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Conceptualizing the public good for genomics in the global South: a cross-disciplinary roundtable dialogue
No full textSince the Human Genome Project, initiatives to genetically sequence and profile populations around the world have expanded rapidly. The rationales guiding this expansion are diverse: on the one hand, the concentration of genetic technologies in the global North threatens to widen the yawning gaps in healthcare available in advanced versus developing nations. On the other, more ‘genetic diversity’ in global databases can reveal new points of genetic variation associated with health or disease. This promises to pave the way to a more personalized medicine of the future—more powerful and prosperous, with tailored prevention regimens and genetic treatments targeted to every individual’s specific genetic vulnerabilities. These rationales are advanced to claim a public good case for genomics. However, the expansion of genomics to underserved populations in the global South has provoked many sociopolitical and ethical challenges. Critics have pointed to the inevitable entanglement of genomics with private commercial interests. These concerns are overlaid on deeper anxieties stemming from global asymmetries in scientific and technological power, and historical patterns of value extraction from colonized and marginalized populations. How then do we disentangle the public good? How do we build a genomics science that is just and equitable for the vast majority of the world? This conversation convenes leading genomics practitioners and critical science studies scholars to address these questions. We draw on an ongoing transdisciplinary dialogue, integrating the natural and social sciences, and bring together perspectives and scholars from the global North and South. Our aim is to cultivate a more holistic and grounded engagement with the scientific and political challenges we face, to truly understand the requirements of a genomics that centers the question of justice.</p
A systematic review of robotic colorectal surgery programs worldwide and a comprehensive description of local robotic training programme
No full textAbstract
Background
Robotic-assisted colorectal surgery (RACS) is gaining widespread adoption, with a growing number of procedures performed globally. These have been performed mostly by consultants, many of whom have gained sufficient proficiency to begin to educate their trainees. RACS offers a range of benefits to the surgeon and patient, yet safe and effective utilisation hinges on well-structured training programs for colorectal trainees within their general surgery residency. This systematic review aimed to evaluate the structure currently employed worldwide in RACS training programs for colorectal surgery trainees. In addition it delineates the conceptualization and implementation of a locally developed RACS program tailored to senior colorectal trainees and fellows at our Trust.
Methods
A comprehensive search of Ovid Medline and Embase databases (January 2010- March 2024) following PRISMA guidelines identified six studies reporting on RACS training curricula. Critical analysis of programme structure and curricula tools utilised was performed. Articles involving training of consultants were excluded. The quality and bias score of each study were assessed using the Newcastle Ottawa Score for observational studies.
Results
Six out of 77 studies were selected as suitable for analysis describing RACS training using Da Vinci platform. All apart from one programme described a phased or parallel robotic curriculum with four studies incorporating theoretical knowledge and laboratory or cadaveric training. Six programmes incorporated simulation, bedside assisting and console training. The use of validated objective or subjective metrics at each phase varied. Formal feedback is provided in only two of the programmes. Reflecting on above results we present our Trust training program which run over the last two years. Our program ensures clear learning goals for trainees and trainers, maintains patient safety, and is easily replicated across other UK RACS units.
Conclusion
The establishment of a standardised curriculum for colorectal surgery training worldwide, including in the UK, is vital. Currently, there is a scarcity of validated, objective assessment methods, which must be adequately standardised to create consistent progression criteria and competency-based metrics. Standardising these methods will enable reliable and robust assessment of trainee progression and competence to create a generation of robotically competent colorectal surgeons within their standard training program timeframe.
PROSPERO database registration
No.-CRD42024530340.</p
Resampling Imbalanced Healthcare Data for Predictive Modelling
No full textImbalanced datasets pose significant challenges in healthcare for developing accurate predictive models in medical diagnostics. In this work, we explore the effectiveness of combining resampling methods with machine learning algorithms to enhance prediction accuracy for imbalanced heart and lung disease datasets. Specifically, we integrate undersampling techniques such as Edited Nearest Neighbours (ENN) and Instance Hardness Threshold (IHT) with oversampling methods like Random Oversampling (RO), Synthetic Minority Oversampling Technique (SMOTE), and Adaptive Synthetic Sampling (ADASYN). These resampling strategies are paired with classifiers including Decision Trees (DT), Random Forests (RF), K-Nearest Neighbours (KNN), and Support Vector Machines (SVM). Model performance is evaluated using accuracy, precision, recall, F1 score, and the Area Under the Curve (AUC). Our results show that tailored resampling significantly boosts machine learning model performance in healthcare settings. Notably, SVM with ENN undersampling markedly improves accuracy for lung cancer predictions, while SVM and RF with IHT achieve higher validation accuracies for both diseases. Random oversampling shows variable effectiveness across datasets, whereas SMOTE and ADASYN consistently enhance accuracy. This study underscores the value of integrating strategic resampling with machine learning to improve predictive reliability for imbalanced healthcare data.</p
Introduction and assessment of the thematic hierarchy process method for prioritisation of requirements for software product lines
No full textThis paper introduces a novel prioritisation method, the Thematic Hierarchy Process, designed to work with software release cycles in a matrix product development organisation with software product lines and multiple business lines. Three challenges are identified for prioritisation of requirements for software product lines with multiple business lines: scale, complexity and stakeholder discordance. The paper reviews current prioritisation methods and assesses their application to software product lines with multiple business lines with respect to these three challenges, and concludes that none of the existing methods can satisfactorily address all of them. In this paper we define the Thematic Hierarchy Process method, and provide a framework that can be applied by software product managers and researchers to their own software releases and requirements data. The Thematic Hierarchy Process was assessed using requirements data from Company A demonstrating strong alignment with real software release cycles, as shown by the high similarity scores of 0.87 and 0.91 in predicting release contents. Interviews carried out with domain experts to evaluate the Thematic Hierarchy Process to supplement the assessments also showed positive results. We conclude that the Thematic Hierarchy Process can satisfy the prioritisation challenges of scale, complexity and stakeholder discordance with software product lines with multiple business lines.</p
'Keeping us Warm': Trainee Teachers' Perspectives on School to University Transition Activities
No full textThe aim of this study was to capture student perspectives on the range of activities they were invited to take part in as part of their transition to university for the first new teacher training degree written in England for 30 years. As part of the design of this new BEd, significant attention was paid to the design of a range of activities to ensure students were well prepared to begin their teacher training. These were designed from the point of offer following a face-to-face interview to the point of enrolment. This study explores the evidence base of the activities chosen (Ball et al., 2024) including in person events, online webinars, pre-arrival questionnaires and 1:1 support sessions as well as the specifics of their design and implementation for the cohort of prospective teachers. It uses student feedback to consider the following questions:1. How did the pre-course activities (from interview to enrolment) affect student transition from school to university?2. Which pre-course activities were most effective in supporting student transition from school to university? Using a mixed method study, trainees provided feedback on the impact of these activities using a questionnaire and three focus groups (one per campus of delivery). The data collected was then synthesised and analysed using thematic analysis (Clarke & Braun, 2017) to elicit the findings. Results indicated that trainees valued opportunities for face-to-face interactions to establish the initial social bonds (for example following an on-campus applicant day a group engaged in social activities including sharing a meal together) and opportunities to engage with lecturers and key staff who would be supporting them on their journey as teachers. Less valued were central university activities that were not personalised to their course or prior experiences. As a result of the research the activities will be amended for the second cohort of students, reflecting the suggestion and feedback of the first group and the learning from their findings.</p
Understanding the relationship of sleep-related problems with positive affect and negative affect in young people: insights from the EHDLA study
No full textBackground: The prevalence of sleep-related problems in adolescents has been recognized as a public health issue. Research on how specific sleep-related problems may be related to mood and affect variations in this age group is scarce. Therefore, the current study aims to explore the relationships between sleep-related problems and positive and negative affect in a sample of Spanish adolescents.Methods: The present study uses a cross-sectional design based on secondary data collected in the Eating Healthy and Daily Life Activities (EHDLA) study. The sample consisted of 645 Spanish adolescents (Median age = 14.0) attending secondary schools in the Valle de Ricote in the Region of Murcia (Spain) during the 2021 and 2022 academic years. The BEARS (B = bedtime issues, E = excessive daytime sleepiness, A = night awakenings, R = regularity and duration of sleep, and S = snoring) sleep screening tool was used to assess sleep-related problems, whereas the Positive and Negative Affect Schedule 10-Children (PANAS-C10) was used to examine positive and negative affect.Results: The findings show that the presence of sleep-related problems is associated with a lower positive affect score and a greater negative affect score. Specifically, the presence of bedtime problems (unstandardized beta coefficient [B] = −2.82; 95 % confidence interval [CI] −3.77 to −1.86; p Conclusions: The presence of sleep-related problems and their increased frequency are associated with lower positive affect, whereas having these problems and experiencing multiple problems simultaneously are linked to greater negative affect. Future research should explore specific sleep-related problems and their potential impact on different health-related outcomes in this age group while considering other covariates or confounding variables. Public health efforts should be aimed at providing education on sleep and promoting sleep hygiene, improving the health of adolescents and young adults.</p
Communicating risk of dementia: a scoping review
No full textBackground: Dementia is a syndrome characterised by progressive cognitive and functional decline arising from a neurodegenerative disease. Genetic testing, imaging and fluid biomarkers mean that levels of risk of dementia diagnosis are becoming frequent and complex. How risk is communicated in this context is an increasingly important topic.Aims: The aim of this scoping review is to map the existing literature regarding the components of risk communication, the factors influencing its outcomes and the guidelines developed to support clinicians in this process.Methods: This is a systematic scoping review addressing the communication of risk to individuals living with or at risk of dementia, as well as perspectives of family, carers and healthcare professionals.Results: 115 articles were identified, including genetic (n=41), amyloid (n=45) and other biomarkers (n=9). Patients expressed a desire to be informed about their risk of developing dementia, listing future planning and participation in clinical research as benefits of disclosure. While risk disclosure did not significantly impact anxiety or depression, it was associated with increased event distress among participants identified as elevated risk. Individuals at high risk frequently overestimated their likelihood of developing dementia. Tools and guidelines that have supported clinicians in risk disclosure emphasised the use of educational materials, clear communication about risk and prognosis, and regular follow-up appointments. Gaps in literature include blood biomarkers, non-Alzheimer’s disease dementias and communication to people with cognitive impairment.Conclusions: Risk communication is a crucial topic for healthcare professionals, especially since the emergence of novel techniques to predict dementia.</p
A multimodal predictive model for chronic kidney disease and its association with vascular complication in patients with type 2 diabetes: model development and validation study in South Korea and the UK
No full textObjective: To develop a multimodal model to predict chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM), given the limited research on this integrative approach.Research Design and Methods: We obtained multimodal data sets from Kyung Hee University Medical Center (n = 7,028; discovery cohort) for training and internal validation and UK Biobank (n = 1,544; validation cohort) for external validation. CKD was defined based on ICD-9 and ICD-10 codes and/or estimated glomerular filtration rate (eGFR) ≤60 mL/min/1.73 m2. We ensembled various deep learning models and interpreted their predictions using explainable artificial intelligence (AI) methods, including shapley additive explanations (SHAP) and gradient-weighted class activation mapping (Grad-CAM). Subsequently, we investigated the potential association between the model probability and vascular complications.Results: The multimodal model, which ensembles visual geometry group 16 and deep neural network, presented high performance in predicting CKD, with area under the receiver operating characteristic curve of 0.880 (95% CI, 0.806–0.954) in the discovery cohort and 0.722 in the validation cohort. SHAP and Grad-CAM highlighted key predictors, including eGFR and optic disc, respectively. The model probability was associated with an increased risk of macrovascular complications (tertile 1 [T1]: adjusted hazard ratio, 1.42 [95% CI, 1.06–1.90]; T2: 1.59 [1.17–2.16]; T3: 1.64 [1.20–2.26]) and microvascular complications (T3: 1.30 [1.02–1.67]).Conclusions: Our multimodal AI model integrates fundus images and clinical data from binational cohorts to predict the risk of new-onset CKD within 5 years and associated vascular complications in patients with T2DM.</p
Global, regional, and national prevalence of child and adolescent overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021
No full textBackgroundDespite the well documented consequences of obesity during childhood and adolescence and future risks of excess body mass on non-communicable diseases in adulthood, coordinated global action on excess body mass in early life is still insufficient. Inconsistent measurement and reporting are a barrier to specific targets, resource allocation, and interventions. In this Article we report current estimates of overweight and obesity across childhood and adolescence, progress over time, and forecasts to inform specific actions.MethodsUsing established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021, we modelled overweight and obesity across childhood and adolescence from 1990 to 2021, and then forecasted to 2050. Primary data for our models included 1321 unique measured and self-reported anthropometric data sources from 180 countries and territories from survey microdata, reports, and published literature. These data were used to estimate age-standardised global, regional, and national overweight prevalence and obesity prevalence (separately) for children and young adolescents (aged 5–14 years, typically in school and cared for by child health services) and older adolescents (aged 15–24 years, increasingly out of school and cared for by adult services) by sex for 204 countries and territories from 1990 to 2021. Prevalence estimates from 1990 to 2021 were generated using spatiotemporal Gaussian process regression models, which leveraged temporal and spatial correlation in epidemiological trends to ensure comparability of results across time and geography. Prevalence forecasts from 2022 to 2050 were generated using a generalised ensemble modelling approach assuming continuation of current trends. For every age-sex-location population across time (1990–2050), we estimated obesity (vs overweight) predominance using the log ratio of obesity percentage to overweight percentage.FindingsBetween 1990 and 2021, the combined prevalence of overweight and obesity in children and adolescents doubled, and that of obesity alone tripled. By 2021, 93·1 million (95% uncertainty interval 89·6–96·6) individuals aged 5–14 years and 80·6 million (78·2–83·3) aged 15–24 years had obesity. At the super-region level in 2021, the prevalence of overweight and of obesity was highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and the greatest increase from 1990 to 2021 was seen in southeast Asia, east Asia, and Oceania (eg, Taiwan [province of China], Maldives, and China). By 2021, for females in both age groups, many countries in Australasia (eg, Australia) and in high-income North America (eg, Canada) had already transitioned to obesity predominance, as had males and females in a number of countries in north Africa and the Middle East (eg, United Arab Emirates and Qatar) and Oceania (eg, Cook Islands and American Samoa). From 2022 to 2050, global increases in overweight (not obesity) prevalence are forecasted to stabilise, yet the increase in the absolute proportion of the global population with obesity is forecasted to be greater than between 1990 and 2021, with substantial increases forecast between 2022 and 2030, which continue between 2031 and 2050. By 2050, super-region obesity prevalence is forecasted to remain highest in north Africa and the Middle East (eg, United Arab Emirates and Kuwait), and forecasted increases in obesity are still expected to be largest across southeast Asia, east Asia, and Oceania (eg, Timor-Leste and North Korea), but also in south Asia (eg, Nepal and Bangladesh). Compared with those aged 15–24 years, in most super-regions (except Latin America and the Caribbean and the high-income super-region) a greater proportion of those aged 5–14 years are forecasted to have obesity than overweight by 2050. Globally, 15·6% (12·7–17·2) of those aged 5–14 years are forecasted to have obesity by 2050 (186 million [141–221]), compared with 14·2% (11·4–15·7) of those aged 15–24 years (175 million [136–203]). We forecasted that by 2050, there will be more young males (aged 5–14 years) living with obesity (16·5% [13·3–18·3]) than overweight (12·9% [12·2–13·6]); while for females (aged 5–24 years) and older males (aged 15–24 years), overweight will remain more prevalent than obesity. At a regional level, the following populations are forecast to have transitioned to obesity (vs overweight) predominance before 2041–50: children and adolescents (males and females aged 5–24 years) in north Africa and the Middle East and Tropical Latin America; males aged 5–14 years in east Asia, central and southern sub-Saharan Africa, and central Latin America; females aged 5–14 years in Australasia; females aged 15–24 years in Australasia, high-income North America, and southern sub-Saharan Africa; and males aged 15–24 years in high-income North America.InterpretationBoth overweight and obesity increased substantially in every world region between 1990 and 2021, suggesting that current approaches to curbing increases in overweight and obesity have failed a generation of children and adolescents. Beyond 2021, overweight during childhood and adolescence is forecast to stabilise due to further increases in the population who have obesity. Increases in obesity are expected to continue for all populations in all world regions. Because substantial change is forecasted to occur between 2022 and 2030, immediate actions are needed to address this public health crisis.</p
Determinants of public support for vigilantism in pre-war and wartime Ukraine
No full textThis study contributes to the field of ‘conflict policing’ by discussing police legitimacy and the public perception of vigilantism in wartime Ukraine. Employing a cross-sectional sample (N = 15,127) of the residents of the Kharkiv region of Ukraine, we test Bottoms and Tankebe’s (2012) police legitimacy model and analyse the determinants of public support for vigilantism in pre-war and wartime Ukraine. Our results show that the Bottoms–Tankebe model proves adequate for both time periods. Our study shows that the impact of the war has led to an increase in support for vigilantism and that a higher level of support for vigilantism has been positively associated with the perception of police fairness. Policing during conflict requires a strong presence in terms of officers and may indicate a double standard amongst the general public regarding police corruption in the sense of making it seem more understandable.</p
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