Now showing items 1-20 of 7745

    • Nutritional parameters and outcomes in patients admitted to intensive care with COVID-19: a retrospective single-centre service evaluation.

      Eden, Timothy; McAuliffe, Shane; orcid: 0000-0002-7166-4299; Crocombe, Dominic; Neville, Jonathan; Ray, Sumantra (2021-08-06)
      COVID-19 is an inflammatory syndrome caused by novel coronavirus SARS-CoV-2. Symptoms range from mild infection to severe acute respiratory distress syndrome (ARDS) requiring ventilation and intensive care. At the time of data collection, UK cases were around 300 000 with a fatality rate of 13% necessitating over 10 000 critical care admissions; now there have been over 4 million cases. Nutrition is important to immune function and influences metabolic risk factors such as obesity and glycaemic control, as well as recovery from acute illnesses. Poor nutritional status is associated with worse outcomes in ARDS and viral infections, yet limited research has assessed pre-morbid nutritional status and outcomes in patients critically unwell with COVID-19. Investigate the effect of body mass index (BMI), glycaemic control and vitamin D status on outcomes in adult patients with COVID-19 admitted to an intensive care unit (ICU). Retrospective review of all patients admitted to a central London ICU between March and May 2020 with confirmed COVID-19. Electronic patient records data were analysed for patient demographics; comorbidities; admission BMI; and serum vitamin D, zinc, selenium and haemoglobin A1c (HbA1c) concentrations. Serum vitamin D and HbA1c were measured on admission, or within 1 month of admission to ICU. Primary outcome of interest was mortality. Secondary outcomes included time intubated, ICU stay duration and ICU-related morbidity. Seventy-two patients; 54 (75%) men, mean age 57.1 (±9.8) years, were included. Overall, mortality was 24 (33%). No significant association with mortality was observed across BMI categories. In the survival arm admission, HbA1c (mmol/mol) was lower, 50.2 vs 60.8, but this was not statistically significant. Vitamin D status did not significantly associate with mortality (p=0.131). However, 32% of patients with low vitamin D (<25 IU/L) died, compared with 13% of patients with vitamin D levels >26 IU/L. Serum zinc and selenium, and vitamin B and folate levels were measured in 46% and 26% of patients, respectively. Increased adiposity and deranged glucose homeostasis may potentially increase risk of COVID-19 infection and severity, possibly relating to impaired lung and metabolic function, increased proinflammatory and prothrombotic mechanisms. Vitamin D deficiency may also associate with poorer outcomes and mortality, supporting a possible role of vitamin D in immune function specific to pulmonary inflammation and COVID-19 pathophysiology. There are plausible associations between raised BMI, glycaemic control, vitamin D status and poor prognosis, as seen in wider studies; however, in this service evaluation audit during the first wave of the pandemic in the UK, with a limited data set available for this analysis, the associations did not reach statistical significance. Further research is needed into specific nutritional markers influencing critical care admissions with COVID-19. [Abstract copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.]
    • Novel Pyrolusite-Templated Biochar as an Outstanding Catalyst for Persulfate Activation: Structural Design, Synergistic Effect, and Mechanism

      Feng, Wenwei; Faraj, Yousef; Yan, Yuan; An, Yaoxiao; Xie, Ruzhen; orcid: 0000-0001-7883-1566; Lai, Bo; orcid: 0000-0002-7105-1345 (American Chemical Society (ACS), 2022-01-18)
    • Victorian Material Culture

      Wynne, Deborah; Yates, Louisa; University of Chester; Gladstone's Library
      This book is one of a five-volume series, Victorian Material Culture (general editors Tatiana Kontou and Vicky Mills), designed to present primary source materials on aspects of Victorian culture. This volume (volume IV) focuses on manufactured things, including textiles (fabrics, clothing, paper, carpets etc.), metal goods (cutlery, pins, locks etc.), and household items (including ceramics, glassware, soap, candles etc.). The volume's editors, Wynne and Yates, offer detailed introductions to each section as well as an extensive introduction to the whole volume, which demonstrates the significance of manufacturing to the political, social and cultural environment of the Victorian period.
    • Ischemic Heart Disease in Nigeria: Exploring the Challenges, Current Status, and Impact of Lifestyle Interventions on Its Primary Healthcare System.

      Nnate, Daniel A; orcid: 0000-0002-8432-9377; Eleazu, Chinedum O; Abaraogu, Ukachukwu O; orcid: 0000-0002-1967-1459 (2021-12-25)
      The burden of ischemic heart disease in Nigeria calls for an evidence-based, innovative, and interdisciplinary approach towards decreasing health inequalities resulting from individual lifestyle and poor socioeconomic status in order to uphold the holistic health of individuals to achieve global sustainability and health equity. The poor diagnosis and management of ischemic heart disease in Nigeria contributes to the inadequate knowledge of its prognosis among individuals, which often results in a decreased ability to seek help and self-care. Hence, current policies aimed at altering lifestyle behaviour to minimize exposure to cardiovascular risk factors may be less suitable for Nigeria's diverse culture. Mitigating the burden of ischemic heart disease through the equitable access to health services and respect for the autonomy and beliefs of individuals in view of achieving Universal Health Coverage (UHC) requires comprehensive measures to accommodate, as much as possible, every individual, notwithstanding their values and socioeconomic status.
    • ABO Blood Groups Do Not Predict <i>Schistosoma mansoni</i> Infection Profiles in Highly Endemic Villages of Uganda.

      Francoeur, Rachel; orcid: 0000-0003-1860-4374; Atuhaire, Alon; Arinaitwe, Moses; Adriko, Moses; orcid: 0000-0001-9748-1207; Ajambo, Diana; Nankasi, Andrina; Babayan, Simon A; orcid: 0000-0002-4949-1117; Lamberton, Poppy H L; orcid: 0000-0003-1048-6318 (2021-11-27)
      <i>Schistosoma mansoni</i> is a parasite which causes significant public-health issues, with over 240 million people infected globally. In Uganda alone, approximately 11.6 million people are affected. Despite over a decade of mass drug administration in this country, hyper-endemic hotspots persist, and individuals who are repeatedly heavily and rapidly reinfected are observed. Human blood-type antigens are known to play a role in the risk of infection for a variety of diseases, due to cross-reactivity between host antibodies and pathogenic antigens. There have been conflicting results on the effect of blood type on schistosomiasis infection and pathology. Moreover, the effect of blood type as a potential intrinsic host factor on <i>S. mansoni</i> prevalence, intensity, clearance, and reinfection dynamics and on co-infection risk remains unknown. Therefore, the epidemiological link between host blood type and <i>S. mansoni</i> infection dynamics was assessed in three hyper-endemic communities in Uganda. Longitudinal data incorporating repeated pretreatment <i>S. mansoni</i> infection intensities and clearance rates were used to analyse associations between blood groups in school-aged children. Soil-transmitted helminth coinfection status and biometric parameters were incorporated in a generalised linear mixed regression model including age, gender, and body mass index (BMI), which have previously been established as significant factors influencing the prevalence and intensity of schistosomiasis. The analysis revealed no associations between blood type and <i>S. mansoni</i> prevalence, infection intensity, clearance, reinfection, or coinfection. Variations in infection profiles were significantly different between the villages, and egg burden significantly decreased with age. While blood type has proven to be a predictor of several diseases, the data collected in this study indicate that it does not play a significant role in <i>S. mansoni</i> infection burdens in these high-endemicity communities.
    • “How you keep going”: Voluntary sector practitioners' story‐lines as emotion work

      Quinn, Kaitlyn; orcid: 0000-0001-9981-1388; Tomczak, Philippa; orcid: 0000-0002-2347-2479; BUCK, GILLIAN; orcid: 0000-0003-4398-8445 (Wiley, 2022-01-16)
    • A grounded theory exploration into situational adaptation strategies developed by Paramedics when dealing with mass casualty incidents

      Finnegan, Alan; Templeman, Jenni; Hooper, Craig (University of Chester, 2020-11)
      The Manchester (U.K.) Arena bombing took place on the 22nd May 2017 at 22:31, when a suicide bomber detonated an improvised explosive device in the foyer of the Manchester Arena, as the crowd was leaving an event. The attack claimed the lives of 22 people, and a further 116 people required medical treatment, mostly for ballistic injuries. A key objective for Ambulance Service Commanders was to establish a casualty management system consisting of clinical triage, treatment, and transport of patients from a Casualty Collection Point into the hospital network. To achieve this, two Hazardous Area Response Teams were deployed alongside Consultant and Advanced Paramedics. The purpose of which was to provide point of injury care within the vicinity of the blast area. Whereas previous studies have identified how individuals react to the biopsychosocial response to traumatic incidents post the event, understanding how Ambulance Service personnel adapt to situations while deploying to, or during mass casualty incidents, remains an area that has received limited research in relation to defining empirical evidence. This study aimed to identify a process that either supported or inhibited Paramedics in achieving situational adaptability when dealing with a mass casualty situation. Constructivist Grounded Theory was used as the chosen methodology, with fifteen Paramedics volunteering to participate in the research. Analysis identified eleven theoretical categories, which were then divided into four theoretical themes. Combined, these formed the basis for four major theoretical propositions: ‘Training & Education’, appropriate application of ‘Incident Management Frameworks’, established ‘Peer Support Networks’, and individual reaction to ‘Stress stimuli’. This study makes a novel contribution to the phenomenon of situational adaptively. The significance of the resulting theory is that situational adaptability can be enabled through the application of effective decision making strategies, being able to draw on previous experiences, along with effective scene management. This along with communication strategies, support from peers, the incident commander, and multi-agency partners. Key identified inhibitors are presented as situational stressors, perceptions of threat, risk appetite, and environmental stimuli. Consequently, it is now possible to provide four recommendations for Paramedics preparing to respond to mass casualty incidents.
    • ‘The Berwyn Way’: A Qualitative Study of the Rehabilitative Model at HMP Berwyn

      Hughes, Caroline; Gorden, Caroline; Prescott, Joanne A. (University of ChesterWrexham Glyndŵr University, 2021-07)
      Typified predominantly as ‘agencies of disempowerment and deprivation’, traditional prisons represent the antithesis of a rehabilitative setting (De Viggiani, 2007a, p.115). As such, the aim of this qualitative study was to explore the physical, psychological, and social implications of HMP Berwyn’s rehabilitative model (The Berwyn Way) from the perspective of prison residents and operational staff. As a single-site project, Berwyn was of particular interest because of its recent introduction to the UK prison estate. Opening in February 2017, Berwyn, a North Walian establishment, housing up to 2106 adult males, opened with an ambitious rehabilitative agenda which promised to normalise the prison setting by focusing on rehabilitative cultures and values, improved spatial design, therapeutic staff-resident relationships and a person-first lexicon which aimed to replace traditional prison terminology with inclusive alternatives. These are but some of the approaches listed under the ‘Berwyn Way’, and in addressing the many others, this thesis discusses the wider implications of Berwyn’s approach, and does so, with accounts from a sample of 20 prison residents and 20 operational staff, using semi-structured interviews. To capture further nuances, triangulation was utilised and included ethnographic observations and detailed fieldnotes. Thematic analysis of the triangulated dataset generated four themes: The Berwyn Way; Lifting the liminal veil between the outside and inside; Managing behaviour, and finally, Actions speak louder than words: rethinking prison language, relationships and interactions. Findings from the study did not support the expectation that Berwyn’s rehabilitative model would be broadly accepted, and instead there was some resistance to rehabilitative change, both from a resident and staff perspective. From a rehabilitative standpoint, there were however areas of notable best-practice, with certain operational areas encapsulating the essence of Berwyn’s rehabilitative model with consistent professional practice, acceptance to Berwyn’s overarching vision and a willingness to challenge the orthodox narrative of punitive imprisonment. The thesis concludes with observations surrounding the implications of the study for rehabilitative penal practice within prisons in England and Wales, and recommendations for future research.
    • Prevalence of common mental health disorders in military veterans: using primary healthcare data

      Finnegan, Alan; orcid: 0000-0002-2189-4926; Randles, R; orcid: 0000-0002-7401-5817 (BMJ Publishing Group, 2022-01-18)
      Introduction: Serving military personnel and military veterans have been identified as having a high prevalence of mental disorders. Since 1985, UK patients’ primary healthcare (PHC) medical records contain Read Codes (now being replaced by Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) codes) that mark characteristics such as diagnosis, ethnicity and therapeutic interventions. This English study accesses a cohort profile of British Armed Forces veterans to examine the diagnosed common mental disorders by using PHC records. Methods: This analysis has been drawn from initiatives with PHC practices in the Northwest of England to increase veteran registration in general practice. Demographic data were collected including gender, age and marital status. Data were also collected on common mental health disorders associated with the Armed Forces. Result: 2449 veteran PHC records were analysed. 38% (N=938) of veterans in this cohort had a code on their medical record for common mental health disorders. The highest disorder prevalence was depression (17.8%, N=437), followed by alcohol misuse (17.3%, N=423) and anxiety (15.0%, N=367). Lower disorder prevalence was seen across post-traumatic stress disorder (PTSD) (3.4%, N=83), dementia (1.8%, N=45) and substance misuse (0.8%, N=19). Female veterans had a higher prevalence of mental disorders than their male counterparts, while men a higher prevalence of PTSD; however, the gender difference in the latter was not significant (p>0.05). Conclusion: The SNOMED searches do not detail why certain groups had higher recordings of certain disorders. A future study that accesses the PHC written medical notes would prove enlightening to specifically identify what situational factors are having the most impact on the veteran population. The results from a sizeable English veteran population provide information that should be considered in developing veteran-specific clinical provision, educational syllabus and policy.
    • Regucalcin ameliorates doxorubicin-induced cytotoxicity in Cos-7 kidney cells and translocates from the nucleus to the mitochondria.

      Mohammed, Noor A; Hakeem, Israa J; Hodges, Nikolas; Michelangeli, Francesco; orcid: 0000-0002-4878-046X (2022-01-01)
      Doxorubicin (DOX) is a potent anticancer drug, which can have unwanted side-effects such as cardiac and kidney toxicity. A detailed investigation was undertaken of the acute cytotoxic mechanisms of DOX on kidney cells, using Cos-7 cells as kidney cell model. Cos-7 cells were exposed to DOX for a period of 24 h over a range of concentrations, and the LC50 was determined to be 7 µM. Further investigations showed that cell death was mainly via apoptosis involving Ca2+ and caspase 9, in addition to autophagy. Regucalcin (RGN), a cytoprotective protein found mainly in liver and kidney tissues, was overexpressed in Cos-7 cells and shown to protect against DOX-induced cell death. Subcellular localization studies in Cos-7 cells showed RGN to be strongly correlated with the nucleus. However, upon treatment with DOX for 4 h, which induced membrane blebbing in some cells, the localization appeared to be correlated more with the mitochondria in these cells. It is yet to be determined whether this translocation is part of the cytoprotective mechanism or a consequence of chemically induced cell stress.
    • Clinical, humanistic, and economic burden of severe haemophilia B in adults receiving factor IX prophylaxis: findings from the CHESS II real-world burden of illness study in Europe.

      Burke, Tom; Asghar, Sohaib; orcid: 0000-0001-8276-0131; O'Hara, Jamie; Chuang, Margaret; Sawyer, Eileen K; Li, Nanxin; email: (2021-12-20)
      <h4>Background</h4>Real-world studies of the burden of severe haemophilia B in the context of recent therapeutic advances such as extended half-life (EHL) factor IX (FIX) products are limited. We analysed data from the recent CHESS II study to better understand the clinical, humanistic, and economic burden of severe haemophilia B in Europe. Data from male adults with severe haemophilia B receiving prophylaxis were analysed from the retrospective cross-sectional CHESS II study conducted in Germany, France, Italy, Spain and the United Kingdom. Inhibitors were exclusionary. Patients and physicians completed questionnaires on bleeding, joint status, quality of life, and haemophilia-related direct and indirect costs (2019-2020). All outcomes were summarised using descriptive statistics.<h4>Results</h4>A total of 75 CHESS II patients were eligible and included; 40 patients (53%) provided self-reported outcomes. Mean age was 36.2 years. Approximately half the patients were receiving EHL versus standard half-life (SHL) prophylaxis (44% vs 56%). Most patients reported mild or moderate chronic pain (76%) and had ≥ 2 bleeding events per year (70%), with a mean annualised bleed rate of 2.4. Mean annual total haemophilia-related direct medical cost per patient was €235,723, driven by FIX costs (€232,328 overall, n = 40; €186,528 for SHL, €290,620 for EHL). Mean annual indirect costs (€8,973) were driven by early retirement or work stoppage due to haemophilia. Mean quality of life (EQ-5D) score was 0.67.<h4>Conclusions</h4>These data document a substantial, persistent real-world burden of severe haemophilia B in Europe. Unmet needs persist for these patients, their caregivers, and society.
    • Correction to: The LUCID study: living with ulcerative colitis; identifying the socioeconomic burden in Europe.

      Ruiz-Casas, Leonardo; Evans, Jonathan; orcid: 0000-0002-3490-7191; email:; Rose, Alison; Pedra, Gabriel Ghizzi; Lobo, Alan; Finnegan, Alan; Hayee, Bu; Peyrin-Biroulet, Laurent; Sturm, Andreas; Burisch, Johan; et al. (2021-12-15)
    • Mirror self-recognition in gorillas (Gorilla gorilla gorilla): a review and evaluation of mark test replications and variants.

      Murray, Lindsay E; orcid: 0000-0002-7810-9546; email:; Anderson, James R; Gallup, Gordon G, Jr (2022-01-07)
      Mirror self-recognition (MSR), widely regarded as an indicator of self-awareness, has not been demonstrated consistently in gorillas. We aimed to examine this issue by setting out a method to evaluate gorilla self-recognition studies that is objective, quantifiable, and easy to replicate. Using Suarez and Gallup's (J Hum Evol 10:175-183, 1981) study as a reference point, we drew up a list of 15 methodological criteria and assigned scores to all published studies of gorilla MSR for both methodology and outcomes. Key features of studies finding both mark-directed and spontaneous self-directed responses included visually inaccessible marks, controls for tactile and olfactory cues, subjects who were at least 5 years old, and clearly distinguishing between responses in front of versus away from the mirror. Additional important criteria include videotaping the tests, having more than one subject, subjects with adequate social rearing, reporting post-marking observations with mirror absent, and giving mirror exposure in a social versus individual setting. Our prediction that MSR studies would obtain progressively higher scores as procedures and behavioural coding practices improved over time was supported for methods, but not for outcomes. These findings illustrate that methodological rigour does not guarantee stronger evidence of self-recognition in gorillas; methodological differences alone do not explain the inconsistent evidence for MSR in gorillas. By implication, it might be suggested that, in general, gorillas do not show compelling evidence of MSR. We advocate that future MSR studies incorporate the same criteria to optimize the quality of attempts to clarify the self-recognition abilities of gorillas as well as other species. [Abstract copyright: © 2022. The Author(s).]
    • Raising the bar in sports performance research.

      Abt, Grant; orcid: 0000-0002-4079-9270; Jobson, Simon; orcid: 0000-0002-1377-2128; Morin, Jean-Benoit; orcid: 0000-0003-3808-6762; Passfield, Louis; orcid: 0000-0001-6223-162X; Sampaio, Jaime; orcid: 0000-0003-2335-9991; Sunderland, Caroline; orcid: 0000-0001-7484-1345; Twist, Craig; orcid: 0000-0001-6168-0378 (2022-01-06)
    • A modified grounded theory study exploring the impact of military service in Northern Ireland on mental wellbeing

      Kingston, Paul; Taylor, Lou; Finnegan, Alan; Frith, Anthony (University of Chester, 2021-11)
      Military service in Operation Banner during the Northern Ireland Troubles posed significant challenges for individual soldiers. The purpose of this study is to explore the impact of service in Operation Banner on the mental wellbeing of veterans who served in this conflict, and factors that have hindered or facilitated acquiring help in those who have experienced mental distress. This is a qualitative study that has utilised a modified grounded theory methodology and adopted a symbolic interactionism theoretical framework. Data were collected in semi-structured interviews with 16 veterans, recruited via advertising in newsletters distributed by veterans’ organisations to their members, advertising via posters and local radio and through snowballing. Data analysis was by open and focussed coding, supported by computer assisted qualitative data analysis software. The study confirms that for the majority, military service did not result in long-term mental distress and participants gained useful career and life skills. Yet, for some mental distress has persisted. Since leaving Operation Banner, the ability of veterans to cope with the past and meet present or future challenges has been through a combination of innate skills, resilience, individual initiative, outside support, and making use of opportunity. For some, though, coping has been hindered by internal barriers such as self-isolation, emotional suppression, legacies of military culture and veterans’ perceptions of indifference or even hostility by society and politicians. These barriers have led to some veterans to being predominantly oriented towards the past and unable or unwilling to seek help, a situation made worse by threats of prosecuting veterans, which have reinforced memories of the past. This study theorises, therefore, that there is no single way to help these veterans without understanding each veteran’s perception of themselves. When this self-identity is predominantly past-oriented, internal barriers negate the relevance of external help. When the veteran’s self tends towards future-orientation, external barriers to accessing help are more relevant. Understanding this individuality of self-perception may help to address factors that are maintaining past-orientation. Yet, for those who seek a resilient future, providing the right services, at the right time and in the right format is critical. This study helps to fill the relative gap in qualitative studies on UK veterans and those from Operation Banner in particular. Recommendations are made for the support of Operation Banner veterans and for future research.
    • Recovery capital in the context of homelessness, high levels of alcohol consumption, and adverse significant life events

      Ross-Houle, Kim; Porcellato, Lorna; orcid: 0000-0002-8656-299X (Informa UK Limited, 2021-12-16)
    • ‘Every partnership [… is] an emotional experience’: towards a model of partnership support for addressing the emotional challenges of student–staff partnerships

      Healey, Ruth L.; orcid: 0000-0001-6872-4900; France, Derek; orcid: 0000-0001-6874-6800 (Informa UK Limited, 2022-01-10)
    • Interaction between Dietary Fat Intake and Metabolic Genetic Risk Score on 25-Hydroxyvitamin D Concentrations in a Turkish Adult Population

      Isgin-Atici, Kubra; orcid: 0000-0002-3088-8675; email:; Alathari, Buthaina E.; email:; Turan-Demirci, Busra; orcid: 0000-0001-5497-0887; email:; Sendur, Suleyman Nahit; email:; Lay, Incilay; orcid: 0000-0002-1466-5746; email:; Ellahi, Basma; email:; Alikasifoglu, Mehmet; email:; Erbas, Tomris; orcid: 0000-0003-1377-9394; email:; Buyuktuncer, Zehra; email:; Vimaleswaran, Karani Santhanakrishnan; orcid: 0000-0002-8485-8930; email: (MDPI, 2022-01-17)
      Previous studies have pointed out a link between vitamin D status and metabolic traits, however, consistent evidence has not been provided yet. This cross-sectional study has used a nutrigenetic approach to investigate the interaction between metabolic-genetic risk score (GRS) and dietary intake on serum 25-hydroxyvitamin D [25(OH)D] concentrations in 396 unrelated Turkish adults, aged 24−50 years. Serum 25(OH)D concentration was significantly lower in those with a metabolic-GRS ≥ 1 risk allele than those with a metabolic-GRS 1 risk allele (p = 0.020). A significant interaction between metabolic-GRS and dietary fat intake (energy%) on serum 25(OH)D levels was identified (Pinteraction = 0.040). Participants carrying a metabolic-GRS ≥ 1 risk allele and consuming a high fat diet (≥38% of energy = 122.3 ± 52.51 g/day) had significantly lower serum 25(OH)D concentration (p = 0.006) in comparison to those consuming a low-fat diet (38% of energy = 82.5 ± 37.36 g/d). In conclusion, our study suggests a novel interaction between metabolic-GRS and dietary fat intake on serum 25(OH)D level, which emphasises that following the current dietary fat intake recommendation (35% total fat) could be important in reducing the prevalence of vitamin D deficiency in this Turkish population. Nevertheless, further larger studies are needed to verify this interaction, before implementing personalized dietary recommendations for the maintenance of optimal vitamin D status.