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“Who am I to say that I'm not going to take it”: patient perspectives on decisions about antithrombotic therapy in the context of advanced cancer
Get PDFIntroduction: The decision to reconsider antithrombotic therapy (ATT) in cancer patients nearing the end of life is complex given the increasing risk of haemorrhage and thrombosis. A decision support tool (DST) is being developed to facilitate this process. Understanding patients' experiences, values, and perspectives are an essential component, yet remain largely unexplored. Aim: To explore these patients' experiences, values and perspectives regarding ATT use. Methods: Qualitative study using semi-structured interviews with patients with advanced cancer receiving ATT, across Denmark, France, Spain, and the United Kingdom. Data were analysed using Framework Analysis. Results: Sixty patients and 13 relatives participated. Three major themes were generated: 1. ATT is important and lifelong: Deprescription was perceived as counterintuitive; continuation was preferred, providing a sense of security. 2. Varying perspectives regarding roles and responsibilities in ATT decision-making: Patients' views regarding their role varied. When a good relationship existed with their clinician, patients trusted them to lead on the decision. Relatives played a key supportive role. 3. Challenges in navigating ATT management in the context of advanced cancer and multiple comorbidities: Decisions relating to ATT were rarely made in isolation. Patients prioritised cancer management and described difficulties navigating multiple health concerns. Conclusion: Patients found decision-making around ATT near the end of life multifaceted, occurring amid a myriad of competing priorities. While patients reported a reticence to discontinuing, ultimately many deferred such decisions to a clinician, whose role was highly valued. These findings support a need for a DST, to support informed and shared choices in ATT decisions
Implementing breathlessness self-management in low- and middle-income countries: co-design of breathlessness self-management resources for use in India
Get PDFBreathlessness is prevalent in societies worldwide, with widespread health and socioeconomic impacts. Breathlessness self-management interventions developed in high-income countries (HICs) are promising but require contextual adaptation for low- and middle-income countries (LMICs) like India, where cultural beliefs, language, and delivery systems differ. We co-designed breathlessness self-management resources for use in India using a programme theory approach and Community-Based Participatory Research methods. We convened three stakeholder groups (Doctors (n = 9), Nurses and allied health (n = 6) and lived experiences (n = 9)) and added a fourth group (community health workers (n = 6)) based on emerging findings. We re-analysed 104 academic and lay sources identified iteratively and systematically by the Breathe-India project and presented evidence to stakeholder groups for discussion and feedback. Three rounds of online/face-to-face stakeholder workshops. Stakeholders reviewed evidence, developed shared definitions, and iteratively co-designed intervention components. Stakeholder engagement and evidence synthesis led to identification of seven key domains informing the intervention: (1) Identifying breathlessness— teach the difference between acute and persistent breathlessness (and acute-on persistent breathlessness); (2) Developing shared language—emphasising lived experience of breathlessness in simple, translatable language; (3) Addressing fear—teaching accessible methods (e.g. facial cooling) for regaining control that build confidence; (4) Building resilience—reframing activity as safe and beneficial; (5) Daily coping strategies—aligning with local beliefs and behaviours, e.g. inclusion of nutritional ‘dos and don’ts’; (6) Delivery through community infrastructure—teaching Accredited Social Health Activists (ASHAs) how to identify breathlessness in communities and challenge unhelpful beliefs—at the point of care. Outputs included training curricula, educational resources, and public-facing materials co-developed with ASHA trainers and stakeholders. We co-designed India’s first multicomponent, community-deliverable breathlessness self-management intervention using participatory methods and theory-driven processes. Implementation-effectiveness hybrid evaluation is needed to test feasibility, acceptability, and impact on patients and families
Establishing Flow through education: supporting learners who have experienced complex trauma.
Get PDFThis article provides a series of fictitious case studies as vignettes to exemplify how educators can support complex trauma impacted children in school to establish Flow. Flow contributes to effective immersion in learning, where educators can quickly recognise states and emotions which disrupt the Flow, and can lead to disengagement in learning. Through consideration of the case studies, educators can envisage solutions to challenges they face in their learning spaces, and most importantly support learners impacted by complex trauma to get the most out of their education and to reach their potential. This is more than Trauma Informed Practice; it is a social-emotional- psychological-physiological theory that underpins and supports daily educational practices with children and youth
Impacts of Foreign Direct Investment on Economic Growth in China
Get PDFImpacts of inward FDI on economic growth are assessed in the case of large developing countries, China and India. The underlying analytical structure is based on the Solow model. FDI complements to main factors of production, labour and capital and leads to GDP growth. Comprehensive evidence-based suggestions are provided that can be useful for making policies that spur the long-term growth for the benefit of all people in such emerging economies
Evaluation of Bending Deformations in Slender Cylindrical Structures Using Distributed Optical Fibre Strain Sensing
Get PDFStructures with slender cylindrical geometries, such as subsea power cables are critical components of infrastructure systems. These structures are prone to bending deformation under load, which can ultimately cause structural failure. In this study, distributed optical fibre sensors are used to monitor the bending deformation in slender cylindrical structures. Brillouin optical time-domain reflectometry-based strain sensing was used to experimentally study three-point bending and approximately constant curvature bending of a 6 m long circular hollow section (CHS). Optical fibres were attached to the outer surface of the CHS in two different configurations: parallel to the longitudinal axis and helically wound around the CHS. Strain responses due to changing magnitudes of deformation and changing orientation of the optical fibre around the circumference of the CHS were studied. A finite element model was employed to simulate and interpret the observed strain responses. A strain response inverse analysis was conducted using the strain data obtained from the experimental study to reconstruct the deformed shapes of the CHS. Both the longitudinally aligned and helically wound fibres showed distinct strain profiles that differentiate the three-point bending and constant curvature bending behaviours. The results revealed the ability of optical fibre sensing to evaluate the type; magnitude; and orientation of the bending deformations. This fundamental understanding supports the design of sensing systems for critical cylindrical infrastructure
ICONQUER: A Transformer-based Instruction-finetuned Context-aware Medical Question Answering Model with Knowledge Graph Augmentation
Get PDFMedical Question Answering (MQA) systems are vital for clinical decision support, yet most existing models struggle with complex query processing, fine-grained context awareness, and explainability. This study introduces ICONQUER, a transformer-based MQA model that integrates instruction-finetuned embeddings and knowledge graph (KG) augmentation to improve semantic coherence, contextual relevance, interpretability and response accuracy. We designed five sequential experiments to evaluate ICONQUER across MedQA and HotPotQA datasets: (i) representation analysis of multiple embeddings, (ii) answer generation on MedQA development data, (iii) validation on the MedQA test set, (iv) robustness testing with external biomedical knowledge sources (Wikipedia, BioPortal), and (v) cross-domain generalization on HotPotQA. Results show that ICONQUER achieves the strongest semantic alignment (cosine similarity = 0.9446 on MedQA train; 0.9387 on MedQA test; 0.914 on HotPotQA), consistently outperforming state-of-the-art MQA systems leveraging E5, BioBERT, and BERT-Large baselines. While external knowledge enrichment yielded limited benefits, knowledge graph integration substantially improved interpretability and the capture of semantic relationships. This advancement enabled more contextually precise answers, positioning ICONQUER as a promising tool for clinical decision-making. Future work will extend ICONQUER by incorporating broader biomedical ontologies (e.g., SNOMED CT, UMLS), clinical trial repositories, and electronic health records. These enhancements aim to improve adaptability across medical subfields and to strengthen explainability through intuitive medical reasoning, thereby supporting global applicability. Further efforts will address the integration of advanced AI techniques, reinforcement of data security, support for multilingual use, and improvements in transparency and flexibility
Dementia risk prediction: A comparative analysis of the ANU-ADRI, CAIDE, CogDrisk, LIBRA, and LIBRA2 indices in the HUNT study
Get PDFBACKGROUND/OBJECTIVE: Dementia is a major global health concern, necessitating effective risk assessment tools and early intervention. This study compared the performance of five modifiable dementia risk indices - ANU-ADRI, CAIDE, CogDrisk, LIBRA, and LIBRA2 and a "demographics-only" (age, education) model. METHODS: We analyzed data from 5247 Norwegian participants in the Trøndelag Health Study (HUNT4 70+, 2017-2019) and dementia risk indices from baseline data in HUNT3 (2006-2008). Logistic regression models assessed associations between standardized index scores and all-cause dementia and Alzheimer's disease (AD) across age group (<65 vs. ≥65 years), sex, and APOE4 status. RESULTS: During the mean follow-up of 10.6 (9.3-12.3) years (SD=0.74), all indices significantly predicted dementia and AD, though none outperformed the demographics-only model. CogDrisk showed significantly better discriminative ability than all other indices (0.76, 95 % CI:0.74-0.78; DeLong p < 0.05), followed by LIBRA (0.75, 95 % CI:0.72-0.77) and ANU-ADRI (0.74, 95 % CI:0.72-0.76). LIBRA2 (0.69, 95 % CI:0.66-0.71) and CAIDE (0.59, 95 % CI:0.56-0.61) had significantly lower accuracy (DeLong p < 0.001). Removing demographics maintained rank order but reduced accuracy across all indices. Stratified analyses showed stronger performance in those ≥65 years and females at HUNT3, while APOE4 status did not affect performance. CONCLUSION: All indices were associated with dementia risk, with CogDrisk performing best across all conditions, and LIBRA2 and CAIDE performing weakest. No index outperformed a model including age and education only. Future research should refine risk indices for age- and sex-specific applications and assess whether simpler demographic models may suffice in some contexts
Coaching and Mentoring to develop learner autonomy for non-traditional (WP) students. A guide for HE educators
No full textThis resource explores the role of coaching and mentoring in developing learner autonomy within higher education, with particular focus on supporting non-traditional and widening participation students
A healthier future: A long-term vision to tackle alcohol harm in the UK
No full textExecutive Summary:Alcohol harm is a serious and growing concern in the UK, impacting people’s health and wellbeing, the NHS, social services, criminal justice, and our economy. These impacts are felt most by people on low incomes or who live in deprived areas.With the last UK alcohol strategy published in 2012, and alcohol deaths at an all-time high, the time for meaningful, evidence-based policy action is now. The limited commitments to prevent alcohol harm in the 10 Year Health Plan are driving calls for a standalone strategy to get to grips with the alcohol emergency. This document, developed by a broad range of experts in alcohol policy, research, and treatment, offers a blueprint for achieving long-term progress