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Optimising the delivery and impacts of interventions to improve hospital doctors’ workplace wellbeing in the NHS: The Care Under Pressure 3 realist evaluation study
Get PDFBackground: The key role of medical workforce well-being in the delivery of excellent and equitable care is recognised internationally. However, doctors are known to experience significant mental ill health and erosion of their well-being due to challenging demands and pressurised work environments. Existing workplace support strategies often have limited effect and do not consider the multiple factors contributing to poor well-being in doctors (e.g. individual, organisational and social), nor whether interventions have been implemented effectively. Aim: To work with, and learn from, diverse hospital settings to understand how to optimise strategies to improve doctors’ workplace well-being and reduce negative impacts on the workforce and patient care. Design and method: Three inter-related sequential phases of research activity: • Phase 1: a typology of interventions and mapping tool to improve hospital doctors’ workplace well-being based on iterative cycles of analysis of published and in-practice interventions and informed by relevant theories and frameworks and engagement with stakeholders. • Phase 2: realist evaluation consistent with Realist And MEta-narrative Evidence Syntheses: Evolving Standards quality standards of existing strategies to improve hospital doctors’ workplace well-being in eight purposively selected acute National Health Service trusts in England based on 124 interviews with doctors, well-being intervention implementers/practitioners and leaders. • Phase 3: codeveloped implementation guidance for all National Health Service trusts to optimise their strategies to improve hospital doctors’ workplace well-being – drawing on phases 1 and 2, and engagement with stakeholders in three online national workshops. Results: • Phase 1: although many sources did not clarify their underlying assumptions about causal pathways or the theoretical basis of interventions, we were able to develop a typology and mapping tool which can be used to conceptualise interventions by type (e.g. whether they are designed to be largely preventative or ‘curative’). • Phase 2: key findings from our realist interviews were that: (1) solutions needed to align with problems to support doctor’s well-being and avoid harm to doctors; (2) involving doctors in creating solutions was important to address their well-being problems; (3) doctors often do not know what well-being support is available and (4) there were physical and psychological barriers to accessing well-being support. • Phase 3: our ‘Workplace well-being MythBuster’s guide’ provides constructive evidence-based implementation guidance, while authentically representing the predominantly negative experiences reported in phase 2. Limitations: Although we sampled for diversity, the eight trusts we worked with may not be representative of all trusts in England. Conclusions: Misaligned well-being solutions can cause harm. It is paramount to prioritise improvements in working environments, instead of well-being ‘add-on’s, and to involve doctors and other relevant staff in identifying problems and in planning how to address these. Future work: Further research is required to tailor the findings to primary care, mental health and social care settings. Health economic studies of well-being interventions (ideally, at systems level) are urgently required, since small investments could have far-reaching positive impacts
Economic and Life Cycle Assessment of novel hybrid energy and fuel generation systems from municipal waste through plasma gasification and anaerobic digestion coupled with carbon capture and storage
Get PDFAchieving climate goals demands novel system designs that enable the conversion of municipal waste, such as plastic and food waste into energy and fuels with minimal environmental impact. This study proposes an innovative multi-energy generation system that integrates plasma gasification for plastic waste and anaerobic digestion for food waste, coupled with carbon capture and storage (CCS) technologies. This novel conceptual design aims to maximize energy recovery while reducing lifecycle emissions compared to conventional waste-to-energy (WtE) pathways. Two novel system configurations were assessed: (1) a combined cooling, heating, and power (CCHP) system, and (2) a CCHP system integrated with liquid biomethane production. Each configuration was evaluated under three CCS strategies: no CCS, pre-combustion CCS, and post-combustion CCS. The economic analysis and life cycle assessment (LCA) highlight the economic and environmental trade-offs of each design. Specifically, in Scenario 1, the levelized cost of electricity (LCOE) increases from 0.171 USD/kWh (no CCS) to 0.311 and 0.354 USD/kWh while in Scenario 2, the levelized cost of biomethane (LCObM) rises from 0.176 USD/kWh to 0.314 and 0.374 USD/kWh for pre- and post-combustion CCS, respectively. While CCS raises production costs, they also represent a tangible commitment to reducing emissions and underscore that transitioning to cleaner energy systems often entails higher near-term expenditures. Across both scenarios, the levelized cost of waste treatment (LCOWT) spans 0.081–0.236 USD/kg of waste. Global warming potential (GWP) ranges from −0.191 to 0.662 kgCO2-eq/kg of feedstock for Scenario 1, and 0.123 to 0.746 kgCO2-eq/kg for Scenario 2. This work provides the first integrated assessment of such a hybrid WtE system, offering new insights for sustainable waste valorisation. The proposed novel designs support future detailed engineering studies and inform policymaking for low-carbon waste management
SmartRead: A Multimodal eReading Platform Integrating Computing and Gamification to Enhance Student Engagement and Knowledge Retention
Get PDFThis paper explores the integration of computing and multimodal technologies into personal reading practices to enhance student engagement and knowledge assimilation in higher education. In response to a documented decline in voluntary academic reading, we investigated how technology-enhanced reading environments can re-engage students through interactive and personalized experiences. Central to this research is SmartRead, a proposed multimodal eReading platform that incorporates gamification, adaptive content delivery, and real-time feedback mechanisms. Drawing on empirical data collected from students at a higher education institution, we examined how features such as progress tracking, motivational rewards, and interactive comprehension aids influence reading behavior, engagement levels, and information retention. Results indicate that such multimodal interventions can significantly improve learner outcomes and user satisfaction. This paper contributes actionable insights into the design of innovative, accessible, and pedagogically sound digital reading tools and proposes a framework for future eReading technologies that align with multimodal interaction principles
Unravelling the Sequence and Timing of Fault-Related Deformation in Superimposed Rift Basins, Inner Moray Firth, NE Scotland
Get PDFDevonian rocks of the Palaeozoic Orcadian Basin are well exposed along the northern flanks of the younger Mesozoic to Cenozoic Inner Moray Firth Basin in Scotland. These rocks preserve a succession of structures related to superimposed rifting and inversion events spanning nearly 400 Myrs. We combine new detailed field observations augmented by drone photography and the creation of 3D digital outcrops, coupled with U-Pb geochronology of syn-faulting calcite-mineralized veins to better constrain the absolute timing of fault movements and decipher the kinematic history of basin opening and inversion.Using this approach, we were able to isolate characteristic structures, fault kinematics, fault rock development and associated mineralization types related to five regional deformation events: (1) Devonian transtensional rifting associated to sinistral Great Glan Fault movements leading to the development of the Orcadian Basin; (2) Late Carboniferous inversion related to dextral Great Glen Fault reactivation; (3) minor N-S, possibly Permian calcite veins; (4) Late Jurassic–Early Cretaceous rifting related to the development of the IMFB; and finally, (5) Cenozoic uplift, reactivation, and local inversion. Our study demonstrates the utility of microstructurally constrained U-Pb geochronology of fault-related calcite mineralization. Applied elsewhere, our methodology has the potential to give consistent and regionally significant new insights into the nature and timing of superimposed rift-related deformation processes worldwide
Volcanic eruptions and the global subsea telecommunications network
Get PDFWhen the first transoceanic telegraph cables were laid in the mid-1800s, rapid communication between continents became possible. The advent of fibre-optic submarine cables in the 1990s catalyzed a global digital revolution. Today, a network of > 1.7 million kilometres of fibre-optic cables crosses the oceans, carrying more than 99% of all digital data traffic worldwide and trillions of dollars in financial transactions. These arteries of the global internet underpin many aspects of our daily lives, and are particularly important for remote island communities that rely on submarine cables for telemedicine, e-commerce, and online education. However, these same remote communities are often in seismically and volcanically active regions and can be prone to natural hazards that threaten their critical subsea communication infrastructure. This vulnerability was acutely exposed in January 2022, when the collapse of the eruption plume of Hunga Volcano triggered fast-moving density currents that damaged Tonga’s only international submarine cable, cutting off an entire nation from global communications in the midst of a volcanic crisis. Here, we present a new comprehensive analysis of damage to subsea communications cables by volcanic events from around the world, and document their diverse impacts. Examples include (i) severing of the telegraph cable crossing the Sunda Strait by a tsunami triggered by the 1883 Krakatau eruption, Indonesia; (ii) ocean-entering pyroclastic density currents, lahars, and landslides during the 1902 eruptions of Mount Pelée, Martinique, that damaged six telegraph cables; (iii) destruction of a cable landing station on Montserrat by a pyroclastic density current in 1997; (iv) submarine slope failure at Kick ‘em Jenny, Grenada, that damaged two fibre-optic cables; (v) complete loss of the telecommunications network due to power outages following the 2000 eruption of Miyake-jima, Japan; and (vi) disruption to subsea cables resulting from the 2021 eruption of La Soufrière, St. Vincent. We find that the causes of damage typically relate to secondary hazards that occur not only at the same time as the eruption climax, but also some time after. There does not appear to be an explosivity intensity threshold for cable-damaging events; however, the extent of damage may be related to the original volcano morphology (e.g. steep slopes), spatial location (e.g. near the coast or partially/totally submerged), the eruption size or explosivity, and/or volcanic depositional processes involved. Based on these diverse case studies, we present lessons learned for enhancing telecommunications resilience, and discuss how subsea cables themselves can be used as sensors to improve understanding and early warning of volcanic hazards, potentially filling a monitoring gap for remote island communities
Skeletal age prediction models by maturity status in male soccer players.
Get PDFThis study focus is to develop a new model to estimate skeletal age (SA) as a function of the state of biological maturation in male soccer players, and to propose cut-off points to classify the state of biological maturation based on the percentage of adult height (PAH) in male soccer players. SA was determined in 747 Portuguese male soccer players, using the Tanner-Whitehouse (TW) 3 method, and PAH was predicted by TW3 (P-TW3) and Khamis-Roche (P-KR) methods. Subsequently, the sensitivity and specificity of the P-TW3 were estimated to classify late, on-time and early maturers to obtain cut-off points, by age; and to develop specific equations for each maturation stage. Both the model using P-TW3 and the model using P-KR showed a SA predictive capacity of 93%. The average differences were similar to zero. P-TW3 cutoff points were established by ROC curve analysis to identify late and early maturers according to their SA. Following, predictive models were developed to estimate SA according to maturity status. The predictive capacity of the models was 87.3% in late maturers, 92.3% in early maturers and 93.5% in early maturers. The prediction models are a reliable and cost-effective method to estimate SA in male soccer players
Byte Latent Mamba with State Space and Knowledge Distillation for Hyperspectral Image Classification
Get PDFHyperspectral image classification (HSIC) is a challenging task due to the high dimensionality of hyperspectral data, the complex interplay of spatial and spectral features, and the scarcity of annotated samples. Existing approaches, mainly based on tokenization-based feature extraction, introduce artificial segmentation, increasing computational cost, and may lead to information loss. To address these issues, a novel framework, byte latent Mamba with knowledge distillation (BLM-KD), which overcomes explicit tokenization by directly learning byte-level spectral–spatial representations from raw hyperspectral data, is proposed. The byte latent Mamba architecture learns compact and expressive byte-level features through an end-to-end convolutional encoder, preserving spectral continuity and spatial structure. A structured state-space model (SSM) is integrated to model long-range spatial–spectral dependencies efficiently via learned dynamic state transitions. Additionally, an adaptive knowledge distillation (KD) strategy is adopted, where a high-capacity teacher model selectively transfers salient features to a lightweight student model, driven by a temperature-controlled weighting schedule. This ensures robust generalization with reduced model complexity. A patch-based preprocessing scheme also excludes irrelevant zero-labeled samples, refining the training process. Extensive experiments conducted on multiple real-world hyperspectral benchmarks demonstrate that BLM-KD outperforms existing state-of-the-art methods in both classification accuracy and computational efficiency
Evaluating the impact of child labour bans for Malawi’s Southern Region tea and tobacco communities
Get PDFThis thesis investigates the lived experiences of children and their families within tea and tobacco-growing communities in southern Malawi following the ban on children working on adjacent commercial plantations during the early 2000s. Using a political economy framework, the study situates these legislative measures within Malawi’s historical, socio-economic, and legal context, while critically evaluating how neoliberal development paradigms shape the mechanisms intended to eradicate child labour. These bans, inspired by the 2000 Employment Act and aligned with ILO Convention No. 138, represent efforts to reconcile international standards with domestic socio-economic realities.Adopting an interpretivist research philosophy alongside a mixed-methods approach, the research encompasses qualitative and quantitative data collected from the districts of Mulanje, Thyolo, and Zomba. The methodologies employed included focus group discussions, interviews with children, community leaders, and household surveys. This methodological framework enhances children’s agency and situates their experiences within broader structural disparities. Ethical considerations guided participatory methods, such as drawings and language-sensitive practices, which were vital for authentically capturing the voices of children, their families, communities and policy implementers.The research findings for this thesis reveal that while formal child labour bans have reduced commercial estate child labour, these policies have been influenced by neoliberal logics that prioritise private sector self-regulation and corporate social responsibility over meaningful systemic transformation. Before 2017, plantation managers lacked effective state-enforced age verification mechanisms, subsequently relying on subjective assessments that disproportionately excluded vulnerable children based on superficial criteria rather than substantial protections grounded in children's rights. Children displaced from plantation work frequently migrate towards informal, uncertain employment that evades regulatory oversight, emphasising the displacement of exploitative labour rather than its genuine elimination.This thesis argues that neoliberal child labour interventions, while seemingly protective, obscure deep-rooted causes of child vulnerability, such as historical land disparities, limited access to education, and unstable livelihoods. Therefore, effective and sustainable solutions should transcend minimum-age formalism, addressing exploitative economic structures and prioritising community empowerment and resilience. By situating child labour within these broader political-economic relations, the study emphasises the necessity for transformative approaches that focus on children's lived realities and rights, ultimately challenging the deficiencies of current child labour policies
Downscaling climate projections to forecast ecological changes in river systems
Get PDFFreshwater ecosystems are experiencing accelerating degradation due to climate change, yet predictive assessments that integrate thermal stress and habitat fragmentation remain limited. This study evaluates the combined impacts of rising maximum summer temperatures (Tmax) and precipitation variability on Atlantic salmon (Salmo salar) in Newfoundland and Labrador by integrating downscaled climate projections with river connectivity assessments. High-resolution climate models (ClimGen-derived model outputs) were used to project Tmax and precipitation shifts, while the Dynamic Connectivity Assessment Tool (D-CAT), used for assessing river connectivity, quantified how climate-induced thermal stress and migration barriers exacerbate habitat fragmentation. Findings indicate that by 2090–2094, over 70 % of rivers will exceed the physiological stress threshold of 22 °C, with some interior watersheds surpassing 25 °C, reaching lethal limits for salmon. Increasing precipitation variability—marked by alternating drought-induced habitat desiccation and high-intensity rainfall-driven sedimentation—is projected to amplify hydrological instability. The overlap between thermal stress zones and in-stream barriers will severely restrict migration routes, with 70 % of barriers located in regions exceeding critical Tmax thresholds, limiting access to essential spawning and rearing habitats. A detailed assessment of 13 case study rivers reveals significant geographic variability in climate vulnerability, with interior rivers exhibiting the highest Tmax increases, while coastal systems face more volatile precipitation patterns. These results emphasize the urgent need for integrated climate adaptation strategies that prioritize barrier mitigation, adaptive hydrological management, and riparian restoration to improve freshwater connectivity. While downscaling enhances regional climate impact assessment, uncertainties remain regarding short-term climate extremes (heatwaves, flash floods) and species-level adaptation responses