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Development of a ‘systems map’ exploring the factors influencing excess weight in children 0–5 years: a Northern Ireland perspective
No full textChildhood obesity rates are rising across the UK (UK) with widening gaps in inequalities. Data from Northern Ireland (NI) in2024 illustrated that 17% of children in Primary 1 from the least deprived backgrounds are living with excess weight versus 24%from the most deprived. Advancing understanding of the causal inter-relationships of key influences on obesity development in young children through systems mapping is needed. An iterative stakeholder engagement approach was taken to create a systems map, starting with a workshop with n = 23 stakeholders in the UK to produce an initial map (Phase 1). A further discussion group with six parents refined the map (Phase 2), and a workshop with n = 22 additional stakeholders in NI was used to inform the final map (Phase 3). This abstract reports Phase 3 outcomes. The aim of Phase 3 was to build upon the map, consider any omissions and discuss it from an NI perspective with early years organisations/NI government departments/ public health staff/ healthcare practitioners/ commissioners/ charities/ community organisations and parents. The workshop involved an introduction to the map outlining the domains, nodes, and connections to prompt discussion followed by a weightings exercise, where participants indicated nodes/domains on the map of greatest importance regarding the development of excess weight in 0–5 year olds. The final map contained 20 domains of influence and 153 factors. Several new nodes were suggested in Phase 3 relating to behaviours e.g., screen time and physical activity (lack of fundamental movement skills); cultural factors e.g., norms around babies weight gain and a lack of breastfeeding culture; environmental factors such as predominance of unhealthy food choices for children eating out of home; and, psychological factors e.g., stigma of childhood overweight/obesity. There was an emphasis on importance of parental mental health, inequalities, poverty and income. Inadequate government policies and a lack of NI government stability were also prominent and linked directly to insufficient funding for early years services, particularly in rural areas which lack services for large proportions of the NI population. Findings illustrate multiple interacting influences on excess weight gain in 0–5 year olds and findings should be used to contextualise future intervention development
Standardization of OCT angiography nomenclature in retinal vascular diseases: consensus-based recommendations
No full textObjectiveTo develop a consensus nomenclature for OCT angiography (OCTA) findings in retinal vascular diseases (RVDs).DesignExpert consensus using standardized online surveys with modified Likert scale.ParticipantsRetinal vascular disease imaging experts, OCT biomedical engineers, and the members of the International Retinal Imaging Society (IntRIS)MethodsA PubMed literature review identified quantitative and qualitative terms forming the basis for a consensus-building process using a modified Delphi method. Agreement levels were categorized as “Accepted” (median ≥6), “Considerable Consensus” (median, 6–7; interquartile range [IQR] ≤3), “Strong Consensus” (median ≥8; IQR ≤2), and “Refined Strong Consensus” (median ≥8, IQR ≤2, with ≥70% of responses in the 8–10 range).A multidisciplinary expert panel refined the terminology through 3 survey rounds, leading to a final survey conducted by IntRIS members.Main Outcome MeasuresConsensus on OCTA nomenclature in RVD.ResultsThe literature review identified 58 relevant papers, yielding 51 quantitative and 108 qualitative terms. A series of 3 surveys was used to refine the nomenclature framework for describing OCTA findings. The selected framework includes a generic term (“OCTA signal”), adjective terms (“presence/absence,” “decreased/increased,” “normal/abnormal”), and descriptive/etiologic terms (“of unknown cause,” “due to blockage,” “due to non-perfusion”).In the final survey among 44 IntRIS members, the framework achieved strong consensus for overall acceptance (median, 8.0; IQR, 7.0–9.0). The term “OCTA signal” met refined strong consensus criteria (median, 8.0; IQR, 8.0–9.0, with ≥70% of responses in the 8–10 range). Adjective terms, including “absence/presence” and “increased/decreased,” were also rated with strong consensus (median, 8.0; IQR, 7.0–9.0). Similarly, descriptive/etiologic terms achieved strong consensus (median, 8.0; IQR, 7.0–9.0).Adoption of the framework for clinical practice and scientific reporting was rated with strong consensus (clinical: median, 8.0; IQR, 7.0–9.0; scientific: median, 9.0; IQR, 8.5–10.0).ConclusionsThis study establishes a strong consensus framework for reporting OCTA findings in RVD for clinical and scientific contexts.<br/
Exploring adolescents’ psychosocial experiences when affected by parental pancreatic cancer: a qualitative study protocol
No full textObjectives/Purpose: This study aims to explore the psychosocial experiences of adolescents in the UK who have had a parent diagnosed with pancreatic cancer. Parental cancer can have a profound impact on adolescents (aged 10-19 years) as it is a critical development period marked by a desire for independence from family, and they have heightened emotional and cognitive capacity to understand their parent’s pain. Pancreatic cancer is the least survivable cancer in the United Kingdom (UK), and the only cancer with a 5-year survival rate of less than 10%. It is known for its rapid disease trajectory and severe symptom burden, with individuals often dying within weeks of diagnosis. Early-onset pancreatic cancer incidences are rising and therefore growing numbers of individuals with pancreatic cancer likely have adolescent children. Adolescents whose parent has an incurable cancer often face heightened difficulties, such as more intense and urgent support needs. Yet, adolescent experiences of parental pancreatic cancer have not been explored. Sample and Setting: Approximately 15 young people aged 10-24 years in the UK, who have experienced parental pancreatic cancer when they were an adolescent, will be interviewed. The adolescents’ parents will also be interviewed to explore how parents perceive their adolescent children's experiences. Procedures: This study will employ a multi-perspectival interpretative phenomenological analysis approach. Findings will inform a participatory action phase which will utilise the World Café method to engage key stakeholders to collaboratively identify solutions to improve psychosocial support in this area. Results: The research will be the first to provide rich, in-depth insights into the psychosocial experiences of adolescents affected by parental pancreatic cancer, from both adolescent and parent perspectives. Conclusion and clinical implications: Findings will contribute to understanding of adolescents’ psychosocial experiences, subsequently informing policy and practice recommendations to promote support for adolescents impacted by parental pancreatic cancer
‘Storm beyond control’: black workers, the Republican Party and class conflict in reconstruction South Carolina
No full textA series of explosive confrontations in low country South Carolina in the immediate aftermath of emancipation call into question a number of assumptions once deeply embedded in Reconstruction historiography, and still influential in popular memory. Most obviously they turn on its head the assertion made universally by white conservatives and later absorbed into historical writing by the Dunning School that northern ‘carpetbaggers’ had manipulated docile former slaves into entering a political upheaval they did not (indeed, could not) comprehend. Freedpeople's repeated collisions with military and party officials illuminates another critical issue, however: the complicated relationship between black political mobilization and the Republican Party. In this article I aim to demonstrate that the tensions evident in several prominent early collisions were on display frequently throughout the period of Reconstruction in South Carolina, and that these divisions help to explain how white conservatives (mostly former Confederates, and led by propertied ex-slaveholders) were able to find their way back to power in a black-majority state
The effect of reduction temperature of graphene oxide on the structure and properties of polystyrene/thermally reduced graphene oxide nanocomposites
No full textThe adoption of an eco-friendly approach to reduce graphene oxide (GO) and the employment of the obtained reduced graphene oxide (rGO) to prepare high-performance polymer nanocomposites represent a considerable challenge. Vacuum assisted low temperatures were used to obtain rGO from GO. GO was reduced at 130, 165 and 200 °C for 24 h to produce rGOs of different degrees of reduction. Fourier infrared spectroscopy (FTIR), X-ray diffraction (XRD), Raman spectroscopy, thermogravimetric analysis (TGA) and X-ray photoelectron spectroscopy confirmed a successful reduction of GO and the preparation of rGOs with different degrees of reduction. To study the effect of rGOs on the structure and properties of polymers, rGOs were mixed with polystyrene (PS) at 1.0 mass% loading to prepare nanocomposites using a solution blending method. The results of FTIR, XRD, and scanning electron microscopy showed a possible interaction and good dispersion of GO and its reduced forms within the host medium of PS. Differential scanning calorimetry, TGA, and dynamic mechanical analysis showed that thermal and thermomechanical behaviour were improved with the incorporation of rGOs as compared with nanocomposite reinforced with pristine GO and the neat polymer. The higher values of thermal degradation temperature, glass transition temperature and storage modulus for PS/rGOs as compared with PS/GO and the neat polymer confirmed the role of rGO in achieving better performance for the nanocomposites
Use of prescription drugs in primary care in the years before and after a malignant hematologic diagnosis: a register-based study
No full textHematologic malignancies are rare in primary care and the often-unspecific symptoms pose a diagnostic challenge, potentially leading to delays in referral and subsequent diagnosis. To aid early detection, we aimed to uncover new patterns of early disease presentation by conducting a comprehensive description of new prescription drug use before and after diagnosis in a large population-based dataset using new prescriptions as a marker for pre-diagnostic symptoms. Using data from the nationwide Danish Cancer Register (2008-2016), we identified patients with malignant hematologic diagnoses and matched them with five population controls from the Danish background population. Information on new drug use was collected from three years prior to two years post diagnosis via the Danish Nationwide Prescription Register. Among 33,715 hematologic cancer patients, new drug use increased 18 months before diagnosis, peaking at the time of diagnosis at three times the rate of population controls, mainly driven by antibiotics and analgesics. For certain diagnoses including myelodysplastic neoplasms, drug use was elevated from the beginning of the study period, i.e. three years pre-diagnosis. We did not identify new patterns of early disease but highlighted familiar symptoms such as frequent infections and chronic pain, supporting a pre diagnostic time-window of up to several years. These observations stress the importance of improving detection of malignant hematologic diseases and focusing on known disease markers to enhance risk predictions and guide interventions in the future.<br/
Evaluation of autonomous intrusion response agents in adversarial and normal scenarios
No full textThe emergence of threats to networked cyber-physical systems (CPS) such as FrostyGoop (2024), Pipedream (2022) and Industroyer2 (2022), motivates a desire for improved automated defences against such threats. Research has found deep reinforcement learning (DRL) can enable autonomous intrusion response systems (IRS) to learn optimal response policies from experience, without relying on static pre-configured rules or explicit system models. The goal of autonomous defence is protecting against multi-stage attacks by learning to minimise disruption to the normal operation of the system and restore CPS functionality. However, this approach is dependent on the training environment being representative of a real system while being conducive to learning. Previous approaches focus on designing agents to adapt to adverse training conditions and neglect evaluation in scenarios absent of the adversary and/or defence agent. In contrast, we focus on improving the design of the training environment proposing both adversarial and normal scenarios for evaluation. Our analysis reveals several novel observations linked to suboptimal training conditions. For example, through evaluation of normal scenarios, it was revealed that security alerts were still present in the absence of the adversary. These observations challenge the assumptions made about the environment implementation in previous work. Our contributions support improved agent training for effective autonomous IRS.<br/
Mental health and well-being of residents with Parkinson’s disease in care homes: a scoping review
No full textIntroduction: As the prevalence of Parkinson’s disease (PD) increases, care homes face growing challenges in managing residents’ complex mental health needs. Residents may experience low mood, anxiety, and hallucinations. Methods: A scoping review (ScR) was conducted following the methodological framework of Arksey and O’Malley and reported according to the PRISMA-ScR checklist. Four databases (CINAHL, Embase, PsycINFO, and Scopus) and grey literature sources were searched up to June 2025, alongside grey literature (European Public Health Association (EUPHA), the UK Department of Health and Social Care, the National Institute for Health and Care Excellence (NICE), and the World Health Organisation (WHO), with the aim of mapping the existing evidence on the mental health and well-being of people living with Parkinson’s disease in care homes, in order to identify gaps in the literature. Screening and data extraction were conducted independently by two reviewers using Covidence software, with discrepancies resolved through discussion. Results: Eleven studies met the inclusion criteria, encompassing quantitative, qualitative, and mixed-methods designs. The findings indicate that mental health disorders are common and severe among care home residents with PD; 61% of individuals experienced at least one, contributing to reduced quality of life, increased care dependency, emotional distress, and social isolation. Caregivers report significant burden associated with managing symptoms associated with mental health disorders and residents frequently experience a decline in psychosocial well-being. Conclusions: Although few studies evaluated interventions, the findings highlight the need for both pharmacological and non-pharmacological approaches. Specialised staff training and adherence to international care guidelines are needed to improve recognition and management of mental health needs in residents living with PD.<br/