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What are we missing? Reflections on the ‘problem’ of missed appointments in the UK
Get PDFBackground:
Tackling missed appointments has become a prominent part of
conversations about the ‘recovery’ of the UK NHS from the COVID-19
pandemic. With long waiting lists, delays in access to primary care,
and overburdened staff, it seems logical that efforts should be made
to reduce the time lost to unused appointment slots. Yet care needs to
be taken to reflect on how and why missed appointments have
become an area of focus, and to be transparent about what this
means for patient care and health inequalities. This article provides a
critical perspective on the current mainstream approach to missed
appointments in policy, research and practice.
Methods:
The study applies Bacchi’s “what is the problem represented to be”
method of policy analysis to provide critical commentary on findings
from a realist review of 253 documents; interviews with 61 ‘key
informants’ whose personal and professional experiences relate to
missingness; and a series of co-design workshops with a Stakeholder
Advisory Group of 16 professionals and experts-by-experience. It also includes an informal analysis of national news media and NHS news
pieces covering missed appointments since 2015.
Results:
Analysis identified a consistent approach to missed appointments
across research, practice and media and policy statements. This
approach focuses on the impacts of missed appointments for services;
places responsibility on the shoulders of patients; and limits
interventions to things that seek alter their behaviours in pursuit of a
service-wide reduction in missed appointments. The hegemony of this
approach is sustained by research that has failed to adequately
engage with the most marginalised patients; failed to explore causes
in depth; and failed to include an inequalities lens in its approach to
interventions. We propose an alternative viewpoint – applying a
missingness lens – built from an alternative evidence base that
combines critical literature review, qualitative interviews, and
participatory methods with those experiencing missingness and with
key professionals.
Conclusions:
Embedding an alternative perspective in practice and in research has
significant potential as a non-stigmatising, inequalities-based and
effective approach to understanding and addressing missed
appointments
Gilded decades: a celebration of Plasma Physics marking the 50th anniversary of the Plasma Physics Group Annual Conference
No full textA review of the key steps in the evolution of plasma physics across the last 8 decades, from magnetic and laser fusion, to plasma processing and low temperature plasma applications
RAR: Reversing Visual Attention Re-Sinking for Unlocking Potential in Multimodal Large Language Models
Get PDFMultimodal Large Language Models (MLLMs) have achieved remarkable success in vision-language tasks, yet they frequently exhibit suboptimal output layers, where intermediate decoder layers outperform the final ones, signaling underutilized model capacity. In this work, we delve into the root causes and attribute this issue to the Visual Attention Re-sinking phenomenon, precipitated by attention gradient sparsity driven by textual supervision dominance. This degradation causes attention heads to evolve into sink heads that prioritize low-semantic backgrounds, thereby disrupting modality fusion, neglecting visual information, and biasing outputs toward textual priors, ultimately impairing model performance. To mitigate this, we introduce a parameter-free Sink Attention Dynamic Sparsification (SADS) framework that dynamically identifies and retains all vision heads(concentrating visual attention on semantically relevant regions) while sparsifying sink heads, preserving essential global context through a shared head. Integrated into diverse MLLMs, our framework yields substantial performance gains across 20 benchmarks spanning five task categories (visual grounding, general VQA, OCR-related VQA, vision-centric tasks, and visual hallucination mitigation) surpassing supervised fine-tuning while boosting inference speed by 10.3%. This approach offers a novel avenue for maximizing MLLMs capabilities
Security and privacy in O-RAN for 6G: a comprehensive review of threats and mitigation approaches
No full textOpen Radio Access Network (O-RAN) is a major advancement in the telecommunications field, providing standardized interfaces that promote interoperability between different vendors’ technologies, thereby enhancing network flexibility and reducing operational expenses. By leveraging cutting-edge developments in network virtualization and artificial intelligence, O-RAN enhances operational efficiency and stimulates innovation within an open ecosystem. In the context of 6G, the potential capabilities of O-RAN have been significantly expanded, enabling ultra-reliable low-latency communication, terabit-level data rates, and seamless integration of terrestrial and non-terrestrial networks. Despite these benefits, its open architecture paradigm also brings critical security and privacy challenges, which, if not addressed, could compromise network integrity and data confidentiality. This paper conducts a comprehensive investigation into the security vulnerabilities and privacy issues associated with the O-RAN architecture in the context of the evolving 6G landscape, systematically categorizing fundamental vulnerabilities, meticulously examining potential attack vectors, and assessing current and future threats. In addition, this study also examines the existing and emerging security mechanisms of O-RAN and reviews the ongoing standardization activities aimed at strengthening the O-RAN security framework
Genetic evidence for GLP1R agonists in non-ischaemic heart failure
No full textBackground: Glucagon-like peptide-1 receptor (GLP1R) agonists reduce cardiovascular events in patients with obesity and diabetes, and recent trials demonstrate symptomatic and functional benefits in heart failure with preserved ejection fraction (HFpEF). Whether these benefits reflect glycaemic control, weight reduction, or additional mechanisms remains uncertain.
Methods: We performed drug-target Mendelian randomization (MR) using genetic variants in the GLP1R locus to proxy GLP1R activation. MR estimates for GLP1R agonism were scaled to per 0.1 log-odds lower liability to type 2 diabetes (T2DM) and compared with general type 2 diabetes (T2DM) or body mass index (BMI) lowering effects. Summary statistics were obtained from the largest available GWAS of HF, non-ischaemic HF (ni-HF), ni-HFpEF, ni-HFrEF, and atrial fibrillation (AF). Primary inverse-variance weighted analysis was adjusted for multiple testing and validated via weighted median and MR-Egger sensitivity analyses.
Results: Genetically proxied GLP1R activation was associated with lower risk of overall HF (OR 0.96 [95% CI 0.95–0.98], p=0.0002), ni-HF (0.94 [0.91–0.96], p=0.0001), and ni-HFpEF (0.82 [0.74–0.90], p=0.0001) per 0.1 log-odds lower T2DM liability. The GLP1R-proxied effects were greater than those expected from glycaemic lowering alone and were of comparable magnitude to those from BMI reduction. Associations for ni-HFrEF were directionally adverse but not significant. AF showed a nominal, exploratory association consistent with BMI lowering and driven by a single cis-BMI variant.
Conclusions: This study provides genetic support for a protective association between GLP1R activation and HF, particularly ni-HFpEF, with effects beyond glycaemia. The magnitude and subtype specificity are consistent with contemporary trial evidence and support further evaluation of GLP1R agonism in cardiometabolic HFpEF
Theory of mind on demand: do we prepare or react?
Get PDFReasoning about others’ thoughts, emotions, or intentions is a sophisticated human ability. Modelling such a complex phenomenon with limited available resources is a challenging pursuit. This work proposes the hypothesis of demand-driven and reactive ToM in humans as an additional strategy to establish sufficient mental inferences in complex social spaces. The authors consider a perspective of bounded rationality and cognitive costs in conceptualising ToM and understanding how humans form, maintain, and reason with models of others efficiently and effectively. This study presents qualitative data exploring what patterns in human ToM may allow humans to quickly and seemingly effortlessly perform the complex task of inferring other people’s mental states. The results consist of several themes, which point to various heuristics that may be employed in shaping tractable ToM mechanisms. In conclusion, this qualitative approach to understanding ToM efficiency shaped the hypothesis of reactive ToM mechanisms human cognition, which needs to be tested in confirmatory quantitative studies. Study limitations, implications for modelling, and directions for future research are discussed
Mechano-adaptation of adipose tissue: ECM-mediated control of obesity and breast cancer progression
Get PDFObesity triggers ample reorganization of adipose tissue through mechanical and biological mechanisms that extend beyond simple energy storage. Here, we analyse how the extracellular matrix (ECM) mechanically controls obesity's effects on tissue function. We examine three interconnected mechanisms: first, how obesity triggers cellular adaptations through hypertrophy, hyperplasia, and phenotypic transitions; second, how these changes activate specific mechanosensitive pathways through ECM-generated forces; and third, how the resulting matrix alterations promote breast cancer progression through coordinated changes in adipocyte phenotype and tissue mechanics. We critically evaluate current in vitro models for studying these processes and discuss their limitations in recapitulating the complex adipose-tumour microenvironment. By elucidating these ECM-mediated mechanisms, we identify potential therapeutic targets for obesity-related pathologies, particularly breast cancer, while noting the broader applicability of these mechanobiological principles to other adipose-associated malignancies
OsKAT1 is a short Shaker potassium channel involved in root-to-shoot potassium translocation and contributes to rice grain yield
Get PDFShaker potassium channels play essential roles in K⁺ uptake and distribution in plants. Studies on Shaker channels in Arabidopsis have provided a paradigmatic framework, but the rice genome encodes an additional member, OsKAT1, whose function remians poorly defined. OsKAT1-type channels are characterized by an innately short cytosolic C terminus, forming a unique clade of monocot-specific short Shakers that is prevalent in Poaceae species. In rice, OsKAT1 is predominantly expressed in the root stele. Disruption of OsKAT1 (KO mutation) leads to a significant reduction in K⁺ secretion into the xylem sap delivered to the shoot. Patch-clamp experiments on root stele protoplasts of WT and KO plants indicate that OsKAT1 functions as an inward channel. Functional analyses in Xenopus oocytes reveal that despite activating at weakly negative voltages, OsKAT1 is intrinsically incapable of mediating substantial outward currents—a property attributed to its truncated C terminus. Together with outward K⁺ channel activity, this feature enables stelar cells to remain significantly permeable to K⁺ around the K⁺ equilibrium potential. When expressed in Arabidopsis, OsKAT1 contributes to K⁺ transport in the xylem sap, but only in wild-type plants that express SKOR, a Shaker channel specialized for this role. These results demonstrate that OsKAT1 constitutes a component of K⁺ translocation to shoots and shed light on the energization and regulation underlying this function. Moreover, OsKAT1 is shown to improve rice adaptation to environmental conditions and enhance grain yield under field conditions through its facilitating root-to-shoot ion translocation
A critical review of cushion gas in underground hydrogen storage: Thermophysical properties, interfacial interactions, and numerical perspectives.
Get PDFUnderground hydrogen storage (UHS) represents a large-scale energy storage system, aiming to ensure a consistent supply by storing hydrogen generated from surplus energy. In the practice of UHS, cushion gas is typically injected into the formation to maintain reservoir pressure for efficient hydrogen withdrawal. This paper reviews the impact of cushion gas on the performance of UHS from both experimental and numerical simulation perspectives. The thermophysical (e.g., density, viscosity, compressibility, and solubility) and petrophysical (interfacial tension, wettability, and relative permeability) properties, as well as the mixing and diffusion behavior of different cushion gases, were compared. The corresponding impact of different cushion gases on plume migration and trapping potential is then discussed. Furthermore, this review critically analyzes and explains the impact of various factors on the performance of UHS, including the type of cushion gas, the composition of cushion gas mixtures, the volume of injected cushion gas, and the effects of bio-methanation processes. The corresponding analysis specifically focuses on key performance indicators, including H₂ recovery factor, formation pressure, brine production, and H₂ outflow purity. Thus, this review provides a comprehensive analysis of the role of cushion gas in UHS, offering insight into the effective management and optimization of cushion gas injection in field-scale UHS operations
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