were obtained from the circulating slides from the main digital pathology trial (IRAS number: 258799). These were presented to five pathologists with varying experience (1.5 to 40 years) whose examinations were recorded. Data of visual fixations were collected using eye-tracking cameras, and the magnification data and zooming behaviors were extracted in an objective fashion by an automated algorithm. The relationship between experience and metrics was analyzed using mixed-effects regression analyses. Results: There was a significant association between experience and both reading times ( p < 0.001 ) and a number of fixations ( p < 0.001 ), with these relationships being inversely proportional. The greater experience was also associated with greater diagnostic accuracy ( p = 0.033 ). We found that experience was significantly associated with greater use of magnification changes ( p < 0.001 ). Conversely, less experience showed a near significant association with the increased proportion of time spent panning ( p = 0.070 ). Conclusions: Fewer fixations needed to reach a diagnosis and quicker reading times are indicative of greater cognitive and visual processing capabilities with greater experience. These cognitive capabilities may be a prerequisite for the more frequent zooming changes that are more prevalent with increasing experience.
Previous studies have addressed some of the issues of customers' perceptions of mobile marketing, particularly the affordances of multiple communications and channels. Despite a proliferation of studies in this field, the theoretical exploration of luxury fashion customers' perceptions of multiple mobile communications and marketing channels remains at an exploratory stage. Drawing on the elaboration likelihood model and a social constructivist perspective, the current study conducted 37 in-depth interviews with Generation Z mobile luxury customers. We specifically examined how customers' emotionally and cognitively based perceptions emerge as they navigate multiple mobile marketing channels and message communications. Our model conceptualizes four elements of customers' perceptions of their mobile marketing journey that can drive mobile customer engagement and acquisition behavior. The integrative model opens up interesting avenues for further research on mobile marketing and luxury fashion consumers’ perceptions of the effects of multiple communications and marketing channels.
Emerging technologies have the potential to create new industries and transform existing ones, particularly the promotion of sustainable transitions in the luxury fashion industry [...]
Optimising patient care through the delivery of specialist resource allocation at the point of injury improves patient outcomes. As identified by the NHS, high-quality call handling and dispatch of the right response, first time, is critical to these outcomes ( NHS, 2015 ). Aim This article presents an objective literature review and critical analysis of the evidence base concerning clinical dispatch. This study aims to highlight key differences between the triage and dispatch processes of specialist resources, to establish if the evidence supports the use of one model to manage these resources, and to ascertain best practice. Method A structured literature review was undertaken and thematic analysis was used to explore the findings of the literature, leading to the establishment of recommendations for best practice in this area. Results The literature discourages dispatching specialist teams based solely on computer-aided dispatch software codes, and recognises that specialist paramedic dispatchers have a better understanding of the clinical and ethical challenges of appropriately dispatching specialist, finite resources. Conclusion The literature supports the use of clinicians in dispatching specialist resources to best meet the needs of those patients who are critically ill or injured.
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