East Scotland Research Articles

Predicting asthma attacks in primary care: protocol for developing a machine learning-based prediction model

IntroductionAsthma is a long-term condition with rapid onset worsening of symptoms (‘attacks’) which can be unpredictable and may prove fatal. Models predicting asthma attacks require high sensitivity to minimise mortality...

Changes in resistance among coliform bacteraemia associated with a primary care antimicrobial stewardship intervention: A population-based interrupted time series study.

BackgroundPrimary care antimicrobial stewardship interventions can improve antimicrobial prescribing, but there is less evidence that they reduce rates of resistant infection. This study examined changes in broad-spectrum antimicrobial prescribing in the community and resistance in people admitted to hospital with community-associated coliform bacteraemia associated with a primary care stewardship intervention.Methods and findingsSegmented regression analysis of data on all patients registered with a general practitioner in the National Health Service (NHS) Tayside region in the east of Scotland, UK, from 1 January 2005 to 31 December 2015 was performed, examining associations between a primary care antimicrobial stewardship intervention in 2009 and primary care prescribing of fluoroquinolones, cephalosporins, and co-amoxiclav and resistance to the same three antimicrobials/classes among community-associated coliform bacteraemia. Prescribing outcomes were the rate per 1,000 population prescribed each antimicrobial/class per quarter. Resistance outcomes were proportion of community-associated (first 2 days of hospital admission) coliform (Escherichia coli, Proteus spp., or Klebsiella spp.) bacteraemia among adult (18+ years) patients resistant to each antimicrobial/class. 11.4% of 3,442,205 oral antimicrobial prescriptions dispensed in primary care over the study period were for targeted antimicrobials. There were large, statistically significant reductions in prescribing at 1 year postintervention that were larger by 3 years postintervention when the relative reduction was −68.8% (95% CI −76.3 to −62.1) and the absolute reduction −6.3 (−7.6 to −5.2) people exposed per 1,000 population per quarter for fluoroquinolones; relative −74.0% (−80.3 to −67.9) and absolute reduction −6.1 (−7.2 to −5.2) for cephalosporins; and relative −62.3% (−66.9 to −58.1) and absolute reduction −6.8 (−7.7 to −6.0) for co-amoxiclav, all compared to their prior trends. There were 2,143 eligible bacteraemia episodes involving 2,004 patients over the study period (mean age 73.7 [SD 14.8] years; 51.4% women). There was no increase in community-associated coliform bacteraemia admissions associated with reduced community broad-spectrum antimicrobial use. Resistance to targeted antimicrobials reduced by 3.5 years postintervention compared to prior trends, but this was not statistically significant for co-amoxiclav. Relative and absolute changes were −34.7% (95% CI −52.3 to −10.6) and −63.5 (−131.8 to −12.8) resistant bacteraemia per 1,000 bacteraemia per quarter for fluoroquinolones; −48.3% (−62.7 to −32.3) and −153.1 (−255.7 to −77.0) for cephalosporins; and −17.8% (−47.1 to 20.8) and −63.6 (−206.4 to 42.4) for co-amoxiclav, respectively. Overall, there was reversal of a previously rising rate of fluoroquinolone resistance and flattening of previously rising rates of cephalosporin and co-amoxiclav resistance. The limitations of this study include that associations are not definitive evidence of causation and that potential effects of underlying secular trends in the postintervention period and/or of other interventions occurring simultaneously cannot be definitively excluded.ConclusionsIn this population-based study in Scotland, compared to prior trends, there were very large reductions in community broad-spectrum antimicrobial use associated with the stewardship intervention. In contrast, changes in resistance among coliform bacteraemia were more modest. Prevention of resistance through judicious use of new antimicrobials may be more effective than trying to reverse resistance that has become established.

The relationship between implicit and explicit attitudes to British accents in enhancing the persuasiveness of children’s oral health campaigns

Abstract This paper seeks to improve the persuasiveness of oral health campaigns by investigating the relationship between implicit and explicit attitudes to British accents. Forty-seven participants from Tayside, East Scotland, first completed an implicit task which asked participants to judge the truth value of 120 trivia statements, divided into six different accents, as quickly as possible. This was complimented by an identical written task at the end of the experiment in less pressurised conditions. Both audio and written responses to the statements were analysed using signal detection theory, which revealed that Estuary English was more persuasive than the local accent, Dundee English (p = 0.039), and the stigmatised multi-ethnolect, Multicultural London English (p = 0.002). Participants also completed an explicit task involving two matched-guise tests with the same six accents in a neutral and dental context. Results update our knowledge of explicit attitudes to British accents in a modern linguistic landscape, and shed light on correlations between implicit and explicit attitudes. Using Bassili and Brown’s (2005) Potentiated Recruitment Framework, it is argued that the relationship is mediated by participants’ self-presentation concerns and the perceived social penalties of expressing bias. Sociolinguistic implications of implicit measurement procedures are discussed regarding the development of oral health campaigns.

\u201cIt\u2019s just in that sea of things that I never cared about\u201d: perception of hepatitis B amongst university students in Aberdeen, North-East Scotland

BackgroundA significant proportion of international students at UK universities are from regions with medium to high hepatitis B prevalence rates. Understanding the perception of students regarding hepatitis B infection is crucial for the development of appropriate information and services for this population group.MethodsTwenty semi-structured interviews were conducted with students from the University of Aberdeen. The following key areas were covered: knowledge, awareness, practices including testing, cultural and social aspects and general attitudes to health information and services. Interviews were transcribed verbatim and coded using a framework analysis approach.ResultsThe participants acknowledged hepatitis B to be a serious disease yet did not consider themselves to be at risk. They felt able to go to their General Practitioner if concerned about hepatitis B but emphasised that there was no indication that this was required. There was a general lack of knowledge about the disease including confusion over other types of hepatitis. This was linked to the perceived lack of attention given to hepatitis B in, for example, sexual health education and disease awareness raising campaigns. The participants expressed a desire for information on hepatitis B to be relevant to the student population, easy to understand, socially acceptable and easily accessible on student portals and social media platforms.ConclusionsOur study suggests that students in Aberdeen, North East Scotland lack knowledge and awareness of hepatitis B and do not perceive themselves as being at risk of hepatitis B infection. There is a need for more tailored hepatitis B messages to be incorporated into a range of contexts with clearer risk communication for the student population.

Evaluating the predicted impact of changes to the AJCC/TMN staging system for differentiated thyroid cancer (DTC): A prospective observational study of patients in South East Scotland.

To assess the impact of the eighth edition AJCC/TMN staging system on patients with new diagnoses of differentiated thyroid cancers presenting to our regional multidisciplinary team meetings. We analysed Endocrine Cancer MDT meeting records from 2009 to 2015 to identify all patients in the region presenting with a new diagnosis of differentiated thyroid cancer. We re-staged patients according to the eighth edition AJCC/TNM staging classification and analysed the survival outcomes of patients in each stage under the seventh and eighth systems. Tertiary referral centre in South East Scotland (NHS Lothian). Three hundred and sixty-one patients were newly diagnosed with DTC within South East Scotland during the study period and met our inclusion criteria. Disease-specific mortality at any time during follow-up. In total, 119 of 361 (33%) patients were re-staged when the eighth edition AJCC/TMN system was applied. The number of patients classified as having advanced stage (III/IV) disease fell from 76 (21%) to 8 (2%). The most common reason for down-staging was re-classification of tumour size, a factor in 96 (80.7%) down-staged patients. The five-year disease-specific survival of the cohort overall was 98%. Overall, 7 (1.9%) thyroid cancer-related deaths occurred during follow-up, three of whom were down-staged. On implementation of the eighth edition of the AJCC/TMN staging system, we expect many patients who would previously have been considered to have advanced thyroid cancer will now be classified as early stage. This will accurately reflect their excellent survival outcomes.

Neurobehavioral problems in children with early-onset epilepsy: A population-based study

PurposeNeurobehavioral problems (i.e., cognitive impairment/behavior problems) are a major challenge in childhood epilepsy. Yet there are limited data in children with early-onset epilepsy (CWEOE; onset ≤4 years), the period in which the incidence of childhood epilepsy is highest. This study aimed to determine the prevalence, spectrum, and risk factors for neurobehavioral problems CWEOE. MethodsThis prospective, population-based, case-controlled study identified children with newly diagnosed early-onset epilepsy in South East Scotland using active multisource capture–recapture surveillance (May 2013 – June 2015). The CWEOE and controls completed an age-appropriate neurobehavioral assessment battery across seven domains: general cognitive ability (GCA), adaptive behavior, externalizing, internalizing, executive functioning, social functioning, and Autism Spectrum Disorder (ASD) risk. ResultsFifty-nine CWEOE were identified with an ascertainment of 98% (95% confidence interval [CI] 94, 103). Forty-six (78% [95% CI 65.9, 86.6]) CWEOE (27 male, median age 25.5, range 1–59, months) and 37 controls (18 male, median age 31.5, range 3–59, months) consented for study entry. The CWEOE were similar to controls in gender, age, prematurity, and family history of psychopathology, but not socioeconomic status (Fisher's exact test [FET] < .001). Neurobehavioral assessments were carried out a median of 2.97 (Interquartile range [IQR] 1.51–4.95) months post epilepsy diagnosis.More CWEOE (63% [95% CI 48.6, 75.5]) had neurobehavioral problems compared with controls (27% [95% CI 15.4, 43.0]); p < 0.01. This observation was independent of socioeconomic status. Multidimensional problems were prevalent in CWEOE with 43% having two or more different domain-level problems; GCA impairment, adaptive behavior, internalizing, social functioning, and ASD risk were particularly marked. Risk factors varied by domain. DiscussionThis novel study using comprehensive psychometric assessments found that neurobehavioral problems in CWEOE were detectable, common, and multidimensional. The degree of cooccurrence implies that problems are the norm, and multidimensional screening should be considered at epilepsy onset. The findings could aid policy development on health and educational provision in CWEOE.

Outcomes following induction of labour in east of Scotland: Comparative analysis of past vs. present

Introduction: Induction of labour (IOL) has been steadily increasing in Scotland, 32% in 2017 from 31.2% in 2016. Although in our population (Tayside) induction rate is on decline recently, however its been 24% in 2011.

Donald Trump’s Golf Resort in Aberdeenshire, Scotland: The ‘ Greatest ’ Incomplete Planning Disaster in the World?

In 2006 Donald Trump submitted a planning application to transform an area of protected dunes and open countryside along the coast of north east Scotland into a major golf and leisure resort. He claimed the golf course would be the greatest in the world and would transform the region’s oil economy. Citing the economic benefits the Scottish Government approved the project in 2008. Trump has constructed the golf course but has failed to deliver the hotel and other elements of the project. Against the backdrop of planning deregulation, the paper examines why the officials failed to include appropriate planning conditions to ensure delivery of the project and prevent a great incomplete planning disaster. Recognising the limitations of current public law enforcement mechanisms it invokes concepts borrowed from contract law. Holding that Trump is in breach of contract and has benefitted from unjust enrichment, it examines the scope for applying damages, restitution and specific performance as alternative remedies.

Enantioselective LC-MS/MS for anthropogenic markers of septic tank discharge

Households in rural locations utilize septic tanks for wastewater treatment and can cause surface water contamination. A new methodology was developed to help investigate the role septic tanks play in the dissemination of prescription and over-the-counter drugs, personal care products and stimulants in the aqueous environment. Simultaneous analysis of 16 chiral and achiral anthropogenic markers was achieved using a Chirobiotic V2® enantioselective column in polar ionic mode. The optimized method achieved quantitation limits for 16 compounds in the range 0.001–2.9 μg L−1 and 0.0002–0.43 μg L−1 for septic tank effluent and stream water, respectively. Application of the method to samples collected in North East Scotland found caffeine to be ubiquitous in all samples studied suggesting it as a good indicator of septic tank discharge. In rural streams studied, concentrations of all prescription drugs investigated were ≤0.02 μg L−1. However, analgesics and stimulants were at high concentration in one location indicating direct discharge of septic tank wastewater (i.e., not dissipated through a soak away). For example, paracetamol, cotinine and caffeine were measured at 1100 μg L−1, 31 μg L−1 and 200 μg L−1, respectively, which is comparable to septic tank effluents. Furthermore, S(+)-amphetamine and R(−)-amphetamine were present in this stream sample at 0.20 and 0.27 μg L−1. This corresponds to an enantiomeric fraction of 0.43, which is typical of untreated wastewaters in the UK. Findings illustrate further study on the diffuse impact of septic tanks to surface water is needed and can be supported using this new multi-residue enantioselective method.

Open randomised trial of the (Arabin) pessary to prevent preterm birth in twin pregnancy with health economics and acceptability: STOPPIT-2—a study protocol

IntroductionThe STOPPIT-2 study aims to determine the clinical utility of the Arabin cervical pessary in preventing preterm birth in women with a twin pregnancy and a short cervix, about which...

Understanding cauda equina syndrome: protocol for a UK multicentre prospective observational cohort study

IntroductionCauda equina syndrome (CES) is a potentially devastating condition caused by compression of the cauda equina nerve roots. This can result in bowel, bladder and sexual dysfunction plus lower limb...

An evaluation of the Health Equality Framework in south east Scotland

An evaluation of the Health Equality Framework in south east Scotland

Open Science approaches at the University of Edinburgh

Watch the VIDEO.The University of Edinburgh is a large, research-intensive, civic university at the heart of Scotland’s capital. As a member of the League of European Research Universities (LERU), the Universitas 21 consortium and the Russell Group, we value and cultivate partnerships and collaborations as second nature, and seek to be recognised among the world’s top universities. These are interesting times for us, not least from Open (and data-driven) Science perspectives. In May 2018 the LERU Rectors Assembly assembled in Edinburgh, where they collectively endorsed LERU’s Roadmap for Open Science; a movement which requires considerable alterations to traditional researcher behaviours, and increasingly balancing intellectual investment and ownership of research with “the common good.” More recently, in August the UK Prime Minister and the Scottish First Minister met at the University to launch the Edinburgh and South East Scotland City Region Deal, a £1.3bn investment package designed to increase the contribution of research, data analytics expertise and graduate skills to the region’s economy, ultimately aiming to make Edinburgh “the data capital of Europe.” The timing of these developments provides a challenge, however, as Edinburgh, Scotland and the rest of the UK prepare to leave the European Union in the Spring of 2019. In an ideal world Science and Scholarship would be independent of political shifts, focused as they are on ideals of universal truth, but the means via which research is funded, performed and disseminated are necessarily grounded in political reality. Edinburgh’s default responses to the changes and challenges we face are to influence them positively – or mitigate them proactively – wherever we can, and to prepare ourselves for their impact where we cannot do otherwise. The University’s newly integrated Research Data Support (RDS) team is a cornerstone of our institutional Digital Research Services. We aim to provide holistic, responsive, tailored and researcher-focused support to the University community, helping collectively meet contemporary expectations in scholarly communications, including Open Science requirements to make data (and code) available alongside publications to enable their conclusions to be reproduced. The RDS has published a Roadmap for ongoing development, and alongside other infrastructural and support units such as the Scholarly Communications and Research Information Systems functions – and together with the externally focused infrastructure, advocacy and skills development centres that Edinburgh hosts, such as the Digital Curation Centre and the Software Sustainability Institute – we are a key component of the University’s broader Open Science strategy. In this presentation we will describe and discuss Edinburgh’s Open Science environment and approaches, within the broader landscape of changing expectations, political risks and scientific and societal opportunities. We will discuss the benefits and challenges of Open approaches within and beyond the Sciences, and the challenges involved in turning the European Commission’s “as open as possible, as closed as necessary” dictum into reality, including outreach and skills development activities. Finally we will look at the University’s current RDS Roadmap, and consider how this might develop and adapt in the exciting (and potentially turbulent) years ahead.

The Community Empowerment Act and localism under devolution in Scotland

PurposeIn Scotland, the Community Empowerment (Scotland) Act represents a significant development towards greater localism in the way public services are designed and delivered in Scotland. This also represents a different approach to that adopted in the rest of the UK. The purpose of this paper is to explore the stakeholder perceptions of localism within a council ward.Design/methodology/approachThis paper is based on an in-depth exploratory case study of a single council ward in East Scotland. The fieldwork involved 61 in-depth interviews with multiple stakeholders including local councillors, public service managers and residents.FindingsThe findings highlight that, whilst the discourse of community empowerment represents policy divergence, there remain some significant structural and social barriers to meaningful community empowerment in practice. Finally, it is argued that there are three key factors to consider when developing community empowerment: a shared strategy, shared resources and shared accountability.Originality/valueThe research draws on extensive data from an in-depth case study to explore the realities of community empowerment within a single local authority ward. In doing so, it provides a rich contextual narrative of how the rhetoric of community empowerment is perceived within a council ward setting.

Substance misuse in patients who have comorbid chronic pain in a clinical population receiving methadone maintenance therapy for the treatment of opioid dependence

Aims: To compare specific substance misuse in treatment-seeking, opioid-dependent patients with and without comorbid chronic pain, and to assess the respective value of urinalysis and patient reports in assessing substance misuse.Methods: Participants comprised a clinical population in a regional NHS Substance Misuse Service in the East of Scotland (N = 521). The Brief Pain Inventory – Short Form was used to assess pain, and the Maudsley Addiction Profile and urinalysis were used to assess substance misuse at study inception. Urinalysis was used to assess substance misuse during the 5-year follow-up period. Data were hosted, linked, anonymized and analyzed within a national Safe Haven.Results: Compared with opioid-dependent patients with no pain, a significantly higher proportion of treatment-seeking, opioid-dependent patients with chronic pain were engaged in non-medical benzodiazepine use (69% versus 58%; p = 0.016) and illicit cannabinoid use (84% versus 65%; p = 0.025) at study inception. Furthermore, a significantly higher proportion of this group was shown to continue non-medical benzodiazepine use (70% versus 42%; p = 0.037) and illicit cannabinoid use (100% versus 31%; p = 0.002) during the 5-year follow-up period. There were significant correlations between drug screen results and patient-reported use of opioids (Tetrachoric ϱ = 0.4944; p < 0.001), benzodiazepines (Tetrachoric ϱ = 0.2641; p = 0.001) and cannabinoids (Tetrachoric ϱ = 0.8384; p < 0.001).Conclusions: Whilst gaining control of illicit opioid use during treatment, opioid-dependent patients with comorbid chronic pain demonstrated persistent problematic use of benzodiazepines and cannabinoids. This pattern of misuse was shown to persist during the 5-year follow-up period.

The development of the Pictish symbol system: inscribing identity beyond the edges of Empire

The date of unique symbolic carvings, from various contexts across north and east Scotland, has been debated for over a century. Excavations at key sites and direct dating of engraved bone artefacts have allowed for a more precise chronology, extending from the third/fourth centuries AD, broadly contemporaneous with other non-vernacular scripts developed beyond the frontiers of the Roman Empire, to the ninth century AD. These symbols were probably an elaborate, non-alphabetic writing system, a Pictish response to broader European changes in power and identity during the transition from the Roman Empire to the early medieval period.

P2.13-25 Analysis of EGFR Mutations Using Circulating Tumour DNA (ctDNA) in Non-Small Cell Lung Cancer Patients in North East Scotland

P2.13-25 Analysis of EGFR Mutations Using Circulating Tumour DNA (ctDNA) in Non-Small Cell Lung Cancer Patients in North East Scotland

The effect of chemical dispersant concentration on hydrocarbon mobility through permeable North-East Scotland sands

Accidental releases of oil to the marine environment can reach sensitive shorelines resulting in a wide range of environmental impacts. Chemical dispersant is a response tool employed to minimise damage to coastal ecosystems by facilitating dispersal of oil slicks before they reach shores. However, chemical dispersants may increase entrainment of hydrocarbons into coastal sediments following an oil spill, resulting in higher hydrocarbon residence times in sediments. Here, the effect of dispersant concentration on the entrainment capability of hydrocarbons in permeable coastal sands from North East Scotland (United Kingdom) was evaluated. Hydrocarbon entrainment into sands was facilitated by dispersant application at concentrations below manufacturer-recommended dosage. Percolation of water-soluble hydrocarbons beyond 10 cm deep was not affected by chemical dispersant application and water-insoluble hydrocarbon concentrations increased with dispersant concentration. Results highlighted that the application of dispersant readily mobilised less water-soluble hydrocarbons through coastal sands but did not affect pore-water transport of more water-soluble hydrocarbons.

Advective pore-water transport of hydrocarbons in North East Scotland coastal sands.

Oil spills in the marine environment can cause ecosystem-level impacts. Dispersant application as an oil spill response measure leads to the widespread distribution of hydrocarbons in the water column and marine sediments. The North Sea is an area of intense hydrocarbon production and is at risk of oil spills, which are of concern to its benthic ecosystem due to its sediments' high permeability. Here, entrainment of hydrocarbons via pore-water advection into permeable North Sea sands and the associated effect of Superdispersant-25, a commercial oil dispersant, were evaluated in a laboratory. Centrally stirred chambers that induce advective pore-water fluxes in sediments were filled with sediment, seawater and mixtures of oil and Superdispersant-25. Dispersant application had contrasting effects on hydrocarbon interactions with sediment: (1) it reduced accumulation of hydrocarbons in surface sediments and (2) facilitated the entrainment of hydrocarbons up to 8cm deep into sediments by increasing hydrocarbon solubility in seawater and its subsequent washout or pumping into sediment by pore-water movement. Results here show that dispersant application can have counter-intuitive effects on hydrocarbon interactions with marine sediments and highlight the need for further research in this area to make better informed decision in an oil spill response scenario.

Evaluating the Impact of Changes to the AJCC/UICC Staging System for Differentiated Thyroid Cancer (DTC) on Patients in South East Scotland

Evaluating the Impact of Changes to the AJCC/UICC Staging System for Differentiated Thyroid Cancer (DTC) on Patients in South East Scotland