University of Hull

INTRODUCTION It is unclear how midlife depression and anxiety affect dementia risk. We examined this in a Norwegian cohort followed for 30 years. METHODS Dementia status at age 70+ in the fourth wave of the Trøndelag Health Study (HUNT4, 2017–2019, N = 9745) was linked with anxiety and depression from HUNT1 (1984–1985), HUNT2 (1995–1997), HUNT3 (2006–2008), and HUNT4. Longitudinal anxiety and depression score, and prevalence trajectories during 1984–2019 by dementia status at HUNT4 were fitted using mixed effects regression adjusting for age, sex, education, and lifestyle and health factors. RESULTS Dementia at HUNT4 was associated with higher case prevalence at all waves, from 1.9 percentage points (pp) (95% CI: 0.1–3.7) higher at HUNT1 to 7.6 pp (95% CI: 5.7–9.6) higher at HUNT4. DISCUSSION Our findings show that depression and anxiety was more common more than 30 years before dementia onset in those who later developed dementia. Highlights Older individuals with dementia had a higher prevalence of mixed anxiety‐ and depressive symptoms (A + D), both concurrently with and more than three decades prior to their dementia diagnosis. Older individuals with dementia had higher levels of anxiety, both concurrently and up to two decades prior to their dementia diagnosis. Depressive symptoms increased by time among those who developed dementia, but not among others. Results were similar for all cause dementia, Alzheimer's disease, and other types of dementia; however, for vascular dementia, the difference was not significant until dementia was present.

Limited empirical evidence exist on local-level institutions’ innovations and experiences in facilitating climate-smart agriculture (CSA) adoption. Qualitative interviews with farmers and local institutions supporting agriculture in Nandom, Ghana, were conducted. We found that local-level institutions employed (1) farmer-field schools (FFS) for capacity building to provide relevant knowledge for managing CSA practices; and (2) credit extension packages to reduce financial barriers to accessing inputs and technologies for CSA. We also found that sociocultural, financial, logistical, and technological constraints are the most important barriers hampering local-level institutions` ability to effectively facilitate CSA adoption. Furthermore, we observed that to encourage the uptake of CSA practices, particularly among vulnerable groups such as women, social power dynamics surrounding resource access and utilization must be addressed. For practice, the findings (1) serve as a case for learning different innovations that can be adapted in different contexts; and (2) give insights on how to overcome social barriers to CSA adoption and facilitation. We recommend that governmental institutions such as the Ministry of Food and Agriculture allocate resources and design policies that builds the of implementers. Training institutions must tailor contents to the needs and assimilation levels of target communities. Additionally, development partners should establish long-term funding mechanisms beyond grant cycles to provide sustainable financial support for CSA upscale.

Plain Language Summary Seafloor avalanches of sediment, called turbidity currents, transport huge volumes of sediment and organic carbon to the deep‐sea, and they break critical seabed telecommunication cables that underpin global data transfer. However, turbidity currents are very difficult to measure directly as they often damage sensors placed in their flow path, so they are poorly understood. Here we show that turbidity currents generate ground vibrations that can be measured using ocean‐bottom seismographs placed outside the flow's destructive path, revolutionizing flow monitoring. These seismographs recorded the longest sediment flows yet measured in action on Earth, which traveled >1,000 km along the submarine Congo Canyon‐Channel offshore West Africa. We use these observations to test fundamental models of turbidity current flow behavior. Our measurements show that the front of the flows contain a fast frontal‐zone with high sediment concentrations, which can be up to ∼400 km long, whilst the whole duration of the flow can last for more than 3 weeks. These frontal‐zones develop near‐uniform durations and speeds, despite extensive seabed erosion that adds sediment into the flow. New information on flow durations shows how turbidity currents rapidly deliver prodigious volumes of organic carbon, sediment, and warm water to the deep‐ocean floor.

Background Chronic Obstructive Pulmonary Disease (COPD) exacerbations are clinically significant events that affect millions globally. Aim To explore patients’ and carers’ experiences, understandings and responses to exacerbations. Design & setting Semi-structured interviews with COPD patients and carers. Method Interviews were conducted with a purposive sample of COPD patients and carers from four centers in England. Interviews were analysed using reflexive thematic analysis, theoretically informed by the Breathing Space concept. This research is reported in line with the Standards for Reporting Qualitative Research. Results Forty patient-participants were recruited: 21 female, 28 white, mean age 69 years [SD 8.1], mean COPD duration 11.3 years [SD 8.3], median 1.5 exacerbations in past year [range 0-9]. Seven carer-participants were recruited: 6 female, 6 white. Three themes were identified: 1) The language clinicians use in COPD is important; 2) Episodes of symptom worsening have profound patient and carer impact and 3) Patients’ early experiences, including the responses of clinicians to their help-seeking, have a lasting effect on their behaviour. How patients respond to symptom worsening can be considered holistically in the context of the Breathing Space framework. Breathlessness affected all patient-participants and was a key symptom that precipitated action. Conclusions Our novel findings show how early help-seeking experiences shape later behaviour. Early emphasis on symptom management, preparation for exacerbations and post-exacerbation reviews are practical ways that clinicians can support patients and carers to manage these events better. The Breathing Space concept provides a useful framework to identify needs and tailor COPD management appropriately.

Objectives To describe end of life care in settings where, in the UK, most children die; to explore commonalities and differences within and between settings; and to test whether there are distinct, alternative models of end of life care. Methods An online survey of UK neonatal units (NNUs), paediatric intensive care units (PICUs) and children/young people’s cancer principal treatment centres (PTCs) collected data on aspects of service organisation, delivery and practice relevant to end of life outcomes or experiences (referred to as the core elements of end of life care) across three domains: care of the child, care of the parent and bereavement care. Results 91 units/centres returned a survey (37% response rate). There was variation within and between settings in terms of whether and how core elements of end of life care were provided. PTCs were more likely than NNUs and PICUs to have palliative care expertise strongly embedded in the multidisciplinary team (MDT), and to have the widest range of clinical and non-clinical professions represented in the MDT. However, bereavement care was more limited. Many settings were limited in the practical and psychosocial-spiritual care and support available to parents. Conclusions Children at end of life, and families, experience differences in care that evidence indicates matter to them and impact outcomes. Some differences appear to be related to the type of setting. Subsequent stages of this research (the ENHANCE study) will investigate the relative contribution of these core elements of end of life care to child/parent outcomes and experiences.

Two new, isostructural, metal–organic frameworks {[Co(O2CC6H4O)(DMF)]2}n and {[Mn(O2CC6H4O)(DMF)]2}n have been synthesised and structurally characterized. Use of p-hydroxybenzoic acid resulted in a three-dimensional MOF featuring a linker with a carboxylic group and a para-hydroxyl group. Ring opening polymerization of ε-caprolactone and δ-valerolactone has been performed using these MOFs as catalysts, and results compared with the known zinc MOF Zn(O2CC6H4O). The resulting products are predominantly cyclic polymers. The manganese and zinc MOFs exhibit significant recyclability during ring opening polymerization.

Type I Diabetes is an endocrine disorder that prevents the pancreas from regulating the blood glucose (BG) levels in a patient’s body. The ubiquitous Linear-Quadratic-Integral-Regulator (LQIR) is an optimal glycemic regulation strategy; however, it is not resilient enough to withstand measurement noise and meal disruptions. The Sliding-Mode-Controller (SMC) yields robust BG regulation effort at the expense of a discontinuous insulin infusion rate that perturbs the BG concentrations. Hence, the novel contribution of this article is the formulation of a hybridized LQIR-driven SMC strategy that retrieves the benefits of the aforesaid control schemes while avoiding their inherent problems. The proposed control approach is realized by linearly combining a glycemic LQIR law with an innovative sign function sliding mode reaching law that is driven by a customized LQIR-driven sliding surface. The hybridized control scheme generates optimal control decisions yielded by the LQIR while mimicking the robustness characteristic of SMC against bounded exogenous disturbances. Additionally, the SMC reaching law in the proposed control scheme is augmented with a nonlinear adaptation mechanism that flexibly modulates the control activity to effectively compensate for the external perturbations while minimizing the chattering content. The controller parameters are numerically optimized offline. The efficacy of the prescribed hybrid control law is analyzed via customized MATLAB simulations that normalize the patient’s BG level to 80 mg/dL, under measurement noise and meal disruptions, from an initial hyperglycemic state. The results justify the improved BG regulation accuracy and disturbance-rejection capability of the proposed control procedure.

Advancements in material science, manufacturing and sensor technologies, Artificial Intelligence, and the Internet of Things have paved the way for fabricating new parts using additive manufacturing in microgravity conditions. NASA has successfully demonstrated 3D printing onboard the International Space Station (ISS), though at a minor scale. Nevertheless, the parts built onboard the ISS were returned to Earth for further testing and verification. The logistics of bi-directional transportation of raw materials from Earth to ISS and 3D-printed parts from ISS back to Earth is complex, expensive, and slow. Harnessing materials from space to establish in-orbit manufacturing as a sustainable process is both technically and economically challenging. The potential to reuse, repurpose or recycle space debris is not well studied, though there is an increasing momentum in Active Debris Removal (ADR) missions. Unlike the standard research or review paper, this is a visionary paper in which the authors explicitly address the intersection between space debris removal and in-space manufacturing. This paper defines a pathway towards implementing an operational in-orbit manufacturing and debris removal model. For the first time, the authors introduce the application of Cloud-Based Design and Manufacturing (CBDM) for in-space manufacturing in this paper. The paper aims to define a roadmap towards implementing a space operational model for in-orbit manufacturing and debris removal. Future enabling technologies that will leverage the advances in robotics, automation, and Space 5.0-based solutions to create a new environmentally friendly and economically profitable orbital ecosystem are presented. The authors analyze the pros and cons of robotic ADR, upcycling and recycling space debris for on-demand manufacturing in orbit and present a systematic approach to implementing in-orbit manufacturing as a new frontier. Recommendations are made to establish an imminent Earth-independent space logistics and supply chain system for operating an orbital factory or warehouse that will help realize a suite of in-orbit manufacturing, maintenance, and assembly missions.

Tissue factor (TF) possesses additional physiological functions beyond initiating the coagulation cascade. Cellular signals initiated by cellular TF or on contact with TF‑containing microvesicles, contribute to wound healing through regulating a number of cellular properties and functions. TF regulates the cell cycle checkpoints, however the underlying signalling mechanisms have not been determined. Endothelial (human dermal blood endothelial cells and human umbilical vein endothelial cells) and epithelial [human telomerase reverse transcriptase‑human pancreatic nestin‑expressing ductal cells (hTERT‑HPNE) and AsPC‑1] cells were exposed to different concentrations of recombinant TF, and the influence on G1/S checkpoint regulators examined. Short‑term exposure to a lower concentration of TF promoted increased p16INKa and decreased p21CIP1/WAF1 expression, together with higher early region 2 binding factor (E2F) transcriptional activity and increased phosphorylation of Thr821/826 within retinoblastoma protein, leading to cell proliferation. The increase in p16INKa expression was prevented following inhibition of β1‑integrin, or blocking the exosite within TF with AIIB2 and 10H10 antibodies, respectively. Exposure of cells to higher concentrations of TF induced disproportionate increases in p16INKa and p21CIP1/WAF1 expression, reduced retinoblastoma protein phosphorylation and E2F activity. Prolonged treatment of the immortalised hTERT‑HPNE cells with recombinant TF, resulted in significant downregulation of p16INKa protein, which was partially due to reduced mRNA expression, together with increased E2F activity, and cyclin E mRNA expression. Although an increase in the methylation of the p16INKa promoter was detected, the reduction in p16INKa protein was concurrent with, and partly attributed to increased p14ARF expression. TF appears early at the site of trauma, and its concentration is an ideal gauge for determining the extent of cellular damage, initiating clearance and repair. It is hypothesised that the balance of this signal is also dependent on the ability of cells to moderate the TF, and therefore on the level of damage. However, prolonged exposure of cells for example due to inflammation, leads to the dysregulation of the G1/S checkpoint by the tumour suppressors, leading to aberrant growth.

The use of technology for educational purposes has become widespread with the advent of the fourth industrial revolution (Dal santo et al., 2022). Drawing from Masdonati’s et al. (2022) model, the current research aims to show that the digital educational context can allow for decent education and play a tremendous role in the success of the school-to-work-transition. The study develops a model exploring how digital educational context is related to motivation to learn, proactive skill development during university studies, and career satisfaction once employed. We tested our hypotheses with a three-wave panel study composed of 297 individuals via a structural equation modeling analysis involving a sequential mediation. The results support our hypotheses and emphasize the importance of digital educational context for a better school-to-work-transition through motivation to learn and proactive skill development. The study provides practical implications which are discussed.

This paper acknowledges M.J. Jackson's contributions to the development of systems thinking and particularly to organisational cybernetics. It also reviews his criticisms of Stafford Beer's Viable System Model (VSM) as a ‘unitary , functionalist’ systemic approach, unable to deal with individual, social and political issues, and of Team Syntegrity (TS) as a ‘simple, and somewhere in the middle between pluralist and coercive’, approach. It argues that whilst Jackson has evolved his view of VSM and TS over the last few decades and has become more supportive of them, Beer and his followers have addressed several of his original criticisms. By referring to recent VSM theoretical and methodological developments, and providing examples of VSM applications in complex, politicised multi‐stakeholder's environments, it illustrates how the VSM deals with individual, social and political complexities in practice. It then suggests that, to strengthen Jackson's legacy on systems research and multimethodology, it would be useful to develop a ‘critical empathetic approach’—not only still critical but also supportive and creative—to nourish the development of a more robust trans‐disciplinary systems research agenda.

Long-term datasets provide context and understanding of complex ecological processes, including temporal variations in species diversity and ecosystem dynamics. This dataset is comprised of body length measurements (mm) of more than 380,000 larval or juvenile fish of 30 species from five English river catchments collected almost monthly over two decades. Such information can be used to determine growth rates, future recruitment success, population structure and compliance with monitoring protocols and conservation objectives. The dataset provides a baseline for analysing the impacts of anthropogenic disturbances such as climate change, pollution and habitat degradation, and, given that many fish populations are size structured with a positive relationship between fish body length and various biological attributes such as swimming ability, survival and fecundity, it will be invaluable for investigating natural and human- induced disturbances.

The COVID‐19 pandemic led to far‐reaching detrimental impacts, with challenges weighted toward women, who experience a double‐burden of paid work and care/domestic work. Professional lives were enacted in new spaces, as many were ordered to work from home. This was particularly testing for women, who found themselves servicing additional expectations each day, such as complex relational work and home‐schooling. For many, this caused stress, damage to career, and strained relationships. Yet, as women academics, we were surprised to see that some of our peers were reporting they had positive experiences during lockdowns. Drawing on interview data from 23 women academics based in the United Kingdom, we found that participants did not report damage to their professional identities; indeed, in some cases the pandemic provided new ways to expand academic identities, for example through skill development and international networking. Furthermore, participants reported the pandemic as a chance to choose how to focus their energies, withdrawing from relationships and activities that did not contribute to the achievement of the selves they sought to become and capitalising on those that did. This paper is therefore valuable in revealing the techniques and resources (narrative and otherwise) that can enable women to report positive experiences, even when facing adversity.

Communities worldwide face escalating flood risks due to climate change, a fact that emphasises the critical role of flood preparedness in community flood resilience. Globally, flood risk is expected to double by 2050. In the United Kingdom, where this study is set, approximately one property in six is already at risk of flooding, with that figure set to increase significantly in coming decades. Children and young people are often overlooked in work on flood resilience and response. Researchers working with flood‐affected children have learned from their experiences and supported them in telling their stories and sharing insights about how to best manage flood risk in the future. Here, we advance a research approach that co‐created with young people and teachers a suite of educational resources centred on using innovative 360° animation and immersive storytelling approaches. That work has allowed us to bring to life testimonies by children affected by flooding and to advance debates on how empathy can be amplified to widen engagement across a range of audiences and stakeholders. The tools we developed place the user in the centre of the child’s flood‐impacted world, something that has received relatively little attention. The results provide significant new insights on the use of 360° storytelling approaches that can prompt enhanced, empathic responses that motivate users to want to learn more about flooding, help create a sense of solidarity, and inspire action. We argue that such empathy‐driven, action‐oriented responses are crucial when developing future flood preparedness plans and enhancing broader community flood resilience.

Background Choosing to have dialysis or conservative kidney management is often challenging for older people with advanced kidney disease. While we know that clinical communication has a major impact on patients’ treatment decision-making, little is known about how this occurs in practice. The OSCAR study (Optimising Staff-Patient Communication in Advanced Renal disease) aimed to identify how clinicians present kidney failure treatment options in consultations with older patients and the implications of this for patient engagement. Methods An observational, multi-method study design was adopted. Outpatient consultations at four UK renal units were video-recorded, and patients completed a post-consultation measure of shared decision-making (SDM-Q-9). Units were sampled according to variable rates of conservative management. Eligible patients were ≥ 65 years old with an eGFR of ≤ 20 mls/min/1.73m² within the last 6 months. Video-recordings were screened to identify instances where clinicians presented both dialysis and conservative management. These instances were transcribed in fine-grained detail and recurrent practices identified using conversation-analytic methods, an empirical, observational approach to studying language and social interaction. Results 110 outpatient consultations were recorded (105 video, 5 audio only), involving 38 clinicians (doctors and nurses) and 94 patients: mean age 77 (65–97); 61 males/33 females; mean eGFR 15 (range 4–23). There were 21 instances where clinicians presented both dialysis and conservative management. Two main practices were identified: (1) Conservative management and dialysis both presented as the main treatment options; (2) Conservative management presented as a subordinate option to dialysis. The first practice was less commonly used (6 vs. 15 cases), but associated with more opportunities in the conversation for patients to ask questions and share their perspective, through which they tended to evaluate conservative management as an option that was potentially personally relevant. This practice was also associated with significantly higher post-consultation ratings of shared decision-making among patients (SDM-Q-9 median total score 24 vs. 37, p = 0.041). Conclusions Presenting conservative management and dialysis as on an equal footing enables patient to take a more active role in decision-making. Findings should inform clinical communication skills training and education. Clinical trial number No trial number as this is not a clinical trial.

Background The architecture and design of healthcare settings impact health outcomes, satisfaction, and wellbeing (Ulrich, Zimring, Zhu, X, et al. HERD. 2008;1(3):61–125). Homelike design is recommended for hospices internationally (Verderber, Refuerzo. Innovations in hospice architecture. Taylor & Francis Group; 2010), but the kinds of domestic residence evoked by homelike hospice design in England have not been identified, nor how they relate to those of the population served. Aim To establish the extent to which hospice buildings in England are homelike and explore the types of residence homelike designs reflect. Methods A database of all hospices with adult inpatient units in England was created using a dataset provided by Hospice UK. A representative sample of 10 sites was selected using a sampling frame based on size, location, organisational model, area demographics and building type. Sites were examined and photographed by a researcher trained in architectural analysis. The approach to homelike design in primary documents from each site was assessed. Data analysis was informed by critical geography of architecture approaches (Lees. Ecumene. 2001;8(1),51–86). Results All hospice buildings visited included some degree of structural or decorative homelike design features but the presentation of homelike design varied. Hospices in converted residences typically retained their appearance as large detached houses with private gardens, a residence type negatively correlated in England with the most deprived areas, social renters, and households with a black, Asian or minority ethnic household reference person (Ministry of Housing, Communities and Local Government. English housing survey: households report, 2017–18; 2019). Purpose-built hospices varied from visually institutional and un-homelike, to homelike settings reflecting the layout of detached homes with private gardens, or inspired by luxury hotel and spa design. Conclusion The reflection in homelike hospice buildings of design associated with the homes of majority ethnic and wealthier demographics, and the design of luxury settings, raises questions as to the inclusivity of this design trend and its potential to contribute to the documented inequity of access to hospice care among disadvantaged and minoritized groups (Nelson, Wright, Peeler, et al. Am J Hosp Palliat Med. 2021;38(11):1378–1390).