South West Region Of England Research Articles

Women, Empire, and Entomology: An Object Biography of Eleanor Glanville’s Pipevine Swallowtail, c. 1700

Today, the gentlewoman Eleanor Glanville (1655–1709) is often remembered as the first lady of British butterflies. In Glanville’s own lifetime, she gained a reputation amongst London naturalists as an astute collector of butterflies from the South West region of England. Yet, a turn towards Glanville’s material archive, namely, her extant specimens held at the Natural History Museum, London, reveals Glanville’s success as a collector of rare butterflies from the Americas and thus, her complicity in colonial collecting. This article provides an object biography of a single pipevine swallowtail or Battus philenor, c. 1700, labeled “Glandvill.” It follows the butterfly specimen from its obscure origins in the Americas, to Glanville’s residence in the Atlantic port city of Bristol, and to London naturalists’ cabinets of curiosities, where it would became part of a collection that helped found the British Museum, the first public museum of its kind. The life cycle of this object attests to the role that empire played in building one woman’s collection of insects and her contributions to the making of present-day museums. It also suggests that while empire opened up opportunities for some women naturalists, it did not necessarily advance their reputations as collectors.

Decolonisation of curricula in undergraduate dental education: an exploratory study

Aims To explore experiences and perceptions of students and staff regarding decolonisation of the curriculum in a dental undergraduate programme.Methods Participants were invited to respond to an online survey on decolonisation of the dental curriculum. The target population included current students on the Bachelor of Dental Surgery and Bachelor of Dental Therapy and Hygiene programmes, as well as dental staff at a university in the South West region of England. The common items for student and staff versions of the survey were focused on six themes: representation; content; peer engagement; assessment; language and communication; and culture. All responses were anonymous. Data on programme, year of study, age, sex and ethnicity were captured on a voluntary basis.Results In total, 34 staff members and 120 students from two different programmes participated in the survey, yielding a response rate of 87.17% for staff and 45.28% for students. A comparison showed that average student responses were lower compared with average staff responses. Of the 24 survey items, 17 showed significantly lower scores reported by minority ethnic (ME) students. ME students were, when compared with white counterparts, less likely to report that their programme included opportunities for group discussions about ethnicity and privilege. Similar comparisons of staff responses did not show significant differences between white and ME staff. Nevertheless, responses by staff and students across the board highlighted the need for further steps to improve the representation of ME groups in the curriculum.Conclusions This study provides useful insights into the perceptions and experiences of students and staff regarding the decolonisation of the dental curriculum in an undergraduate dental programme. Responses by the participants across the board identified several areas which could benefit from better representation of ME groups. Significant differences were noted between staff and student scores and also between white and ME students, indicating the latter group demonstrated more awareness regarding issues of representation. The findings underscore the need to take further steps to decolonise dental curricula.

What drives differences in preferences for health states between patients and the public? A qualitative investigation of respondents’ thought processes

Cost-effectiveness analyses using quality-adjusted life-years (QALYs) are used in decision-making regarding which interventions are available via many national healthcare systems. QALYs are calculated based on health state values provided by preference elicitation techniques. Several national decision-making bodies recommend that health state values should be based on preferences elicited from general populations, rather than from patients. Previous studies have shown systematic differences between health state values elicited from members of the general population and from patients. Various explanations for this phenomenon have been proposed, however empirical evidence for these is scarce. We aimed to explore possible reasons for discrepancies between public and patient valuations by undertaking qualitative cognitive interviews, asking 14 members of the general population and 12 people with multiple sclerosis (MS) to think aloud while completing a preference elicitation task (time trade-off) for MS-related health states. The interviews were undertaken between December 2016 and October 2017 in the South West region of England, and were analysed using the Framework Method. As anticipated, we found that participants with MS had more experience of health problems and used this experience to consider how they might adapt to the health states over time, and which dimensions of health-related quality of life were most important to them. We found no evidence that participants with MS were less affected by framing effects and focusing illusions, more likely to prioritise non-physical dimensions of health, or more prone to loss aversion, endowment effects and non-compensatory decision-making. These findings contribute to our understanding of how patients and members of the general population respond to preference elicitation exercises, and why their preferences may differ, and may help to inform developing areas of research, such as the joint presentation of cost-effectiveness results from multiple perspectives, and the use of preferences elicited from patients for experienced health states.

Abstract PS3-31: Training multi-professional mammogram readers to interpret abbreviated breast MRI (FAST MRI): A UK multi-centre study

Abstract Background: As a breast cancer screening test, FAST MRI has the potential to combine the sensitivity of dynamic contrast enhanced breast MRI (DCE-MRI) with costs nearer to those of mammography. In the UK the NHS Breast Screening Programme (NHSBSP) screens women aged 50-70 with a mammogram every 3 years and has a workforce of radiologists, breast clinicians and advanced practitioner radiographers who interpret over 2 million screening mammograms annually. For FAST MRI to be used as a UK population screening tool it will need to be interpreted by the existing multi-professional workforce of mammogram readers. Our research team developed a single study day of standardised training in FAST MRI interpretation. In our single centre pilot study, a group of readers with no previous experience of DCE-MRI interpretation achieved an accuracy just 5% less than expert DCE-MRI readers (Br J Radiol 2019:92 DOI:10.1259/bjr.20190663). Our current study aimed to validate the feasibility of training the NHSBSP workforce in FAST MRI interpretation. We developed display software (MedXViewer) containing ground truth information for each FAST MRI case to train and assess mammogram readers, who represented multiple NHSBSP sites in the South West Region of England. Methods: The study was funded by the National Institute for Health Research (Research for Patient Benefit funding stream; ISRCTN 16624917). A per breast analysis of the frequency of results against the true outcome was obtained overall and for each reader. Differences in accuracy, sensitivity and specificity across reader groups (group 1 = mammogram readers experienced in DCE-MRI interpretation; group 2 = mammogram readers with no previous experience in DCE-MRI interpretation) were analysed using a multilevel generalised mixed model to account for multiple readers per case. Results: 37 NHSBSP mammogram readers at 6 NHSBSP sites attended the training day and completed interpretation of the summative assessment dataset (17 in group 1 and 20 in group 2). All 37 readers completed the reading task of 125 cases (250 breasts), for a total of 9250 reads. Median interpretation time was 99.08 seconds (interquartile range 66.83-150.54). The table below shows per breast analysis comparing the readers’ classification with the true outcome (cancer or normal): The concordance with the ground truth (accuracy) of 83% achieved by Group 2 (4129/5000 (95% CI 82-84%)) was significantly lower than that achieved by Group 1 (3814/4250 (90%; 89-91%); p<0.0001) but differed by only 7%. The concordance with the true outcome improved for the group 2 readers from the first 55 cases to the remaining 70 cases (p=0.02), whereas there was no significant improvement for the expert readers of group 1 (p=0.81). Conclusions: This study validates the feasibility of training the workforce of mammogram readers to interpret FAST MRI with only one day of standardised training. Improvement in performance with experience by the group 2 readers indicates a learning curve and suggests the performance gap between the two groups might be narrowed by further training for group 2. TotalGroup 1Group 2MeasureConcordance (Accuracy)7943/9250 (86%)3814/4250 (90%)4129/5000 (83%)True positive rate (Sensitivity)1806/2109 (86%)858/969 (89%)948/1140 (83%)True negative rate (Specificity)6137/7141 (86%)2956/3281 (90%)3181/3860 (82%)False positive rate1004/7141 (14%)325/3281 (10%)679/3860 (18%)False negative rate303/2109 (14%)111/969 (11%)192/1140 (17%) Citation Format: Lyn IL Jones, Rebecca Geach, Sam A Harding, Andrea Marshall, Sadie McKeown-Keegan, Sian Taylor-Phillips, Premkumar Elangovan, Mark Halling-Brown, Sarah Vinnicombe, Elizabeth O'Flynn, Hesam Ghiasvand, Claire T Hulme, Janet A Dunn. Training multi-professional mammogram readers to interpret abbreviated breast MRI (FAST MRI): A UK multi-centre study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS3-31.

External validation of the Dutch prediction model for prehospital triage of trauma patients in South West region of England, United Kingdom.

This paper investigates the use of a major trauma prediction model in the UK setting. We demonstrate that application of this model could reduce the number of patients with major trauma being incorrectly sent to non-specialist hospitals. However, more research is needed to reduce over-triage and unnecessary transfer to Major Trauma Centres. To externally validate the Dutch prediction model for identifying major trauma in a large unselected prehospital population of injured patients in England. External validation using a retrospective cohort of injured patients who ambulance crews transported to hospitals. South West region of England. All patients ≥16 years with a suspected injury and transported by ambulance in the year from February 1, 2017. 1) Patients aged ≤15 years; 2) Non-ambulance attendance at hospital with injuries; 3) Death at the scene and; 4) Patients conveyed by helicopter. This study had a census sample of cases available to us over a one year period. Tested the accuracy of the prediction model in terms of discrimination, calibration, clinical usefulness, sensitivity and specificity and under- and over triage rates compared to usual triage practices in the South West region. Major trauma defined as an Injury Severity Score>15. A total of 68799 adult patients were included in the external validation cohort. The median age of patients was 72 (i.q.r. 46-84); 55.5% were female; and 524 (0.8%) had an Injury Severity Score>15. The model achieved good discrimination with a C-Statistic 0.75 (95% CI, 0.73 - 0.78). The maximal specificity of 50% and sensitivity of 83% suggests the model could improve undertriage rates at the expense of increased overtriage rates compared with routine trauma triage methods used in the South West, England. The Dutch prediction model for identifying major trauma could lower the undertriage rate to 17%, however it would increase the overtriage rate to 50% in this United Kingdom cohort. Further prospective research is needed to determine whether the model can be practically implemented by paramedics and is cost-effective.

SA114 - GENETIC ETIOLOGY OF SELF-RATING OF THE EFFECTS OF ALCOHOL (SRE) SCORES IN YOUNG ADULTS

Background Alcohol misuse is a significant public health concern with social, medical, and economic consequences. Previous studies suggest that initial sensitivity to alcohol may impact use of the substance: those with low sensitivity may drink more, potentially establishing unhealthy drinking habits that persist into adulthood. The Self-Rating of the Effects of Alcohol (SRE) scale was developed to quantify initial sensitivity to alcohol, and SRE scores have been positively associated with concurrent and later drinking behaviors. Furthermore, evidence suggests that SRE scores are influenced by familial factors, raising the possibility that genetic liability to low alcohol sensitivity may increase risk of later alcohol misuse. We sought to clarify the role of genetic factors on SRE scores in two samples of young adults. Methods We derived SRE scores in two population-based cohort studies. ALSPAC participants were born between 1991–1992 in the southwest region of England and have been assessed at least once per year since birth. SRE scores were derived based on assessments at ages 15.5, 16.5, and 17.5. S4S participants were students at a large, public, urban university in the southeastern US, enrolled during the fall or spring of their freshman year (2011–2013), and assessed each subsequent spring. Participants were of diverse ancestry and were 18+ years of age at initial enrollment. The first available SRE score was used for subsequent analyses. Phenotypic and genotypic data meeting all quality control filters were available for a total of N=7339 participants. We conducted Genome-Wide Association Studies (GWAS) within each sample/ancestry group, using ancestry-informative principal components, sex, and age at first available SRE assessment as covariates. Initial GWAS results were meta-analyzed in METAL. SNP-based heritabilities for each sample/ancestry group were estimated in GCTA. Additional secondary analyses were conducted in VEGAS and JEPEGMIX2. Results A total of 15,642,250 markers were analyzed in at least one group. No individual marker met genome-wide significance criteria. The top marker, rs146298733 (p=3.16e-07), mapped to an intron in DLGAP1, variants in which have been previously associated with psychiatric outcomes including major depression and obsessive-compulsive disorder. Meta-analysis of GCTA results indicated that SRE is modestly heritable (h2SNP=0.19, SE=0.10), though this was driven primarily by the ALSPAC sample, for which assessments were prospective. Pathway analyses implicated the GABAergic system and genes related to thromboxane signaling, both of which have been associated with alcohol-related phenotypes. Discussion We present evidence consistent with prior reports that initial sensitivity to alcohol is influenced by genetic factors. Preliminary analyses implicate systems known to influence other alcohol phenotypes and provide novel targets for future analysis. Implicated loci and aggregate genetic risk should be confirmed in independent samples. Heterogeneity across samples suggests that assessment methods are important to SRE measurement, which may have implications for genetic analyses. Further characterization of genetic influences may elucidate mechanisms underlying the pathway from initial sensitivity to alcohol problems.

“His tummy's only tiny” – Scientific feeding advice versus women's knowledge. Women's experiences of feeding their late preterm babies

ObjectiveThis paper reports on one element of a study exploring the experiences of women who are caring for late preterm baby/babies (LPBs) and focuses on their experiences of breastfeeding. DesignAs this study aimed to privilege women's experiences, a feminist approach was utilised, with individual qualitative interviews in two phases conducted with a purposefully selected sample of women who were caring for a late preterm baby or babies. Template Analysis linked to Birth Territory Theory (BTT) was used to identify key issues and experiences of women. Setting and participantsWomen (N = 24 to N = 14) were recruited from an NHS Trust Hospital in the South West region of England. FindingsInfant feeding was planned with alarm clock precision. Babies, whether breast or formula fed, were subject to strict feeding guidelines/supplementation/volumes dictated by doctors and enforced by nurses and midwives and greatly impacted on women's experiences of caring. Women were powerless at times to influence feeding and regimes did not facilitate instinctive mother-care or enable babies to demonstrate innate feeding behaviours (such as rooting and early feeding cues). Key conclusions and implications for practiceThe current approach to caring for women and their late PTBs tends to result in feeding becoming a source of stress and anxiety for women, rather than a positive experience. To resolve this, staff caring for women who have LPBs should focus on supporting women to trust their instincts, and to guide them in developing confidence in their ability to read their babies’ cues, rather than in focusing on strict regimes of feeding. This should include individualised consideration of whether supplementation is required in the early days

Understanding quit decisions in primary care: a qualitative study of older GPs

ObjectiveTo investigate the reasons behind intentions to quit direct patient care among experienced general practitioners (GPs) aged 50–60 years.Design and settingQualitative study based on semistructured interviews with GPs in the...

Transition of new dental graduates into practice: a qualitative study.

The aims of this study were to explore the transition of new dental graduates to gain a deeper understanding of the merits and challenges of a mentored year for new graduates in general dental practice settings. The study was conducted in the south-west region of England. Qualitative methods were used to engage a range of stakeholders in dental education including dental students, academics, general dental practitioners, new graduates, specialists and representatives of the postgraduate dental deanery. Purposive sampling was employed, and after ethical approval, participants were contacted through professional channels. All interview transcripts were transcribed verbatim. The data were imported into NVivo 10 (QSR International Pty Ltd) and analysed thematically. Sixteen participants representing a variety of stakeholder groups were interviewed. The participants shared their perceptions and experiences regarding the transition new dental graduates into dental practice. The challenges and benefits are discussed along with strategies to facilitate a smooth transition. This study provides an insight into experience of a mentored year for new dental graduates in general practice settings. Foundation training provides a structured introduction into general practice and serves as a safety net before new graduates gain further independence in clinical practice.

Preparedness of dental graduates for foundation training: a qualitative study.

The aims of this study were to articulate the concept of preparedness of dental graduates for foundation training programme in the United Kingdom and identify the essential attributes of preparedness. A qualitative approach using semi-structured interviews was used to explore the concept of preparedness. The study was carried out in the South West region of England. Participants were recruited from a range of stakeholders in dental education and foundation training using purposive sampling. Participants were recruited using email through appropriate professional channels. Stakeholders included dental students (DS), dental academics (DA), foundation dental practitioners (FDP), foundation trainers (FT), general dental practitioners (GDP) and a postgraduate dental deanery representative (DDR). Interviews were transcribed verbatim and data were imported into NVivo 9 and analysed thematically. Sixteen interviews were carried out with representation from all stakeholder groups. Participants expressed their views on a range of issues related to the preparedness of dental graduates. This study provides useful insights into the concept of preparedness as perceived by the stakeholders. The findings of this study may offer clarity on the essential attributes required by dental graduates upon entry into foundation training.

Regions, Territories and Relationality: Exploring the Regional Dimensions of Political Practice

Goodwin M. Regions, territories and relationality: exploring the regional dimensions of political practice, Regional Studies. Recent conceptual innovations in the discipline of geography have sought to establish the notion of the ‘relational region’. In opposition to the idea that regions are bounded and discrete, lying within a hierarchy of nested scales, the relational view sees a region as open and discontinuous, forged through a set of spatially stretched articulations and networks. This paper explores what this relational view might contribute to an understanding of the region's role in promoting sustainability, using the South West region of England as a case study. It concludes by arguing that regions are constituted through territoriality as well as relationality.

Planning and policy documents as transactions costs: the case of rural decision-making in England

The growth in community involvement in public domain decisions for rural spaces in England over the past 20 years has increased the overall costs of such decision-making. These transaction's costs can be grouped into four types pertaining to organisations, institutions, belief systems and knowledge and information (K&I). Within the last of these, costs can arise because of a lack of K&I, the costs of procuring K&I and K&I overload. In an empirical survey in Gloucestershire county in the south west region of England K&I transaction's costs were found to be increasing, particularly in relation to procurement and overload. The number of planning and policy documents as a subset of K&I had increased considerably in the case study area such that for the rural district of the Cotswolds 60 plans pertained simultaneously in 2007. Despite this, many of those involved in decision-making about rural spaces felt the costs involved in assimilating the information that they contained were worth paying if it allowed them to be better informed.

An investigation into the challenges facing the future provision of continuing professional development for allied health professionals in a changing healthcare environment

This paper outlines current challenges facing healthcare providers and education providers in trying to ensure Allied Health Professionals (AHPs) are fit for practice, in a climate driven by financial constraints and service improvement directives from the Department of Health (DH). Research was undertaken in 2009 to investigate the current provision of Continuing Professional Development (CPD) in the southwest region of England. The purpose was to define exactly what problems existed with this provision, and to propose changes which could be implemented in order to ensure that the provision meets the needs of stakeholders in future years.

Early Re-Resection for T1 Transitional Cell Carcinoma of the Bladder—A Study of Current Practice in the South West of England

Objective: To evaluate resection and re-resection practice in the South West region of England in patients with newly diagnosed T1 bladder cancer. Patients and methods: All patients diagnosed with T1 disease between 2005 and 2008 were identified. Patients with incomplete primary resections were excluded. Results: Of 344 patients identified, the primary resection specimen did not contain deep muscle in 110 (32%). In total, 76 patients (22%) underwent a planned re-resection within 8 weeks of their primary resection. In 225 patients, a routine check cystoscopy was performed at an interval of 3 months or greater. The remainder had no further cystoscopy. Residual disease was present in 38 (50%) patients undergoing early re-resection and 89 (40%) patients in the routine check cystoscopy group. Upstaging of tumours from T1 to T2 was demonstrated in 7% and 5% of patients within these respective groups. Grade of operating surgeon was not a predictor of adequacy of resection or tumour persistence/recurrence. Conclusions: Primary transurethral resection remains an area for improvement in contemporary practice. Early re-resection should be performed in patients with newly diagnosed T1 bladder cancer unless precluded by co-morbidity to ensure complete resection, accurate staging and facilitate risk stratification. Selective approaches to re-resection risk delayed treatment of significant residual disease.

Responding to the ‘needs’ of young people in jobs without training (JWT): some policy suggestions and recommendations

In this paper we draw upon our findings from a project in the South West region of England. The research involved a collaboration between a group of university researchers and Connexions service personal advisers and mainly comprised interviews with young people, who were in ‘jobs without training’ (JWT). A key aim of the research was to explore the experiences of this group of marginalised and socially disadvantaged young people over a period of 1 year, as they moved into and out of work. In this paper we address the main findings and questions raised by the research. We challenge some commonly held assumptions about young people in JWT and their perceived needs. We end with a number of policy and practice-related suggestions and recommendations.

‘Disadvantaged Learners’: Who Are We Targeting? Understanding the Targeting of Widening Participation Activity in the United Kingdom Using Geo‐Demographic Data From Southwest England

AbstractThis paper analyses the definition of the appropriate target group for widening participation activities advanced by the Higher Education Funding Council for England in their Targeting Disadvantaged Learners advice to Aimhigher and higher education providers. This definition includes components of area deprivation and higher education participation rates, which are apparently intended to act as a proxy to reach learners from lower socio‐economic groups. Through statistical analysis of geo‐demographical data from the Southwest region of England, this paper questions whether the HEFCE targeting guidance is likely to meet the policy aims that underpin it and reach the ‘disadvantaged learners’ of its title. It is found that the geographical proxy tends to miss learners from lower socio‐economic groups in areas of wider affluence and those in rural areas. The paper concludes by questioning whether the areas identified by a rigorous application of the targeting guidance are likely to be the most fruitful locations for outreach activities in the short‐term given the ingrained, multi‐faceted and multi‐generational challenges which they face.

Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England

Objectives To investigate the factors associated with sudden infant death syndrome (SIDS) from birth to age 2 years, whether recent advice has been followed, whether any new risk factors have...

A bioenergy resource assessment for the south west of England

Bioenergy will need to play a significant role in the future of Europe's energy provision in order to maintain energy security and sustainability. In this context, a regional assessment of biomass availability for energy use has been carried out for the south west region of England. Current bioenergy production, the maximum present resource availability and the maximum available future feedstock (at around 2020) in the region have been evaluated on the basis of a resource flow analysis. Extensive agricultural land (over 80% of the total land cover) and optimum climatic conditions of the region make it favourable for bioenergy feedstock development. Nevertheless, the slow uptake of bioenergy technologies has resulted in only modest feedstock growth and supply. Bioenergy production in the region at present is comparatively low at around 1300 GWh (approximately 4·32 PJ) of primary energy, with a significant portion of this resource being recovered from waste. It is therefore argued that a shift towards the use of perennial crops is desirable, along with increased farm-waste energy recovery. The regional bioenergy potential by around 2020 is estimated to be 5500–13 800 GWh (20–50 PJ) of primary energy, which would provide 4–9% of the region's primary energy consumption.

The Partners for Change project: involving socially excluded young people in shaping public library services

The Partners for Change project aimed to encourage disadvantaged young people aged 11–19 in the South West region of England to get involved in making decisions about public libraries. The project was developed using an action research approach and took place between May 2005 and June 2007. An action research approach was used so that learning from the project could inform the development of national tools for public library services in England as part of a programme known as Fulfilling their Potential. The project found that disadvantaged young people are happy to offer ideas to improve their local public library if they have had the opportunity to develop a trusting relationship with library staff. However, many young people feel that they are often asked for their views on public services but are seldom told what happens as a result. The project found that if public libraries are to be successful in involving young people in decision-making, library staff need training and sufficient resources to work in-depth with relatively small groups of young people. Project lessons have been incorporated into the Fulfilling their Potential programme so that public libraries across England can develop effective strategies for engaging disadvantaged young people.

Supporting young mothers into education, employment and training: assessing progress towards the target

The government has set a target of increasing the participation of teenage mothers in education, employment and training (EET) to 60% by 2010 to reduce their risk of long-term social exclusion. This paper presents the findings of a qualitative research project conducted in the South West region of England to establish the tracking practices employed by practitioners working with young parents to ascertain whether and to what extent teenage parents are engaged in EET. The range of support that is currently needed by and provided to teenage parents when returning to or continuing their EET was also investigated. Semi-structured telephone interviews were conducted with 24 participants from a unitary authority, county and city within the region; participants were working in a variety of professional roles with responsibilities for teenage parents. The results show that in the South West there are currently no standard procedures or practices in place for effectively tracking the participation of teenage parents in EET. There was evidence of a good understanding of the needs of young parents amongst practitioners and that a variety of support was being provided to them. However, it needs to be understood, and addressed, that having contact with young parents and providing them with support does not necessarily lead to the standardised information that is needed in order to assess progress towards the target. We conclude that in order to assess in a meaningful way progress towards the target of 60% participation by 2010, a clear protocol for the collection and collation of information--and responsibility for this--needs to be developed and implemented.