• Blue and grey urban water footprints through citizens’ perception and time series analysis of Brazilian dynamics

      Souza, Felipe Augusto Arguello; orcid: 0000-0002-2753-9896; Bhattacharya-Mis, Namrata; orcid: 0000-0003-4967-8325; Restrepo-Estrada, Camilo; orcid: 0000-0001-7953-1768; Gober, Patricia; Taffarello, Denise; orcid: 0000-0003-0093-0542; Tundisi, José Galizia; Mendiondo, Eduardo Mario; orcid: 0000-0003-2319-2773 (Informa UK Limited, 2021-03-04)
    • Evaluating the impact of COVID-19 on supportive care needs, psychological distress and quality of life in UK cancer survivors and their support network.

      Hulbert-Williams, Nicholas J; orcid: 0000-0001-9041-5485; Leslie, Monica; Hulbert-Williams, Lee; Smith, Eilidh; Howells, Lesley; Pinato, David J (2021-03-25)
      The COVID-19 pandemic is having considerable impact on cancer care, including restricted access to hospital-based care, treatment and psychosocial support. We investigated the impact on unmet needs and psychosocial well-being. One hundred and forty four participants (77% female), including people with cancer and their support networks, were recruited. The most prevalent diagnosis was breast cancer. Forty-one participants recruited pre-pandemic were compared with 103 participants recruited during the COVID-19 pandemic. We measured participants' unmet supportive care needs, psychological distress and quality of life. Half of our patient respondents reported unexpected changes to treatment following pandemic onset, with widespread confusion about their longer-term consequences. Although overall need levels have not increased, specific needs have changed in prominence. People with cancer reported significantly reduced anxiety (p = 0.049) and improved quality of life (p = 0.032) following pandemic onset, but support network participants reported reduced quality of life (p = 0.009), and non-significantly elevated anxiety, stress and depression. Psychological well-being of people with cancer has not been detrimentally affected by pandemic onset. Reliance on home-based support to compensate for the lost availability of structured healthcare pathways may, however, explain significant and detrimental effects on the well-being and quality of life of people in their support and informal care networks. [Abstract copyright: © 2021 The Authors. European Journal of Cancer Care published by John Wiley & Sons Ltd.]
    • Current strength, temperature, and bodyscape modulate cleaning services for giant manta rays

      Murie, Calum; Spencer, Matthew; Oliver, Simon P.; orcid: 0000-0002-2975-1233; email: s.oliver@chester.ac.uk (Springer Berlin Heidelberg, 2020-04-07)
      Abstract: The cleaner–client system among reef teleosts has received considerable attention in both wild and captive environments, but the spatially and taxonomically diverse associations between cleaner fish and elasmobranchs are less understood. Using remote video, we investigated interactions between giant manta rays (Mobula birostris) and cleaner wrasse at a seamount in the Philippines. Cleaning events occurred between 11:00 and 16:00 h on a seasonal basis and were constrained by current strengths and ambient water temperatures. The frequency with which giant manta rays interacted with cleaner fish varied on an individual basis. Blue streaked cleaner wrasse (Labroides dimidiatus) and moon wrasse (Thalassoma lunare) selectively foraged on manta rays’ gills and pelvis, with L. dimidiatus also demonstrating slight preferences for the pectoral fins. Cleaners’ foraging preferences may indicate ectoparasitic infections in specific areas of a manta ray’s body. The exclusivity with which giant manta rays visited a particular cleaning station on the seamount may be a response to the quality of services that cleaners provide there. Giant mantas’ fidelity to this site may also be attributed to localised concentrations of food that are available nearby. The seamount provides habitat that appears to be important to the life history strategies of the region’s giant manta rays.
    • The Fall of the House of Wynnstay: The 1885 Election in East Denbighshire

      Peters, Lisa; University of Chester (University of Wales Press, 2021-06)
      This article discusses the 1885 election in East Denbighshire when the Williams-Wynn family of Wynnstay lost the parliamentary seat that the family had represented for over 170 years. The election took place amidst the backdrop of legislative changes to corrupt practices, the electorate, and changing constituency boundaries. Conservative and Liberal party organisation in East Denbighshire is discussed.
    • Clinical, humanistic, and economic burden of severe hemophilia B in the United States: Results from the CHESS US and CHESS US+ population surveys.

      Burke, Tom; Asghar, Sohaib; orcid: 0000-0001-8276-0131; O'Hara, Jamie; Sawyer, Eileen K; Li, Nanxin; email: n.li@uniqure.com (2021-03-20)
      Hemophilia B is a rare congenital bleeding disorder that has a significant negative impact on patients' functionality and health-related quality of life. The standard of care for severe hemophilia B in the United States is prophylactic factor IX replacement therapy, which incurs substantial costs for this lifelong condition. Accurate estimates of the burden of hemophilia B are important for population health management and policy decisions, but have only recently accounted for current management strategies. The 'Cost of Severe Hemophilia across the US: a Socioeconomic Survey' (CHESS US) is a cross-sectional database of medical record abstractions and physician-reported information, completed by hematologists and care providers. CHESS US+ is a complementary database of completed questionnaires from patients with hemophilia. Together, CHESS US and CHESS US+ provide contemporary, comprehensive information on the burden of severe hemophilia from the provider and patient perspectives. We used the CHESS US and CHESS US+ data to analyze the clinical, humanistic, and economic burden of hemophilia B for patients treated with factor IX prophylaxis between 2017 and 2019 in the US. We conducted analysis to assess clinical burden and direct medical costs from 44 patient records in CHESS US, and of direct non-medical costs, indirect costs, and humanistic burden (using the EQ-5D-5L) from 57 patients in CHESS US+. The mean annual bleed rate was 1.73 (standard deviation, 1.39); approximately 9% of patients experienced a bleed-related hospitalization during the 12-month study period. Nearly all patients (85%) reported chronic pain, and the mean EQ-5D-5L utility value was 0.76 (0.24). The mean annual direct medical cost was $614,886, driven by factor IX treatment (mean annual cost, $611,971). Subgroup analyses showed mean annual costs of $397,491 and $788,491 for standard and extended half-life factor IX treatment, respectively. The mean annual non-medical direct costs and indirect costs of hemophilia B were $2,371 and $6,931. This analysis of patient records and patient-reported outcomes from CHESS US and CHESS US+ provides updated information on the considerable clinical, humanistic, and economic burden of hemophilia B in the US. Substantial unmet needs remain to improve patient care with sustainable population health strategies.
    • National Health Service interventions in England to improve care to Armed Forces veterans.

      Bacon, Andrew; email: andy.bacon@nhs.net; Martin, E; Swarbrick, R; Treadgold, A (2021-03-19)
      Armed Forces veterans (AFVs) are first and foremost citizens of the UK and are therefore-like all UK residents-entitled to universal healthcare, free at the point of need. This means that AFVs have nearly all their healthcare needs met by the NHS, which provides access to a full range of generic services. However, since 2013 there has been an Armed Forces team that can also support veterans. This review is an assessment of the work of this group over the last eight years. The health needs of AFVs have been investigated and are not significantly different from those of their demographically matched peers. However, due to their demographics, selection at recruitment and their roles, AFVs compared with the general population are more likely to be male, white and old and have fewer pre-existing or hereditary conditions. However, they do suffer from higher rates of musculoskeletal injury, different patterns of mental health illness and have historically been higher users-and abusers-of alcohol and tobacco. In addition to supporting mainstream services used by AFVs, the NHS in England commissions a bespoke range-specific NHS services such as those for mental health or for rehabilitation of veterans using prostheses. New interventions are continuing to be developed to improve AFVs' healthcare and are aligned to the NHS Long Term Plan and the restoration and recovery plans after the COVID-19 pandemic. [Abstract copyright: © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.]
    • Humanity, expectations, access and transformation (HEAT): revisiting South African higher education entrance assessment in a postcolonial context

      Francis, Suzanne; Lewis, Janine; Fredericks, Brenton; Johnson, Belinda (Informa UK Limited, 2020-07-19)
    • Student authored atlas tours (story maps) as geography assignments

      Treves, Richard; Mansell, Damien; France, Derek; orcid: 0000-0001-6874-6800 (Informa UK Limited, 2020-10-21)
    • The emotional face of anorexia nervosa: The neural correlates of emotional processing.

      Halls, Daniel; orcid: 0000-0002-5372-3179; Leslie, Monica; Leppanen, Jenni; Sedgewick, Felicity; Surguladze, Simon; Fonville, Leon; Lang, Katie; Simic, Mima; Nicholls, Dasha; Williams, Steven; et al. (2021-03-19)
      Social-emotional processing difficulties have been reported in Anorexia Nervosa (AN), yet the neural correlates remain unclear. Previous neuroimaging work is sparse and has not used functional connectivity paradigms to more fully explore the neural correlates of emotional difficulties. Fifty-seven acutely unwell AN (AAN) women, 60 weight-recovered AN (WR) women and 69 healthy control (HC) women categorised the gender of a series of emotional faces while undergoing Functional Magnetic Resonance Imaging. The mean age of the AAN group was 19.40 (2.83), WR 18.37 (3.59) and HC 19.37 (3.36). A whole brain and psychophysical interaction connectivity approach was used. Parameter estimates from significant clusters were extracted and correlated with clinical symptoms. Whilst no group level differences in whole brain activation were demonstrated, significant group level functional connectivity differences emerged. WR participants showed increased connectivity between the bilateral occipital face area and the cingulate, precentral gyri, superior, middle, medial and inferior frontal gyri compared to AAN and HC when viewing happy valenced faces. Eating disorder symptoms and parameter estimates were positively correlated. Our findings characterise the neural basis of social-emotional processing in a large sample of individuals with AN. [Abstract copyright: © 2021 The Authors. Human Brain Mapping published by Wiley Periodicals LLC.]
    • Social network analysis of small social groups: Application of a hurdle GLMM approach in the Alpine marmot ( Marmota marmota )

      Panaccio, Matteo; orcid: 0000-0002-1903-154X; Ferrari, Caterina; Bassano, Bruno; Stanley, Christina R.; orcid: 0000-0002-5053-4831; von Hardenberg, Achaz; orcid: 0000-0002-9899-1687 (Wiley, 2021-03-24)
    • Should you be using mobile technologies in teaching? Applying a pedagogical framework

      France, Derek; orcid: 0000-0001-6874-6800; Lee, Rebecca; Maclachlan, John; McPhee, Siobhán R (Informa UK Limited, 2020-06-10)
    • 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)
    • The city‐island‐state, wounding cascade and multi‐level vulnerability explored through the lens of Malta

      Main, Geoff; orcid: 0000-0001-8453-1527; Schembri, John; Speake, Janet; Gauci, Ritienne; Chester, David (Wiley, 2021-03-20)
    • Evaluation of a ‘drop box’ doorstep assessment service to aid remote assessments for COVID-19 in general practice

      Irving, Greg; orcid: 0000-0002-9471-3700; Lawson, David; Tinsley, Adele; Parr, Helen; Whittaker, Cheryl; Jones, Hayley; Cox, Stephen (BMJ Publishing Group, 2021-03-28)
      The COVID-19 is an established threat whose clinical features and epidemiology continues to evolve. In an effort to contain the disease, the National Health Service has adopted a digital first approach in UK general practice resulting in a significant shift away from face-to-face consultations. Consequently, more consultations are being completed without obtaining objective recording of vital signs and face-to-face examination. Some regions have formed hot hubs to facilitate the review of suspected COVID-19 cases and keep their practice site ‘clean’ including the use of doorstep observations in avoiding the risk of face-to-face examination. To support the safe, effective and efficient remote assessment of suspected and confirmed patients with COVID-19, we established a doorstep assessment service to compliment telephone and video consultations. This allows physiological parameters such as temperature, pulse, blood pressure and oxygen saturation to be obtained to guide further triage. Quality improvement methods were used to integrate and optimise the doorstep assessment and measure the improvements made. The introduction of a doorstep assessment service increased the proportion of assessments for patients with suspected COVID-19 in routine care over weeks. At the same time we were able to dramatically reduce face-to-face assessment over a 6-week period by optimising through a range of measures including the introduction of a digital stethoscope. The majority of patients were managed by their own general practitioner following assessment supporting continuity of care. There were no adverse events during the period of observation; no staff absences related to COVID-19. Quality improvement methods have facilitated the successful integration of doorstep assessments into clinical care.
    • Acceptance and commitment therapy (ACT)-enhanced communication skills: development and evaluation of a novel training programme

      Hulbert-Williams, Nicholas J; orcid: 0000-0001-9041-5485; Hulbert-Williams, Lee; orcid: 0000-0001-5892-6488; Patterson, Pandora; orcid: 0000-0002-1686-3252; Suleman, Sahil; Howells, Lesley (BMJ Publishing Group, 2021-03-24)
      Background: Psychological suffering is ubiquitous with cancer and frequently presents as an unmet supportive care need. In clinical practice, distress-related needs are often addressed by nurses and non-psychologist allied healthcare professionals who may have limited training in psychological therapeutic frameworks, particularly more recently developed interventions such as Acceptance and Commitment Therapy (ACT). Aims: We developed a single-day training programme for professionals working in supportive and palliative cancer care settings to change the nature of clinical communication about psychological distress and suffering towards an ACT-consistent approach. Method: We report on experiences of training delivery, and evaluation data about training satisfaction and intention to apply the training to clinical practice, from three training iterations in British and Australian, government-funded and charitable sectors. One hundred and sixteen cancer care professionals participated in the training. Evaluation data were collected from 53 participants (at either 2-week or 3-month follow-ups, or both) using self-report survey, including both quantitative and free-text questions. Results: At 2 week follow-up, 73% of trainees rating our course as having relevance to their work, and at 3 month follow-up, 46% agreed that they were better placed to provide improved clinical services. Qualitative feedback supported the inclusion of experiential learning and theoretical explanations underpinning ACT techniques. Undertaking this training did not significantly increase trainees’ stress levels, nor did implementation of this new way of working negatively affect staff well-being. Positive, ACT-consistent, changes in communication behaviours and attitudes were reported, however there was a lack of significant change in psychological flexibility. Discussion: Acceptability and applicability of this training to supportive and palliative healthcare is positive. The lack of change in psychological flexibility suggests a potential need for more experiential content in the training programme. Logistical challenges in one training group suggests the need for more robust train-the-trainer models moving forward.
    • Mesenchymal stem cell conditioned medium increases glial reactivity and decreases neuronal survival in spinal cord slice cultures.

      Wood, Chelsea R; Juárez, Esri H; Ferrini, Francesco; Myint, Peter; Innes, John; Lossi, Laura; Merighi, Adalberto; Johnson, William E B (2021-03-03)
      spinal cord slice cultures (SCSC) allow study of spinal cord circuitry, maintaining stimuli responses comparable to live animals. Previously, we have shown that mesenchymal stem/stromal cell (MSC) transplantation reduced inflammation and increased nerve regeneration but MSC survival was short-lived, highlighting that beneficial action may derive from the secretome. Previous studies of MSC conditioned medium (CM) have also shown increased neuronal growth. In this study, murine SCSC were cultured in canine MSC CM (harvested from the adipose tissue of excised inguinal fat) and cell phenotypes analysed via immunohistochemistry and confocal microscopy. SCSC in MSC CM displayed enhanced viability after propidium iodide staining. GFAP immunoreactivity was significantly increased in SCSC in MSC CM compared to controls, but with no change in proteoglycan (NG2) immunoreactivity. In contrast, culture in MSC CM significantly decreased the prevalence of βIII-tubulin immunoreactive neurites, whilst Ca transients per cell were significantly increased. These results contradict previous and reports of how MSC and their secretome may affect the microenvironment of the spinal cord after injury and highlight the importance of a careful comparison of the different experimental conditions used to assess the potential of cell therapies for the treatment of spinal cord injury. [Abstract copyright: © 2021 Published by Elsevier B.V.]
    • Evidence of a disability paradox in patient‐reported outcomes in haemophilia

      O’Hara, Jamie; Martin, Antony P.; Nugent, Diane; Witkop, Michelle; orcid: 0000-0003-0758-286X; Buckner, Tyler W.; Skinner, Mark W.; orcid: 0000-0002-0934-0680; O’Mahony, Brian; Mulhern, Brendan; Morgan, George; orcid: 0000-0003-2014-3415; Li, Nanxin; et al. (Wiley, 2021-02-17)