Search Results (189)

This paper focuses on regeneration projects in ‘first-generation’ seaside resorts in England from the perspective of those leading and managing such projects. There have been numerous recent initiatives intended to revive seaside resorts and enable them to regain competitiveness, but limited analysis of what is necessary for such regeneration projects to be successful. This paper contributes to debates about the role of critical success factors (CSFs) in regeneration by identifying issues that apply to the specific context of seaside resorts. In-depth interviews were undertaken with ten managers responsible for individual projects focusing on the CSFs necessary for regeneration projects to succeed. Four such factors were identified: (1) the need to secure appropriate funding (and associated difficulties); (2) the importance of involving stakeholders (particularly the local authority and local community); (3) the need for a strong business plan (which must evolve as the project progresses); and (4) the importance of considering best practices elsewhere. The importance of each success factor varied by the sector (public/commercial/third) leading the regeneration initiative and varied at different stages of a regeneration project. These findings have practical implications for local authorities, commercial enterprises, and third-sector bodies in seaside destinations. Full article

Background: Nutritional disorders may affect short-term recovery after major orthopaedic surgery, but evidence is lacking. This study assessed whether and how different nutritional disorders diagnosed at admission could influence early recovery after hip replacement. Methods: A prospective analytical study was designed to include 60 patients scheduled for elective primary hip replacement and assess their nutritional status to diagnose 5 malnutrition phenotypes: undernutrition, sarcopenia, obesity, sarcopenic obesity, and sarcopenic undernutrition. Outcome measures were 24 h change in neutrophils, 72 h change in haemoglobin, and 10-day gait speed regain. Results: Haemoglobin reached the nadir at day 2–3 and partially recovered by day 10 in all patients, with sarcopenia and undernutrition being the strongest predictors of the postoperative drop (−2.37 g∙dL⁻¹ and −0.80 g∙dL⁻¹, p < 0.05). Neutrophils peaked immediately after surgery and returned to baseline levels at discharge, with sarcopenic undernutrition displaying a blunted response after surgery (−16.20%, p < 0.01). Undernutrition was found to be the most influential preoperative variable on gait speed recovery, but with a marginal effect. None of the patients covered the reference energy and protein needs through diet in the 10 postoperative days. Conclusions: In this cohort, nutritional disorders with reduced body function and reserves (sarcopenia and undernutrition) grounded a greater vulnerability to surgery in terms of early stress response and short-term recovery. This calls for both advanced planning of nutritional prehabilitation strategies for these conditions and adequate postoperative nutritional support. Full article

Artificial intelligence (AI) is rapidly transforming diagnostic approaches in different fields of medical sciences, demonstrating an emerging potential to revolutionize dermatopathology due to its capacity to process large amounts of data in the shortest possible time, both for diagnosis and research purposes. Different AI models have been applied to neoplastic skin diseases, especially melanoma. However, to date, very few studies have investigated the role of AI in dermatoses. Herein, we provide an overview of the key aspects of AI and its functioning, focusing on medical applications. Then, we summarize all the existing English-language literature about AI applications in the field of non-neoplastic skin diseases: superficial perivascular dermatitis, psoriasis, fungal infections, onychomycosis, immunohistochemical characterization of inflammatory dermatoses, and differential diagnosis between the latter and mycosis fungoides (MF). Finally, we discuss the main challenges related to AI implementation in pathology. Full article

Objectives: The purpose of the present study was to investigate the relationship between acute and chronic loads, and the fatigue response within male elite professional football players. Design: 40-week longitudinal study across the 2021–2022 season in the English Championship. Methods: Twenty-three outfield football players had workload measured using global positioning system (Distance, High-Intensity Distance and Sprint Distance) and perceived exertion. Load-response was measured via a perceived wellbeing questionnaire, counter-movement jump (CMJ) and salivary immunoglobulin A. Results: General estimating equation models identified 18 significant interactions between workload and load-response markers. Thirteen significant interactions were found between acute and chronic workloads and CMJ variables, jump height, eccentric duration and flight contraction time. A poor CMJ was observed when acute sprint workload was >+1 standard deviation and chronic distance increased. However, when chronic perceived exertion increased, and acute sprint workload was >+1 standard deviation an advantageous response was detected on counter movement jump variables. The S-IgA response to acute and chronic workload was more variable; when chronic loads were >+1 standard deviation above mean values and acute workload increased, salivary immunoglobulin A was both suppressed and elevated depending on the interacting acute variable. Higher chronic workload was associated with better perceived wellbeing, even when acute workload was >+1 standard deviation above the mean. Conclusion: In general, low chronic workloads and acute spikes in workload were associated with poorer neuromuscular and immune function. Furthermore, CMJ performance and perceived wellbeing improved when chronic workloads were higher, despite the occurrence of acute spikes in workload. Full article

Photogrammetry captures and stitches multiple images together to generate a digital model of the human body, called an avatar, making it potentially useful in healthcare. Its validity for anthropometry remains to be established. We evaluated the reliability and agreement of measurements derived from a three-dimensional digital avatar generated by photogrammetry compared to manual collection. Fifty-three volunteers (34.02 ± 11.94 years of age, 64% female, 22.5 kg∙m⁻² body mass index) were recruited, and twenty-two body regions (neck, armpits, biceps, elbows, wrists, chest, breast, waist, belly, hip, thighs, knees, calves, ankles) were taken by an individual rater with a tape measure. Digital measurements were generated from photogrammetry. Participants’ intraclass correlation coefficients indicated strong consistency, with agreement of over 90% for limb regions such as biceps, elbows, wrists, thighs, knees, calves, and ankles, while chest and armpits showed lowest agreement (<60%). Random errors were low in limb regions, while trunk measurements showed highest errors (up to >1 cm) and variation. Bland–Altman analysis revealed wider limits of agreements and higher biases for chest (−2.44 cm), waist and belly (around −1.2 cm), and armpits (around −1.1 cm) compared to limbs. Our findings suggest that photogrammetry-based digital avatars can be a promising tool for anthropometric assessment, particularly for limbs, but may require refinement in trunk-related regions. Full article

Phytoplankton are single-celled microorganisms with short generation times that may comprise high diversity in genetic and phenotypic traits, allowing them to acclimate to changes rapidly. High intraspecific genetic variation is well known in phytoplankton, but less is known about variation in physiological traits. To investigate variability and plasticity in genetic, morphological, and physiological traits of the toxigenic diatom genus Pseudo-nitzschia in a global warming scenario, we exposed 40 strains of the cold-water P. seriata to different temperatures (2 °C, 6 °C and 10 °C). The maximum growth rate and cellular toxin content showed extensive intraspecific variation, whereas morphological and genetic variation was minor. Thermal reaction norms showed a general increase in growth rate with increasing temperature; however, three distinct types of thermal responses were found among the 40 strains. All 40 strains contained toxins (domoic acid) in both exponential and stationary growth phase, and toxin content increased significantly with temperature. Most strains (>87%) contained measurable levels of domoic acid at all three temperatures. In conclusion, P. seriata shows extensive intraspecific variation in measured physiological traits like growth and toxin content, a variation exceeding the response of each strain to increases in temperature. Intraspecific variation in harmful species thus needs attention for the future understanding of food web dynamics, as well as the management and forecasting of harmful blooms. Full article

An EBSL-encoding plasmid, pESBL-PH, was identified during a nosocomial outbreak of Klebsiella pneumoniae ST628 at a United Kingdom general district hospital in 2018. The plasmid from the earliest 2018 K. pneumoniae strain discovered during the outbreak was assembled using both Oxford nanopore long reads and illumina short reads, yielding a fully closed plasmid, pESBL-PH-2018. pESBL-PH-2018 was queried against the complete NCBI RefSeq Plasmid Database, comprising 93,823 plasmids, which was downloaded on 16 July 2024. To identify structurally similar plasmids, strict thresholds were applied, including a mash similarity ≥0.98. This returned 61 plasmids belonging to 13 unique sequence types (STs) hosts. The plasmids were detected from 13 unique countries, dating from 2012 to 2023. The AMR region of the plasmids varied. Interestingly IS26-mediated tandem amplification of resistance genes, including the ESBL gene bla_CTX-M-15 was identified in two independent strains, raising their copy number to three. Furthermore, the genomic background of strains carrying a pESBL-PH-2018-like plasmid were analyzed, revealing truncation of the chromosomal ompK36 porin gene and carbapenem resistance gene carriage on accessory plasmids in 17.85% and 26.78% of strains with a complete chromosome available. This analysis reveals the widespread dissemination of an ESBL-encoding plasmid in a background of resistance-encoding strains, requiring active surveillance. Full article

Consumers are increasingly demanding higher-quality mutton. Crossbreeding has been recognized as an effective means to improve meat quality. However, the phenomenon underlying these molecular system mechanisms remains largely unidentified. In this study, 48 male lambs aged 3 months were selected, including ♂ Hu sheep × ♀ Hu (HH, n = 16), ♂ Polled Dorset × ♀ Hu sheep F₁ hybrid lambs (DH, n = 16), and ♂ Southdown × ♀ Hu sheep (SH, n = 16) F₁ hybrid lambs, and raised in a single pen under the same nutritional and management conditions for 95 days. Then, seven sheep close to the average weight of the group were selected and fasted for 12 h prior to slaughter. By comparing the muscle fiber characteristics of the Longissimus dorsi of the three groups of sheep, and through transcriptomic and metabolomic analyses, we revealed molecular differences in the meat quality of Hu sheep crossbred with different parent breeds. The results of this study showed that muscle fiber diameter and cross-sectional area were significantly greater in the DH group than in the HH group, and collagen fiber content in the DH group was also significantly higher than in the HH group (p < 0.05). A total of 163 differential genes and 823 differential metabolites were identified in the three groups, most of which were related to muscle development and lipid metabolism. These included the AMPK signaling pathway, the PI3K-Akt signaling pathway, glycerophospholipid metabolism, and the related genes EFHB, PER3, and PPARGC1A. The results of this study offer valuable insights into the molecular mechanisms underlying the impact of crossbreeding on meat quality and provide a theoretical foundation for sheep crossbreed production. Full article

Background: Stroke has high mortality. Challenges in providing end-of-life care include uncertainty among healthcare professionals about when to start care. While generic tools and guidelines exist, which outline components of quality end-of life care, they may not fully address stroke’s unpredictable trajectories, complicating care planning. Objective: To enhance understanding of end-of-life care post-stroke. Methods: We undertook an explanatory sequential mixed methods approach, including a cross-sectional survey and semi-structured interviews. All 286 United Kingdom (UK) National Health Service (NHS) hospitals providing inpatient stroke care were approached for participation in an on-line cross-sectional survey. The survey of healthcare professionals from UK stroke units was used to map current stroke end-of-life care and models of care. Fourteen staff who completed the survey and agreed to a future interview were purposively selected. The semi-structured interviews with healthcare professionals involved in delivering end-of-life care post-stroke were conducted and interpreted using the Theoretical Domains Framework. We aimed to enhance our understanding of the experiences, expectations, challenges and barriers in providing end-of-life care post-stroke, including effective clinical decision-making. Results: Across 108 responding survey sites, 317 responses were received. Results showed a lack of structured tools and approaches, an absence of stroke-specific guidance and variable delivery of end-of-life care post-stroke. Thirteen staff (nurses, occupational therapists, medical stroke consultants, and a speech and language therapist) agreed to be interviewed. The data provided a fuller understanding of the context within which end-of-life care post-stroke is delivered. The varied challenges faced include: uncertain prognosis, complex decision-making process, varying skill levels, staffing levels, the hospital environment, emotional strain on both families and staff, inequitable access to specialist palliative care, and difficulties associated with different models of care (stroke service structures and cultural context). Conclusions: Provision of end-of-life care post-stroke is complex, challenging, uncertain, and inconsistent. There is limited evidence or guidance to support healthcare professionals. There is a need for implementation support, which includes education, to better enable quality and more consistent end-of-life care post-stroke. Further research is required to assess interventions that can support end-of-life care post-stroke to aid clinicians in providing quality palliative care for stroke patients. Full article

A significant number of UK fire fatalities have been reported to involve textiles contaminated with emollients. In the following study, the flammability of a variety of fabrics containing 14 different emollients, including paraffin-free creams, was evaluated. This is the first time the impact of the presence of such a large range of emollients has been examined. Horizontal burn tests were conducted on emollient-contaminated fabrics. Significantly earlier ignition time were noted upon heating for all emollient-contaminated fabrics (p < 0.001) when compared to the behaviour of blank fabrics were noted using a vertical burn test. The mean time to ignition for 100% cotton fabric (151 ± 2 g/m²) was reduced from 71.5 to 14.4 s and for 52%/48% polyester/cotton fabric (103 ± 2 g/m²) from 328 to 12.9 s by the presence of emollients. Horizontal burn tests with a direct flame on 100% cotton fabric (114 ± 1 g/m²) displayed an accelerated mean flame speed from 0.0032 to 0.0048 ms⁻¹ and an increased maximum flame height of 56.6 to 175.4 mm for emollient-contaminated fabrics. These findings demonstrate the fire risk of fabrics contaminated with a dried emollient. Their potential to ignite quickly and to propagate a fire may strongly decrease the reaction time of an impacted individual. Therefore, it is important that this risk and appropriate safety advice be continually highlighted and communicated not only in the UK but worldwide. Full article

Microalgae form the basis of marine food webs, essential in sustaining top predators including seabirds. However, certain species of microalgae synthesize biotoxins, which can accumulate in shellfish and fish and may cause harm to marine animals feeding on them. Toxins produced by dinoflagellates have been previously observed to be poisonous to seabirds. Also, in freshwater and brackish habitats, cyanobacteria have caused bird mortality events. In this work, we analyze the prevalence of six families of biotoxins (paralytic shellfish toxins (PSTs), microcystins (MCs), anatoxins, amnesic shellfish toxins (ASTs), cylindrospermopsin, and tetrodotoxins (TTXs)) in 340 samples from 193 wild birds admitted to a wildlife rehabilitation centre in south Portugal. Furthermore, we consider the clinical picture and signs of 17 birds that presented quantifiable levels of biotoxins in their tissues. The relationship between toxin burdens and the symptomatology observed, as well as possible biotoxin sources, are discussed. Based on previously published research data, we conclude that, in these birds, the biotoxins are unlikely to be the only cause of death but might contribute to some extent to a reduction in birds’ fitness. Full article

Background and Objectives: Malnutrition’s prevalence and its relationship with functional ability in patients with end-stage spine pathologies, i.e., any disease of the vertebral bodies, intervertebral discs, and associated joints requiring surgical intervention, are yet to be explored. This retrospective study aimed to investigate the association between malnutrition, disability, and physical health in patients undergoing elective spine surgery in our Italian hospital. Materials and Methods: Data between 2016 and 2019, recorded at pre-admission visits, were extracted from our institutional spine registry (ClinicalTrials.gov number: NCT03644407), excluding minor patients or those undergoing emergency or oncological surgery. The measures were the Oswestry disability index (ODI) and the physical health (PH) summary of the 36-item Short-Form Health Survey. Clinical data were linked to nine laboratory parameters from pre-operative routine blood tests, and equations to ascertain the risk of malnutrition and its diagnosis were attributed. Results: The study sample included 2258 spine patients (58.15% females) who underwent surgery in our Italian hospital. The ODI and PH significantly varied across body weight difference (BWd) strata in younger adults (adjusted-p = 0.046, η² = 0.04; adjusted-p = 0.036, η² = 0.06) and adults (adjusted-p = 0.001, η² = 0.02; adjusted-p = 0.004, η² = 0.02). Protein malnutrition with acute/chronic inflammation (PMAC) in both adults (adjusted-p < 0.001, η² = 0.04; adjusted-p < 0.001, η² = 0.04) and older adults (adjusted-p = 0.010, η² = 0.04; adjusted-p = 0.009, η² = 0.05) had also a discernible impact in determining the ODI and PH. In older adults, the ODI was associated with iron deficit malnutrition (IDM) (adjusted-p = 0.005, η² = 0.06) and both the ODI and PH were associated with vitamin B deficit (VBD) (adjusted-p = 0.037, η² = 0.01; adjusted-p = 0.049, η² = 0.01). Trend monotonicity was diagnosis- and sex-specific, with meaningful ordered patterns being observed mostly in young males and older females. Conclusions: Functional ability showed an association with malnutrition in younger adults and adults when using BWd, in adults and older adults when using PMAC, and in older adults when using IDM and VBD. The authors advocate for the inclusion of nutritional management in the pre-operative evaluation to potentially enhance recovery after spine surgery. Full article

With the spread of enhanced recovery protocols, the management of the perioperative pathway of patients undergoing major orthopaedic surgery has been harmonised to these international standards. A natural evolution of the enhanced recovery framework is to integrate personalised pathways of care for those with unique needs, thus addressing inter-individual differences. Personalised nutrition is the practice of attributing a personal imprint to the perioperative nutritional support and has the potential to ensure more effective and equitable care for those patients who may require more than standard support. The authors of this opinion article review each important element of personalisation with respect to their coverage of what is important in the perioperative care of major orthopaedic procedures such as hip and knee replacement. Full article

This study examines luxury tourists’ behavior toward sustainability in the aftermath of the pandemic, with a particular focus on the Maldives, a destination renowned for both its luxury offerings and commitment to sustainable practices. A qualitative approach was employed, featuring structured interviews with one hundred European tourists who had visited the Maldives and stayed at luxury resorts, alongside semi-structured interviews with three tour operator managers who sell the destination. In addition, secondary data provided by the tour operator were used to support the analysis and triangulate the data for more robust findings. The results show a significant shift in consumer attitudes: luxury travelers have become increasingly sensitive to sustainability and the protection of the environment since the pandemic. The tourists in the sample reported heightened awareness of their personal environmental impact and a greater desire to mitigate it. Furthermore, participants expressed a willingness to pay a premium for environmentally sustainable services and products, demonstrating a clear preference for businesses that can substantiate their eco-friendly practices through credible certifications and accreditations. These findings highlight the growing importance of sustainability in shaping luxury consumer behavior in the post-pandemic era. Full article

Background: Ceramic may be an alternative bearing surface that could be used to deal with the negative sequalae associated with the use of metal-on-metal (MoM) hip resurfacing implants, keeping the benefits of hip resurfacing without the risks. The aim of this study is to evaluate the additional financial and logistical implications that MoM hip resurfacing has, in comparison to its ceramic-on-ceramic (CoC) counterpart. Methods: Two different follow up protocols were analysed, according to current practice guidance, on how to follow up with hip resurfacing procedures. Reference costs were identified using the latest national cost collection data and data from the local biochemistry department. The results incorporated the number of hip resurfacings performed nationally. Results: The non-MoM protocol yielded a per operation lifetime follow up cost of £802.50, whereas the MoM protocol yielded a cost of £2132.83 at 25 years. Nationally, according to the 2023 data, this amounted to £561,750 versus £1,492,981 per year, respectively. MoM hip resurfacing is 2.6 times more expensive to be followed up with when compared to the standard protocol. Conclusion: The cost of the follow up of MoM bearings far exceeds that of non-MoM bearings. If CoC hip resurfacing is as clinically effective as MoM hip resurfacing, then the economics favour CoC bearing for resurfacing. Full article