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Artificial intelligence (AI) in healthcare describes algorithm-based computational techniques which manage and analyse large datasets to make inferences and predictions. There are many potential applications of AI in the care of older people, from clinical decision support systems that can support identification of delirium from clinical records to wearable devices that can predict the risk of a fall. We held four meetings of older people, clinicians and AI researchers. Three priority areas were identified for AI application in the care of older people. These included: monitoring and early diagnosis of disease, stratified care and care coordination between healthcare providers. However, the meetings also highlighted concerns that AI may exacerbate health inequity for older people through bias within AI models, lack of external validation amongst older people, infringements on privacy and autonomy, insufficient transparency of AI models and lack of safeguarding for errors. Creating effective interventions for older people requires a person-centred approach to account for the needs of older people, as well as sufficient clinical and technological governance to meet standards of generalisability, transparency and effectiveness. Education of clinicians and patients is also needed to ensure appropriate use of AI technologies, with investment in technological infrastructure required to ensure equity of access. [ABSTRACT FROM AUTHOR]

Objectives: Dentists and other members of the dental team could raise awareness by talking about oral cancer during routine dental check‐ups. A communication guide has been developed to facilitate this. However, it has been suggested that discussions about oral cancer may raise patients' anxiety and this has been documented by dentists as a barrier to having these conversations. The current research aimed to investigate implementation of the communication guide and its impact on the dental patient. Methods: A consecutive‐case sample of adult dental patients attending primary dental care for a routine NHS check‐up at one dental practice were invited to take part in the study via letter prior to their appointment. Consultations of participating patients (n = 77) were audio‐recorded. Before and after their appointment, patients were asked to rate their current anxiety via the six‐item version of Spielberger's State‐Trait Anxiety Inventory. Audio recordings of each consultation were reviewed by two raters to determine the extent to which the dentist covered the topics recommended in the communication guide. Results: The dentist informed all patients that they were being checked for oral cancer, spoke about signs and symptoms, and discussed risk factors. However, they rarely recommended where help should be sought or addressed barriers to seeking help. Discussions took an average of 95 s. The extent to which oral cancer was discussed did not correlate with patients' post‐appointment anxiety. Patients made positive or neutral responses to the discussions. The few questions that were asked were easily addressed. Conclusions: As findings are based on one dentist working at one practice, generalization of these results should be cautious. The study indicated that using an evidence‐based guide to talk about oral cancer did not appear to raise patients' anxiety in this practice population. This could help to increase awareness of oral cancer in the endeavour to facilitate early cancer diagnosis. [ABSTRACT FROM AUTHOR]

There are national and global moves to improve effective digital data design and application in healthcare. This New Horizons commentary describes the role of digital data in healthcare of the ageing population. We outline how health and social care professionals can engage in the proactive design of digital systems that appropriately serve people as they age, carers and the workforce that supports them. Key Points Healthcare improvements have resulted in increased population longevity and hence multimorbidity. Shared care records to improve communication and information continuity across care settings hold potential for older people. Data structure and coding are key considerations. A workforce with expertise in caring for older people with relevant knowledge and skills in digital healthcare is important. [ABSTRACT FROM AUTHOR]

Background: As a pragmatic randomised timing-of-birth trial, WILL adapted its trial procedures in response to the COVID-19 pandemic. These are reviewed here to inform post-pandemic trial methodology.Methods: The trial (internal pilot) paused in March 2020, re-opened in July 2020, and is currently recruiting in 37 UK NHS consultant-led maternity units. We evaluated pandemic adaptations made to WILL processes and surveyed sites for their views of these changes (20 sites, videoconference).Results: Despite 88% of sites favouring an electronic investigator site file (ISF), information technology requirements and clinical trial unit (CTU) operating procedures mandated the ongoing use of paper ISFs; site start-up delays resulted from restricted access to the CTU. Site initiation visits (SIVs) were conducted remotely; 50% of sites preferred remote SIVs and 44% felt that it was trial-dependent, while few preferred SIVs in-person as standard procedure. The Central team felt remote SIVs provided scheduling and attendance flexibility (for sites and trial staff), the option of recording discussions for missing or future staff, improved efficiency by having multiple sites attend, and time and cost savings; the negative impact on rapport-building and interaction was partially mitigated over time with more familiarity with technology and new ways-of-working. Two methods of remote consent were developed and used by 30/37 sites and for 54/156 recruits. Most (86%) sites using remote consenting felt it improved recruitment. For remote data monitoring (5 sites), advantages were primarily for the monitor (e.g. flexibility, no time constraints, reduced cost), and disadvantages primarily for the sites (e.g. document and access preparation, attendance at a follow-up meeting), but 81% of sites desired having the option of remote monitoring post-pandemic.Conclusions: COVID adaptations to WILL trial processes improved the flexibility of trial delivery, for Central and site staff, and participants. Flexibility to use these strategies should be retained post-pandemic.Trial Registration: ISRCTN77258279. Registered on 05 December 2018. [ABSTRACT FROM AUTHOR]

Keywords: Feminist ethic of care; informal care; family relations; time-space practices; death and bereavement; ubuntu; Senegal west africa; ética feminista del cuidado; cuidado informal; relaciones familiares; prácticas espacio-temporales; muerte y duelo; Senegal; África Occidental; Éthique féministe du care; care informel; relations familiales; pratiques spatiotemporelles; mort et deuil; Sénégal Afrique occidentale EN Feminist ethic of care informal care family relations time-space practices death and bereavement ubuntu Senegal west africa ES ética feminista del cuidado cuidado informal relaciones familiares prácticas espacio-temporales muerte y duelo Senegal África Occidental FR Éthique féministe du care care informel relations familiales pratiques spatiotemporelles mort et deuil Sénégal Afrique occidentale 1174 1192 19 10/12/22 20221001 NES 221001 Introduction After her father's death, Diami (then aged 14) moved from Kaolack to Dakar to earn money to help her mother and siblings. Here, our discussion of caringscapes focuses on the role of time-space relationships in care practices and the importance of interactions between care practices and the social and physical infrastructures of care. While we do not set out to provide anything so ambitious as a "geohistory" of care practices in Senegal, we describe local geographies of care practices and explore how these are entangled with particular conceptions of how and by whom care should be done. Gendered inequalities in family care practices in South Africa have prompted some to note that Ubuntu's encouragement of communal care responsibilities through recognition of human interdependencies still supports a patriarchal division of care work (Gouws & Van Zyl, [15]). [Extracted from the article]

Background: A third of children admitted to paediatric intensive care units (PICUs) in the United Kingdom (UK) are transported by paediatric critical care transport services (PCCTs). Parents have described the transfer journey as particularly stressful. Critical care nurses have a key role in mitigating the impact of the journey on parents. Evaluating parents' experiences is important to inform service improvements. Aim and objectives: Our aim was to describe the development of a new measure of parents' experiences of PCCTs, derived from data collected in the Differences in access to Emergency Paediatric Intensive Care and care during Transport (DEPICT) study. Design: A descriptive cross‐sectional survey was used. Methods: As part of the DEPICT study, a 17‐item transport experience questionnaire was developed and given to parents of children transported by PCCTs to 24 UK PICUs during a 12‐month period. Analyses included exploratory factor analysis and a validation review by a PCCT stakeholder group. Results: Families of 1722 children (1798 journeys) completed questionnaires. Five items were excluded from further analysis as correlation coefficients were <0.3. Two factors explained 53% of the variance and all 12 items loaded on one of these factors. Factor 1 (8 items) explained 47% of the variance, had excellent internal reliability and the clustered items were conceptually coherent with a specific relevance to PCCTs; these were offered for consideration, with other items possibly discarded. Twenty‐eight PCCT clinicians reviewed the questions. Using a 70% agreement threshold, one additional, previously discarded, item was identified for inclusion, resulting in a nine‐item experience measure. Conclusion: Our brief measure of parents' experience of critical care transport provides a standardized measure that can be used across all PCCTs, enabling national benchmarking of services and potentially increasing the collection and use of parent experience data to improve services. Relevance to clinical practice: Being able to measure experience provides an opportunity to understand how to make services better to improve experience. [ABSTRACT FROM AUTHOR]

Background: Maternal mortality remains a problem in low-income countries (LICs). In Zimbabwe, there has been an unprecedented increase in maternal mortality in the last 2.5 decades. Effective prenatal care delivery, particularly early visits, appropriate number of visits, and receiving recommended care is viewed as key to reducing fatal care outcomes. Aims: This study sought to model and identify gaps requiring service and care delivery improvement in prenatal care pathways for pregnant women visiting Mpilo Central Hospital in Bulawayo, Zimbabwe. Methods: This was a case study of the services offered by an antenatal care department at Mpilo Central Hospital in Bulawayo, Zimbabwe. Evidence from literature in low-income countries was used to develop prenatal care pathway guidelines as a tool to guide care delivery and identify gaps in care and service delivery. One hundred cases of prenatal care records were reviewed to determine the prenatal care pathway and care delivered to pregnant women. This data was complemented by interviews with 20 maternity care clinicians. Results: In 100 maternity case records studied, 53% booked for prenatal care. Of the 53% (n = 53) pregnant women who booked, their first visit on their pregnancy was late at an average gestational age of 27.1 weeks with extremes of 30 to 40 weeks in 38% (n = 20) cases. Missing scheduled prenatal care appointments was prevalent, with only 11% (n = 6) having attended all the expected 5 visits, whilst 60% (n = 32) missed 3 or more. There were inadequacies in the care delivered to women in each visit compared to that expected in such areas as obstetrics, physical examinations and haematological tests. Maternity care clinicians attributed the cost of prenatal booking fees in the background of poverty and poor family support systems as key factors hindering women's access to prenatal services. Conclusions: The current prenatal care pathway at MCH requires improvement in the areas of referral, adherence to appointment by pregnant women and visiting prenatal care early. Clinicians also need to adhere to standard clinical tests recommended for each specific pregnant woman's visit. In the Zimbabwean setting with limited resources, where the number of visits is already low, pathways with reduced visits may not be appropriate. An investment into prenatal care by the government is recommended to enable the utilisation of interventions such as e-health technologies that may improve care delivery as well as adherence to best practices. E-health and mobile health technologies involving e-referrals, e-booking, decision support, and reminder systems are recommended for clinicians to manage and deliver appropriate care to patients as well as pregnant women to adhere to scheduled visits. [ABSTRACT FROM AUTHOR]

People undergoing investigations for suspected cancer have to undergo a number of investigations before they know their full diagnosis and treatment plan. We examined predictors of distress among patients undergoing staging investigations for suspected colorectal or lung cancer. Patients were prospectively recruited to two multi-centre trials comparing WB-MRI with standard scans. Patients completed a questionnaire, administered at trial recruitment, measuring demographic and psychological variables (n = 129, 66 colorectal, 63 lung; median age 66.4, range: 31–89). Predictors of distress were analysed using logistic regression. Forty percent of patients reported high distress (a score of 4 or higher on the GHQ-12). Higher deprivation and greater intolerance of uncertainty (IU) predicted high distress in both unadjusted (low deprivation: OR 0.352, 95% CIs 0.144 to 0.860, p = 0.022; IU: OR 1.972, 95% CIs: 1.357 to 2.865, p < 0.001) and adjusted analyses (low deprivation: OR 0.243, 95% CIs 0.083 to 0.714, p = 0.010; IU: OR 2.231, 95% CIs 1.429 to 3.485, p < 0.001). Age, gender, presence of comorbid illness, cancer type, probable knowledge of cancer diagnosis, and a final diagnosis of cancer did not predict high distress. Future research should examine how to reduce distress in patients undergoing investigations for cancer, particularly among those who find uncertainty difficult to manage. [ABSTRACT FROM AUTHOR]

Background: Centralisation of paediatric intensive care units (PICUs) has the increased the need for specialist paediatric critical care transport teams (PCCT) to transport critically ill children to PICU. We investigated the impact of care provided by PCCTs for children on mortality and other clinically important outcomes.Methods: We analysed linked national data from the Paediatric Intensive Care Audit Network (PICANet) from children admitted to PICUs in England and Wales (2014-2016) to assess the impact of who led the child's transport, whether prolonged stabilisation by the PCCT was detrimental and the impact of critical incidents during transport on patient outcome. We used logistic regression models to estimate the adjusted odds and probability of mortality within 30 days of admission to PICU (primary outcome) and negative binomial models to investigate length of stay (LOS) and length of invasive ventilation (LOV).Results: The study included 9112 children transported to PICU. The most common diagnosis was respiratory problems; junior doctors led the PCCT in just over half of all transports; and the 30-day mortality was 7.1%. Transports led by Advanced Nurse Practitioners and Junior Doctors had similar outcomes (adjusted mortality ANP: 0.035 versus Junior Doctor: 0.038). Prolonged stabilisation by the PCCT was possibly associated with increased mortality (0.059, 95% CI: 0.040 to 0.079 versus short stabilisation 0.044, 95% CI: 0.039 to 0.048). Critical incidents involving the child increased the adjusted odds of mortality within 30 days (odds ratio: 3.07).Conclusions: Variations in team composition between PCCTs appear to have little effect on patient outcomes. We believe differences in stabilisation approaches are due to residual confounding. Our finding that critical incidents were associated with worse outcomes indicates that safety during critical care transport is an important area for future quality improvement work. [ABSTRACT FROM AUTHOR]

Background: Maternal mortality remains a problem in low-income countries (LICs). In Zimbabwe, there has been an unprecedented increase in maternal mortality in the last 2.5 decades. Effective prenatal care delivery, particularly early visits, appropriate number of visits, and receiving recommended care is viewed as key to reducing fatal care outcomes. Aims: This study sought to model and identify gaps requiring service and care delivery improvement in prenatal care pathways for pregnant women visiting Mpilo Central Hospital in Bulawayo, Zimbabwe. Methods: This was a case study of the services offered by an antenatal care department at Mpilo Central Hospital in Bulawayo, Zimbabwe. Evidence from literature in low-income countries was used to develop prenatal care pathway guidelines as a tool to guide care delivery and identify gaps in care and service delivery. One hundred cases of prenatal care records were reviewed to determine the prenatal care pathway and care delivered to pregnant women. This data was complemented by interviews with 20 maternity care clinicians. Results: In 100 maternity case records studied, 53% booked for prenatal care. Of the 53% (n = 53) pregnant women who booked, their first visit on their pregnancy was late at an average gestational age of 27.1 weeks with extremes of 30 to 40 weeks in 38% (n = 20) cases. Missing scheduled prenatal care appointments was prevalent, with only 11% (n = 6) having attended all the expected 5 visits, whilst 60% (n = 32) missed 3 or more. There were inadequacies in the care delivered to women in each visit compared to that expected in such areas as obstetrics, physical examinations and haematological tests. Maternity care clinicians attributed the cost of prenatal booking fees in the background of poverty and poor family support systems as key factors hindering women's access to prenatal services. Conclusions: The current prenatal care pathway at MCH requires improvement in the areas of referral, adherence to appointment by pregnant women and visiting prenatal care early. Clinicians also need to adhere to standard clinical tests recommended for each specific pregnant woman's visit. In the Zimbabwean setting with limited resources, where the number of visits is already low, pathways with reduced visits may not be appropriate. An investment into prenatal care by the government is recommended to enable the utilisation of interventions such as e-health technologies that may improve care delivery as well as adherence to best practices. E-health and mobile health technologies involving e-referrals, e-booking, decision support, and reminder systems are recommended for clinicians to manage and deliver appropriate care to patients as well as pregnant women to adhere to scheduled visits. [ABSTRACT FROM AUTHOR]

Objective: To determine rates of psychiatric comorbidity in a clinical sample of childhood movement disorders (MDs).Design: Cohort study.Setting: Tertiary children's hospital MD clinics in Sydney, Australia and London, UK.Patients: Cases were children with tic MDs (n=158) and non-tic MDs (n=102), including 66 children with dystonia. Comparison was made with emergency department controls (n=100), neurology controls with peripheral neuropathy or epilepsy (n=37), and community controls (n=10 438).Interventions: On-line development and well-being assessment which was additionally clinically rated by experienced child psychiatrists.Main Outcome Measures: Diagnostic schedule and manual of mental disorders-5 criteria for psychiatric diagnoses.Results: Psychiatric comorbidity in the non-tic MD cohort (39.2%) was comparable to the tic cohort (41.8%) (not significant). Psychiatric comorbidity in the non-tic MD cohort was greater than the emergency control group (18%, p<0.0001) and the community cohort (9.5%, p<0.00001), but not the neurology controls (29.7%, p=0.31). Almost half of the patients within the tic cohort with psychiatric comorbidity were receiving medical psychiatric treatment (45.5%) or psychology interventions (43.9%), compared with only 22.5% and 15.0%, respectively, of the non-tic MD cohort with psychiatric comorbidity.Conclusions: Psychiatric comorbidity is common in non-tic MDs such as dystonia. These psychiatric comorbidities appear to be under-recognised and undertreated. [ABSTRACT FROM AUTHOR]

Despite calls for cross-cultural research, Minority world perspectives still dominate death and bereavement studies, emphasizing individualized emotions and neglecting contextual diversities. In research concerned with contemporary African societies, on the other hand, death and loss are generally subsumed within concerns about AIDS or poverty, with little attention paid to the emotional and personal significance of a death. Here, we draw on interactionist sociology to present major themes from a qualitative study of family deaths in urban Senegal, theoretically framed through the duality of meanings-in-context. Such themes included family and community as support and motivation; religious beliefs and practices as frameworks for solace and (regulatory) meaning; and material circumstances as these are intrinsically bound up with emotions. Although we identify the experience of (embodied, emotional) pain as a common response across Minority and Majority worlds, we also explore significant divergencies, varying according to localized contexts and broader power dynamics. [ABSTRACT FROM AUTHOR]

Young refugees and diasporic youth often have multiply located senses of self. Using a creative visual methodology, recently arrived young Syrian refugees and young people of diverse African heritages born in the United Kingdom (aged 16–20) produced digital self‐portraits to express their translocal subjectivities. Young Syrians represented themselves as "bilingual becomings"; learning English occupied their minds and was key to their imagined futures, but their hearts were often associated with the homeland they had lost. In contrast, speaking English was sometimes taken for granted in the art work produced by young people of African heritages, which portrayed hybrid, multilingual selves and translocal relationality. Both groups embraced signifiers of national, religious, and cultural identity but through their silences and omissions, dis‐identified with exclusionary notions of "Britishness," nationhood, and citizenship. Their self‐representations provide hopeful counter‐narratives to hegemonic sociopolitical discourses that position "Black African" youth and Muslim young men as a "threat" and "illegitimate" citizens. [ABSTRACT FROM AUTHOR]

Introduction: Whole body magnetic resonance imaging (WB-MRI) may be more efficient in staging cancers, but can be harder for patients to tolerate. We examined predictors of patient preference for WB-MRI vs. CT/ PET-CT for staging colorectal or lung cancer.Methods: Patients recruited prospectively to two multicentre trials comparing diagnostic accuracy of WB-MRI with standard staging scans were sent two questionnaires: the first, administered at trial registration, captured demographics, educational level and comorbidities; the second, administered after staging completion, measured emotional distress (GHQ-12), positive mood (PANAS), perceived scan burden, patients' beliefs about WB-MRI, and preference for either WB-MRI or CT (colorectal trial), WB-MRI or PET-CT (lung trial). Preference for WB-MRI or CT/ PET-CT was analysed using logistic regression.Results: Baseline and post-staging questionnaires were completed by 97 and 107 patients, respectively. Overall, 56/107 (52%) preferred WB-MRI over standard scans and were more likely to have no additional comorbidities, higher positive mood, greater awareness of potential benefits of WB-MRI and lower levels of perceived WB-MRI scan burden. In adjusted analyses, only awareness of potential WB-MRI benefits remained a significant predictor (OR: 1.516, 95% CIs 1.006-2.284, P = 0.047). Knowledge that WB-MRI does not use radiation predicted preference (adjusted OR: 3.018, 95% CIs 1.099-8.288, P = 0.032), although only 45/107 (42%) patients were aware of this attribute.Conclusions: A small majority of patients undergoing staging of colorectal or lung cancer prefer WB-MRI to CT/ PET-CT. Raising awareness of the potential benefits of WB-MRI, notably lack of ionizing radiation, could influence preference. [ABSTRACT FROM AUTHOR]

Female Genital Mutilation/Cutting (FGM/C) has risen up the global advocacy agenda and is recognized as an important child-safeguarding issue. The topic crystallizes key debates in my module, Culture and Development in Africa, and enables Geography undergraduates to explore complex intersections of childhood, gender, sexuality, and ethnicity in diverse African communities. In this paper, in light of in my efforts to teach for social transformation, I reflect on the inquiry-based learning approach I adopt and on its potential benefits. Conscious of postcolonial feminist critiques of processes of racialized "Othering", I discuss dilemmas about how to frame FGM/C and support students' critical engagement with the conflicting, sometimes confusing, discourses of cultural relativism and universal human rights. I seek to foster independent learning and research skills using a "real world" NGO assignment. Qualitative feedback suggests students develop more in-depth subject-knowledge, reflections on the ethics of "development", changes in self-theories and gain important skilful practices that may enhance their employability. Linking my teaching to my work with a charity tackling FGM/C has enabled co-learners to regard this as both a cultural practice that affects "distant others", and as a form of gender-based heteronormative violence and child abuse that has resonance in the local community. [ABSTRACT FROM AUTHOR]

The 'family' is associated with powerful, often emotive discourses in both the Majority and Minority worlds. However, family geographies to date have been largely focused on research with children and families in the Minority world, reflecting the wider dominance of geographical knowledge and social science theories developed in affluent, Anglophone contexts. In this intervention, I reflect on the tensions in attempting to theorise family meanings, practices and struggles in West Africa without imposing Minority world framings and perspectives. In my research in urban Senegal, the team's approach of 'uncomfortable reflexivity' enabled us to have frank conversations about our own experiences of 'family' and the death of a significant person, about our differing emotional responses to participants' experiences and about the nuances of the language used. My collaborative research with Ghanaian academics highlights the importance of time and space to develop shared qualitative understandings of everyday family struggles for publication in international journals. Given global inequalities in social science knowledge production, an ethic of care is needed that seeks to collaborate reflexively with others across disciplinary, linguistic and Majority-Minority world boundaries. This endeavour will hopefully generate more nuanced insights into the plurality and diversity of everyday family lives globally, while recognising the commonalities we share, situating knowledge in place and approaching the 'global' from the Majority world. [ABSTRACT FROM AUTHOR]

This article concerns the past and present migrations of people between and within Wales and Appalachia, told through the art of visual storytelling, drawing people into their migrant histories through folk art exhibitions, folk tales, and illustrated books. There have been many waves of migrations from Wales into Appalachia, from seventeenth-century Baptists and Quakers fleeing persecution at home, to miners and agricultural workers escaping poverty, unemployment, and land loss. However, there is irony in displaced Welsh people arriving in a new land and displacing Native people. The book The Moon-Eyed People , on which this article is based, views these stories through the eyes of Native and enslaved people in Appalachia and nomadic and marginalized people in Wales, lending an ear to lost and forgotten voices. This is folk history, stories of people with complex identities who developed roots in more than one culture. [ABSTRACT FROM AUTHOR]

Despite significant work on family geographies in recent years, geographers have paid less attention to changes and challenges that may be considered 'family troubles' in diverse contexts. Through this editorial and the special section, we unpack time-space dynamics of 'family troubles' in diverse contexts, with a particular focus on care and relationality. Our discussion foregrounds ambiguities and tensions surrounding geographical proximity and propinguity, material-emotional responses, and diverse meanings of 'family', 'home' and belonging in the context of troubling changes in family lives, intergenerational relations and practices of care. We seek to establish an agenda for future geographical work and interdisciplinary dialogue on 'family troubles', vulnerabilities and social suffering in contexts of (troubling) changes and diversity. Such analyses are crucial in our efforts to envision a more relational understanding of our 'being-in-the-world', underpinned by care ethics and support for differentially positioned family members throughout the lifecourse and across generations. [ABSTRACT FROM AUTHOR]

Objectives: To determine the importance placed by patients on attributes associated with whole-body MRI (WB-MRI) and standard cancer staging pathways and ascertain drivers of preference. Methods: Patients recruited to two multi-centre diagnostic accuracy trials comparing WB-MRI with standard staging pathways in lung and colorectal cancer were invited to complete a discrete choice experiment (DCE), choosing between a series of alternate pathways in which 6 attributes (accuracy, time to diagnosis, scan duration, whole-body enclosure, radiation exposure, total scan number) were varied systematically. Data were analysed using a conditional logit regression model and marginal rates of substitution computed. The relative importance of each attribute and probabilities of choosing WB-MRI-based pathways were estimated. Results: A total of 138 patients (mean age 65, 61% male, lung n = 72, colorectal n = 66) participated (May 2015 to September 2016). Lung cancer patients valued time to diagnosis most highly, followed by accuracy, radiation exposure, number of scans, and time in the scanner. Colorectal cancer patients valued accuracy most highly, followed by time to diagnosis, radiation exposure, and number of scans. Patients were willing to wait 0.29 (lung) and 0.45 (colorectal) weeks for a 1% increase in pathway accuracy. Patients preferred WB-MRI-based pathways (probability 0.64 [lung], 0.66 [colorectal]) if they were equivalent in accuracy, total scan number, and time to diagnosis compared with a standard staging pathway. Conclusions: Staging pathways based on first-line WB-MRI are preferred by the majority of patients if they at least match standard pathways for diagnostic accuracy, time to diagnosis, and total scan number. Key Points: • WB-MRI staging pathways are preferred to standard pathways by the majority of patients provided they at least match standard staging pathways for accuracy, total scan number, and time to diagnosis. • For patients with lung cancer, time to diagnosis was the attribute valued most highly, followed by accuracy, radiation dose, number of additional scans, and time in a scanner. Preference for patients with colorectal cancer was similar. • Most (63%) patients were willing to trade attributes, such as faster diagnosis, for improvements in pathway accuracy and reduced radiation exposure. [ABSTRACT FROM AUTHOR]

Introduction Following centralisation of UK paediatric intensive care, specialist retrieval teams were established who travel to general hospitals to stabilise and transport sick children to regional paediatric intensive care units (PICUs). There is national variation among these PICU retrieval teams (PICRTs) in terms of how quickly they reach the patient's bedside and in the care provided during transport. The impact of these variations on clinical outcomes and the experience of stakeholders (patients, families and healthcare staff) is however unknown. The primary objective of this study is to address this evidence gap. Methods and analysis This mixed-methods project involves the following: (1) retrospective analysis of linked data from routine clinical audits (2014-2016) to assess the impact of service variations on 30-day mortality and other secondary clinical outcomes; (2) a prospective questionnaire study conducted at 24 PICUs and 9 associated PICRTs in England and Wales over a 12-month period in 2018 to collect experience data from parents of transported children as well as qualitative analysis of in-depth interviews with a purposive sample of patients, parents and staff to assess the impact of service variations on patient/family experience; (3) health economic evaluation analysing transport service costs (and other associated costs) against lives saved and longer term measurements of quality of life at 12 months in transported children and (4) mathematical modelling evaluating the costs and potential impact of different service configurations. A final work stream involves a series of stakeholder workshops to synthesise study findings and generate recommendations. Ethics and dissemination The study has been reviewed and approved by the Health Research Authority, ref: 2 18 569. Study results will be actively disseminated through peer-reviewed journals, conference presentations, social media, print and broadcast media, the internet and stakeholder workshops. [ABSTRACT FROM AUTHOR]

We present a case of a 38-year-old man with no medical comorbidities who presented to the hospital with haemoptysis and shortness of breath on a background of vaping home-manufactured cannabis oil. He developed e-cigarette or vaping product use-associated lung injury (EVALI) visible on chest X-ray requiring oxygen, and corticosteroid treatment before making a recovery. Research reports that the contents vitamin E acetate and tetrahydrocannabinol are frequently found in substances acquired from informal sources which increase the likelihood of EVALI developing. Further research into their synergistic effect is ongoing. Although safer than smoking, vaping is not risk free and EVALI should be considered in patients presenting with respiratory disease. [ABSTRACT FROM AUTHOR]

This paper reflects on the methodological complexities of producing emotionally-sensed knowledge about responses to family deaths in urban Senegal. Through engaging in ‘uncomfortable reflexivity’, we critically explore the multiple positionings of the research team comprised of UK, Senegalese and Burkinabé researchers and those of participants in Senegal and interrogate our own cultural assumptions. We explore the emotional labour of the research process from an ethic of care perspective and reflect on how our multiple positionings and emotions influence the production and interpretation of the data, particularly exemplified through our differing responses to diverse meanings of ‘family’ and religious refrains. We show how our approach of ‘uncomfortable reflexivity’ helps to reveal the work of emotions in research, thereby producing ‘emotionally sensed knowledge’ about responses to death and contributing to the cross-cultural study of emotions. [ABSTRACT FROM PUBLISHER]

Objective To describe the experience and acceptability of whole-body magnetic resonance imaging (WB-MRI) staging compared with standard scans among patients with highly suspected or known colorectal or lung cancer. Design Qualitative study using one-to-one interviews with thematic analysis. Setting Patients recruited from 10 hospitals in London, East and South East England between March 2013 and July 2014. Participants 51 patients (31 male, age range 40-89 years), with varying levels of social deprivation, were recruited consecutively from two parallel clinical trials comparing the diagnostic accuracy and cost-effectiveness of WB-MRI with standard scans for staging colorectal and lung cancer ('Streamline-C' and 'Streamline-L'). WB-MRI was offered as an additional scan as part of the trials. Results In general WB-MRI presented a greater challenge than standard scans, although all but four patients completed the WB-MRI. Key challenges were enclosed space, noise and scan duration; reduced patient tolerance was associated with claustrophobia, pulmonary symptoms and existing comorbidities. Coping strategies facilitated scan tolerance and were grouped into (1) those intended to help with physical and emotional challenges, and (2) those focused on motivation to complete the scan, for example focusing on health benefit. Our study suggests that good staff communication could reduce anxiety and boost coping strategies. Conclusions Although WB-MRI was perceived as more challenging than standard scans, it was sufficiently acceptable and tolerated by most patients to potentially replace them if appropriate. Trial registration number ISRCTN43958015 and ISRCTN50436483. [ABSTRACT FROM AUTHOR]

Copyright of Mortality is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the context of HIV, there is considerable debate about the role of schools and teachers as potential sources of care and support for vulnerable children. This qualitative research examines ‘care’ as experienced and practiced by pupils and teachers in rural Western Kenya. In primary and secondary schools, interviews were conducted with 18 teachers and 57 orphaned and vulnerable pupils, alongside Photovoice. Drawing on thematic analysis and an ‘ethic of care’ theoretical perspective, we unpack the informal caring practices of teachers within resource-constrained settings. The research provides glimpses of schools as spaces of care, participation and support for orphaned and vulnerable pupils. Recognising and providing institutional support for the development of an ethic of care in schools may help to tackle the considerable educational barriers facing girls and boys who are orphaned and vulnerable and move ‘care’ closer towards the centre of educational policy and practice in the global South. [ABSTRACT FROM PUBLISHER]

This article describes a project that was set up to offer user participation in the development of a group for pregnant women and new mothers in an area of the UK where attendance at NHS antenatal classes and other groups was low. Responsibility for the implementation of the project was shared between a midwife, a health visitor and a children's centre manager who successfully applied for an NHS Patients First programme bursary from the Foundation of Nursing Studies. In the first 6 months of the project, women sampled crafts, music, 'pampering' and hypnobirthing, and worked with facilitators to design a rolling programme of activities of their choice. The aims of the project included building confidence for labour and motherhood, and making connections with a supportive local network of fellow mothers and children's centre staff. [ABSTRACT FROM AUTHOR]

Copyright of Gender, Place & Culture: A Journal of Feminist Geography is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

While many academics are sceptical about the 'impact agenda', it may offer the potential to re-value feminist and participatory approaches to the co-production of knowledge. Drawing on my experiences of developing a UK Research Excellence Framework ( REF) impact case study based on research on young caregiving in the UK, Tanzania and Uganda, I explore the dilemmas and tensions of balancing an ethic of care and participatory praxis with research management demands to evidence 'impact' in the neoliberal academy. The participatory dissemination process enabled young people to identify their support needs, which translated into policy and practice recommendations and in turn, produced 'impact'. It also revealed a paradox of action-oriented research: this approach may bring greater emotional investment of the participants in the project in potentially negative as well as positive ways, resulting in disenchantment that the research did not lead to tangible outcomes at local level. Participatory praxis may also pose ethical dilemmas for researchers who have responsibilities to care for both 'proximate' and 'distant' others. The 'more than research' relationship I developed with practitioners was motivated by my ethic of care rather than by the demands of the audit culture. Furthermore, my research and the impacts cited emerged slowly and incrementally from a series of small grants in an unplanned, serendipitous way at different scales, which may be difficult to fit within institutional audits of 'impact'. Given the growing pressures on academics, it seems ever more important to embody an ethic of care in university settings, as well as in the 'field'. We need to join the call for 'slow scholarship' and advocate a re-valuing of feminist and participatory action research approaches, which may have most impact at local level, in order to achieve meaningful shifts in the impact agenda and more broadly, the academy. [ABSTRACT FROM AUTHOR]

This article develops a framework of risk and protective factors to conceptualize the relationship between HIV-related stigma, asset inheritance and chronic poverty among widows and caregiving children and youth in Eastern Africa. Analysis of two qualitative studies with 85 participants in rural and urban areas of Tanzania and Uganda reveals that gendered and generational inequalities and stigmatization sometimes leads to property grabbing and chronic poverty. Human and social capital and preventative measures however may help widows and caregiving young people in HIV-affected households to safeguard land and other assets, within a wider supportive environment that seeks to tackle structural inequalities. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study was to investigate the ocular bacterial flora in patients scheduled to undergo cataract surgery and compare the antibacterial effects of besifloxacin ophthalmic suspension 0.6% and moxifloxacin ophthalmic solution 0.5% in these patients. Methods: This was a prospective, randomized, laboratory-masked clinical trial. Patients received besifloxacin or moxifloxacin "quater in die" or QID (four times a day) for 3 days before cataract surgery in the surgical eye and 1 hour before surgery in the nonsurgical fellow eye. Conjunctival and eyelid swabs were obtained from both eyes at baseline and after treatment, on the day of surgery (Visit 2). Swabs were processed for bacterial colony counts (in terms of colony-forming units) and species identification. In vitro antibiotic susceptibilities of isolates were determined using Clinical and Laboratory Standards Institute breakpoints. Results: Fifty-nine patients (n=28 besifloxacin, n=31 moxifloxacin) completed the study. The majority (73%) of conjunctival samples were culture negative at baseline. The most frequent isolates were coagulase-negative staphylococci (CoNS, 89%), specifically Staphylococcus epidermidis (72%). Both fluoroquinolones reduced the lid CFU values when administered QID for 3 days (P<0.019), but only besifloxacin reduced the lid CFU estimate 1 hour following instillation of a single drop (P=0.039). Fewer besifloxacin-treated eyes had lids that were culture positive for CoNS at Visit 2 compared with moxifloxacin-treated eyes regardless of dosing regimen (P<0.03). The minimum inhibitory concentration (MIC90) of besifloxacin against methicillin-resistant S. epidermidis (MRSE) was eightfold lower than that of moxifloxacin. Conclusion: Besifloxacin appeared more effective in reducing bacterial counts on eyelids of patients undergoing cataract surgery, with significant reductions as early as 1 hour postdose, compared with moxifloxacin. Besifloxacin was more active in vitro against MRSE. [ABSTRACT FROM AUTHOR]

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The delivery of a modern cancer service is dependent on the nurse specialist occupying a central role in the overall pathway. However, there are significant variations in the access to a lung cancer clinical nurse specialist (CNS) across the UK and the USA. In the UK, the lung cancer CNS plays a pivotal role in the delivery of high-quality care and treatment to patients with (presumed) thoracic malignancy. They are in an ideal position to provide holistic care to patients with lung cancer--ensuring that all needs are addressed from the time of initial referral to commencement of definitive treatment or palliative care. In addition the role provides support and advice to people on the increasingly complex treatment options and on survivorship, and plays an essential role in end-of-life care. In the USA, the nurse navigator is a core member of the lung cancer screening programme. In this review the authors provide a transatlantic perspective on the history, current practice and potential future roles for the lung cancer CNS in the UK and nurse navigator in the US. [ABSTRACT FROM AUTHOR]

Background: The ability to cure hepatitis C viral infection, with specific reference to the prisoner population and the prison environment, will be challenged, even if opiate replacement therapy is concurrently offered and even if bleach is available. The missing elements, widely available in the community are a regulated injecting equipment exchange and tattooing parlours. Case presentation: We report a case of re-infection of hepatitis C in a prisoner treated with a direct-acting antiviral. What makes this case so remarkable is that it was entirely predictable and preventable. Conclusions: Hepatitis C infection will continue to test both the strengths and the weaknesses in the relationship between health and corrective services in Australia. Nothing less than full implementation of all harm minimisation modalities will be necessary to eliminate the clinical and public health risks of hepatitis C infection, both in prison and by extension into the general community. [ABSTRACT FROM AUTHOR]

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Background In the UK there has been an effort, through the National Awareness and Early Diagnosis Initiative (NAEDI), to increase early stage diagnoses and ultimately cancer survival. Encouraging early symptom presentation through awareness-raising activities in primary care is one method to achieve this goal. Understanding GPs' views about this type of activity, however, is crucial prior to implementation. Aim To describe GPs' attitudes to raising public awareness of gynaecological cancers, and their views about the potential impact on primary care services. Design and setting An online survey with a convenience sample recruited from 1860 UK general practices. Method An invitation was emailed to GPs via practice managers and included a weblink to a draft education leaflet and an online survey about the impact of sending a leaflet giving information about symptoms associated with gynaecological cancers to all women on GPs' lists. Participants could offer additional free text comments which were coded using content analysis. Results A total of 621 GPs participated. Most (77%, 477) felt that raising awareness of cancers was important. Only half (50%, 308), however, indicated that they would distribute such a leaflet from their practice. Barriers to implementation included concerns about financial costs; emotional impact on patients; increased demand for appointments and diagnostic services, such as ultrasound. Conclusions GPs were generally positive about an intervention to improve patients' awareness of gynaecological cancers, but had concerns about increasing rates of presentation. There is a need for research quantifying the benefits of earlier diagnosis against resource costs such as increased consultations, investigations, and referrals. [ABSTRACT FROM AUTHOR]