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Interventions for cognitive frailty: developing a Delphi consensus with multidisciplinary and multisectoral experts
Get PDFThe conjunction of physical frailty and cognitive impairment without dementia is described as Cognitive Frailty (CF). Indications that CF is potentially reversible have led to proposals that risk factors, symptoms or mechanisms of CF would be appropriate targets for interventions for prevention, delay or reversal. However, no study has brought experts together across sectors to determine targets, content or mode of interventions, and most resources on interventions are from the perspective of academic or clinical researchers only. This international Delphi consensus study brings together experts from academic and clinical research, lay people with lived experience of CF, informal carers, and professional care practitioners/clinicians. Three rounds of Delphi study were held to discern which factors and statements were agreed upon by the whole sample and which generated different views in those with differing expertise. A scoping review and Round 1 (29 participants) were used to gather initial statements. In Round 2, 58 people responded to statements and open text items, comprising 7 lab-based researchers, 27 researchers working with people, 14 people with lived experience or informal family carers, and 10 professional carers/clinicians. Percent agreement and qualitative responses were analyzed to provide a final set of statements which were checked by 38 respondents in Round 3. Analysis of Round 2 quantitative data provided 74 statements on which there was at least 70% agreement and qualitative data produced a further 24 statements. These were combined to provide 90 statements for Round 3. There was Consensus for 89 of the statements. A few differences between the groups were observed at both stages. The consensus for statements associated with CF interventions provides a useful first step in defining health promotion activities and interventions. Given the prevalence and potential disability caused by CF in older populations, the consensus statements represent expert opinion that is inter-sectoral and will inform public health policies to support implementation of evidence-based prevention and intervention plans. This study is an important step toward changing current approaches, by including all stakeholders from the outset. Outcomes can be used to feed into co-creation of interventions for cognitive frailty
Exploring the factors that influence engagement with and experiences of integrated care for adults at risk of cardiovascular disease and mild-to-moderate mental health concerns in the UK (OptICS): a systematic review protocol
Get PDFBackground: Cardiovascular disease (CVD) is one of the leading causes of premature death globally. CVD is expensive to treat and therefore carries a significant cost for public healthcare systems and the people in them. Those most likely to develop CVD often report co-occurring mental health concerns such as depression and anxiety, in addition to behavioural factors (e.g. physical inactivity) and physical health conditions (e.g. hypertension, high cholesterol, obesity and diabetes). Due to these inter-connecting issues, healthcare provision for CVD patients necessitates a joined-up care pathway providing holistic, person-centred support. Despite the rapid emergence and growth in attempts to deliver such care, evidence concerning how it is experienced and how to promote engagement is fragmented. This review aims to capture the experiences and factors that influence integrated care engagement, reported by adults with CVD risk factors and mild-to-moderate mental health concerns. Methods: This systematic review protocol will be reported according to the updated Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA-P) guidelines. Proposed database searches will include Emcare, MEDLINE, PsycINFO (via OVID), CINAHL and preprint databases for grey literature. Articles of interest will include adults’ experiences of and factors that influence engagement with integrated care in the UK, specifically for support with CVD risk and mild-to-moderate mental health concerns. Any study design reporting qualitative primary data will be included (excluding conference abstracts). Data on study population (actors/targets), what they do (behaviours) care setting (context), care format (time) and participant experiences and perspectives will be extracted. Where appropriate, thematic synthesis of extracted data will be coded to the Theoretical Domains Framework (TDF), updated Consolidated Framework for Implementation Research (CFIR) and Action, Actor, Context, Target and Time (AACTT) framework. Discussion: Findings from this review will provide foundation evidence for a behavioural systems map and recommendations for policymakers, commissioners and those involved or interested in integrated care for people at risk of CVD with mental health concerns. Such evidence can be used to develop future intervention strategies to assist the optimisation of integrated care. Systematic review registration: PROSPERO (CRD42024554282.</p
‘Biographical continuity’: a qualitative study of the role of complementary and alternative medicine in restoring the self after breast cancer diagnosis
Get PDFIntroduction Breast cancer patients frequently use complementary and alternative medicine (CAM) alongside biomedical treatment for symptom relief and to address the disruption caused by diagnosis and treatment. These experiences, however, are often overlooked within the cancer clinical encounter. This study explored CAM use in women with breast cancer, focusing on three main research questions: Why do women with breast cancer use CAM? In what ways does CAM help them maintain or regain a sense of normality? What barriers or tensions do they face when considering or using CAM? Methods The study used a qualitative interpretative-constructivist research design to analyse the subjective meanings women with breast cancer ascribed to their CAM use during their breast cancer journey. Unstructured interviews were conducted with nine female breast cancer patients undertaking treatment at a major NHS cancer centre in Southeast England. The interviews were analysed using reflexive thematic analysis. Results The women engaged with a wide range of CAM therapies during their cancer journey. CAM was used not only to alleviate symptoms, but also to restore a sense of ‘ordinariness’ and biographical continuity. Central to this process were practices of self-care, self-help, and self-management, and the collaboration of CAM practitioners and open-minded medical doctors. Barriers included dominant biomedical approaches, limited information sharing and communication about CAM, financial and geographical constraints, and little clinical validation by medical staff. Conclusion These women experienced tensions and conflicts when trying to use CAM alongside cancer treatment. They sought overall well-being but often encountered barriers to accessing CAM and sharing their experiences within a biomedical context. The study highlights the role and value of CAM in restoring a sense of normality in the lives of breast cancer survivors, and recommends raising professional awareness of CAM use by women with breast cancer, normalising CAM dialogue in the clinical encounter, and considering relational care in training
The role of artificial intelligence in the tourism and hospitality sector
No full textThis timely, expert-led book brings together the latest academic and practitioner insights on Al technology within the hospitality and tourism industries. The disruptive nature of Al is captured in a logically structured and accessible way, with global case studies covering the latest technological developments in Al via a wide range of detailed, 'real-world' examples designed to help the reader understand how this complex subject area is applied in industry. Topics covered include privacy concerns, Al in hotels, personalisation of the guest experience, travel planning, virtual assistants and recommendation systems, sustainability, blockchain, AR, VR, loT, smart destinations and big data analytics, amongst others. Chapters also include insights on governmental policies, environmental sustainability, social change, and how these impact and interact with Al technologies within the context of tourism and hospitality. This volume is of pivotal interest to students, scholars and academics in the fields of tourism, hospitality, business, management, human geography, social sciences and sustainability, as well as those with an interest in Al technology more generally
Extreme context exposure and counterproductive work behaviour:the role of exhaustion, authentic leadership and spirituality
No full textIn recent years, research on extreme contexts has expanded significantly, focussing on management practices in unusual or atypical work environments. However, individual behavioural responses in these settings have received less attention. Our study addresses this gap by using Job-Demand Resources (JD-R) theory to explore how extreme context exposure (i.e. frequent exposure to extreme events) influences counterproductive work behaviour towards the organisation (CWB-O) in high-risk contexts of aviation and shipping. In Study 1, based on data from 297 flight cadre, we found that extreme context exposure is positively linked to CWB-O, with exhaustion linking the two variables. Study 2 replicated these findings with data from 309 seafarers, reinforcing the robustness of our results. Additionally, we identified authentic leadership and spirituality as key job and personal resources that moderate this relationship, reducing the impact of extreme context exposure on CWB-O. We conclude by discussing the theoretical and practical implications of our findings, emphasising the importance of addressing individual behaviours in extreme work environments.</p
An efficient and explainable machine learning framework for Alzheimer's disease detection
No full textAlzheimer's disease detection is of paramount importance as it is a global health problem in terms of early detection, interventions, and management. The study applies prominent machine learning classification to Alzheimer's disease by integrating longitudinal and cross-sectional data analysis. With careful correlation analysis, we derived the following important predictive features: 'M/F', 'Age', 'Education', 'SES', 'CDR', 'MMSE', 'eTIV', 'nWBV', 'ASF', and 'Hand'. In this study, the entire dataset was divide into training (80%) and testing (20%) sets, with eight machine learning models implemented on it for classification: CatBoost-CB, Logistic Regression-LR, Extreme Gradient Boosting-XGB, Support Vector Machine-SVM, Random Forest-RF, K-Nearest Neighbors-KNN, Decision Tree-DT, and Gradient Boosting-GB. Our results demonstrated superior performance from ensemble models, with RF, XGB, GB, DT, and CB achieving 98.1% accuracy, 98.2% precision, and 98.1% recall. These models showed exceptional performance with a Kappa score of 0.95, indicating strong reliability in classification. We have also used LIME explainability to enhance model transparency, providing insight into the contribution of different features in support of the interpretability of the model. In this study, we stress the power of machine learning for early detection of Alzheimer's disease, and provide future research directions on improving the predictive accuracy and transparency of predictive models
Interventions supporting people from Black, Asian and Minority Ethnic groups in the United Kingdom with musculoskeletal disorders: a scoping review
Get PDFBackground: Musculoskeletal disorders (MSDs) significantly impact quality of life, particularly among Black, Asian, and Minority Ethnic communities in the UK, who face disproportionate burdens and barriers to care. Despite growing recognition of ethnic health disparities, there is limited understanding of interventions tailored to these populations. This scoping review aimed to map the existing literature on interventions for MSDs among Black, Asian, and Minority Ethnic groups in the UK, identifying key approaches, gaps, and opportunities for culturally appropriate healthcare delivery. Method: A scoping review was conducted following the Population–Concept–Context (PCC) framework. Seven databases (PubMed Central, CINAHL, Scopus, Medline Full-text, Web of Science, PsycInfo, and Cochrane) were systematically searched up to April 2025. Studies were included if they assessed MSD interventions among Black, Asian and Minority Ethnic individuals in the UK. Both qualitative and quantitative studies were considered. Data were synthesised narratively using thematic analysis supported by NVivo v.11 software. Findings: Nine studies met the inclusion criteria. Three primary themes emerged: (1) language and communication initiatives, such as multilingual resources and telephone helplines; (2) pharmacological and dietary interventions, particularly addressing vitamin D deficiency and rheumatoid arthritis management; and (3) peer-support and educational initiatives, including community-based and culturally tailored programmes. A significant underrepresentation of Black African and Black Caribbean populations was identified alongside a noticeable lack of participatory or qualitative research approaches. Conclusion: There is a critical need for ethnically inclusive, culturally tailored MSD interventions in the UK. Future research should prioritise holistic, community-based approaches and actively address structural inequalities to improve health outcomes and ensure equitable care across all ethnic groups.</p
Millennials’ perception of environmental sustainability and its impact on purchase intention and actual purchase: a personal value perspective
No full textRepresentations of students and educational institutions in the Netflix series Adolescence: a roundtable discussion
Get PDFThis roundtable discussion explores how adolescence, student identity and educational institutions are framed and positioned in the Netflix series Adolescence. The creators of Adolescence wished to “provoke a conversation” about young people’s experiences in the digital age, male violence and the manosphere. In this roundtable discussion, six UK based educators reflect on the series and engage in a critical discussion regarding its representations of students on screen
Whatever happened to the affluent worker?:deindustrialisation, the British sociology of class and class composition in Luton, UK
Get PDFThis article challenges longstanding trends in the British sociology of class by drawing on insights drawn from class composition analysis and applying them to Luton, UK, the site of the original affluent worker study. Class composition has received little attention from sociologists, though neo-Weberian and cultural approaches struggle to grapple with the relationship between deindustrialisation, social reproduction, migration and class. This is because both approaches are (1) methodologically nationalist; (2) concerned primarily with subjective identification with a class, and (3) ahistorical in their theory building. Class composition offers a means of mediating between the objective and subjective dimensions of class. This demonstrates how class has changed in response to the demands for continued surplus-value creation through waged and unwaged work. Finally, the article will take a historical view ofLuton’s class composition as a way to demonstrate how the approach can offer an alternative to the sociology of class
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