11237 research outputs found
Sort by
Healthcare 4.0: the use of digital twins prototype for healthy living
No full textObjectives: The aim of this thesis is to design and validate a behaviour-aware Digital Twin (DT)framework for Type 2 Diabetes Mellitus (T2DM) prediction and prevention. Existing approaches are often constrained by an overreliance on biomarkers, limited integration of psychosocial and lifestyledeterminants, and insufficient causal interpretability or scalability across diverse populations.Methods: A three-decade bibliometric review (1991–2024) was undertaken to identify research trends and gaps in machine learning models for T2DM. Using UK Biobank data, survival models were developed with penalized Cox regression and enriched with causal inference techniques to simulate preventive interventions. A prototype offline DT was constructed that incorporated psychosocial and behavioural determinants. Neural network coherence and centrality analyses were conducted to explore bidirectional interactions between diet, sleep, stress, and psychological factors.Results: The bibliometric review revealed persistent gaps, including dataset homogeneity, poor integration of behavioural variables, and limited clinical translation. Penalized Cox regression models achieved strong predictive performance (C-index = 0.90). Psychosocial determinants such as loneliness, insomnia, and mental health history, along with dietary factors, emerged as significant predictors, with pronounced ethnic disparities in T2DM risk. The DT prototype allowed simulation of intervention effects, showing that improvements in sleep, diet, and mental health substantially reduced estimated hazards. Neural network based analyses uncovered cascading disruption chains, with stress leading to poor sleep and unhealthy diet, that precede metabolic decline and reframe T2DM as a systemic reorganization of behavioural networks.Conclusion: This thesis shifts T2DM research from reactive, biomarker-centric prediction toward holistic, interpretable, and preventive frameworks. By embedding psychosocial and behavioural determinants within a causally informed DT prototype, it advances early detection, personalized prevention, and scalable strategies with public health significance, particularly for diverse and resource limited populations.</p
Illustrating non-fiction: a practice-based exploration of visual and material strategies in non-fiction children's books
No full textThis practice-based investigation explores visual and material strategies used by illustrators to present and structure the information, organise the book’s content, and influence the perceived reliability of the depictions in non-fiction picturebooks. The study was motivated by a shift in the genre that resulted in the proliferation of visually-conceptualised books, and in an increased presence of the illustrator in their ideation and development.The methodological bricolage employed in the study enabled a combination of methods, at the core of which was creative practice. A review of primary literature led to the identification of visual strategies used in the genre, which were analysed in view of the degree of reliability they are perceived to convey by using the social semiotic concept of visual modality. Finding potential in introducing features from informational spaces into the book, four projects were developed through creative practice, exploring connections between non-fiction picturebooks and cabinets of curiosities, museums, and collections. Reflective processes were holistically applied through the research to reveal insights during making, and to extract conclusions from the findings.Through this study, I found that modality can be expressed through pictorial, design and material means in non-fiction picturebooks. While certain strategies risk conveying authoritarian implications, they can be reframed, resignified or contested through conceptual, visual and material approaches. This investigation thus highlighted the illustrator’s role in shaping the content of non-fiction picturebooks through their subjective voice, creative choices, and modality conveyed by the strategies employed.The investigation concluded that, given the convergence of the creative and the informational in non-fiction picturebooks, illustrators have the possibility of using visual and material means to communicate information, influence the perceived reliability of the depictions, reinforce the narrative, enhance the content, and generate alternative reading experiences. The picturebook can thereby offer great expressive potential for the illustrator to construct informational experiences by making use of the multimodal nature of this form.</p
It's not me, it's you: a creative inquiry into disruptive second-person narratives
No full textAcross a series of original stories, my writing explores the British class system and uses the mode of second-person in ways that are explored in the accompanying critical commentary. I seek to demonstrate that the second-person point-of-view offers writers of narrative short fiction an opportunity to disrupt conventional reading expectations.The twenty-four stories that make up the collection, It’s Not Me, It’s You, are all written in the second-person. My creative aim was to explore the possibilities of a second-person narrator over a series of short stories to ascertain how the address can be used to obtain effects that are not so readily available or possible in first- and third-person narratives. The stories include literary fiction, folk horror and ghost stories, as well as poetic prose. I sought to write stories that use the second-person mode of address to either ‘pull in’ the reader, or to ‘reach out’ to the reader by implicating them in the story through the double-address that ‘you’ performs as a speech act in text.Furthermore, I wanted to explore how contemporary writing can use the address to talk about class and erasure by implicating the reader in the narrative. What power do narrators possess, and how does this precisely manifest in second-person narration? The stories in this thesis experiment with how both the protagonist and reader are addressed and consider how class and identity are consistently challenged or erased.In the critical paper, I discuss my methodology and through a series of close readings of five contemporary short stories published between 2009 and 2020, I demonstrate how the mode is being adopted by what Brian Richardson (1994) calls ‘oppositional writers’ to explore the effects of dominant ideologies on those that are marginalized. The first two stories are by contemporary black writers who adopt the second-person pronoun to implicate the reader in events caused by globalization and the capitalist system. Next, I look at contemporary British short stories all published within the last five years that use a similar approach with the second-person address to focus on the class system within a global world.Finally, using Sandrine Sorlin’s six points of reference from her 2022 book, The Stylistics of You, I explore how these references work, and how they apply to my own collection. Sorlin’s schema will then be placed in wider critical contexts to examine class, using Louis Althusser’s conceptual framing of ideology via Repressive State Apparatus (RSA) and Ideological State Apparatus (ISA), how subjects are hailed by what he terms ‘appellation’. This critical approach will examine narrative power and its relationship to class. The thesis will conclude by demonstrating how the position and power of the reader is disrupted by the second-person and how that disruption manifests.</p
Wearable Electronic Monitoring of Vital Signs in Hospitalised Adults: A Nursing Focused Scoping Review of Clinical, Economic and Implementation Outcomes
No full textAim:
To map and synthesise evidence on wearable devices for continuous vital signs monitoring in adult hospital inpatients, focusing on clinical effectiveness, nursing perspectives, workflow impact, patient acceptance and experience and resource implications
Design: Scoping review
Review Methods: Joanna Briggs Institute methodology reported using PRISMA-ScR guidelines.
Data Sources: Six databases (CINAHL, MEDLINE, EMBASE, Scopus, Web of Science, Cochrane), Scite.ai, and hand searching for studies published between January 2015 and November 2025. Data were synthesised using reflexive thematic analysis.
Results: Sixty-seven studies from 19 countries were included. Four integrative themes were identified. 1. Enhancing clinical safety through continuous monitoring: wearable devices consistently enable earlier recognition of physiological deterioration; however, downstream outcomes such as length of stay and transfers to intensive care units were mixed and context dependent. 2. Transforming nursing practice and workflow integration highlighted improved situational awareness and potential efficiency gains, alongside challenges related to alarm overload, parallel documentation and implementation workload. 3. Patient experience of wearable monitoring: most patients reported reassurance and perceived safety, though experiences reflected a tension between monitoring as care and monitoring as surveillance; discomfort, anxiety, and privacy considerations were infrequently examined. 4. Economic and organisational consequences: potential system value was suggested through workforce efficiencies, but economic benefits were largely inferred, with infrastructure and training costs often underreported.
Conclusion: Wearable continuous monitoring technologies show clear potential to support nursing observations enabling improved early detection of deterioration. Realising these benefits depends on effective integration into workflows, robust governance, and sustained nursing leadership rather than technological capability alone. Significant evidence gaps remain regarding long-term outcomes, economic evaluation, and large-scale implementation.
Impact: Wearable monitoring can enhance patient safety and nursing practice but introduces new challenges related to alert management, data interpretation, equity, and system integration. Transformational nursing leadership is central to ensuring safe, ethical, and sustainable adoption.</p
Implications of ischaemic preconditioning at the ankle in people with diabetes
No full textIntroduction: In the UK, 4.6 million people are living with diabetes, resulting in serious health complications, including ~184 lower-limb amputations per week. Amputations typically stem from diabetic foot, associated with a 25% lifetime risk of ulceration, placing a long-term burden on healthcare services. The thesis aims to use ischaemic preconditioning (IPC), which involves alternating occlusion-reperfusion cycles, to improve foot health in people with diabetes. By applying IPC, there will be potential improvements in the microcirculation and endothelial function.Methods: Firstly, a systematic review investigated the existing evidence base for IPC and the associated physiological responses. Following ethical approval, four experimental studies were conducted using near-infrared spectroscopy (NIRS) as a proxy indicator of foot health. The first investigated the reliability of NIRS during three intra-session occlusions. The following two studies applied a four-week IPC intervention in a healthy population and people with diabetes. The final study explored the longitudinal monitoring of the foot over six months.Results: The systematic review highlighted few studies investigating reliability during lower limb IPC, with no relevant publications investigating the ankle. The reliability study successfully applied IPC at the ankle, showing good to excellent reliability in the NIRS variables. The four-week intervention demonstrated no changes in foot health in a healthy population. However, four weeks of IPC in people with diabetes significantly increased the maximum oxygen saturation, indicating improved foot oxygenation. Finally, the longitudinal study observed no changes over six months during the long-term monitoring of the foot.Conclusion: IPC combined with NIRS can both monitor and improve foot health in people with diabetes. This thesis explored a novel repeated ankle IPC intervention, offering an alternative approach for people with foot complications who are unable to exercise. Long-term, this has important clinical implications to potentially reduce complications and develop measures for detecting any deterioration in foot health.</p
A sustainable maritime supply chain framework: an overview for academics and practitioners
No full textMaritime transportation accounts for over 80% of global trade by volume, primarily due to its cost efficiency. As global supply chains evolve, sustainability has become a critical concern for the maritime sector. This study reviews the most relevant papers on maritime transportation, sustainable supply chains, and maritime supply chains (MSC), aiming to advance the field through the development of an integrated classification framework. The proposed framework systematically categorizes existing academic studies based on supply chain planning features, key maritime stakeholders, and sustainability dimensions. We begin by analyzing the MSC network, focusing on its structural components and interconnections, including ports, shipping companies, and maritime logistics providers. We then examine MSC planning problems, emphasizing decision-making and optimization challenges across three core dimensions: time horizon, product/service type, and geography. Subsequently, we explore the interactions among stakeholders, highlighting how their collaborative and competitive dynamics influence sustainability outcomes. The proposed framework enables a structured evaluation of maritime logistics sustainability, bridging the gap between regulatory requirements and practical industry applications. By addressing two key aspects: (1) a micro-level analysis of sustainability challenges, stakeholder interactions, and solution approaches, and (2) a critical discussion of key trends, research gaps, and future directions, this paper offers a practical roadmap for integrating sustainability into the maritime transportation sector. The insights provided are valuable for both academic research and industry practice.</p
An app-based behavioural support intervention promoting physical activity (APPROACH) in patients diagnosed with breast, prostate or colorectal cancer: protocol for a randomised controlled trial
No full textBackground: Strong evidence highlights that sufficient physical activity (PA) has multiple benefits for people living with and beyond cancer. However, many are not meeting PA recommendations. APPROACH is a trial of a theory-driven, app-based behavioral support intervention to promote brisk walking after breast, prostate, or colorectal cancer.Objective: The aim of this trial is to evaluate the efficacy and cost-effectiveness of the intervention.Methods: APPROACH is a multicenter, phase III, 2-armed, individually randomized controlled trial (N=472). We will recruit patients with localized breast, prostate, or colorectal cancer from hospitals in Yorkshire and surrounding areas in the North of England, United Kingdom, and randomize them 1:1 between the intervention and control arm (usual care). The intervention consists of an app designed for the general population to encourage brisk walking (NHS Active 10), supplemented with habit-based behavioral support, including 2 brief telephone or video calls, a leaflet, website, and walking planners. The primary endpoint is the difference between trial arms in the changes from baseline in activPAL-assessed average minutes of brisk walking (≥100 steps per minute) after 3 months.Demographic and medical characteristics will be collected through self-report and hospital records. Secondary outcomes (assessed at 0, 3, and 6 months) will be the other activPAL-assessed outcomes (brisk walking at 6 months, total steps, light PA, standing time, and sitting times, weekly metabolic equivalent of task), self-reported PA, and self-reported BMI and waist circumference. Patient-reported outcome measures of quality of life, fatigue, sleep, anxiety, depression, self-efficacy, habit strength for walking, and social support will also be collected. Interviews will explore experiences of receiving the intervention. We will use health economic modeling to estimate the cost-effectiveness of the intervention over a lifetime horizon.Results: The study was funded in June 2019. Trial recruitment commenced in November 2023 and is planned to be completed in 2025. As of December 2025, a total of 473 participants have been randomized. The publication of the main results is expected in autumn 2027 after all follow-up data collection and analysis are complete.Conclusions: Overall findings will determine the clinical and cost-effectiveness of the intervention for patients diagnosed with breast, prostate, or colorectal cancer. If successful, APPROACH provides a potential model of supportive care to increase PA among people living with and beyond cancer.Trial Registration: ISRCTN Registry ISRCTN14149329; https://www.isrctn.com/ISRCTN14149329International Registered Report Identifier (IRRID):DERR1-10.2196/77096</p
A global gap in autonomy assessment among older adults: a COSMIN systematic review
No full textAutonomy is increasingly recognised as the basis of healthy ageing and person-centred care; however, it remains under-represented in clinical assessments and policy. We systematically reviewed patient-reported outcome measures and clinician-reported outcome measures of autonomy in adults aged 60 years and older (older adults), following the consensus-based standards for the selection of health measurement instruments (COSMIN) methodology (PROSPERO CRD42025640772). Across 116 studies involving 861 338 older adults in 42 countries, 50 instruments were evaluated for structural validity, reliability, internal consistency, cross-cultural validity, and responsiveness. High-quality evidence supported structural validity in 29 instruments, internal consistency in 33, and test–retest reliability in 17, whereas content validity and responsiveness were often insufficient. 14 instruments met the COSMIN category A criteria (ie, instruments with sufficient content validity and at least low-quality evidence for sufficient internal consistency, indicating that they are reliable and suitable for recommendation) and were recommended for research and clinical use. Substantial gaps remain, particularly in cross-cultural validity and responsiveness of the tested instruments, highlighting the need for internationally aligned, culturally robust, and cocreated tools. Health authorities should adopt validated measures to assess autonomy, guide policy, and ensure equitable resource allocation.</p
Refining classification of complex agroforestry mosaic landscape from drone-based imagery: implications for landscape management and conservation
No full text1. Accurately and efficiently mapping landscape compositions is a conservation priority as natural habitats that are reservoirs of biodiversity are increasingly lost or modified. Globally, agroforestry is a rising sustainable land use type that benefits landowners and biodiversity, but these land-use land-cover (LULC) mosaics can be challenging to map due to the size and distribution of different patches of LULC, requiring improved methodologies to map these areas and refine landscape-based conservation management strategies. 2. We classified an agroforestry landscape in West Java, Indonesia, which includes the habitat of a Critically Endangered primate, the Javan slow loris (Nycticebus javanicus). We used object-based image analysis of high-resolution drone (DJI Phantom 4, 2.87 cm/px mean resolution) and satellite (PlanetLabs, 3 m resolution) imagery, comparing how the resulting classifications differ and impact classification of loris GPS waypoints. 3. Estimations of LULC types significantly differed between the classified drone and satellite imagery, affecting all habitat types. Compared to classifications from drone imagery, satellite imagery-based classifications overestimated forest-cover by an average of 18.81% and chayote (a local vining crop) by 16.02%, while underestimating non-chayote agriculture by 18.72%. Specific crop types were also classified from drone imagery that were impossible to classify using satellite imagery. 4. Image classification differences are reflected in significantly different classifications of loris GPS waypoints, with an overestimation of the amount of waypoints in forest and chayote, and underestimation of waypoints in non-chayote agriculture. 5. Synthesis and applications: Together, these results show that significant differences in landscape classification between high-resolution satellite and drone imagery can substantially change our understanding of slow loris habitat availability. Thus, it can be beneficial to use the highest resolution imagery to characterize species’ habitats, whenever possible, particularly within mosaic landscapes. Additionally, image and map resolution should be explicitly reported. Less accurate area estimations of LULC types, particularly for forest and agriculture, directly impact conservation planning because species persistence may rely on these habitat patches and restoration of connectivity between them. Changes to forest and agriculture LULC can reflect the socioeconomic processes driving landscape changes.</p
Addressing fragmentation in cardiac arrest survivorship research: the Cardiac Arrest Research Hub
No full textThe 2025 European Resuscitation Council “Systems Saving Lives” guidelines and their updated Chain of Survival explicitly recognise the importance of survivorship. They emphasise the long-term process of recovery and focus on improving the quality of life for survivors and their supporters. Yet, there are many challenges to implementing these recommendations. Surviving a cardiac arrest is still relatively rare, with diverse consequences requiring multidisciplinary input via different health and third sector services.</p
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! 👇