11237 research outputs found
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Exploring Staff Perceptions of the Management of Clinical Trials and Its Impact on Enhancing Health Service Delivery
No full textThe role of clinical trials cannot be ignored due to its contribution to innovative treatment, therapies, and drug development in promoting quality service delivery. We investigated and explored the management aspect of clinical trials and its impact on health?care service delivery within the NHS. A qualitative methodology with an interpretivism approach was adopted to collect data from nine participants using a purposive sampling method in the management of clinical trials at the NHS. A semi-structured interview with open-ended questions and probing techniques conducted via Microsoft Teams was used as a data collection tool. The collected data were thematically analysed with the support of NVivo 14 software. The staffs’ perceptions were somewhat effective and highlights required improvement for better performance regarding clinical trial management at the NHS setting. The findings represent improved patient outcomes, increasing evidence-based decision making, and the development of innovative therapies and research infrastructure could be some positive impacts of the effective management of clinical trials. However, the findings show that improvement in stakeholder collaboration and communication is vital to combat the existing challenges such as regulatory hurdles and issues in partici?pant recruitment, retention, and communication. The findings provide practical values and insight into the staff working in the management of clinical trial processes and the audiences relevant to this field. A comprehensive understanding of the proactive measures and factors that are essential for the improvement of clinical trial management has been interpreted. In the hospital’s settings, supervision and improvement of clinical trials are necessary to promote innovative therapies, research infrastructure, and quality patient care and service delivery.</p
Developing sustainable knowledge partnerships: Joining the DOTS between inter-organisational research
No full textCommissioned research projects are commonplace in the UK between National Health Service (NHS) Trusts and universities to advance knowledge and inform practice. However, establishing sustainable research relationships between such differing and large organisations is seldom considered. This position paper describes our experience of developing and sustaining such a relationship. By detailing how we, as academics and NHS leaders, experienced our participation in leading and doing the research, we developed a shared understanding of why our collaboration is effective. From our reflections, we developed DOTS: Deciding together, Optimising outcomes, Time to get to know one another and Sharing knowledge and skills. This paper details how we worked through inter-organisational complexity by applying DOTS. The time taken to apply DOTS across inter-organisational contexts can develop team efficiency and enhance its effectiveness. DOTS provides a framework to enrich professional relationships and informs cooperative conversations, leading to agreed action. Our intention is to share our experience to inspire, stimulate and inform academic and practice-based colleagues to work together to produce high-quality and sustainable knowledge partnerships.</p
Letter to the Editor RE ‘Lid wiper epitheliopathy: topical review of current identification strategies and future perspectives’
No full textDear Editor, We read with interest the recent article by Arvind et al [1] which presents a topical review of current identification strategies for lid wiper epitheliopathy (LWE) and future perspectives. We agree with the authors that an up-to-date overview on this topic is relevant since developments in LWE identification and grading have been proposed since a previous extensive review on this topic...</p
Primary hepatic neuroendocrine carcinoma associated with carcinoid syndrome and pellagra: a case report
No full textCarcinoid tumours are slow-growing neuroendocrine neoplasms mainly affecting the gastrointestinal tract, the respiratory tree, ovaries and kidneys. Approximately 20% of patients with carcinoid tumour are affected by carcinoid syndrome, characterised by chronic diarrhoea and/or flushing in the presence of systemically elevated levels of specific markers as serotonin or 5-hydroxyindolacetic acid. Skin manifestations include flushing of the face, neck and anterior surface of the chest but after repeated and prolonged relapses, the skin lesions become fixed, acquiring a bluish-red tint with telangiectasias. Patients may also develop pellagra skin symptoms including erythema, xerosis, scaling, hyperkeratosis and pigmentation, caused by a deficiency of tryptophan, due to its high consumption for serotonin synthesis.</p
Fanning the flame - a process-relational view on creative hub practices for rural development
No full textWhile there is growing evidence of the possible socio-economic contributions of creative hubs, how these contributions are achieved is underresearched. The research question ‘how can creative hubs become entrepreneurial anchor organisations for rural development’ is answered through making visible the internal workings of a UK rural creative hub. Applying the conceptual lens of entrepreneurial placemaking, the research investigates the interplay of agency, places and contexts, drawing on socio-materiality to demonstrate how entrepreneurial activities are enacted in rural creative hubs and contribute to rural development. Our research applied ethnographic methods to capture entrepreneurial practices from the perspective of studio holders in a rural creative hub, Artistheaven. We identify four subsets of entrepreneurial practices – event making, exhibiting, shelving, crafting – that constitute ‘rural creative hub-bing’, the label for the complex set of practices realizing the becoming of the creative hub. The study extends the entrepreneurial placemaking literature by making visible the ways in which agents draw on socio-materiality to enact temporary entrepreneurial places in rural settings, thus, contributing to the rural entrepreneurship literature. Policy implications discuss the relevance of creative hub management and pro-active local and regional government action for rural development. The article contributes to rural entrepreneurship and entrepreneurship-as-practice conversations.</p
Realism and the specificity of stop-motion puppet animation aesthetics in Wes Anderson's Fantastic Mr Fox
No full textThis thesis offers a new perspective on the question of realism in animation by scrutinizing the behaviour of physical materials in Wes Anderson’s animations, particularly Fantastic Mr. Fox (2009). It challenges orthodox definitions of realism in animation, mainly associated with verisimilitude, and contributes to the current body of animation studies, filling a gap in the theory of puppet animation. The thesis seeks realism in the specificities of traditional puppet animation, the implications of its use of physical textures and a handmade production process. It argues that the mode of puppet animation that Anderson employs establishes a relationship to the real world through its use of materials that constantly refer viewers to the physical world and their daily life experiences.Fantastic Mr. Fox relates to the aesthetics of stop-motion puppet animation that have been used historically in films including King Kong (Merian C. Cooper and Ernest B. Schoedsack, 1933) and The Tale of the Fox (Ladislaw Starewicz, 1937) as well as recent independent animations such as Peter and the Wolf (Suzie Templeton, 2006) and A Love Story (Anushka Naanayakkara, 2016). Fantastic Mr. Fox is unique among contemporary feature-length films because it counters the tendency to create self-sufficient worlds that conceal any reference to their means of production. Laika’s animations, such as Kubo and the Two Strings (Travis Knight, 2016) and Missing Link (Chris Butler, 2019), are representative of that trend.In addition to providing a close analysis of key scene and sequences from key films, this research employs a range of concepts and theories from animation and cinema studies to support its arguments, including Paul Wells’s concept of hyper-realism and Siegfried Kracauer’s film theory which suggest that animation is not capable of representing the real world. However, this thesis shows how their theories, and others, actually support the affinity between animation and realism by looking at the question of realism from a different angle. In order to establish the new perspective on the discussion of realism in stop-motion puppet animation, this research also develops a new terminology such as “arbitrary motion”.</p
Epicardial and microvascular coronary physiological assessment using guidewire and angiography-derived indices
No full textCoronary microvascular dysfunction (CMD) impairs the coronary microvasculature's ability to adapt flow to myocardial oxygen demands, leading to adverse symptoms and outcomes. Despite its clinical significance, CMD quantification in the cardiac catheterisation laboratory remains underexplored, particularly novel methods such as continuous thermodilution, and angiography-derived analysis. This thesis investigates novel CMD assessment methods, namely continuous thermodilution in acute (ACS) and chronic coronary syndromes (CCS), and develops novel angiography-derived methods of assessing CMD. First, a comparative analysis of bolus and continuous thermodilution was conducted, assessing their diagnostic agreements as binary classification tools in ACS and CCS. Second, a novel angiography-derived method of deriving a vasodilatory reserve ratio was investigated and validated against continuous thermodilution. Lastly, a novel method of interpreting continuous thermodilution was developed, with the intention of improving reproducibility and interpretability. Key findings include significant diagnostic disagreement between bolus and continuous thermodilution in revascularised ACS and CCS patients, suggesting that pre-existing cut-off points should not be used interchangeably for the two methods. Second, a novel angiography derived Coronary Flow Reserve CFR demonstrated promising "rule-in" utility for CMD detection, despite moderate negative predictive value. Finally, prolonged trace-averaging approaches in continuous thermodilution had a neutral effect on reproducibility, however, had a negative impact on diagnostic accuracy.The three studies in this thesis are the first demonstrations of three new findings. First, bolus and continuous thermodilution have poor correlations and diagnostic agreements in revascularised coronary syndromes. Second, angiogram derived coronary flow velocity can be used to derive a vasodilatory reserve ratio for the detection of CMD; however it has modest negative predictive value. Lastly, prolonged trace-averaging of continuous thermodilution traces is feasible, however does not improve reproducibility.</p
Designing Under Extreme Resource Constraints: How practicing Distributed Realities in Afghanistan can shape the future of Distributed Design
No full textThe concept of designing under extreme resource constraints (both physical and psychological constraints) has become increasingly relevant in an era of local and global uncertainty, where geographically isolated, politically volatile, socially complex societies demand adaptability, serious design, contextual and responsible thinking and making. These connected forms of global challenges can be referred to as distributed realities: urban conditions that are dispersed across spatial, temporal, and cultural dimensions, which require holistic thinking and interconnected engagement by committed and dedicated people across a dynamic range of locally networked yet distributed forms of knowledge and decision-making. While the existing concept of Distributed Design positions creative skills and the making approach close to communities of knowledge and practice and points of demand, practicing it in extremely resource-constrained regions such as Afghanistan requires a comprehensive [holistic] approach influenced by the different types of realities found on the ground. This enhanced form of Distributed Design [proposed in this article] aims to increase the resilience of local businesses and small-scale production through a larger and more connected form of interface with communities of shared identity and the wider society to deliver design outcomes that are culturally appropriate and seamlessly integrated with traditional craftsmanship and small enterprises.</p
Risk factors of late intraocular Lens displacement: A multi-national study
No full textPurpose
To examine potential risk factors of late intraocular lens displacement (LIOLD); a rare complication of cataract surgery believed to be due to progressive zonular insufficiency which is often managed with pars plana vitrectomy (PPV) and intraocular lens (IOL) exchange.
Setting
16 centers across the UK, Germany and Greece
Design
Retrospective case control study
Methods
Cases of LIOLD occurring between June 2018 and January 2023 were identified. Demographics, biometry data, previous medical and ocular history were interrogated and multivariate logistic regression was performed.
Results
434 eyes experiencing LIOLD were identified. 20,321 eyes not experiencing LIOLD during the same period formed the control group. Following multivariate analysis, YAG capsulotomy (OR 17.17, 95% CI 12.44–23.70,
p
< 0.001), pseudoexfoliation (OR 15.63, 95% CI 10.78–22.64,
p
< 0.001), complicated cataract surgery (OR 17.60, 95% CI 12.94–23.95,
p
< 0.001), previous PPV (OR 4.86, 95% CI 3.50–6.75,
p
< 0.001), younger age at cataract surgery (OR 0.94, 95% CI 0.93–0.95,
p
< 0.001) and axial myopia (OR 1.16, 95% CI 1.09–1.24,
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< 0.001) were identified as risk factors. Female sex was associated with reduced risk (OR 0.64, 95% CI 0.51–0.80,
p
< 0.001). Patients having cataract surgery under 60 years had an increased risk (40 years OR 2.90, 30 years OR 4.92).
Conclusion
Risk factors are known to vary by geographical location and our study being the first multinational study provides a significant contribution. Future studies may look at prevention for at-risk individuals and compare outcomes of different IOL fixation techniques.</p
Co-administration of curcumin forms with supplemental iron: a study of effects on iron absorption and intestinal cellular health
No full textIron deficiency (ID) and iron deficiency anaemia (IDA) are significant global public health issues, with their main line of treatment being oral iron supplementation that often leads to gastrointestinal (GI) adverse effects and early discontinuation. Strategies to improve the efficiency of oral iron supplements and to ameliorate their associated GI effects could help resolve ID and IDA. Curcumin, a potent antioxidant and anti-inflammatory, iron chelating compound from turmeric may mitigate some of these issues. This study aimed to mechanistically assess the interaction of iron (20 and 100 μM) with two different forms of curcumin – native, unformulated curcumin versus a formulated curcumin (HydroCurc®) at 5, 10 and 20 μM, and the consequent effects on iron uptake and intestinal cellular health. Presence of formulated curcumin incremented ferritin levels by 160.5% versus free iron treatment alone (p < 0.0001) in intestinal Caco-2 cells. A greater ferric iron reducing power by the formulated curcumin was observed (p < 0.001). Formulated curcumin also protected against iron-induced permeability of the intestinal barrier (p < 0.05). Our data points to formulated curcumin's ability to limit oxidation of divalent iron as a possible mechanism to explain the greater iron uptake by intestinal cells. This study characterises for the first time the distinct interaction behaviour of curcumin forms with iron and the potential consequences on iron uptake and intestinal health, providing novel insights that may help optimise therapeutic approaches to tackle ID and IDA.</p
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