University of Worcester
  • Worcester, United Kingdom
Recent publications
This article examines several factors that can affect how raising of concerns can be supported. Nurse leaders play a vital role in this process to maintain patient safety and act accordingly within the Nursing and Midwifery Council Code. Considerations are provided to explore how the nurse leader can facilitate communication with all team members to influence organisational culture, where colleagues feel confident in voicing concerns. Professional responsibilities pertinent to this process are highlighted, including the nurse leader as an advocate and supporting constructive challenge.
Purpose : To analyze tactical behaviors associated with performance in track middle-distance global championship finals. Methods : Finalists’ season-best finishing race time, 100-m section times, and intermediate positions were obtained from 800- and 1500-m men’s and women’s finals in 2 Olympic Games and 5 World Championships. Differences between medalists, fourth- to eighth-ranked (T8), and ninth- to 12th/13th-ranked finalists in relative performance (relative to season-best), race time, and section times were determined. Pearson correlations between intermediate position and section speed with final position and probability of winning a medal at each race point were calculated. Results : A very high correlation was found between intermediate and final position at the first 100 m in the women’s 800-m ( r = .84; P = .008), which was maintained throughout the race. Medalists were relatively faster than T8 in men’s and women’s 800-m finals ( P = .006; d = 0.87, and P = .039; d = 0.59, respectively). Differences in relative performance between groups in 1500-m finals appeared at the end of the race, although they arose earlier in women’s races. The probability of winning a medal decreased with lower intermediate positions, especially in the latest race stages. Conclusions : A high intermediate position, as well as the ability to run fast in the latest race stages, seems critical to medaling in track middle-distance global championship finals. The abilities to adopt leading positions for the whole 800-m event and to generate an end spurt relatively faster than the rest of competitors in the 1500-m event are critical.
British left-wing politics does not know what to think about mothers. In left-wing women’s movements, motherhood has been recognised as essential and difficult; necessary for future revolutions, not least in raising future revolutionaries. In less radical circles, it has been understood as a crucial contribution to the functioning of society, often forming the basis of women’s claims to citizenship and maternalist forms of politics. On the other hand, motherhood has been seen as a ‘natural’ function of women and a private responsibility, rather than a public good or a collective act which needs comprehensive state support. The family, in this reading, is a rather conservative force, better left to social reactionaries. Mothering has added additional hurdles to the gendered obstacles women already face in pursuing politics as activists or elected representatives. Perhaps because of this, many mothers in politics have sought to downplay or distance themselves from their roles as mothers, emphasising instead their contributions as workers and activists who can be fully committed to the left cause. Feminist historians have often followed their lead and have tended to write around political mothers’ maternal roles in their scholarship. This roundtable develops themes first explored in our November 2023 workshop, generously supported by the Royal Historical Society.
Bipolar disorder is a leading contributor to the global burden of disease¹. Despite high heritability (60–80%), the majority of the underlying genetic determinants remain unknown². We analysed data from participants of European, East Asian, African American and Latino ancestries (n = 158,036 cases with bipolar disorder, 2.8 million controls), combining clinical, community and self-reported samples. We identified 298 genome-wide significant loci in the multi-ancestry meta-analysis, a fourfold increase over previous findings³, and identified an ancestry-specific association in the East Asian cohort. Integrating results from fine-mapping and other variant-to-gene mapping approaches identified 36 credible genes in the aetiology of bipolar disorder. Genes prioritized through fine-mapping were enriched for ultra-rare damaging missense and protein-truncating variations in cases with bipolar disorder⁴, highlighting convergence of common and rare variant signals. We report differences in the genetic architecture of bipolar disorder depending on the source of patient ascertainment and on bipolar disorder subtype (type I or type II). Several analyses implicate specific cell types in the pathophysiology of bipolar disorder, including GABAergic interneurons and medium spiny neurons. Together, these analyses provide additional insights into the genetic architecture and biological underpinnings of bipolar disorder.
Over recent years there has been a raft of literature drawing attention to the inequity of working conditions for those in the Early Childhood Education and Care (ECEC) sector in England; however, it remains rare that we have the opportunity to hear the voices of the practitioners telling their own story. Through an online anonymous survey, we gained rich qualitative data from 59 ECEC practitioners in England who discussed feeling disillusionment, injustice and exhaustion; experiences and emotions that were magnified through their experiences during and after the pandemic. In this article we argue that the ECEC sector has reached breaking point, and that immediate action is needed if we are to avoid the loss of a passionate, skilled and dedicated workforce, and if we are to avoid the risk of our most vulnerable children suffering the consequences.
Invasive Phytophthora species infect a very broad range of herbaceous and woody hosts globally. The UK alone has experienced a particularly damaging series of outbreaks and epidemics of new, invasive Phytophthora species affecting the nation's trees over the last 30 years. The link between Phytophthora outbreaks and the importation and spread of infected nursery stock is well established across many countries worldwide. To understand better the pathways of spread of Phytophthora in the nursery trade in Britain, we applied a standardized nursery sampling method combined with a refined metabarcoding detection method to capture the diversity of Phytophthora species at 134 British plant nurseries representing a range of biosecurity and trading practices over multiple sampling years between 2016 and 2022. This included root and water samples collected from 17 nurseries sampled seasonally and root samples collected from 117 nurseries sampled once as part of plant health inspections. Based on analyses of 1894 pooled samples, DNA barcodes of 85 Phytophthora species or complexes were detected, with variation in species' relative frequencies across nurseries. We present the top 20 host– Phytophthora associations ranked by relative frequency and report five novel Phytophthora records for the UK. We identified surprisingly high‐risk hosts (such as Douglas fir) with the greatest number of Phytophthora associations and revealed Phytophthora nursery niche preferences for water or roots. We discuss the implications of our findings in terms of pathogen diversity and abundance, high‐risk hosts, our information dissemination approach and resulting advice on nursery practices aimed at reducing risk.
Background Accurate diagnosis of bipolar disorder (BPD) is difficult in clinical practice, with an average delay between symptom onset and diagnosis of about 7 years. A depressive episode often precedes the first manic episode, making it difficult to distinguish BPD from unipolar major depressive disorder (MDD). AimsWe use genome-wide association analyses (GWAS) to identify differential genetic factors and to develop predictors based on polygenic risk scores (PRS) that may aid early differential diagnosis. Method Based on individual genotypes from case–control cohorts of BPD and MDD shared through the Psychiatric Genomics Consortium, we compile case–case–control cohorts, applying a careful quality control procedure. In a resulting cohort of 51 149 individuals (15 532 BPD patients, 12 920 MDD patients and 22 697 controls), we perform a variety of GWAS and PRS analyses. ResultsAlthough our GWAS is not well powered to identify genome-wide significant loci, we find significant chip heritability and demonstrate the ability of the resulting PRS to distinguish BPD from MDD, including BPD cases with depressive onset (BPD-D). We replicate our PRS findings in an independent Danish cohort (iPSYCH 2015, N = 25 966). We observe strong genetic correlation between our case–case GWAS and that of case–control BPD. Conclusions We find that MDD and BPD, including BPD-D are genetically distinct. Our findings support that controls, MDD and BPD patients primarily lie on a continuum of genetic risk. Future studies with larger and richer samples will likely yield a better understanding of these findings and enable the development of better genetic predictors distinguishing BPD and, importantly, BPD-D from MDD.
Importance Among older adults with ischemic heart disease, participation in traditional ambulatory cardiac rehabilitation (CR) remains low. While mobile health CR (mHealth-CR) provides a novel opportunity to deliver care, age-specific impairments to technology use may limit uptake, and efficacy data are currently lacking. Objective To test whether mHealth-CR improves functional capacity in older adults. Design, Setting, and Participants The RESILIENT phase 2, multicenter, randomized clinical trial recruited patients aged 65 years or older with ischemic heart disease (defined as a hospital visit for myocardial infarction or coronary revascularization) from 5 academic hospitals in New York, Connecticut, and Massachusetts between January 9, 2020, and April 22, 2024. Intervention Participants were randomized 3:1 to mHealth-CR or usual care. mHealth-CR consisted of commercially available software delivered on a tablet computer, coupled with remote monitoring and weekly exercise therapist telephone calls, delivered over a 3-month duration. As RESILIENT was a trial conducted in a routine care setting to inform decision-making, participants in both arms were also allowed to receive traditional CR at their cardiologist’s discretion. Main Outcomes and Measures The primary outcome was change from baseline to 3 months in functional capacity, measured by 6-minute walk distance (6MWD). Secondary outcomes were health status (12-Item Short Form Health Survey [SF-12]), residual angina, and impairment in activities of daily living. Results A total of 400 participants (median age, 71.0 years [range, 65.0-91.0 years]; 291 [72.8%] male) were randomized to mHealth-CR (n = 298) or usual care (n = 102) and included in the intention-to-treat analysis. Of those, 356 participants (89.0%) returned in person for 6MWD assessment at 3 months. For the primary outcome, there was no adjusted difference in 6MWD between participants receiving mHealth-CR vs usual care (15.6 m; 95% CI, −0.3 to 31.5 m; P = .06). Among subgroups, there was an improvement in 6MWD among women (36.6 m; 95% CI, 8.7-64.4 m). There were no differences in any secondary outcomes between groups (eg, adjusted difference in SF-12 physical component scores at 3 months: −1.9 points; 95% CI, −3.9 to 0.2 points). Based on inverse propensity score weighting, there was no effect of mHealth-CR on 6MWD among those who did not attend traditional CR (25.7 m; 95% CI, −8.7 to 60.2 m). Conclusions and Relevance In this randomized clinical trial of mHealth-CR vs usual care, mHealth-CR did not significantly increase 6MWD or result in improvements in secondary outcomes. The findings suggest the older adult population may require more age-tailored mHealth strategies to effectively improve outcomes. Trial Registration ClinicalTrials.gov Identifier: NCT03978130
This paper examines the reasons why Chinese Managers come to the UK to study a postgraduate management qualification. Semi-structured interviews were conducted with 27 managers from the Guangxi province in China, who were studying a Master of Arts award in Management Studies at the University of Worcester. The research indicates that managers were motivated by increased knowledge of Western management practices, improved business English skills and personal reasons such as travel opportunities and culture experiences. Nonetheless, without financial support from employers, it is doubtful whether these individuals would have committed to study in the UK. The paper concludes by suggesting actions that universities could make in order to maximize the learning experience of Chinese students in the UK.
Increasingly managerial posts are being advertised with CPD (Continuing Professional Development) as a stated benefit alongside the usual job benefits of bonus, car, life assurance etc. Yet CPD as a job perk, rather than an integral element of the person specification, not only challenges the underlying premise of CPD; it is morally inappropriate. While CPD has become a universal term, whose use covers a wide range of professions (e.g. law, accounting, architecture, teaching, engineering, town planning, and medicine), in this paper, we specifically focus on CPD for managers, particularly examining why managers should be concerned with CPD and discussing the implications for managers of CPD being specified as a job benefit.
Introduction: There continues to be much discussion around optimisation of thyroid hormone status in hypothyroid individuals. We here looked the way that free T4(FT4) and thyroid-stimulating hormone (TSH) related to each other in a large laboratory sample of people who underwent a thyroid function test (TFT), split between those on levothyroxine replacement (monitoring test) and those who underwent a test to check for thyroid hormone imbalance (diagnostic test; not on levothyroxine). Methods: TFT test (FT4/TSH) results were extracted from the Salford Royal Hospital Laboratory Information Management System during 2009-2012. This was a single site study. Requests includes a tick box for 'on levothyroxine' (yes or no). To minimise comorbidity effects, only samples taken in General Practices were used. For untreated patients only those who had single tests results were used; for treated patients, the median value across all their results was used. Cluster analysis considered an ellipse with centre on median values for log (TSH) and FT4 and the vertex based on 5% and 95% percentile values of both. The percentage of patients falling outside the ellipse boundary was considered for both treated and untreated populations. Results: The total data set included 290,000 tests on 130,000 individuals. After filtering, FT4/TSH results were used from 12,006 (F 9231/M 2775; age < 60 5850/age ≥ 60 6567) treated patients with 43,846 test results. These were compared to the single results for 43,394 untreated patients (F 24,386/M19,008; age < 60 32,537/age ≥ 60 10,857). Cluster analysis showed for untreated patients, median values for TSH and FT4 were 1.8 mU/L and 15.5 pmol/L, respectively, with 24% of patient results falling outside the untreated 5%/95% percentiles. For treated patients, the median TSH was 2.3 mU/L (+30% vs. untreated) and FT4 was 18.9 pmol/L (+22% vs. untreated), with 22% of treated patients falling outside the treated 5%/95% percentiles. When considered against the untreated limits, 68% of treated results fell outside (split male 63%, female 70% and age < 60 67%, Age ≥ 60 64%). Conclusion: The current treatment regimens of either low or high dose levothyroxine are not delivering the expected laboratory TFT profiles, with significant numbers of treated patients being well outside the expected values: both TSH and FT4 being significantly higher. This effect appears to be more prevalent in women than men.
Breast cancer treatment can lead to psychological distress, including depression, anxiety, and stress. We systematically investigated the effect of physical exercise on these factors in women surviving breast cancer (WSBC). Eight databases were searched to identify eligible randomized controlled trials (RCTs). Data extraction and bias risk analysis were conducted using standardized tools, with meta-analysis performed using RevMan ® software. Out of 3529 documents initially identified, 15 RCTs were included, comprising 2756 WSBC (1284 in intervention groups and 1472 in control groups), with 2082 participants in depression analyses, 513 in anxiety analyses, and 161 in stress analyses. Meta-analyses showed that physical exercise promoted significant reduction in depression and anxiety. Subgroup analyses showed greater reduction in anxiety when aerobic and resistance exercise were combined. Only two studies investigated stress, with less robust data suggesting improvement when combining aerobic and resistance interventions. Future RCTs with standardized intervention protocols are needed to confirm these findings.
Purpose : In world-class middle- and long-distance running races, a Wavelight signal has recently been used as a pacing guide for setting records. The aim of the present study was to compare performance and psychophysiological effects between light-guided, drafting, and nonassisted pacing conditions in distance runners. Methods : Fifteen male middle- and long-distance runners of national and regional standard ran three 5000-m time trials in a counterbalanced order with the following pacing distribution: the first 4000 m and last 1000 m were covered at submaximal and maximal intensities, respectively. The 3 trials (conditions) were (1) self-paced, (2) guided by a light signal, and (3) guided by a cyclist in front (drafting condition). Pace, heart rate, rating of perceived exertion, and affective valence were recorded every 500 m. Results : No statistically significant differences were found between pacing-light and self-paced conditions. Running time was shorter in the drafting versus self-paced condition in the final 500-m section ( P = .031; d = 0.76). No differences were found between drafting and light conditions. Similarly, whereas 9 out of 10 significant differences in terms of lower heart rate, or rating of perceived exertion, or higher affective valence responses were found in the drafting versus self-paced condition ( P = .004–.041; d = 0.63–1.39), only 4 were found across the tests in the drafting versus light condition ( P = .005–.016; d = 0.66–0.84). Conclusion : Light-guided pacing did not influence performance or psychophysiological responses in distance runners during a 5000-m test, but drafting produced a large effect.
Objectives A modified e‐Delphi was used to explore subject‐expert consensus to create a minimum & gold standard assessment for young‐onset dementia (YOD) for clinicians based in Australia. Methods A list of 72 statements adapted from an international study, O'Malley et al. 2020, was included in an online survey that was distributed to clinical experts in the field. Respondents were asked to rate statements on a Likert scale of 1–7 (ranging from ‘1’ being ‘not at all important’ to ‘7’ being ‘absolutely essential’). The mean and standard deviation (SD) were calculated for each statement. Full consensus, designated as ‘minimum standard’ was defined as 100% of respondents rating statement(s) as ‘absolutely essential’ (7) or ‘very important’ (6), while high consensus, designated as ‘gold standard’ was defined as 80% (16 out of 20) of respondents rating statement(s) as either ‘absolutely essential’ or ‘very important’ in the assessment for YOD. The statements that had overall mean scores below 6 did not reach consensus. Results Full consensus was achieved on 13 statements (‘minimum standard’), 80% consensus was reached on 37 statements (‘gold standard’), and no consensus was reached on 35 statements. Most clinicians agreed that the diagnosis of YOD is largely based on history, with less emphasis placed on aspects of the examination and investigations conducted. History of first‐degree family members with YOD and any past psychiatric symptoms were reported to be potential triggers for a YOD diagnosis. There was agreement that the routine dementia blood screen and baseline structural imaging should be a part of the diagnostic assessment criteria of YOD. Comparisons were made between the results of this Australian‐based study to the original international study, which found that 55/72 statements (76%) were similarly rated. Conclusions Based on the results of this modified e‐Delphi study, full and high consensus was reached on 37 statements which were comparable to results in an international study. This suggests that in general, clinicians in Australia have agreement with international experts about what is important for the assessment and diagnosis of YOD. Because the statements used in the international study were used in this Australian study, consideration of what issues may be specific to the Australian context such as YOD in Aboriginal Australians and rurality may have not been ascertained. In spite of this, these results may be useful to aid clinicians in their assessment for YOD but consensus statements may change over time as development in knowledge and available tests increases.
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Derek M Peters
  • Institute of Health & Society
Erica Bowen
  • Institute of Health and Society
Eleanor Bradley
  • Institute of Health and Society
Matt Smith
  • School of Science and the Environment
Steven Coles
  • Institute of Science and the Environment
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Worcester, United Kingdom
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HRH Prince Richard The Duke of Gloucester