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Nature based solutions for tackling nuclear waste
No full text© 2025 UK Parliament. Written evidence submitted to the Public Accounts Committee Inquiry Decommissioning Sellafield. Available online: https://committees.parliament.uk/work/8586/decommissioning-sellafield/publications/written-evidence
Investigating advanced practice for people with intellectual disability and autism: a mixed methods study
No full text© 2025 The Authors. Published by Wiley. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1111/jocn.17696Introduction
Little is known about the advanced practice contribution health professionals make when working with People with Intellectual Disability and Autism. This paper shares the findings from a study investigating the delivery and impact of two university-led online postgraduate certificates. These programmes specifically focused on preparing health professionals to practice at an advanced level, with people with intellectual disability and autism across the lifespan.
Aims
The aim was to evaluate the opportunities and challenges the programmes provided, reviewing the online delivery capacity and its usefulness for preparing this group of health professionals at an advanced level across two cohorts of learners.
Methods
A concurrent mixed methods approach was adopted, collating descriptive and qualitative data virtually between February 2023 and January 2024. Adults with intellectual disability and autism were involved in the panel deciding the outcome of the research tender, as steering group members and as members of a national workforce advisory panel. No computerised software was used for the data analysis.
Results
Observations from minimal descriptive data, virtual focus group, nine one-to-one interviews, text-based and a jam-board data revealed online pedagogical decisions through multi-professional action learning sets. This supported enhanced practice confidence, enquiry-based practice and inter-professional capability.
Conclusions
Policy and decision makers should invest in more advanced practice programmes in this field, as they strengthen the care contribution for people with intellectual disabilities and autism.
Implications for Practice
Advanced practice learning can raise both practice confidence levels and improve opportunities for evidence-based service change for a group of people with complex needs.
Reporting Method
Mixed Methods Reporting in Rehabilitation Health Science.This work was supported by NHS ENGLAND
Change in stigma severity following psychiatric hospitalisation: a study of associated clinical factors in an Indian setting
No full text© 2026 The Authors. Published by SAGE. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1177/0253717625141536Background:
While stigma surrounding mental illness continues to affect management, there are hardly any studies reflecting any change following psychiatric admission. We aimed to examine how self-stigma changes during treatment in an inpatient setting and how it relates to improvements in symptoms and functioning.
Methods:
We analyzed stigma, depression, anxiety, stress, insight, well-being, functioning, and disability in 100 consecutive patients at admission and discharge in a psychiatric hospital in Kerala.
Results:
At admission, 34.5% (confidence interval [CI]: 24.5–45.7) of patients reported self-stigma, which decreased to 23.2% (CI: 15.1–32.9) at discharge; the stigma score decreased from 17.1 ± 6.6 to 14.9 ± 4.7 (p < .005). However, stigma levels did not change between admission and discharge for most (68.3%) patients; 87.5% had minimal stigma, with no scope for further reduction. In a minority (7.3%), stigma severity increased. Stigma correlated positively with depression, anxiety, functioning, and insight, and negatively with age and well-being at admission; and at discharge, positively with stress. Patients reporting stigma had higher depression, anxiety, insight, and poorer well-being both at admission and discharge.
Conclusions:
Most patients had a lower level of stigma; average stigma severity decreased during psychiatric admission; however, in a minority, it increased. While usual care was beneficial, the effectiveness of a proactive approach to stigma reduction warrants further study
Metformin for patients with metastatic prostate cancer starting androgen deprivation therapy: a randomised phase 3 trial of the STAMPEDE platform protocol
Full text link© 2025 The Authors, published by Elsevier. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website: https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(25)00231-1/fulltextBackground: Metformin is a widely used anti-diabetic drug. Several studies have suggested that metformin has anticancer activity in some malignancies, including prostate cancer. Metformin might also mitigate the adverse metabolic effects of androgen-deprivation therapy (ADT). We hypothesised that metformin might improve survival in patients with metastatic hormone-sensitive prostate cancer and reduce metabolic complications associated with ADT. Methods: The STAMPEDE multi-arm, multi-stage, randomised phase 3 trial recruited patients with high-risk locally advanced or metastatic adenocarcinoma of the prostate staged by conventional imaging with isotope bone and CT scanning. This publication reports findings for the most recent STAMPEDE research question, testing the addition of metformin to standard of care for non-diabetic (glycated haemoglobin [HbA1c] 2) and WHO performance status 0–2. This trial recruited from 112 hospitals in the UK and Switzerland to the STAMPEDE protocol. Patients were randomly allocated (1:1) to standard of care or standard of care plus metformin 850 mg twice daily. Random assignment was by telephone using minimisation with a random element of 20% (developed and maintained by the MRC Clinical Trials Unit at UCL), stratified for randomising hospital, age (<70 years vs ≥70 years), WHO performance status (0 vs 1 or 2), type of ADT, regular long-term use of aspirin or non-steroidal anti-inflammatory drugs (NSAIDs; yes vs no), pelvic nodal status (positive vs negative), planned radiotherapy (yes vs no), and planned docetaxel or androgen receptor pathway inhibitor (ARPI) use (docetaxel vs abiraterone, enzalutamide, or apalutamide vs none). Standard of care comprised ADT with or without radiotherapy and with or without docetaxel or ARPI. The primary outcome measure was overall survival, defined as the time to death from any cause, assessed in the intention-to-treat population. Safety was assessed in patients who started treatment. The trial is registered with ClinicalTrials.gov, NCT00268476 and ISRCTN, ISRCTN78818544. Findings: Between Sep 5, 2016, and Mar 31, 2023, 1874 patients with metastatic disease were randomly allocated to standard of care (n=938) or standard of care plus metformin (n=936). The median patient age was 69 years (IQR 63-73) and the median PSA was 84 ng/mL (24–352). 1758 (94%) of 1874 patients were newly diagnosed with metastatic disease and 116 (6%) were diagnosed with metachronous relapsing disease. 1543 (82%) of 1874 patients received ADT plus docetaxel and 52 (3%) received abiraterone, enzalutamide, or apalutamide. The median time to most recent case report form follow-up was 60 months (IQR 49–72). 473 deaths were reported in the standard of care group; median survival was 61·8 months (IQR 29·7 to not reached). There were 453 deaths in the metformin group; median survival was 67·4 months (32·5 to not reached; HR 0·91, 95% CI 0·80–1·03; p=0·15). Grade 3 or worse adverse events were reported in 487 (52%) of 938 patients in the standard of care group and 523 (57%) of 921 patients in the standard of care plus metformin group. 61 (7%) patients in the standard of care group and 84 (9%) patients in the standard of care plus metformin group reported at least one grade 3 or worse gastrointestinal adverse event; all other body systems showed no difference in grade 3 adverse events. There were six drug-related deaths in the standard of care group and one in the standard of care plus metformin group. Interpretation: We did not find significant evidence of an overall survival benefit of adding metformin to standard of care in the overall population of patients with metastatic hormone-sensitive prostate cancer. The side-effect profile of metformin was as expected and consisted mainly of diarrhoea. Adverse metabolic side-effects of ADT were significantly reduced in the metformin group compared with the standard of care group. Funding: Cancer Research UK, Prostate Cancer UK, and UK Research and Innovation Medical Research Council.The STAMPEDE trial is funded by Cancer Research UK (CRUK_A12459). This work was supported by Prostate Cancer UK through a Research Innovation Award (RIA 18-ST2-021) and by the UK Medical Research Council (MRC_MC_UU_12023/25 and MC_UU_00004/01 and MC_UU_00004/02) as part of UK Research and Innovation.Published versio
Refractory status epilepticus and therapeutic uncertainties: a comprehensive review on targeting neuroinflammation and rationale for developing a platform trial
No full text© 2026 The Authors. Published by Elsevier. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website:Refractory Status Epilepticus (RSE) is a neurological emergency associated with considerable morbidity and mortality. The molecular mechanisms contributing to neuroinflammation in RSE are increasingly being recognized. Despite its severity, high-quality and conclusive evidence is lacking for many RSE treatments, especially regarding the optimization of antiseizure medications and emerging immunotherapies. In this manuscript, the use of immunotherapy as a valuable treatment option in RSE is reviewed. The example of Toclizumab is used, its potential efficacy demonstrated by a case series from our center. Traditional clinical trial designs have proven inadequate in efficiently addressing these evidence gaps for this complex and heterogeneous condition. In examining the wider evidence for the use of anti-inflammatory agents, including early immunotherapy, the scope for adaptive platform trials is explored to be utilized to develop an evidence base in this area. Neuroinflammation plays a role in propagating seizures and associated neuronal injury in RSE; these pathways may be amenable to immunomodulation. In this review, the limitations of existing observational data and the need for efficient, quickly translatable clinical trials are highlighted to evaluate multiple interventions for RSE. Innovative trial designs, such as adaptive platform trials, help generate robust evidence for rapid uptake in RSE.Published versio
Exploring smart furniture's experienced benefits and use cases for end users and care professionals
No full text© 2026 The Authors. Published by SAGE. This is an open access article available under a Creative Commons licence.
The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1177/18761364251372070This study explores perceived benefits and use cases of three smart furniture prototypes, a smart chair, a smart mirror, and a smart table, designed to support ageing-in-place and care delivery. The research applies the Design for Somebody (DfS) methodology, focusing on modular, user-centered development for individuals with specific needs.
An online survey incorporating video demonstrations was conducted with 21 healthcare professionals and 18 end-users across six European countries. Participants assessed the perceived benefits of the prototypes, proposed enhancements, and identified relevant user groups. Quantitative data were analysed using descriptive statistics and chi-square tests, while qualitative responses were subjected to thematic analysis.
Findings indicate that the smart chair received the most positive feedback, particularly for promoting physical activity and motivation. The smart mirror was valued for daily reminders and memory support, while the smart table raised concerns due to reliance on smartphone interaction. Although no statistically significant differences were found between user groups, responses varied by role and gender.
This study provides practical contributions to the development of inclusive and adaptable smart furniture within care environments. By integrating co-design practices, DfS methodology, and video-based surveys, the research demonstrates an effective approach to mapping user needs. The findings offer novel insights into modular, user-driven design strategies that support the advancement of ambient assisted living technologies.The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: We are grateful for the financial support of the European Research Agency through the EU Horizon 2020 MSCA RISE Project, ReACTIVE Too, Grant Agreement No 871163.Published versio
Investigating the inhibitory effects of secreted proteins on macrophage in glioblastoma
No full textA thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the degree of Master of Philosophy.Cancer is one of the major causes for the mortality in the whole world and among the cancers, glioblastoma is the most common and aggressive form of malignant brain tumours, especially in the adults. The complex tumour microenvironment of glioblastoma contributes to immune suppression and inhibition of T cell activity through secreted immuno-suppressive proteins and cytokines, dysfunction of immune cells and upregulation of immune checkpoint molecules. Macrophages are the most populous non neoplastic cells in glioblastoma microenvironment, which is a part of the innate immune response and are involved in immune suppression, tumour growth, invasion, and metastasis.
The glioblastoma secretions to the microenvironment were studied using conditioned media and the day 3 with higher protein concentration were considered for studying the phagocytic activity and antigen presentation marker expression. The proteins present in the conditioned medium which were derived from these glioblastoma cell lines exert an inhibitory effect on macrophage phagocytosis. The transition from monocyte to macrophages and analysed the antigen presentation markers on monocytes and macrophages and antigen presentation marker HLA-DR had downregulated and the co-stimulatory molecule CD86 got upregulated in the presence of conditioned media suggests secretions from glioblastoma have inhibitory effect on monocytes, macrophages and the LPS stimulated M1 macrophages.
Previous studies using mass spectrometry had revealed that out of 59 glioblastoma samples, 58 showed Galectin-1 as commonly secreted protein and galectin-1 was accumulated near T cells which were present around the blood vessels in glioblastoma samples. The galectin-1 secretion was regulated by IFN-ϒ, which might be from activated T cells. Along with this, the PDL-1 and galectin-9, the immune checkpoint molecules expressed on human brain endothelial cells were studied in the presence of conditioned media and IFN-ϒ. The PDL-1 was upregulated on IFN-ϒ treated conditioned media, and galectin-9 upregulated upon IFN-ϒ and the conditioned media. The immune checkpoint molecules upregulation from IFN-ϒ and conditioned media gives insight to the immune suppression in glioblastoma
Analytical deflection modelling of symmetric non-prismatic reinforced laterite-concrete slabs
No full text©2025 The Authors. Published by Elsevier. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link: https://doi.org/10.1016/j.engstruct.2025.120255This study investigates the intricate interplay between geometric attributes and mechanical characteristics of non-prismatic concrete slabs. Analytical models were derived which showed the extent to which the geometry, as well as the mechanical properties of non-conventional constituent materials, influence the flexural response of non-prismatic slabs. This study adapted the Euler-Bernoulli beam theory as well as the theory of plates and shells to derive a time-dependent model. The derived time-deflection response includes a Weierstrass function which was resolved through the assumptions of appropriate boundary conditions. Experiments were also carried out to obtain basic mechanical properties of reinforced laterite-concrete prismatic beams which were used as input parameters in the analytical model for the non-prismatic slabs. The singly reinforced concrete slab model investigated showed a non-linear relationship between the anchorage bond and the shear adequacy due to the addition of laterite, thereby increasing the shear capacity of the slab by over 70 % at a replacement of total aggregate volume by 22 % of laterite. The optimization of aggregate proportion was obtained using a pseudo-inverse model, with coefficients of determination of 99.91 % and 99.95 % for the respective grades of concrete, hence indicating the robustness of the findings. This study is expected to contribute to the development of more precise analytical models for designing and optimizing non-prismatic concrete slabs
Tourism, place branding, and consumer behaviour
No full textThis is an accepted manuscript of a book chapter published by Palgrave MacMillan in Brands, Branding, and Consumerism on 11 March 2025, available online: https://link.springer.com/chapter/10.1007/978-3-031-80859-3_6
The accepted version of the publication may differ from the final published version. For information on re-use, please refer to the publisher’s terms and conditions.Given the symbolic significance of places such as nations, regions, cities, and gated communities, the ideas of brands and branding are being applied to them in recent times. For example, nation branding is becoming common especially as countries compete among themselves for resources and opportunities like investment inflows and skilled professionals. Similarly, consumers make inferences about goods and services offered in the marketplace based on the extent of the attractiveness of the countries where they originated from. This is commonly tagged country-of-origin (COO) effect. As there are several stakeholders associated with places such as tourists, residents, and governments, it becomes imperative for place marketers to consider inclusivity in the formulation of brand strategies. This chapter explores these issues and how they are being influenced by the digital transformation which permeates virtually all elements of the marketing systems. Apart from unpacking these salient issues with references to some pertinent cases, the chapter also features a discussion of the future of place branding consumer behaviour as well as the wide-ranging implications of the ideas.Accepted manuscrip
Establishing the priorities for dementia care curricula in higher education: the views of carers of people living with dementia and Admiral Nurses
Full text linkA thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the Professional Doctorate in Health and Wellbeing.The study focused on understanding the perspective of carers of people living with dementia and Admiral Nurses. The aim being to produce a broader insight into understanding dementia care education priorities in the higher education curricula for student nurses. To achieve this the study focused on four research objectives, these were:
1. To obtain the views of carers of people living with dementia regarding the key dementia education priorities for student nurses.
2. To obtain the views of Admiral Nurses regarding the key dementia education priorities for student nurses.
3. To determine if there are key differences in terms of the education priorities between the two groups.
4. To establish how their views inform the dementia education priorities in the pre-registration nursing curricula.
The research has incorporated a pragmatic approach. To maintain congruence and philosophical alignment, this study used a qualitative e-Delphi method of data collection to solicit the views of the expert groups and reach consensus.
The expert views obtained in this study emphasised the diverse ways that dementia can impact the person living with the condition and their family. When comparing the views of carers to the views of Admiral Nurses key differences were established. Admiral Nurses identified 34 topic areas, whereas the carers identified 12.
The study provided further evidence regarding the complexity of dementia education and demonstrated the breadth of knowledge needed to deliver dementia care. Nine key recommendations have been put forward, these include: the need for direct reference to dementia to be included within the platforms of the standards of proficiency for registered nurses (Nursing and Midwifery Council (NMC), 2024a). Student nurses’ need an understanding of dementia. Education on the brain and the changes that occur because of dementia, including an understanding of memory is recommended. Emphasis was placed on the importance of person-centred care and family centred care; this was seen as being essential. Alongside this it was felt that focus needs to be placed on seeing the positive aspects of what the person living with dementia is still able to do rather than what they have lost. Student nurses need to develop knowledge and skills in communication and dementia. Managing distress reactions and pain, using non-pharmacological approaches was highlighted as important. Student nurses require educational content relating to the progressive nature of dementia. Student nurses need to be aware of the impact of dementia on the carer and be able to support them by having an awareness of the services available in their local area