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Randomised controlled community trial assessing efficacy of the AWACAN-ED public toolkit to improve cancer symptom awareness and intention to seek help in South Africa and Zimbabwe: study protocol.
Get PDFINTRODUCTION: Despite the benefits of early diagnosis, most cancers in sub-Saharan African (SSA) countries are diagnosed at an advanced stage due to late presentation of symptoms, inadequate referral systems and poor diagnostic capacity. Health communication interventions have been used extensively in high-income countries to increase people's awareness of cancer symptoms and encourage timely help-seeking. However, in SSA, there is still limited evidence on the effectiveness of these interventions and existing evaluations are mainly focused on communicable diseases rather than cancer. METHODS AND ANALYSIS: A randomised, multisite, controlled community trial will evaluate a culturally tailored health infographic toolkit delivered in rural and urban settings in the Western Cape Province in South Africa and Harare and surrounding provinces in Zimbabwe. Participants will be randomised to receive one of three African aWAreness of CANcer and Early Diagnosis (AWACAN-ED) cancer awareness tools, coproduced with local communities, comprising health communication infographics with descriptions of breast, cervical and colorectal cancer symptoms plus messages to encourage consultation with primary care providers if symptoms occur, all presented in English and four local languages. We will recruit 144 participants in each of the three intervention groups (N=432). The primary outcome will be recall of symptoms and the secondary outcomes will be (1) intention to seek help, (2) emotional impact and (3) acceptability of the toolkit. Outcomes will be measured preintervention and at two points postintervention: after 15 min and 1 month. ETHICS AND DISSEMINATION: Ethical approval was obtained in both participating countries, South Africa (148/2025) and Zimbabwe (363/2021). All participants will be required to provide written informed consent prior to participation. Findings will be disseminated through peer-reviewed publications, conference presentations and the AWACAN-ED programme website. TRIAL REGISTRATION NUMBER: PACTR202505475803308
Experience of NHS diagnostic investigation following a multi-cancer early detection (MCED) screening test: qualitative interviews with NHS-Galleri trial participants who had a cancer signal detected
Get PDFVivien Leigh’s Voice: A Quantitative Analysis Methodology
No full textIn the field of Film Studies there has been some research into the critical analysis of film acting, but not enough, with the vast majority focused on an actor’s physical movements of face and body. Beyond using broad brushstrokes of adjectives - such as louder, softer, shouting, whispering, mumbling - within anecdotal and impressionistic descriptions, no known empirical research has focused on interrogating the contribution that vocal performance makes to an actor’s characterisation. The aim of this thesis is to propose a methodological framework to analyse the subtleties and nuances of an actor’s vocal performance. Developments in the field of Speech Analysis mean it is now possible to extract the exact data relating to pitch (Hz), sound-power (dB) and rate of articulation, for every line, utterance, word and syllable that is heard on a film’s soundtrack. Using Vivien Leigh, the two-time Academy Award winning actor, as a case study, this thesis seeks to obtain the data that will test this methodology and address the research gap within vocal performance analysis. The data generated will be used to examine Leigh’s voice and vocal performances: an overview of her voice changed across her thirty-year career; by examining how Leigh created her characterisation through her developing vocal ability in her early British films; and; how she altered her vocal delivery to express character arc and development. The findings of this thesis provide solid evidence for the inclusion of this methodology in the area of vocal performance analysis within Film Studies
Continuing use of e‐cigarettes after stopping smoking and relapse: Secondary analysis of a large randomised controlled trial
Get PDFAbstract Background and aims Smokers quitting successfully with the help of e‐cigarettes often continue vaping. It is not known whether this promotes or prevents relapse back to smoking. This study aimed to determine whether use of e‐cigarettes after successful smoking cessation affects the probability of relapse later on. Design Secondary analysis of a randomised controlled trial where participants received combination nicotine replacement therapy (NRT) or e‐cigarettes to compare relapse rates in the two study arms and in abstainers who did and did not use e‐cigarettes. Setting Four stop‐smoking services in the United Kingdom. Participants 886 smokers (median age 41, smoking on average 15 cigarettes per day, 48% female) seeking help with stopping smoking. Measurements Main outcome was relapse to smoking by 12 months in participants who were abstinent at 4 weeks or at 6 months. Relapse was defined as abstinence at 4 weeks but not at one year or abstinence at 6 months but not at one year. Abstinence from smoking was defined as no smoking over the past 7 days. E‐cigarette use was defined as using e‐cigarettes at the time of abstinence on at least one day per week. Findings Abstainers in the e‐cigarette arm were less likely to relapse than abstainers in the NRT arm [relative risk (RR) = 0.78, 95% confidence interval (CI) = 0.64–0.96 for relapse between 4 weeks and 1 year; RR = 0.71, 95% CI = 0.55–0.93 for relapse between 6 months and 1 year). Relapse rates over both time periods were also lower in abstainers who used e‐cigarettes compared with abstainers who did not use e‐cigarettes (RR = 0.79, 95% CI = 0.65–0.97 and RR = 0.75, 95% CI = 0.57–0.98, respectively). Conclusions Use of e‐cigarettes after stopping smoking is associated with a reduced risk of relapse. </jats:sec
Survival With a Cost: Increased Long-Term Coronary Artery Disease Risk After Adjuvant Fluoropyrimidine Chemotherapy in Colorectal Cancer Survivors
No full textGeometric Invariants and Null Gluing Constructions in General Relativity
Get PDFIn this thesis, geometric invariants and null gluing problems for the Einstein vacuum equations are investigated. In the first part of the thesis, the construction of a geometric invariant characterising the stationarity of black hole spacetimes is described. This is accomplished by extending Dain’s construction of geometric invariants characterising stationarity to the case of initial data sets for the Einstein equations corresponding to black hole spacetimes. We prove the existence and uniqueness of solutions to a boundary value problem showing that one can always find solutions in a black hole spacetime and these solutions coincide with Killing vectors when they are present. In the time-symmetric setting, a geometric invariant on a marginally outer trapped surface that vanishes if and only if the Killing initial data equations are locally satisfied is constructed. Next, a characterisation of the Kerr spacetime close to future null infinity is constructed using the asymptotic characteristic initial value problem in a conformally compactified spacetime. By a theorem of M. Mars characterising the Kerr spacetime, conditions are provided for the existence of an asymptotically timelike Killing vector on the development of the initial data by demanding that the spacetime is endowed with a Killing spinor. The conditions on the characteristic initial data ensuring the existence of a Killing spinor are, in turn, analysed. The conditions on the initial data in terms of the free data in the characteristic initial value problem are given. As a result, the Kerr spacetime is characterised using only a section of future null infinity and its intersection with an outgoing null hypersurface. Finally, the C3-null gluing is investigated. That is, the null gluing of up to and including third-order derivatives of the metric is considered. In the regime where the characteristic data is close to Minkowski data, it is shown that the C3-null gluing problem is solvable up to a 20-dimensional space of obstructions. The obstructions correspond to 20 linearly conserved quantities: 10 of which are already present in the C2-null gluing problem analysed by Aretakis, Czimek and Rodnianski, and 10 are novel obstructions inherent to the C3-null gluing problem. The 10 novel obstructions are linearly conserved charges calculated from third-order derivatives of the metric. Subsequently, we show that the novel conserved quantities are no longer conserved when the characteristic data is close to Schwarzschild data
THE MUSE BENCHMARK: PROBING MUSIC PERCEPTION AND AUDITORY RELATIONAL REASONING IN AUDIO LLMS
Get PDFMultimodal Large Language Models (MLLMs) have demonstrated capabilities in audio understanding, but current evaluations do not demonstrate relational reasoning. We introduce the Music Under- standing and Structural Evaluation (MUSE) Benchmark, consisting of 10 tasks designed to probe fundamental music perception skills. We evaluate four SOTA models (Gemini Pro and Flash, Qwen2.5- Omni, and Audio-Flamingo 3) against humans (N=200). Results reveal a wide variance in SOTA capabilities and a persistent gap with human experts. While Gemini Pro succeeds on basic percep- tion, Qwen and Audio Flamingo 3 perform at or near chance, ex- posing severe perceptual deficits. Furthermore, we find Chain-of- Thought (CoT) prompting provides inconsistent, often detrimental results. MUSE is a critical tool for evaluating invariant musical rep- resentations and driving development of more robust AI systems
A preliminary study and assessment of the effects of beaver engineering on river condition and its relevance for Biodiversity Net Gain
No full textPatients' and carers' perspectives on unrestricted weight-bearing and early mobilisation after hip fracture surgery in Saudi Arabia: a qualitative study.
Get PDFPURPOSE: This study explored how patients and carers experienced weight-bearing instructions and mobilisation timing following hip fracture surgery. It also examined their views on unrestricted weight-bearing and early mobilisation and perceived barriers to these practices. METHODS: Semi-structured interviews were conducted with 25 participants (18 carers, 7 patients) from Saudi Arabia's healthcare systems. The data were analysed using inductive thematic analysis. RESULTS: Participants viewed unrestricted weight-bearing and early mobilisation as important when prescribed by clinicians, reflecting strong trust in professional judgement. However, their experiences showed inconsistency in clinical instructions and how these were understood and implemented. Implementation was shaped by clinical instructions, clarity of communication, perceived safety, and patients' physical capacity and psychological state. Concerns about falls were mostly reported by carers as barriers to mobilisation, although some patients also described fear shaped by past injuries, difficult recoveries, or uncertainty about undiagnosed complications. Carers played a key role in encouraging mobilisation, adapting instructions, and maintaining continuity of care when weight-bearing and mobilisation were challenging for patients. CONCLUSION: To support adherence to weight-bearing and mobilisation instructions, clinicians should provide timely, consistent prescriptions aligned with evidence-based guidance. Communication must be inclusive to support understanding, confidence, and autonomy among patients and carers