Southwest England Research Articles

Near real-time prediction of urgent care hospital performance metrics using scalable random forest algorithm: A multi-site development

While previous studies have shown the potential value of predictive modelling for emergency care, few models have been implemented for producing near real-time predictions across various demand, utilisation and performance metrics. In this study, 33 independent Random Forest (RF) algorithms were developed to forecast 11 urgent care metrics over a 24-hour period across three hospital sites in an Integrated Care System (ICS) in South West England. Metrics included: ambulance handover delay; emergency department occupancy; and patients awaiting admission. Mean Absolute Error (MAE), Root Mean Squared Error (RMSE) and Symmetric Mean Absolute Percentage Error (SMAPE) were used to assess the performance of RF and compare it to two alternative models: naïve baseline (NB) and Auto-Regressive Integrated Moving Average (ARIMA). Using these measures, RF outperformed NB and ARIMA in 76% (N = 25/33) of urgent care metrics according to SMAPE, 88% (N = 29/33) according to MAE and 91% (N = 30/33) according to RMSE. The RFs developed in this study have been implemented within the local ICS, providing predictions on an hourly basis that can be accessed by local healthcare planners and managers.

Pre-hospital blood products for hazardous area response team paramedics: A service evaluation to inform decisions on future practice

Aim To identify the number of incidents, over a 1-year period in a single UK Ambulance Service Trust, where patients attended by Hazardous Area Response Team (HART) paramedics where eligible to receive Pre-hospital Blood Products (PHBP) but did not due to the unavailability of a suitably trained clinician. Methods This was a Service Evaluation using a three-stage method of filtering data to reduce bias and improve accuracy when identifying eligible cases. These stages consisted of an initial data request, a peer review filtering stage and then finally an Expert Consensus Panel review of cases to determine whether PHBP should have been administered. Results The consensus group considered 14 cases that would have ‘Likely’ or ‘Certainly’ have received PHBP if a suitably trained clinician was available on scene. Twelve cases involved a traumatic cause whilst the remaining two were medical. Similarly, 12 cases involved patients with spontaneous circulation whilst two patients had no pulse. South Western Ambulance Service Foundation Trust (SWASFT) Bristol HART attended eight and Exeter HART six of these cases. Conclusion This study reveals that across the South West of England, there were a number of patients, being attended by HART, who may potentially benefit from PHBP but are not receiving this intervention due to the unavailability of a suitably trained clinician. This could be far more in the event of a multi or mass-casualty event. HART paramedic access to PHBPs would enable more patients to access a potentially lifesaving treatment and contribute to narrowing the care gap identified in the Manchester Arena Inquiry. The authors recommend that a local pilot trial is undertaken to explore whether a HART PHBP service is feasible, sustainable, cost-effective, appropriate, and safe.

Exploring the impact of disruption on university staff resilience using the dynamic interactive model of resilience

The unanticipated changes in Higher Education settings brought about as a result of COVID–19 resulted in a range of personal, pedagogical and organisational challenges. This paper reports on research undertaken within a university in South West England, exploring how the pandemic impacted the working practices of academic and professional staff, the implications of those changes and the factors the respondents interpreted as influencing their resilience. A mixed methods approach was adopted whereby data were gathered from 159 academic and professional staff members using an online survey. Nine respondents were then individually interviewed. The data were analysed using the Dynamic Interactive Model of Resilience (DIMoR) in order to explore protective and risk factors from the various systems surrounding the respondents, alongside their more personal vulnerabilities/invulnerabilities. The results highlight the importance of considering individual and wider contexts when analysing the potential for resilience to emerge in times of disruption. The significance of movement of proximal and distal influences depending on the individual and their context also emerged, offering implications for university leaders to consider in supporting staff within their institutions. The value of the DIMoR is discussed as a lens for analysis to support understanding and future action.

Nest material preferences in wild hazel dormice Muscardinus avellanarius: testing predictions from optimal foraging theory.

Obtaining nesting material presents an optimal foraging problem, collection of materials incurs a cost in terms of risk of predation and energy spent and individuals must balance these costs with the benefits of using that material in the nest. The hazel dormouse, Muscardinus avellanarius is an endangered British mammal in which both sexes build nests. However, whether material used in their construction follows the predictions of optimal foraging theory is unknown. Here, we analyze the use of nesting materials in forty two breeding nests from six locations in Southwest England. Nests were characterized in terms of which plants were used, the relative amount of each plant, and how far away the nearest source was. We found that dormice exhibit a preference for plants closer to the nest, but that the distance they are prepared to travel depends on the plant species. Dormice traveled further to collect honeysuckle Lonicera periclymenum, oak Quercus robur, and beech Fagus sylvatica than any other plants. Distance did not affect the relative amount used, although the proportion of honeysuckle in nests was highest, and more effort was expended collecting honeysuckle, beech, bramble Rubus fruticosus and oak compared to other plants. Our results suggest that not all aspects of optimal foraging theory apply to nest material collection. However, optimal foraging theory is a useful model to examine nest material collection, providing testable predictions. As found previously honeysuckle is important as a nesting material and its presence should be taken account when assessing suitability of sites for dormice.

Origins, characteristics and destination of nursing students in South West England

BackgroundWorldwide there are concerns about the supply of nurses into health systems. Understanding and balancing the supply of and demand for healthcare professionals is crucial to efficient healthcare delivery, yet there is relatively little research that examines in detail where nursing students come from and where they go after qualification.ObjectivesTo investigate the demographic characteristics of applicants to nursing and midwifery programmes in England, those that are enrolled, attrition during study, and their career intentions on graduation.MethodsA descriptive case study was conducted in south west England drawing on a complementary set of analyses of routinely collected application and enrolment data from 2017–2020. These were augmented by derivation of student deprivation indices and a follow-up study of nursing and midwifery students qualifying between May 2020 and April 2021.ResultsThe percentage of males applying for nursing doubled and the mean age of all enrolled students (except midwifery) increased during the study period. The mean level of deprivation of applicants increased from the 51st to the 55th centile indicating widening of participation. Most applying and enrolled students originated from the same region as the nursing school and remained working there on qualification. Successively more males than females were lost from the system at each stage from application to qualification. Qualifying students most common job choice was within acute Trusts, with Medical, District nursing and surgical being the most common choices. The most important factors regarding job choice were location, the characteristics of the Trust, having been there as a student, and family considerations.ConclusionsThe data provide useful information on the nursing educational pipeline. The data discussed here raise questions that would benefit from further regional and national empirical research.

Spatial variability in the structure of fish assemblages associated with Laminaria hyperborea forests in the NE Atlantic

Understanding fish-habitat associations is critical for ecosystem-based approaches to management and conservation. Kelp species, which are estimated to inhabit around 25% of the world's coastline and underpin highly productive and biodiverse ecosystems, are widely recognised as important nursery and foraging habitats for coastal fish species. However, quantitative assessments of fish assemblages within kelp forests are lacking for many regions. Here, we used Baited Remote Underwater Video (BRUV) and Underwater Visual Census (UVC) to quantify fish assemblages in Laminaria hyperborea forests at eight shallow subtidal rocky reefs that spanned 9° of latitude in the United Kingdom (UK). Fish assemblages were a ubiquitous and conspicuous component of kelp forest communities at all sites. BRUV surveys recorded marked regional-scale variability, with latitudinal shifts in assemblage structure and particularly distinct assemblages recorded in southwest England. These patterns were largely due to greater abundances of Pollachius spp. (i.e. saithe and pollock) in northern regions and higher numbers of Gobiusculus flavescens (two-spotted goby) and labrid species (i.e. rock cook, goldsinny and ballan wrasses) in southern regions. Unlike BRUVs, UVC surveys did not detect significant regional-scale variation in assemblage structure but did detect significant site-level differences, highlighting differences between the two techniques. BRUV surveys also recorded clear latitudinal trends in richness, with more taxa recorded at lower latitudes. Fish assemblages in the NE Atlantic have been, and will continue to be, impacted by ocean warming and fishing activities. Greater spatiotemporal coverage of kelp forest surveys and ongoing robust monitoring is needed to better understand and manage future ecological changes.

Amputation and advance care plans: An observational study exploring decision making and long-term outcomes in a vascular centre.

Half of those undergoing major lower limb amputation for peripheral arterial disease die within 1year. Advance care planning reduces days in hospital and increases the chance of dying in a preferred place. To investigate the prevalence and content of advance care planning for people having a lower limb amputation due to acute or chronic limb-threatening ischaemia or diabetes. Secondary aims were to explore its association with mortality, and length of hospital stay. A retrospective observational cohort study. The intervention was advance care planning. Patients admitted to the South West England Major Arterial Centre between 1 January 2019 and 1 January 2021 who received unilateral or bilateral below, above, or through knee amputation due to acute or chronic limb-threatening ischaemia or diabetes. 116 patients were included in the study. 20.7% (n = 24) died within 1year. 40.5% (n = 47) had an advance care planning discussion of which all included cardiopulmonary resuscitation decisions with few exploring other options. Patients who were more likely to have advance care planning discussions were ≥75years (aOR = 5.58, 95%CI 1.56-20.0), female (aOR = 3.24, 95%CI 1.21-8.69), and had multimorbidity (Charlson Comorbidity Index ≥5, aOR = 2.97, 95%CI 1.11-7.92). Discussions occurred more often in the emergency pathway and were predominantly initiated by physicians. Advance care planning was associated with increased mortality (aHR = 2.63, 95%CI 1.01, 5.02) and longer hospital stay (aHR = 0.52, 95%CI 0.32-0.83). Despite a high risk of death for all patients in the months following amputation, advance care planning occurred in fewer than half of people and mostly focused on resuscitation.

Sonic methodologies for more-than-human geographies: the politics of listening in a traditional slaughterhouse in the UK

Sound is an established parameter in animal welfare studies. A sonic ethnographic study of a traditional slaughterhouse in south-west England reveals how animal welfare, conceived as ‘respect for the animal’ at slaughter, is based on sonically attuned practices. Such sonic engagement distinguishes the traditional slaughterhouse from industrial operations and works to dispel the stigma of killing for the workers. A sonic approach centers the more-than-human methodologically whilst also revealing the politics of listening in the slaughterhouse.

Historical anthropogenic disturbances explain long-term moorland vegetation dynamics.

Upland moorlands are important landscapes, but many are considered degraded as a result of human activities. Consequently, their protection and restoration are of substantial concern. In Europe, restoration activities are often aimed at reversing the effects of 19th and 20th century "agricultural improvements," which often involved major drainage schemes. However, the ecological effects and long-term ecological context of "agricultural improvement" are not yet fully understood. To develop this understanding, we analyze paleoecological data (pollen, coprophilous fungal spores, microcharcoal) from five upland peatland sites using a range of analytical approaches: cluster analysis, principal component analysis, rate-of-change analysis, and regression analyses incorporating documentary historical data. The sites are located on Exmoor (South West England, UK), a landscape that typifies historic upland degradation. We demonstrate that in this landscape, 19th century drainage is associated with declines in Sphagnum and non-arboreal taxon richness; over longer timescales burning is associated with enhanced graminoid monocot abundance and grazing with lower taxon richness. We also show that rate-of-change in moorland vegetation communities during the 19th century is not distinctive in a long-term context: change has been a constant in this landscape, rather than an exception during the 19th century. Our findings indicate that the aims of "restoration" interventions intended to increase Sphagnum abundances, increase taxon richness and reduce graminoid dominance are consistent with the long-term dynamics of peatland systems, such as those on Exmoor. "Restoration" deemed successful in these terms may or may not resemble pre-drainage conditions, which were themselves a function of millennia of successive moorland management regimes.

Associations between autistic traits and early ear and upper respiratory signs: a prospective observational study of the Avon Longitudinal Study of Parents and Children (ALSPAC) geographically defined childhood population

ObjectiveTo determine whether early ear and upper respiratory signs are associated with the development of high levels of autistic traits or diagnosed autism.DesignLongitudinal birth cohort: Avon Longitudinal Study of Parents...

Towards literacies of immanence: Getting closer to sensory multimodal perspectives on research

In this article, we propose ‘literacies of immanence’ as a term for sensory-laden, embodied multimodal practices that happen when researchers get out of the way to allow for modal diversity in meaning making. The learning encounters that we observed during our research combined senses with a kaleidoscope of modes that were hard to describe through more traditional multimodal methods. Literacies of immanence is the most fitting phrase for these practices because they were fluid, open, and they did not rely on written and spoken texts. Researching in a primary and secondary special school that are part of an academy trust in the southwest of England, the research team engaged in research-creation propositions (Truman, 2021) where we watched and built on multimodal meaning making supplementing it with story-making activities. Writing and sharing fieldnotes and filming interactions, we abandoned original plans and instead shaped methods and theoretical framings around the population of learners we met. Fieldnotes were shared on a blog and filmmaking helped us to describe and draw out multimodal, immanent literacies and their epiphanic qualities. This article features fieldnotes along with images of multimodal-sensory encounters and ways that they helped us relate to the learners, their teachers and Head Teacher as well as each other as researchers. The article is of relevance to researchers looking for ways to capture visible and invisible modal practices at work across settings and a movement away from a definite or true-false rendering of multimodality to one that allows for divergent ways of being with modes.

The functions of leisure in later life: bridging individual- and community-level perspectives

Abstract Leisure participation in older age has principally been researched from individual-level theoretical perspectives that view leisure as reflecting adaptations to ageing-related losses and change. Recent orientations to later-life leisure participation, such as innovation theory, emphasise positive developmental aspects and uses of older individuals' leisure pursuits, driven by personal agency. Moreover, the potential of later-life leisure activities to contribute to community is conceptualised in social capital theory perspectives that bridge individual- and community-level functions of leisure participation. This paper presents findings from qualitative thematic analysis of oral histories on leisure conducted with 58 persons aged 60 and over in rural south-west England, to examine the personal uses and functions of their leisure occupations in older age, and the role that these activities play in connecting older individuals to their communities. While participants described lifetime patterns of leisure characterised by a core set of activities and interests, later life was a period of leisure transitions in which they actively used new and continuing pastimes to adapt to changing personal circumstances, abilities and aspirations. The findings also demonstrate how participants' leisure activities – ranging from avidly pursued hobbies to formal volunteering – served individual adaptive and developmental purposes, and were a means of fostering social connectivity and contributing to rural community life. Implications of these findings are discussed in regard to leisure theory, policy and practice. This paper adds to the literature on ageing and leisure by identifying the benefits of examining older persons' leisure participation from a combined conceptual perspective that can elucidate its functions at both the micro- and meso-levels of society.

Laotris luzulae (Hymenoptera, Braconidae, Alysiinae, Dacnusini), a new species from the southwest of England

Laotris luzulae Godfray, sp. nov. is described in the small genus Laotris Nixon, 1943, (Braconidae, Alysiinae, Dacnusini) from five specimens reared from Cerodontha silvatica (Groschke, 1957) (Diptera, Agromyzidae) mining Luzula sylvatica (Huds.) Gaudin (Juncaceae) in Devon and Gloucestershire in the southwest of Great Britain. Six further specimens from Somerset caught as adults in the 1950s are also noted. It differs morphologically from the three described species of Laotris and shows a 4.2% and 6.6% genetic distance at the CO1 barcode locus from an undescribed North American species and from the European L. striatula (Haliday, 1839), respectively.

Impact of test, vaccinate and remove protocol on home ranges and nightly movements of badgers in a medium density population

In the British Isles, the European badger (Meles meles) is thought to be the primary wildlife reservoir of bovine tuberculosis (bTB), an endemic disease in cattle. Test, vaccinate or remove (‘TVR’) of bTB test-positive badgers, has been suggested to be a potentially useful protocol to reduce bTB incidence in cattle. However, the practice of removing or culling badgers is controversial both for ethical reasons and because there is no consistent observed effect on bTB levels in cattle. While removing badgers reduces population density, it may also result in disruption of their social behaviour, increase their ranging, and lead to greater intra- and inter-species bTB transmission. This effect has been recorded in high badger density areas, such as in southwest England. However, little is known about how TVR affects the behaviour and movement of badgers within a medium density population, such as those that occur in Northern Ireland (NI), which the current study aimed to examine. During 2014–2017, badger ranging behaviours were examined prior to and during a TVR protocol in NI. Nightly distances travelled by 38 individuals were determined using Global Positioning System (GPS) measurements of animal tracks and GPS-enhanced dead-reckoned tracks. The latter was calculated using GPS, tri-axial accelerometer and tri-axial magnetometer data loggers attached to animals. Home range and core home range size were measured using 95% and 50% autocorrelated kernel density estimates, respectively, based on location fixes. TVR was not associated with measured increases in either distances travelled per night (mean = 3.31 ± 2.64 km) or home range size (95% mean = 1.56 ± 0.62 km2, 50% mean = 0.39 ± 0.62 km2) over the four years of study. However, following trapping, mean distances travelled per night increased by up to 44% eight days post capture. Findings differ from those observed in higher density badger populations in England, in which badger ranging increased following culling. Whilst we did not assess behaviours of individual badgers, possible reasons why no differences in home range size were observed include higher inherent ‘social fluidity’ in Irish populations whereby movements are less restricted by habitat saturation and/or that the numbers removed did not reach a threshold that might induce increases in ranging behaviour. Nevertheless, short-term behavioural disruption from trapping was observed, which led to significant increases in the movements of individual animals within their home range. Whether or not TVR may alter badger behaviours remains to be seen, but it would be better to utilise solutions such as oral vaccination of badgers and/or cattle as well as increased biosecurity to limit bTB transmission, which may be less likely to cause interference and thereby reduce the likelihood of bTB transmission.

Impacts of Schmallenberg virus infection in early lambing sheep flocks following the second wave of virus circulation in South West England in 2012/2013: a mixed-methods descriptive study

Impacts of Schmallenberg virus infection in early lambing sheep flocks following the second wave of virus circulation in South West England in 2012/2013: a mixed-methods descriptive study

Just transition in the post-pandemic city

ABSTRACT This paper asks how the pandemic has affected climate governance, with a specific focus on just transition in cities. We respond to Westman and Castán Broto’s (2021) challenge that three assumptions are frequently reproduced in the urban climate governance literature and ask: (1) Are social justice and environmental sustainability separated? (2) Does a sectoral perspective on cities constrain conceptions of climate justice? and (3) Is there action rather than just plans? We address these questions by studying three cities in the South West of England (Bristol, Bath, and Exeter) that have expressed aspirations for rapid and just transition to net zero. There are promising signs of climate action, although the pandemic slowed it down somewhat. Climate justice is not sufficiently embedded in plans or actions. Commitment to just transition is present but partial and often unspecified. Social justice and ecological sustainability are too often treated as separate goals, more likely to come into conflict with each other, than addressed jointly. Too much climate work in cities takes place in silos around energy and transport but separate from other sectors. There is a notable failure to engage with civil society for a just transition. We conclude that for cities to truly implement a just transition, better engagement with grassroots actors from across sectors and parts of society is necessary. The development of tools which support cities to analyse the complex interplay of distributional, recognitional, participatory and restorative aspects of justice could be an important part of delivering this change.

Educator views regarding young people’s aspirations in peripheral coastal communities in England: a Q study

ABSTRACT In this paper, we deploy data collected through a Q study with educators in south-west England. The mixed methodology involved the two stages of forced choice statement sorting by educator participants and subsequent factor analysis. Through abductive analyses, four views regarding aspirations and young people in peripheral communities are identified. Of these, only one viewpoint, named ‘acknowledge the barriers to finding employment’, aligns with taken for granted narratives on encouraging school students to pursue careers in the knowledge economy, with transition to higher education being the acknowledged pathway to flourishing futures. Three further viewpoints are identified and discussed. The paper contributes new insights to understanding educational landscapes in peripheral places through employing a novel approach, that of Q method, to illuminate educators’ lived experiences in such communities.

Association of metals with expanded polystyrene in the marine environment

Expanded polystyrene (EPS) has characteristics distinctively different to many thermoplastics that strongly influence its behaviour in the marine environment. However, the extent and nature of its interactions with metals are poorly understood. In the present study, fragments of beached EPS have been retrieved from an urban harbour and an open sandy beach in southwest England and the concentrations, locations and availabilities of various metals (and metalloids) of geochemical importance and anthropogenic significance determined. Total (aqua regia-digestible) metal concentrations at the surface (normalised to a depth of 0.5 cm) were considerably greater than surface concentrations reported for polyolefins retrieved from the same region and, with the exception of Cd, Sb and Zn, were significantly greater than those in unweathered EPS packaging material. Median surface concentrations of Al, As, Co, Fe, Mn, Ni and Sb were significantly greater at the open beach than the harbour, but concentrations of Cu and Pb were significantly greater at the latter. Where measured, concentrations of all metals were similar at the surface and subsurface (0.5 to 1 cm), and availability to 0.7 M HCl ranged from <20 % for Al and Fe to >60 % for Mn and Pb. These results, coupled with visible characteristics, suggest that aqueous and particulate metals are able to interact with the EPS surface via a number of mechanisms (adsorption, precipitation, entrapment) and migrate through the weathered, porous structure to within the polymer matrix. Enrichment factors normalised to Al as a granulometric proxy and relative to a regional baseline indicate “moderately severe” contamination with respect to Cd, Cu, Pb, Sb and Zn in at least one of the environments studied, suggesting that EPS might be a significant carrier and means of exposure for these metals in the marine environment.

Glass microbeads in coastal sediments as a proxy for traffic-related particulate contamination

Retroreflective glass microbeads used in road markings have been characterised and subsequently identified in urban coastal sediments. Clear or translucent silica beads range in diameter from about 30 to 700 μm and readily break from the matrix of detached or damaged markings on abrasion. At an urban location close to the city centre of Plymouth, southwest England, and in an estuary below a large road bridge, microbeads were detected in nearly all intertidal sediments analysed (n = 18) and at concentrations up to about 550 kg−1 dw. At a location not immediately impacted by major roads, beads were entirely absent from sediments (n = 9). With a size range and density similar to silt-sand, glass beads appear to accumulate in sediment subject to road runoff and act as persistent proxies for traffic-related contamination. Although beads are unlikely to be inherently toxic, they may serve as indicators of more harmful chemicals in road dust.

Results from a New Robotic Rectal Cancer Service in South West England

Background: Robotic colorectal surgery was first described by Weber et al in 2002. Robotic anterior resection of rectal cancers is a safe alternative to laparoscopic and open approaches. Financial barriers remain the primary challenge in establishing a new robotic service. We set out to establish whether a new regional robotic rectal cancer service could improve outcome and remain cost effective. The primary outcome was inpatient length of stay. Secondary outcomes of major complications, 90 day mortality and lymph node yield were recorded. Cost effectiveness was calculated.