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Assessing the effects of levothyroxine use in an ageing United Kingdom population
No full textBackground: Subclinical hypothyroidism, characterised by elevated thyroid-stimulating hormone (TSH) with normal free thyroxine (fT4) levels, is common among individuals aged over 50 years and is associated with adverse health outcomes. However, the impact of levothyroxine (LT4) treatment on cardiovascular and bone health in this population remains uncertain.
Methods: We conducted a retrospective cohort study and an emulated target trial using healthcare records from The Health Improvement Network (THIN), a database of anonymised primary care records covering 6% of the United Kingdom population, which is broadly representative of the general population. The cohort study included 53,899 individuals for cardiovascular outcomes and 56,878 individuals for bone health outcomes. The emulated target trial included 17,755 participants for cardiovascular outcomes and 19,364 participants for bone health outcomes.
Results: In the cohort study with a 10-year follow-up, the adjusted time-varying hazard ratio was 0.91 (95% CI: 0.87-0.97, p < 0.001) for cardiovascular events and 1.21 (95% CI: 1.14-1.28, p < 0.001) for bone health outcomes. In the emulated target trial with a 10-year follow-up, the adjusted time-varying hazard ratio for cardiovascular events was 0.78 (95% CI: 0.71-0.86, p < 0.001), and for bone health outcomes, it was 1.26 (95% CI: 1.15-1.39, p < 0.001).
Conclusion: Our findings highlight consistent results between the cohort study and emulated target trial, indicating potential protective cardiovascular effects and adverse bone health outcomes associated with LT4 treatment in individuals with subclinical hypothyroidism aged over 50 years. Combining bone protection alongside LT4 treatment may be beneficial in these patients
The PFI Sustainability Evaluation Tool: A Methodology for Evaluating of Sustainability within PFI Housing Projects
Full text linkIn the UK there is a need to provide more housing in order to meet increased demand. The problemis particularly acute in the social housing sector. There is also a drive to reduce CO2 emissions fromhousing, whilst addressing issues of social sustainability. Accordingly governments have sought tocombine the goals of sustainable development with housing policy in order to provide not just morehousing, but more sustainable housing. In a time of public sector expenditure restraint the PrivateFinance Initiative (PFI) has been used as a means to procure social housing using private money,however sustainability within PFI housing projects has received little attention. This paperintroduces a methodology for evaluating sustainability within PFI bids. Developed and tested duringthe procurement stage of a large PFI housing project in the North East of England, results suggestthat the introduction of clear, transparent and robust evaluation criteria can enhance sustainability
Coaching: How are the dynamics of 'support' between coach and client defined, and reflexively maintained throughout a workplace coaching intervention?
Full text linkSupport is often described as central to coaching, but it remains loosely defined and rarely taught. While it is widely expected that coaches will provide support throughout the process, how that support is created and managed in practice is often left to the coaches' best intention rather than an explicit agreement and collaboration with the client. This research challenges the notion that support is an assumed skill. Instead, it explores what support really means in workplace coaching, how it is enacted, and how it is managed reflexively throughout the coaching intervention.
Adopting a pragmatist stance and drawing on symbolic interactionism and discourse analysis, the research followed an exploratory sequential mixed methods design. A national survey (108 responses) was used to gather broad insight into how coaches describe support, its role in their practice, and how it is (or is not) addressed in training. The findings indicated a strong consensus around the value of support, but limited clarity on how it is developed or taught. This informed a second qualitative phase involving twenty in-depth interviews with experienced workplace coaches. These interviews explored how support is actually applied in practice, and how coaches navigate the ethical, emotional, and relational complexities that surround it.
Five themes are presented, showing that support is not a fixed behaviour or a set of standardised actions. Instead, it is deeply reflexive, shifting in response to context, client need, emotional tone, and the moment-to-moment flow of the coaching relationship. Participants described moving between care, containment, challenge, and perspective shifting, often drawing on embodied judgement rather than structured models. Support was described as something co-created, not imposed, and something that requires presence, awareness, and relational skill.
This thesis contributes to theory by reframing support as an active, relational skill rather than a passive or backgrounded quality. It positions support as something that is negotiated through interaction, shaped by both coach and client, and embedded in the dynamics of the working alliance. The research also contributes to the coaching practice by providing a new conceptual lens for naming, teaching, and developing support in more explicit and practical ways. A new framework, The Four Dimensions of the Coaching Support Lens, is proposed to help coaches integrate support more explicitly into their practice, offering a practical contribution to coach education and supervision. It argues that support should be recognised as a core skill, not simply something coaches are expected and assumed to “hold” without guidance. These findings carry implications for coach education, supervision, and professional standards, particularly in how relational skills are developed and assessed