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CONTACT: a non- randomised feasibility study of bluetooth- enabled wearables for contact tracing in UK care homes during the COVID- 19 pandemic
Get PDFThe need for effective non-pharmaceutical infection prevention measures such as contact tracing in pandemics remains in care homes, but traditional approaches to contact tracing are not feasible in care homes. The CONTACT intervention introduces Bluetooth-enabled wearable devices (BLE wearables) as a potential solution for automated contact tracing. Using structured reports and reports triggered by positive COVID-19 cases in homes, we fed contact patterns and trends back to homes to support better-informed infection prevention decisions and reduce blanket application of restrictive measures. This paper reports on the evaluation of feasibility and acceptability of the intervention prior to a planned definitive cluster randomised trial of the CONTACT BLE wearable intervention.
Methods
CONTACT was a non-randomised mixed-method feasibility study over 2 months in four English care homes. Recruitment was via care home research networks, with individual consent. Data collection methods included routine data from the devices, case report forms, qualitative interviews (with staff and residents), field observation of care, and an adapted version of the NoMaD survey instrument to explore implementation using Normalisation Process Theory. Quantitative data were analysed using descriptive statistical methods. Qualitative data were thematically analysed using a framework approach and Normalisation Process Theory. Intervention and study delivery were evaluated against predefined progression criteria.
Results
Of 156 eligible residents, 105 agreed to wear a device, with 102 (97%) starting the intervention. Of 225 eligible staff, 82% (n = 178) participated. Device loss and damage were significant: 11% of resident devices were lost or damaged,~50% were replaced. Staff lost fewer devices, just 6%, but less than 10% were replaced. Fob wearables needed more battery changes than card-type devices (15% vs. 0%). Structured and reactive feedback was variably understood by homes but unlikely to be acted on. Researcher support for interpreting reports was valued. Homes found information useful when it confirmed rather than challenged preconceived contact patterns. Staff privacy concerns were a barrier to adoption. Study procedures added to existing work, making participation burdensome. Study participation benefits did not outweigh perceived burden and were amplified by the pandemic context. CONTACT did not meet its quantitative or qualitative progression criteria.
Conclusions
CONTACT found a large-scale definitive trial of BLE wearables for contact tracing and feedback-informed IPC in care homes unfeasible and unacceptable - at least in the context of shifting COVID-19 pandemic demands. Future research should co-design interventions and studies with care homes, focusing on successful intervention implementation as well as technical effectiveness.
Funding
This publication was funded by the Health Technology Assessment programme as a part of award number NIHR132197
Shattering the illusion: state-imposed informality and ambivalent accountability in postcolonial governance
No full textPurpose
This study examines how, during the COVID-19 crisis, the Sri Lankan state embedded informality within formal welfare structures to produce accountability through ambiguity. It theorizes state-imposed informality as a postcolonial governance strategy that shifts responsibility downward while retaining top-down controls.
Design/methodology/approach
Using a subaltern perspective and reflexive interpretive methodology, the study investigates a cash transfer program through 29 interviews with beneficiaries and state actors across local to national levels. It draws on theories of postcolonial accountability, strategic informality, and subaltern agency.
Findings
The study reveals how austerity, political interests, and institutional constraints produced an ambiguous governance regime. Formal mechanisms were selectively mobilised while informality was embedded to manage crisis demands. Public officers and beneficiaries, though marginalised, negotiated, adapted to, and resisted this regime through moral judgement and relationality.
Originality/value
The paper conceptualises state-imposed informality as an ethically charged mode of postcolonial crisis governance and reframes public accountability as relational, contested, and shaped from below. It contributes to critical accounting and postcolonial governance by highlighting how accountability is not only displaced but also reconstituted through subaltern practice
"You and TikTok are, and will remain at all times, independent contractors"
Get PDFSocial media platforms are significant actors within the creator economy, shaping the visibility vital for content distribution and facilitating a range of monetisation models. Private governance, established through platform documentation, determines rules for influencers and regulates how monetisation takes place. This article brings together work from influencer studies with the field of platform governance to examine the regulation by platforms in the creator economy. Using TikTok as a case study, we systematically examine the classification of influencers and monetisation practices within platform documentation. Drawing on a data set of 85 policy documents, the article demonstrates the complex configuration of documentation influencers must navigate, drawing attention to hyperlinking practices and issues of accessibility. It approaches the documentation qualitatively to examine the discursive construction of influencers as creators’ which collapses boundaries between ordinary and monetising users, softens the hierarchy of eligibility shaped by region and metrics, and downplays professional identity. We also address the specificities of governance across different monetisation practices, which are nested within TikTok’s consistent downplaying of responsibility. Within its documentation, TikTok showcases its power to establish and set rules for monetisation and engender dependence whilst ensuring its obligations towards influencers remain tightly constrained and strategically vague
Efficacy of behavioural therapies for irritable bowel syndrome: a systematic review and network meta-analysis
No full textBackground
Irritable bowel syndrome (IBS) management guidelines recommend that behavioural therapies, particularly brain–gut behaviour therapies, should be considered as a treatment. Some, such as IBS-specific cognitive behavioural therapy (CBT) or gut-directed hypnotherapy, have specific techniques and, therefore, are in their own class of brain–gut behaviour therapy, while others, such as stress management or relaxation training, are common or universal techniques that are present in most classes of brain–gut behaviour therapy. In addition, there are other behavioural therapies or treatment options, including digital therapies, which are not classed as brain–gut behaviour therapies. We aimed to evaluate relative efficacy of the available behavioural therapies in IBS.
Methods
For this systematic review and network meta-analysis we searched MEDLINE, EMBASE, EMBASE Classic, PsychINFO, and the Cochrane Central Register of Controlled Trials from inception to April 23, 2025, to identify randomised controlled trials (RCTs) comparing the efficacy of behavioural therapies for adults with IBS with each other, or a control intervention. We judged efficacy using dichotomous assessments of improvement in global IBS symptoms. We pooled data with a random effects model, with efficacy of each intervention reported as pooled relative risks (RRs) with 95% CIs. We ranked behavioural therapies according to their P score, which is the mean extent of certainty that one treatment is better than another, averaged over all competing behavioural therapies.
Findings
We identified 67 eligible RCTs, comprising 7441 participants. After completion of treatment, and compared with waiting list control, behavioural therapies with the largest numbers of trials, and patients recruited, that showed efficacy were: minimal contact CBT (RR for global IBS symptoms not improving at first point of follow-up post-treatment 0·55 [95% CI 0·39–0·76], P score 0·78; two RCTs, 511 patients), telephone disease self-management (0·57 [0·41–0·80], P score 0·75; two trials, 746 patients), dynamic psychotherapy (0·59 [0·43–0·80], P score 0·72; three RCTs, 303 patients), CBT (0·65 [0·53–0·80], P score 0·64; nine trials, 1150 patients), disease self-management (0·68 [0·50–0·92], P score 0·58; three RCTs, 375 patients), internet-based minimal contact CBT (0·77 [0·61–0·96], P score 0·43; five RCTs, 705 patients), and gut-directed hypnotherapy (0·79 [0·66–0·95], P score 0·39; 12 trials, 1507 patients). After completion of treatment, among trials recruiting only patients with refractory symptoms, telephone disease self-management and contingency management were both superior to attention placebo control (0·52 [0·28–0·94] and 0·50 [0·26–0·96], respectively) and routine care (0·46 [0·31–0·69] and 0·45 [0·24–0·85], respectively), and group CBT (0·50 [0·29–0·86]), internet-based minimal contact disease self-management (0·58 [0·40–0·86]), and dynamic psychotherapy (0·61 [0·44–0·86]) were all superior to routine care. Analyses for global IBS symptoms at first point of follow-up post-treatment, and for global IBS symptoms at first point of follow-up post-treatment when behavioural therapies were studied according to treatment class, showed evidence of publication bias when compared with waiting list control. The Cochrane risk of bias tool indicated that no RCT was at low risk of bias across all domains.
Interpretation
Several behavioural therapies are efficacious for global symptoms in IBS, although the most evidence exists for those classed as brain–gut behaviour therapies. However, certainty in the evidence for all direct and indirect comparisons across the network were rated as either low or very low confidence, due in part to publication bias and the risk of bias of the included trials.
Funding
None
Is emergency doctors’ tolerance of clinical uncertainty on a novel measure associated with doctor well-being, healthcare resource use and patient outcomes?
Get PDFIntroduction Emergency doctors routinely face uncertainty—they work with limited patient information, under tight time constraints and receive minimal post-discharge feedback. While higher uncertainty tolerance (UT) among staff is linked with reduced resource use and improved well-being in various specialties, its impact in emergency settings is underexplored. We aimed to develop a UT measure and assess associations with doctor-related factors (eg, experience), patient outcomes (eg, reattendance) and resource use (eg, episode costs).
Methods From May 2021 to February 2022, emergency doctors (specialty trainee 3 and above) from five Yorkshire (UK) departments completed an online questionnaire. This included a novel UT measure—an adapted Physicians’ Reaction to Uncertainty scale collaboratively modified within our team according to Hillen et al’s (2017) UT model. The questionnaire also included well-being-related measures (eg, Brief Resilience Scale) and assessed factors like doctors’ seniority. Patient encounters involving prespecified ‘uncertainty-inducing’ problems (eg, headache) were analysed. Multilevel regression explored associations between doctor-level factors, resource use and patient outcomes.
Results 39 doctors were matched with 384 patients. The UT measure demonstrated high reliability (Cronbach’s α=0.92) and higher UT was significantly associated with better psychological well-being including greater resilience (Pearson’s r=0.56; 95% CI=0.30 to 0.74) and lower burnout (eg, Cohen’s d=−2.98; −4.62 to −1.33; mean UT difference for ‘no’ vs ‘moderate/high’ burnout). UT was not significantly associated with resource use (eg, episode costs: β=−0.07; −0.32 to 0.18) or patient outcomes including 30-day readmission (eg, OR=0.82; 0.28 to 2.35).
Conclusions We developed a reliable UT measure for emergency medicine. While higher UT was linked to doctor well-being, its impact on resource use and patient outcomes remains unclear. Further measure validation and additional research including intervention trials are necessary to confirm these findings and explore the implications of UT in emergency practice
Experimental analysis of the thermal management and internal quantum efficiency of terahertz quantum cascade laser harmonic frequency combs
Get PDFQuantum cascade laser (QCL) harmonic state frequency combs (HFCs) have recently attracted considerable interest for applications ranging from the generation of tones of high spectral purity, high data rate wireless communication networks, radiofrequency arbitrary waveform synthesis, and for fundamental light-matter investigations in quantum physics. However, a detailed knowledge of the nature of the electronic and thermal energy distribution in these devices is of paramount importance for the refinement of their thermal management and quantum efficiency, which are key to the widespread adoption of QCL HFC technology in a new generation of integrated optical quantum platforms. Here, we perform a comparative study of the thermal and electronic properties of Fabry–Perot and micro-ring HFC QCLs, operating in the terahertz frequency range, using micro-probe band-to-band photoluminescence. By monitoring the lattice temperature and the electron cooling above the threshold for stimulated emission, we extract the device thermal resistances and the internal quantum efficiencies, highlighting the key role of the resonator architecture
The long-term effects of gas removal from hydrodynamic simulations of star formation
Get PDFThe removal of gas left over from star formation has long been thought to dominate the dynamical evolution, and dissolution of star-forming regions. Feedback from massive stars from their stellar winds, photoionizing radiation and supernovae is postulated to expel significant amounts of gas, altering the gravitational potential energy of the star-forming region and causing a supervirial expansion, which disperses the stars into the Galaxy on rapid time-scales (
10 Myr). The majority of previous work has utilized N-body simulations with a background potential to model the effects of gas removal. Here, we adopt a different approach where we take the end point of hydrodynamic simulations of star formation in which stars form with and without feedback from massive stars and then evolve the stars as N-body simulations. We also scale the velocities of the stars to various virial ratios, to mimic slower or faster removal of gas, and evolve these as additional N-body simulations. We find that the simulations where the stars inherit the velocities of the sink particles from the hydrodynamic simulations predominantly evolve more like a simulation in virial equilibrium, rather than the supervirial behaviour we would expect after gas removal. We see no significant differences in the dynamical evolution between the simulations where the stars inherit velocities directly from the hydrodynamical simulations and the simulations with (sub)virial velocities. This strongly suggests that gas removal by feedback processes does not lead to rapid expansion of star-forming regions, beyond the expansion caused by dynamical relaxation in star-forming regions
Artificial intelligence and work: A review of the European policy landscape
Get PDFThe rapid evolution of Artificial Intelligence (AI) and algorithmic management (ARM) systems is transforming the workplace, raising significant debates about net employment, work organisation and working conditions. This article critically reviews key European policy aimed at regulating AI and ARM at work, as well as identifies gaps in the current policy framework. The European Union (EU) has adopted a distinct human-centric approach to AI, prioritising ethical and trustworthy design and use, rooted in its fundamental values. Though generally welcomed, the risk-based approach of the EU AI Act is insufficient, on its own, to protect workers from the potential harms of AI. Hence, specific additional employment legislation, either at the EU- or national levels, combined with collective bargaining at the sectoral and company levels, is needed to address the regulatory gap. Upskilling of social partners, including trade union officials, work council members and employers, is required so they obtain insights into the ‘black box’ of algorithms, and so they can have meaningful input into the design and deployment of AI systems
Associations between physical activity, adiposity, appetite and metabolic health in adolescent males
No full textRegular physical activity for adults is associated with optimal appetite regulation, though little work has been performed in adolescents. To address this gap in the literature, we conducted a study examining appetite across a range of physical activity and adiposity levels in adolescent males. Healthy males (N=46, 14-18 years old) were recruited across four body weight and activity categories: normal weight/high active (n=11), normal weight/low active (n=13), overweight, obese/high active (n=14), overweight, obese/low active (n=8). Participants from each group completed a six-hour appetite assessment session on Day 0, followed immediately by a 14-day free-living physical activity and dietary assessment period on Days 1-14, and a fitness test session occurring between Days 15-18. Subjective and objective assessment of appetite, resting energy expenditure, body composition using dual energy absorptiometry‘, and thermic effect of feeding was conducted on Day 0. Physiological variables in the normal weight low active group that were different than their peers included lower fat-free mass, cardiorespiratory fitness, glucose/fullness response to a standardized meal, thermic effect of feeding in response to a standardized meal, lower self-rated fullness and satiety, and higher self-rated hunger to a standardized meal. Conversely, the overweight, obese high active group displayed better subjective appetite responses, but higher insulin responses to a standardized meal. Taken together, these results suggest that physical inactivity during adolescence has a negative impact on metabolic health and appetite control which may contribute to future weight gain
Evidencing responsibility for use of AI in safety critical systems
Get PDFIn recent years there has been much dialogue surrounding concepts of "responsible AI" in areas such as ethics, fairness and risk of existential harm from generative AI. However, this dialogue is rarely targeted at AI-based Safety Critical Systems (AI-SCS), which have many unique regulatory and disciplinary challenges compared to other domains. Safety engineers are being increasingly required through regulation to evidence responsible use of AI, but the discipline lacks the conceptual clarity or methodology to do so. This multi-disciplinary paper uses philosophical models of responsibility (moral, causal, role and legal) to provide clarity for the discipline of safety engineering. We consider AI-SCS challenges including causal responsibility gaps, the risk of a human in the loop being unfairly blamed after an AI-SCS accident, and the problem of "many hands" hiding responsibility during development. We propose presenting evidence of responsible AI use via responsibility models, suitable for safety engineers to present as evidence as part of a system safety justification. We illustrate the application of our approach with two different contrasting examples. The first is a retrospective accident analysis of the death of a pedestrian in Tempe, Arizona 2018 involving an autonomous vehicle. The second is a predictive example for an AI-based clinical decision support tool. We show that by using our approach we can uncover residual risk and improve safety, allocating tasks to the most appropriate responsible actors. We conclude that using our models can support safety engineers in demonstrating responsible use of AI. We also identify complex issues around moral answerability and causal contribution for safety tasks
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