Birmingham City University

A new periodontitis classification scheme has been adopted, in which forms of the disease previously recognized as "chronic" or "aggressive" are now grouped under a single category ("periodontitis") and are further characterized based on a multi-dimensional staging and grading system. Staging is largely dependent upon the severity of disease at presentation as well as on the complexity of disease management, while grading provides supplemental information about biological features of the disease including a history-based analysis of the rate of periodontitis progression; assessment of the risk for further progression; analysis of possible poor outcomes of treatment; and assessment of the risk that the disease or its treatment may negatively affect the general health of the patient. Necrotizing periodontal diseases, whose characteristic clinical phenotype includes typical features (papilla necrosis, bleeding, and pain) and are associated with host immune response impairments, remain a distinct periodontitis category. Endodontic-periodontal lesions, defined by a pathological communication between the pulpal and periodontal tissues at a given tooth, occur in either an acute or a chronic form, and are classified according to signs and symptoms that have direct impact on their prognosis and treatment. Periodontal abscesses are defined as acute lesions characterized by localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus, rapid tissue destruction and are associated with risk for systemic dissemination.

<h3>Importance</h3> Cancer and other noncommunicable diseases (NCDs) are now widely recognized as a threat to global development. The latest United Nations high-level meeting on NCDs reaffirmed this observation and also highlighted the slow progress in meeting the 2011 Political Declaration on the Prevention and Control of Noncommunicable Diseases and the third Sustainable Development Goal. Lack of situational analyses, priority setting, and budgeting have been identified as major obstacles in achieving these goals. All of these have in common that they require information on the local cancer epidemiology. The Global Burden of Disease (GBD) study is uniquely poised to provide these crucial data. <h3>Objective</h3> To describe cancer burden for 29 cancer groups in 195 countries from 1990 through 2017 to provide data needed for cancer control planning. <h3>Evidence Review</h3> We used the GBD study estimation methods to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs). Results are presented at the national level as well as by Socio-demographic Index (SDI), a composite indicator of income, educational attainment, and total fertility rate. We also analyzed the influence of the epidemiological vs the demographic transition on cancer incidence. <h3>Findings</h3> In 2017, there were 24.5 million incident cancer cases worldwide (16.8 million without nonmelanoma skin cancer [NMSC]) and 9.6 million cancer deaths. The majority of cancer DALYs came from years of life lost (97%), and only 3% came from years lived with disability. The odds of developing cancer were the lowest in the low SDI quintile (1 in 7) and the highest in the high SDI quintile (1 in 2) for both sexes. In 2017, the most common incident cancers in men were NMSC (4.3 million incident cases); tracheal, bronchus, and lung (TBL) cancer (1.5 million incident cases); and prostate cancer (1.3 million incident cases). The most common causes of cancer deaths and DALYs for men were TBL cancer (1.3 million deaths and 28.4 million DALYs), liver cancer (572 000 deaths and 15.2 million DALYs), and stomach cancer (542 000 deaths and 12.2 million DALYs). For women in 2017, the most common incident cancers were NMSC (3.3 million incident cases), breast cancer (1.9 million incident cases), and colorectal cancer (819 000 incident cases). The leading causes of cancer deaths and DALYs for women were breast cancer (601 000 deaths and 17.4 million DALYs), TBL cancer (596 000 deaths and 12.6 million DALYs), and colorectal cancer (414 000 deaths and 8.3 million DALYs). <h3>Conclusions and Relevance</h3> The national epidemiological profiles of cancer burden in the GBD study show large heterogeneities, which are a reflection of different exposures to risk factors, economic settings, lifestyles, and access to care and screening. The GBD study can be used by policy makers and other stakeholders to develop and improve national and local cancer control in order to achieve the global targets and improve equity in cancer care.

In recent years focus-group interviews, as a means of qualitative data collection, have gained popularity amongst professionals within the health and social care arena. Despite this popularity, analysing qualitative data, particularly focus-group interviews, poses a challenge to most practitioner researchers. The present paper responds to the needs expressed by public health nutritionists, community dietitians and health development specialists following two training sessions organised collaboratively by the Health Development Agency, the Nutrition Society and the British Dietetic Association in 2003. The focus of the present paper is on the concepts and application of framework analysis, especially the use of Krueger's framework. It provides some practical steps for the analysis of individual data, as well as focus-group data using examples from the author's own research, in such a way as to assist the newcomer to qualitative research to engage with the methodology. Thus, it complements the papers by Draper (2004) and Fade (2004) that discuss in detail the complementary role of qualitative data in researching human behaviours, feelings and attitudes. Draper (2004) has provided theoretical and philosophical bases for qualitative data analysis. Fade (2004) has described interpretative phenomenology analysis as a method of analysing individual interview data. The present paper, using framework analysis concentrating on focus-group interviews, provides another approach to qualitative data analysis.

IMPORTANCE: The Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) provided systematic estimates of incidence, morbidity, and mortality to inform local and international efforts toward reducing cancer burden. OBJECTIVE: To estimate cancer burden and trends globally for 204 countries and territories and by Sociodemographic Index (SDI) quintiles from 2010 to 2019. EVIDENCE REVIEW: The GBD 2019 estimation methods were used to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 2019 and over the past decade. Estimates are also provided by quintiles of the SDI, a composite measure of educational attainment, income per capita, and total fertility rate for those younger than 25 years. Estimates include 95% uncertainty intervals (UIs). FINDINGS: In 2019, there were an estimated 23.6 million (95% UI, 22.2-24.9 million) new cancer cases (17.2 million when excluding nonmelanoma skin cancer) and 10.0 million (95% UI, 9.36-10.6 million) cancer deaths globally, with an estimated 250 million (235-264 million) DALYs due to cancer. Since 2010, these represented a 26.3% (95% UI, 20.3%-32.3%) increase in new cases, a 20.9% (95% UI, 14.2%-27.6%) increase in deaths, and a 16.0% (95% UI, 9.3%-22.8%) increase in DALYs. Among 22 groups of diseases and injuries in the GBD 2019 study, cancer was second only to cardiovascular diseases for the number of deaths, years of life lost, and DALYs globally in 2019. Cancer burden differed across SDI quintiles. The proportion of years lived with disability that contributed to DALYs increased with SDI, ranging from 1.4% (1.1%-1.8%) in the low SDI quintile to 5.7% (4.2%-7.1%) in the high SDI quintile. While the high SDI quintile had the highest number of new cases in 2019, the middle SDI quintile had the highest number of cancer deaths and DALYs. From 2010 to 2019, the largest percentage increase in the numbers of cases and deaths occurred in the low and low-middle SDI quintiles. CONCLUSIONS AND RELEVANCE: The results of this systematic analysis suggest that the global burden of cancer is substantial and growing, with burden differing by SDI. These results provide comprehensive and comparable estimates that can potentially inform efforts toward equitable cancer control around the world.

Abstract In this paper, we discuss two complementary commitments of interpretative phenomenological analysis (IPA): the phenomenological requirement to understand and ‘give voice’ to the concerns of participants; and the interpretative requirement to contextualize and ‘make sense’ of these claims and concerns from a psychological perspective. The methodological and conceptual bases for the relationship between these phenomenological and interpretative aspects of IPA appear to be underdeveloped in the literature. We, therefore, offer some thoughts on the basis of this relationship, and on its context within qualitative psychology. We discuss the epistemological range of IPA's interpretative focus, and its relationship to the more descriptive features of phenomenological analysis. In order to situate our conclusions within a contextualist position, we draw upon concepts from Heideggerian phenomenology. The argument is illustrated by excerpts from our own research on relationship break-up. We conclude by encouraging IPA researchers to embrace the interpretative opportunities that are offered by this approach. Key words: HeideggerhermeneuticIPAmethodologyphenomenology

BACKGROUND: Explainability is one of the most heavily debated topics when it comes to the application of artificial intelligence (AI) in healthcare. Even though AI-driven systems have been shown to outperform humans in certain analytical tasks, the lack of explainability continues to spark criticism. Yet, explainability is not a purely technological issue, instead it invokes a host of medical, legal, ethical, and societal questions that require thorough exploration. This paper provides a comprehensive assessment of the role of explainability in medical AI and makes an ethical evaluation of what explainability means for the adoption of AI-driven tools into clinical practice. METHODS: Taking AI-based clinical decision support systems as a case in point, we adopted a multidisciplinary approach to analyze the relevance of explainability for medical AI from the technological, legal, medical, and patient perspectives. Drawing on the findings of this conceptual analysis, we then conducted an ethical assessment using the "Principles of Biomedical Ethics" by Beauchamp and Childress (autonomy, beneficence, nonmaleficence, and justice) as an analytical framework to determine the need for explainability in medical AI. RESULTS: Each of the domains highlights a different set of core considerations and values that are relevant for understanding the role of explainability in clinical practice. From the technological point of view, explainability has to be considered both in terms how it can be achieved and what is beneficial from a development perspective. When looking at the legal perspective we identified informed consent, certification and approval as medical devices, and liability as core touchpoints for explainability. Both the medical and patient perspectives emphasize the importance of considering the interplay between human actors and medical AI. We conclude that omitting explainability in clinical decision support systems poses a threat to core ethical values in medicine and may have detrimental consequences for individual and public health. CONCLUSIONS: To ensure that medical AI lives up to its promises, there is a need to sensitize developers, healthcare professionals, and legislators to the challenges and limitations of opaque algorithms in medical AI and to foster multidisciplinary collaboration moving forward.

Importance: The increasing burden due to cancer and other noncommunicable diseases poses a threat to human development, which has resulted in global political commitments reflected in the Sustainable Development Goals as well as the World Health Organization (WHO) Global Action Plan on Non-Communicable Diseases. To determine if these commitments have resulted in improved cancer control, quantitative assessments of the cancer burden are required. Objective: To assess the burden for 29 cancer groups over time to provide a framework for policy discussion, resource allocation, and research focus. Evidence Review: Cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) were evaluated for 195 countries and territories by age and sex using the Global Burden of Disease study estimation methods. Levels and trends were analyzed over time, as well as by the Sociodemographic Index (SDI). Changes in incident cases were categorized by changes due to epidemiological vs demographic transition. Findings: In 2016, there were 17.2 million cancer cases worldwide and 8.9 million deaths. Cancer cases increased by 28% between 2006 and 2016. The smallest increase was seen in high SDI countries. Globally, population aging contributed 17%; population growth, 12%; and changes in age-specific rates, -1% to this change. The most common incident cancer globally for men was prostate cancer (1.4 million cases). The leading cause of cancer deaths and DALYs was tracheal, bronchus, and lung cancer (1.2 million deaths and 25.4 million DALYs). For women, the most common incident cancer and the leading cause of cancer deaths and DALYs was breast cancer (1.7 million incident cases, 535 000 deaths, and 14.9 million DALYs). In 2016, cancer caused 213.2 million DALYs globally for both sexes combined. Between 2006 and 2016, the average annual age-standardized incidence rates for all cancers combined increased in 130 of 195 countries or territories, and the average annual age-standardized death rates decreased within that timeframe in 143 of 195 countries or territories. Conclusions and Relevance: Large disparities exist between countries in cancer incidence, deaths, and associated disability. Scaling up cancer prevention and ensuring universal access to cancer care are required for health equity and to fulfill the global commitments for noncommunicable disease and cancer control.

A new periodontitis classification scheme has been adopted, in which forms of the disease previously recognized as "chronic" or "aggressive" are now grouped under a single category ("periodontitis") and are further characterized based on a multi-dimensional staging and grading system. Staging is largely dependent upon the severity of disease at presentation as well as on the complexity of disease management, while grading provides supplemental information about biological features of the disease including a history-based analysis of the rate of periodontitis progression; assessment of the risk for further progression; analysis of possible poor outcomes of treatment; and assessment of the risk that the disease or its treatment may negatively affect the general health of the patient. Necrotizing periodontal diseases, whose characteristic clinical phenotype includes typical features (papilla necrosis, bleeding, and pain) and are associated with host immune response impairments, remain a distinct periodontitis category. Endodontic-periodontal lesions, defined by a pathological communication between the pulpal and periodontal tissues at a given tooth, occur in either an acute or a chronic form, and are classified according to signs and symptoms that have direct impact on their prognosis and treatment. Periodontal abscesses are defined as acute lesions characterized by localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus, rapid tissue destruction and are associated with risk for systemic dissemination.

Imitation learning techniques aim to mimic human behavior in a given task. An agent (a learning machine) is trained to perform a task from demonstrations by learning a mapping between observations and actions. The idea of teaching by imitation has been around for many years; however, the field is gaining attention recently due to advances in computing and sensing as well as rising demand for intelligent applications. The paradigm of learning by imitation is gaining popularity because it facilitates teaching complex tasks with minimal expert knowledge of the tasks. Generic imitation learning methods could potentially reduce the problem of teaching a task to that of providing demonstrations, without the need for explicit programming or designing reward functions specific to the task. Modern sensors are able to collect and transmit high volumes of data rapidly, and processors with high computational power allow fast processing that maps the sensory data to actions in a timely manner. This opens the door for many potential AI applications that require real-time perception and reaction such as humanoid robots, self-driving vehicles, human computer interaction, and computer games, to name a few. However, specialized algorithms are needed to effectively and robustly learn models as learning by imitation poses its own set of challenges. In this article, we survey imitation learning methods and present design options in different steps of the learning process. We introduce a background and motivation for the field as well as highlight challenges specific to the imitation problem. Methods for designing and evaluating imitation learning tasks are categorized and reviewed. Special attention is given to learning methods in robotics and games as these domains are the most popular in the literature and provide a wide array of problems and methodologies. We extensively discuss combining imitation learning approaches using different sources and methods, as well as incorporating other motion learning methods to enhance imitation. We also discuss the potential impact on industry, present major applications, and highlight current and future research directions.

New oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with non-valvular atrial fibrillation (AF). Both physicians and patients will have to learn how to use these drugs effectively and safely in clinical practice. Many unresolved questions on how to optimally use these drugs in specific clinical situations remain. The European Heart Rhythm Association set out to coordinate a unified way of informing physicians on the use of the different NOACs. A writing group listed 15 topics of concrete clinical scenarios and formulated as practical answers as possible based on available evidence. The 15 topics are: (1) Practical start-up and follow-up scheme for patients on NOACs; (2) How to measure the anticoagulant effect of NOACs; (3) Drug-drug interactions and pharmacokinetics of NOACs; (4) Switching between anticoagulant regimens; (5) Ensuring compliance of NOAC intake; (6) How to deal with dosing errors; (7) Patients with chronic kidney disease; (8) What to do if there is a (suspected) overdose without bleeding, or a clotting test is indicating a risk of bleeding? (9) Management of bleeding complications; (10) Patients undergoing a planned surgical intervention or ablation; (11) Patients undergoing an urgent surgical intervention; (12) Patients with AF and coronary artery disease; (13) Cardioversion in a NOAC-treated patient; (14) Patients presenting with acute stroke while on NOACs; (15) NOACs vs. VKAs in AF patients with a malignancy. Since new information is becoming available at a rapid pace, an EHRA Web site with the latest updated information accompanies this text (www.NOACforAF.eu).

Metal nanoclusters have physical properties differing significantly from their bulk counterparts. Metallic properties such as delocalization of electrons in bulk metals which imbue them with high electrical and thermal conductivity, light reflectivity and mechanical ductility may be wholly or partially absent in metal nanoclusters, while new properties develop. We review modern synthetic methods used to form metal nanoclusters. The focus of this critical review is solution based chemical synthesis methods which produce fully dispersed clusters. Control of cluster size and surface chemistry using inverse micelles is emphasized. Two classes of metals are discussed, transition metals such as Au and Pt, and base metals such as Co, Fe and Ni. The optical and catalytic properties of the former are discussed and the magnetic properties of the latter are given as examples of unexpected new size-dependent properties of nanoclusters. We show how classical surface science methods of characterization augmented by chemical analysis methods such as liquid chromatography can be used to provide feedback for improvements in synthetic protocols. Characterization of metal clusters by their optical, catalytic, or magnetic behavior also provides insights leading to improvements in synthetic methods. The collective physical properties of closely interacting clusters are reviewed followed by speculation on future technical applications of clusters. (125 references).

Abstract ChatGPT and its variants that use generative artificial intelligence (AI) models have rapidly become a focal point in academic and media discussions about their potential benefits and drawbacks across various sectors of the economy, democracy, society, and environment. It remains unclear whether these technologies result in job displacement or creation, or if they merely shift human labour by generating new, potentially trivial or practically irrelevant, information and decisions. According to the CEO of ChatGPT, the potential impact of this new family of AI technology could be as big as “the printing press”, with significant implications for employment, stakeholder relationships, business models, and academic research, and its full consequences are largely undiscovered and uncertain. The introduction of more advanced and potent generative AI tools in the AI market, following the launch of ChatGPT, has ramped up the “AI arms race”, creating continuing uncertainty for workers, expanding their business applications, while heightening risks related to well‐being, bias, misinformation, context insensitivity, privacy issues, ethical dilemmas, and security. Given these developments, this perspectives editorial offers a collection of perspectives and research pathways to extend HRM scholarship in the realm of generative AI. In doing so, the discussion synthesizes the literature on AI and generative AI, connecting it to various aspects of HRM processes, practices, relationships, and outcomes, thereby contributing to shaping the future of HRM research.

1. The low-molecular-weight components of myosin freshly prepared by the standard procedure from adult rabbit skeletal muscle migrated as four main bands Ml(1), Ml(2), Ml(3) and Ml(4) on polyacrylamide-gel electrophoresis in 8m-urea. 2. The number of bands increased on storage. This change was accelerated by increasing the temperature and pH. 3. None of the bands had electrophoretic mobilities identical with those of the well-characterized proteins of the myofibril or with the sarcoplasmic proteins. 4. By varying the ionic conditions and concentration of muscle mince used for the initial extraction it was possible to change the relative proportions of the two electrophoretic bands of intermediate mobility, Ml(2) and Ml(3). 5. The four-band picture similar to that obtained with rabbit was observed with myosin isolated from skeletal muscle of the rat, mouse, hamster, pigeon and chicken. 6. Rabbit cardiac myosin gave only two bands on electrophoresis. Myosin from rabbit red muscle gave a pattern intermediate between cardiac and white-skeletal-muscle myosin, i.e. the two fastest bands were present in decreased relative amounts. 7. It is suggested that the differences in the low-molecular-weight components of myosin from different types of muscle are a consequence of differences in the isoenzyme composition of the myosins.

Abstract This article differentiates between descriptive and explanatory factors to develop a typology and a theory of stakeholder and public engagement. The typology describes different types of public and stakeholder engagement, and the theory comprises four factors that explain much of the variation in outcomes (for the natural environment and/or for participants) between different types of engagement. First, we use a narrative literature search to develop a new typology of stakeholder and public engagement based on agency (who initiates and leads engagement) and mode of engagement (from communication to coproduction). We then propose a theory to explain the variation in outcomes from different types of engagement: (1) a number of socioeconomic, cultural, and institutional contextual factors influence the outcomes of engagement; (2) there are a number of process design factors that can increase the likelihood that engagement leads to desired outcomes, across a wide range of sociocultural, political, economic, and biophysical contexts; (3) the effectiveness of engagement is significantly influenced by power dynamics, the values of participants, and their epistemologies, that is, the way they construct knowledge and which types of knowledge they consider valid; and (4) engagement processes work differently and can lead to different outcomes when they operate over different spatial and temporal scales. We use the theoretical framework to provide practical guidance for those designing engagement processes, arguing that a theoretically informed approach to stakeholder and public engagement has the potential to markedly improve the outcomes of environmental decision‐making processes.

The analytic hierarchy process (AHP) has gained increasing attention in construction management (CM) domain as a technique to analyse complex situations and make sound decisions. However, AHP per se or its potential applications on CM problems are ill-defined within extant literature. The present paper reviews 77 AHP-based papers published in eight selected peer-reviewed CM journals from 2004 to 2014 to better define and delineate AHP application areas and decision-making problems solved within CM. The findings indicated that risk management and sustainable construction were the most popular AHP application areas in CM. It was also revealed that AHP (1) is flexible and can be used as a stand-alone tool or in conjunction with other tools to resolve construction decision-making problems; and (2) is widely used in Asia. In addition, the most prominent justifications for using AHP were found to be small sample size, high level of consistency, simplicity and availability of user-friendly software. This paper provides a useful reference for researchers and practitioners interested in the application of AHP in CM. Future research is needed to compare and contrast between AHP and other multicriteria decision-making methods; such work could reveal which techniques provide optimized solutions under various decision-making scenarios.

BACKGROUND Endometriosis is a chronic condition affecting between 2 and 17% of women of reproductive age. Common symptoms are chronic pelvic pain, fatigue, congestive dysmenorrhoea, heavy menstrual bleeding and deep dyspareunia. Studies have demonstrated the considerable negative impact of this condition on women's quality of life (QoL), especially in the domains of pain and psychosocial functioning. The impact of endometriosis is likely to be exacerbated by the absence of an obvious cause and the likelihood of chronic, recurring symptoms. The aims of this paper are to review the current body of knowledge on the social and psychological impact of endometriosis on women's lives; to provide insights into women's experience of endometriosis; to provide a critical commentary on the current state of knowledge and to make recommendations for future psycho-social research. METHODS The review draws on a method of critical narrative synthesis to discuss a heterogeneous range of both quantitative and qualitative studies from several disciplines. This included a systematic search, a structured process for selecting and collecting data and a systematic thematic analysis of results. RESULTS A total of 42 papers were included in the review; 23 used quantitative methods, 16 used qualitative methods and 3 were mixed methods studies. The majority of papers came from just four countries: UK (10), Australia (8), Brazil (6) and the USA (5). Key categories of impact identified in the thematic analysis were diagnostic delay and uncertainty; 'QoL' and everyday activities; intimate relationships; planning for and having children; education and work; mental health and emotional wellbeing and medical management and self-management. CONCLUSIONS Endometriosis has a significant social and psychological impact on the lives of women across several domains. Many studies have methodological limitations and there are significant gaps in the literature especially in relation to a consideration of the impact on partners and children. We recommend additional prospective and longitudinal research utilizing mixed methods approaches and endometriosis-specific instruments to explore the impact of endometriosis in more diverse populations and settings. Furthermore, there is an urgent need to develop and evaluate interventions for supporting women and partners living with this chronic and often debilitating condition.

The upcoming fifth generation (5G) of wireless networks is expected to lay a foundation of intelligent networks with the provision of some isolated artificial intelligence (AI) operations. However, fully intelligent network orchestration and management for providing innovative services will only be realized in Beyond 5G (B5G) networks. To this end, we envisage that the sixth generation (6G) of wireless networks will be driven by on-demand self-reconfiguration to ensure a many-fold increase in the network performance and service types. The increasingly stringent performance requirements of emerging networks may finally trigger the deployment of some interesting new technologies, such as large intelligent surfaces, electromagnetic-orbital angular momentum, visible light communications, and cell-free communications, to name a few. Our vision for 6G is a massively connected complex network capable of rapidly responding to the users' service calls through real-time learning of the network state as described by the network edge (e.g., base-station locations and cache contents), air interface (e.g., radio spectrum and propagation channel), and the user-side (e.g., battery-life and locations). The multi-state, multi-dimensional nature of the network state, requiring the real-time knowledge, can be viewed as a quantum uncertainty problem. In this regard, the emerging paradigms of machine learning (ML), quantum computing (QC), and quantum ML (QML) and their synergies with communication networks can be considered as core 6G enablers. Considering these potentials, starting with the 5G target services and enabling technologies, we provide a comprehensive review of the related state of the art in the domains of ML (including deep learning), QC, and QML and identify their potential benefits, issues, and use cases for their applications in the B5G networks. Subsequently, we propose a novel QC-assisted and QML-based framework for 6G communication networks while articulating its challenges and potential enabling technologies at the network infrastructure, network edge, air interface, and user end. Finally, some promising future research directions for the quantum- and QML-assisted B5G networks are identified and discussed.

Internationally, health authorities and governments are warning older people that they are at a higher risk of more serious and possible fatal illness associated with COVID-19. Mortality data from Oxford COVID-19 Evidence Service (25/3/20) indicate a risk of mortality of 3.6% for people in their 60s, which increases to 8.0% and 14.8% for people in their 70s and over 80s. Therefore, the global recommendation for older populations includes social isolation, which involves staying at home and avoiding contact with other people, possibly for an extended period of time, currently estimated to be between three and four months. Older populations in this current context refers to people over 70 years and 50 years in some particularly vulnerable Indigenous populations. Social isolation includes avoiding social contact with family members and friends, organising the delivery of essential items, such as groceries and medications, where social contact is also to be avoided by maintaining a distance of two metres from the person delivering goods. Over the course of the pandemic, we have seen evidence of openly ageist discourses, which we argue, complicates the experiences of living through COVID-19 for older people. There have been distressing reports of older people abandoned in care homes (Keeley, 2020) and concerns about the representation and positioning of older people in the social media discourses around COVID-19. Ageism evident through phrases such as #BoomerRemover has emerged in relation to COVID-19. The hashtag #BoomerRemover has even been trending on social media platforms; often accompanied with ageist disparaging and devaluing memes (Sparks, 2020), as well as considerable media coverage and online discussions and commentary about potential for rationing of care with older people being potentially disadvantaged and positioned as more expendable than persons in other age groups. Some of the coverage seems to suggest that the death of older people somehow is not as important as loss of life of younger people (Haffower, 2020). These ageist discourses and the subtext of negativity and devaluing of older people can and will very likely contribute to feelings of worthlessness in older people, a sense of being burdensome and having no value. These factors when considered in relation to current social restrictions make older people particularly vulnerable to a range of negative health and social outcomes, particularly social isolation and loneliness. We know that loneliness is a real risk factor to the health and well-being of all people, and even in the best of times, older people can be more vulnerable to being lonely. Social circles can decline with ageing, due to factors such as the development of long-term conditions and deteriorating health, death of partners and friends, so older people may have fewer closer relationships and may be more likely to live alone (Victor & Bowling, 2012). Environmental barriers also impact on social isolation and loneliness of older people, such as the feeling of being unsafe in their neighbourhoods and there can be a lack of resources to support socialising or attending activities, leading to both boredom and inactivity (Cohen-Mansfield, Hazan, Lerman, & Shalom, 2016). Social isolation and loneliness are related but distinct concepts. Social isolation refers to a lack of contact with or physical separation from family, friends, or broader social networks and the lack of involvement in social activities (Valtorta & Hanratty, 2012) and is due to environmental restrictions, rather than an individual's ability to create or maintain social relationships (Tanskanen & Anttila, 2016). Loneliness is a complex, subjective emotion, experienced as a feeling of anxiety and dissatisfaction associated with a lack of connectedness or communality with others, and a deficit between the actual and desired quality and quantity of social engagement (Victor, Scambler, Bowling, & Bond, 2005). Social isolation and loneliness are correlated, albeit weakly (Steptoe, Shankar, Demakakos, & Wardle, 2013); however, these terms are often used interchangeably. The acknowledgement of social isolation and loneliness of older people is essential and paramount due to the detrimental impact on their physical and mental health, which has been recognised for over two decades. Social isolation and loneliness increases older people's risk of anxiety, depression, cognitive disfunction, heart disease and mortality (Barth, Schneider, & Kanel, 2010; Holt-Lunstad, Smith, & Layton, 2010; Santini et al., 2020; Shankar, McMunn, Demakakos, Hamer, & Steptoe, 2017). Prior to COVID-19, this was acknowledged in health and social care policies and campaigns. In the UK, the Campaign to End Loneliness (2011) created a network of national, regional and local organisations to work together to ensure that loneliness of older people remains a public health priority. Similarly, the government in New Zealand committed to a vision of positive ageing principles to promote community participation and prevent social isolation (Ministry of Social Development, 2001). There is also a need to recognise that older people who previously had not reported being socially isolated and lonely may be disproportionately affected by the requirements of social isolation due to COVID-19, because of the removal of social contacts, which may have occurred during grocery shopping, attending community groups and places of worship and other day-to-day activities. As well, older people may be adversely affected by the ageist discourses that may seem to imply that the loss of older life is not as important as loss of life of other age groups. Alongside, the recognition of the continued impact on older people who do not have friends or family members and rely on social care, who may feel further isolated, especially when services become disrupted. A further population of older people who are at risk of becoming more socially isolated are those residing in residential care homes, as their friends and family members are not currently permitted to visit. Therefore, there is an urgent need to support older people to mitigate the negative impacts on their physical and mental health from social isolation and ageist discourses around COVID-19. We must support older people to have and retain their connectedness and communality with others to better enable a sense of belonging. One immediate element that needs to be highlighted is the possibility of previously vigorous older people becoming increasingly frail due to reducing their activities, especially walking, and leading an (enforced) more sedentary lifestyle, which will likely impact on their mobility and well-being over time (Hartmann-Boyce, Davies, Frost, Bussey, & Park, 2020). Along with social isolation, social distancing has been recommended when older people leave their homes for essential items and exercise. The terms social isolation, self-isolation and social distancing have often been applied interchangeably potentially causing confusion. Self-isolation refers to remaining at home when someone has symptoms of COVID-19, been in contact with someone with symptoms, or on return from overseas; usually recommended for 14 days, rather than for an extended or continued time period. The advice for older people is to maintain social isolation for an extended period, with all the attendant risks that entails. One response from Public Health England on 29 March 2020 included the publication of guidance on maintaining mental health and well-being during COVID-19 social restrictions (Public Health England, 2020). The guidance for older people included the importance of staying connected and getting practical help, alongside the provision of an Age UK helpline phone number, but no advice on how to achieve staying connected, or how this could be achieved nationwide for every older person. There has been a media campaign to recruit volunteers to support older people who might otherwise have fallen through the cracks, but is this a robust and inclusive approach to ensure no older person is left isolated, or sustainable over an extended period of time? Other responses to socially support older people have included the development of social networks through online technologies, such as Facebook, Twitter, WhatsApp and other similar platforms. In the UK, one example is the development of social networks through WhatsApp, supported through the national Neighbourhood Watch scheme, encouraging people to get online and talk. Other initiatives wider than the UK include the Nextdoor App, a platform for neighbours and communities, which again encourages conversations and connections between people. These apps could create a sense of belonging for those who are able to engage with these technologies. Beyond this, online therapies such as cognitive behaviour therapy have been identified as potentially decreasing loneliness (Käll et al., 2020). Creative ways of supporting not only older people, but the general population, have also emerged, although the majority are delivered through online platforms, such as performances of symphony orchestras in virtual concert halls, or becoming a member of a virtual choir, playing board games online, and joining online masses and religious services. Indeed, the majority of advice is to connect with older people virtually which leaves those most disadvantaged vulnerable and at risk. However, although many older people are highly IT literate, there will remain disparities in access and abilities, and so alternative ways of supporting older people are imperative. Whilst mail deliveries continue, cards, letters and parcels provide other avenues to ensure older people feel connected with the outside world. A further way to support older people during the current health crisis could involve regular meaningful telephone conversations, to ensure meeting mental, social and physical health needs, and that older people know how to ask for and access help if required. Family members, friends, local charities, voluntary organisations and community nurses could develop comprehensive networks to ensure each older person has some meaningful social contact to support them. Through an organised and comprehensive approach, charities, organisations and healthcare providers could work together to support older people through this period of social isolation and to minimise and mitigate the negative impact of negative ageism, social isolation and loneliness.

M. M. Petty, Gail W. McGee, Jerry W. Cavender, A Meta-Analysis of the Relationships between Individual Job Satisfaction and Individual Performance, The Academy of Management Review, Vol. 9, No. 4 (Oct., 1984), pp. 712-721

Increasing use of assays for TSH with improved sensitivity as a first-line test of thyroid function has raised questions regarding prevalence and clinical significance of abnormal results, especially values below normal. We have assessed the thyroid status of 1210 patients aged over 60 registered with a single general practice by measurement of serum TSH using a sensitive assay. High TSH values were more common in females (11.6%) than males (2.9%). TSH values below normal were present in 6.3% of females and 5.5% of males, with values below the limit of detection of the assay present in 1.5% of females and 1.4% of males. Anti-thyroid antibodies were found in 60% of those with high TSH but only 5.6% of those with subnormal TSH. Eighteen patients were hypothyroid (high TSH, low free thyroxine) and one thyrotoxic (low TSH, raised free thyroxine) at initial testing. Seventy-three patients with elevated TSH but normal free T4 were followed for 12 months; 13 (17.8%) developed low free T4 levels and commenced thyroxine, TSH returned to normal in four (5.5%) and 56 (76.7%) continued to have high TSH values. Sixty-six patients with TSH results below normal were followed. Of the 50 subjects with low but detectable TSH at initial testing, 38 (76%) returned to normal at 12 months; of those 16 with undetectable TSH followed, 14 (87.5%) remained low at 12 months. Only one subject (who had an undetectable TSH) developed thyrotoxicosis. In view of the marked prevalence of thyroid dysfunction in the elderly, we suggest that screening of all patients over 60 should be considered.(ABSTRACT TRUNCATED AT 250 WORDS)