• Comparing physician associates and foundation year two doctors-in-training undertaking emergency medicine consultations in England: a mixed-methods study of processes and outcomes

      Halter, Mary; orcid: 0000-0001-6636-0621; Drennan, Vari; orcid: 0000-0002-8915-5185; Wang, Chao; Wheeler, Carly; Gage, Heather; Nice, Laura; de Lusignan, Simon; orcid: 0000-0001-5613-6810; Gabe, Jonathan; Brearley, Sally; Ennis, James; et al. (BMJ Publishing Group, 2020-09-01)
      Objectives: To compare the contribution of physician associates to the processes and outcomes of emergency medicine consultations with that of foundation year two doctors-in-training. Design: Mixed-methods study: retrospective chart review using 4 months’ anonymised clinical record data of all patients seen by physician associates or foundation year two doctors-in-training in 2016; review of a subsample of 40 records for clinical adequacy; semi-structured interviews with staff and patients; observations of physician associates. Setting: Three emergency departments in England. Participants: The records of 8816 patients attended by 6 physician associates and 40 foundation year two doctors-in-training; of these n=3197 had the primary outcome recorded (n=1129 physician associates, n=2068 doctor); 14 clinicians and managers and 6 patients or relatives for interview; 5 physician associates for observation. Primary and secondary outcome measures: The primary outcome was unplanned re-attendance at the same emergency department within 7 days. Secondary outcomes: consultation processes, clinical adequacy of care, and staff and patient experience. Results: Re-attendances within 7 days (n=194 (6.1%)) showed no difference between physician associates and foundation year two doctors-in-training (OR 0.87, 95% CI 0.61 to 1.24, p=0.437). If seen by a physician associate, patients were more likely receive an X-ray investigation (OR 2.10, 95% CI 1.72 to 4.24), p<0.001), after adjustment for patient characteristics, triage severity of condition and statistically significant clinician intraclass correlation. Clinical reviewers found almost all patients’ charts clinically adequate. Physician associates were evaluated as assessing patients in a similar way to foundation year two doctors-in-training and providing continuity in the team. Patients were positive about the care they had received from a physician associate, but had poor understanding of the role. Conclusions: Physician associates in emergency departments in England treated patients with a range of conditions safely, and at a similar level to foundation year two doctors-in-training, providing clinical operational efficiencies.
    • Comparing physician associates and foundation year two doctors-in-training undertaking emergency medicine consultations in England: a mixed-methods study of processes and outcomes.

      Halter, Mary; orcid: 0000-0001-6636-0621; email: m.halter@sgul.kingston.ac.uk; Drennan, Vari; orcid: 0000-0002-8915-5185; Wang, Chao; Wheeler, Carly; Gage, Heather; Nice, Laura; de Lusignan, Simon; orcid: 0000-0001-5613-6810; Gabe, Jonathan; Brearley, Sally; Ennis, James; et al. (2020-09-01)
      To compare the contribution of physician associates to the processes and outcomes of emergency medicine consultations with that of foundation year two doctors-in-training. Mixed-methods study: retrospective chart review using 4 months' anonymised clinical record data of all patients seen by physician associates or foundation year two doctors-in-training in 2016; review of a subsample of 40 records for clinical adequacy; semi-structured interviews with staff and patients; observations of physician associates. Three emergency departments in England. The records of 8816 patients attended by 6 physician associates and 40 foundation year two doctors-in-training; of these n=3197 had the primary outcome recorded (n=1129 physician associates, n=2068 doctor); 14 clinicians and managers and 6 patients or relatives for interview; 5 physician associates for observation. The primary outcome was unplanned re-attendance at the same emergency department within 7 days. consultation processes, clinical adequacy of care, and staff and patient experience. Re-attendances within 7 days (n=194 (6.1%)) showed no difference between physician associates and foundation year two doctors-in-training (OR 0.87, 95% CI 0.61 to 1.24, p=0.437). If seen by a physician associate, patients were more likely receive an X-ray investigation (OR 2.10, 95% CI 1.72 to 4.24), p<0.001), after adjustment for patient characteristics, triage severity of condition and statistically significant clinician intraclass correlation. Clinical reviewers found almost all patients' charts clinically adequate. Physician associates were evaluated as assessing patients in a similar way to foundation year two doctors-in-training and providing continuity in the team. Patients were positive about the care they had received from a physician associate, but had poor understanding of the role. Physician associates in emergency departments in England treated patients with a range of conditions safely, and at a similar level to foundation year two doctors-in-training, providing clinical operational efficiencies. [Abstract copyright: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.]
    • A quest for relaxation? A figurational analysis of the transformation of yoga into a global leisure time phenomenon

      Thurston, Miranda; orcid: 0000-0001-7779-3836; Bloyce, Daniel; orcid: 0000-0003-4114-3588 (Informa UK Limited, 2020-08-31)
    • The ethical challenge of Big Tech’s “disruptive philanthropy”

      Manning, Paul; orcid: 0000-0003-3231-3653; Baker, Nigel; Stokes, Peter (Informa UK Limited, 2020-08-31)
    • Rethinking role models in general practice.

      Holden, John; Cox, Stephen; Irving, Greg (2020-08-27)
    • A review of organic waste enrichment for inducing palatability of black soldier fly larvae: Wastes to valuable resources.

      Raksasat, Ratchaprapa; Lim, Jun Wei; email: junwei.lim@utp.edu.my; Kiatkittipong, Worapon; Kiatkittipong, Kunlanan; Ho, Yeek Chia; Lam, Man Kee; Font-Palma, Carolina; Mohd Zaid, Hayyiratul Fatimah; Cheng, Chin Kui (2020-08-26)
      The increase of annual organic wastes generated worldwide has become a major problem for many countries since the mismanagement could bring about negative effects on the environment besides, being costly for an innocuous disposal. Recently, insect larvae have been investigated to valorize organic wastes. This entomoremediation approach is rising from the ability of the insect larvae to convert organic wastes into its biomass via assimilation process as catapulted by the natural demand to complete its lifecycle. Among the insect species, black soldier fly or Hermetia illucens is widely researched since the larvae can grow in various environments while being saprophagous in nature. Even though black soldier fly larvae (BSFL) can ingest various decay materials, some organic wastes such as sewage sludge or lignocellulosic wastes such as waste coconut endosperm are destitute of decent nutrients that could retard the BSFL growth. Hence, blending with nutrient-rich low-cost substrates such as palm kernel expeller, soybean curd residue, etc. is employed to fortify the nutritional contents of larval feeding substrates prior to administering to the BSFL. Alternatively, microbial fermentation can be adopted to breakdown the lignocellulosic wastes, exuding essential nutrients for growing BSFL. Upon reaching maturity, the BSFL can be harvested to serve as the protein and lipid feedstock. The larval protein can be made into insect meal for farmed animals, whilst the lipid source could be extracted and transesterified into larval biodiesel to cushion the global energy demands. Henceforth, this review presents the influence of various organic wastes introduced to feed BSFL, targeting to reduce wastes and producing biochemicals from mature larvae through entomoremediation. Modification of recalcitrant organic wastes via fermentation processes is also unveiled to ameliorate the BSFL growth. Lastly, the sustainable applications of harvested BSFL biomass are as well covered together with the immediate shortcomings that entail further researches. [Abstract copyright: Copyright © 2020 Elsevier Ltd. All rights reserved.]
    • Identity, Culture and Belonging: Educating Young Children for a Changing World

      Power, Michael; orcid: 0000-0002-9926-094X (Informa UK Limited, 2020-08-24)
    • Are advance care plans of any value?

      Willis, Derek; orcid: 0000-0003-2286-2827; email: derekw@severnhospice.org.uk; George, Rob (2020-08-21)
    • Do educators realise the value of Bring Your Own Device (BYOD) in fieldwork learning?

      Clark, Katherine A.; orcid: 0000-0001-6712-1569; Welsh, Katharine E.; Mauchline, Alice L.; France, Derek; orcid: 0000-0001-6874-6800; Whalley, W. Brian; Park, Julian (Informa UK Limited, 2020-08-20)
    • ‘Even if you don’t care…you do care after all’: ‘Othering’ and physical education in Norway

      Røset, Linda; Green, Ken; Thurston, Miranda (SAGE Publications, 2020-08-18)
      In the past decade or more, improving young people’s mental health has been identified as a priority for policy-makers in many countries, including Norway. Physical education, as a setting for physical activity, is increasingly viewed as having a potentially significant role to play in addressing mental health among the young. This paper reports the findings from a study of 148 Norwegian youngsters (68 girls and 80 boys) from the 10th grade (15–16 years old) in eight secondary schools in Norway in 2017. It explores Norwegian youngsters’ experiences of physical education in relation to aspects of their mental health – specifically, being judged and, by extension, ‘othered’. The findings suggest that physical education may undoubtedly serve to generate positive feelings associated with physical activity and games and, in doing so, bolster some youngsters’ self-esteem and self-identities. On the other hand, however, for those less competent in sporting terms, and whose bodily self-image is not particularly positive, the public nature of physical education and the nature of the activities that constitute the subject can give rise to unplanned and unintended harm to some youngsters’ mental health – especially in countries, such as Norway, where sport is a significant aspect of the group habitus and collective ‘we-group’ identity.
    • Terahertz Signatures of Hydrate Formation in Alkali Halide Solutions.

      Chen, Ligang; Ren, Guanhua; Liu, Liyuan; orcid: 0000-0002-7050-3792; Guo, Pan; Wang, Endong; Zhou, Lu; Zhu, Zhongjie; Zhang, Jianbing; Yang, Bin; Zhang, Wentao; et al. (2020-08-18)
      We systematically studied the ability of 20 alkali halides to form solid hydrates in the frozen state from their aqueous solutions by terahertz time-domain spectroscopy combined with density functional theory (DFT) calculations. We experimentally observed the rise of new terahertz absorption peaks in the spectral range of 0.3-3.5 THz in frozen alkali halide solutions. The DFT calculations prove that the rise of observed new peaks in solutions containing Li , Na , or F ions indicates the formation of salt hydrates, while that in other alkali halide solutions is caused by the splitting phonon modes of the imperfectly crystallized salts in ice. As a simple empirical rule, the correlation between the terahertz signatures and the ability of 20 alkali halides to form a hydrate has been established.
    • ‘Even if you don’t care…you do care after all’: ‘Othering’ and physical education in Norway

      Røset, Linda; Green, Ken; Thurston, Miranda (SAGE Publications, 2020-08-18)
      In the past decade or more, improving young people’s mental health has been identified as a priority for policy-makers in many countries, including Norway. Physical education, as a setting for physical activity, is increasingly viewed as having a potentially significant role to play in addressing mental health among the young. This paper reports the findings from a study of 148 Norwegian youngsters (68 girls and 80 boys) from the 10th grade (15–16 years old) in eight secondary schools in Norway in 2017. It explores Norwegian youngsters’ experiences of physical education in relation to aspects of their mental health – specifically, being judged and, by extension, ‘othered’. The findings suggest that physical education may undoubtedly serve to generate positive feelings associated with physical activity and games and, in doing so, bolster some youngsters’ self-esteem and self-identities. On the other hand, however, for those less competent in sporting terms, and whose bodily self-image is not particularly positive, the public nature of physical education and the nature of the activities that constitute the subject can give rise to unplanned and unintended harm to some youngsters’ mental health – especially in countries, such as Norway, where sport is a significant aspect of the group habitus and collective ‘we-group’ identity.
    • Terahertz Signatures of Hydrate Formation in Alkali Halide Solutions

      Chen, Ligang; Ren, Guanhua; Liu, Liyuan; orcid: 0000-0002-7050-3792; Guo, Pan; Wang, Endong; Zhou, Lu; Zhu, Zhongjie; Zhang, Jianbing; Yang, Bin; Zhang, Wentao; et al. (American Chemical Society (ACS), 2020-08-18)
    • The impact of factor infusion frequency on health-related quality of life in people with haemophilia

      Pedra, Gabriel; Christoffersen, Pia; Khair, Kate; Lee, Xin Ying; O’Hara, Sonia; O’Hara, Jamie; Pasi, John (Haemnet, 2020-08-15)
      AbstractBackgroundSome studies suggest that people with haemophilia (PwH) who use prophylaxis value low frequency of clotting factor administration more than a lower risk of bleeding. However, more frequent infusions offer the potential of reducing joint disease and pain, which in turn may improve functioning and quality of life.AimsTo explore the impact on health-related quality of life (HRQoL) aspects of haemophilia associated with adherence and annual infusion rate in the context of factors influencing treatment that are important to patients, including prophylaxis, chronic pain, concomitant conditions and hospital admission.Materials and methodsHRQoL was assessed in participants with severe haemophilia in the ‘Cost of Haemophilia in Europe: a Socioeconomic Survey’ (CHESS) study who were using prophylaxis. Patients using on-demand treatment were excluded. This multivariate analysis examined the interaction between factors potentially influencing treatment and HRQoL, and minor and major bleeds.ResultsFrom the total CHESS population (n=1,285), 338 (26%) participants provided responses for major and minor bleeds and target joints, and 145 (11%) provided EQ-5D-3L responses. Major and minor bleeds were associated with pain. Patients with severe chronic pain reported a substantial negative impact on HRQoL; but this was significantly improved by increases in the annual infusion rate. This was not apparent in participants with mild or moderate pain.ConclusionIncreasing the frequency of prophylaxis infusions is associated with improved quality of life in PwH who have severe chronic pain. However, increasing the number of infusions per week in those with mild or moderate chronic pain with the intention of improving prophylactic effect may not have the same effect.
    • Self-dual codes using bisymmetric matrices and group rings

      Gildea, J.; email: j.gildea@chester.ac.uk; Kaya, A.; email: abidin.kaya@harmonytx.org; Korban, A.; orcid: 0000-0001-5206-6480; email: adrian3@windowslive.com; Tylyshchak, A.; email: alxtlk@bigmir.net (Elsevier, 2020-08-14)
      Abstract In this work, we describe a construction in which we combine together the idea of a bisymmetric matrix and group rings. Applying this construction over the ring F 4 + u F 4 together with the well known extension and neighbour methods, we construct new self-dual codes of length 68 . In particular, we find 41 new codes of length 68 that were not known in the literature before.
    • Aneurysm Growth After Endovascular Sealing of Abdominal Aortic Aneurysms (EVAS) with the Nellix Endoprosthesis.

      Yafawi, Asma; email: asma@yafawi.com; McWilliams, Richard G; Fisher, Robert K; England, Andrew; Karouki, Maria; Uhanowita Marage, Ruwanka; Torella, Francesco (2020-08-14)
      The aim of this study was to measure the incidence of post endovascular aneurysm sealing (EVAS) abdominal aortic aneurysm (AAA) growth, and its association with stent migration, in a cohort of patients with differing compliance to old and new Instructions For Use (IFU). A retrospective single centre study was conducted to review the computed tomography (CT) and clinical data of elective, infrarenal EVAS cases, performed as a primary intervention, between December 2013 and March 2018. All included patients had a baseline post-operative CT scan at one month and at least one year follow up. The primary outcome measure was the incidence of AAA growth and its association with stent migration. AAA growth was defined as a ≥5% increase in aortic volume between the lowermost renal artery and the aortic bifurcation post EVAS at any time during follow up, in comparison to the baseline CT scan. Migration was defined according to the ESVS guidelines, as > 10 mm downward movement of either Nellix stent frame in the proximal zone. Seventy-six patients were eligible for inclusion in the study (mean age 76 ± 7.4 years; 58 men). AAA growth was identified in 50 of 76 patients (66%); adherence to IFU did not affect its incidence (mean growth within IFU-2016 compliant cohort vs. non-compliant: 16% vs. 13%, p = .33). Over time, the incidence of AAA growth increased, from 32% at one year to 100% at four years. AAA growth by volume was progressive (p < .001), as its extent increased over time. Migration was detected in 16 patients and there was a statistically significant association with AAA growth (13 patients displayed migration and AAA growth, p = .036). Patients treated with EVAS are prone to AAA growth, irrespective of whether their aortic anatomy is IFU compliant. AAA growth by volume is associated with stent migration. Clinicians should continue close surveillance post EVAS, regardless of whether patients are treated within IFU. [Abstract copyright: Copyright © 2020. Published by Elsevier B.V.]
    • The role of specific biomarkers, as predictors of post-operative complications following flexible ureterorenoscopy (FURS), for the treatment of kidney stones: a single-centre observational clinical pilot-study in 37 patients.

      Hughes, Stephen Fôn; orcid: 0000-0001-6558-9037; email: Stephen.hughes6@wales.nhs.uk; Moyes, Alyson Jayne; Lamb, Rebecca May; Ella-tongwiis, Peter; Bell, Christopher; Moussa, Ahmed; Shergill, Iqbal (2020-08-14)
      The number of patients diagnosed and subsequently treated for kidney stones is increasing, and as such the number of post-operative complications is likely to increase. At present, little is known about the role of specific biomarkers, following flexible ureterorenoscopy (FURS) for the surgical treatment of kidney stones. The main aim of the study was to evaluate the role of kidney and infection biomarkers, in patients undergoing FURS. Included were 37 patients (24 males, 13 females), who underwent elective FURS, for the treatment of kidney stones. Venous blood samples were collected from each patient: pre-operatively, and at 30 min, 2 and 4 h post-operatively. Changes to kidney (NGAL, Cystatin-C) and infection (MPO, PCT) biomarkers was quantified by means of ELISA, Biomerieux mini-vidas and Konelab 20 analysers. Four patients developed post-operative complications (3 - UTIs with urinary retention, 1 - urosepsis. NGAL concentration increased significantly following FURS (p = 0.034). Although no significant changes were seen in Cystatin C, MPO and PCT (p ≥ 0.05) some key clinical observation were noted. Limiting factors for this study were the small number of patients recruited and restriction in blood sampling beyond 4 h. Although not confirmative, changes seen to biomarkers such as Cystatin C, NGAL and MPO in our observational clinical pilot-study may warrant further investigation, involving larger cohorts, to fully understand the role of these biomarkers and their potential association with post-operative complications which can develop following FURS.
    • The role of specific biomarkers, as predictors of post-operative complications following flexible ureterorenoscopy (FURS), for the treatment of kidney stones: a single-centre observational clinical pilot-study in 37 patients

      Hughes, Stephen Fôn; orcid: 0000-0001-6558-9037; email: Stephen.hughes6@wales.nhs.uk; Moyes, Alyson Jayne; Lamb, Rebecca May; Ella-tongwiis, Peter; Bell, Christopher; Moussa, Ahmed; Shergill, Iqbal (BioMed Central, 2020-08-14)
      Abstract: Background: The number of patients diagnosed and subsequently treated for kidney stones is increasing, and as such the number of post-operative complications is likely to increase. At present, little is known about the role of specific biomarkers, following flexible ureterorenoscopy (FURS) for the surgical treatment of kidney stones. The main aim of the study was to evaluate the role of kidney and infection biomarkers, in patients undergoing FURS. Methods: Included were 37 patients (24 males, 13 females), who underwent elective FURS, for the treatment of kidney stones. Venous blood samples were collected from each patient: pre-operatively, and at 30 min, 2 and 4 h post-operatively. Changes to kidney (NGAL, Cystatin-C) and infection (MPO, PCT) biomarkers was quantified by means of ELISA, Biomerieux mini-vidas and Konelab 20 analysers. Results: Four patients developed post-operative complications (3 - UTIs with urinary retention, 1 - urosepsis. NGAL concentration increased significantly following FURS (p = 0.034). Although no significant changes were seen in Cystatin C, MPO and PCT (p ≥ 0.05) some key clinical observation were noted. Limiting factors for this study were the small number of patients recruited and restriction in blood sampling beyond 4 h. Conclusions: Although not confirmative, changes seen to biomarkers such as Cystatin C, NGAL and MPO in our observational clinical pilot-study may warrant further investigation, involving larger cohorts, to fully understand the role of these biomarkers and their potential association with post-operative complications which can develop following FURS.
    • Biomechanical measures of short-term maximal cycling on an ergometer: a test-retest study

      Burnie, Louise; Barratt, Paul; Davids, Keith; orcid: 0000-0003-1398-6123; Worsfold, Paul; Wheat, Jon; orcid: 0000-0002-1107-6452 (Informa UK Limited, 2020-08-11)