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A cross-sectional review of UK healthcare professionals’ attitudes to and priorities for the delivery of head & neck cancer prehabilitation
No full textAim: To explore healthcare professionals’ attitudes to and priorities for delivering head and neck cancer prehabilitation.Methods: Healthcare professionals working with head and neck cancer patients in the United Kingdom participated in a cross-sectional e-survey. Quantitative data were analysed using descriptive statistics. Free text comments were analysed using qualitative content analysis. Findings: Of 118 respondents, over 90% (n=113) support the provision of multimodal Prehabilitation for head and neck cancer patients, with a preference for delivery in a multidisciplinary clinic. However, less than half of respondents (n=68, 57%) report having workload capacity to provide prehabilitation and would not have the confidence to design and/or deliver a service at present. Priorities for prehabilitation service delivery should include: investment, having a multi-disciplinary team based approach and robust governance structures. Over half of participants (n=60, 53%) expressed the need for training on prehabilitation. Training should incorporate 1) the component principles of prehabilitation 2) service design and implementation.Conclusions: Findings describe healthcare professionals’ attitudes and perceived capacity to deliver prehabilitation and articulate priorities and training needs. These findings should be considered when integrating prehabilitation into the cancer pathway
Physiotherapy capabilities in the health care of adult patients at increased risk of osteoporotic fractures: A scoping review protocol
Get PDFObjectives: This scoping review will explore and map the extent and type of literature related to physiotherapy capabilities in the health care of adult patients at increased risk of osteoporotic fractures and identify gaps in the literature. Background: With an ageing population, osteoporosis and fractures and their associated costs are increasing. Unfortunately, many people with, or at increased risk of, osteoporotic fractures remain undiagnosed and untreated. The scope of physiotherapy has expanded over recent years with enhanced, advanced and consultant roles. This presents opportunities for physiotherapists to help reduce the osteoporosis care gap. Clarifying capabilities is important to ensure successful implementation of new roles and development of holistically competent practitioners. Eligibility Criteria: Literature will be included if it relates to capabilities of qualified physiotherapists involved in the health care of adult patients (aged 18 and over) at increased risk of osteoporotic fractures in any clinical setting. All published and non‐published literature to include research studies, editorials, and grey literature will be considered. Methods: A scoping review will be carried out in accordance with JBI guidelines. Peer‐reviewed databases including MEDLINE, EMBASE, EMCARE, CINAHL, SCOPUS, Cochrane, PEDro and ProQuest will be searched for literature between 2003 and 2025, alongside a comprehensive search for grey literature (including reports and government publications) from additional sources to ensure a broad representation of available evidence. Source selection will use the PRISMA‐ScR flow chart against agreed eligibility criteria. Data extraction will be mapped out in tabular and/or diagrammatic format with a supporting narrative synthesis. Trial Registration: https://doi.org/10.17605/OSF.IO/47UY
Eugenol@Montmorillonite vs. Citral@Montmorillonite Nanohybrids for gelatin-based extruded, edible, high oxygen barrier, active packaging films
Get PDFIn the context of the circular economy, the valorization of bio-derived waste has become a priority across various production sectors, including food processing and packaging. Gelatin (Gel), a protein which can be recovered from meat industry byproducts, offers a sustainable solution in this regard. In this study, pork-derived gelatin was used to develop novel edible active packaging films, designed for meat products. Glycerol (Gl) was used as a plasticizer. Two types of montmorillonite-based nanohybrids were employed as both reinforcing agents and carriers of antioxidant/antibacterial compounds: eugenol-functionalized montmorillonite (EG@Mt) and citral-functionalized montmorillonite (CT@Mt). The active films were formulated as Gel/Gl/xEG@Mt and Gel/Gl/xCT@Mt, where x = 5, 10, or 15 wt.%. Controlled-release kinetics showed that EG@Mt released up to 95% of its adsorbed eugenol, whereas CT@Mt released up to 55% of its adsorbed citral. The films were evaluated using the DPPH (2,2-diphenyl-1-picrylhydrazyl) assay and tested for antibacterial activity against Escherichia coli and Listeria monocytogenes. Results demonstrated that the Gel/Gl/xEG@Mt films exhibited superior antioxidant and antibacterial performance compared to the Gel/Gl/xCT@Mt films. All formulations were impermeable to oxygen. Although the incorporation of EG and CT slightly reduced cell viability, values remained above 80%, indicating non-toxicity. In conclusion, the film containing 15 wt.% EG@Mt achieved an oxygen transmission rate of zero, an effective concentration (EC60) of 9.9 mg/L to reach 60% antioxidant activity, and reduced E. coli and L. monocytogenes populations by at least 5.8 log CFU/mL (p < 0.05), bringing them below the detection limit. Moreover, it successfully extended the shelf life of fresh minced pork by two days
Investigating factors influencing takeover performance in conditionally automated driving: The role of uncertainty communication
No full textSafe transition following a Takeover Request (ToR) in Level 3 automated driving requires a high situational awareness, which is influenced by traffic complexity, non-driving-related tasks (NDRTs), and communication strategies. These factors are often studied in isolation, focusing on individual elements such as the effects of NDRT, ToR timing, or alert design. However, a holistic investigation that considers the interdependencies of these factors is lacking. This study provides a comprehensive analysis of the human, environmental, situational, and vehicle-system factors affecting takeover performance, examining their interactions under conditions with and without uncertainty communication. We explored the effectiveness of adaptive uncertainty communication-preparatory alert prior to the ToR-in enhancing driver readiness and response in time-constrained scenarios. A simulation-based online study (N = 60) was conducted, where participants experienced multimodal takeover alerts across diverse scenarios involving varying traffic conditions and NDRT types. Our findings indicate that uncertainty communication mitigated the impact of human factors such as trust, fatigue, and stress. Without such communication, these effects were more pronounced. It also improved participants' understanding of the ToR reason and perceived appropriateness of ToR timing. While task-switching remained a challenge under high distraction, uncertainty communication modestly reduced task-switching difficulty. Overall, scenarios involving the preparatory alert received higher ratings for notice time, preparedness, and alert effectiveness. Drawing on insights from the correlation analysis across all factors, we outline key challenges and directions for future research undertaking adaptive alert strategies that support real-time mode transitions
Defining paediatric abusive head trauma using routinely collected patient datasets: Definition development for a UK primary care cohort
Get PDFExisting definitions used to identify abusive head trauma (AHT) from routinely collected patient data are developed for use in secondary care or mortality data. Incidence estimates calculated using these definitions do not include mildly symptomatic cases of AHT presenting to primary care, therefore underestimating the true population incidence. To (1) develop AHT definitions for use with primary care, secondary care and accident and emergency data in the UK setting; (2) compare incidence using these definitions in a UK primary care cohort. The cohort included all infants in Clinical Practice Research Database (CPRD) Aurum, under 1year old between January 2013 and June 2021, with linkages to Hospital Episodes Statistics Admitted Patient Care (HES APC), Accident and Emergency (HES AE) data and Diagnostic Imaging Dataset (DID). This study had two parts, (1) definition development via clinical expert consensus, and (2) comparative testing of definitions in a UK primary care cohort. Definitions of AHT were developed based on combinations of traumatic brain injury, abuse and head computerised tomography codes present in UK health records. Our definitions for AHT presenting to general practice, hospital and ED identified higher incidence in our cohort than all ICD-10 based definitions identified in the literature. Inclusion of injuries presenting to GP, ED or admitted to hospital, in our definitions is likely to produce a more accurate estimate of AHT in the population. Caution should be applied, however, regarding potential inclusion of false positives and missed cases due to non-presentation to healthcare. [Abstract copyright: Copyright © 2025. Published by Elsevier Ltd.
Damage to and destruction of the natural environment - Terraforming warfare in Gaza and accountability for ecocentric crimes
No full textThis contribution considers the significant and well-recorded environmental destruction in Gaza, following Israel’s full-scale military operations that started in October 2023. It is argued that, in the absence of ecocentric legal frameworks, war crimes law and international humanitarian law (IHL) more generally provide appropriate avenues for the protection of the environment and to close the accountability gap. In doing so, it argues that despite the lack of ecocentric crimes in the international criminal justice system, the humanitarian imperative, and anthropocentric crimes (including core international crimes like genocide, crimes against humanity, and war crimes) could be used as the tools to hold to account those responsible for environmental harm in the context of terraforming warfare, a concept which best describes situations of utter infrastructural and environmental destruction and topographic change with long-term, systemic consequences. The war crimes framework is analysed, and a way forward is proposed. The paper argues that the humanitarian norm, foundational to IHL and war crimes law, informs both state and individual liability for the violation of primary rules, which include the protection of the natural environment in times of war
The clinical and economic burden of obesity in low- and middle-income countries: A systematic review
Get PDFObesity has emerged as a critical public health challenge globally, with substantial health and economic repercussions. This study aimed to evaluate the literature on the clinical and economic burdens associated with obesity, specifically in low- and middle-income countries (LMICs). A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. The CINAHL, MEDLINE, PubMed, Web of Science and Scopus databases were systematically searched for studies published from inception to March 28, 2025. The costs of illness for all included studies were converted to 2024 United States (US) dollars, using country-specific gross domestic product inflators. Conversion to US dollars was based on purchasing power parity (PPP). The quality of all included studies was assessed via the Newcastle‒Ottawa Scale (NOS). Of the total of 676 reports identified by the search strategy, six studies were prevalence-based, four studies were survey-based, and three model-based studies (n = 13) were eligible for inclusion on the basis of predefined inclusion criteria. These studies published data from Brazil, Ghana, China, Iran, South Africa, Mexico, and Thailand. Three of the 13 studies reported indirect costs. Two studies reported the clinical impact of obesity. Methodological quality was deemed moderate. The annual direct and indirect costs associated with obesity for a population in LMICs ranged from USD 0.2 billion to USD 12.56 billion and USD 223 million to USD 227.5 million, respectively. Hospitalisation was the main cost driver in five of the included studies. One study reported the total number of hospitalisations/number of person-years for men and women as 803/9207 and 2354/25,173, respectively. This is the first systematic review to summarise the clinical and economic burdens associated with obesity in LMICs. The clinical and economic burden of obesity on individuals and healthcare systems is significant, necessitating effective prevention and management strategies. To increase the accuracy and comparability of findings, future research should adopt a standardised cost-of-illness methodology. This approach will provide clearer insights into the economic impact of obesity and facilitate more effective public health interventions. [Abstract copyright: © 2025. The Author(s).
“The perfect place to make a fresh start”: Unproblematic constructions of migration in the UK television programme Wanted Down Under
Get PDFResearch on media discourses about migration in the United Kingdom primarily focus on immigration, and particularly the ways in which refugees and asylum seekers are constructed as invaders, criminals or drains on the UK. By contrast, research about British citizens who emigrate from the UK has been less widely conducted, particularly in relation to the media. This article addresses this lacuna through a critical discursive analysis of the UK daytime television programme Wanted Down Under, in which British participants are given a trial week living in Australia or New Zealand to help them decide if migrating is the right decision for them. Fifty episodes were analysed using the principles of Critical Discursive Psychology and three interpretative repertoires were identified: Few restrictions make migration possible and easy; Migration as a better lifestyle; and the urgency of realising long-held dreams. In addition, two ideological dilemmas were identified: Separation from family ties as a reason to not migrate; and Lifestyle at home a reason to not migrate. These discourses are discussed in relation to privileged notions of migration and we suggest that these mediated discourses draw on colonial narratives that imply that migration for British citizens is unproblematic and easy
Close Reading: The Basics
No full textClose reading is an essential skill that literature students continue to develop across the full length of their studies. This book, now in its second edition, is a complete guide to this foundational practice, providing an effective first principles methodology that can be used for poetry, novels, drama, and beyond.Offering model close readings of classic works of literature, including Hamlet, The Great Gatsby and Beloved, David Greenham presents a unique, contextual approach to close reading, while addressing key questions such as:What is close reading?What is the importance of the relationships between words?How can close reading enhance reading pleasure?Is there a method of close reading that works for all literary genres?How can close reading unlock complexity?How does the practice of close reading relate to contemporary theoretical, critical and political concerns?The second edition of Close Reading: The Basics is carefully formulated to bring together reading pleasure and analytic techniques that will engage the student of literature and enhance their reading experience
Explainable Deep Learning for Endometriosis Classification in Laparoscopic Images
Get PDFBackground/Objectives: Endometriosis is a chronic inflammatory condition that often requires laparoscopic examination for definitive diagnosis. Automated analysis of laparoscopic images using Deep Learning (DL) may support clinicians by improving diagnostic consistency and efficiency. This study aimed to develop and evaluate explainable DL models for the binary classification of endometriosis using laparoscopic images from the publicly available GLENDA (Gynecologic Laparoscopic ENdometriosis DAtaset). Methods: Four representative architectures—ResNet50, EfficientNet-B2, EdgeNeXt_Small, and Vision Transformer (ViT-Small/16)—were systematically compared under class-imbalanced conditions using five-fold cross-validation. To enhance interpretability, Gradient-weighted Class Activation Mapping (Grad-CAM) and SHapley Additive exPlanations (SHAP) were applied for visual explanation, and their quantitative alignment with expert-annotated lesion masks was assessed using Intersection over Union (IoU), Dice coefficient, and Recall. Results: Among the evaluated models, EdgeNeXt_Small achieved the best trade-off between classification performance and computational efficiency. Grad-CAM produced spatially coherent visualizations that corresponded well with clinically relevant lesion regions. Conclusions: The study shows that lightweight convolutional neural network (CNN)–Transformer architectures, combined with quantitative explainability assessment, can identify endometriosis in laparoscopic images with reasonable accuracy and interpretability. These findings indicate that explainable AI methods may help improve diagnostic consistency by offering transparent visual cues that align with clinically relevant regions. Further validation in broader clinical settings is warranted to confirm their practical utility