38541 research outputs found
Sort by
‘Driving a Micra and working in nasty homes’: a qualitative study of a community nursing service in England
No full textThe National Health Service (NHS) is costly to run, which has led to numerous reforms aiming to improve quality of services and reduce costs. One of the more significant NHS reforms was the managerialist reform in the form of New Public Management (NPM) that led to attempts to resolve the inefficiencies of public administration through management. Three decades after the introduction of NPM, NPM policies are believed to have harmed the NHS. Although several studies researched the impact of NPM on nursing, most research focus on nursing managers or nurses working in a hospital setting with a limited knowledge of the impact on NPM on community nursing.
Since the 1990s NHS policies have started advocating for the delivery of evidence-based care in nursing. Evidence-based practice (EBP) promotes the use of best available evidence to guide decision-making and the provision of efficient and effective care. Introducing evidence into practice however brings several challenges. Most studies researching EBP in the community focus on factors influencing the uptake of EBP, however, less is known about how EBP impacts care delivery in the community.
This qualitative study which uses an ethnographic approach offers a contemporaneous view of a community nursing service at the point of implementing a new care pathway for patients with chronic oedema and wet legs. In this study, chronic oedema is used as a case study through which community nursing was explored. The account is presented from the perspective of nurses working in the community and how they navigate the healthcare system within which they are required to operate. The ethnographic approach used for this study combined participant observations and semi-structured interviews with nurses working in the community to provide an in-depth insight into their working lives. Data were analysed using a thematic analysis. In addition, the composite narrative approach was used to present similarities in community nurses’ experiences that are combined to create a joint narrative which depicts shared experiences of participants.
Findings are presented in three empirical chapters. First, a composite nurse chapter is presented to describe a typical day of a community nurse. The first chapter aims to provide context and sets the scene for the remaining two findings chapters. The second empirical chapter focuses on how community nurses respond to workplace policies that are imposed onto them by their employer. Community nurses did not display resistance to management control mechanisms but instead adopted workarounds by finding a way to deliver care to all patients. The third empirical chapter focuses on the overarching theme of assigning blame as presented from the perspective of community nurses. The intensification of care and growing caseloads, resulting from managerialist policies, led community nurses to make moral judgements about their patients and engage in the practice of labelling patients. Based on community nurses’ accounts of their patients, a typology of non-compliant patients is provided. The chapter also explores the issue of evidence-based practice and how evidence-based interventions that are ‘too rigid’ and ‘prescriptive’ contradict community nurses’ wishes to deliver patient-centred care.
To conclude, this study shows that community nurses adopt long-term workarounds to address long-term workplace issues triggered by managerialism. Community nurses were observed to employ the practice of labelling patients to make sense of their patients who did not behave as community nurses would expect them to. Community nurses wish to deliver patient-centred, holistic care which at times can contradict the delivery of evidence-based practice
The psychology of video on demand (VoD) consumption and binge-watching typologies: how platforms may be designed to optimise user autonomy
Get PDF‘Binge-watching’ has been in the vernacular for 20 plus years and, according to Forbes [1], has been included in the Oxford English Dictionary since 2018. Here, it is defined as "watching multiple episodes of a television show consecutively or in rapid succession".
The facility for a consumer to watch what they want, when they want to, has allowed them to avoid interruption and fully immerse themselves in a narrative, but it’s not without its downsides, which are worthy of consideration, not least for the sheer volume of consumers worldwide. For example, Netflix, the largest paid-for Video on Demand (VoD) broadcaster globally (according to a number of sources [2][3][4][5]), has a consumer base of more than 230 million [6] who at the height of the pandemic in 2020, were watching an average of 3.2 hours per day [2].
For some, there exists a gap between TV (terrestrial broadcast & VoD) consumption intentions and behaviour which may be explained by several psychological drivers such as social pressure; VoD interface design; content narrative and neutralisation effect. This research adopted a mixed methods approach combining qualitative and quantitative data to investigate this gap, following an exploratory sequential design of semi-structured depth interviews, surveys, analysis of viewing data and industry dialogue.
The research addressed how platforms might be designed to optimise user autonomy in VoD consumption, examining what constitutes binge-watching, its associated positive and negative aspects, how digital media interfaces influence viewer autonomy, and what features might better serve consumers.
This paper aims to address the following research question: How might platforms be designed to optimise user autonomy in VoD consumption? To do this, the researcher has sought to first address the following:
• Research Question 1. What constitutes binge-watching, how might it be defined?
• Research Question 2. What positive and or negative aspects may be associated with binge-watching?
• Research Question 3. What aspects of Digital Media interfaces (if any) reduce consumer autonomy in their viewing behaviours?
• Research Question 4. What inter-personalisation features of the interface might better serve the consumer?
In order to address these questions, the research approach adopted four interconnected studies:
1. A qualitative exploration of consumer experiences through in-depth interviews, providing rich, contextual data on binge-watching behaviours and perceptions.
2. A quantitative survey on viewing habits and attitudes that allowed for statistical analysis and generalisation of findings to a broader population.
3. An unobtrusive measures study involving the analysis of BBC iPlayer viewing data and related Twitter discourse, that offered insights into real-world viewing patterns and social media engagement around binge-watching.
4. Industry dialogues with key decision-makers and designers, bridging the gap between academic research and practical application in VoD interface design.
This comprehensive approach provided a holistic understanding of binge-watching, connecting empirical findings with real-world applications.
A key contribution is the development of a novel framework for understanding binge-watching through viewing typologies mapped along dimensions of duration, frequency, and compulsion. This framework intentionally avoids defining specific thresholds, allowing for flexible application across different research contexts and methodologies. The research identified five distinct viewing typologies: Routine Episodic Streaming, Compulsive Streaming, Non-Consequential Recreational Streaming, Periodic Streaming Strategist, and Passive Streaming.
Key findings revealed that binge-watching cannot be understood through simple time-based measures. The research demonstrated that while auto-play features significantly influence viewing behaviour (reported by 85% of survey respondents), viewers express strong interest in features supporting more intentional viewing patterns. Analysis of actual viewing data from BBC iPlayer showed how release strategies can impact viewing patterns, with some viewers consuming up to ten episodes (approximately 7.9 hours) on the first day of release.
The framework shows promise beyond media consumption, offering potential applications for understanding engagement patterns across various domains of human behaviour. The research has significant implications for both academia and industry, contributing to theoretical understanding while providing practical guidance for developing more user-centric streaming interfaces. By integrating perspectives from viewers, data analysis, and industry professionals, this research aims to influence industry practices in ways that better serve viewer needs and wellbeing, while contributing to ongoing dialogue about corporate responsibility in the digital age
The Effect of Interactive Digital Storytelling on Kindergarteners’ Learning of Challenging English Phonemes in their Foreign Language
No full textThis thesis investigated the effectiveness of non interactive digital storytelling (DST) and different degrees of interactive digital storytelling (IDST) in addressing the challenges Saudi EFL kindergartners face in perceiving and distinguishing the English /p/ and /b/ phonemes. It also explored the kindergartners’ enjoyment of DST and different formats of IDST. The thesis involved 125 Saudi EFL kindergartners. The research design included four experimental groups—non-interactive DST, non-targeted IDST, targeted IDST, and highly-targeted IDST—and a control group with non-interactive DST. All experimental groups experienced the same story content presented in different formats, while the control group was exposed to a non interactive DST with different content. Data were collected using a pre- and post-test to measure children’s phoneme perception across words with varying familiarity based on their frequency in the kindergarteners’ curricula. Additionally, a five-point rating task was used to assess children’s enjoyment of different types of DST.
The results showed that all experimental groups outperformed the control group in phoneme perception. Thus, encountering the phonemes more times (i.e., 10 vs. 89) has clear learning benefits. Turning to the experimental conditions, results demonstrated that targeted and highly targeted interactivity improved performance. In Study 1, there was no difference in phoneme perception between the non-interactive DST and the non-targeted IDST groups. Study 2 revealed that the targeted IDST group significantly outperformed the non-targeted IDST group on both familiar and novel word items. In Study 3, no difference in performance was found between the targeted IDST and highly-targeted IDST groups. Across all three studies, children in the IDST groups reported greater enjoyment of the digital stories compared to those in the non-interactive DST group.
Overall, the findings indicate that the amount of phoneme input in DST and IDST learning conditions is crucial for enhancing phoneme perception. While interaction in IDST generally benefits phoneme learning, targeted interactive activities focusing on specific phonemes yield the most significant improvements. The results demonstrate that interactivity not only enhances kindergartners’ phoneme learning but also boosts their enjoyment
Assessing chronic musculoskeletal pain in horses and the effectiveness of the administration of paracetamol in addition to non-steroidal anti-inflammatories for chronic pain
Get PDFEquine lameness is a common problem which affects both equine athletes and geriatric horses, with geriatric horses being at increased risk of lameness (BlueCross, 2018, Ireland et al., 2011). Lameness leads to a shortened working career, increased financial losses and reduction in welfare (Ireland et al., 2012, Marshall et al., 2012). Lameness is also very important to owners, however there is significant under recognition of lameness by owners (Dyson et al., 2017, McGowan et al., 2010). As lameness is a manifestation of pain due to a musculoskeletal injury, when lameness is not recognised horses can continue to be worked leading to compromised welfare (Vinuela-Fernandez et al., 2011). Recognition of musculoskeletal pain relies on assessments including pain scales, subjective lameness grading scales and objective technologies including forceplates, kinematic technology and inertial measurement units. Subjective lameness grading scales have been shown to have marginal agreement between observers especially when considering mild or hindlimb lameness (Dyson, 2011, Hammarberg et al., 2016, Keegan et al., 2010). Objective gait analysis systems may be more reliable especially when considering mild lameness. A narrative review briefly compared both objective and subjective gait analysis systems (Crecan and Peștean, 2023), however there are currently no published systematic reviews which compare the effectiveness of subjective and objective gait analysis.
Once detected, lameness often requires analgesia, with phenylbutazone, a non-steroidal anti-inflammatory drug (NSAID), being most commonly used (De Grauw et al., 2014, Duz et al., 2019, Sabate et al., 2009). However, NSAID use can lead to side effects including gastrointestinal toxicity, with phenylbutazone being the most likely to induce adverse events (Bowen et al., 2020). Paracetamol is used in horses alongside NSAIDs for multi-modal analgesia (Bruniges et al., 2019, West et al., 2011), however to date there are only a few studies published which have investigated its analgesic effect in the horse as a monotherapy (Foreman et al., 2016, Mercer et al., 2023a, Mercer et al., 2023b, Mercer et al., 2022). As a single analgesic at 20mg/kg administered orally, paracetamol has been shown to significantly reduce lameness score and heart rate compared to a control in an inducible acute foot pain model, and was comparable to flunixin meglumine (Foreman et al., 2016). In another acute mechanically induced lameness model, paracetamol at 30mg/kg orally was shown to reduce the lameness score, however 20mg/kg did not (Mercer et al., 2022). This study also compared paracetamol to phenylbutazone, and showed that oral paracetamol at 30mg/kg and oral phenylbutazone at 2.2mg/kg did improve lameness scores compared to the control group, although this occurred at different times post treatment. Mercer et al. (2023a) investigated paracetamol as a monotherapy in horses with naturally occurring chronic lameness and showed that at 30mg/kg orally there was a transient improvement in lameness both subjectively and objectively. Lameness assessments were only performed after administration of 3 weeks of paracetamol at 30mg/kg twice daily orally. Further studies are required to determine the effect of paracetamol on chronic lameness in combination with an NSAID.
This thesis aims to improve our understanding of assessment of chronic musculoskeletal pain in horses and the effectiveness of the administration of paracetamol in addition to an NSAID for chronic pain. The literature review is therefore focused on discussing pain physiology in the horse and how pain is best assessed and recognised. There is a particular focus on musculoskeletal pain recognition including subjective and objective gait assessments. This is followed by a review of NSAID and paracetamol use in the horse. A systematic review was also conducted to review the literature to answer the question ‘In lame horses does objective gait assessment versus subjective gait assessment improve the accuracy of lameness detection?’. Objective and subjective gait analysis techniques were then used to assess the response to the addition of paracetamol treatment in chronically lame horses currently treated with NSAIDs in order to determine whether paracetamol reduced the lameness severity
Difficult conversations: exploring the practitioner role in applying theatre and drama techniques for adult training in UK educational settings
Get PDFThis thesis explores Applied Theatre (AT) with a focus on Forum Theatre (FT) and their processes in my work and the work of another experienced educational theatre practitioner in the UK. As researcher, I examine and reflect on a range of Applied Theatre practices, focusing on three events in UK educational settings. The key theme of these events, common in much AT and FT work is difficult conversations.
I adopted an reflective research methodology, as it aligns with Jackson’s genealogical critical theories in the development of Applied Theatre (Jackson, 2006). To this end I use autoethnography as a central instrument in reflecting on the research, drawing on autobiographical contextual life story vignettes that are used reflexively and retrospectively. My positionality is embedded fundamentally in this autoethnographic approach. The research explores the nature of reflection and importance of reflexivity in the development of my AT practice.
The study aimed to discover how AT practice and practitioners who use applied drama and theatre techniques as a means of change and transformation have evolved. In the progression and processes of AT practice, there has been an increasing demand for clear ethical guidelines or a framework. Some suggestions of what might be useful in an ethical framework, or guidelines, are suggested as outcomes of this research.
My research draws primarily on the AT practices that have their origins and roots derived from Augusto Boal’s Forum Theatre and are heavily influenced by the education and critical theorist, Paulo Freire (Freire, 1970) and his dialogical pedagogical practice.
This study provides a deeper understanding of FT practitioner work. With an ever-growing body of FT practice, this research supports the development and efficacy of my own practice, with the potential to inform current AT practice and future training, and offers advice for potential ethical guidance or frameworks
Optimum performance controls of multiport converter for transport electrification applications
Get PDFDamage information modelling and retrofitting solutions for substandard RC bridges
No full textBridges in developed countries are continually ageing. There is concern about the deterioration of substandard bridges and the possible impact on their safety and performance. The structural assessment of deteriorated bridges is a vital step in the decision-making process for asset management. Currently, there is a growing shift to employing Building Information Modelling (BIM) in the maintenance phase of the infrastructure.
Despite the widespread use of BIM in engineering practice, engineers still rely on the manual generation of simulations based on design documents and inspection reports to verify structural performance.
This research proposes a novel Bridge Damage Information Modeller (BriDIM) framework that combines BIM with advanced numerical modelling using multi Level of Detail (LoD) to assess the severity of damage and provide adequate retrofitting solutions for substandard Reinforced Concrete (RC) bridges. The research identifies the gaps in knowledge, develops Damage Information Modelling (DIM) based on Industry Foundation Classes (IFC) standards to model the As-damaged bridge. An innovative BIM and Finite Element (FE) integration methodology has been proposed. The bi-directional automated data interpretation and exchange between BIM and FE is created to evaluate the residual structural capacity against limit states based on a comprehensive multi-level numerical model. BriDIM automatically feedback FE analysis results into BIM for visualisation.
In addition, if the FE results show that the bridge is at risk, BriDIM implements a retrofitting solution in BIM, develops Retrofitting Information Modelling (RIM), and executes the FE analysis for the As-retrofitted bridge to measure the improvement in the structural behaviour. BriDIM generates a IFC-DIM-RIM file that contains general and engineering information about the bridge component, inspection process, damage instances, retrofitting process, retrofitting instances, and the objectified relationships in IFC standards
The research findings suggest that utilising BIM as a database that includes structural specifications, damage information and retrofitting aspects brings benefits in terms of consistency, modelling and computational efficiency throughout the life cycle of a structure. The proposed framework transforms the way we approach assessments by consolidating all mechanical damage-related information into one 3D visualised BIM model. Ultimately, BriDIM holds potential in facilitating the development of Digital Twins for existing structures. The model can be used to create scenarios of various damage combinations and provide a reliable tool to simulate the current condition of the bridge and the expected conditions of the bridge in case of damage propagation or change in environmental conditions
Glutamine metabolism and DNA repair in breast cancer
Get PDFMetabolic reprogramming and genomic instability are two key cancer hallmarks. The link between these two hallmarks in different types of cancer has yet to be fully explored. Cancer cells alter their metabolic pathways to meet their necessary energy and cellular block demands. They also modulate the expression of their DNA repair proteins to encounter the DNA damage caused by exogenous and endogenous factors, such as reactive oxygen species. This thesis investigates the association between glutamine metabolism and the DNA repair pathway in breast cancer, focusing on Solute Carrier Family 7 Member 5 (SLC7A5) and two DNA repair proteins, Flap endonuclease 1 (FEN1) and Exonuclease 1 (EXO1). These genes were selected based on their moderate positive correlation at the mRNA level, as identified through Breast Cancer Gene-Expression Miner v5.1 (bc-GenExMiner v5.1) dataset, and due to their established biological relevance in previous cancer studies. SLC7A5 functions as an amino acid exchanger, mediating the uptake of essential large neutral amino acids, particularly leucine, in exchange for intracellular glutamine. This activity supports glutamine-dependent mammalian target of rapamycin complex 1 (mTORC1) signalling, which fuels cell growth and biosynthesis. Meanwhile, FEN1 and EXO1 are structure-specific nucleases involved in distinct DNA repair pathways, base excision repair and mismatch repair, respectively, both play critical roles in preserving genomic stability under oxidative stress.
The biological and clinical outcome of SLC7A5 co-expression with either FEN1 or EXO1 was assessed in large, annotated cohorts of breast cancer at the mRNA and protein levels. In vitro, functional assay experiments were conducted to find the role of SLC7A5/FEN1 high expression in tumour behaviour, and further proteomic analysis was carried out to find common interacting proteins between the two pathways.
The high expression of SLC7A5 and either FEN1 or EXO1 at the mRNA and protein level was associated with poor prognosis, while the high expression of SLC7A5/FEN1 was linked to adverse outcomes in ER-positive tumours, and the high expression of SLC7A5/EXO1 was associated with poor outcomes in ER-negative tumours. Assay experiments demonstrated that double knockdown of SLC7A5 and FEN1 impaired proliferation, reduced breast cancer cell migration and invasion ability, caused S phase cell cycle arrest, and induced apoptosis. Furthermore, the dual knockdown of SLC7A5 and FEN1 disrupted mitochondrial function, marked by reduced ATP production and respiratory capacity, reinforcing their role in maintaining metabolic fitness. Proteomic analysis identified shared interacting proteins enriched in pathways related to DNA repair, RNA metabolism, and mitochondrial function, supporting a functional link between these biological systems.
Collectively, this thesis explored a novel association between glutamine metabolism and DNA repair pathways in breast cancer. The findings position SLC7A5/FEN1 and SLC7A5/EXO1 high expression as clinically relevant prognostic biomarkers and lay the foundation for therapeutic strategies that co-target metabolic and DNA repair vulnerabilities in breast cancer
Ginger, ethnicity and brown adipose tissue activity: investigating the thermogenic potential through in vitro and in vivo approaches
No full textBackground
The ongoing obesity pandemic affects millions of people worldwide, with the rapid increase in obesity rates among individuals from different age groups and ethnicities posing a major public health concern. Brown adipose tissue (BAT) is known to be present in neonates, to maintain body core temperature. Since the rediscovery of BAT in adults in small quantities and its ability to be activated using external stimuli, such as cold exposure, medication or food compounds, it has become a focus of research to maximise its potential anti-obesity benefits. Brown fat also plays a vital role in regulating energy and glucose homeostasis within the body through a process known as non-shivering thermogenesis.
Aim
This thesis aimed to expand knowledge of BAT physiology in response to food compounds by considering confounding factors such as ethnicity via a systematic review approach; in-vitro studies to assess the role of 6-gingerol (a bioactive compound found in fresh ginger) in inducing BAT-like activity; and using a non-invasive technique that measures supraclavicular skin temperature (TSCR) to assess the effects of gingerol on BAT activity.
Method
The systematic review protocol was registered with PROSPERO (CRD42023423461). A comprehensive search was conducted across three data bases (Cochrane, PubMed and Embase) using predefined keywords. Screening involved reviewing titles, abstracts and references to identify studies meeting the inclusion criteria. The search strategy had no restriction on language, publication date, region, gender or intervention type.
Cell culture experiments were conducted at the Biodiscovery Institute of the University of Nottingham (UON), using immortalised human mesenchymal stem cells (IHMSCs) and human dermal fibroblasts (HDFs). Adipogenesis was induced through: (1) non-viral gene delivery using the GAG-binding enhanced transduction (GET) system, for plasmid DNA and peptides; and (2) exposure to 6-gingerol (a bioactive compound found in fresh ginger) to assess its potential role in promoting BAT-like characteristics. Cellular transformation was evaluated using Oil Red O staining (lipid accumulation), qPCR (gene expression of BAT markers) and immunocytochemistry (protein detection)
For the experimental clinical study, participants (aged 18 -45 years, BMI 18.5- 40kg/m2) were recruited through word of mouth, an e-poster and physical posters at the University of Nottingham. Eligibility was determined based on informed consent and predefined criteria (FMHS 85-1022, V2.0:10.07.2023). A randomised, double-blind controlled study was conducted during the winter season in a controlled thermal setting within the Academic Imaging Suite, Queen’s Medical Centre, UoN. BAT activity was assessed using thermal imaging and the PPG stress flow machine to evaluate physiological responses following capsule ingestion.
Result
The first result of the systematic review and meta-analysis included in the final analysis four studies, selected from a total of 6,684. Across these studies, there was an equal representation of 44 Asian and 44 European participants, totalling 88 individuals, examined for BAT characteristics. The results showed no difference in BAT activity between healthy Asian and European male adults.
The second study examined the effect of increasing concentration of 6-gingerol on the mesenchymal stem cells (MSC) differentiated in adipogenesis media. The results showed that the cells reprogrammed into adipocytes with characteristics of BAT, suggesting a beige phenotype.
The third study was a double-blind controlled study conducted on 52 participants, with an equal number of males and females. No significant difference was observed in BAT activity, nor did PPG stress flow measurements indicate any changes in the sympathetic nervous system following ginger/placebo capsule ingestion in either group.
Conclusion
In conclusion, the systematic review found no significant difference in BAT activity between Asian and European individuals. A significant gap exists in this area, primarily due to the lack of robust studies comparing different ethnicities. The study conducted in this thesis shows that consuming ginger in the form of 6-gingerol does not have an acute effect on BAT thermogenesis in adults. Seasonal variation seems to play a role in influencing the study’s significance. However, treating cells with 6-gingerol may encourage the development of BAT characteristics in adipocytes
Access Repository Dashboard
Do you manage Open Research Online? Become a CORE Member to access insider analytics, issue reports and manage access to outputs from your repository in the CORE Repository Dashboard! 👇