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Bridging the gap between policy and practice: the Chilean case of adopting and implementing a psychosocial risk management regulation to protect and promote mental health at work
Full text linkIn 2019, 970 million people worldwide experienced some type of mental burden during their lifespan; hence, mental ill-health has become one of the most concerning health problems across societies. To address this issue, international organisations have highlighted the need to adopt integral strategies that include aspects ranging from structural conditions that influence mental health to reducing the consequences of mental disorders. In this respect, employment is an important social determinant of mental health because it provides individuals with opportunities to develop socially and economically, along with determining the type of occupational risks employees are exposed to. Therefore, during the last decades the international community has made many calls for action to develop national programmes and policies to mobilise organisations to enhance working conditions, known as psychosocial factors, in order to protect and promote employees’ mental health.
However, currently there is a global scarcity of countries that have introduced national policies and regulations regarding psychosocial risk management. Chile, through the publication of the ‘Protocolo de Vigilancia de Riesgos Psicosociales en el Trabajo’ (Psychosocial Risks at Work Surveillance Protocol in English) in 2013, is one of the few nations worldwide that has adopted this sort of legislation. Nevertheless, occupational mental diseases still show an upward trend in this country. This situation evidences a gap between policy and practice, in which governmental actions have not led to effective organisational initiatives in protecting and promoting mental health at work. Unfortunately, this issue has also been recorded in countries from the global north with a longer tradition of managing psychosocial risks.
This thesis aim is to systematise and review the Chilean experience of adopting and implementing a psychosocial risk management regulation. Moreover, it addresses the overarching research question: ‘How have international values and scripts related to psychosocial risk management been adopted, legitimated and implemented in the context of Chilean society and enterprises?’ through a transdisciplinary approach that includes literature from public policy, organisational sociology, psychology, and management. Based on these conceptualisations, a multilevel, integral and bidirectional theoretical framework is proposed to bridge the gap between policy and practice.
The current research is underpinned by a critical realism ontological and epistemological perspective. As such, the Chilean experience of adopting and implementing a psychosocial risk management regulation is framed as a case study reviewed under a qualitative approach. Data was collected with policy documents and semi-structured interviews, while their analysis involved triangulation and thematic analysis techniques. Furthermore, the Chilean experience was examined using three empirical studies. The first study reviews policy development aspects, including introducing psychosocial risk management to the policy agenda and the subsequent formulation, implementation, and consolidation of the Psychosocial Risks at Work Surveillance Protocol. The second study examines the elements that facilitate and hinder the legitimation of this regulation among social and organisational stakeholders. Lastly, the third study revolves around the experience of enterprises in managing psychosocial risks by complying with local legislation.
Findings evidence several gaps that require attention for national initiatives to protect and promote mental health at work effectively. These include integrating psychosocial risk management with national and organisational needs and concerns, developing capabilities and infrastructure that support organisations in complying with this statutory obligation and evaluating the effects of national programmes and policies on psychosocial factors and employees’ mental well-being indicators. To address these gaps, this research suggests fostering vertical and horizontal collaboration between policymakers and other public and private actors. This approach would align stakeholders, roadmaps, infrastructure, resources, and capabilities required to improve the initiatives organisations conduct to enhance their psychosocial work environment.
Overall, this thesis provides insights that are useful both for Chile and on a global scale. On the one hand, it underlines this country’s main strengths and areas for improvement regarding its national psychosocial risk management regulation. On the other hand, stakeholders worldwide can contrast findings from this research with their current situation about protecting and promoting mental health at work. Nevertheless, in this last case, they should be carefully read in accordance with local characteristics
The illusion of choice: barriers faced by mothers with young children in Kazakhstan in re/entering the labour market: an analysis with the concept of defamilisation
Full text linkThis thesis explores women’s experiences when combining motherhood and paid work, and the role that the state, the markets and the family play in this. The theoretical framework is based on the concept of defamilisation in order to explain the extent to which and the way in which three sectors, the state, the labour market and the family, impact the defamilisation of women (Lister, 1994). Mothers of young children, not only in Kazakhstan but in general need support from the state, employers and family (Dugarova, 2016). The state plays a key role not only in ensuring acceptable standards of living for people by decommodifying them from the labour market (Esping- Andersen, 1990; 1999), but it may also provide support to mothers of young children by defamilising them through assistance with childcare and allowing them to have free time to enter paid work (Lister, 1994; Chau and Yu, 2022).
While there is research published on gender inequality in Kazakhstan in terms of gender-based discrimination and wage gender gap they experience (Omarova et al. 2017; Khamzina et al. 2020; Mukhamadiyeva et al. 2019; Bidaishiyeva et al. 2018), there are few if any empirical studies carried out on defamilisation and motherhood penalty in Kazakhstan. This thesis therefore makes an original contribution by filling this gap in research. Through semi-structured focus group discussion and secondary research, it explores whether and how the state, the markets and the family assist or hinder women from (re)entering paid work and their impact on defamilisation. This data was analysed through an interpretive approach and thematic method, and utilising an insider positionality approach (Geene, 2010; Wilson et al, 2022). The data collection for this research took place in December 2021 and May 2022 in Almaty and Turkestan, cities located in South of Kazakhstan. The findings show that despite conservative values and beliefs in the importance of traditional gender roles, a pragmatic rationale for having dual-earner household and women choosing to enter paid work for financial needs prevail. The financial situation in families plays a decisive role in women’s decisions to find paid work and commonly women whose partners earn generously postpone entering the labour market for an indefinite time. The findings also suggest that the state's lack of support for mothers of young children pushes them to seek paid work, but due to difficulties faced there to enter and retain, women remain dependent on their families. The traditional lifestyle of living in multigenerational households mean women are engaged in social exchange with members of extended family and receive support with childcare in return for unpaid domestic services. Therefore, the state, the labour market and the family present a complex environment for mothers of young children engaging in paid work, resulting in a strong pull from the family that ultimately hinders them from being able to maintain an acceptable living standard independently of their families
Compartmentalised signalling and trafficking of CXCR4 and ACKR3
Full text linkThe atypical chemokine receptor 3 (ACKR3) and the C-X-C chemokine receptor type 4 (CXCR4) are known to share the chemokine ligand CXCL12. CXCR4 and ACKR3 involvement in various types of cancer and their tumour environment has also been well-documented. Previous research indicated that, while CXCR4 canonically signals through G proteins, ACKR3 does not couple to G protein and suggested that this atypical receptor functions as a chemokine ‘scavenger’. Understanding the dynamic organisation of these receptors at the plasma membrane is crucial because this profoundly influences their signalling capabilities and receptor desensitisation. This thesis explored the membrane dynamics and organisation of CXCR4 and ACKR3 at the plasma membrane using a variety of advanced imaging and spectroscopic techniques. In addition, it provided insight into the roles of G protein-receptor kinases (GRKs) in ACKR3 trafficking.
To begin with, Surface-Alexa Flour 488-labelled SNAP-CXCR4 was used to assess receptor localisation and receptor diffusion parameters by Fluorescence Correlation Spectroscopy (FCS) and Fluorescence Recovery After Photobleaching (FRAP). CXCR4 oligomeric state was investigated with Photon Counting Histogram (PCH) analysis. Membrane diffusion and oligomerisation parameters were compared in basal, agonist (CXCL12) and antagonist (IT1t) treated conditions. CXCR4 diffusion in the plasma membrane did not change upon ligand stimulation but showed a CXCL12-induced increase in oligomerisation and ligand-induced reduction in mobility, suggesting cluster formation.
ACKR3 dynamics and organisation were assessed using labelled SNAP-ACKR3. Confocal imaging already revealed a partial membrane but mainly the intracellular location of ACKR3 in both basal and CXCL12-stimulated conditions. ACKR3 dynamics were studied using FCS, FRAP and Raster Image Correlation Spectroscopy (RICS) which provide diffusion characteristics at different scales. The nanoscale (FCS) and microscale (FRAP) diffusion coefficients of ACKR3 showed significant reduction upon CXCL12 addition, whilst there was no significant change on the macro scale (RICS). The oligomeric state of the receptor was determined with Photon Counting Histogram (PCH) and Number and Brightness (N&B) analysis showing the presence of distinct oligomeric states of ACKR3, indicating cluster formation in both basal and CXCL12 conditions. Moreover, CXCL12 stimulation led to the reduction of ACKR3 mobility and a decrease in the number of particles on macro scale, suggesting internalisation or higher order oligomerisation and cluster formation.
Furthermore, this study investigated the role of G protein-coupled receptor kinases (GRKs) in the internalisation and trafficking of ACKR3 using CRISPR-Cas9 cells edited to lack GRK expression. Our data suggest that ACKR3 undergoes basal internalisation even in the absence of GRKs. However, GRKs appear to influence post-internalization trafficking of the receptor, as the absence of GRKs shifts ACKR3 towards a degradation (LAMP1-positive) pathway.
In conclusion, the data in this thesis provide insights into the distinct dynamics and organisation of CXCR4 and ACKR3 at the plasma membrane at various spatial scales. Additionally, our findings obtained with GRK depletion cell lines demonstrated a potential GRK role in ACKR3 localisation and trafficking post-internalisation
Midwives’ experiences following the conclusion of a Nursing and Midwifery Council Fitness to Practise Referral: a phenomenological study
No full textBackground:
The Nursing and Midwifery Council (NMC) is an independent regulatory organisation which dictates the standards for practice and education for midwives, and undertakes fitness to practise (FtP) investigations when concerns are raised regarding a midwife’s practice or conduct. Yet, institutions that monitor health and social care regulators in the UK have criticised the NMC’s own practices, condemning the length of time taken to conclude referrals. Concerns have also been raised regarding the possible effects an FtP referral could have on registrants’ health and well-being, however this has not been researched.
The poor health and well-being of UK midwives in general has been evidenced. Midwifery is recognised as a stressful occupation due to the emotional intensity of the role and high workload. Midwives suffer high levels of stress, depression, anxiety, personal and work-related burnout. It is therefore possible that midwives are already emotionally vulnerable when entering the FtP process, with the potential for levels of stress to increase when experiencing an FtP investigation. This raises concerns regarding the effects of the FtP process on midwives and the resultant consequences on the care they provide.
Aims:
The aim of the research was to examine midwives’ experiences following the conclusion of an NMC FtP referral. Particular focus was given to influences on midwives’ experiences, to inform recommendations for improving the FtP process and to improve support midwives receive throughout the FtP process and following its conclusion.
Study design:
A scoping review was completed to assess the existing research on healthcare professionals’ experiences of professional investigations. Empirical research was then undertaken with a philosophical lens of standpoint feminism and a hermeneutic phenomenological methodology. Fourteen semi-structured interviews were conducted. A purposive sample of midwives who had been referred to the NMC FtP process and received the conclusion between 2016 and 2021 were included.
Findings:
Theories of belonging were employed to discuss the findings, as the research found that an FtP referral can affect a midwife’s sense of belonging. Belonging was affected by the FtP referral questioning the midwife’s identity and an accumulation of trauma experienced through the FtP process. The FtP process also required midwives to undertake additional emotion work beyond that involved in the midwife’s role, causing further stress. The research found midwives felt powerless in their relationship with the NMC and the FtP process. This lack of trust in the NMC and the negative impacts of the FtP process on the midwife, led midwives to interpret the support they received, or did not receive, through the lens of trauma, affecting how they engaged with support.
Recommendations:
Reducing the length of time the NMC take to conclude an FtP referral would assist in alleviating the distress experienced by midwives during the process. Midwives should be treated with compassion and empathy by the NMC, recognising the distress a midwife may be experiencing during and following an FtP referral. A support programme for midwives following the conclusion of an FtP referral should be introduced, with the aim of supporting their well-being. More education should be provided to qualified midwives and student midwives, by the NMC and pre-registration institutions, to inform them of the role of the NMC, the FtP process and how to seek support. Research should be undertaken into whether the changes the NMC have introduced to the FtP process since the conclusion of this research have improved the midwives’ experience, as well as more focused research into the experiences of registrants from an ethnic minority
A contrarian in search of tradition: post-war American education and the career of Diane Ravitch
Full text linkThis thesis assesses the career of Diane Ravitch (born 1938) who has influenced American school education in a range of ways — as an historian, commentator and adviser, and as a government official — since the 1960s. Based on a chronological chapter structure, the thesis argues that during her working life, Ravitch has retained certain ‘traditionalist’ ideas, based on support for public schools, the teaching profession, a liberal arts curriculum, and shared American values, but that the way in which she has upheld these ideas has evolved in response to shifts in politics, culture and intellectual life. Having been a liberal Democrat believing in the statist, pro-labour principles of the New Deal, she responded to the challenge to her views posed by the countercultural New Left by joining forces with the right-of-centre neoconservatives. She remained associated with neoconservatism for 40 years, playing an active part in its work on school standards, but refrained from adopting the pro-market ideas increasingly popular among neoconservatives and promoted vociferously by neoliberals until — in what proved to be an exceptional episode in her career — she endorsed the 1990s ‘reform agenda’ of standardised testing, teacher/school ‘accountability’ and ‘school choice’. Realising in the late 2000s that the radical neoliberalism inherent in ‘reform’ was alien to her core principles, and displaying the contrarian instincts which led her to challenge fashionable ideas of the day, she turned away from her neoconservative allies and lent her vigorous support to the centre-left activists fighting for public education and teachers’ rights. The thesis argues that, in defending her traditional ideas first against the left and more latterly against the right, Ravitch has displayed an underlying consistency and continuity in a period of major change
The impact of blockchain technology on financial reporting quality: perspectives from the Kingdom of Saudi Arabia and the United Arab Emirates
No full textBlockchain Technology (BCT) has emerged as a transformative innovation beyond its initial applications in bitcoin trading, impacting sectors such as finance, accounting, and data management. Defined as a shared, distributed ledger that facilitates the documentation of transactions and monitoring of both tangible and intangible assets within a business network (Gupta, 2017), blockchain's potential to enhance Financial Reporting Quality (FRQ) remains empirically underexplored, particularly in emerging markets. This study investigates BCT's impact on FRQ within Saudi Arabia and the United Arab Emirates—regions characterized by varying stages of IFRS adoption and comprehensive regulatory efforts to enhance financial transparency. The unique economic and cultural contexts of these countries provide a distinct backdrop for exploring BCT's potential effects on financial reporting practices. Through a rigorous mixed-methods approach, the research analysed data from 235 financial and governmental professionals across both countries, balanced between blockchain adopters (41.7%) and non-adopters (58.3%), offering comprehensive perspectives on implementation challenges and benefits. This quantitative phase was enriched by 12 in-depth interviews providing detailed contextual insights into blockchain adoption and its impact on financial reporting practices. The findings demonstrate that blockchain's core features—decentralization, distributed ledger technology, immutability, consensus mechanisms, and real-time processing—significantly enhance the qualitative characteristics of financial reporting as defined by IASB. Blockchain's capability to enhance accuracy and integrity improved faithful representation, while its enhanced accessibility and precision strengthened reporting relevance. The technology's inherent standardization promoted comparability across entities, while its transparent nature enhanced verifiability through improved asset tracking and audit processes. Interview findings revealed that firm size significantly moderates these benefits, with larger organizations leveraging economies of scale more effectively, while smaller firms face distinct resource-related challenges. This research makes several significant contributions to both theory and practice. Theoretically, it advances understanding by integrating blockchain capabilities with three fundamental frameworks: agency theory, demonstrating how blockchain mitigates information asymmetries; stakeholder theory, showing enhanced stakeholder engagement through improved transparency; and Resource-Based View (RBV), revealing how firm size influences blockchain's effectiveness as a strategic resource. The study empirically validates blockchain's impact on FRQ through these theoretical lenses, extending academic discourse beyond conceptual propositions. Practically, the research provides actionable insights for organizations implementing blockchain, offering tailored strategies based on firm size and organizational context. It addresses critical implementation challenges including technological complexity, system maturity, scalability issues, privacy concerns, and infrastructure requirements. These insights are particularly valuable for policymakers and corporate managers in emerging economies navigating blockchain adoption. The study identifies several barriers to implementation, including varying levels of management awareness, regulatory compliance needs, and resource constraints. Understanding these challenges is crucial for comprehending potential obstacles affecting blockchain adoption in accounting and financial sectors. Moreover, the research provides detailed examination of the specific economic and regulatory contexts of Saudi Arabia and the UAE, offering in-depth analyses that highlight the distinct impacts of blockchain in these regions. This comprehensive investigation advances both theoretical understanding and practical application of blockchain in financial reporting, while considering the unique characteristics of emerging markets. The findings demonstrate that while blockchain significantly enhances FRQ, its effectiveness varies with organizational context and implementation approach, providing crucial insights for future research and practical application in financial reporting systems
Development and evaluation of a framework to support accountability in Automated Decision-Making (ADM)
No full textThis PhD uses a mixed methods multidisciplinary approach to assist Small and Medium-sized Organisations (SMOs) in understanding the General Data Protection Regulation (GDPR) and increase their accountability when looking to implement Automated Decision-Making (ADM) technologies. To support SMOs with this task, the PhD develops and evaluates a framework to support accountability from Legal, Ethical and Practical perspectives.
I discuss SMOs' challenges in navigating the GDPR when considering implementing ADM technologies. I also present empirical findings from publicly available Ethical Documents (ED) for ADM and use these findings, alongside those of the literature reviews, to design and construct the first proof-of-concept (POC) tool, which I envisage as part of an Automated Decision-Making Impact Assessment (ADMIA). The concept of the ADMIA overall is to be a modular tool-based framework solution to help SMOs understand accountability and decide whether to implement ADM. I create a POC to help users understand the EUGDPR Article 22 (ADM22). I then undertake a study to obtain feedback on the POC to provide insights for improvement and additions for future iterations.
ADM is transforming the world in ways we do not always appreciate or see. While using ADM or algorithms to make decisions is not new, combining big data and high computing power means there is a driving need for better understanding and protection for all. Organisations need tools to support them in their journey to understanding and navigating complex legislation and enabling a robust manner to record and account for their decisions. SMOs may face similar legislative complexity and accountability challenges whether using ADM or not; however, ADM tends to increase complexity and scale, exacerbating the likelihood of matters such as discrimination and bias.
This work predominantly focuses on the legal definitions, such as those in the UK and EU GDPR(s). The lack of universal definitions contributes to the challenges with technology continually progressing alongside experts across disciplines failing to reach any agreement.
This PhD highlights the need for more structured documentation for SMOs to enable a better understanding of ADM and accountability. I designed the POC to appeal to SMOs on two levels. Firstly, this is a tool to help guide them through complex legislation, therefore helping with the necessity of GDPR legal compliance. Using this tool should support users and the SMO with a means to understand their GDPR legal obligations at a level which suits their experience. However, should the SMO discover no GDPR compliance concerns within their intended project, the POC also guides best practices to increase accountability over the decision-making process.
The PhD produces a POC section of the ADMIA as the main contribution to academic knowledge and as a proposed practical solution to assist SMOs in attaining and maintaining accountability when implementing ADM technologies into their organisations. Insights following the design and construction of the POC show that tools are a practical solution to assist SMOs with accountability when implementing ADM technologies
The Silk Road: The Spread and Acculturation of Buddhist Art and Architecture
Full text linkThis work will examine the extent of the acculturation of Buddhist art and architecture as the religion spread along the ‘Silk Road’, focussing upon the regions of ancient Gandhāra in modern-day Pakistan and Afghanistan, and Dunhuang in the modern-day Gansu province of China. It will discuss three case studies, the site of Jamālgarhī in Gandhāra, and Cave 257 and Cave 275 at the site of the Mogao Caves at Dunhuang. Within these case studies, the focus will be on their architecture, including the key Buddhist monument of the ‘stūpa’, in addition to a Buddha image and depictions of stories and scenes from the Dharma, demonstrating that the acculturation of Buddhism within these disparate regions did indeed result in composite visual languages, admixing with the existing architectural and artistic traditions. Given the importance of images within Buddhism, allowing for the spread of key concepts and stories without the need for translation or literacy, the presence of new cultural influences within Buddhist material culture can therefore be seen as a reflection of the acculturation of Buddhism and Buddhist communities as the religion spread along the ’Silk Road'
The development of a measurement system for fortifying Malaysia’s energy security
Full text linkEnergy security (ES) is a complex concept requiring a multifaceted approach to quantify through any set of dimensions, indicators, or variables. For the past two decades, researchers in energy management, policy, and sustainability have studied ES intensively. A critical issue identified in Malaysia is the lack of a consolidated framework and policy documentation for ES. The over-reliance on fossil fuels for energy generation, driven by the need for affordable, always-available energy, often overshadows environmental sustainability. This study's first objective is to create system dynamics models using primary and secondary data to map the most feasible dimensions of Malaysia’s ES. Stakeholder engagement follows to further add input and context to this data, leading to primary data collection that identifies five ES dimensions. These dimensions are then used to create a framework for quantifying ES through indicator mapping, data normalization, and aggregation.
The methodology involves creating system dynamics models using Vensim based on secondary data from energy policies and reviews and complemented by primary data from stakeholder engagement and semi-structured interviews (SSIs) to identify five critical ES dimensions. The interviews, analysed with Quirkos using an inductive grounded theory approach, identified five dimensions from seven emerging themes focused on reducing fossil fuel dependency and enhancing energy efficiency. These themes include the role of renewable energy, fossil fuels, technology applicability, the 4A’s of energy security, environmental sustainability, economic development, and governance. The Malaysian ESI is constructed using data normalization and aggregation techniques, visualized through radar charts, showing an improvement in energy security scores from 4.88 in 2006 to 6.64 in 2018.
The study underscores the need to reduce Malaysia's fossil fuel reliance by shifting to renewable energy and energy-efficient technologies, crucial for enhancing energy efficiency, affordability, and availability. While energy equity is central to Malaysia's energy trilemma, environmental sustainability also requires equal focus. The findings reveal inadequacies in addressing current ES dimensions, with some dimensions showing deterioration in scores, highlighting the need for a targeted ES policy. This study advocates for the development of a dedicated ES policy, emphasizing a data-driven and stakeholder-engaged approach to secure natural resources, promote sustainable economic growth, and mitigate environmental impacts
Identification and surveillance of antibiotic resistance in Helicobacter pylori in the UK
Full text linkHelicobacter pylori is the leading cause of peptic ulcers and gastric cancer. Treatment is becoming more problematic due to increasing antimicrobial resistance (AMR) rates globally. There is no routine surveillance of H. pylori antimicrobial sensitivities in the UK, and published data is lacking as culture-based sensitivity testing is time-consuming and technically involved. This study aimed to characterise antimicrobial sensitivities of isolates collected in Nottingham since 2001, and to compare levofloxacin phenotypic and genotypic resistance rates. Additionally, whole genome sequencing methods for determining antibiotic resistance in clinical isolates were investigated, and how that data can be used with online resistance detection tools to predict phenotypic resistance.
Gastric biopsy samples were collected, with informed written consent and ethics approval, from patients attending the Queen’s Medical Centre in Nottingham for an upper GI tract endoscopy. Antibiotic sensitivity was assessed using disc diffusion and E-test methods, with strain NCTC (National Collection of Type Cultures) 11637 as a control. Of 241 isolates tested, 27.8% were resistant to clarithromycin, 61.8% to metronidazole, and 2.5% to amoxicillin, which are used in first-line therapies. For those used in second-line therapies, 0% of isolates were resistant to tetracycline, and 4.1% to levofloxacin. Multi-drug resistance was found in 27.4% of isolates. Resistance to clarithromycin increased dramatically between 2001-2005 and 2011-2018 (15.6% to 40.0%; p=0.011).
Inappropriate prescription of antibiotics leads to treatment failure and the development of further resistance. In localities with high levels of clarithromycin resistance, alternatives such as levofloxacin should be considered, although use should be safeguarded to prevent the further development of resistance. Genetic determination of levofloxacin resistance in the gyrA gene has previously been investigated; however, genotypic sensitivity testing does not reliably predict phenotypic resistance. To investigate levofloxacin resistance mechanisms, the quinolone resistance determining region in the gyrA gene of 37 H. pylori isolates were amplified via PCR and Sanger sequenced. The minimum inhibitory concentration (MIC) and sequencing data were compared. Of the 9 phenotypically resistant isolates, 88% had a substitution at gyrA amino acid position 87 or 91. Every isolate containing a substation at position 91 or an Asn87Lys substitution had a resistant MIC of ≥32 to levofloxacin, evidencing that those mutations are predictors for resistance. One phenotypically resistant isolate did not contain any gyrA mutations.
To further investigate this, whole genome sequencing (WGS) was undertaken. However, H. pylori has a highly mutable genome which makes the correct assembly of short-read sequences problematic. Conversely, the higher error rate of long-read sequencing can obscure the presence of resistance polymorphisms. Therefore, a hybrid approach was tested. 13 isolates with a range of levofloxacin MICs were selected for whole genome sequencing using Illumina and Oxford Nanopore Technologies. The long-read sequencing data were used to construct de novo genome assemblies. Polishing using long- and short-read data increased the genome length and mean quality while decreasing sequencing gaps. Polished genome sequences were analysed for resistance genes using the Comprehensive Antibiotic Resistance Database (CARD). The agreement rate between genotypic and phenotypic resistance to both levofloxacin and tetracycline was 100%, metronidazole was 61%, while clarithromycin and amoxicillin had low accordance with 23% and 0% respectively.
In summary, resistance rates to clarithromycin and metronidazole were higher than had previously been estimated for UK isolates. Based on the resistance profiles, treatment failure is more likely to occur when patients are given first-line therapies without amoxicillin. Levofloxacin resistance can be predicted from sequencing of the gyrA gene, and polishing of whole genome sequences can be used to confidently identify levofloxacin resistance genes using the online tool CARD. Based on this data, it is recommended that resistance rates of H. pylori should be more extensively monitored, and alternative eradication therapies should be considered. Further advancement of PCR and WGS-based AMR detection methods should be explored
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