University of London

Introduction: Artificial Intelligence (AI) has the potential to transform medical imaging and radiotherapy; both fields where radiogra-phers' use of AI tools is increasing. This study aimed to explore the views of those professionals who are now using AI tools. Methods: A small-scale exploratory research process was employed, where qualitative data was obtained from five UK-based participants; all professionals working in medical imaging and radiotherapy who use AI in clinical practice. Five semi-structured interviews were conducted online. Verbatim transcription was performed using an open-source automatic speech recognition model. Conceptual content analysis was performed to analyse the data and identify common themes. Results: Participants spoke about the possibility of AI deskilling staff and changing their roles, they discussed issues around data protection and data sharing strategies, the important role of effective leadership of AI teams, and the seamless integration into workflows. Participants thought that the benefits of adopting AI were smoother clinical work-flows, support for the workforce in decision-making, and enhanced patient safety/care. They also highlighted the need for tailored AI ed-ucation/training, multidisciplinary teamwork and support. Conclusion: Participants who are now using AI tools felt that clinical staff should be empowered to support AI implementation by adopting new and clearly defined roles and responsibilities. They suggest that attention to patient care and safety is a key to successful AI adoption. Despite the increasing adoption of AI, participants in the UK described a gap in knowledge with professionals still needing clear guidance, education and training regarding AI in preparation for more widespread adoption.

Background The COVID-19 pandemic accelerated the adoption of remote care, or telemedicine, in many clinical areas including maternity care. One component of remote care, the use of self-monitoring of blood pressure in pregnancy, could form a key component in post-pandemic care pathways. The BUMP trials evaluated a self-monitoring of blood pressure intervention in addition to usual care, testing whether it improved detection or control of hypertension for pregnant people at risk of hypertension or with hypertension during pregnancy. This paper reports the qualitative evaluation which aimed to understand how the intervention worked, the perspectives of participants in the trials, and, crucially, those who declined to participate. Methods The BUMP trials were conducted between November 2018 and May 2020. Thirty-nine in-depth qualitative interviews were carried out with a diverse sample of pregnant women invited to participate in the BUMP trials across five maternity units in England. Results Self-monitoring of blood pressure in the BUMP trials was reassuring, acceptable, and convenient and sometimes alerted women to raised BP. While empowering, taking a series of self-monitored readings also introduced uncertainty and new responsibility. Some declined to participate due to a range of concerns. In the intervention arm, the performance of the BUMP intervention may have been impacted by women’s selective or delayed reporting of raised readings and repeated testing in pursuit of normal BP readings. In the usual care arm, more women were already self-monitoring their blood pressure than expected. Conclusions The BUMP trials did not find that among pregnant individuals at higher risk of preeclampsia, blood pressure self-monitoring with telemonitoring led to significantly earlier clinic-based detection of hypertension nor improved management of blood pressure. The findings from this study help us understand the role that self-monitoring of blood pressure can play in maternity care pathways. As maternity services consider the balance between face-to-face and remote consultations in the aftermath of the COVID-19 pandemic, these findings contribute to the evidence base needed to identify optimal, effective, and equitable approaches to self-monitoring of blood pressure.

Introduction Advancing research and support for neurologically diverse populations requires novel data harmonisation methods that are capable of aligning with contemporary approaches to understanding health and disability. Objectives We present the International Classification of Functioning, Disability and Health (ICF) as a conceptual framework to support harmonisation of mental health data and present a proof of principle within the Risk and Resilience in Developmental Diversity and Mental Health (R2D2-MH) consortium. Method 138 measures from various mental health datasets were linked to the ICF following the WHO’s established linking rules. Findings Findings support the notion that the ICF can assist in the harmonisation of mental health data. The high level of shared ICF codes provides indications of where items may be readily harmonised to develop datasets that may align more readily with contemporary approaches to understanding health and disability. Although the linking process necessarily entails an element of subjectivity, the application of established rules can increase rigour and transparency of the harmonisation process. Conclusions We present the first steps towards data harmonisation in mental health that is compatible with contemporary approaches in psychiatry, being more capable of capturing diversity and aligning with more transdiagnostic and neurodiversity-affirmative ways of understanding data. Clinical implications Our findings show promise, but future work is needed to address quantitative harmonisation. Similarly, issues related to the traditionally ‘pathophysiological’ frameworks that existing datasets are often embedded in can hinder the full potential of harmonisation based on the ICF.

Essential tremor (ET) is one of the most common movement disorders in adults. Deep brain stimulation (DBS) of the ventralis intermediate nucleus (VIM) of the thalamus and/or the posterior subthalamic area (PSA) has been shown to provide significant tremor suppression in patients with ET, but with significant inter-patient variability and habituation to the stimulation. Several non-invasive neuromodulation techniques targeting other parts of the central nervous system, including cerebellar, motor cortex, or peripheral nerves, have also been developed for treating ET, but the clinical outcomes remain inconsistent. Existing studies suggest that pathology in ET may emerge from multiple cortical and subcortical areas, but its exact mechanisms remain unclear. By simultaneously capturing neural activities from motor cortices and thalami, and hand tremor signals recorded via accelerometers in fifteen human subjects who have undergone lead implantations for DBS, we systematically characterized the efferent and afferent cortico-thalamic tremor networks. Through the comparisons of these network characteristics and tremor amplitude between DBS OFF and ON conditions, we further investigated the associations between different tremor network characteristics and the magnitude of DBS effect. Our findings implicate the thalamus, specifically the contralateral hemisphere, as the primary generator of tremor in ET, with a significant contribution of the ipsilateral hemisphere as well. Although there is no direct correlation between the cortico-tremor connectivity and tremor power or reduced tremor by DBS, the strength of connectivity from the motor cortex to the thalamus and vice versa at tremor frequency predicts baseline tremor power and effect of DBS. Interestingly, there is no correlation between these two connectivity pathways themselves, suggesting that, independent of the subcortical pathway, the motor cortex appears to play a relatively distinct role, possibly mediated through an afferent/feedback loop in the propagation of tremor. DBS has a greater clinical effect in those with stronger cortico-thalamo-tremor connectivity involving the contralateral thalamus, which is also associated with bigger and more stable tremor measured with an accelerometer. Interestingly, stronger cross-hemisphere coupling between left and right thalami is associated with more unstable tremor. Together this study provides important insights into a better understanding of the cortico-thalamic tremor generating network and its implication for the development of patient-specific therapeutic approaches for ET.

This Element provides a fresh approach to the representation and experience of the French Disease, by reassessing a wide range of textual and visual sources through the lens of contemporary medical ideas. It analyses how knowledge about the Great Pox was transmitted to a literate and also a wider public through performance and the circulation of popular prints. Chronicles, satirical and moralistic poems and plays about prostitutes, along with autobiographical accounts, described symptoms and the experience of patients, reflecting how non-medical men and women understood the nature of this terrible new disease and its profound physical and psychological impact. The second major theme is how the French Disease was represented visually. Woodcuts and broadsheets showing the moral and physical decline of courtesans are analysed together with graphic medical illustrations of symptoms and their treatment together with images of the diseased body of St Job, patron saint of the French Disease.

Previous studies on psychological adaptations to pathogen threats revealed the link between pathogen psychology and group behavior, especially in-group-oriented mindsets such as conformity, and the endorsement of group binding moral values. The relationship between behavioral immune responses and in-group attitudes has been mostly discussed in relation to the adaptive strategy to avoid pathogens. Yet, there is the other side of the behavioral immune system: reactive defense against pathogens (e.g., soliciting social support from others). By operationally defining in-group-oriented mindsets as the endorsement of group binding moral values, we explored how the tendencies to avoid diseases and minimize the negative influences of contracted diseases were each related to in-group-oriented mindsets in two countries (Study 1: the UK, N = 645; Study 2: Japan, N = 651). We found that the endorsement of group binding moral values was robustly associated with the latter but not with the former, suggesting that the reactive side of pathogen psychology may play an important role in shaping in-group-oriented mindsets.

Introduction Physician assistant/associate (PA) courses rely heavily on hands-on experience during clinical placement, and higher education institutes aim to provide students with an equitable experience. This article aims to understand how student gender and supervisor gender affect student experience on clinical placement at 2 PA courses in the United Kingdom, where PAs are known as physician associates. We found no evidence of pedagogical literature that focused on the gender differences in PA experience, so we aim to be the first to provide this research. Methods To assess student experience, student feedback was collected through online qualitative surveys and stratified by student and supervisor gender. 95% confidence intervals were calculated for scaled questions. Results Qualitative feedback from students shows a clear difference in their clinical placement experiences. Male students report fewer opportunities to observe and assess female patients, while female students report fewer opportunities observe and assess male patients. The most significant difference is seen when male students are seeing female patients. The discrepancy becomes more pronounced when male students are supervised by male supervisors and when female students are supervised by female supervisors. Discussion In planning clinical placements for students, programs must understand and recognize the potential for differences in experience based on student and supervisor gender and should take action to ensure a more equitable experience for all students.

Introduction Understanding barriers to seeking eye care and providing evidence‐based theory‐informed solutions can improve the uptake of eye care services. Therefore, in this cross‐sectional study, we aim to report and analyse barriers to seeking eye care services among individuals with vision impairment in the Akividu region of Andhra Pradesh, India. Methods Out of the 3000 enumerated participants, a total of 2587 were examined. All participants with vision impairment were asked to report barriers for not seeking eye care despite noticing reduced vision using a validated questionnaire. The reported barriers were mapped to the theoretical domains framework (TDF) to explore potential individual and environmental influences on the uptake of eye care services. Results Barriers to seeking eye care services are most frequently mapped to the ‘beliefs about capabilities’, ‘environmental context and resources’ and ‘social influences’ domains of the TDF. The most frequently reported barrier was ‘aware of the problem but can manage’ (beliefs about capabilities), expressed by 43.4% ( n = 156) and 55.7% ( n = 337) of participants with distance and near vision impairment, respectively. ‘No one to accompany’ for an appointment (social influences) was a significant barrier for participants with distance vision impairment ( n = 44, 12.2%) in comparison to participants with near vision impairment ( n = 19, 3.1%). Additionally, fear of losing eyesight or operation or consultation (emotion) was a major deterrent for seeking eye care services, particularly among participants with distance vision impairment ( n = 31, 8.6%) when compared with near vision impairment ( n = 17, 2.8%). Conclusion The uptake of eye care services is influenced by a complex set of interacting factors. Identification of potentially modifiable target behaviours provides an opportunity to develop theory‐informed solutions to improve uptake of services and prevent avoidable vision loss.

Background Powerful new genomic technologies are transforming the way healthcare is delivered, shaping medical practice across all specialties. In this rapidly changing landscape, there is an urgent need to equip the clinical workforce with knowledge and skills to navigate the new healthcare terrain. Co-design of healthcare resources with end users is increasingly gaining traction as a method of ensuring that educational content and delivery are tailored to users’ needs, increasing likelihood of use and resulting in better outcomes for patients. Here we describe the co-design and ongoing co-creation of GeNotes – an NHS England National Genomics Education flagship online resource providing genomics education at the point of patient care. Methods To understand the barriers to implementation of genomic medicine and the training needs of the diverse NHS workforce, we adopted a co-design approach with clinicians from both primary and secondary care who are uniquely placed to understand the context in which they are working and identify their own training needs. Concept design, initial user research and subsequent ‘alpha’ and ‘private beta’ phase user research was conducted in a series of co-design iterations employing a mixed methodology integrating quantitative and qualitative data collection and analysis. Results User evaluation data demonstrated excellent feedback across the tested domains (content, navigation, likelihood of use and recommendation to colleagues). We identified several key themes from user testing that shaped the resource’s development. Conclusions The co-design approach to the development of this point-of-care genomics education resource for clinicians has allowed insight into the education needs, challenges and learning styles of end-users. The utility of this approach was supported by excellent user feedback across the tested domains, and we recommend it to others involved in developing healthcare resources in a fast-paced environment.

In Bruno Monsaingeon's 2009 film portrait of Piotr Anderszewski cinematic technique, voice-over commentaries and musical performances combine to create an “affective” geography in which the pianist moves between significant Central Eastern European places. Anderszewski is filmed traveling in a special train carriage (including a grand piano) which, the director said, “as a place of meditation and reflection … would facilitate the use of flashbacks.” Memory, identity, and origins become central to the film's symbolism. After Freud, railway journeys can be interpreted as a privileged “analogy” for unconscious and repressed thought processes. Train metaphors may thus facilitate an imaging of the mental apparatus and its “lines of conduction.” The essay focuses on three symbolic locations in Anderszewski's journey – Warsaw, Budapest and Zakopane – and on performances of music by Chopin, Schumann and Szymanowski (the first heard in the railway carriage, the second in the Liszt Academy, Budapest, and the third in Szymanowski's house in Zakopane). Each of these sites and musical examples are interpreted primarily through Freud's notion of “displacement” to reveal counterpoints and conjunctions of displaced musical “voices” and identities. These hearings reveal the complexities and dissonances between Monsaingeon's French vision of “Eastern” Europe and Anderszewski's Polish-Hungarian self-identity as “Central” European cosmopolitan.

Objective In screening for small‐for‐gestational age ( SGA ) using third‐trimester antenatal ultrasound, there are concerns about the low detection rates and potential for harm caused by both false‐negative and false‐positive screening results. Using a selective third‐trimester ultrasound screening program, this study aimed to investigate the incidence of adverse perinatal outcomes among cases with (i) false‐negative compared with true‐positive SGA diagnosis and (ii) false‐positive compared with true‐negative SGA diagnosis. Methods This prospective cohort study was nested within the UK ‐based DESiGN trial, a prospective multicenter cohort study of singleton pregnancies without antenatally detected fetal anomalies, born at > 24 + 0 to < 43 + 0 weeks' gestation. We included women recruited to the baseline period, or control arm, of the trial who were not exposed to the Growth Assessment Protocol ( GAP ) intervention and whose birth outcomes were known. Stillbirth and major neonatal morbidity were the two primary outcomes. Minor neonatal morbidity was considered a secondary outcome. Suspected SGA was defined as an estimated fetal weight ( EFW ) < 10 th percentile, based on the Hadlock formula and fetal growth charts. Similarly, SGA at birth was defined as birth weight ( BW ) < 10 th percentile, based on UK population references. Maternal and pregnancy characteristics and perinatal outcomes were reported according to whether SGA was suspected antenatally or not. Unadjusted and adjusted logistic regression models were used to quantify the differences in adverse perinatal outcomes between the screening results (false negative vs true positive and false positive vs true negative). Results In total, 165 321 pregnancies were included in the analysis. Fetuses with a false‐negative SGA screening result, compared to those with a true‐positive result, were at a significantly higher risk of stillbirth (adjusted OR ( aOR ), 1.18 (95% CI , 1.07–1.31)), but at lower risk of major ( aOR , 0.87 (95% CI , 0.83–0.91)) and minor ( aOR , 0.56, (95% CI , 0.54–0.59)) neonatal morbidity. Compared with a true‐negative screening result, a false‐positive result was associated with a lower BW percentile (median, 18.1 (interquartile range ( IQR ), 13.3–26.9)) vs 49.9 ( IQR , 30.3–71.7)). A false‐positive result was also associated with a significantly increased risk of stillbirth ( aOR , 2.24 (95% CI , 1.88–2.68)) and minor neonatal morbidity ( aOR , 1.60 (95% CI , 1.51–1.71)), but not major neonatal morbidity ( aOR , 1.04 (95% CI , 0.98–1.09)). Conclusions In selective third‐trimester ultrasound screening for SGA , both false‐negative and false‐positive results were associated with a significantly higher risk of stillbirth, when compared with true‐positive and true‐negative results, respectively. Improved SGA detection is needed to address false‐negative results. It should be acknowledged that cases with a false‐positive SGA screening result also constitute a high‐risk population of small fetuses that warrant surveillance and timely birth. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

This paper addresses the comparability and related scalability constraint of Maier et al. (VOLUNTAS 26: 1805–1830, 2015) of social impact measurement by deploying experimental mapping of the Sustainable Development Goals (SDGs) target indicators onto social return on investment (SROI) data proxies. Datasets on the unit cost database model hosted by the Greater Manchester Authority are derived for the UK and for the US. Discreet differences in data terminology between financial proxies in the UK and in the USA are translated with a contextual approach for data optimization. The resultant mapped datasets of financial proxies offer early evidence in support of the scalability of SROI. This is valuable for local measurement of progress towards the global 2030 Agenda for Sustainable Development. This research finds that there are comparatively wide differences in sufficient data both within and across the UK and the US datasets. Yet, mapped data counts show sufficient cross-geographic financial proxy overlaps, pointing to the viability of data collection with financial proxy sampling and mapping both for the better understanding of place-based social value creation and for comparative localised social value contribution. This paper concludes that initial mapping of data onto the SDG target indicators improves the comparability constraint of SROI.

Background Gesture and speech collaborate in conveying meaning, and gesture is often leveraged by people with neurogenic communication disorders, such as aphasia, cognitive‐communicative impairments and primary progressive aphasia, when words fail them. Because gesture is imagistic, transitory and holistic, there are inherent challenges when assessing and treating it. Aims The survey had three primary research questions: (1) what gesture assessment practices, and (2) what gesture treatment practices, are employed by speech and language therapists (SLTs) internationally; and (3) what are the factors that influence these practices? Methods and Procedures An online survey of practice using Qualtrics was piloted and then disseminated to practising SLTs working with people with neurogenic communication disorders. In addition to descriptive statistics summarising across the three research questions, statistical comparisons were made for two independent groups: primary work setting (research versus clinical), and primary work setting considering years of experience specific to neurogenic communication disorders (research, high; research, low; clinical, high; and clinical, low). Outcomes and Results A total of 130 international SLTs completed the first two parts of the survey. A total of 107 completed all four sections of the survey. Fifty percent of respondents reported assessing gesture sometimes/for some clients, with only 5% reporting that they never assessed gesture. Nearly 70% of respondents reported never using a published test to evaluate gesture, with qualitative results suggesting a lack of formal assessments. This was further highlighted by the most prominent barrier being a lack of published tests (50% of respondents said this). The primary reason for evaluating gesture was to assess nonverbal communication. There was no significant difference in gesture assessment practices across comparison groups. The research group, and those within the research group with most years of experience, tended to target gestures during treatment and write treatment goals containing gesture more than other respondents. The most common facilitator to assessing or treating gesture was that the family or individual prioritised gesture for enhancing communication (53.1% of respondents). No group differences were identified for barriers/facilitators. Conclusions and Implications Findings indicate that whilst gesture is a critical nonverbal communicative behaviour, there is an unmet need for empirical and standardised methods for assessing gesture in speech and language clinical practice and there is a lack of gesture‐specific treatment resources. SLTs working in research settings may feel more able, or have more resources, to include gesture during treatment. Essential next steps include creating empirical and standardised methods for assessing gesture in speech and language clinical practice. WHAT THIS PAPER ADDS What is already known on the subject Gesture is a complex and crucial aspect of communication. It is a key part of the role of speech and language therapists (SLTs), as described in clinical guidelines, to assess people with aphasia's use of gesture and consider whether it could be enhanced through treatment. What this study adds to existing knowledge This is the first international survey of practice focusing on gesture assessment and treatment. It highlights the variety of methods used by SLTs to assess and treat gesture, the importance they attach to this area and the need for standardised assessment tools and treatment resources. What are the clinical implications of this work? This study provides a comprehensive overview of practices for assessing and treating gesture in neurogenic communication disorders, as well as a list of gesture resources being actively used by clinicians and researchers. These may be useful for clinicians looking to expand their understanding of approaches and resources for assessment and treatment in this domain. The study also reports on the reasons clinicians assess gesture and the barriers and facilitators they encounter which may inform clinical practice in this area.

In this article, we contribute to the analysis of protest participation on a gradient from non- to actual participation. Using survey data from six European countries, we take the analysis beyond a binary differentiation between participants and non-participants. We evidence a participation gradient underpinned by a combination of social and political variables and separate patterns that allow for distinctions between non-, potential, and actual protesters. We establish that some factors have a gradual, linear, relation to protest participation, increasing the likelihood of moving from non-participation to potential participation and from potential to actual participation. Second, we find evidence of a punctuated rather than a linear participation gradient in as far as a range of variables distinguish protesters and potential protesters from non-participants but do not differentiate them from each other. Our findings provide practical insights into mobilization pathways while also inviting further research into intervening factors influencing protest behavior.

The perception/action model posits distinct streams of visual processing for perception and online motor guidance. This model is apparently supported by experiments showing that visual illusions affect action tasks less than perception. In recent years, however, critics have argued against both the validity of these experiments and their support (irrespective of their validity) for the perception/action model. In this article, I reexamine this psychophysical evidence. I argue that it strongly supports the existence of distinct representations for “perception” and “action” but only moderately supports the existence of distinct systems generating those representations.

Background The global movement of people in the context of strict immigration laws and policies places significant numbers of people in insecure migration status worldwide. Insecure status leaves people without recourse to legal, governmental or social protection from violence and abuse. This review synthesized qualitative studies that reported how migrants associated physical and physically enforced sexual violence they experienced with their insecure migration status. Methods We conducted a qualitative evidence synthesis of 31 studies published between 1 January 2000 and 31 May 2023, with data from Europe, North America, East Asia, South Asia, the Middle East and Africa. Our thematic synthesis produced 14 inductive descriptive codes, four descriptive themes and three analytical themes. Results We generated robust qualitative evidence showing that women experienced sexual violence while in transit or without status in a host state, and that they associated that violence with their insecure migration status. This was the case across the various geographic routes and destination countries. We found evidence that women associated intimate partner violence with lacking (legal) access to support because of their insecure migration status. We found evidence that women connected their unwillingness to leave violent circumstances, and therefore their prolonged or repeated exposure to violence, with a fear of immigration removal produced by their insecure migration status. Conclusion To protect people in insecure migration status from experiencing violence that they associated with their migration status, it’s necessary to ensure that the reporting of violence does not lead to immigration enforcement consequences for the victim.

The main binocular vision and accommodative anomalies are considered in turn: strabismus, heterophoria, convergence insufficiency, binocular instability, accommodative insufficiency, and accommodative infacility. For each of these conditions, any associations with reading difficulties are reviewed. Each review includes an assessment as to whether the anomaly may contribute causally to reading difficulties. The treatment of these conditions is discussed, also addressing the general question of when optometric factors need to be treated. The chapter closes with a table summarising the above conditions. It is concluded that binocular instability (fusional vergence dysfunction) is correlated with dyslexia, but is unlikely to be a major cause of the condition.

This chapter starts with reflections on visual stress and the multifactorial nature of reading difficulties. Priorities for research are outlined, both concerning vision and reading difficulties. The various research designs that have been used are described together with some of their pitfalls. Suggestions for eye care practice are offered, noting the importance of research evidence, patient (and parent) preferences, and clinical state and circumstances. The chapter concludes with comments for educational professionals, parents, and students.