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Introduction: Circular Economy and Technological Innovations: Synergies and Regional Implications.
Get PDFThe sustainability agenda has taken the central stage on the global agenda amid heightened concerns that the planet's resources are being stretched to the limit. In the past few centuries, and especially since the beginning of the twentieth century, the global economy has seen astronomical industrial growth powered by advances in technological innovations across a whole spectrum of industries
Teaching history of mathematics for first year undergraduate skills development
Get PDFThere has long been a recognition of the role history can play in supplementing the mathematics curriculum, perhaps to make the mathematics “easier, clearer, or more interesting” [1], though not all view this positively [2]. Beyond this, history of mathematics is often taught in its own right at university
Enhancing Soft Target Protection in Smart Cities: Comparing Stakeholder and Citizen Perspectives
Get PDFThe protection of public spaces against serious threats such as violent attacks and terrorism is an ongoing challenge. Smart city initiatives aim to support security actors by implementing advanced capabilities that support automatic monitoring, data collection, interpretation, and integration of data streams. To do so successfully, societal acceptance is one a core requisite. However, direct stakeholders (i.e., users and people directly affected by the technologies) often have different views on what is acceptable or of benefit when it comes to the deployment of advanced technologies compared to the general public (citizens). While this is acknowledged, direct comparisons of stakeholders and citizens are rare, leaving a knowledge gap for decision- and policy-makers on how to choose and/or inform the citizens about the deployment of specific capabilities for public space protection. In this paper, we offer such a comparison of perspectives for soft target protection in public spaces. We identify considerably overlaps in attitudes, but also demonstrate that citizen perspectives may be more nuanced and varied than those of direct stakeholders. These findings carry implications for deployments and meaningful public engagements about smart city security
Best practice for patient-centred radiotherapy in clinical trials and beyond – a national multidisciplinary consensus
Get PDFAims
Patient-centred radiotherapy refers to an approach where patients' needs and preferences are prioritised. Guidelines for this personalised approach are lacking. We present a multidisciplinary national consensus with the aim to provide recommendations for best practice in patient-centred radiotherapy for both clinical trials and routine practice.
Materials and methods
A multidisciplinary working group was formed, comprising of healthcare professionals and patient advocates with lived experience of radiotherapy. Three interlinking themes were identified around patient-centred radiotherapy: information, decision-making, and outcomes. Scoping reviews were carried out for each theme, considering current challenges and recommendations for best practice. Recommendations were shaped through consultation with 12 patient advocates.
Results
There is a pressing need to better support patients prior to, during, and following radiotherapy. Radiotherapy-related patient information is often complex and challenging to understand. Information resources should be cocreated with patient advocates and individualised wherever possible, including for patients from under-served groups.
Shared decision-making (SDM) processes may enhance treatment satisfaction and reduce decision-regret, but these are not widely implemented. SDM requires prepared patients, trained teams, alongside adequate resources and should be offered as per patients' preferences.
Healthcare system data offer complementary information to clinical trials, with the potential to provide additional insight into long-term benefits and risks of radiotherapy within ‘real-world’ conditions. Patient-reported outcome measures may provide greater insight regarding toxicity and impact on quality of life and should be used in synergy with clinician-reported outcomes. Outcome measures should be collected in the long term, and results should be widely disseminated to both the public and professional communities. Equity of access to radiotherapy, clinical trials, and survivorship services is a priority.
Conclusion
Patients rightly expect more from healthcare professionals, and it is important that the radiotherapy community recognises this and embraces changes which will enhance patient-centred care. Our recommendations aim to guide best practice for patient-centred radiotherapy
The acceptability of a novel seismocardiography device for measuring VO 2 max in a workplace setting: a mixed methods approach
Get PDFBackground: Workplace health screening rarely includes measures of cardiorespiratory fitness, despite it being a greater predictor of cardiovascular disease and all-cause mortality than other routinely measured risk factors. This study aimed to determine the comparative acceptability of using a novel seismocardiography device to measure cardiorespiratory fitness via VO2 max during a workplace health check. Methods: Participants were invited to participate in workplace health screening sessions where VO2 max was assessed by both seismocardiography at rest and sub-maximal exercise testing, in order for acceptability of both to be compared across multiple domains. Questionnaires and focus group guides for participants and practitioners were developed based on the Theoretical Framework of Acceptability. Data were analysed using t-tests and deductive thematic analysis. Results: There was a significant difference in the acceptability domain of ‘affective attitude’ between the novel SCG device (M = 9.06 ± 1.14) and the sub-maximal exercise testing (M = 7.94 ± 1.79); t = 3.296, p = .001, d = 0.50, and in the domain of ‘burden’ between the novel SCG device (M = 9.16, ± 0.55) and the sub-maximal exercise testing (M = 7.41 ± 1.45); t = 7.033, p = < 0.001, d = 1.45. Practitioners and employees highlighted the potential of seismocardiography to create a more inclusive and accessible workplace offer, allowing those with restricted mobility or those with differing physical or emotional needs to participate in wellness testing; yet there was a lack of understanding in both groups around intervention effectiveness and coherence. Conclusions: Seismocardiography may offer an acceptable route to cardiorespiratory fitness testing in the workplace, due to the low effort requirement and simplicity of administration. This study suggests that practitioners delivering such services have a critical role to play in acceptability of health interventions at work, as employees will be heavily influenced by practitioner beliefs around coherence and effectiveness. Comprehensive delivery training is important for the adoption of new health-related technologies such as seismocardiography into workplace health screening
Assessing the Value of New Antimicrobials: Evaluations of Cefiderocol and Ceftazidime-Avibactam to Inform Delinked Payments by the NHS in England.
Get PDFObjectives
The UK has recently established subscription-payment agreements for two antimicrobials: cefiderocol and ceftazidime-avibactam. This article summarises the novel value assessments that informed this process and lessons learned for future pricing and funding decisions.
Methods
The evaluations used decision modelling to predict population incremental net health effects (INHEs), informed by systematic reviews, evidence syntheses, national surveillance data and structured expert elicitation.
Results
Significant challenges faced during the development of the evaluations led to profound uncertainty in the estimates of INHEs. The value assessment required definition of the population expected to receive the new antimicrobials; estimating value within this heterogenous population; assessing comparative efficacy using antimicrobial susceptibility data due to the absence of relevant clinical data; and predicting population-level benefits despite poor data on current numbers of drug-resistant infections and uncertainties around emerging resistance. Though both antimicrobials offer the potential to treat multi-drug resistant infections, the benefits estimated were modest due to the rarity of true pan-resistance, low life expectancy of the patient population and difficulty of identifying and quantifying additional sources of value.
Conclusions
Assessing the population INHEs of new antimicrobials was complex and resource intensive. Future evaluations should continue to assemble evidence relating to areas of expected usage, patient numbers over time and comparative effectiveness and safety. Projections of patient numbers could be greatly enhanced by the development of national level linked clinical, prescribing and laboratory data. A practical approach to synthesising these data would be to combine expert assessments of key parameters with a simple generic decision model
A Modified Parallel NET (MPNET)-Based Deep Learning Technique for the Segmentation of Visceral and Superficial Adipose Tissues Quantification of CT Scans
Get PDFThis study introduces a modified parallel net (MPNET), a novel deep learning model designed for accurate segmentation and quantification of visceral and superficial adipose tissues. This was used to quantify the visceral and superficial adipose tissues found at the L3 levels of vertebra in CT scans. This will be used to predict the likelihood of the patient developing diabetes or cardiovascular diseases from existing CT scan data. MPNET was compared with state-of-the-art models like UNET, R2UNET, UNET++, and nnUNET. This approach advances the accuracy and efficiency of image segmentation demonstrating a faster learning curve and lower losses at early epochs than traditional models., We developed and validated using a limited dataset of 14 single-slice DICOM files for each patient extracted from the National Health Service UK. The outputs from MPNET not only matched but often exceeded traditional metrics such as the Dice coefficient and IoU in nuanced anatomical delineation, providing greater clinical realism and applicability in segmentation results. As a pilot study, this research paves the way for a forthcoming validation study on a larger and more ethnically diverse dataset
Spalling failure mechanism of a railway turnout made from carbide-free bainitic steel
Get PDFRailway turnouts play a transition role between straight and branching rails and therefore suffer from spalling failure as a result of repeated rolling contacts with wheels, as well as shear and impact loads. In this paper, we present a comprehensive failure investigation on the spalling failure mechanism of an off-track turnout made from bainitic steel. The experimental research was focused on the rolling-induced microstructural evolution from various depths to the rail top which caused the cracking and spalling wear. The worn turnout was analysed both on the rail top and on metallographically polished cross-sections using a variety of methods including optical microscopy, microhardness testing, field-emission scanning electron microscopy and energy dispersive X-ray spectroscopy, transmission electron microscopy, and quantitative X-ray diffraction for crystallography and surface residual stress analysis.
The results revealed that, the turnout was a low carbon and Si-Mn-Cr-Ni-Mo alloyed steel showing a dual-phase carbide-free microstructure of bainitic ferrite laths and retained inter-lath austenite. The rolling contact fatigue on the rail top resulted in the formation of spalling pits, cracking, extreme hardening, embrittlement, and the creation of a compressive residual stress of 400 MPa. The spalling failure was associated with a gradient microhardness profile to a depth of 1.5 mm, from HV0.1 7.3 GPa of the rail top to HV0.1 3.9 GPa of the bulk steel. Surface cracks were found to have propagated from the rail top to various depths up to 0.9 mm. The spalling failure was caused by deformation induced microstructure evolution within a depth of 0.2 mm from strain-free bainite to sub-micro and nano-scale laminates and eventually to quasi-amorphous rail top. Phenomena of transformation induced plasticity (TRIP) were found, not only including the decrease of retained austenite in the laminate structure, but also the formation of martensitic laths beneath the laminates
Parental engagement and transformation as a marker of quality in Early Childhood Education and Care
Get PDFDespite the extensive research evidence about the importance of high-quality Early Childhood Education and Care (ECEC), English policy makers continue to promote nurseries for the ‘childcare’ they provide, rather than the transformational effects they can have in areas of socio-economic challenge. The aim of this study was to investigate if and how access to early years provision impacted on parents/carers and their children during the Covid pandemic in a newly established early years community research centre, situated in an area of economic and social challenge. Group analysis of interview data by a team of researchers and stakeholders suggests that access to nursery provision and the positive and trusting relationships within the nursery had a transformative impact on children and their parents/carers. Drawing on the data, we adopt an ecological perspective to theorise quality provision as holistic and relational and challenge policy makers to reconceptualise quality as a holistic endeavour. Specifically, this paper offers a new lens for policy makers to revisit existing evidence about the value of integrated care and education centres for improving child outcomes