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To Stop or Not to Stop? The Dilemma of Cascading Risks in Megaprojects
No full textThis case study explores the decision-making process of project termination versus suspension during the delivery stage by presenting a decision scenario. With a mix of real and fictional facts, the case leverages the construction of Line 1 of the Medellín Metro, the first metro line in the country. By examining a project with high political stakes, financial volatility due to unregulated currency exposure, lack of institutional experience, and divergent stakeholder priorities, the case challenges readers to evaluate the decision of termination versus suspension in contexts where strategic, financial, and political pressures collide
Introduction: The Global Politics of Memory: Feminist Perspectives on the Curation of Violence
Get PDFQuantifying the impact of a computer‐aided diagnostic score on the clinical diagnosis of functional seizures
Get PDFObjective
The diagnosis of functional/dissociative seizures (FDS) without ictal video-electroencephalography is challenging. The Functional/Dissociative Seizures Likelihood Score (FSLS) is a machine learning-based diagnostic score that aims to help clinicians identify FDS. We evaluated whether a human-in-the-loop implementation of the FSLS improved the performance of clinicians identifying FDS as compared to epileptic seizures (ES).
Methods
We constructed 117 anonymized cases about patients with ictal video-electroencephalography-documented FDS, epilepsy, co-occurring ES and FDS, or physiological seizurelike events. Text-based clinical history was presented followed by the FSLS. Readers were asked the most likely diagnosis after each piece of information. We used mixture modeling combined with mixed effects logistic regression to perform data-driven grouping of participants based on observed patterns of diagnostic performance.
Results
Overall, 163 readers saw 1142 cases (median = 4 cases/reader), and 146 (90%) had a performance higher than chance. More formal training in seizures was associated with better performance (epileptologist accuracy = 67%, mental health clinician accuracy = 52%). Data-driven groups including 66% of readers benefitted from the FSLS (accuracy improvement = 12%–15%, p .75).
Significance
Clinicians with more formal seizure training identified possible FDS more accurately than others, but formal training did not guarantee high diagnostic performance. Two performance-based groups, which included 66% readers, benefitted from the FSLS because they identified when to change their mind on the basis of the FSLS's suggestion. The implementation of machine learning in the diagnosis of FDS should focus on identifying clinical settings where it can effectively enhance clinicians' decision-making
Emotional Responses to State Repression Predict Collective Climate Action Intentions
No full textAs climate activism has expanded in recent years, governments have increasingly repressed disruptive but non-violent protests. Yet evidence remains mixed regarding whether repression inhibits or galvanizes activism. In this study, we examine how anticipated and experienced repression predict intentions to engage in normative (rule-conforming) and non-normative (rule-violating) collective climate action, over and above past activism and core psychological antecedents. Survey data from Extinction Rebellion UK mailing-list subscribers (N = 1,375) showed that experienced repression positively predicted non-normative action intentions, and showed a positive indirect predictive effect on non-normative action via reduced fear. Although anticipated repression was not directly associated with either action type, it had positive indirect predictive effects on both action types via anger/outrage, and on non-normative action via contempt. Conversely, it also had a negative indirect predictive effect on non-normative action through heightened fear. These findings predominantly reflect a galvanizing effect of repression on disruptive collective climate action among committed activists
Multiarm multistage randomised controlled trial of inflammatory signal inhibitors (MATIS) for patients hospitalised with COVID-19 pneumonia during the UK pandemic
Get PDFObjectives
To determine the safety and efficacy of ruxolitinib (RUX) and fostamatinib (FOS) compared with standard of care (SOC) in patients requiring hospital admission for the treatment of COVID-19 pneumonia.
Design
Adaptive multiarm, multistage, randomised, open-label trial (three arm, two stage).
Setting
Five hospitals in England between October 2020 and September 2022.
Participants
Hospitalised patients (≥18 years) with COVID-19 pneumonia defined by a modified WHO COVID-19 severity grade of 3 or 4.
Interventions
Participants were randomly assigned 1:1:1 to receive RUX (10 mg two times per day for 7 days then 5 mg two times per day for 7 days), FOS (150 mg two times per day for 7 days then 100 mg two times per day for 7 days) or SOC.
Main outcome measures
Primary outcome was development of severe COVID-19 pneumonia (modified WHO severity grade≥5) within 14 days of randomisation. Secondary outcomes included mortality, invasive and non-invasive ventilation, venous thromboembolism, duration of hospital stay, readmissions, inflammatory markers and serious adverse events (SAEs).
Results
At stage 1, 181 patients were randomised, with 4 assessed as ineligible post randomisation. FOS was stopped early for futility with 16 participants (27.6%, n=58) developing severe COVID-19 pneumonia compared with 15 (25.0%, n=60) in the SOC arm (adjusted odds ratio (aOR) compared with SOC: 1.12; 95% CI 0.49 to 2.58; p=0.608). RUX progressed to stage 2 but the trial was stopped early due to slow recruitment. At the final analysis, 10 participants (16.1%, n=62) developed severe COVID-19 pneumonia in the RUX arm compared with 15 (24.6%, n=61) in the SOC arm (aOR: 0.63; 95% CI 0.25 to 1.57; p=0.161). Four (7.4%) participants in the FOS arm, none in the RUX arm and three (5.5%) in the SOC arm died within 14 days of randomisation. Infections were the most frequently reported SAE and were numerically higher in the FOS (10, 17.2%) and RUX (10, 16.1%) arms compared with SOC (7, 11.5%). Two unexpected serious adverse reactions occurred in the RUX arm only.
Conclusions
We found no evidence that FOS was superior to SOC for the treatment of COVID-19 pneumonia in patients requiring hospital admission. Due to early stopping, the trial was underpowered to establish RUX’s effect in this population. Further study is needed.
Trial registration number
NCT04581954; EUDRA-CT: https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-001750-22/GB
Supporting Research Supervision Practice: a review of UK provision
Get PDFThis report uses available data from 149 research degree awarding institutions in the UK. It builds on the 2018 Eligibility to Supervise: a study of UK Institutions report and provides a snapshot of the current professional development provision for, and reward and recognition of, supervisory practice. The report concludes by recommending that institutions review the duration and content of their development programmes, to better reflect the complex nature of modern research supervision.
The findings of this report underpin RSVP’s drive to develop what Taylor describes as Initial Professional Development (IPD) for less experienced supervisors and Continuing Professional Development (CPD) for those with more experience. This provision aims to address the growing challenges that research supervisors face in providing consistent, high-quality supervision in the context of a rich and diverse PGR pipeline
Student accommodation in Scotland: home, emotions and diverse experiences
Get PDFThis article explores how emotions intersect with students’ experiences of student accommodation and influence their ability to make a home. The expansion of Higher Education in the UK has led to increased student populations, a housing crisis, and a shift towards financialised purpose-built student accommodation (PBSA). However, little attention has been paid to students' lived experiences. Drawing on interviews with 45 students across three university catchment areas in Scotland, the study examines how students navigate PBSA emotionally and socially. It finds that students’ relationships to PBSA as “home” are shaped by their housing biographies, the dynamics of shared living, and the material environment. The article emphasises the importance of intersectional experiences, using Ahmed’s (2014) theory of how emotions “stick” to bodies to explore how minoritised students can experience exclusion and precarity, undermining a sense of home and belonging. The research contributes a more nuanced understanding of how students inhabit PBSA
Effects of bovine milk-derived extracellular vesicles on a 3D intestinal stromal compartment
Get PDFMilk is an essential component of the diet. Among its diverse molecular constituents, it contains nanoscale entities, known as extracellular vesicles (EVs), which play a pivotal role in intercellular communication. In particular, milk-derived EVs (MEVs) influence intestinal homeostasis by mitigating inflammatory responses, modulating gut microbiota composition, and contributing to epithelial integrity preservation and restoration. Currently, there are no information regarding their impact on intestinal connective tissue. Here, we investigate bovine MEV effects on the porcine gut stromal compartment, exposing intestinal decellularized bio-scaffolds repopulated with primary intestinal stromal fibroblasts, to different MEV concentrations (106, 108, and 1010 particles/mL). We observed a dose-dependent effect of MEVs on stromal fibroblast proliferation rate at concentrations higher than 106 particles/mL. In addition, when MEVs were used to pre-condition the decellularized intestinal bio-scaffolds prior to cell repopulation, fibroblast growth was further boosted. Overall, these findings suggest that MEVs may play a significant role in promoting tissue remodeling and repair. This activity appears particularly relevant for enhancing intestinal homeostasis and resilience, as stromal fibroblasts contribute to the maintenance of gut integrity, barrier function, and immune balance. Moreover, the data here presented suggests the possibility of using MEVs to develop serum-free, chemically defined culture media for the generation of advanced three-dimensional (3D) models and intestinal artificial organs
Listening at Home and Beyond: Music Polymedia and Everyday Life
Get PDFThis article applies polymedia theory to music and everyday life, with particular attention to musical engagement within families and the home, and to commuting and workspace environments. We focus on three issues: the role of music polymedia in managing multiscreen, intergenerational households, including their use as remote offices; listening practices while traveling and commuting as extensions of the home, and the influence of work schedules on musical experience; and the adoption of streaming in workspaces and the blurring of boundaries between home and work, and between professional and personal engagements with music
PaEdiatric Rheumatology FramEworK for Technology enabled care (PeRFekT): A protocol for a consensus study
Get PDFBackground
Children and young people (CYP) cared for in rheumatology services are largely managed in the outpatient environment. Conditions such as Juvenile Idiopathic Arthritis are usually chronic and complex in nature, necessitating input from a range of multidisciplinary healthcare professionals. Technology Enabled Care (TEC) practices in paediatric rheumatology can be varied and may have the potential to better support families and clinical teams in managing rheumatological conditions. CYP people are known to be able users of technology but evidence-driven guidance to maximise the potential for technology enabled care remains limited. Drawing on previous PhD work package findings, the aim of this current project is to develop guidance through a modified Delphi consensus exercise.
Methods
Findings from previous PhD work packages will be synthesised into a list of statements around the concept of technology enabled care. Following assembly of a Study Advisory Group, stakeholders will be approached to undertake two online modified Delphi technique rounds. For Round 1, stakeholders will indicate their level of perceived importance using a Likert scale, for each statement. Statements not reaching consensus will be voted on again during a second Round. Stakeholders will then vote, in order of priority, on all statements reaching consensus. Descriptive quantitative analyses will be used to describe minimal stakeholder credentials and to demonstrate >75% consensus. The top 10-20 statements will be included in the final guidance.
Discussion
All project risks and benefits have been considered, minimised, and presented as part of the Research Ethics Committee (REC) application to the School of Medicine at the University of Leeds (REC project reference 2550). Project dissemination is planned for traditional routes through appropriate academic journals and paediatric specialty-specific conferences. Further dissemination will take place following ongoing collaboration with Patient and Public representatives.
Trial registration
Not applicabl
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