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Entrepreneurship in the digital era
No full textThis study uses panel data from 297 prefecture-level cities from 2010 to 2021 to explore the relationship between digital economy development and urban entrepreneurship. By leveraging the “Broadband China” pilot city policy as a quasi-natural experiment, we investigate how the growth of the digital economy influences entrepreneurship. The results show that digital advancements, indicated by the policy, contribute to increased entrepreneurial activity. This effect is stronger in cities with higher administrative status, better geographical positions, well-developed infrastructure, and greater market opportunities. Further analysis identifies venture capital investment, the business environment, human capital, and innovation as key channels through which the digital economy promotes entrepreneurship. These findings offer insights for understanding how digital development can support urban entrepreneurship and economic growth
A comparison of high-fidelity and virtual reality simulation as assessment tools in undergraduate medical education
Get PDFBackground: Simulation is widely used across many aspects of health professions education and, in recent years, has begun to be explored as an assessme nt tool, particularly in relation to examining technical clinical skills. Although previous research has suggested that simulation may be an effective tool for assessing clinical skills, there is a lack of evidence exploring which form of technology may be a more reliable assessment tool. This crossover study aimed to compare two forms of simulation technology—a high-fidelity manikin and virtual reality, as potential tools for assessing acute clinical care assessment skills. Methods: The participating students completed two different simulation scenarios: one scenario using a high-fidelity manikin and one using a virtual reality system. The two scenarios were then marked using a checklist created for the research and a global assessment score. The results for each simulation technology were compared with one another and compared with the participants’ medical final summative assessment scores. Results: Sixteen students participated in the research. The assessment checklist scores from the two technologies were comparable, with no statistically significant difference (p = 0.918) and a strong positive correlation between the two (correlation coefficient = 0.665, p = 0.005). However, neither simulation technology had a statistically significant correlation with the summative final written examination paper (high-fidelity manikin: correlation coefficient = − 0.25, p = 0.927; virtual reality: correlation coefficient = 0.363, p = 0.167) or final clinical examination scores (high-fidelity manikin: correlation coefficient = − 0.204, p = 0.449; virtual reality: correlation coefficient = − 0.201, p = 0.455). Conclusions: The findings from this research suggest that virtual reality simulation is comparable to high-fidelity simulation when comparing student scores across the two forms of simulation. However, neither method demonstrated a strong correlation with final summative examination outcomes, suggesting that a single scenario assessment using either technology may not provide an appropriate alternative to existing final summative examinations. To better understand the role of simulation in assessment, further research is needed to compare these two simulation technologies in more depth and provide additional evidence to support educators in understanding how they can be best used within health professions education
Experiencing the wild: red fox encounters are related to stronger nature connectedness, not anxiety, in people
Get PDFFrequent and positive wildlife experiences can strengthen people’s physical and mental connection with nature, potentially improving public health and pro-environmental behaviors. Red foxes are the most widespread terrestrial carnivore on the planet and may, therefore, be an important gateway for people to connect with nature. However, it remains unclear how interactions with foxes might influence (positively or negatively) nature connectedness and health in people, such as general anxiety. We surveyed 230 people using an online questionnaire. Frequent, positive experiences were related to better attitudes and tolerance toward foxes, as well as broader nature connectedness. Nature connectedness was negatively related to urbanization but unrelated to age or education. General anxiety was inversely related to age, but unrelated to urbanization, education, frequency and quality of fox experiences, or the interaction between urbanization and fox experiences. These findings suggest a potential role of foxes in shaping people’s broader nature connectedness, particularly in cities
The Influence of Breathing Pathway on Cognitive Processes
Get PDFBreathing, a fundamental rhythm of life, has traditionally been associated with the exchange of oxygen and carbon dioxide. However, recent research in both animals and humans has unveiled additional roles of breathing in modulating cortical neuronal activity, influencing sensory, motor, emotional, and cognitive processes, with a particular advantage for nasal breathing in comparison to oral breathing. A small but growing area of research has found a nasal breathing advantage for cognitive processes, particularly attention and memory. The understanding of this advantage is limited.This thesis poses four primary questions:1. Does nasal breathing enhance memory consolidation for stimuli beyond olfaction?2. Is the nasal breathing advantage specific to wakeful rest, or does it extend to a more active cognitive delay period?3. Does nasal breathing influence cognitive processes beyond memory consolidation, such as working memory and attention?4. Can pupil dilation serve as a proxy for respiratory driven neural synchrony that is implicated in the nasal advantage? And is disruption in this synchrony reflected in behavioural performance?Chapter 1 critically discusses the existing literature regarding the influence of breathing pathway on physiology and cognitive processes and identifies the current gaps in the research.Chapter 2 consists of two empirical experiments addressing the first primary question.Experiment 1 examines whether oral breathing disrupts the consolidation of declarative memory.Experiment 2 examines whether oral breathing disrupts the consolidation of perceptual memory.Chapter 3 consists of Experiment 3, which examines the relationship between waking rest and breathing pathway. Previously it has been established that the nasal advantage for consolidation occurs during rest. This study aims to establish if the nasal advantage also persists during an active task, answering the second primary question.Chapter 4 consists of two empirical experiments addressing the third and fourth primary questions. Experiment 4 aims to examine the neural synchrony suggested to occur during nasal breathing using the proxy measure of pupillometry. Pupillometry has been shown to be a reliable indicator of neural activity and breathing has been shown to influence neural activity. Thus, it is suggested that a direct synchronous relationship should exist between the two phenomena. Experiment 5 will establish whether this synchrony between respiration and pupillometry is modulated by breathing pathway, confirming it is a viable proxy measure for the respiratory driven synchrony found during nasal breathing.Chapter 5 contains a stage 1 pre-registered report of Experiment 6, which examines the generalisation of the nasal advantage to visual search and examines how task difficulty may moderate this.Chapter 6 concludes this thesis by summarizing and critically evaluating its contributions to understanding how the breathing pathway affects cognitive processes and physiology. The chapter assesses the two main themes, the influence of the breathing pathway on memory and attention and discusses remaining questions and potential directions for future research
Evidence gap in predicting intracranial haemorrhage risk in people with glioma on anticoagulants: a scoping review
Get PDFBackground: People with glioma (PwG), a type of brain tumour, have an elevated risk of developing venous thromboembolism (VTE). When VTE occurs, anticoagulant therapy is typically initiated, and in some cases, it may be prescribed prophylactically. However, these patients are also at risk of intracranial haemorrhage (ICH) as a complication of anticoagulation. Despite the clinical importance of this risk-benefit balance, it remains unclear whether predictive tools exist to guide anticoagulation decisions in this population. Methods: We conducted a scoping review to determine whether predictive models exist for estimating the risk of intracranial haemorrhage (ICH) in people with glioma (PwG) receiving anticoagulant therapy. For any models identified, we assessed their methodological quality and predictive performance. Our search included MEDLINE, EMBASE (via Ovid), and the Cochrane Library, covering publications up to 29 November 2024. Studies were eligible if they employed predictive modelling to assess ICH risk in anticoagulated PwG. Two reviewers independently screened studies and extracted data. We used the PROBAST tool to evaluate model quality. Results: Of the 1,585 articles screened, none met the inclusion criteria. Although some studies reported on ICH risk in PwG, none developed or validated predictive models tailored to this clinical context. One excluded study provides conceptual insights that may inform future modelling efforts. Conclusions: The absence of these models underscores a critical gap in neuro-oncology research and highlights the urgent need for targeted model development to support anticoagulation decision-making in PwG
Effects of exercise training on cardiovascular risk within HIV-infected adults in Malawi, Africa
No full textBackground: Antiretroviral therapy (ART) has successfully improved survival rate among people living with human immunodeficiency virus (HIV) infection (PLHIV), especially in Sub-Saharan Africa (SSA). Seventy percent (70%) of the global population of PLHIV reside in SSA. However, chronic viral infection and ART use, alongside specific ART regimens, have been linked to nearly 15% of cardiovascular disease (CVD) cases within four countries in SSA. Due to limited evidence from comprehensive screening studies in SSA, it remains difficult to understand the CVD risk attributable to ART treatment and regime switching, viral infection and other strong, independent, lifestyle-related risk factors such as poor cardiorespiratory fitness (CRF) and sedentary behaviours, among PLHIV.Notably, physical activity (PA), structured exercise therapy (ET) and lifestyle modification targeted interventions have been shown to be effective in improving CRF and reducing CVD risk in healthy adults, PLHIV and those with established CVD. However, access to such gold-standard interventions in SSA is challenging, and there is limited literature available regarding the effects of PA/ET on CVD risk among PLHIV on ART in healthcare settings in resource-constrained Malawi, SSA.Broadly, the thesis aimed to assess the effects of ET and lifestyle modification on CRF and global cardiovascular risk among PLHIV in both primary and secondary CVD prevention care settings in Blantyre, Malawi. The project also aimed to assess the effects of delivering a low-cost, supervised and structured ET on improving CRF and lowering CVD risks among PLHIV in Malawi. Furthermore, the thesis aimed to examine the accuracy of the Framingham CVD risk algorithm for PLHIV on ART in Malawi. Lastly, the project aimed to engage the PLHIV in designing a peer-led community-based CVD prevention intervention delivery approach in this resource constrained setting.Methods:Given this thesis focuses on designing and delivering supervised ET to higher risk clinical groups in resource-limited settings, an initial validation study of CRF measurement (Chapter 4) was conducted in young, African adults. Overall, this novel validation study supported the use of Chester step (CST) and Incremental Shuttle walk (ISWT) submaximal tests in assessing CRF outcomes by comparison to criterion maximal Treadmill-based walking testing with expired gas analysis. Specifically, the submaximal ISWT with portable gas analysis; or CST without gas analysis, were both highly valid when assessing CRF, as defined by maximal oxygen consumption (VO2max), in young adults of African descent.Chapter 5 presents a secondary data analysis of a randomised controlled trial (RCT) amongst 60 participants with chronic heart failure (CHF) aged 18 years and above, who were recruited from the Queen Elizabeth Central Hospital (QECH) for a cardiac rehabilitation (CR) study (Namanja et al., 2024). This study compared the effects of structured 12-week exercise training CR versus usual care on CRF outcomes in patients with CHF. This was a post hoc evaluation of participants living with and without HIV infection. The PLHIV were well-distributed amongst different sexes (males n=14, 51.9%) and most (n=18, 66.7%) reported being on ART for >5 years.The mean left ventricular ejection fraction (EF) between people living with and without HIV was comparable (54.0±10.9% versus 52.03±10.5%, respectively, p=0.47). The EF classes were also comparable with larger proportions in both groups (63% and 51.5%, respectively) having heart failure preserved EF (HFpEF). The CRF measure in this QECH study was the six-minute walk distance (6MWD), a valid, reliable and most widely applied submaximal test of functional capacity in CHF. This is the first study, in SSA, to compare physiological responses to ET between cardiac patients living with and without HIV.A cross-sectional study of CVD risk was then undertaken of PLHIV and adults without HIV infection in Malawi (Chapter 6). Initially, a total of 316 PLHIV (aged 18 to 65 years) on ART (for >6 months) attending the ART clinic at Ndirande health centre (NHC), Blantyre, were screened for conventional CVD risk factors. Thereafter, a dataset from Malawi’s large, cross-sectional epidemiological database (Malawi epidemiological research unit [MEIRU]), with age and gender matched 316 PLHIV and 316 non-HIV adults, was extracted and utilised to (i) compare and better characterise the global CVD risk in the SSA region and (ii) examine the CVD risk factor effects attributable to HIV infection and ART treatment. To the investigators’ knowledge, this is the first study to comprehensively assess the CVD risk among PLHIV, on a relatively large sample size and focusing on key factors highly associated with chronicity of HIV-infection and ART use.Using higher 30-year Framingham CVD risk scores, together with a novel CVD risk measure, namely the visceral adiposity index (VAI), higher CVD risk participants (n=48) (from the Ndirande distribution) were identified. These higher CVD risk PLHIV from the Ndirande cohort were selected for a RCT of supervised, structured exercise intervention or usual care lifestyle modification/education advice (Chapter 7). Participants were randomised, using a concealment method, into a low-cost, structured, 14-weeks supervised ET (n=24) or a personalised cardio-protective lifestyle enhancing advice (n=24). The primary variables constituted predicted peak oxygen consumption (Pred.VO2peak), composite 30-year CVD risk, VAI and quality of life (QoL) outcomes. Secondary measurements included blood markers for chronic inflammation, cardiometabolic metabolism, anthropometric measures, and CVD risk knowledge and perception. Such measures make this study outstanding among the other few studies that have conducted similar investigations between 2008 and 2015 in SSA. Participants were screened at baseline and end of intervention. The ET constituted both aerobic and strength exercises prescribed at 40-80% of VO2peak (or 12-16 Borg-20 scale) and 60-80% and 40-60% of one repetition maximum for upper and lower extremities, respectively. The group-based circuit interval ET was delivered at NHC three times a week, for 14 weeks duration. The usual care was delivered via face-to-face on commencement at the hospital, and subsequently once a week for 14 weeks via a phone call and short message service. This study is also the first to be done in Malawi, on primary prevention of CVD on PLHIV.Chapter 8 describes the CVD knowledge and risk perception of PLHIV, and their perceptions on accessing CVD preventive interventions with special focus on a peer-led community-based intervention delivery approach. Two focus group discussions were conducted on randomly selected (n=20) participants a week after the intervention period. The novel findings of this study helped in designing an acceptable approach to delivering such an intervention in this setting, which will be assessed for feasibility, effectiveness and sustainability post this thesis. Descriptive and inferential statistics were conducted using SPSS version 29. Deductive thematic analysis was performed on qualitative data, and NVivo software assisted with data management within the Ndirande RCT. The studies were approved by the research ethics committees at the Kamuzu University of Health Sciences in Malawi (p.06/23-0105) and the University of Hull in the United Kingdom (FHS 22-23.18), and it was registered in the Pan African Clinical Trial Registry (PACTR202310853413416). The QECH-CR study was originally approved by the Kamuzu University of Health Sciences (p.10/20/3167), and the conduct of secondary analysis on this dataset was approved by the University of Hull research ethics committee (FHS 22-23.67).Results:Among 316 PLHIV in Ndirande, dyslipidaemia (82.3%) (specifically low concentrations of high-density lipoprotein cholesterol [HDL-c] [74.1%] and high triglycerides [56.6%]), undiagnosed high blood pressure (36%), high VAI (74.4%) and sedentary lifestyles (61.7%) were highly prevalent. Whereas the majority of PLHIV recruited were only classified as having low or moderate Framingham 30-year CVD risk (91.8%). The cross-sectional studies showed that the global 30-year Framingham CVD risk scoring method may underestimate the emerging CVD risk among PLHIV, by not capturing biomarkers underlying the pathophysiology of the CVD atherogenic process. Specifically, HIV infection and the inherent side-effects of the medications used to supress viral load, may exacerbate lipodystrophy or atherogenic dyslipidaemia, hypertension, insulin resistance/glucose intolerance and chronic sub-clinical inflammation. Over 70% of the RCT participants were classified into a moderate CVD risk class, yet they had markedly higher VAI (incorporating higher abdominal adiposity and TAG, with lower HDL-c) and arterial stiffness (SI) indices. Therefore, there is need to further consider how best to assess the CVD risk and CVD risk algorithms for PLHIV.The RCT of supervised, structured exercise intervention or usual care lifestyle modification/ education advice showed that 14-weeks of ET led to improvements in the CRF measures (Pred.VO2peak, VO2Submax), and functional capacity (ISWT walking distance) of the enrolled participants. Participants who received the ET intervention perceived that their health improved significantly, also with trends towards improved domains of QoL namely vitality, social functioning, and role limitations due to emotional health were observed in favour of ET. Additionally, ET led to improvements in biomarkers of CVD risk namely hs-CRP, HbA1C, HDL-c and TAG. Overall, CVD risk perception and unknown risk perception, and knowledge on CVD risk factors also showed improvement. Collectively, these RCT findings suggest that low-cost, structured and short-duration ET intervention is an effective CVD primary preventive measure in PLHIV within resource constrained settings. Participants expressed the need to promote community groups, empowering them with knowledge, material resources and leadership, to implement a peer-led community-based CVD prevention intervention locally.The findings of a secondary analysis of supervised, structured 12-weeks ET in CHF; showed that patients living with and without HIV exhibited broadly comparable physiological impairments, including lower functional capacity and CRF variables. Although both groups responded positively to ET intervention, resting systolic and diastolic blood pressures improved more among PLHIV compared to those living without HIV infection. Improvements in CRF measures (resting heart rate, 6MWD and Pred.VO2peak) were more pronounced in non-HIV infected individuals at the end of the 12-weeks intervention period. However, following a further three-month follow-up period, improvements were further observed in 6MWD and Pred.VO2peak in both groups, with more positive changes occurring among PLHIV.Conclusion:In summary, the findings of this thesis suggest that PLHIV in Malawi are at a high risk for CVD. Supervised low-cost and short-duration ET was effective in improving CRF/functional capacity and various QoL measures. Emerging CVD risk factors (related to HIV infection and treatment) notably the VAI and systemic inflammatory measures, were lowered with ET, hence contributing to CVD risk reduction. Moreover, the supervised and structured ET was effective in improving CRF and comorbidities among CHF patients living with and without HIV, who displayed more significant baseline physiological impairments.Future investigations should focus on establishing a CVD risk predictive algorithm sensitive to specific CVD risks (linked to HIV-infection and/or ART), namely hypertriglyceridaemia, low HDL-c, and visceral adiposity measures for PLHIV. Future investigators should also consider assessing the effects of low-cost long-term ET on CVD risk reduction, on a larger sample size of PLHIV in the SSA settings and comparing the effects of PA and lifestyle modification targeted interventions between PLHIV and their age and gender matched non-HIV counterparts. Lastly, assessing the effectiveness, feasibility and sustainability of the proposed peer-led community-based CVD prevention intervention approach is warranted in this setting
Should the altruist stay at home?
Get PDFWe consider altruism as a core characteristic of human beings, grounded on an awareness of our interdependence. We address some of the difficulties that an altruist might encounter when promoting the wellbeing of those who are different from himself. In cases like this we can find that: the beneficiaries disagree with the altruist about what is good for them, what will benefit them or improve their well-being; and/or the ‘goods’ or benefits that the beneficiaries want the altruist to promote may actually conflict with the altruist’s values. We will discuss whether or not the altruist should ‘stay home’ and refrain from exercising altruism with those who are different from him. We will offer (tentative) solutions that allow (at least I some instances) altruism to be promoted in cases in which the altruist and the beneficiaries have a different understanding of what would promote the wellbeing of the beneficiaries
948 Risk Factors for Impaired Wound Healing in Non-Implant-Based Breast Reconstruction: A Cohort Study
No full textAbstractAimThis study aimed to assess the association between clinical risk factors, treatment-related variables, and postoperative wound complications in breast reconstructive surgery.MethodThis retrospective cohort study included patients undergoing reconstructive breast surgery at a single centre between August 2017 and January 2024. Data on risk factors, including obesity, smoking status, age, diabetes mellitus, hypertension, preoperative haemoglobin levels, nutritional status, and preoperative use of immunosuppressants, chemotherapy, and targeted anticancer therapy eg: Herceptin were collected. Wound healing outcomes were classified using the breast reconstruction specific Clavien-Dindo classification. Relationships were evaluated using an ordered multivariate logistic regression.ResultsA total of 215 patients were included (mean age 51.4 ± 10.1 years). Preoperative therapies included chemotherapy (48.6%), radiotherapy (37.7%), oestrogen receptor blockers (15.5%), aromatase inhibitors (18.8%), and targeted anticancer drugs (15.6%). Obesity was identified as a strong predictor of higher-grade complications according to the Clavien-Dindo classification (OR = 3.17 [95% CI: 1.77–5.67], p < 0.001). Preoperative targeted anticancer drugs (OR = 0.36 [95% CI: 0.15–0.84], p = 0.018), nutrition scores (OR = 1.16 [95% CI: 1.04–1.30], p = 0.007), and immunosuppressant use (OR = 3.43 [95% CI: 1.01–10.90], p = 0.036) were also significant predictors of higher-grade complications (p<0.05) . The model was statistically significant (p = 0.0013).ConclusionsTargeted anticancer therapies, obesity, nutrition, and immunosuppressant use significantly influence wound complication severity. Preoperative optimisation and individualised risk stratification are crucial to reducing surgical wound complications. Future research should explore underlying mechanisms using ex vivo models and develop standardised wound reporting criteria for breast reconstruction
Gender in preschool
Get PDFA short form article aimed at Early Childhood practitioners which explored the impact gender stereotypes and norms have on children’s experiences within early childhood education
