University of Cumbria

Thematic analysis is a highly popular technique among qualitative researchers for analyzing qualitative data, which usually comprises thick descriptive data. However, the application and use of thematic analysis has also involved complications due to confusion regarding the final outcome’s presentation as a conceptual model. This paper develops a systematic thematic analysis process for creating a conceptual model from qualitative research findings. It explores the adaptability of the proposed process across various research methodologies, including constructivist methodologies, positivist methodologies, grounded theory, and interpretive phenomenology, and justifies their application. The paper distinguishes between inductive and deductive coding approaches and emphasizes the merits of each. It suggests that the derived systematic thematic analysis model is valuable across multiple disciplines, particularly in grounded theory, ethnographic approaches, and narrative approaches, while also being adaptable to more descriptive, positivist-based methodologies. By providing a methodological roadmap, this study enhances the rigor and replicability of thematic analysis and offers a comprehensive strategy for theoretical conceptualization in qualitative research. The contribution of this paper is a systematic six-step thematic analysis process that leads to the development of a conceptual model; each step is described in detail and examples are given.

Summary The effects of increased atmospheric nitrogen inputs, from both NO y and NH x, on diversity in various semi‐natural and natural ecosystems are reviewed. The severity of these impacts depends on abiotic conditions (e.g. buffering capacity, soil nutrient status and soil factors that influence the nitrification potential and nitrogen immobilization rate) in the particular system. The sensitivity of fresh water ecosystems, wetlands and bogs, species‐rich grasslands, heathlands and field layer of forests, all of which have conservational value, are discussed in detail. The most important effects of nitrogen deposition are: (i) accumulation of nitrogenous compounds resulting in enhanced availability of nitrate or ammonium; (ii) soil‐mediated effects of acidification; and (iii) increased susceptibility to secondary stress factors. Long‐term nitrogen enrichment has gradually increased the availability of nitrogen in several vegetation types, leading to competitive exclusion of characteristic species by more nitrophilic plants, especially under oligo‐ to mesotrophic soil conditions. Soil acidification (with losses of buffering capacity and increased concentrations of toxic metals) is especially important after nitrification of ammonium in weakly buffered environments: acid‐resistant plant species then become dominant at the expense of the often rare plants typical of intermediate pH. The related change in the balance between ammonium and nitrate may also affect the performance of several species. The susceptibility of plant species to secondary stress factors (pathogens; frost and drought) may be affected by air‐borne nitrogen but data are only available for a few communities (e.g. dry heathlands). Most global biodiversity is contained within natural and semi‐natural vegetation. It is thus crucial to control emissions of nitrogenous compounds to the atmosphere, in order to reduce or prevent effects on diversity in these systems. Most research has focused on acidification in forestry stands and lakes and on the effects on trees. We highlight serious gaps in knowledge of other ecosystems.

1. Over the past three decades changes in agricultural management have resulted in increased crop and grass production. This intensification has been accompanied by population declines among farmland bird species and a decline in farmland biodiversity. We have analysed trends in agricultural management in order to quantify the degree of intensification, and have considered how they match change in the farmland bird community. 2. Changes in agriculture through time (1962–95) were examined quantitatively for 31 variables representing crop areas, livestock numbers, fertilizer application, grass production and pesticide use. The majority were highly intercorrelated because factors facilitating intensification simultaneously affected many management activities. 3. Change in agriculture was measured using detrended correspondence analysis (DCA). The period 1970–88 saw most intensification, characterized by increases in the area of oilseed rape, autumn‐sown cereals, and the use of pesticides and inorganic fertilizers. Spring‐sown cereals, bare fallow and root crops declined. 4. Indices of relative population change between 1962 and 1996 were determined for 29 bird species using data from Common Birds Census (CBC) plots on farmland in England and Wales. Principal components analysis (PCA) described a gradient from species that had declined most to those that had increased. 5. The ordinations of agricultural change and bird population change were broadly matching but with a time lag in the response of birds. The most accurately measured agricultural variables for the period 1974–91 matched the changes in farmland birds more closely. 6. We conclude that large shifts in agricultural management are a plausible explanation for the declines in farmland bird populations. We propose a threshold model relating to critical amounts of high‐quality habitat or food resources that may be relevant in explaining the lag in response of birds, and propose it should be taken into account in predicting the effects of future agri‐environment schemes. Identifying individual factors responsible for bird declines is not possible without detailed experimental work because many components of intensification are interdependent. Birds may be responding to a suite of interacting factors rather individual aspects of farm management. Holistic conservation strategy that encourages general extensification of farming practices will be most likely to benefit farmland bird communities.

Authenticity has been identified as a key characteristic of assessment design which promotes learning. Authentic assessment aims to replicate the tasks and performance standards typically found in the world of work, and has been found to have a positive impact on student learning, autonomy, motivation, self-regulation and metacognition; abilities highly related to employability. Despite these benefits, there are significant barriers to the introduction of authentic assessment, particularly where there is a tradition of ‘testing’ decontextualised subject knowledge. One barrier may be the lack of conceptualisation of the term authentic assessment sufficient to inform assessment design at the individual course level. This article tackles that omission by a systematic review of literature from 1988 to 2015. Thirteen consistent characteristics of authentic assessment are identified leading to the classification of three conceptual dimensions: realism, cognitive challenge and evaluative judgement. These dimensions are elaborated and used to propose a step-based model for designing and operating authentic assessment in individual higher education subjects.

5 Background: In estrogen-receptor-positive (ER+) early breast cancer, 5 years of tamoxifen reduces breast cancer death rates by about a third throughout years 0-14. It has been uncertain how 10 years of tamoxifen compares with this. Methods: During 1991-2005, 6,953 women with ER+ (n=2755), or ER untested (4198, estimated 80% ER+ if status known) invasive breast cancer from 176 UK centres were, after 5 years of tamoxifen, randomized to stop tamoxifen or continue to year 10. Annual follow-up recorded compliance, recurrence, mortality, and hospital admissions. Results: Allocation to continue tamoxifen reduced breast cancer recurrence (580/3468 vs 672/3485, p=0.003). This reduction was time dependent: rate ratio 0.99 during years 5-6 [95%CI 0.86-1.15], 0.84 [0.73-0.95] during years 7-9, and 0.75 [0.66-0.86] later. Longer treatment also reduced breast cancer mortality (392 vs 443 deaths after recurrence, p=0.05), rate ratio 1.03 [0.84-1.27] during years 5-9 and 0.77 [0.64-0.92] later; and overall mortality (849 vs 910 deaths, p=0.1), rate ratio 1.05 [0.90-1.22] during years 5-9 and 0.86 [0.75-0.97] later. Non-breast-cancer mortality was little affected (457 vs 467 deaths, rate ratio 0.94 [0.82-1.07]). There were 102 vs 45 endometrial cancers RR=2.20 (1.31-2.34, p<0.0001) with 37 (1.1%) vs 20 (0.6%) deaths (absolute hazard 0.5%, p=0.02). Combining the similar results of aTTom and its international counterpart ATLAS (Lancet 2013) enhances statistical significance of recurrence (p<0.0001), breast cancer mortality (p=0.002) and overall survival (p=0.005) benefits. Conclusions: aTTom confirms that, in ER+ disease, continuing tamoxifen to year 10 rather than just to year 5 produces further reductions in recurrence, from year 7 onward, and breast cancer mortality after year 10. Taken together with the reduction in breast cancer deaths seen in trials of 5 years of tamoxifen vs none, these results indicate that 10 years of adjuvant tamoxifen, compared to no tamoxifen, reduces breast cancer mortality by about one third in the first 10 years following diagnosis and by a half subsequently. Clinical trial information: ISRCTN17222211.

In the third trimester of pregnancy, the human fetus has the capacity to process perceptual information [1-3]. With advances in 4D ultrasound technology, detailed assessment of fetal behavior [4] is now possible. Furthermore, modeling of intrauterine conditions has indicated a substantially greater luminance within the uterus than previously thought [5]. Consequently, light conveying perceptual content could be projected through the uterine wall and perceived by the fetus, dependent on how light interfaces with maternal tissue. We do know that human infants at birth show a preference to engage with a top-heavy, face-like stimulus when contrasted with all other forms of stimuli [6, 7]. However, the viability of performing such an experiment based on visual stimuli projected through the uterine wall with fetal participants is not currently known. We examined fetal head turns to visually presented upright and inverted face-like stimuli. Here we show that the fetus in the third trimester of pregnancy is more likely to engage with upright configural stimuli when contrasted to inverted visual stimuli, in a manner similar to results with newborn participants. The current study suggests that postnatal experience is not required for this preference. In addition, we describe a new method whereby it is possible to deliver specific visual stimuli to the fetus. This new technique provides an important new pathway for the assessment of prenatal visual perceptual capacities.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden.

This paper seeks a perspective on the forms of phosphorus which promote aquatic eutrophication, with the particular quest of establishing their sources. A short background traces the development of understanding of nutrient enrichment and the suppositions about the relative contributions of agriculture, sewage and detergent residues. Most aquatic systems, and their primary producers, are naturally deficient in biologically-available phosphorus. Aquatic plants have evolved very efficient phosphorus uptake mechanisms. The biomass responses to an increase in the supply of phosphorus are stoichiometrically predictable. The most bioavailable forms of phosphorus are in solution, as orthophosphate ions, or are readily soluble or elutable from loose combinations. Ready bioavailability coincides well with what is measurable as molybdate-reactive (MRP) or soluble-reactive phosphorus (SRP). Most other forms, including phosphates of the alkaline earth metals, aluminium and iron are scarcely available at all. Orthophosphate ions sorbed to metal oxides and hydroxides are normally not biologically available either, except through weak dissociation ('desorption'). The production of alkaline phosphatase provides organisms with an additional mechanism for accelerating the sequestration of phosphate from organic compounds. Bioavailable phosphate is liberated when redox- or alkali-sensitive metal hydroxides dissolve but these processes are minor contributors to the biological responses to nutrient enrichment. Most of the familiar eutrophication is attributable to the widespread application of secondary sewage treatment methods to the wastes emanating from a burgeoning and increasingly urbanised human population. The use of polyphosphate-based detergents, now in decline, has contributed to the problem. In aquatic systems, the additional phosphorus raises the biological supportive capacity, sometimes to the capacity of the next limiting factor (carbon, light, hydraulic retention or of another nutrient). At high orthophosphate loadings, the straight stoichiometric yield relationship between biomass yield and phosphorus a vailability is lost. Movements of phosphorus and its recycling within aquatic systems do not prevent the slow gravitation of phosphorus to the bottom substrata. The phosphorus retentivity of sediments depends upon their chemical composition. While oxide-hydroxide binding capacity in the surface sediments persists, they act as a sink for phosphorus and a control on further cycling. Iron-rich and clay-rich sediments perform best in these conditions; calcareous sediments least so. Eutrophication may lead to the exhaustion of sediment P-binding capacity. Non-sorbed phosphate is readily recyclable if primary producers have access to it. Recycling is most rapid in shallow waters (where sediment disturbance, by flow, by wind action and through bioturbation, is frequent and least in deep ventilated sediments. The contributions of phosphorus from catchments are assessed. The slow rate of weathering of (mostly apatitic) minerals, the role of chemical binding in soils and the incorporation and retentivity bv forested terrestrial ecosystems each contribute to the minimisation of phosphorus leakage to drainage waters. Palaeolimnological and experimental evidence confirms that clearance of land and ploughing its surface weakens the phosphorus retentivity of catchments. The phosphorus transferred from arable land to drainage remains dominated by sorbed fractions which are scarcely bioavailable. Some forms of intensive market gardening or concentrated stock rearing may mobilise phosphates to drainage but it is deduced that drainage from agricultural land is not commonly a major source of readily bioavailable phosphorus in water. Careful budgeting of the phosphates in run-off from over-fertilised soils may nevertheless show that a proportionately small loss of bioavailable phosphorus can still be highly significant in promoting aquatic plant production. The bioavailable-phosphorus (BAP) load achieving the OECD threshold of lake eutrophy (35 mg P m(-3)) is calculated to be equivalent to a terrestrial loss rate of approximately 17.5 kg BAP km(-2) year(-1)), or only 1-2% of a typical fertiliser application. The output is shown to be comparable with the P yield from secondary treatment of the sewage produced by a resident population of 30-44 persons km(-2). With tertiary treatment, the equivalence is with approximately 200 persons km(-2).

Abstract Lignin methods based on an acid‐detergent fibre pre‐extraction were evaluated for grass, straw, heather and spruce litter. Quantification following oxidative attack to destroy the lignin by permanganate proved to be unreliable for the woody heather material and spruce litter. In contrast the method of isolation involving hydrolysis of the cellulose component with 72% sulphuric acid (H2SO4) was precise and robust. The acid detergent reagent dissolves most of the hemi‐cellulose and offers the opportunity to quantify the residual alpha‐cellulose fraction.

The present and future live birth prevalence of Down syndrome (DS) is of practical importance for planning services and prioritizing research to support people living with the condition. Live birth prevalence is influenced by changes in prenatal screening technologies and policies. To predict the future impact of these changes, a model for estimating the live births of people with DS is required. In this study, we combine diverse and robust datasets with validated estimation techniques to describe the non-selective and live birth prevalence of DS in the United States from 1900-2010. Additionally, for the period 1974-2010, we estimate the impact of DS-related elective pregnancy terminations (following a prenatal diagnosis of DS) on the live births with DS. The live birth prevalence for DS in the most recent years (2006-2010) was estimated at 12.6 per 10,000 (95% CI 12.4-12.8), with around 5,300 births annually. During this period, an estimated 3,100 DS-related elective pregnancy terminations were performed in the U.S. annually. As of 2007, the estimated rates at which live births with DS were reduced as a consequence of DS-related elective pregnancy terminations were 30% (95% CI: 27.3-31.9) for the U.S. as a whole. Our results and our model provide data on the impact of elective pregnancy terminations on live births with DS and may provide a baseline from which future trends for live births with DS can be estimated.

Mineral nutrient concentrations were determined in leaves of 83 mostly herbaceous species collected from central England. Most samples were analysed for N, P, K, Ca, Mg, Na, Fe, Al, Mn, Cu and Zn. Concentrations of K, N and P showed similar levels of interspecific variability, with the highest concentrations being 6-9 times the lowest. Mg and (especially) Ca were much more variable, with the highest concentrations being 24 and 49 times the lowest respectively. Only in the case of P concentration was the majority of the variance in the data found at or below the species level. Most of the variance in Ca and Mg concentrations was between monocots and dicots. Concentrations of N and P were strongly positively correlated with each other. Only Ca and Mn were consistently associated with soil pH, positively and negatively respectively. Dicots tended to accumulate more Ca and Mn from high soil concentrations than did monocots. Concentration of P was significantly positively correlated with maximum potential relative growth rate. Plants of woodland and arable habitats contained high concentrations of P, and those of pasture and skeletal habitats contained low concentrations of P. The P: N ratio was higher in plants of arable habitats. Species with P-rich leaves tended to be currently increasing in abundance. The results suggest that plants with nutrient-rich foliage grow quickly, dominate nutrient-rich ecosystems and are generally increasing as a result of the eutrophication and disturbance arising from human exploitation.

Summary 1. Ellenberg's indicator values scale the flora of a region along gradients reflecting light, temperature, continentality, moisture, soil pH, fertility and salinity. They can be used to monitor environmental change. 2. Ellenberg values can be extended from central Europe, for which they were defined, to nearby parts of Europe. Given a database of quadrat samples, they can be repredicted by a simple algorithm consisting of two‐way weighted averaging, followed by local regression. 3. A database of British samples was assembled from two large surveys. Ellenberg values were repredicted. 4. Except for the indicator of continentality, the correlation of repredicted and original values was in the range 0·72 (light) to 0·91 (moisture). The continentality indicator could not be adequately repredicted by the algorithm, and is unusable in Britain. 5. Discrepancies between original and repredicted values can be attributed to various causes, including wrong original values, differing ecological requirements in Britain and central Europe, biased sampling of the British range of habitats, and the occurrence of small plants in shaded or basic microhabitats within well illuminated or predominantly acid quadrats. 6. The repredicted values were generally reliable, but a small proportion was clearly wrong. Wrong values were due to either inadequate sampling of species’ realized niches in Britain or sampling with quadrats that were too large and included species that were not close associates.

There has been much recent interest in the concept of rewilding as a tool for nature conservation, but also confusion over the idea, which has limited its utility. We developed a unifying definition and 10 guiding principles for rewilding through a survey of 59 rewilding experts, a summary of key organizations' rewilding visions, and workshops involving over 100 participants from around the world. The guiding principles convey that rewilding exits on a continuum of scale, connectivity, and level of human influence and aims to restore ecosystem structure and functions to achieve a self-sustaining autonomous nature. These principles clarify the concept of rewilding and improve its effectiveness as a tool to achieve global conservation targets, including those of the UN Decade on Ecosystem Restoration and post-2020 Global Biodiversity Framework. Finally, we suggest differences in rewilding perspectives lie largely in the extent to which it is seen as achievable and in specific interventions. An understanding of the context of rewilding projects is the key to success, and careful site-specific interpretations will help achieve the aims of rewilding.

Loss-on-ignition (LOI) and the organic C content have been used to estimate soil organic matter. Organic matter is often estimated from organic C by applying a factor of 1.724. Several authors have examined the relationship between LOI, used as an estimate of organic matter, and C by simple linear regressions. In the present study, this approach was examined in relation to two sets of data. LOI overestimates organic matter in soils with significant proportions of clay minerals because of bound water, and correcting for bound water gives some LOI: C ratios of less than 1. It is concluded that differences in the nature of the organic matter in different soils and horizons make the simple regression approach unsuitable. More attention needs to be paid to studies of the nature of the organic matter.

With the predicted depletion of natural resources and alarming environmental issues, sustainable development has become a popular as well as a much-needed concept in modern process industries. Hence, manufacturers are quite keen on adopting novel process monitoring techniques to enhance product quality and process efficiency while minimizing possible adverse environmental impacts. Hardware sensors are employed in process industries to aid process monitoring and control, but they are associated with many limitations such as disturbances to the process flow, measurement delays, frequent need for maintenance, and high capital costs. As a result, soft sensors have become an attractive alternative for predicting quality-related parameters that are ‘hard-to-measure’ using hardware sensors. Due to their promising features over hardware counterparts, they have been employed across different process industries. This article attempts to explore the state-of-the-art artificial intelligence (Al)-driven soft sensors designed for process industries and their role in achieving the goal of sustainable development. First, a general introduction is given to soft sensors, their applications in different process industries, and their significance in achieving sustainable development goals. AI-based soft sensing algorithms are then introduced. Next, a discussion on how AI-driven soft sensors contribute toward different sustainable manufacturing strategies of process industries is provided. This is followed by a critical review of the most recent state-of-the-art AI-based soft sensors reported in the literature. Here, the use of powerful AI-based algorithms for addressing the limitations of traditional algorithms, that restrict the soft sensor performance is discussed. Finally, the challenges and limitations associated with the current soft sensor design, application, and maintenance aspects are discussed with possible future directions for designing more intelligent and smart soft sensing technologies to cater the future industrial needs.

Purpose The purpose of this paper is to explore the nature of leadership learning in the entrepreneurial context, by building a dynamic learning perspective of entrepreneurship. It draws on contemporary leadership literature to appreciate entrepreneurial leadership as a social process of becoming located in particular contexts and communities. Design/methodology/approach Through qualitative phenomenological interviews with nine entrepreneurs the lived experience of learning to lead is explored. The principles of interpretative phenomenological analysis (IPA) are utilised to analyse the data and enable inductive theory‐building. Findings The findings illustrate situated leadership patterns and relationships unique to the entrepreneurial context. A number of significant structural and experiential factors are identified that both shape and restrict the development of leadership practice in small ventures. Specifically, the limited opportunities for leadership enactment and observation, the dominance of the business as the crucible for leadership learning, the influence of the family and the low salience of leadership are highlighted. Research limitations/implications In appreciating the leadership learning task that nascent entrepreneurs are faced with it is vital that further research delves deeper into the varying levels of “leadership preparedness” brought to new venture creation. From a policy perspective, there is significant value in enabling entrepreneurs to engage in meaningful dialogue, critical reflection and purposive action with their peers through the creation of leadership “learning networks”. Originality/value The research demonstrates leadership learning processes and pathways that are significantly different to those experienced by managers in the employed context. In so doing, this article represents the first systematic attempt to apply a learning perspective to the subject of entrepreneurial leadership.

Frailty, the state of increased vulnerability to physical stressors as a result of progressive and sustained degeneration in multiple physiological systems, is common in those with chronic kidney disease (CKD). In fact, the prevalence of frailty in the older adult population is reported to be 11%, whereas the prevalence of frailty has been reported to be greater than 60% in dialysis-dependent CKD patients. Frailty is independently linked with adverse clinical outcomes in all stages of CKD and has been repeatedly shown to be associated with an increased risk of mortality and hospitalization. In recent years there have been efforts to create an operationalized definition of frailty to aid its diagnosis and to categorize its severity. Two principal concepts are described, namely the Fried Phenotype Model of Physical Frailty and the Cumulative Deficit Model of Frailty. There is no agreement on which frailty assessment approach is superior, therefore, for the time being, emphasis should be placed on any efforts to identify frailty. Recognizing frailty should prompt a holistic assessment of the patient to address risk factors that may exacerbate its progression and to ensure that the patient has appropriate psychological and social support. Adequate nutritional intake is essential and individualized exercise programmes should be offered. The acknowledgement of frailty should prompt discussions that explore the future care wishes of these vulnerable patients. With further study, nephrologists may be able to use frailty assessments to inform discussions with patients about the initiation of renal replacement therapy.

Immunosenescence is characterized by deterioration of the immune system caused by aging which induces changes to innate and adaptive immunity. Immunosenescence affects function and phenotype of immune cells, such as expression and function of receptors for immune cells which contributes to loss of immune function (chemotaxis, intracellular killing). Moreover, these alterations decrease the response to pathogens, which leads to several age-related diseases including cardiovascular disease, Alzheimer's disease, and diabetes in older individuals. Furthermore, increased risk of autoimmune disease and chronic infection is increased with an aging immune system, which is characterized by a pro-inflammatory environment, ultimately leading to accelerated biological aging. During the last century, sedentarism rose dramatically, with a concomitant increase in certain type of cancers (such as breast cancer, colon, or prostate cancer), and autoimmune disease. Numerous studies on physical activity and immunity, with focus on special populations (i.e., people with diabetes, HIV patients) demonstrate that chronic exercise enhances immunity. However, the majority of previous work has focused on either a pathological population or healthy young adults whilst research in elderly populations is scarce. Research conducted to date has primarily focused on aerobic and resistance exercise training and its effect on immunity. This review focuses on the potential for exercise training to affect the aging immune system. The concept is that some lifestyle strategies such as high-intensity exercise training may prevent disease through the attenuation of immunosenescence. In this context, we take a top-down approach and review the effect of exercise and training on immunological parameters in elderly at rest and during exercise in humans, and how they respond to different modes of training. We highlight the impact of these different exercise modes on immunological parameters, such as cytokine and lymphocyte concentration in elderly individuals.

BACKGROUND: Accurate optical characterisation and removal of small adenomas (<10 mm) at colonoscopy would allow hyperplastic polyps to be left in situ and surveillance intervals to be determined without the need for histopathology. Although accurate in specialist practice the performance of narrow band imaging (NBI), colonoscopy in routine clinical practice is poorly understood. METHODS: NBI-assisted optical diagnosis was compared with reference standard histopathological findings in a prospective, blinded study, which recruited adults undergoing routine colonoscopy in six general hospitals in the UK. Participating colonoscopists (N=28) were trained using the NBI International Colorectal Endoscopic (NICE) classification (relating to colour, vessel structure and surface pattern). By comparing the optical and histological findings in patients with only small polyps, test sensitivity was determined at the patient level using two thresholds: presence of adenoma and need for surveillance. Accuracy of identifying adenomatous polyps <10 mm was compared at the polyp level using hierarchical models, allowing determinants of accuracy to be explored. FINDINGS: Of 1688 patients recruited, 722 (42.8%) had polyps <10 mm with 567 (78.5%) having only polyps <10 mm. Test sensitivity (presence of adenoma, N=499 patients) by NBI optical diagnosis was 83.4% (95% CI 79.6% to 86.9%), significantly less than the 95% sensitivity (p<0.001) this study was powered to detect. Test sensitivity (need for surveillance) was 73.0% (95% CI 66.5% to 79.9%). Analysed at the polyp level, test sensitivity (presence of adenoma, N=1620 polyps) was 76.1% (95% CI 72.8% to 79.1%). In fully adjusted analyses, test sensitivity was 99.4% (95% CI 98.2% to 99.8%) if two or more NICE adenoma characteristics were identified. Neither colonoscopist expertise, confidence in diagnosis nor use of high definition colonoscopy independently improved test accuracy. INTERPRETATION: This large multicentre study demonstrates that NBI optical diagnosis cannot currently be recommended for application in routine clinical practice. Further work is required to evaluate whether variation in test accuracy is related to polyp characteristics or colonoscopist training. TRIAL REGISTRATION NUMBER: The study was registered with clinicaltrials.gov (NCT01603927).

This article contributes to understanding of the professional learning of expert school teachers when they are appointed as university‐based teacher educators. In this case study of a single department a qualitative analysis is used to interpret the transcripts of 16 semi‐structured interviews with lecturers in teacher education within four years of their appointment to higher education roles. They experience tensions within the educational partnership and professional field about the value of abstract knowledge compared with work‐based practice and about what a lecturer in teacher education should be. The situated learning of the new lecturers within their particular departmental context encourages them to hold on to their existing identities as school teachers, rather than embrace new identities as academics.