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Tobacco cessation intervention for individuals with severe mental illness in Bangladesh, India, and Pakistan: protocol for a multi-country feasibility randomised controlled trial (SCIMITAR-SA)
Get PDF“Tired of spinning plates": Synopsis of mixed methods exploration of mental health experiences of adult/older carers of adults with learning disabilities
Get PDFBackground
This research addresses the mental health of family carers of adults with learning disabilities. We investigated participants’ perceptions of their mental health and views on the accessibility and quality of support.
Design and methods
The research involved seven work packages which included public involvement, a rapid scoping review of evidence about family carers’ mental health and support, an online exhibition, interviews with parent and sibling carers, digital storytelling workshops, key stakeholder discussions and the creation of learning and teaching materials.
Results
Caregiving driven by love is often exploited by health and social care services which deny basic support, information and kindness. Enduring struggle for support and worries about the future are often the cause of mental distress. Participants know what supports mental well-being but have little time to look after themselves due to the lack of support. Social services were described as ‘hostile’ or absent and participants viewed themselves as exhausted by the lack of support, rather than depressed. Medication can help but can be offered without consideration of their caring role or because there are no alternatives. Participants ask for their statutory entitlements for health and social care support to be met with kindness.
Outputs and dissemination
We delivered: (1) an expansive public engagement model; (2) an innovative and creative participatory approach to generate stories of care; (3) a dissemination strategy to raise awareness of the mental health of family carers and (4) the development of general practitioner resources.
We published journal articles, blogs, magazine articles, an online exhibition, films and presented findings at international conferences.
Public and stakeholder involvement and engagement
Family carers and people with learning disabilities were involved across the study, and in the Study Steering Group.
Limitations
Recruitment was slower than expected. Carers were unable to use care replacement costs because of a lack of alternative care. There were challenges involving marginalised communities. We engaged with fewer respondents through the Exhibition than the planned survey; however, it was important to respond to participants’ views.
Conclusions
Health and care services often fail to recognise or adjust support for family carers despite provision under the Equality Act. The role of love in caring relationships, the absence of consideration of this in research, and the exploitation of this love by service systems which rely heavily on family carers were highlighted. Provisions in The Care Act and The Equalities Act are not always upheld, family carers struggle to gain support over years and even the ‘feeblest’ acts of kindness make a difference in health and care delivery. There is a need for policy-makers and practitioners to review and develop robust monitoring of the provision set out in legislation to ensure family carers and people with learning disabilities’ entitlements are met. Small acts of kindness on the part of health and social care providers have a big impact on the well-being of family carers.
Future work
Further exploration of care as a relational activity.
The development of ways of monitoring compliance and adherence to legal frameworks.
Bringing together the perceptions, views and experiences of people with learning disabilities, siblings and parent carers to generate a comprehensive understanding of the support needs of these groups.
An exploration of the mental health experiences of LGBTQI+ family carers and family carers of autistic adults without learning disabilities.
Funding
This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR135080
Field evaluation of a ground-source heat pump system for frost heave control in high-speed railway subgrades
Get PDFFrost heave in seasonally frozen subgrades destabilizes railway track geometry and leads to significant maintenance demand in cold regions. As a thermally driven process, its mitigation requires reliable and energy-efficient temperature control. This study develops and field-tests an integrated ground-source heat pump (GSHP) thermal management system designed to actively heat frost-susceptible subgrade zones using shallow geothermal energy. The system consists of vertical heat-collector pipes, horizontal heat-supply pipes, and modular surface heat-pump units. A 20 m full-scale test section was implemented on the Shenyang–Baishan high-speed railway and operated throughout the 2024–2025 winter. Pre-installation heat-load modeling identified a peak thermal demand of 1183 W/m, guiding the deployment of ten 1.2 kW heat-pump units with intermittent operation (2.5 h ON/0.5 h OFF). During operation, outlet pipe temperatures remained stable at 18.7 °C, reducing frost depth to 70–83 cm at the track center and 34–44 cm at the shoulder, and suppressing track heave to within 5 mm. In contrast, untreated subgrade experienced frost penetration of 195–224 cm and heave up to 6.6 mm. These results demonstrate that GSHP-based active heating can effectively limit frost penetration, elevate minimum soil temperatures, and enhance the service reliability of transport infrastructure. The findings also highlight the potential for geothermal-based thermal management in energy-intensive cold-region applications
From the rare to the essential: analyzing the needs of physicians and families managing rare diseases
Get PDFBackground
This study aims to identify the social and healthcare needs of patients with rare diseases (RD) and their physicians within a Universal Health Care System. It seeks to provide valuable insights for policymakers, patient organizations, and healthcare professionals while informing about these diseases, raising awareness, and designing strategies to improve access to quality, timely medical care, including therapies and medication at a local and regional level.
Methods
Two semi-structured surveys were conducted between May 2023 and August 2024, targeting family members of patients with RD (N = 64) and physicians (N = 56) in Uruguay. Surveys were self-administered via email or conducted by an interviewer, and were disseminated through healthcare professionals, RD associations, and social media, using “snowball” methodology and word-of-mouth references.
Results
Uruguay faces significant deficiencies in access to diagnosis and treatment for rare diseases, leading to a prolonged “diagnostic odyssey” for families and multiple barriers for physicians, ranging from lack of training to limited access to specialized tools. The low reporting rate to the National Registry of Congenital Defects and Rare Diseases and the lack of updates to the Comprehensive Health Care Plan exacerbate inequities in access to diagnosis and treatment. A key finding is inequality in access to whole-exome sequencing (WES), despite its proven effectiveness in reducing diagnostic times and improving accuracy. Its use remains restricted due to high costs and lack of universal coverage, highlighting the need for a national genomic medicine strategy and medical training in molecular diagnosis.
Conclusion
The survey results indicate that RDs have a significant physical, emotional, and economic impact on patients and families. The main concerns raised include diagnostic delays, partly due to difficulties accessing specific tests and treatments. The medical community also acknowledges these issues. The healthcare system needs to update its coverage to include genomic diagnostics, improve medical training, strengthen coordination, and ensure equitable treatment access. These results mimic what is seen in other countries in Latin America and the Southern Cone. They call for a comprehensive, formalized framework for diagnosis, treatment, and care of rare diseases at local and regional levels, accounting for family experiences and prioritizing family wellbeing
Formulating white rice with low–glycemic index potential: The effect of low–acyl gellan gum on textural properties and starch digestibility reduction
Get PDFWhite rice is a staple food worldwide, yet its high glycemic index (GI), driven by rapidly digestible starch, raises significant public health concerns.
This study explores the application of low–acyl gellan gum (LAGG) as a bio–macromolecular strategy to modulate starch digestibility while preserving desirable textural properties in cooked rice. Two rice types, jasmine rice (JR, high–GI) and parboiled rice (PR, low–GI), were cooked with 0–3% LAGG and systematically analyzed using a multi–scale approach, including thermal properties at grain and starch levels, microstructural features in raw and cooked forms, and texture and digestibility at the whole grain level, reflecting typical consumption conditions.
Microstructural evaluation of cooked rice revealed that LAGG formed a hydrogel coating on rice grains, enhanced β–sheet protein structures and promoted the formation of starch–LAGG complexes. These structural modifications strengthened the protein–starch matrix, particularly in JR. As a result, hardness (8–26%) and chewiness (1.4–2.3×) increased in JR, while minimal effects were observed in PR. In–vitro starch digestibility analysis showed that LAGG addition reduced starch hydrolysis, shifting digestion toward slower and resistant fractions and lowering predicted GI by 10–22% across LAGG levels (1–3%), with JR showing a stronger response. When integrated with microstructural and thermal observations, these results are consistent with reduced enzymatic accessibility to starch.
Collectively, these findings offer mechanistic insights into LAGG as a distinct hydrocolloid capable of reinforcing rice structure and lowering glycemic impact through multi–scale interactions, supporting its practical and scalable application in the development of healthier rice–based foods
Mutational insights and in silico characterization of NEK family kinases in OSCC patients from the Pakistani population
Get PDFIntroduction: Oral squamous cell carcinoma (OSCC) is a prevalent malignancy characterized by aggressive behavior, poor prognosis, and limited therapeutic options. Mutations in the NIMA-related kinase (NEK) family are increasingly implicated in tumorigenesis across various cancers. However, their contributions to OSCC pathogenesis remain largely unexplored.
Methods: Here, we employed whole-exome sequencing (WES) of formalin-fixed paraffin-embedded (FFPE) tissue blocks from 31 OSCC tumors and 9 adjacent paired normal samples derived from patients of Khyber Pakhtunkhwa (KP), Pakistan, to systematically profile NEK gene alterations. Subsequent in-silico analyses were performed to evaluate the structural and functional consequences of the identified mutations.
Results: We identified 46 mutations overall (78.3% (36/46) somatic, 21.7% (10/46) germline), consisting of 82.6% (38/46) non-synonymous single-nucleotide variants (SNVs), 10.9% (5/46) frameshift deletions, 2.2% (1/26) non-frameshift deletions, and 4.3% (2/46) stop-gain mutations; notably, 10.9% (5/46) represented novel variants (not reported previously). NEK1 displayed the highest mutation frequency, followed by NEK10, NEK5, NEK11, NEK2, and NEK3. ISPRED-SEQ classified 37.0% (17/46) of mutations as residing at protein-protein interaction interfaces, indicating potential functional relevance, with several mutations including NEK1p.D409Y, NEK1p.N643K, NEK9 p.H174Y, NEK10 p.R275C, and NEK10 p.E596K predicted to be deleterious and destabilizing by multiple tools, occurring at conserved residues and altering structural stability via molecular dynamics simulations. Clinically, NEK4 mutations were significantly associated with tumor site (P=0.02), NEK9 with tobacco exposure (P=0.01), and NEK10 with improved overall survival (P=0.01). Mutations including NEK11p.E347V (31/31), NEK9p.R429H (23/31), NEK10p.L513S (15/31), NEK4p.P136A (7/31), NEK5p.K255Q (6/31) and NEK1 p.E650G (5/31) were found to be recurring mutations and can be validated further in large-scale studies for biomarker applicability.
Conclusion: Collectively, these findings suggest NEK mutations as candidate drivers of OSCC pathogenesis, underscoring their potential as prognostic biomarkers and therapeutic targets, particularly in tobacco-associated disease
Roadmap: Integrating artificial intelligence in structural health monitoring systems
Get PDFAdvances in computing and machine learning methods have led to a rapid rise in artificial intelligence (AI) research and applications in many fields. AI research benefitted from advances in computation hardware, collection and distribution of large data sets, and proliferation of software techniques. AI techniques include machine learning for provable results, deep learning for data exploration, reinforcement learning for control, and active learning for adaptive systems. Likewise, AI algorithms can handle large amounts of data, construct unknown representations, and provide a direct link between data and classification for decision making. These unmatched capabilities have been seen as a path to solving hard engineering problems, including that of structural health monitoring (SHM). SHM consists of automating the condition assessment task of civil, health, mechanical, and aerospace systems using measurements obtained from temporary or permanently installed sensors. Often, the systems of interest are geometrically large and/or technically complex, which complicates the development and application of physics-based methods. It follows that AI is seen as a key potential contributor enabling SHM in field applications for data-driven analysis. As with many research endeavors, many concepts using AI for SHM have been explored in the literature. Nevertheless, very few AI methods have been deployed in the context of SHM, which may be due to the lack of available data supporting their capabilities, limited integrated AI-SHM systems capable of providing results to users and operators with decision-making capabilities, or certification of AI methods for safety-critical applications. The objective of this Roadmap publication is to discuss the integration of AI at the system level enabling SHM, including associated challenges and opportunities such as those found in common metrics of concern (e.g., transparency, interpretability, explainability, security, certifiability, etc.), with a particular focus on providing a path to research and development efforts that could yield impactful field applications. The overview of available methods and directions will provide the readers with applicability of AI for certain SHM designs (software), availability of common data sets for further AI comparisons (data), and lessons learned in implementation (hardware)
Exploring the heterogeneous impacts of Indonesia’s conditional cash transfer scheme (PKH) on maternal health care utilisation using instrumental causal forests
Get PDFThis paper uses instrumental causal forests, a novel machine learning method, to explore the treatment effect heterogeneity of Indonesia’s conditional cash transfer scheme on maternal health care utilisation. Using randomised programme assignment as an instrument for enrollment in the scheme, we estimate conditional local average treatment effects for four key outcomes: good assisted delivery, delivery in a health care facility, pre-natal visits, and post-natal visits. We find significant treatment effect heterogeneity by supply-side characteristics, even though supply-side readiness was taken into account during programme development. Mothers in areas with more doctors, nurses, and delivery assistants were more likely to benefit from the programme, in terms of increased rates of good assisted delivery outcome. We also find large differences in benefits according to indicators of household poverty and survey wave, reflecting the possible impact of changes in programme design in its later years. The impact on post-natal visits in 2013 displayed the largest heterogeneity among all outcomes, with some women less likely to attend post-natal check-ups after receiving the cash transfer in the long term
Tagging, privacy intrusion and racial injustice:the case of GPS monitoring and migrant rights in the United Kingdom
No full textElectronic monitoring (EM) was implemented under the Criminal Justice and Public Order Act 1994 and it is largely outsourced and managed by the private security companies. EM is a surveillance tool designed to track offenders and suspects, verify their whereabouts and establish remotely whether they are complying with a set of pre-established conditions as stated in the court or prison order. Under the Asylum and Immigration (Treatment of Claimants) Act 2004, the use of this technology was extended to immigration controls, and individuals deemed as ‘high risk’ of harm, reoffending or absconding are fitted with an ankle device and subjected to curfew. The initial device consisted of a radio-frequency technology, designed to measure person’s distance between tag and the base-unit and establish whether they are at home or not (in other words, gather binary data). However, in 2021, the Home Office adopted a new generation of ankle tags, equipped with a fundamentally different and more intrusive technology – the Global Positioning System (“GPS ankle tags”). These tags monitor individual geolocation continuously and gather a vast amount of trail data. Records of subject’s geolocation data are then stored and retained for years, available for authorities to access for a wide variety of purposes. In 2022, the EM provision was extended to asylum seekers who recently arrived on boats and via other irregular means. In this chapter, we shed light on the evolution of tagging technology, privacy intrusion and the breach of data protection, and how it is experienced by racialised minorities. Towards the end, we outline the resistance by the third sector organisations and legal professionals. The chapter uncovers the racial dynamics of the technology, and adds to the literature on migration, surveillance studies, critical data studies, and state racism
Simultaneous Removal of Caesium and Strontium Ions with Advanced CoPrecipitation Methods and its Process Intensification
Get PDFThe generation of composite materials by combining natural clinoptilolite and BaSO₄ to remove ¹³⁷Cs and ⁹⁰Sr simultaneously. Improvement solid/liquid separation degree with the help of fast sedimentation of composite coagulants for waste volume reduction, which facilitates waste encapsulation for safe long-term waste management. The process intensification of the proposed method by using an agitated tubular reactor for enhanced ion removal while reducing plant footprint, cost and waste generation
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