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The Macmillan–Scottish ambulance partnership: driving change in end-of-life care
No full textObjectives Unnecessary hospital admissions for palliative emergencies strain resources and may not meet patients’ end-of-life preferences. This study evaluates the impact of a 3-year partnership between Macmillan Cancer Support and the Scottish Ambulance Service (SAS), launched in 2022, to strengthen community-based palliative care and establish alternative referral pathways.Methods A retrospective comparative analysis of SAS call data linked to emergency department (ED) outcomes was conducted for 2022 and 2023. We assessed changes in key metrics: acute-care hospital admissions, ambulance conveyance rates and 7-day mortality using χ2 and two-proportion z-tests. Costs were estimated using NHS data and scenario modelling of patient length of stay.Results A statistically significant 5.47% reduction in hospital conveyances was observed, equating to over 1600 fewer incidents conveyed to hospital. Estimated ambulance service savings totalled £570 871, with ED-related cost reductions from £3.6 to £5.6 million. A modest increase in 7-day mortality was noted, consistent with increasing acuity of patients managed in the community.Conclusions The SAS–Macmillan collaboration demonstrates that targeted education, alternative referral pathways and integrated community care can reduce avoidable hospital admissions and improve efficiency. The initiative offers a scalable model to enhance patient-centred, community-based palliative and end-of-life care, aligned with patient preferences.<br/
Cytotoxicity and cell cycle changes in prostate cancer cells with differing PSMA expression and p53 status after treatment with PSMA-targeting radioligand [<sub>212</sub>Pb]Pb-AB001
No full textTargeted alpha therapy holds promise for treating advanced prostate cancer, but the interplay between prostate-specific membrane antigen (PSMA) expression, p53 status, and downstream cell fate remains poorly defined. This study evaluates the cytotoxic and cell cycle effects of the alpha-emitting radioligand [ Pb]Pb-AB001 in prostate cancer cell lines with differing PSMA expression and p53 status: C4-2 (PSMA /TP53-wild-type) and PC-3 PIP (PSMA / TP53-null). [ Pb]Pb-AB001 significantly inhibited proliferation and clonogenic survival in both cell lines in an activity-dependent manner. At 95% clonogenic inhibition, both cell lines exhibited G2-phase arrest, S-phase suppression and reduced mitotic entry on day 1. At higher activities, PC-3 PIP cells showed polyploidy, and features consistent with mitotic catastrophe and senescence. Cytotoxicity was more pronounced in C4-2 3D spheroid models than in 2D monolayers, suggesting contribution of crossfire and bystander effects. Total cell-bound activity, rather than added activity, better predicted radiotoxicity in both TP53-wild-type and TP53-null cell lines, indicating that its therapeutic effect is primarily governed by PSMA-mediated uptake rather than p53 status. These results support the therapeutic potential of [ Pb]Pb-AB001 across cells with varying TP53 status and suggest that combining [ Pb]Pb-AB001 with DNA repair or checkpoint inhibitors may enhance treatment efficacy
The definition of sex: For Women Scotland (FWS) Ltd v The Scottish Ministers (2025)
No full textThis case concerns a legal challenge by For Women Scotland against the Scottish Government’s revised statutory guidance on its Gender Representation on Public Boards (Scotland) Act 2018, which For Women Scotland argued misinterpreted the definition of ‘sex’ under the Equality Act 2010. The case centred on statutory interpretation and whether the term ‘sex’ in the Equality Act should be interpreted in light of the Gender Recognition Act 2004 which allows individuals with a Gender Recognition Certificate to be legally recognised in their acquired gender
A systematic review of autistic adults’ experiences of anxiety from a qualitative perspective
No full textPurposeMany autistic adults experience anxiety in ways that are qualitatively unique when compared to the experiences of non-autistic adults. In this systematic review we aimed to explore these experiences from a first-person perspective through a synthesis of qualitative evidence.MethodsOur protocol development was guided by the PRISMA framework. A search strategy was implemented across three databases, and the evaluation of study quality was conducted using a standardized measure. A total of 11 studies exploring the experiences of anxiety in autistic adults from a first-person perspective were included in the review. Eligible research comprised qualitative and mixed methods studies where identifiable quotations from autistic adults were present. The study synthesized qualitative data from primary research published in English in peer-reviewed journals. The data extracted underwent analysis via thematic synthesis.ResultsFour descriptive themes were identified: “Describing Anxiety”, “Contributors to Anxiety”, “Impact of Anxiety” and “Managing Anxiety”. Three analytical themes were identified: “The Cyclical Nature of Anxiety”, “Feeling like the Other” and “Sensory Experiences as a Source and Expression of Anxiety”.ConclusionThe current qualitative literature suggests that autistic experiences of anxiety are cyclical in nature, with factors that both converge and diverge with the non-autistic experience. Feelings of Othering can contribute to these issues, as well as being a barrier to support, while sensory experiences can play a role in the development, maintenance and soothing of anxious experiences.<br/
Measurement of turbulent velocity and bounds for thermal diffusivity in laser shock compressed foams by x-ray photon correlation spectroscopy
No full textExperimental benchmarking of transport coefficients under extreme conditions is required for validation of differing theoretical models. To date, measurement of transport properties of dynamically compressed samples remains a challenge with only a limited number of studies able to quantify transport in high pressure and temperature matter. x-ray photon correlation spectroscopy utilizes coherent x-ray sources to measure time correlations of density fluctuations, thus providing measurements of length and timescale-dependent transport properties. Here, we present a first-of-a-kind experiment to conduct x-ray photon correlation spectroscopy in laser shock compression experiments. We report measurement of the turbulent velocity in the wake of a laser driven supersonic shock and place an upper bound on thermal diffusivity in a solid density plasma on nanosecond timescales
MAPK-driven epithelial cell plasticity drives colorectal cancer therapeutic resistance
No full textThe colorectal epithelium is rapidly renewing, with remarkable capacity to regenerate following injury. In colorectal cancer (CRC), this regenerative capacity can be co-opted to drive epithelial plasticity. While oncogenic MAPK signalling in CRC is common, with frequent mutations of both KRAS (40-50%) and BRAF (10%) 1, inhibition of this pathway typically drives resistance clinically. Given the development of KRAS inhibitors, and licensing of BRAF inhibitor combinations 2-4, we have interrogated key mechanisms of resistance to these agents in advanced preclinical CRC models. We show that oncogenic MAPK signalling induces epithelial state changes in vivo, driving adoption of a regenerative/revival stem like population, while inhibition leads to rapid transcriptional remodeling of both Kras- and Braf-mutant tumours, favoring a Wnt-associated, canonical stem phenotype. This drives acute therapeutic resistance in Kras- and delayed resistance in Braf-driven models. Importantly, where plasticity is restrained, such as in early metastatic disease, or through targeting ligand-dependent Wnt-pathway Rnf43 mutations, marked therapeutic responses are observed. This explains the super response to BRAF+EGFR targeted therapies previously observed in a BRAF/RNF43 co-mutant patient population, highlighting the criticality of cellular plasticity in therapeutic response. Together, our data provides clear insight into the mechanisms underpinning resistance to MAPK targeted therapies in CRC. Moreover, strategies that aim to corral stem cell fate, restrict epithelial plasticity or intervene when tumours lack heterogeneity may improve therapeutic efficacy of these agents. </p
Compression Hosiery to Avoid the Post-Thrombotic Syndrome: a synopsis of the CHAPS RCT
No full textBackgroundApproximately half of adults diagnosed with deep vein thrombosis will develop the post-thrombotic syndrome leading to chronic symptoms – including leg pain, oedema, venous ectasia and, in 5% of cases, venous ulceration. Risk factors include older age, obesity, a history of blood clots, cancer and heart failure. Despite adequate anticoagulation, post-thrombotic syndrome remains a chronic health condition with significant financial burden for patients and health services.The effectiveness of compression stockings in preventing post-thrombotic syndrome is unclear and whether the risks and costs associated with compression stockings are justified.DesignThe Compression Hosiery to Avoid Post-Thrombotic Syndrome study was a multicentre, pragmatic, assessor-blind, randomised controlled trial of adults with a first proximal deep vein thrombosis.SettingSecondary care National Health Service hospitals in the United Kingdom.ParticipantsPatients ≥ 18 years, with imaging-confirmed, symptomatic presentation of first deep vein thrombosis in the lower limb (popliteal, femoral, iliac or combination), ≤ 3 weeks from diagnosis.InterventionsParticipants were randomised 1 : 1 to standard care (anticoagulation as per local guidelines) or intervention (anticoagulation as per local guidelines and regular use of a graduated compression stocking).Primary outcomeThe primary outcome was any incidence of post-thrombotic syndrome using the Villalta criteria over a median of 18-month follow-up (range 6–30 months). This was planned to be assessed on up to three occasions (6 and 12 months post randomisation and at study end), depending on when an individual was randomised.Secondary outcomesPlanned secondary outcomes:incidence of venous ulceration (measured by the validated Villalta criteria)employment status (change in the number of days working from baseline)change in disease-specific and generic quality of life – Venous Insufficiency Epidemiological and Economic Study (VEINES-QOL/Sym) and EuroQol-5 Dimensions scales from baseline over 6 months, 12 months and end of study visitadherence to stockings and anticoagulants (patient self-report)cost-effectiveness of stocking prescription – incremental cost-effectiveness ratio from the EuroQol-5 Dimensions questionnaire, with appropriate sensitivity analysis.ResultsThe trial closed early due to poor recruitment during the COVID-19 pandemic; and, of the planned sample size of 864, 152 participants were randomised. Post-thrombotic syndrome occurred in 51% of the control arm and in 30% of the intervention arm at last follow-up. No serious adverse events relating to stockings were recorded. Stocking adherence was a mean of 6 days (standard deviation 2) per week.ConclusionsThe sample size was not reached, which precluded any formal statistical analysis. Although a difference in the incidence of post-thrombotic syndrome was demonstrated, the effect size could not be determined. There is interest in understanding optimal strategies for the prevention of post-thrombotic syndrome in these patients and a re-run of this trial should occur.LimitationsThe main limitation was its early termination. As a result, it did not reach the required sample size to draw any adequately powered conclusions. The analyses are descriptive and therefore we cannot determine whether there were any differences between trial arms.Future workAnswering the question of whether graduated compression stockings help prevent the post-thrombotic syndrome is important to both patients and clinicians
AI-driven transformation of cost management in Qatar’s construction industry: opportunities, challenges, and future directions
No full textThis study aims to explore the transformative potential of Artificial Intelligence (AI) in enhancing cost planning and control within Qatar’s construction industry. By examining both opportunities and challenges associated with the adoption of AI, it seeks to uncover that AI can lead to significant improvements in accuracy in cost estimates and optimisation of various resources. The nation faces significant cost-overruns influenced by delays, shifting market conditions, and although AI has demonstrated its benefits in cost-control management globally, there is a lack of research on its practical applications in Qatar’s construction industry. Existing practical applications are more likely to experience errors due to them requiring manual labour and limited pattern recognition. Meanwhile, this study attempts to align AI-driven advancements with Qatar’s Vision 2030, which emphasises sustainable development and economic diversification. It adopts an analysis of semistructured interviews with a group of experienced professionals from leading construction companies in Qatar, giving a comprehensive picture of the current landscape and future prospect for AI in the construction industry. The findings of this study reveal that AI technologies can significantly mitigate common issues in the construction industry, such as cost overruns, project delays, and resource wastage. On the other hand, this study identifies various obstacles that inhibit AI adoption, including high financial costs and insufficient training data. By weaving together theoretical understandings and practical experiences, it highlights the importance of integrating AI technologies within existing workflows while addressing key concerns
Pinching-antenna systems (PASS): power radiation model and optimal beamforming design
No full textPinching-antenna systems (PASS) improve wireless links by configuring the locations of activated pinching antennas along dielectric waveguides, namely pinching beamforming. In this paper, a novel adjustable power radiation model is proposed for PASS, where power radiation ratios of pinching antennas can be flexibly controlled by tuning coupling spacing between pinching antennas and waveguides. The closed-form coupling spacings are derived to achieve flexible and equal-power radiation. Based on the commonly-assumed equal-power radiation, a practical PASS framework relying on discrete activation is considered, where pinching antennas can only be activated among a set of predefined locations. A transmit power minimization problem is formulated, which jointly optimizes the transmit beamforming, pinching beamforming, and the numbers of activated pinching antennas, subject to each user’s minimum rate requirement. (1) To obtain globally optimal solutions of the resulting highly coupled mixed-integer nonlinear programming (MINLP) problem, branch-and-bound (BnB)-based algorithms are proposed for both single-user and multi-user scenarios. (2) A low-complexity many-to-many matching algorithm is further developed. Combined with the Karush-Kuhn-Tucker (KKT) theory, locally optimal and pairwise-stable solutions are obtained within polynomial-time complexity. Simulation results demonstrate that: (i) PASS significantly outperforms conventional multi-antenna architectures, particularly when the number of users and the spatial range increase; and (ii) The proposed matching-based algorithm achieves near-optimal performance, resulting in only a slight performance loss while significantly reducing computational overheads. Code is available at https://github.com/xiaoxiaxusummer/PASS_Discrete
A comparative study of non-linear car following models in Real-Driving Scenarios
No full textCar following models (CFMs) are the most prominent microscopic traffic flow models that capture the follower behaviour through detailed representation of leader–follower interactions. Models vary in their interaction logic, but it is generally assumed that all established models can produce realistic vehicle responses under real-world driving conditions. In this study, the efficacy of three well-established CFMs—nonlinear Newell model, the Optimal Velocity Model (OVM), and the intelligent driver model is evaluated in real driving conditions represented by Worldwide harmonized light vehicle testing cycles (WLTC). The choice of leader vehicle profile such as WLTC, captures speed variations corresponding to driving conditions such as rural, urban and highway. The model responses to WLTC were investigated for extreme behaviour analysis, characterized by high acceleration or jerk values. Model robustness is compared using nominal range sensitivity analysis and the response surface method, yielding insights into reducing model complexity during calibration exercises. The results reveal OVM to be the least robust model of the three. The findings highlight unphysical and unrealistic model outputs, offering critical insights to inform model selection and guide improvements for more accurate and reliable microscopic traffic simulations