University of Sunderland

Introduction The plasminogen activating (PA) system has a multitude of functions such as wound healing, proteolytic activity, collagen degradation and cell growth, and the role of the urokinase plasminogen activator/urokinase plasminogen activator receptor (uPA/uPAR) system has been studied in many disease states. The aim of this study was to investigate salivary concentrations of uPA, uPAR and uPA activity in patients with periodontitis to identify biomarkers and novel pathogenic relationships. Methods Saliva samples were obtained from 169 participants, comprising patients with periodontitis ( n = 103) and periodontally healthy volunteers ( n = 66) and analysed for uPA and uPAR with a multiplex protein assay using proximity extension analysis in a subset of samples, followed by validation with ELISA. The protease activity of salivary uPA was quantified using a fluorometric assay. Results Patients with periodontitis had a 4.0‐fold higher ( p < 0.001) salivary uPA and a 2.5‐fold higher ( p < 0.001) salivary uPAR concentration in comparison to periodontally healthy participants. The salivary uPA activity (median [IQR]) from patients with periodontitis (123.21 [188.29] U/mL) was 1.6‐fold higher ( p < 0.01) than the salivary uPA activity from periodontally healthy participants (76.83 [98.09] U/mL). Levels of uPA and uPAR were strongly correlated with periodontal indices, whereas only weak correlations were found with BMI and age. Conclusion Activation of uPA/uPAR likely plays a role in the pathogenesis of periodontal diseases. uPA/uPAR may have potential utility as candidate salivary biomarkers in periodontal pathogenesis.

The reliance on replacement blood donors in developing countries has led to an increased prevalence of transfusion-transmitted infections (TTIs), including HIV. This systematic review and meta-analysis aimed to assess the seroprevalence of HIV among blood donors in South Asian countries and disseminate the findings in choropleth maps. In addition, gender-specific prevalence or the yearly trend of HIV prevalence among blood donors was also investigated. Following the PRISMA guidelines, we searched PubMed, Scopus, CAB abstracts, CINAHL, and Google Scholar for articles published between January 2000 and December 2022. The DerSimonian–Laird effect model was used due to the high heterogeneity of the data. Data analysis was performed using R Studio version 4.1.0, ArcGIS, and GraphPad Prism 7.0. The pooled seroprevalence of HIV among blood donors in South Asian countries was found to be 0.13%, with the highest prevalence of 0.19% in India and the lowest prevalence of 0.02% in Bangladesh and Bhutan. Female blood donors had a higher seroprevalence than their male counterparts (0.24%, vs. 0.17%). In contrast to voluntary blood donors with an HIV seroprevalence of 0.13%, replacement blood donors have a higher HIV prevalence of 0.26%. The observed high heterogeneity was attributed to variations in country, gender, type of blood donors, and study year. This study demonstrates a significant burden of HIV among blood donors in South Asia, emphasizing the need for enhanced donor screening protocols, targeted interventions and educational campaigns to ensure the safety of blood transfusion services. Future research should explore additional risk factors and focus on expanding screening methods, particularly in resource-limited settings.

Educators and researchers are reliant upon access to data to drive teaching methods, curricular improvements, and progress in medical education research. However, data are not always accessible, due to resource constraints, institutional policies, and privacy concerns. Researchers have attempted to access novel data sources through surveys, semistructured interviews, and databases; however, these methodologies are limited. To improve access to data, Freedom of Information (FOI) Acts grant researchers the ability to formally request data that any public institute holds. Researchers have been reluctant to use this tool due to negative perceptions, despite its unique benefits. To increase awareness of this underutilized methodology, we summarize the process of FOI Act requests, its strengths and weaknesses, and the ways in which health professions education can leverage FOI requests within research. We provide examples of the use of FOI requests as a research method within adjacent fields and nascent use within the field of health professions research. In doing so, we hope to highlight how FOI requests can be a useful tool in health professions education researchers and its potential to increase access to unique data sources.

The Hastelloy C276 superalloy is one of the versatile and promising alloys considered for high-temperature applications. In the present work, the crystallographic properties and nanomechanical behaviour of Hastelloy C276 superalloy manufactured via gas metal arc welding (GMAW) based wire-arc additive manufacturing (WAAM) were evaluated. The WAAM-processed C276 superalloy mainly comprises columnar dendrites with the predominant <100> and <111> textures at the middle region. Also, p phases rich in Mo and W were noticed within the interdendritic regions of the austenitic matrix. Small-scale mechanical testing revealed that the WAAM-processed Hastelloy C276 superalloy exhibited a reduced elastic modulus compared to its wrought counterpart. The average nanohardness (H) and reduced elastic modulus (Er) in the horizontal direction were 5.40 ± 0.51 GPa and 192.42 ± 4.50 GPa, and 4.28 ± 0.14 GPa and 122.26 ± 2.0 GPa in the vertical direction. From the nanoindentation responses, the dendritic cores have a reduced nanohardness than that of the interdendritic regions due to the localized segregation of Mo and W in the interdendritic regions, resulting in solid solution hardening. The H³/Er² ratio revealed the comparable plastic deformation resistance of WAAM-processed Hastelloy C276 in the horizontal and vertical directions at the nanoscale level.

Objectives The Newcastle Sjogren’s Stratification Tool (NSST) stratifies Sjogren’s disease patients into four subtypes. Understanding the stability of the subtypes is vital if symptom-based stratification is to be more broadly adopted. In this study, we stratify patients longitudinally to understand how symptom-based subtypes vary over time and factors influencing subtype change. Methods 274 patients from the United Kingdom Primary Sjögren’s Syndrome Registry (UKPSSR) with data permitting NSST subtype assignment from two study visits were included. The French Assessment of Systemic Signs and Evolution of Sjogren’s Syndrome (ASSESS) cohort (n=237) acted as an independent comparator. Group analyses of significant differences were performed, with logistic regression models used to assess covariates of subtype stability. Results UKPSSR and ASSESS cohorts showed a broadly similar proportion of subjects in each subtype and similar baseline clinical characteristics except body mass index (BMI). Several baseline characteristics differ significantly between the subtypes, most notably anti-Ro status and BMI. Subtype membership was reasonably stable in both cohorts with 60% and 57% retaining subtype. The high-symptom burden subtype was the most stable over time with 70% and 67% retaining subtype. Higher baseline probability score was the greatest predictor of subtype stability with higher C4 levels, antidepressant use, and a higher CCI score also predicting increased stability. Conclusion NSST subtype membership remains stable over time in a large proportion of patients. When subtype transition is associated with factors at baseline, it is most strongly associated with an uncertain subtype allocation. Our findings support the hypothesis that symptom-based subtypes reflect genuine pathobiological endotypes and therefore maybe important to consider in trial design and clinical management.

This chapter addresses empathic attention through the lens of contemporary art-making and is developed from my practice-based doctoral research. Throughout the text, empathy is seen through material engagement, as a particular kind of knowledge located in the provisional, in the speculative sense of becoming other. In doing so, it engages with phenomenological, aesthetic, and experimental methods of artistic production such as filming isolated gestures, using the body to mirror actions, exploring details in archival materials, and creating discreet installations. This chapter focuses on artworks in which gesture, orientation, and attention are key methods in the articulation and reception of the work. The chapter will examine the role of the photograph in my own artwork, considering it through phenomenological and affective lenses. Using my own experience of making art, the essay looks at how we might define the nature of empathic attention through art practice. To do this I will examine the affects and effects of art, both my own and others, to consider what Peter Goldie has termed “perspective shift,” framing empathy by examining its effects.

Nigeria’s healthcare system faces significant challenges in financing and quality, impacting the delivery of services to its growing population. This study investigates healthcare workers’ perceptions of these challenges and their implications for healthcare policy and practice. A cross-sectional survey was conducted with 600 healthcare professionals from eight states across Nigeria, representing a variety of healthcare occupations. Participants completed a questionnaire that assessed their perceptions of healthcare financing, quality of care, job satisfaction, and motivation using a 5-point Likert scale, closed- and open-ended questions. Descriptive statistics, Chi-squared test, and regression analysis were used to analyze the data. The findings revealed that healthcare workers were generally not satisfied with the current state of healthcare financing and system quality in Nigeria. Poor funding, inadequate infrastructure, insufficient staffing, and limited access to essential resources were identified as major challenges. These challenges contributed to low job satisfaction, demotivation, and a desire to leave the profession. Socioeconomic factors, location State of practice, professional designation (clinical vs nonclinical), clinical designation (profession), and employment type (full-time vs part-time) were found to influence healthcare workers’ perceptions (p < 0.05). The findings indicated a need to improve healthcare workers’ satisfaction and retention, and quality of care in Nigeria, by increasing healthcare funding, transparent fund management protocols, investing in infrastructure and human resource development, and addressing regional healthcare disparities. By implementing these reforms, Nigeria can enhance the quality and accessibility of healthcare services and improve the health and well-being of its citizens.

Hysterosalpingography (HSG) is a minimally invasive procedure that can be painful. This study aimed to examine the impact of a tailored training program on anxiety and perceived pain intensity in infertile women undergoing HSG. This research was a clinical trial involving 86 infertile women who were candidates for HSG and conducted at the radiology department of the Royan Infertility Center in Tehran, Iran, between November 22, 2021, to March 11, 2023.The participants were divided into two groups:43 women in the intervention group and 43 women in the control group. The randomization of the samples was carried out using a random number table. The women in the intervention group received two face-to-face group training sessions. Data were collected using valid questionnaires. Additionally, the heart rate and blood pressure of the participants were recorded. Data analysis showed the training intervention was significantly associated with reducing anxiety levels, perceived pain, systolic blood pressure, diastolic blood pressure, and heart rate in women undergoing HSG (p < 0.05). These findings support the use of structured training interventions to improve the overall experience and outcomes for patients undergoing HSG. Trial Registration Number: IRCT20150905023897N4.

Introduction Adherence to medicines in osteoporosis is poor, with estimated 1 year persistence rates between 16% and 60%. Poor adherence is complex, relating to combinations of fear of side effects, beliefs about medication being unnecessary, doubts about effectiveness and the burden of medication management. This is compounded by an absence of monitoring, as many patients are effectively discharged from ongoing care following the initial prescription. Clinical pharmacists in general practice are a relatively new workforce in the UK NHS; this is an unexplored professional group that could provide person-centred, adherence-focused interventions in an osteoporosis context. A model consultation intervention to be delivered by clinical pharmacists in general practice for patients already prescribed fracture prevention medications will be developed using existing evidence and theory and empirical qualitative work outlined in this protocol. Methods and analysis We will investigate the current practice and barriers and facilitators to a clinical pharmacist-led osteoporosis intervention, including exploring training needs, through focus groups with people living with osteoporosis, pharmacists, general practitioners, osteoporosis specialists and service designers/commissioners. Framework analysis will identify and prioritise salient themes, followed by mapping codes to the theoretical domains framework and normalisation process theory to understand integration and implementation issues. We will further develop the content and model of care for the new consultation intervention through co-design workshops with stakeholder and patient and public involvement and engagement group members. The intervention in practice will be refined in a sequential process with workshops and in-practice testing with people prescribed fracture prevention medication, pharmacists and the multidisciplinary team. Ethics and dissemination Ethical approval was obtained from NHS North West—Greater Manchester South Research Ethics Committee (Ref 23/NW/0199). Dissemination and knowledge mobilisation will be facilitated through a range of national bodies/stakeholders. Impact and implementation plans will accelerate this research towards a future clinical trial to determine cost and clinical effectiveness.

Contraception is freely available in the UK from the NHS through pharmacies or private providers, such as Brook clinics. Despite wider societal acceptance of contraception, practical, psychological and social barriers remain to access for a range of groups. A first consultation to assess contraceptive needs will require a longer appointment as there are many issues to discuss alongside those pertaining directly to contraceptive use, such as emergency contraception, safeguarding and sexually transmitted infection risk. Health professionals must consider consent and confidentiality in any consultation and be aware of groups who are at higher risk of abuse, such as vulnerable adults and those from the LGBTQ+ community. This article discusses contraception use, and forms of available contraception in the UK, including common risks and benefits, barriers to accessing contraception and emergency contraception.

Psoriasis and breast cancer are two examples of diseases where associated inflammatory pathways within the body’s immune system are implicated. Psoriasis is a complex, chronic and incurable inflammatory skin disorder that is primarily recognized by thick, scaly plaques on the skin. The most noticeable pathophysiological effect of psoriasis is the abnormal proliferation of keratinocytes. Breast cancer is currently the most diagnosed cancer and the leading cause of cancer-related death among women globally. While treatments targeting the primary tumor have significantly improved, preventing metastasis with systemic treatments is less effective. Nanocarriers such as liposomes and lipid nanoparticles have emerged as promising drug delivery systems for drug targeting and specificity. Advances in technologies and drug combinations have emerged to develop more efficient lipid nanocarriers to include more than one drug in combinational therapy to enhance treatment outcomes and/or relief symptoms for better patients’ quality of life. Although there are FDA-approved liposomes with anti-cancer drugs for breast cancer, there are still unmet clinical needs to reduce the side effects associated with those nanomedicines. Hence, combinational nano-therapy may eliminate some of the issues and challenges. Furthermore, there are no nanomedicines yet clinically available for psoriasis. Hence, this review will focus on liposomes encapsulated single and/or combinational therapy to augment treatment outcomes with an emphasis on the effectiveness of combinational therapy within liposomal-based nanoparticulate drug delivery systems to tackle psoriasis and breast cancer. This review will also include an overview of both diseases, challenges in delivering drug therapy and the roles of nanomedicines as well as psoriasis and breast cancer models used for testing therapeutic interventions to pave the way for effective in vivo testing prior to the clinical trials.

Background Coronavirus Disease 2019 (COVID-19) booster vaccine uptake has been lower than that of the initial vaccine doses in many countries. Approaches to vaccination vary, with some countries implementing mandatory vaccination and others not. This study aimed to predict COVID-19 booster vaccination intention using Protection Motivation Theory (PMT), coronavirus conspiracy beliefs, social media use, and sociodemographic factors, comparing the United Kingdom (UK), Jordan, Germany, and Austria. Methods A cross-sectional online survey was conducted in the UK, Germany, Austria, and Jordan. Convenience sampling was used to recruit 287 fully vaccinated participants. The survey included items measuring PMT constructs, conspiracy beliefs, social media use, and sociodemographic variables. Data were analysed using bivariate analysis and binary logistic regression. Results Participants with high booster dose intention showed lower religiosity, conspiracy beliefs, perceived rewards of not getting vaccinated, and perceived costs of getting vaccinated. They had higher Twitter use, perceived susceptibility, severity of COVID-19, self-efficacy, and vaccine efficacy. Four PMT constructs (severity, self-efficacy, maladaptive response rewards, and response efficacy) significantly predicted booster dose intention. Conclusions While PMT constructs predict booster vaccination intention, additional factors such as conspiracy beliefs, social media use, and religiosity need to be taken into account in public health campaigns to increase COVID-19 booster dose uptake. Highlights • Intention to get the COVID-19 booster dose can be predicted with Protection Motivation Theory. • Religiosity, conspiracy beliefs, and Twitter use were associated with booster dose intention. • Campaigns to increase booster dose uptake need to take these factors into account.

Background Direct oral anticoagulants (DOACs) interfere with coagulation assays potentially leading to inaccurate results. This study determined the effectiveness of DOAC-stop® and DOAC-remove® in overcoming DOAC interference. It aimed to investigate the extent to which apixaban, rivaroxaban, and dabigatran had an effect on thrombophilia and lupus tests using normal plasma, as well as whether DOACs interfere with true-positive results by testing abnormal controls. Methods Apixaban (0.03 mg/mL), rivaroxaban (0.01 mg/mL), and dabigatran (0.019 mg/mL) stock solutions were made and added to the normal pool at three different concentrations (200, 400 and 600 ng/mL) and to the abnormal controls at a single concentration. These samples and untreated DOAC controls were tested before and after adding either DOAC-stop® or DOAC-remove®. The measured parameters included protein C, protein S, antithrombin III (ATIII), DRVVS, DRVVC, PTT-LA and DOAC concentration. The normal pool spiked with DOAC was repeated seven times for each DOAC at each concentration level and the abnormal controls spiked with DOAC were repeated four times at a single concentration level for each DOAC. Results In the normal pool, dabigatran and rivaroxaban affected all lupus anticoagulant tests, whereas apixaban only affected DRVVS and DRVVC. While dabigatran led to false-positive protein S deficiency and falsely elevated ATIII. Both DOAC-stop® and DOAC-remove® brought the thrombophilia results and all falsely elevated lupus anticoagulant results back within the normal range for apixaban and rivaroxaban. For dabigatran all the affected lupus anticoagulant tests remained abnormal following DOAC-remove®, unlike DOAC-stop® treatment, where only DRVVS and DRVVC at 600 ng/mL remained abnormal. In abnormal controls, all DOACs falsely elevated the lupus anticoagulant tests, whereas dabigatran caused false negative ATIII results, that were corrected (remained abnormal) with DOAC-stop® and DOAC-remove®. DOAC-stop® showed a greater reduction in lupus anticoagulant results than DOAC-remove®, causing a false-negative DRVVT ratio for rivaroxaban. Conclusion DOAC-stop® is more effective than DOAC-remove® in removing all DOACs below the reference range, whereas DOAC-remove® failed to remove dabigatran.

In recent years, there has been a change in the objectives of Higher Education (HE): the inclusion of employability. The successful inclusion of employability as a goal of HE requires a change to the sector’s teaching, learning and assessment (TLA) methods, which ought to be part of an HEI’s strategy. In particular, there needs to be an emphasis on adjustments to both curriculum design and modes of assessment, both for the inclusion of employability and also in preparation for digital transformation (Education 4.0) as well as internationalisation. Any HEI development plan should acknowledge the importance of employability. To meet national standards and keep up with evolving trends in the job market, every programme needs to equip students with the necessary skills, knowledge, and experience to succeed in their future careers. Every institution is obligated to provide opportunities for students from all backgrounds and capabilities to learn about work.

Claire Urwin, Principal Lead for Pre-Registration Developments in London/Programme Leader M Nurse, University of Sunderland (claire.urwin@sunderland.ac.uk), reviews the development of the registered nursing associate role and considers factors relating to professional development for role holders

Introduction: Sports psychiatry is an emerging medical and psychiatric discipline that has experienced significant development in recent years. This growth has been accompanied by an increase in scientific outputs from sports psychiatrists and other academics that address the three fields of activity of sports psychiatry: namely, mental health and disorders in competitive and elite sports, mental health and sport-specific mental disorders in recreational sports, and the use of sport, exercise and physical activity in the prevention and treatment of mental disorders. Conceptual publications have discussed the scope of sports psychiatry and education and training. However, some topics receive more attention than others, with evidence gaps in other key areas of sports psychiatry. Advancing the field towards evidence-based practice requires an assessment of the current state of the literature and the development of a strategic research agenda. Methods: Following the Working Group on Research Gaps, Priorities and Agenda at the Summit on Sports Psychiatry arranged by the International Society for Sports Psychiatry (ISSP), the ISSP Scientific Committee conducted a narrative review of the sports psychiatry literature to benchmark the current academic state of the discipline and further developed the research agenda to provide a strategic framework for future research directions. Results: We discuss a research agenda according to five key areas: sports psychiatry as a discipline, education and training in sports psychiatry, and the three clinical fields of activity of sports psychiatry. Conclusion: This sports psychiatry research agenda provides a framework to guide the strategic development of the scientific literature in the field.

Given the rising challenge of client-based web attacks through vulnerabilities in websites, traditional pattern detection methods often fall short in identifying emerging threats. To bridge this gap, our study proposes a methodology employing machine learning algorithms to counteract three specific types of client-based web attacks: Malicious JavaScript, phishing attacks, and script-based web attacks. Our method extracts significant features from the source code and URLs, subsequently applying a range of machine learning models, including random forest (RF), deep neural network (DNN), and convolutional neural network (CNN), to pinpoint the most effective model. Experimental evidence from our research highlights the RF model’s exceptional accuracy, achieving 99.99% in detecting Malicious JavaScript, 95.11% for phishing attacks, and 94.77% for script-based web attacks. Additionally, our work extends beyond theoretical contributions, evidenced by the development of a Chrome extension based on the high-performing RF model, offering a tangible solution for enhancing web browsing security.