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Artificial Intelligence technologies for assessing skin lesions for referral on the urgent suspected cancer pathway to detect benign lesions and reduce secondary care specialist appointments:early value assessment
Get PDFBACKGROUND: Skin cancers are some of the most common types of cancer. Dermatology services receive about 1.2 million referrals a year, but only a small minority are confirmed skin cancer. Artificial intelligence may be helpful in the diagnosis of skin cancer by identifying lesions that are or are not cancerous. OBJECTIVES: To investigate the clinical and cost-effectiveness of two artificial intelligence technologies: DERM (Deep Ensemble for Recognition of Malignancy, Skin Analytics) and Moleanalyzer Pro (FotoFinder), as decision aids following a primary care referral. METHODS: A rapid systematic review of evidence on the two technologies was conducted. A narrative synthesis was performed, with a meta-analysis of diagnostic accuracy data. Published and unpublished cost-effectiveness evidence on the named technologies, as well as other diagnostic technologies were reviewed. A conceptual model was developed that could form the basis of a full economic evaluation. RESULTS: Four studies of DERM and two of Moleanalyzer Pro were subject to full synthesis. DERM had a sensitivity of 96.1% to detect any malignant lesion (95% confidence interval 95.4 to 96.8); at a specificity of 65.4% (95% confidence interval 64.7 to 66.1). For detecting benign lesions, the sensitivity was 71.5% (95% confidence interval 70.7 to 72.3) for a specificity of 86.2% (95% confidence interval 85.4 to 87.0). Moleanalyzer Pro had lower sensitivity, but higher specificity for detecting melanoma than face-to-face dermatologists. DERM might lead to around half of all patients being discharged without assessment by a dermatologist, but a small number of malignant lesions would be missed. Patient and clinical opinions showed substantial resistance to using artificial intelligence without any assessment of lesions by a dermatologist. No published assessments of the cost-effectiveness of the technologies were identified; three assessments related to skin cancer more broadly in a National Health Service setting were identified. These studies employed similar model structures, but the mechanism by which diagnostic accuracy influenced costs and health outcomes differed. An unpublished cost-utility model was provided by Skin Analytics. Several issues with the modelling approach were identified, particularly the mechanisms by which value is driven and how diagnostic accuracy evidence was used. The conceptual model presents an alternative approach, which aligns more closely with the National Institute for Health and Care Excellence reference case and which more appropriately characterises the long-term consequences of basal cell carcinoma. LIMITATIONS: The rapid review approach meant that some relevant material may have been missed, and capacity for synthesis was limited. The proposed conceptual model does not capture non-cash benefits associated with demand on dermatologist time. An assessment of the likely budget impact and resource use could not be provided. CONCLUSIONS: DERM shows promising diagnostic accuracy for triage and diagnosis of suspicious cancer lesions in selected patients referred from primary care. Its impact on the diagnostic pathway and patient care is, however, uncertain. Moleanalyzer Pro shows promising accuracy for diagnosing melanoma, but its evidence base is limited. FUTURE WORK: While artificial intelligence has the potential to be cost-effective for the identification of benign lesions, further research addressing the limitations in the diagnostic accuracy evidence is necessary. Without comparative evidence on the diagnostic accuracy of artificial intelligence technologies, their value will remain uncertain. STUDY REGISTRATION: This study is registered as PROSPERO CRD42023475705. FUNDING: This award was funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis programme (NIHR award ref: NIHR136014) and is published in full in Health Technology Assessment; Vol. 30, No. 10. See the NIHR Funding and Awards website for further award information
Creative social prescribing groups during lockdown: a photo-elicitation evaluation of group users' experiences
Get PDFPrevious research has examined the experiences of voluntary, community, and social enterprise (VCSE) group providers, but the voices of group users, especially those recovering from, or living with SMI, are sparse. This study addresses that gap, using the COVID-19 pandemic lockdown as a natural experiment to gain insights into the experiences of individuals participating in VCSE-run creative and social groups, and comparing this with the experiences of providers. We conducted photo-elicitation focus groups to explore group members' perspectives. Lockdown highlighted to group members what they valued most, and therefore what they missed about attending groups. Participants reflected on how significant their group was to their experiences of social connectedness and belonging. Group members' experiences differed significantly from providers' experiences of delivering online groups during lockdown. In some cases lockdown exacerbated existing challenges for marginalized individuals, highlighting the critical importance of compassionate, skilled, and well-informed group leadership. The needs of marginalized populations and the risk that these may be overshadowed by other public health priorities were highlighted. Our findings underline the urgency of developing inclusive policies and practices that prioritize voices of marginalized groups. By listening to these voices, policymakers and group leaders can create fairer and more responsive support systems
Ascorbic acid mediated hydrolysis of galactomannans
Get PDFAscorbic acid (AA) is an antioxidant widely used in the food industry to prevent colour fade and spoilage. This study assesses the effect of 0.02 wt% AA on the rheology of common food thickeners – galactomannans (GM). GMs immediately exhibit a significant reduction in solution viscosity upon AA addition: guar gum (−67 % ± 7 %), locust bean gum (−47 % ± 5 %), and cassia gum (−58 % ± 4 %). Other food acids at 0.02 wt% showed no decline in viscosity, nor did another reducing agent, potassium iodide. GMs were then mixed with xanthan gum (XG) ± low acyl gellan gum (LAG) and AA's impact was assessed using small amplitude oscillatory shear rheology. As the temperature decreased, the storage modulus decreased in the presence of AA compared to without. The molecular weight (MW) of the GMs ± AA, was assessed using size exclusion chromatography – multi angle light scattering. The reduction in MW, was between 6 and 8 times for each GM, and was supported with analytical ultracentrifugation. This established the hydrolytic decomposition of GMs by AA, leading to a decrease in function due to a reduction in MW. This hydrolytic effect was observed regardless of pH, showing that acid hydrolysis isn't the primary mechanism. This study shows, for the first time, that AA causes extensive degradation of galactomannans, affecting their viscoelastic characteristics. These findings could affect many products; informing decisions on their quality and shelf life, as well as their cost-effectiveness and environmental life cycle
Bridging Borders and Disciplines: A Systems Thinking Approach to International Education in Sustainable Chemistry and Engineering
Get PDFAssociations between vision anomalies and sensorimotor processes in children aged 7–16 years
Get PDFClinical relevance
Vision plays an important role in the normal motor development of children. Increased understanding of this relationship is important for providing appropriate advice in a clinical setting.
Background
Growing evidence indicates that vision anomalies are associated with reduced motor performance in children. This study investigated whether feedback loop noise, induced by common vision anomalies, adversely affects sensorimotor processing in children aged 7 to 16.
Methods
Sensorimotor function was measured in 409 children aged 7–8, 10–11, and 15–16 years as part of an annual school vision programme. The vision programme included assessment of visual acuity, binocular vision and refraction. Aiming and steering sensorimotor performance were measured using a validated tool that utilised a stylus on a tablet computer. Analysis of covariance models tested whether visual function (binocular near visual acuity, amplitude of accommodation, near point of convergence) and refractive error, along with age, contributed to the variance in aiming and steering performance.
Results
Sensorimotor performance showed considerable variation within each age group. The simplest models that captured aiming variance included age and refractive error (R² = 0.42, F[3, 402] = 99.04, p < 0.001), whilst age and accommodative function contributed towards steering variance (R² = 0.22, F[3, 400] = 38.72, p < 0.001).
Conclusion
Hyperopic refractive errors and reduced accommodative function affect the ability to perform sensorimotor transformations, negatively impacting age-expected manual control skill levels. Longitudinal research is needed to test whether correcting hyperopia can: (i) improve the development of sensorimotor processing; (ii) produce beneficial changes in motor skill abilities
Parameter Optimisation in 3D Extrusion Printing of Polyhydroxybutyrate Using Design of Experiment Methodology
Get PDFThis study systematically optimised extrusion-printing parameters for polyhydroxybutyrate (PHB) using a Design of Experiment (DoE) approach to improve printability and construct fidelity. A five-factor DoE was conducted to evaluate the individual and interactive effects of printhead temperature, printing pressure, printing speed, bed temperature, and cartridge heating time on the dimensional accuracy of printed constructs. The resulting regression model enabled the identification of statistically significant main and interaction effects among processing variables. An optimised parameter set (printhead temperature 145 °C, pressure 150 kPa, speed 15 mm s⁻¹, bed temperature 25 °C, and cartridge heating time 120 s) enabled the fabrication of PHB scaffolds with substantially improved shape fidelity, which was experimentally validated using verification prints. These results demonstrate that a DoE-based optimisation strategy provides a robust and efficient route for rationally tuning PHB extrusion-printing conditions, thereby enhancing process reliability for scaffold fabrication in regenerative medicine applications
Sustainability of green hydrogen technologies depends on energy mix and supply chain
Get PDFA sustainable international green hydrogen supply chain is crucial for achieving net-zero. Here, we performed a spatial-temporal prospective life cycle assessment of twenty international supply chain scenarios in 2023, 2030, 2040, and 2050 across five hydrogen production technologies (three based on water electrolysis and two on biomass conversion) in fourteen countries. The results underscore the substantial roles of the energy mix and supply chain configuration in shaping green hydrogen sustainability. In 2023, electrolysis-based systems show higher global warming impacts than biomass-based ones. Along the net-zero pathway, ecological impacts vary across scenarios. By 2050, proton exchange membrane electrolysis and dark fermentation exhibit the largest and smallest reductions in global warming impacts, respectively. The most sustainable chain involves manufacturing Proton the United States, identified using a multi-criteria decision analysis method, exchange membrane electrolysis systems in the United Kingdom, with 50% exported to that evaluates overall performance across environmental indicators
Delivering inclusive cultural offers for social prescribing: A realist evaluation involving older people from global majority backgrounds and cultural sector providers in the UK
Get PDFIntroduction
Research shows cultural activities benefit older people's wellbeing, but little is known about why individuals from global majority (minority ethnic) groups engage less with the mainstream cultural sector, or how it could adapt to meet their needs and encourage engagement. The TOUS study (Tailoring cultural Offers with and for diverse older Users of Social prescribing) investigated the question: What tailoring is needed, how, when and for whom, to optimise cultural offers as part of social prescribing for older people (aged 60+) from global majority groups?
Methods
The TOUS study involved focused ethnographies with six cultural-sector organisations throughout the United Kingdom and 11 key informant interviews with cultural providers. A realist approach was adopted, resulting in the development of a programme theory.
Results
The programme theory has three pillars: (1) broker, hook, and opportunity, which support entry into cultural spaces to provide immediate benefits; (2) safety and trust, power-sharing, and meaning, which sustain engagement; and (3) transformative outcomes, including lasting relationships, confidence, and exploring identities.
Conclusions
With intentional engagement and relational practices, organisations can foster inclusive cultural participation and support well-being in later life.
Patient or Public Contribution
The TOUS study was guided by a public involvement group of six contributors (aged 60+ from global majority/minority ethnic backgrounds) who shared experiences of creative practice, and advised on data collection, analysis, model development, and dissemination. The study also involved collaborative analysis of data at case sites
Quantifying the Influences of Epoxide Binding in Epoxide/CO2 Ring Opening Copolymerization Catalysis
Get PDFUnderstanding and predicting the effect of epoxide structure on the rate of polymerization in epoxide/CO2 ring opening copolymerization catalysis is a long-standing challenge. Here, a known highly active Co(III)K(I) catalyst is used to investigate the influences of six different epoxides' binding strengths on their rates of copolymerization. Since calculations and experiments indicate that studying the catalytically relevant Co(III)–epoxide adduct directly is experimentally challenging, epoxide–catalyst binding interactions are quantified using a Co(II)K(I) complex to model the key catalytic intermediate. Epoxide–catalyst coordination is investigated using UV–vis spectroscopy titrations which provide fast and effective determination of association or binding constants. The epoxide–catalyst equilibrium constants show a clear exponential correlation with copolymerization rates and a new catalyst performance linear free energy relationship is revealed. Epoxides exhibiting stronger catalyst binding constants show higher copolymerization rates. The structure–activity correlation is consistent with the polymerization kinetics, mechanism and DFT calculations. Both the methods to investigate epoxide–catalyst coordination and the linear free energy relationship are shown to apply to the series of six epoxides and a second Co(III)K(I) catalyst. These structure–performance relationships are likely applicable to other transition metal catalysts and should expedite future epoxide and catalyst selection to make useful poly(carbonate) materials
Pickering water-in-oil emulsions stabilized by beeswax crystals: Design and stability
Get PDFThe aim of this study was to understand how beeswax can be used to stabilize water-in-oil emulsions and understand the impact of droplet volume fraction on stability. Pickering water-in-oil (W/O) emulsions were successfully designed using beeswax oleogels (4 wt%) as the sole stabilizer via a facile homogenization approach. The effects of beeswax crystals on the formation, stability, and structural organization of W/O emulsions (containing up to 70% v/v water) were systematically investigated. Oleogelation reduced the interfacial tension between oil and water from 21 ± 1 mN/m to 14 ± 1 mN/m, enabling beeswax crystals to stabilize emulsions without the need for synthetic surfactants. X-ray diffraction analysis revealed that beeswax crystals in oleogels exhibited a stable β’ polymorph with orthorhombic packing, maintaining a reduced long-chain spacing from 7.8 nm in pure beeswax to 6.3 nm, which contributed to the stabilization of Pickering W/O emulsions. The emulsions ranged in size (D32) from 8 to 16 μm depending upon the droplet volume fraction and showed no significant change over storage period of 6 weeks. Microscopic observations of the interface demonstrated that emulsion stability was achieved through the synergistic effects of both the Pickering stabilization and bulk network stabilization. This dual stabilization mechanism was further confirmed by thermal cycling experiments and in situ crystallization analysis at the interface as well as rheological measurements showing gel formation at higher volume fractions of droplets. Overall, these findings highlight the potential of beeswax to stabilise W/O emulsions for applications in food and allied soft matter industries
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