UK West Midlands Research Articles

Non-ischaemic preservation of the donor heart in heart transplantation: protocol design and rationale for a randomised, controlled, multicentre clinical trial across eight European countries

IntroductionIschaemic cold static storage (ICSS) is the gold standard in donor heart preservation. This ischaemic time frame renders a time constraint and risk for primary graft dysfunction. Cold oxygenated heart...

A comparative study of the survival of university spin-off companies (USOs) in the post-industrial UK West Midlands region

ABSTRACT This study compares the survival rates of USOs formed by universities in the UK’s West Midlands region between 1983 and 2013 with those from existing studies in the literature. Data were collected from a range of secondary sources to enhance the accuracy of the USO dataset. Survival rates were found to be significantly lower than in previous studies despite the existence of prominent research universities within the region. It is proposed that the difference is in part methodological with the current study including USOs that may have been omitted using different methodologies that rely on institutional memories.

COVID-19 in hematology patients: real world experience in hospitals in the UK West Midlands

© 2021 The Authors. Published by Hilaris. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: [DOI/weblink]

Design, manufacture and construct procurement model for volumetric offsite manufacturing in the UK housing sector

PurposeThe purpose of this study is to gain insight into procurement routes and forms of contract used for volumetric offsite manufacturing (VOSM) in the housing sector of the UK West Midlands. Seminal literature and government reports have established the potential of offsite technologies to improve the supply of quality housing in the UK. However, the lack of a structured procurement route, common to manufacturing approaches in construction, has significantly contributed to delays in large scale adoption.Design/methodology/approachTo achieve the research intention, an exploratory study was undertaken. A literature review of seminal literature and government papers was conducted to establish and benchmark current trends in context. Data was collected using focus groups and interviews with a housing association and housing VOSMs. Grounded theory was used to analyse data and inductively generate themes leading to an original procurement model. The issues identified in the delivery of volumetric housing were categorised into three themes.FindingsThe findings suggest a limited familiarity with offsite manufacturing (OSM) by housing providers. Albeit, a willingness to adopt these technologies to deliver housing were demonstrated by trial attempts. However, due to limited knowledge, the approach to procurement is by adapting existing procurement models, which are not ideal and obstruct the potential benefits of using offsite technologies primarily because of the significant difference in processes. Also, geographical location influenced procurement decisions when comparing cost with conventional procurement and the dearth of specific government incentives to deliver housing using offsite technologies. This study proposes a procurement model for VOSM.Practical implicationsThe results have implications for decisions about procurement routes and contractual terms used by housing providers delivering volumetric offsite manufactured housing at scale. Although this study focussed on the West Midlands region, most of the issues identified were not geographically unique.Originality/valueThis study contributes to the existing body of knowledge on potential barriers to the adoption of OSM in the housing sector of the UK. The findings will be of value to stakeholders involved in delivering housing and offers a useful contextual basis for future research.

Armstrong to relocate UK's West Midlands facility

Armstrong Fluid Technology is planning to move its West Midlands factory, warehouse and offices from Halesowen to larger premises in nearby Droitwich, UK.

The diagnostic accuracy of pre-hospital assessment of acute respiratory failure.

Introduction:Acute respiratory failure (ARF) is a common medical emergency. Pre-hospital management includes controlled oxygen therapy, supplemented by specific management options directed at the underlying disease. The aim of the current study was to characterise the accuracy of paramedic diagnostic assessment in acute respiratory failure.Methods:A nested diagnostic accuracy and agreement study comparing pre-hospital clinical impression to the final hospital discharge diagnosis was conducted as part of the ACUTE (Ambulance CPAP: Use, Treatment effect and Economics) trial. Adults with suspected ARF were recruited from the UK West Midlands Ambulance Service. The pre-hospital clinical impression of the recruiting ambulance service clinician was prospectively recorded and compared to the final hospital diagnosis at 30 days. Agreement between pre-hospital and hospital diagnostic assessments was evaluated using raw agreement and Gwets AC1 coefficient.Results:77 participants were included. Chronic obstructive pulmonary disease (32.9%) and lower respiratory tract infection (32.9%) were the most frequently suspected primary pre-hospital diagnoses for ARF, with secondary contributory conditions recorded in 36 patients (46.8%). There was moderate agreement between the primary pre-hospital and hospital diagnoses, with raw agreement of 58.5% and a Gwets AC1 coefficient of 0.56 (95% CI 0.43 to 0.69). In five cases, a non-respiratory final diagnosis was present, including: myocardial infarction, ruptured abdominal aortic aneurysm, liver failure and sepsis.Conclusions:Pre-hospital assessment of ARF is challenging, with limited accuracy compared to the final hospital diagnosis. A syndromic approach, providing general supportive care, rather than a specifically disease-orientated treatment strategy, is likely to be most appropriate for the pre-hospital environment.

Ensuring skills are available in the right locations: are we there yet? A regional analysis of qualification gaps

ABSTRACT Matching skills supply and demand is critical for economic growth, competitiveness and inclusiveness. Yet, measuring skills is difficult. This paper develops an approach for measuring the gap between demand and supply of skills at the local level in the UK West Midlands region. It uses qualifications as a proxy for skills. By comparing the projected supply of qualifications with the forecast demand for qualifications from occupational forecasts, the analysis reveals significant skill mismatches with potential to constrain regional growth potential. Policy implications for connecting skills, transport and housing policy as part of local industrial strategies are explored.

Do pre-diagnosis primary care consultation patterns explain deprivation-specific differences in net survival among women with breast cancer? An examination of individually-linked data from the UK West Midlands cancer registry, national screening programme and Clinical Practice Research Datalink

BackgroundIn England and Wales breast cancer survival is higher among more affluent women. Our aim was to investigate the potential of pre-diagnostic factors for explaining deprivation-related differences in survival.MethodsIndividually-linked data from women aged 50–70 in the West Midlands region of England, diagnosed with breast cancer 1989–2006 and continuously eligible for screening, was retrieved from the cancer registry, screening service and Clinical Practice Research Datalink. Follow-up was to the end of July 2012. Deprivation was measured at small area level, based on the quintiles of the income domain of the English indices of deprivation. Consultation rates per woman per week, time from last breast-related GP consultation to diagnosis, and from diagnosis to first surgery were calculated. We estimated net survival using the non-parametric Pohar-Perme estimator.ResultsThe rate of primary care consultations was similar during the 18 months prior to diagnosis in each deprivation group for breast and non-breast symptoms. Survival was lower for more deprived women from 4 years after diagnosis. Lower net survival was associated with more advanced extent of disease and being non-screen-detected. There was a persistent trend of lower net survival for more deprived women, irrespective of the woman’s obesity, alcohol, smoking or comorbidity status. There was no significant variation in time from last breast symptom to diagnosis by deprivation. However, women in more deprived categories experienced significantly longer periods between cancer diagnosis and first surgery (mean = 21.5 vs. 28.4 days, p = 0.03). Those whose surgery occurred more than 12 weeks following their cancer diagnosis had substantially lower net survival.ConclusionsOur data suggest that although more deprived women with breast cancer display lifestyle factors associated with poorer outcomes, their consultation frequency, comorbidities and the breast cancer symptoms they present with are similar. We found weak evidence of extended times to surgical treatment among most deprived women who were not screen-detected but who presented with symptoms in primary care, which suggests that treatment delay may play a role. Further investigation of interrelationships between these variables within a larger dataset is warranted.

A summary of knowledge about the oral health of older people in England and Wales.

To summarise what is currently known about the oral health of older adults in England and Wales. Summary of the main findings from a recent review of oral health surveys and demographic and health data relating to older people in the UK (West Midlands, North West, Bolton and Kirklees, East London and the City of London and Wales). Their findings were compared, where possible to estimates from the 2009 Adult Dental Health Survey. A higher proportion of older adults in England and Wales have untreated caries and signs of severe caries than the general adult population. The majority of dentate residents in the care homes surveyed had untreated caries. Despite the poorer oral health of residents in care homes, managers of such services report difficulty in accessing routine and emergency dental care. Existing epidemiological data in England and Wales show that older people in residential and nursing care homes have poorer oral health than the general adult population and inequitable access to dental services. Greater comparability and utility would be gained from regional oral health surveys if standards were agreed for this age group with regard to sampling, consent, questionnaires and clinical measures.

Concentrations of legacy and emerging flame retardants in air and soil on a transect in the UK West Midlands

Passive air samples were collected monthly for 6 months from 8 sites along a transect of Birmingham, United Kingdom between June 2012 and January 2013. Soil samples were collected once at each site. Average concentrations of BDE-209, ΣPBDEs17:183 and ΣPBDEs in ambient air were 150, 49, and 180 pg m−3, respectively. Atmospheric concentrations of PBDEs were negatively correlated with distance from the city centre, exhibiting an “urban pulse”. The average ΣHBCDD air concentration was 100 pg m−3, however concentrations were not correlated with distance from the city centre. Several emerging flame retardants (EFRs) were identified in air and/or soil samples: 2,3,4,5-tetrabromo-bis(2-ethylhexyl) phthalate (BEH-TEBP), 1,2-dibromo-4-(1,2 dibromoethyl)cyclohexane (TBECH or DBE-DBCH), allyl 2,4,6-tribromophenyl ether (ATE), 2-bromoallyl 2,4,6-tribromophenyl ether (BATE), decabromodiphenyl ethane (DBDPE), and dechlorane plus (DP or DDC-CO). Average concentrations of BDE-209, ΣPBDEs17:183 and ΣPBDEs in soil were 11, 3.6, and 15 ng g−1 soil organic matter. PBDE concentrations in soil were higher at sites closest to the city centre, however correlations with distance from the city centre were not significant. BDEs-47 and -99 contributed more to ΣPBDEs in soil samples than air samples, but in both, the predominant congener was BDE-209. BATE was more abundant in air than soil but ATE was abundant in soil but not air.

Migrant maternity in an era of superdiversity: New migrants' access to, and experience of, antenatal care in the West Midlands, UK

Rapid increase in the scale, speed and spread of immigration over the past two decades has led to an increase in complexity of populations termed superdiversity. Concerns have been expressed about impacts of the pressure that superdiversity is said to place upon maternity services. High migrant fertility and infant and maternal mortality rates have long been observed in diverse areas with inadequate antenatal monitoring seen as a major causal factor in migrants' maternity outcomes. Using qualitative data from a study of new migrants' access to maternity services in the UK's West Midlands region, with some of the highest infant and maternal mortality rates in Europe, this paper looks at the reasons migrants' access to antenatal care is poor. The paper finds that contrary to earlier studies which pointed to a lack of priority placed on such care by migrants, a combination of structural, legal and institutional barriers prevent migrant women accessing effective antenatal care.

When floods strike close to home

Flooding and the impact on the highway network is a major influence in the design and implementation of municipal emergency response and disaster relief planning. Worcestershire is a low-lying shire county in the UK West Midlands, bordered to the southwest by the Malvern Hills. Dissected by a number of major waterways, most notably the rivers Severn, Avon and Teme, and the Droitwich, Staffs and Worcester, Grand Union and Stratford upon Avon canals – a combination of both tidal and non-tidal waterways – the impact of prolonged inclement weather can have far-reaching effects on the effectiveness of the highway network and its ability to perform adequately. The year 2013 saw the worst rainfall since records began; this paper outlines actions taken to minimise disruption to the travelling public, methods of working and learning achieved to prepare for future occurrences in light of predicted climate change and its effect on weather patterns.

Beyond Production and Standards: Toward a Status Market Approach to Territorial Innovation and Knowledge Policy

MacNeill S. and Jeannerat H. Beyond production and standards: toward a status market approach to territorial innovation and knowledge policy, Regional Studies. Current theoretical and policy models of innovation are usually production based and give prominence to producer–supplier relations. Drawing on a socio-economic approach to markets, the paper reconsiders these established models in order to broaden the understanding of innovation and territorial knowledge dynamics. The premium segment sports cars innovated in the UK's West Midlands is examined and the production and standard market of the global automotive industry is contrasted with the status market in which new local innovation embed across specific supplier–producer and producer–consumer relations. A status innovation policy approach is finally proposed to address innovation in developed economies.

Teacher experiences of delivering an obesity prevention programme (The WAVES study intervention) in a primary school setting

Objective: There has been a wealth of childhood obesity prevention studies in school-based settings. However, few have investigated the experiences of school staff charged with delivery of such programmes. This study aimed to elicit teachers’ experiences of delivering a childhood obesity prevention programme for children aged 6–7 years. Design: Descriptive-interpretive qualitative study. Setting: Primary schools participating in the UK West Midlands ActiVe lifestyle and healthy Eating in School children (WAVES) study. Method: In all, 14 teachers were recruited from 12 primary schools. Semi-structured interviews were conducted and data analysis was guided by the Framework Approach. Results: Teachers recognised the importance of obesity prevention in primary schools. They reported positively on aspects of the intervention, in particular its flexibility and the ready-prepared materials. Time constraints and gaining support of parents were seen as key challenges to intervention delivery. Conclusions: Delivering an obesity prevention programme in school is feasible but challenging for teachers. Our findings suggest that to maximise the likelihood of delivery, interventions should be hands-on, easy to manage and flexible to the needs of individual schools. The perceived importance of the promotion of healthy lifestyle behaviours by schools was evident, but teachers felt restricted in the resources that could be devoted to achieve and encourage this. National combined with local level direction and support for healthy lifestyles in children would help schools to give this the priority it requires.

The use of the axiophyte species concept to describe the ecological network of the Birmingham and Black Country of the UK West Midlands

Abstract The UK conurbation of Birmingham and the Black Country has recently been surveyed for a new Flora, on the basis of a 1 km square grid. The present paper uses the data to describe the ecological network of the conurbation. The total number of taxa per 1 km squares is shown to be moderately but significantly correlated, and the number of native taxa more strongly correlated, with the area of the previously-established network of protected sites. Nevertheless coincidence maps of total numbers or numbers of native species per 1 km square give only poor representations of the ecological network compared with maps of protected sites. Axiophytes are defined as plant species 90% restricted to conservation habitats and recorded in fewer than 25% of 2km × 2km squares in a county. Applying the concept to 1 km squares in Birmingham and the Black Country creates a list of 256 axiophytes. Numbers of axiophytes are shown to be more strongly correlated with areas of protected sites than total taxa or native taxa and a coincidence map of the axiophytes is found to provide a useful quantitative assessment of the ecological network. Maps of axiophytes are used to divide the network into core and linking areas and their use in consolidating and improving the botanical ecological network is explored.

Exploring SME Advice and Training Needs for Entrepreneurial Rural Firms

This paper reports on two studies carried out to investigate business support needs in the rural south-east and south-west of the UK West Midlands region. The researchers surveyed a sample of 494 micro, small and medium-sized enterprises to provide support for better decision making by regional providers of training and advice in identifying the needs of these firms. The overall findings suggest that rural areas need to be seen within their own contexts and that support requires differentiation to meet specific needs, particularly where there is evidence of curtailed innovation. More detailed research into innovation across rural areas might identify reasons for emerging trends and explain why some rural areas are more entrepreneurial than others. The study findings revealed that innovation was evident in one-third of the businesses, with growth likely to be given the right support, although there was evidence of greater levels of entrepreneurial behaviour in the area with more immigrants and a better transport infrastructure.

Septo-Optic Dysplasia: Antenatal Risk Factors and Clinical Features in a Regional Study

Background: Septo-optic dysplasia (SOD) is a disorder with postulated environmental and genetic aetiology. This study delineates clinical features and potential perinatal environmental factors along with epidemiology in SOD children. Methods: Assessment of patients with SOD triad features in the UK West Midlands region. Results: Of 227 patients identified between 1998 and 2009 with 1 or more feature of the triad, 55 had midline defects, 149 had optic nerve hypoplasia and 132 had hypopituitarism. Eighty-eight children (52% males; incidence 8.3/100,000 live births) had SOD defined as 2 out of 3 features and 21 (24%) had all 3. Sixty-one percent had anterior pituitary deficiency and 21.5% had diabetes insipidus. Median maternal/paternal ages in SOD were 21 and 23.5 years, compared to UK means of 29.3 and 32.4 years (p < 0.001). First trimester bleeding was markedly increased at 12/48 (25%) compared to 0.07% in the UK (p < 0.001). Ethnicity showed a non-significant higher prevalence in Afro-Caribbean and mixed race groups, and significantly lower prevalence (p = 0.004) in South Asian groups compared to West Midland and Birmingham city data: 8% versus 2.5 and 6.7%, 9% versus 1.8 and 3.2% and 3% versus 8.4 and 21%, respectively. Conclusions: SOD is associated with younger maternal and paternal age, primigravida births and ethnic differences. Increased first trimester bleeding may indicate that SOD is a vascular disruption sequence.

Simulation of a water transfer tunnel at catchment scale in the Permo-Triassic Sandstone aquifer, UK

Abstract The Lichfield Permo-Triassic Sandstone aquifer is a strategic groundwater resource for the UK West Midlands. However, the flows of a number of streams have been heavily affected by abstraction. The catchment of one of these, the Leamonsley Brook, is under-drained by the Hanch Tunnel, a 5 km-long water transfer tunnel that is more than 150 years old. The Hanch Tunnel was excavated below the water-table for its entire length and is only partly lined. Regional-scale simulation of the aquifer was undertaken using a version of the USGS MODBRNCH code, which had been previously adapted to enable simulation of both open channel and pressurized pipe flow systems (the ‘Adit Code’). This paper reports on the simulation of the Hanch Tunnel, with an emphasis on the representation of this tunnel, and its effects on the groundwater flow in the Leamonsley Brook catchment. Critical aspects to consider when implementing the Adit Code are identified and discussed. The value of the application of the Adit Code for options appraisal to resolve the low-flow conditions of the Leamonsley Brook is explored.

Viral respiratory infections during the 2009 influenza A(H1N1) outbreak in the West Midlands Region, UK

In spring 2009 a new strain of influenza A(H1N1) emerged and caused a worldwide pandemic. This study utilized a large collection of respiratory specimens from suspected cases of influenza A(H1N1) in the UK West Midlands during the pandemic in order to investigate which other respiratory viruses were circulating and whether they played any role in the increased hospitalization rates seen during that period. Study specimens were selected from community and hospitalized patients positive and negative for influenza A(H1N1) and tested by PCR for other respiratory viruses. A number of infections diagnosed as influenza during the summer influenza outbreak were found to be due to other virus infections (most commonly rhinovirus). No statistically significant difference was found between the rates of respiratory virus co-infection with H1N1 in patients from community or hospital locations suggesting underlying factors were likely to be more significant than viral co-infections in determining severity of influenza A(H1N1) disease.

Prevalence and impact of ocular allergy in the population attending UK optometric practice

To determine the prevalence of ocular allergy in patients attending optometric practices in the UK West Midlands and the impact this has on patients' daily lives. Patients attending 9 optometric practices in the West Midlands, UK, were surveyed about the occurrence of ocular allergy, the severity of the symptoms and their treatment. Patients self-reporting ocular allergy were invited to complete a more detailed questionnaire. Of the 1904 consecutive patients assessed (mean age 47.7±23.2 years, 55% female), 13% reported an allergy, 8% an ocular allergy, rated as at least mild in 85% of cases. Medication was used by 77% of patients reporting ocular symptomology. Patients with ocular allergy (n=126) completed the detailed questionnaire. Seasonal symptoms occurred for 3.4±1.9 months of the year with a peak in June to July. The most common 'hayfever' type symptoms were itchy eyes and a runny nose, and ocular symptoms were itchiness and a desire to rub the eyes. Most had gained medication over the counter (73%) with advice from GPs (53%), pharmacists (41%) or a friend or relative (18%). Only 11% consulted an optometrist. Medication was mainly in the form of antihistamine tablets (71%), eye drops (40%) and nasal spray (40%). Those interested in a specialist ocular allergy service (83%) were willing to pay £15.50 on average. Ocular allergy is relatively common, but treatment is often self-managed, does not appear to totally overcome the discomfort and rarely involves a detailed eye examination.