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Pragmatic Communication for Remote Control of Finite-State Markov Processes
Get PDFPragmatic or goal-oriented communication can optimize communication decisions beyond the reliable transmission of data, instead aiming at directly affecting application performance with the minimum channel utilization. In this paper, we develop a general theoretical framework for the remote control of finite-state Markov processes, using pragmatic communication over a costly zero-delay communication channel. To that end, we model a cyber-physical system composed of an encoder, which observes and transmits the states of a process in real-time, and a decoder, which receives that information and controls the behavior of the process. The encoder and the decoder should cooperatively optimize the trade-off between the control performance (i.e., reward) and the communication cost (i.e., channel use). This scenario underscores a pragmatic (i.e., goal-oriented) communication problem, where the purpose is to convey only the data that is most valuable for the underlying task, taking into account the state of the decoder (hence, the pragmatic aspect). We investigate two different decision-making architectures: in pull-based remote control, the decoder is the only decision-maker, while in push-based remote control, the encoder and the decoder constitute two independent decision-makers, leading to a multi-agent scenario. We propose three algorithms to optimize our system (i.e., design the encoder and the decoder policies), discuss the optimality guarantees ofs the algorithms, and shed light on their computational complexity and fundamental limits
Barriers and Enablers to Leadership in Advanced Practice Nursing: A Systematic Review
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To explore the barriers and enablers influencing leadership enactment by advanced practice nurses and assess how these have evolved over the past decade.
Introduction
Nurses in advanced practice roles are well‐positioned to drive healthcare change, addressing patient needs and service demands. However, their leadership contributions are often underestimated, with greater emphasis placed on clinical practice and education rather than leadership and research.
Methods
A systematic review of cross‐sectional studies was conducted using CINAHL, MEDLINE, EMBASE, APA PsycINFO, and Cochrane databases for studies published between January 2015 and March 2024. Fourteen studies involving 5243 participants were narratively synthesised. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tool, and findings are reported following Preferred Reporting Items for Systematic Review and Meta‐Analyses (PRISMA) 2020 guidelines.
Findings
The review identified 24 barriers and 18 enablers to enacting leadership in advanced practice nursing roles, grouped into eight themes across four structural levels: healthcare system, organisational, team, and individual. Key themes included leadership capacity building, role clarity, development opportunities, resource allocation, and mentorship. Major barriers were unclear roles, limited leadership training, and resource constraints, while enablers included mentorship, leadership programmes, and organisational support.
Conclusion
Despite progress, significant barriers persist in developing leadership capabilities within advanced practice nursing roles, particularly in healthcare systems and organisational levels. Standardised education and training pathways are needed to equip nurses for leadership roles, and further research is required to address these barriers.
Implications for nursing and health policy
Strengthening leadership capacity for advanced practitioners in nursing requires sustained institutional support, standardised education, and strategic engagement with policymakers. Maximising their leadership potential can drive healthcare innovation, improve patient outcomes, and ensure the long‐term sustainability of these roles
European Stroke Organisation (ESO) guideline on aphasia rehabilitation
Get PDFEvidence of effective aphasia rehabilitation is emerging, yet intervention and delivery varies widely. This European Stroke Organisation guideline adhered to the guideline development standard procedures and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The resulting multi-disciplinary, evidence-based recommendations support the delivery of high-quality stroke-related aphasia rehabilitation. The working group identified 10 clinically relevant aphasia rehabilitation questions and rated outcomes’ relevance and importance. Following systematic searching, independent reviewers screened title-abstracts and full-texts for randomised controlled trials of speech-language therapy (SLT) for stroke-related aphasia. Results were profiled using PRISMA. Risk-of-bias was evaluated using the Cochrane Risk-of-Bias 1 tool. We prioritised final-value data. Where possible we conducted meta-analyses (RevMan) using random effects and mean, standardised mean differences (functional communication, quality of life, aphasia severity, auditory comprehension and spoken language outcomes) or odds ratios (adverse events). Using GRADE, we judged quality of the evidence (high-to-very low) and ESO recommendation strength (very strong-to-very weak). Where evidence was insufficient to support recommendations, expert opinions were described. Based on low-quality evidence we recommend the provision of higher total SLT dose (⩾20 h) and suggest higher SLT intensity and frequency to improve outcomes in aphasia rehabilitation. Similarly, we suggest the provision of individually-tailored SLT and digital and group therapy delivery models. Very low-level evidence for transcranial direct current stimulation (tDCS) with SLT informed the expert consensus that such interventions should only be provided in the context of high-quality trials. Evidence-based clinical-research priorities to inform SLT aphasia rehabilitation intervention choice and delivery are highlighted
Implementing routine assessment of perinatal anxiety: case studies
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During pregnancy and the first postnatal year, a substantial proportion of women experience perinatal anxiety, which is associated with increased risk of adverse birth, maternal and child development outcomes. Identification of perinatal anxiety is recommended in various countries, but there is a lack of consensus on the most effective, acceptable and feasible measure to use. The Methods of Assessing Perinatal Anxiety study previously found the Stirling Antenatal Anxiety Scale to be diagnostically accurate and acceptable to women.
Objectives
This study aimed to determine the acceptability and feasibility of implementing new assessment of perinatal anxiety in healthcare services.
Design and methods
Implementation case studies of perinatal anxiety assessment using the Stirling Antenatal Anxiety Scale in three National Health Service sites in the United Kingdom. Semistructured interviews and focus groups were conducted before and after implementation with healthcare professionals working in maternity, primary care and psychological services that had contact with perinatal women. Preimplementation data collection was used to develop an implementation and training strategy for each site. Interviews and focus groups were conducted with the same participants post implementation. Data were analysed using framework analysis and a combined inductive-deductive approach.
Setting and participants
Two National Health Service trusts in England and one National Health Service health board in Scotland. Participants were healthcare professionals, including midwives, health visitors, clinical psychologists and mental health nurses, who used the scale during the implementation period. Other stakeholders such as service managers and team leads were also interviewed. Sites were selected to represent different types of service and pathways of care. The sample comprised 37 participants at preimplementation and 27 at the postimplementation stage.
Intervention
Implementation of new assessment of perinatal anxiety in National Health Service services.
Results
At the English sites, one focus group and two interviews were conducted at site E1, and five interviews at site E2. At the Scottish site, two focus groups and six interviews were conducted. Evaluation findings were categorised into 5 themes (experience of change in practice, barriers/facilitators to implementation, acceptability, feasibility, improvements to implementation strategy) with 16 subthemes. The experience of introducing a new assessment tool in clinical practice was generally seen as positive, with the scale enabling more focused conversations with women about their symptoms and different types of anxiety. Potential barriers to conducting assessments included women not having English as first language and stigma towards anxiety in some cultures. The scale overall was acceptable to healthcare professionals. Recommendations to improve the implementation strategy included adding the tool to patients’ electronic notes and getting wider buy-in from senior management.
Limitations
Healthcare practitioners mainly used paper versions of the scale, while most National Health Service services are moving towards patients’ electronic notes. Only 73% of participants were interviewed at the postimplementation stage. Variation in clinical pathways and services means results may not be generalisable to other settings.
Conclusions
Implementation of a new measure of perinatal anxiety was perceived positively overall.
Future work
Further research should explore the use of a digital version of the tool and translated versions. Replication in National Health Service services with different care pathways is also recommended.
Funding
This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number 17/105/16
Free vibration of moderately thick FGM plates using the dynamic stiffness method and the Wittrick-Williams algorithm
No full textThe dynamic stiffness method (DSM) for free vibration analysis of functionally graded moderately thick plates based on power and sigmoid laws is developed. The functionally graded plates analysed are identified as P-FG and S-FG plates, describing the power and sigmoid laws. The effective material properties of the P-FG and S-FG plates are assumed to vary through the thickness of the plate. First-order shear deformation theory and Hamilton’s principle are used to derive the governing differential equations of motion. The Levy-type solution is sought to derive an efficient analytical formulation for plates with simply supported boundary conditions along two opposite edges. By imposing the boundary conditions for displacements and forces, the dynamic stiffness matrix is developed. Then the Wittrick–Williams (W-W) algorithm is applied to compute the natural frequencies and mode shapes of P-FG and S-FG plates. The influence of the material gradient index, aspect ratio, thickness to length ratio and boundary conditions on the natural frequencies and mode shapes of P-FG and S-FG plates are investigated in detail. Comparing these two grading laws i.e. power and sigmoid grading laws is important, as they yield different stress and stiffness distributions, which directly impact vibration characteristics, stress concentrations, and manufacturability of functionally graded components. To establish the accuracy and validity of results from the present theory, comparative studies utilising existing literature are performed, which show excellent agreement. The results given, can be used as bench-mark solutions when validating finite element and other approximate theories
Germany's populist disruptors and the “politics of fluidity”
No full textIntroduction
The German party system has become increasingly unstable as the “politics of centrality” that was associated with the old Federal Republic has succumbed to a new “politics of fluidity”. The subsequent process of political fragmentation has seen the emergence of populist challenger parties of right and left. The article focuses on the more significant strand of right-wing populism represented by the Alternative für Deutschland (AfD) but also considers the persistence of left populism in elements of the Linke and the recent breakaway Bündnis Sahra Wagenknecht (BSW).
Methods
The article uses mixed methods to explain modern German populism in comparative and historical perspective, and looking at demand and supply side factors, with a focus on party-based populism.
Results
The article demonstrates that Germany's populist challengers have a strong impact on party competition but face significant systemic biases that limit their impact on government formation at the state level and certainly at the Federal level.
Discussion
The article concludes that ceteris paribus the possibility of a right-wing populist government at the national level in Germany is smaller than in European democracies with more majoritarian electoral and party systems such as France. Nevertheless, the emergence of Germany's populist disruptors presents a systemic challenge, not least because of the dangers of over-reaction from Germany's political and legal establishment to the rise of the AfD in particular
Experiences of group antenatal care in the context of the NHS in England: what are the mechanisms by which it functions in this context?
Get PDFIntroduction
Group antenatal care is a model where care is provided in groups of around 6–12 women/birthing people, integrating healthcare with information and learning in a participatory approach. There is international evidence of improved care experiences and outcomes; however, the approach (here called Pregnancy Circles) had not been trialled in the United Kingdom in the context of a universal health system with midwife-led care. We aimed to understand the experience of care and any mechanisms by which group care functions for the different people involved.
Method
This study comprised a qualitative process evaluation nested within a randomised controlled trial. The mixed qualitative methods used in this study included observations of care, interviews with participants, survey open-text responses and written feedback, and a review of relevant documents. Inductive thematic analysis was conducted using a framework of theorised mechanisms based on a realist review. The trial’s clinical and psychosocial outcomes and lessons for implementation are reported elsewhere.
Results
We found a high level of concordance with the framework of mechanisms derived from the literature. The key mechanisms were social support and community building, a critical pedagogy (combining peer learning, an interactive and participatory approach, and health education), satisfaction and engagement with care, and the health professionals’ satisfaction and development. Building on these, the empowerment of participants and midwives formed an overarching mechanism. Relational continuity and time for care were the key underpinning components.
Discussion
Pregnancy Circles address key deficits in contemporary maternity care, including the lack of time and relational or informational continuity of care, the lack of informed choice, and loss of opportunities to enhance empowerment through health knowledge, social support, and confidence in caring for one's own health, in decision-making, and in seeking support. Importantly, midwives felt that facilitating group care enhanced their professional satisfaction and development and collaboration across boundaries, features associated with service safety and resilience. Fidelity in terms of the midwives' skills and confidence in using a facilitative approach was important and was underpinned by continuity. Midwives' and women's empowerment were found to be mutually supportive rather than in tension. Scaling up Pregnancy Circles as a standard care option in the National Health Service may support positive care experiences; however, further research is needed to monitor the longer-term impact and service and public health implications
Characterizing the food environment in Scotland and its association with deprivation: A national study
Get PDFObjectives
To characterize food outlets across Scotland and analyze their distribution by neighborhood deprivation.
Methods
Data from the Food Standards Agency of all registered food businesses in 2024 were categorized as out-of-home (OOH) [including restaurants, pubs, cafés, and takeaways], retail [supermarkets and non-food retailers like pharmacies with limited food items] or other [mobile caterers, charity organizations, and home caterers]. Neighborhood deprivation was quantified using the Scottish Index of Multiple Deprivation.
Results
Of all food outlets, 59 % (n = 18,409) were OOH, 28 % (n = 8757) retail, and 13 % (n = 3969) other. The density of OOH (1.9 per km2) was more than double that of retail (0.8 per km2). Glasgow City had the highest OOH outlet density (18.5 per km2). Argyll and Bute, Western Isles, and Highlands had the lowest density of both OOH and retail (≤0.03 per km2). Compared to the most deprived neighborhoods, the least deprived neighborhoods had more Restaurants/cafés/canteens (37 % versus 23 % of food outlets, respectively) and fewer Takeaways/sandwich shops (16 % versus 24 % of food outlets, respectively).
Conclusion
Though OOH outlets far outnumber retail in all of Scotland, unique food environments exist in different local authorities. These insights can inform local development and support targeted strategies to improve food environments
Target-flanker similarity alters the spatial profile of visual crowding
Get PDFVisual crowding is the disruptive effect of nearby details on the perception of a target. This influence is dependent on both spatial separation and perceived similarity between target and flanker elements. However, it is not clear how these simultaneous influences combine to produce the final “crowded” percept as flankers traverse the limits of the crowding zone.We investigated the reported appearance of a peripherally presented Landolt-C target flanked by a pair of simultaneously presented Landolt-Cs across different levels of target-flanker similarity (relative orientation), spatial separation, and target eccentricity. The distributions of errors in reported target orientation were fitted with a pooling model that simulated errors using a weighted combination of target and flanker orientation signals. The change in error distribution with target-flanker spacing (the “spatial profile”) was fitted with a logistic function, estimating both the rate at which target- and flanker-signal weighting varies as target-flanker spatial separation decreases (slope) and the spatial separation at which signals were balanced (midpoint).We found that the slope of the spatial profile increases as target-flanker similarity decreases, with similar modulation patterns across target eccentricities. In contrast, spatial profile midpoints increased linearly with eccentricity, in line with Bouma’s law, but were invariant of target-flanker similarity. This suggests similarity-related modulation may operate within a fixed spatial extent at each eccentricity. Investigating the spatial profile of crowding disentangles effects related to the appearance of targets and flankers (i.e., similarity) from appearance-independent influences, which can be confounded when using other common measures to define crowding zone extent
The Meaning of Missing: The Hidden Power of Police Data Recording Practices in Rape Cases
Get PDFMissing values represent a major weakness of police-recorded crime data. This article examines missing data in rape cases recorded by five police forces in England and Wales between January 2018 and December 2020. A thematic analysis of semi-structured interviews with police practitioners reveals factors that influence missing information in police datasets, and quantitative data analyses explore the volume and patterns of missing data across cases defined by different victim, suspect and offense characteristics. Finally, we investigate the impact of missing data on outcomes of police investigations. We find that missing data is partly explained by victim, suspect and case characteristics and is also associated with outcomes
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