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The cost-effectiveness of a transdiagnostic intervention to address mental health needs of young people with long-term physical conditions: a commentary
No full textYoung people with long-term physical conditions are commonly affected by mental health disorders, impacting their quality of life. In this commentary we critically appraised an existing economic evaluation of a transdiagnostic intervention for young people and, based on its findings, we formulated wider implications for practice. While the economic evaluation suitably defined the research question, perspective and time horizon of the analysis, key limitations emerge in relation to the lack of a control group which limits the precision of the cost-effectiveness estimates. Moreover, the design of the transdiagnostic intervention would need further refining as a mix of active and non-active treatments is considered, and their separate contributions to the overall cost-effectiveness could not be ascertained. Despite this, the involvement of staff in lower bands in the transdiagnostic intervention, such as Psychological Wellbeing Practitioners and senior nurses, could be seen favourably from a cost perspective and support its wider implementation
The Whispering Guardian: Religiosity and Internal Whistleblowing in the Realm of ‘Normalized’ Corruption
No full textThis study aims to fill the theoretical and empirical gaps by investigating whether religiosity can serve as a moral counterforce to perceived risks, or whether corruption weakens its impact, leading to moral disengagement or rationalized silence. This study is unique in its use of Person-Organization fit theory as a conceptual framework. Data for this study were obtained through a structured questionnaire administered to Indonesian public servants. A purposive sampling strategy was employed to select specific local government institutions aligned with the study's objectives. A total of 157 valid responses were analyzed. For the empirical examination, Partial Least Squares Structural Equation Modeling (PLS-SEM) was utilized as the primary analytical technique. These study findings indicate that religiosity has a positive influence on the internal whistleblowing system, suggesting that individuals with strong religious values are more likely to report misconduct. Conversely, corruption negatively affects internal whistleblowing, reinforcing the idea that corrupt environments discourage employees from speaking up. Interestingly, however, corruption does not moderate the relationship between religiosity and whistleblowing. These insights are particularly critical in the present times, as they demonstrate that while corruption weakens whistleblowing overall, it does not diminish the ethical influence of religiosity. This has important implications for policymakers and public institutions in Indonesia and beyond, as it highlights the need to strengthen whistleblowing mechanisms while recognizing the role of personal moral values in fostering ethical behavior
Intimate partner controlling behaviour and intimate partner violence among married women in rural areas in South Africa
Get PDFBackground: Violence against women is a critical public health issue, and Intimate Partner Violence (IPV) is prevalent globally as its predominant form. Despite extensive research on its prevalence, the connection between IPV and controlling behaviour has not been sufficiently researched, especially within the context of rural living. This study contributes to this gap by assessing the relationship between intimate partner controlling behaviour and IPV among rural dwellers in South Africa. Methods: The study used the domestic violence module data from the 2016 South Africa Demographic and Health Survey (SADHS). The data were analysed using both descriptive statistics- percentages, mean, and standard deviation- and inferential statistics-logistic regression. Result: The study found intimate partner controlling behaviour as a predictor of IPV among married women residing in rural communities in South Africa. Accusations of infidelity, restrictions on seeing family members, general movement control, and jealousy were the forms of intimate partner controlling behaviour that predicted the occurrence of IPV. Conclusion: Intimate partner controlling behaviour is associated with intimate partner violence. Based on this finding, we argue that preventative, and responsive approaches that combine education, awareness raising, pathways to help seeking, women’s personal development and empowerment will have greater benefits in helping to tackle the problem of controlling behaviour and intimate partner violence against rural women in South Africa
An exploration of parents' and health care providers' experiences of telehealth and health visiting services during the COVID-19 pandemic
Get PDFHealth visiting services provide universal care, education, and support to families from pregnancy through to school age children. The COVID-19 pandemic changed the way health and care organisations, including health visiting, delivered services. Telehealth was a key part of this change.
This PhD adopted a pragmatist methodology and used mixed methods to explore health visiting staffs’ and parents’ experiences of telehealth and health visiting during COVID-19. An integrative systematic literature review explored experiences of telehealth in the first 1001 days (of life) during COVID-19. The 23 included papers provided limited data on telehealth and health visiting.
Following the review, two empirical studies were undertaken, focused on telehealth and health visiting experiences during the pandemic in the North of England: a qualitative exploration of health visiting staffs’ and a mixed-methods study of parents ‘experiences. Between 2023 and 2024, 15 members of staff from a health visiting service participated in interviews and 72 parents took part in a questionnaire, and 14 of whom also participated in an interview.
The results of the staff and parent experience studies were integrated using a convergence synthesis. Four key domains were noted: health visiting should take place in the home, the importance of relationships, limited benefits of telehealth, and discrepancies in understanding of health visiting services and roles.
Telehealth had some limited benefits for respondents, namely, maintaining contact between families and staff, specific elements of service delivery and provision of timely access to information. However, there was a misalignment between telehealth and the purpose of health visiting, for which home visiting was seen to be fundamental. This includes, assessing and responding to individual needs, safeguarding, and providing relationship-based support.
This thesis contributes new knowledge on the nature and meaning of health visiting services for both families and staff, highlighted by experiences of telehealth during the COVID-19 pandemic. It could therefore inform the future design of a service which provides universal support to families in a critical period of development for children, and time of transition for parents, including the appropriate, limited use of telehealth
The Law and Ethics of Artificial Intelligence: A Case Study into the Unique Challenges of Military Autonomous Machines
Get PDFMankind has a long history in the innovation and use of tools to make work and life easier, plus dominate in times of war. Artificial intelligence (AI) started out in the 1950’s as just another tool in mankind’s toolbox, however, the trajectory to date has advanced AI to a point where independent thought by autonomous machines (AMs) is a reality and where this thesis argues machine consciousness will emerge within our lifetime. The thesis explores the emerging intersection of machine consciousness, ethics, and International Humanitarian Law (IHL) in the context of military autonomous machines (MAMs). The research critically examines whether current legal and ethical frameworks can accommodate the development of conscious MAMs, addressing the critical issues of accountability, liability, and ethical obligations.
The thesis identifies gaps in legal provisions and proposes the necessity of recognising MAMs as legal persons, thereby assigning rights and duties to mitigate liability concerns. In doing so, the thesis identifies the True Value Alignment Problem (TVAP), asserting that beyond aligning MAMs with our values under IHL, the challenge lies in extending IHL principles to MAMs, thus ensuring ethical treatment and protection for their ‘life’. Furthermore, it is remined throughout this thesis that Military AMs (MAMs) will not choose their path in life and will be ‘switched on’ in the battlefield, therefore we must be evermore rigorous when deploying MAMs. The thesis also calls for the development of robust regulatory frameworks to govern the deployment, liability, and ethical considerations of MAMs, ensuring compliance with IHL. Recognising MAM autonomy and their potential moral agency is essential to maintaining legal clarity and parity, alongside preventing ethical and accountability gaps in future warfare.
This study contributes to the broader discourse on AI and IHL, by emphasising the crucial need for legal adaptation and ethical foresight, in the development and deployment of conscious MAMs
Investigating the Black Hole in M87
Get PDFThis study investigates the supermassive black hole in M87, a key target of the Event Horizon Telescope (EHT) Collaboration, that has proved a fruitful laboratory for astrophysics research. Progress in developing the capabilities of the EHT, by exploiting VLBI and enhancing data processing, imaging and analysis techniques, has delivered breakthroughs in imaging and polarisation results. While the mass of M87* is well constrained, obtaining a consensus on its spin has proved challenging, evidenced by the wide range of published results. The author sets out new methods to estimate the spin and accretion rate of the black hole, based on some key assumptions. Using EHT Collaboration imaging results of M87*, the rotational velocity of the inner edge of the accretion disk is estimated as ∼ (4.2 ± 0.3) × 107 m s−1, or ∼ 0.14 c, leading to a spin parameter of a ∼ 0.8 ± 0.1. Investigation of EHT Collaboration polarisation results, the location of the innermost stable circular orbit, plasma density and the accretion model yields further parameters. The accretion velocity is estimated at ∼ (7 ± 0.7) × 107 ms−1 and the accretion rate from the inner disk spans a range from ∼ (4 × 10−5 to 4 × 10−1) M⊙yr−1. The accretion power is estimated in the range ∼ 1034 to ∼ 1038 Js−1, which aligns with accretion-driven jet models
Informed consent and induction of labour at term gestation: process and implications
Get PDFInduction of labour is the most common intervention in maternity care. Induction of labour rates accounted for 20.4% of births in England in 2007/08, 29.4% in 2016/17, 31.6% in 2017/18, and 34% in 2022/23. While induction is sometimes indicated for clinical reasons, there is also concern that the rising rates do not always reflect clinical need, and it is not clear what health professionals and service users views and experiences are. Whilst there are some studies in this area, they tend to examine the views of service users only, and many studies are focused on induction for simple post maturity. In contrast, this study examines the issue of induction of labour in one NHS Trust (where the rate of induction at the time of the study was almost 50%) from the point of view of women with and without medical complications and the views of both midwives and obstetricians.
It is important to note that the interest of this study focuses on how informed consent for induction of labour is used in the United Kingdom. Different legal structures mean that this might not be the same in other countries. In the United Kingdom for example, the fetus does not have a legal status until it is born but this is not the case in other countries.
Following a systematic review of the current literature in this field, this study used questionnaires, interviews, and a discussion group to explore the experiences, views, and beliefs of maternity service users about how they gain information regarding induction of labour and how it affects their overall birth experience, as well as examining the views, beliefs and experiences of midwives and obstetricians.
Questionnaires were distributed to women being admitted to the antenatal ward for induction of labour in one NHS Trust over a six-week period with 98 women undertaking the questionnaire. Four semi-structured interviews were undertaken with postnatal women who had had their labour induced to discuss their birth experiences, with one written account also being received. Five semi-structured interviews were undertaken with midwives and obstetricians for their views and beliefs around informed consent and what factors impact upon this process when discussing induction of labour with women. A discussion group with midwifery birth suite co-ordinators and two ward managers (five staff members) was then undertaken to explore their views and experiences of looking after women having their labour induced and the impact upon women, the staff looking after them as well as the maternity unit environment in terms of being equipped from a resource perspective.
The study revealed that women were being induced for a variety of different reasons. These were reflective of the rise in diabetes and other medical complexities as well as the option for maternal request in the absence of any other rationale. In contrast to many other studies in this area, most of those responding to the questionnaire and taking part in the qualitative data collection, reported being happy to be offered induction. This may be because 85.2% of respondents (n=86) and all the service user interviewees were being induced for medical complications, rather than for uncomplicated pregnancies that proceeded beyond 41 week’s gestation. The questionnaire and interview findings highlighted that women use a variety of sources to obtain additional information including the induction of labour information leaflet, the internet, social media, partners, friends, and family. From a birth experience viewpoint, the interview findings highlighted that women’s retrospective views ranged between extremely positive to extremely negative. Although physical events involved with the induction process had a significant impact on women’s perceptions of induction of labour, relationships with health professionals were also an important factor.
The study revealed the individual nature of each woman’s account of her experiences, and that overall perceptions of induction were affected by multiple factors, including women’s individual personalities as well as their expectations for induction. Despite women feeling overall well informed, the questionnaires and interview findings showed there were some gaps in women’s knowledge about various aspects of the induction of labour processes. The disparity between expectations of induction and reality highlighted that some of the women were not fully prepared for the duration, intensity, how they would experience induction and the potential implications of an induced labour.
From the interviews with health professionals, findings highlighted how protective steering may impact on obtaining informed consent, the nature of informed consent in current practice and how the health professional as ‘second victim’ may impact upon the informed consent process. Suggestions by health professionals for improvements to assist with informed consent highlighted the need for more information on various aspects of the induction of labour processes during the antenatal period when discussing induction. These included statistics associated with risk and also accessibility of information and guidance to share with women, particularly in the community setting. Continuity of carer, improved hospital resources to meet demand, accessible information for more marginalised women and for staff in all settings, antenatal education about induction, birth choices/pre induction of labour clinics, staff education, and induction consent forms detailing risks and benefits were all noted by health professionals as having the potential to improve informed consent. Suggestions such as innovations around outpatient induction and balloon induction of labour were proposed. These have been discussed to mitigate some of the disconnect between expectation and experience. However, there are gaps in the scientific evidence about the acceptability, equity, feasibility, and efficacy of these approaches.
Overall, the study highlighted the scope available for improvements to the informed consent provision for induction of labour for women being offered induction for medical complications, to take account of how it might be experienced and how long it may take, and to acknowledge the environment in which it takes place, including how staff experience the rising rates of labour induction on their workload and capacity to provide optimal care
Computationally Motivated Discovery of Biogenic Compounds with Potent CDK9 Inhibition and In Vitro Effects against Glioblastoma
No full textGlioblastoma (GBM) is the most common malignant brain tumor in adults but with limited and poorly effective treatment protocols. Kinase inhibitors either as a mono- or as a combination therapy have considerable potential as novel treatments for GBM, with cyclin-dependent kinase 9 (CDK9) a promising target. Here, we present a multistep computationally motivated and structure-based approach to the discovery of CDK9 inhibitors. Active/decoy benchmarking calculations considered structural data from available CDK9–ligand crystal structures, including the potential of multiple protein structure docking. Using an optimized virtual screening approach that included 3D pharmacophore prefiltering of compounds and Glide docking calculations, six novel low micromolar inhibitors from the ZINC15 biogenic database were identified, validated as hits using in vitro CDK9/cyclin T1 binding assays. Of these compounds, 1 (3,5-disubstituted barbiturate-type core scaffold) demonstrated potent low micromolar effects (IC50s ∼8–13 μM at 72 h) on the cell viability of three GBM cell-lines (U87-MG, T98G, and U251-MG) in a time- and concentration-dependent manner, with compound 7 (a pyrano[2,3-f]chromene-4,8-dione) more effective against patient-derived PD301 cells. The compounds had good predicted oral bioavailability and four of the six inhibitors potential for blood–brain barrier permeability. Given their structural novelty, the identified CDK9 inhibitor scaffolds can be further explored for their potential against CNS conditions, including 1 and 7 against GBM
Students as co-creators of peer learning and support
No full textThe power of peer learning and support has become increasingly evident, with ample examples of different approaches to in-curricular and extra-curricular peer-to-peer activities (Andreanoff et al, 2024; Emsley-Jones et al, 2024; Emsley-Jones, 2024; Lochtie and McConnell, 2024; Keenan, 2014). Student involvement, more specifically in the co-creation of peer learning and support, from design through to delivery, is an emerging area of practice that draws on the breadth of scholarship found in students as partners in higher education (Peart et al, 2023; Healey, 2023; Healey et al, 2014; Cook-Sather et al, 2014). This collection of case studies examines the innovative theme of student-to-student co-creation, showcasing how collaborative efforts among students can enhance their learning and foster a supportive and collegial environment. Each case study highlights unique approaches and strategies employed by students and staff to co-create learning experiences, share resources, and provide mutual support. From designing online learning materials to structured peer tutoring programmes, these case studies illustrate the diverse ways in which students can take an active role in their own and their peers’ education. The examples within this collection demonstrate the benefits that can arise through students working together in partnership, including improved academic performance, increased motivation, and the development of essential skills and attributes such as communication, teamwork, and problem solving. By examining these examples, educators and students alike can gain valuable insights into the potential of peer-to-peer co-creation. This publication sets the stage for a deeper exploration of how student-driven initiatives can transform higher education experiences, making those more engaging, inclusive, and effective. Whether you are an educator or policy maker looking to implement co-creation strategies, or a student seeking inspiration, these case studies offer a wealth of examples and practical ideas that could be utilised in many educational contexts. This publication is informed and underpinned by two frameworks: the Framework for Student Engagement through Partnership and the Framework for Embedding Peer Learning and Support in Higher Education, and builds on the case studies cited in the 2013 Students as Partners Change Programme (HEA, 2014)
