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Debye‐scale bipolar structures and their role in the electron trajectory instability at the bow shock
Get PDFA number of mechanisms have been suggested to operate within the terrestrial bow shock to redistribute energy contained in the incoming solar wind flow. The majority of mechanisms involve the generation of turbulence while some are based on particle motion alone. In this paper, we investigate the possible occurrence of the Electron Trajectory Instability, that results from short scale electric field gradients. Spike-like bipolar features in electric field measurements are a commonly observed signature within the terrestrial bow shock. They are usually associated with the passage of electrostatic solitary waves associated with phase space holes in the particle distribution. Using electric field measurements, we compare different interferometric methods to determine the propagation direction, velocity, and spatial scale of these features. Based on these results, it appears that the instability criterion for the Electron Trajectory Instability is fulfilled and the electron trajectories will diverge in the presence of these structures
Rapid review:Three ways local government could improve inequality, public health and wellbeing outcomes in supported housing in England
Get PDFBuilding global learning networks: a practical guide for medical educators
Get PDFAs healthcare becomes increasingly globalized, postgraduate medical education must evolve to prepare clinicians for an increasingly interconnected, diverse, and intercultural healthcare landscape. This article offers nine practical tips for designing and sustaining global learning networks—virtual, collaborative frameworks that connect trainees, educators, and institutions across borders. The recommendations are organized under four themes: (1) designing equitable curricula, (2) facilitating global collaboration, (3) developing culturally competent educators and learners, and (4) sustaining and evaluating learning networks. These recommendations are grounded in the theoretical frameworks of systems thinking and communities of practice. We emphasize co-created curricula, digital platforms for international engagement, culturally responsive pedagogy, inclusive assessment strategies, and decentralized leadership models. Each tip is grounded in peer-reviewed literature, international case studies, and lessons from our collaborative experiences. We address barriers such as time zones, resource inequities, and quality assurance. By embedding global perspectives into postgraduate programmes, global learning networks strengthen intercultural competence, enhance professional identity formation, expand access to medical education in low-resource settings, and foster mutual learning across diverse health systems. This guide supports postgraduate medical educators in cultivating culturally competent clinicians and advancing a more equitable, collaborative, and resilient global healthcare workforce
Polar discontinuities, emergent conductivity, and critical twist-angle-dependent behaviour at wafer-bonded ferroelectric interfaces
Get PDFProbing novel properties, arising from twisted interfaces, has traditionally relied on the stacking of exfoliated two-dimensional materials and the spontaneous formation of van der Waals bonds. So far, investigations involving intimate covalent or ionic bonds have not been a focus. Yet, we show here that an established technique, involving thermocompressional wafer bonding, works well for creating twisted non-van der Waals interfaces. We have successfully bonded z-cut lithium niobate single crystals to create ferroelectric oxide interfaces with strong polar discontinuities and have mapped the associated emergent interfacial conductivity. In some instances, a dramatic change in microstructure occurs, involving local dipolar switching. A twist-induced collapse in the capability of the system to effec8tively screen interfacial bound charge is implied. Importantly, this only occurs around specific moiré twist angles with sparse coincident lattices and associated short-range aperiodicity. In quasicrystals, aperiodicity is known to induce pseudo-bandgaps and we suspect a similar phenomenon here
Effectiveness and Cost-Effectiveness of Emergency Department-Based Violence Intervention Programs in the United Kingdom:Protocol for a Quasi-Experimental Study
Get PDFBACKGROUND: Hospital-Based Violence Intervention Programs (HVIPs), based in Emergency Departments (EDs), have been proposed as a public health response to violence. These programs address the underlying reasons why patients are exposed to violence. In addressing any underlying modifiable risks and vulnerabilities HVIPs can reduce patients' exposure to violence and therefore subsequent unplanned attendance into ED. OBJECTIVE: The objectives of this study are to (1) assess whether patient involvement with a HVIP reduces the likelihood of unscheduled ED reattendance, (2) determine whether the presence of the HVIP improves ascertainment of violence in ED attendances, and (3) derive the costs of the HVIP and compare those to the benefits of the intervention and understand whether the HVIP represents value for money from a health service perspective. If an effect is observed, then models will estimate the health impacts, costs and potential savings over a longer time (eg, 10 years) period and for a national roll-out. METHODS: ED patients are eligible for inclusion in the evaluation if they are normally resident in Wales, United Kingdom, aged 11 years and older. A controlled longitudinal natural experiment will be undertaken. The primary outcome is derived from the Emergency Department Dataset, routinely collected for all EDs in Wales, and is subsequent unplanned ED attendance. Case patients will be matched to control patients attending EDs without an HVIP. Analysis will derive the hazard rate for subsequent unplanned ED attendances using recurrent event analysis. The total monthly count of patients identified as attending because of violence in intervention EDs will be compared to the total count of Welsh control EDs in an interrupted time-series analysis to determine whether HVIPS increase violence ascertainment. To determine whether referral, versus no referral, to the HVIP represents value for money, we will undertake a cost-effectiveness analysis from the perspective of the National Health Service. The approval to access and analyze data housed in the Secure Anonymized Information Linkage (SAIL) databank, an ISO (International Organization for Standardization) 27001 certified and UK Statistics Authority accredited secure data environment, was granted by the SAIL independent Information Governance Review Panel (Ref: 1421). Findings will be presented at local, national, and international conferences and disseminated by peer-reviewed publication. RESULTS: Design inputs arising from public patient involvement and engagement (PPIE) are reported. As a protocol, no further results are available. CONCLUSIONS: Novel methods are developed to provide the first robust evaluation of Emergency Department Violence Intervention Programs (EDVIPs). TRIAL REGISTRATION: ISRCTN Registry ISRCTN68945844; https://www.isrctn.com/ISRCTN68945844?q=68945844&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/86247
Working from home and commute duration: An exploration of ideal and actual measures
Get PDFPrevious studies have found that working from home (WFH) frequency and commute distance/residential location influence each other. However, less attention has been given to the link with commute duration and people’s ideal commute duration. People who have long commute durations and/or do not like to commute may be more inclined to work from home. In this study, we investigate how ideal and actual WFH frequency and ideal and actual commute duration influence each other and identify distinct worker segments based on these combined measures. The role of trip satisfaction, travel mode, residential location, commute frequency, and attitudes towards WFH and commute duration are used to explain different segments. Data from 2023 travel survey of University College London staff (n = 1791) were analyzed using multiple regression and cluster (segmentation) analyses. The average actual and ideal commute durations were about 58 and 34 min, respectively, while the average actual and ideal WFH shares were 41 % and 48 %. The segmentation results show that the staff can be grouped into five distinct clusters: tolerant long commuters (14.9 % of the sample), overburdened hybrid workers (14.8 %), balanced hybrid commuters (22.3 %), remote flex workers (25.2 %), and happy office commuters (22.7 %). The findings show that commute duration alone does not always determine how much people desire to WFH. Workers living in outer London areas and relying on rail are concentrated in the highest-burden clusters. People living in shorter distance, those who usually walk and cycle, are satisfied with their commute and have the least desire for WFH. Finally, policies that limit WFH may place a heavier burden on women and older workers who live farther away and rely on long rail commutes
Unlocking the potential of community pharmacies to address hypertension in South Asia:the COPE-BP programme
Get PDFHypertension is a leading contributor to cardiovascular disease in South Asia, affecting over 40% of adults, of whom most remain undiagnosed or poorly managed. Despite urgent healthcare needs, the already overstretched public primary care systems in low- and middle-income countries, particularly in rapidly growing urban areas, are falling short. Community pharmacies, often the first point of contact for low-income urban residents, represent an opportunity for delivering frontline chronic disease care. The Community-Pharmacies managing hypertension: intervention development and Evaluation in Bangladesh and Pakistan (COPE-BP) programme aims to investigate whether these widely accessed yet under-evaluated community pharmacists are effective and cost-effective, and assess whether the COPE-BP intervention can be successfully integrated into hypertension care pathways in Bangladesh and Pakistan. Beyond evaluating clinical and economic outcomes, COPE-BP seeks to reframe the role of semi-formal providers, including community pharmacies, which are key actors in primary care delivery. Through a stepwise programme encompassing intervention development, a multicentre clinical trial, implementation research, and policy engagement, COPE-BP aims to provide a scalable model for integrating non-traditional providers into national health strategies. In doing so, COPE-BP will help strengthen inclusive, people-centred health systems in LMICs
A Feminist Critique of Cybersecurity:Techno Feminist Imaginaries of Vulnerability and Care
Get PDFIn this collection of five short essays, each authors examine how online spaces produce and reproduce queer marginalisation while also offering opportunities for queer expression, connection, and resistance. Tanvi Kanchan examines Indian queer activists‘ connections with Indigenous and Black politics in the U.S. and anti-gender rhetoric that travels between American conservative contexts and Indian Hindutva contexts to highlight how digitally mediated transnational rhetoric is simultaneously progressive and reactionary. Łukasz Szulc, on the other hand, proposes that feminist and queer manifestos can suggest ways to imagine alternative digital futures and navigate the present. Likewise, Yener Bayramoğlu unearths the ambivalence emerging from digital spaces offering connection, visibility, and resistance while also extracting data and regulating subjects. Ahmet Atay considers how the digital mundane presents an opportunity for queer disruption and activism, and, finally, Rohit Dasgupta encourages the tension of concurrent embodiment in digital and offline spaces. From these essays, we see rising tensions between digitally mediated 'transnational' and the local struggles, and queer critical imaginaries and organisational work. Here, we find space for queer presence and activism within both mediated and unmediated public spaces
From authority to similarity: How Google transformed its knowledge infrastructure using computer vision
Get PDFWe investigate the impact of computer vision models, a prominent artificial intelligence tool, on critical knowledge infrastructure, using the case of Google search engines. We answer the following research question: How do search results for Google Images compare internationally with those for Google Search, and how can these results be explained by changes in Google's knowledge infrastructure? To answer this question, we carry out four steps: (1) Theorise the relationship between web epistemology, calculative technology and issue configuration, illustrating the dynamics of critical knowledge infrastructures on the web; (2) provide a potted history of Google's use of computer vision in search; (3) undertake the first international comparison of search results from Google Search and Google Images; (4) analyse the visual content of search results from Google Images. Adopting a novel research design combining a suite of quanti-quali digital methods including visual content analysis, social semiotics and computer vision network analysis, we analyse six countries’ search results related to environmental change (climate change, biodiversity loss). We present two key findings. First, Google Images search results contain fewer authoritative sources than Google Search across all countries. Second, Google Images results constitute a narrow, homogenised visual repertoire across all countries. This constitutes a transformation in Google's web epistemology from ranking-by-authority to ranking-by-similarity, driven by a shift in calculative technology from web links (Google Search) to computer vision (Google Images). Our framework and findings open up new questions regarding the impact of computer vision on public access to knowledge in increasingly image-saturated digital societies
Alternative pricing policies for multi-indication products:a quantitative analysis
No full textObjectives: Different pricing models have been proposed for multi-indication drugs. We compare the population health impact of three pricing policies: uniform pricing, indication-based pricing (IBP), and a hybrid policy of uniform pricing with IBP applied selectively. Methods: We develop a policy model to compare how these pricing policies affect drug access, health benefits, innovation (numbers of new drugs and indications developed), and pharmaceutical costs over the product lifecycle. The framework is illustrated with numeric examples and case studies, using UK evidence. Results: In the UK context where the cost-effectiveness threshold (approval norm, £30,000/QALY) is higher than both the evidence on and the government measure of opportunity cost (£15,000/QALY), IBP is associated with lower overall population health than uniform pricing. The hybrid pricing policy results in lower population health than uniform pricing when innovation effects are not considered, but higher population health when these effects are considered. To improve health outcomes in the UK, where pricing decisions have limited impact on R&D due its small market size, IBP or hybrid policies would need to be implemented in conjunction with lower cost-effectiveness thresholds. Application of the framework to nivolumab and pembrolizumab found IBP would approximately double expenditure for those products without improving access or health benefits. Conclusions: IBP and hybrid policies can improve access to new drugs but must be carefully designed to avoid cost increases that could harm overall population health. Lower approval norms are required for these policies to contribute positively to population health
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