159370 research outputs found
Sort by
Foveal hypoplasia grading with optical coherence tomography: agreement and challenges across experience levels
Get PDFBackground/Objectives: The diagnosis and prognosis of arrested foveal development or foveal hypoplasia (FH) can be made using the Leicester grading system for FH and optical coherence tomography (OCT). In clinical practice, ophthalmologists and ophthalmic health professionals with varying experience consult patients with FH; however, to date, the FH grading system has only been validated amongst experts. We compare the inter-grader and intra-grade agreement of healthcare professionals against expert consensus across all grades of FH. Methods: Handheld and table-mounted OCT images (n = 341) were graded independently at a single centre by experts (n = 3) with over six years of experience and “novice” medical and allied health professionals (n = 5) with less than three years of experience. Sensitivity, specificity, and Cohen’s kappa scores were calculated for each grader, and expert vs. novice performance was compared. Results: All graders showed high sensitivity (median 97% (IQR: 94–99)) and specificity (median 94% (IQR: 90–95)) in identifying the presence or absence of FH. No significant difference was seen in specificity between expert and novice graders, but experts had significantly greater diagnostic sensitivity (median difference = 5.3%, H = 5.00, p = 0.025). Expert graders had the highest agreement with the ground truth and novice graders showed great variability in grading uncommon grades, such as atypical FH. The proposed causes of misclassification included macular decentring in handheld OCT scans in children. Conclusions: Ophthalmologists of varying experience and allied health professionals can accurately identify FH using handheld and table-mounted OCT images. FH identification and paediatric OCT interpretation can be improved in wider ophthalmic clinical settings through the education of ophthalmic staff
Paid care worker organizing in England: priorities and progress?
Get PDFIntroduction: Despite its growth and ubiquity, paid adult social care (ASC) work in England persists as a site of very low pay, insecurity, and exploitation, where ‘decent work' remains elusive. Promoted by a neoliberal agenda focusing on competition and choice, social care provision has developed a quasi-market model. This involves local authorities assessing and commissioning predominantly independent sector providers to deliver care, which relies on outsourcing and contributes to workforce fragmentation. This atomisation, with thousands of providers and many workers employed to support people in their own homes, contrasts with the terrain of more established trade unionism and impedes organizing. Thus far in the English context, however, this phenomenon has received only limited attention in academic research. These challenges within the sector and limited organizing mean that it is important to understand priorities and progress in relation to ASC organizing.
Methods: Thirty-five semi-structured interviews were conducted with key actors (organizers, administrators, founders) and paid direct care workers involved in organizing in the ASC context in England. Data were examined using thematic analysis.
Results: The results identify four groupings where paid ASC workers and their representatives seek change: Pay and conditions; Systemic/structural change; Awareness-raising and being heard; and Environment and practices.
Discussion: The discussion assesses the implications of these findings for ASC worker organizing and prospects for change. It contends that there remain significant barriers both to meaningful change in the situation of paid care workers, and to care worker organizing playing a greater or more prominent role in driving change. Concluding reflections consider what the issues identified in care worker organizing reveal about the relative status of care work and the circumstances of care workers, and paid care work's position in contemporary neoliberal capitalism
Evolution of treatment of fragility fractures of the pelvic ring. An update
No full textThe term “fragility fractures of the pelvis” refers to the disruptions of the pelvic ring that are caused by low energy injuries (such as low-level falls or falls from the standing position) in the elderly population (age over 65 years) in the absence of metastatic bone disease. These fractures are increasing in numbers, due to the aging population, particularly in the developed countries, causing significant morbidity and mortality [1]. Although some fracture patterns are stable enough requiring only conservative treatment, other fracture types can cause significant pelvic instability, demanding a more insistent management protocol
FUEL POVERTY IS STILL WITH US
Get PDFWe carried out a series of analyses of fuel poverty during the cost-of-living crisis, and also explored the potential impact of social tariffs. Since then, fuel prices have fallen, but they are still above pre-crisis levels, they increased in the last two quarters of 2024/25 and will increase again in the first quarter of 2025/26 by 6.4 per cent. At the same time, all mitigations have ended and the winter fuel allowance for pensioners has been restricted to pensioners on Pension Credit. This paper presents a revised analysis of who will be affected by fuel poverty in January 2025, based on analysis of the ONS Living Costs and Food Survey. We use a threshold of households spending more than 10 and 20 per cent of their net income after housing costs on fuel. The analysis describes their characteristics, fuel poverty rates, and fuel poverty gaps. We find that although there is a clear association between fuel poverty and net income, with fuel poverty concentrated in the lower-income deciles, some richer households also spend more than 20 per cent of their income on fuel, and 26.3% of households in fuel poverty are not income poor. Childless couples and couple pensioner households are less likely than average to be fuel poor, and couples with two or more children and lone parent households are more likely to be fuel poor
Physical Controls on the Variability of Offshore Propagation of Convection From Sumatra
Get PDFPrevious work has explained the physical mechanisms behind nocturnal offshore propagation of convection southwest of Sumatra. Low-level moisture flux convergence due to the land breeze front controls the progression of convection, typically a squall line, away from the coast overnight. However, the diurnal convection over the mountains occurs on only 57% of days in December–February (DJF) and propagates offshore on only 49% of those days. We investigate day-to-day variability in dynamical and thermodynamical conditions to explain the variability in diurnal convection and offshore propagation, using a convection-permitting simulation run for 900 DJF days. A convolutional neural network is used to identify regimes of the diurnal cycle and offshore propagation behavior. The diurnal cycle and offshore propagation are most likely to occur ahead of an active Madden-Julian oscillation, or during El Niño or positive Indian Ocean Dipole; however, any regime can occur in any phase of these large-scale drivers, because the major control arises from the local scale. When the diurnal cycle of convection occurs over land, low-level wind is generally onshore, providing convergence over the mountains, and low-level humidity over the mountains is high enough to make the air column unstable for moist convection. When this convection propagates offshore, midlevel offshore winds provide a steering flow, combined with stronger convergence offshore due to more onshore environmental winds. Low-level moisture around the coast also means that as the convection propagates, the storm-relative inflow of air into the system adds greater instability than would be the case on other days
Understanding e-scooter rider crash severity using a built environment typology: A two-stage clustering and random parameter model analysis
Get PDFE-scooters are an emerging transport mode that is transforming urban mobility; however, their proliferation has raised concerns about safety. This study combines UK e-scooter crash data with built environment characteristics from the crash locations. A two-stage framework was followed: first, a typology of built environments was developed using K-means++; second, crash severity within each cluster was analysed using a random parameter binary logit model. Four built environment clusters were identified: (1) car-centric and mixed-use zones, (2) commercial and industrial zones, (3) intersection-dense areas, and (4) residential and central areas. Collisions with motor vehicles, younger e-scooter riders, and higher speed limits were the most common risk factors across the clusters, with the first two clusters showing a higher impact of these factors on the likelihood of severe crashes. In the first and second clusters, riding on the carriageway significantly increased injury severity. In the second cluster, three collision types were significant, more than in other clusters where only side-impact collisions were significant. This indicates high e-scooter-motor vehicle friction in the second cluster. Among all collision types, head-on collisions increased the likelihood of severe outcomes more than others. In the third and fourth clusters, peak hours were associated with a lower likelihood of severe crashes, while this variable showed the opposite impact in the first cluster. The results highlight that consideration of the surrounding built environment is paramount when analysing e-scooter crash severity, as unique contributing factors were identified specific to each built environment type, along with varying magnitudes or directions of marginal effects
Modelling the case for cost-effectiveness of interventions to improve medication adherence in patients with difficult to control asthma
Get PDFBackground Asthma significantly impacts the United Kingdom, affecting approximately 12% of its population. Patient adherence to asthma therapies is a critical challenge, with research indicating a direct link between poor adherence and increased acute asthma episodes, contributing to worse patient health and substantial costs to the NHS. These incidents are notably correlated with socioeconomic factors, suggesting broader systemic issues influencing treatment adherence. This study aims to explore the cost-effectiveness of interventions designed to improve asthma treatment adherence. The developed model will support the development and implementation of cost-effective interventions to increase adherence to asthma medication. Methods Building on a previously developed decision model structure and incorporating expert clinical input, this study simulates the health status and associated healthcare resource implications of asthma patients over a 20-year period across various adherence scenarios. The model delineates three asthma control states: controlled, partially controlled, and uncontrolled. Age-adjusted utilities and comprehensive healthcare resource utilization data were incorporated, aligning resource use with recent national unit costs and adjusting for inflation. Treatment effectiveness is modeled exponentially in relation to adherence rates, allowing the model to flexibly compare the cost-effectiveness of interventions that improve adherence at different levels. In addition to conventional outputs from a cost-effectiveness decision model—such as expected health profiles and healthcare cost implications for different adherence levels—this study also presents estimates of asthma control and exacerbation rates to inform commissioning decisions. Results Initial analyses indicate that improving asthma medication adherence rates has the potential to:Generate additional patient health benefits, measured in terms of asthma control levels, life expectancy, and quality-adjusted life years (QALYs).Reduce the cost of care to the healthcare system.These findings demonstrate the substantial impact of adherence rates on both economic and health outcomes. Limitations and Implications The study faces limitations in generalizing adherence, as it does not account for the diverse contexts and scenarios of different adherence improvement interventions. Additionally, variations in adherence definitions across studies pose challenges for comparison. However, the study provides a flexible model that enables stakeholders to estimate the cost-effectiveness of interventions with varying effects on adherence levels. By focusing on patient- or user-centered research, this model serves as a valuable tool for policymakers and carers. It highlights the cost-effectiveness of enhancing asthma treatment adherence and underscores the need for targeted interventions that address socioeconomic disparities in healthcare
The Lancet Commission on rethinking coronary artery disease: moving from ischaemia to atheroma
No full textMaterial stocks and embodied carbon in UK buildings: An archetype‐based, bottom‐up, GIS approach
Get PDFDecarbonizing construction through a circular economy requires an in-depth understanding of the materials stocked within, and flows into, between, and beyond, the global built environment. Archetype-based bottom-up material stock analysis (MSA) is increasingly used to estimate the quantity, location, and embodied carbon of different construction materials within existing buildings. European MSA studies typically employ archetypes based on building use (e.g., residential/non-residential) and/or age (e.g., historic/modern), potentially missing significant variation in material composition across different construction types. Such work also generally focuses on residential buildings and derives aggregated and/or synthetic material intensities (MIs), with non-residential buildings in the United Kingdom rarely being considered through real-world design data. This paper investigates the suitability of different archetyping approaches in the bottom-up estimation of material stocks and embodied carbon in UK buildings. Concrete is revealed to consistently contribute the majority of material mass irrespective of use or construction type, with steel consistently representing a majority of superstructural embodied carbon. Despite the relative agreement between overall structural MIs for use- and construction-based archetypes, varying material and sub-/superstructural composition introduces increased heterogeneity in individual-material and sub-building MIs when considering building construction type. Mapping of use- and construction-based MIs to the building stock level is shown to be inhibited by the infrequent specification of construction type within the utilized inventory. This gives rise to a novel, parallel use and/or construction archetyping approach, reiterating the need for the inclusion of building construction types within both MSA archetyping approaches and national building inventories
Data sources:
Access Repository Dashboard
Do you manage Open Research Online? Become a CORE Member to access insider analytics, issue reports and manage access to outputs from your repository in the CORE Repository Dashboard! 👇