University of South Wales

Background Extreme events (e.g. floods and disease outbreaks) can overwhelm healthcare workers (HCWs) and healthcare systems. During the COVID-19 pandemic, high levels of distress and mental ill health were reported by HCWs. Aims To examine and synthesise research findings reported in the qualitative literature regarding the stressors, and their psychosocial impacts, faced by HCWs in the UK during the COVID-19 pandemic, and to provide lessons for future support. Method Qualitative articles were identified in EMBASE and OVID (preregistered on PROSPERO: CRD42022304235). Studies were required to have been published between January 2021 and January 2022 and to have examined the impact of COVID-19 on UK HCWs. We included 27 articles that represented the experiences of 2640 HCWs, assessed their quality using National Institute for Health and Care Excellence criteria and integrated their findings using thematic synthesis. Results Several secondary stressors were identified, including lack of personal protective equipment, ineffective leadership and communication, high workloads and problems stemming from uncertainty and a lack of knowledge. Stressors were related to adverse psychosocial outcomes including worry, fatigue, lack of confidence in oneself and senior managers, impacts on teamwork and feeling unappreciated or that one’s needs are not recognised. Conclusions Our thematic synthesis moves beyond simply mapping stressors faced by HCWs by considering their antecedents, origins and psychosocial impacts. Utilising a theoretical framework that points towards systemic deficiencies, we argue that secondary stressors can be modified to remove their negative effects. Consequently, workforce planning should shift from focusing on individual change towards amending psychosocial environments in which HCWs work.

The accumulation of fossil‐fuel‐based plastic waste drives the need for sustainable packaging materials. Stricter regulations and consumer demand for eco‐friendly products have expanded the biodegradable plastics market. Polyhydroxybutyrate (PHB), a microbial biopolymer, is biodegradable but inherently brittle. This study enhances PHB's strength and ductility by reinforcing it with polyvinyl alcohol (PVA)‐coated cotton fibres and further improving interfacial bonding through maleic anhydride (MA) grafting. Compared to neat PHB, incorporating PVA‐coated cotton fibres increases tensile strength and failure strain by 290% and 109%, respectively. MA grafting further enhances toughness (ninefold increase) and interlaminar fracture toughness (twofold rise), while reducing helium permeation to 60%. These enhancements stem from PVA's hydrophilicity and MA‐induced hydrogen bonding, highlighting the potential of PVA‐coated cotton fibre/MA‐grafted PHB composites as sustainable materials for packaging and biomedical applications.

We use a cyclone‐tracking algorithm to study precipitation produced by extratropical cyclones in reanalysis data and climate models. In the Southern Hemisphere, we find strong zonal asymmetries in extratropical cyclone precipitation, with peaks off the eastern coasts of the three main landmasses. We show that models have negative biases in cyclone precipitation in exactly those centres of peak precipitation. These biases have a structure similar to biases of reanalysis precipitation compared with satellite observations, indicating that the model component of reanalysis products has similar difficulties representing extreme precipitation from extratropical cyclones. Extratropical cyclone precipitation trends are similar in the historical period and future projections, with a poleward shift of the storm tracks in both hemispheres and a general increase in precipitation from extreme extratropical cyclones.

Purpose The aim of this work was to report on the optimization, commissioning, and validation of a beam model using a commercial independent dose verification software RadCalc version 7.2 (Lifeline Software Inc, Tyler, TX, USA), along with 4 years of experience employing RadCalc for offline and online monitor unit (MU) verification on the Elekta Unity MR‐linac (MRL) for a range of clinical sites. Methods Calculation settings and model parameters, including the Clarkson integration settings and radiation/light field offset, have been systematically examined and optimized, and pitfalls in the use of density inhomogeneity corrections and in off‐axis calculations were investigated and addressed. The resulting model was commissioned by comparing RadCalc calculations to measurements for a variety of cases, selected following relevant recommendations, ranging from simple fields in a water tank to end‐to‐end point dose measurements in an anthropomorphic phantom. Results For simple geometries, the agreement was within 2%, and for complex geometries, within 5%. When validating against the Monaco (Elekta AB, Stockholm, Sweden) treatment planning system (TPS), for 39 clinical commissioning plans, the mean total point dose difference was −0.3 ± 0.8% (−2.0%–1.1%). Finally, when applied retrospectively to 4085 clinical plan calculations, the agreement with the TPS was 0.3 ± 1.1% (−4.8%–4.2%), with fail rates of 0.1% for total point dose (discrepancy > 4%) and 0.3% for individual fields (discrepancy > 10%). Conclusions Improved calculation agreement with the TPS and therefore increased confidence in the online QA, opened the way for an automated and physics‐light independent MU verification workflow within our MRL program.

Mixed-methods process mapping is a visualisation tool that identifies the steps, resources and personnel required to deliver a clinical practice, and has been previously used in an ad hoc manner to develop effective implementation strategies and solutions. To realise the potential of mixed-methods process mapping as an implementation tool, we aimed to develop and formalize the methodological steps and provide guidance for contemporary best practice approaches to using this approach for optimising implementation practice and research. Synthesising theory, evidence and expertise, we have identified 10 best practice recommendations and provide the first systematic framework for integrating mixed-methods process mapping into three core phases of health systems implementation, specifically: (1) engaging interest holders (and maintaining engagement), (2) identifying when, where, why, and to whom change is needed (and potential consequences), and, (3) identifying barriers and enablers, and co-designing implementation strategies. For each phase, we provide: (a) a rationale for using mixed-methods process mapping, (b) best practice guidance for combining mixed-methods process mapping with implementation practice and research, and (c) case studies exemplifying best practice. This article provides intelligence on mixed-methods process mapping to improve the consistency and quality of its use among implementation researchers and practitioners. We present a rationale, guidance, and practical tools for conducting mixed-methods process mapping to enhance the quality of implementation research and practice which can be used and adapted internationally. In doing so, it builds capacity and provides an opportunity for researchers and healthcare professionals to better understand and embed evidence-based innovations into health systems, improving service and client outcomes. Further research is needed to establish potential uses of mixed-methods process mapping to support other core components of implementation practice (e.g., adaptation), and to formally test the impact of this approach independently versus as part of a combination of implementation strategies.

Standard immunofluorescence imaging captures just ~4 molecular markers (4-plex) per cell, limiting dissection of complex biology. Inspired by multimodal omics-based data integration approaches, we propose an Extensible Immunofluorescence (ExIF) framework that transforms carefully designed but easily produced panels of 4-plex immunofluorescence into a unified dataset with theoretically unlimited marker plexity, using generative deep learning-based virtual labelling. ExIF enables integrated analyses of complex cell biology, exemplified here through interrogation of the epithelial-mesenchymal transition (EMT), driving significant improvements in downstream quantitative analyses usually reserved for omics data, including: classification of cell phenotypes; manifold learning of cell phenotype heterogeneity; and pseudotemporal inference of molecular marker dynamics. Introducing data integration concepts from omics to microscopy, ExIF empowers life scientists to use routine 4-plex fluorescence microscopy to quantitatively interrogate complex, multimolecular single-cell processes in a manner that approaches the performance of multiplexed labelling methods whose uptake remains limited.

Plain Language Summary Projections of future sea‐level rise on global mean, regional, and coastal scales usually depend on complicated models that simulate different sea‐level components, integrating the atmospheric, oceanic and cryosphere systems. In addition, sea‐level observations have been utilized to project sea‐level rise on global and regional scales. However, this approach has not been applied to coastal regions globally, where predicting sea‐level rise is more challenging due to the influence of complex local processes. Here, we estimate the linear trend and quadratic terms from 222 tide gauge records over 1970–2023. The linear‐plus quadratic fit is extrapolated to 2050 to provide observation‐based projection at individual tide gauges, which are compared with sea‐level projection derived from model simulations from the Intergovernmental Panel on Climate Change Sixth Assessment Report (AR6). By 2050, 96% of tide gauges show a consistent sea‐level rise base on the observation‐based projection and the AR6 projection within the likely range. Although with larger spatial variability, the likely observation‐based projections are well below the low‐likelihood, high‐impact AR6 projections. The observation‐based projection is purely estimated from sea‐level observations and provides independent information on near‐term sea level rise and evaluation on model‐based sea‐level projections. Assessing the current and near‐decades of sea‐level projection is informative and important for adaptation and planning efforts.

This study explores the potential of strontium titanate (STO)‐based devices as artificial synapses for neuromorphic computing. Traditional computing, reliant on the Von Neumann architecture, faces challenges with energy efficiency and scalability, driving interest in neuromorphic systems that mimic the brain's parallel processing capabilities. Here, we investigate the modification of STO thin films through controlled annealing in a forming gas environment, targeting the creation of oxygen vacancies (VOs) to enhance the material's synaptic functionality. Using various characterizations, including X‐ray photoelectron spectroscopy and electron paramagnetic resonance, we confirm the increased VOs after treatment, which positively impacts the switching performance of STO by shifting the energy band position. The STO device demonstrated essential neuromorphic properties, such as short‐ and long‐term plasticity, spike‐timing‐dependent plasticity, and spike‐intensity‐dependent plasticity, which are crucial for efficient synaptic emulation. Additionally, a supervised learning test using an artificial neural network for digit recognition achieved a high accuracy rate, demonstrating the device's robustness under noisy conditions. This work provides a novel approach for enhancing the performance of STO‐based artificial synapses, highlighting their potential for future low‐energy neuromorphic computing image recognition device.

Purpose Literature concerning programmes to support the well-being of carers of cancer survivors is vast, complex, and difficult to navigate, posing difficulties for identifying and translating relevant evidence. This study will advance the field by mapping and synthesising reviews to address the question: “What psychosocial interventions are available to promote the well-being of carers for people diagnosed with cancer, as reported in the evidence from reviews?”. Methods A meta-review was conducted of reviews published between 2013 and 2024. PsycINFO, MEDLINE, CINAHL, and Cochrane Database of Systematic Reviews databases and relevant reference lists were searched for eligible reviews. Records were screened and assessed in accordance with the method with data from included reviews extracted and synthesised. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guided reporting. Reviews were appraised using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. Results Ultimately, 54 reviews met the inclusion criteria. This evidence was mapped regarding populations, interventions, and outcomes, including depression, anxiety, quality of life, and distress. On average, reviews addressed nine of 11 quality checklist items. Insights were gained concerning the role of theory, carer populations, and intervention characteristics. Conclusion Key features of the body of evidence were identified that can hinder progress and which point to ways forward. It is concluded that a recalibrated carer research agenda is needed, one that is designed to synthesise evidence concerning what works, for which carers to achieve what outcomes, or to address which kinds of psychosocial support needs. Implications for Cancer Survivors Despite the need to ensure that carers have access to programs that support their wellbeing as they care for their loved ones, the evidence to guide program development is complex and difficult to navigate. A refocusing of research efforts is needed to advance understanding of what is most effective for carers, and how this can be translated into clinical practice.

Sex and gender are important determinants of health, conditioning health exposures and needs, health seeking behavior, health outcomes, and subsequent consequences. We aim to explore the nature and magnitude of sex differences in disease burden, service awareness, utilization, expenditure and satisfaction while accessing primary health care services in the light of recent primary care reforms implemented in the southern Indian state of Kerala. We conducted a cross-sectional study to explore the nature and magnitude of sex differences in disease burden, service awareness, utilization, expenditure and satisfaction in the public sector of Kerala, India. A household survey using multistage random sampling design was conducted to collect information from 3234 households in the selected eight PHC catchment areas of four districts in the state. Descriptive data analysis was carried out with a focus on disease burdens, place of care seeking, cost of care and patient satisfaction, using STATA 12. More males reported fever as their primary ailment compared to females (67.7% vs. 58.6%). A greater proportion of males as compared to females knew about the recently implemented reforms (43% vs 36%; p = 0.01). Allopathic (modern medicine) care was the most sought-after system of medicine across the sample. A higher proportion of females visited government primary health centres for outpatient care (34.7% vs. 27.5%; p = 0.00).Our analysis found statistically significant differences in the self reported cost of care in the private sector: 20 times greater than in public sector for males, whereas the difference was roughly five fold among females (Private: ₹650, $8.5 (95$1.58 (95%CI ₹17, ₹223, p < 0.001)). Males showed greater awareness of state health reforms than females, and high patient satisfaction existed for both private and public outpatient care across sex groups. We found significant sex differences in health system utilization and expenditure in Kerala, although our present analysis lacks data on trans, intersex and other sexual and gender minority groups. Further research on intersectionalities, such as care-seeking experiences across genders and socioeconomic groups, could enhance our understanding the role of sex in care seeking.

This work presents a conservative phase-field lattice Boltzmann method (LBM) for boiling heat transfer at high density ratios. This method employs the LBM for modeling unsteady flows, the finite difference method for solving the heat transfer equation, and the conservative phase-field method as the interface tracking model. In order to model the boiling process, the conservative Allen–Cahn model is used. The proposed method has been successfully validated by using a bubble rising in a viscous fluid and the film boiling. In order to demonstrate its capability in modeling complex flows, the method is applied to study the flow boiling heat transfer in a microchannel with multiple nucleation cavities. Simulations are performed by varying the Reynolds number (Re) from 50 to 150 and the Stefan number (Ste) from 0.023 to 0.16. Furthermore, the contact angle ( θ) is examined as a design parameter with values of 60° and 90°. The results show that the phase-field LBM successfully achieves the highly unsteady flow boiling heat transfer in microchannels at a high density ratio. It accurately estimates the differences in thermal performance between bottom and upper walls for various excess temperatures and Reynolds numbers, where the boiling heat transfer rates on the bottom wall are higher than those achieved on the upper wall. That is due to the high vapor accumulation rate on the upper wall. Furthermore, the results show the accuracy of thermal fluid–solid interactions at different surface contact angles, and the findings recommend hydrophilic surfaces for higher thermal performance due to the decrease in vapor bubble attachment and deposition over the heated surfaces.

A way to prevent the fast configurational interconversion of tertiary amines is to invoke Tröger's base analogs, which display methano‐ or ethano‐bridged diazocine cores fused to aromatic rings. These derivatives are configurationally stable, even in acidic media when their structures bear ethylene bridges. Here, a two‐ to three‐step synthesis is presented of methano‐ and ethano‐bridged Tröger's base analogs with two peripheral fluorophores, i.e., anthracene, pyrene, and 9,9‐dimethylfluorene units. These compounds, possessing two nitrogen stereogenic centers, exhibit good circularly polarized luminescence (CPL) dissymmetry factors (|glum| up to 1.2 × 10⁻³) and brightnesses (BCPL up to 26.3 M⁻¹ cm⁻¹), as well as excellent fluorescence quantum yields, demonstrating the Tröger´s base core to be a convenient scaffold to prepare CPL emitters upon functionalization with simple achiral fluorophores. Furthermore, the configurationally stable ethano‐bridged Tröger's base analogs are employed to modulate their CPL response, generating a CPL switch through their protonation/deprotonation by consecutive additions of acid and base. The reversibility of the switching process is demonstrated for two cycles without altering the CPL performance of the molecule. It is believed that this straightforward and efficient approach to building CPL emitters employing the Tröger's base core could lead to its incorporation in CPL‐based sensors and materials.

Electrocatalytic hydrazine‐assisted water splitting, incorporating the hydrogen evolution reaction (HER) and hydrazine oxidation reaction (HzOR), offers a promising avenue for hydrogen production. Herein, a Ru/CoP heterostructure is introduced, which enhances bifunctional catalytic activity through interfacial interaction induced by the built‐in electric field between Ru nanoparticles and CoP nanosheets. This interaction optimizes the adsorption of intermediates and facilitates improved HER performances by weakening the strong adsorption of active hydrogen species (*H) on Ru and enhancing *H coverage on CoP through hydrogen spillover. Additionally, this electron interaction promotes the adsorption of N2H4 and its subsequent dehydrogenation, vital for HzOR activity. The heterostructure's significant reduction in required potentials for both reactions underscores its efficiency and potential economic benefits over traditional systems. Furthermore, the study validates the feasibility of using this approach for practical applications in sustainable hydrogen production, emphasizing its lower operational costs and enhanced catalytic stability and activity. This work not only showcases the practical applications of Ru/CoP but also underscores the broader applicability of heterostructure strategy in designing efficient bifunctional electrocatalysts.

Over the last few decades, games have increasingly incorporated morality as a pivotal narrative and interactive factor, which empowers players to make the most challenging dilemmas concerning ethics. The study analyzes the psychological process of the moral decisions that take place in-game and looks at the relationship between virtual deeds and real-life moral standing. The research should answer two fundamental questions: whether moral decisions are made while playing games and how they affect the players' judgments and actions outside the gaming context. Through a mixed-methods approach, the players are subjected to moral dilemma experiments in different game scenarios, their opinions on similar real-life situations are surveyed and discussed after their narrations. The results show that, players often undertake moral choices that are very much internalized and manifested in virtual realities, producing a desirable ultimate outcome of self-examination and empathy in users, which can be transformed into real moral awareness. Moreover, the research shows that games can effectively contribute to the formation of moral values and contemplation of moral dilemmas.

To examine accuracy of two-tiered surveillance to detect developmental disability and autism in a multicultural birth cohort; a subset of the Watch Me Grow Study. Surveillance tools were used at or soon after 18 months of age, including the Parents’ Evaluation of Developmental Status (PEDS), the Ages and Stages Questionnaire (ASQ-3), and the revised Modified Checklist for Autism in Toddlers (M-CHAT-R/F). Children with and without identified concerns were assessed between 18 and 23 months using the Mullen Scales of Early Learning (MSEL) and the Autism Diagnostic Observation Schedule-2 (ADOS-2). Sensitivity and specificity of the surveillance tools used in isolation and in combination in this cohort ranged from 51 to 87% (n = 165). Some children (n = 21) who were not identified with high likelihood of difficulties were later assessed as having probable developmental disability. Adding the M-CHAT-R/F did not significantly improve autism likelihood identification in comparison with tiered developmental surveillance. There was highly variable sensitivity and specificity of combined tools for tiered developmental surveillance in this cohort. There remains a need in Australia to improve methods of, and engagement in, developmental screening and surveillance that includes detection of concerns in community and primary healthcare settings.

Background Dexmedetomidine is an α2-agonist sedative with opioid-sparing properties, is limited by dose-dependent hypotension and bradycardia. Ketamine, an NMDA receptor antagonist, has sympathomimetic effects and may attenuate these cardiovascular effects while contributing analgesia. Whether low-dose ketamine can stabilize dexmedetomidine-induced hemodynamic changes and provide comparable analgesia to an opioid-based regimen is uncertain. Methods In this open-label trial, we enrolled 41 healthy volunteers aged 18 to 45 years. All participants received a ketamine infusion (0.3 mg/kg bolus, then 0.15 mg/kg/hour for 3 hours). At 90 minutes, participants were randomized to receive either dexmedetomidine (0.7 µg/kg/hour for 90 minutes, KET/DEX group) or fentanyl (three 25 µg boluses, KET/FENT group). The primary outcomes were change in blood pressure and pain tolerance (measured by pressure algometry). Secondary outcomes included heart rate, subjective mood and sedation, and adverse events. Data were analyzed using mixed-effects models and Fisher’s exact tests. Results Of 41 randomized participants, 39 completed the protocol (KET/DEX, 19; KET/FENT, 20). KET/DEX resulted in greater reductions in systolic blood pressure (mean decrease 35–40 mm Hg; ~25–30%) compared to KET/FENT (mean change minimal; between-group P<0.001). Heart rate declined modestly with KET/DEX but did not differ significantly between groups. Both regimens increased pain tolerance to a similar degree (mean threshold rise ~30–50 kPa; between-group P=0.80). Participants in the KET/DEX group reported greater sedation and transient negative mood effects (eg, disinterest), while KET/FENT was associated with mild nausea in a minority. Clinically significant hypotension occurred in 4 participants (21%) in the KET/DEX group and in none of the KET/FENT group (P=0.047). All events were transient and responsive to fluid boluses. No respiratory depression occurred in either group. Conclusion Ketamine plus dexmedetomidine produced analgesia equivalent to ketamine plus fentanyl but with more pronounced hypotension and deeper sedation. The hemodynamic effects of dexmedetomidine were not fully offset by low-dose ketamine. These findings suggest that while ketamine–dexmedetomidine may offer an opioid-sparing alternative, careful dose selection and monitoring are required to ensure tolerability. (Funded by Monash University and Monash Health; ACTRN12617000787381). Clinical Trial Number and Registry Url https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372916.

A key aspect of the Offender Personality Disorder Pathway (OPDP) is to provide specialist psychologically informed support to the staff working with high-risk offenders who present with personality difficulties. This includes delivering training and facilitating case consultation and formulation meetings. This study aimed to examine the experiences of probation practitioners who have engaged with core OPDP services within a single delivery unit within Wales. Transcripts derived from audio recordings of one-to-one interviews with five probation practitioners were analysed using Interpretative Phenomenological Analysis. Three central themes were identified: the OPDP as a process for understanding personality disorder; tensions with organisational context and establishing a collaborative working relationship with the OPDP team. These findings can be mapped onto the key pathway objectives relating to staff competence and confidence and add weight to previous benefits and impacts identified by a previous study conducted within a single area of England. They also speak to wider contextual issues and concerns within probation within which the community arm of the OPDP exists.

MoP is one of the most efficient catalysts for hydrogen evolution reaction (HER). However, molybdenum ion exhibits a strong adsorption ability for H* due to the abundant states in the conduction bands associated with the dispersed nature of Mo 4d electrons, which is difficult to change through interactions with other transition metal dopants of d orbital electrons. Herein, lanthanide (Ln: La, Ce, Sm, Gd, and Yb) dopants of localized 4f orbital are used to hybridize with d and p orbitals of MoP to balance the H* adsorption energy to significantly enhance the HER activity. Density functional theory calculations indicate that the localized 4f orbital of Ln extended 4d orbital electronic density states of Mo to modulate the electron configuration near the Fermi level. Among various Ln‐doped MoP with carbon‐encapsulated catalysts (Ln‐MoP@C) catalysts, Gd‐MoP@C containing Mo 4d, C 2p, P 3p, and Gd 4f and 5d orbitals form significant states at the Fermi level, leading to the high intrinsic HER activity with low overpotentials of 74 and 134 mV at 10 mA cm⁻² in alkaline and acid electrolytes, respectively. This study provides a guiding principle for selecting dopants to tune electronic structures and enhance the intrinsic catalytic activities of transition metal catalysts through f‐d‐p orbital coupling.

Income-based poverty measures have been criticised for being narrowly focused on income and lacking consistency with community expectations and experience. The consensual income approach produces a poverty line that draws on community perceptions of how much is needed to avoid poverty (or make ends meet). Perceptions vary widely, although it is possible to estimate the income level at which people would say on average, that their current income is just enough for them to make ends meet. This paper re-examines the approach using new survey data for Hong Kong. The estimated consensual poverty lines are shown to have similarities for some households with those used by the Hong Kong Commission on Poverty, but there are also marked differences, particularly for single-person households. An overlap measure is developed that includes those in consensual poverty who also answered Yes when asked if they regard themselves as living in poverty. This overlap measure is shown to more closely resemble the poverty lines used by the Commission, although the gap for single-person households remains large.

This dataset provides the first annotated, openly available MRI-based imaging dataset for investigations of tongue musculature, including multi-contrast and multi-site MRI data from non-disease participants. The present dataset includes 47 participants collated from three studies: BeLong (four participants; T2-weighted images), EATT4MND (19 participants; T2-weighted images), and BMC (24 participants; T1-weighted images). We provide manually corrected segmentations of five key tongue muscles: the superior longitudinal, combined transverse/vertical, genioglossus, and inferior longitudinal muscles. Other phenotypic measures, including age, sex, weight, height, and tongue muscle volume, are also available for use. This dataset will benefit researchers across domains interested in the structure and function of the tongue in health and disease. For instance, researchers can use this data to train new machine learning models for tongue segmentation, which can be leveraged for segmentation and tracking of different tongue muscles engaged in speech formation in health and disease. Altogether, this dataset provides the means to the scientific community for investigation of the intricate tongue musculature and its role in physiological processes and speech production.