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Outcome measurement in psychological services: a systematic review and empirical study
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Exploring the relationship between male gender, male psychology, and male suicide risk and recovery
Get PDFBackground:
Globally, one of the most consistent facts about suicide is that men are more likely to die than women. In the United Kingdom, suicide is the leading cause of death among men under the age of 50. The magnitude of the male suicide crisis demands urgent investigation into its causes and strategies to reduce its prevalence. Despite the persistent gender disparity in suicide rates, there has been limited research specifically focused on male suicide, and even less exploring the relationship between male gender, male psychology, and suicide. This thesis undertakes preliminary, exploratory study research to enhance our understanding of how gendered aspects of male psychology may intersect with male suicide risk and recovery. The objective of this thesis is to generate new knowledge and propose hypotheses regarding potential phenomena associated with male suicide risk and recovery. As such, this thesis has four overarching aims: 1) Conduct basic, exploratory research to advance our understanding of male gender, male psychology and male suicide; 2) Develop our understanding of the psychological pathways underpinning male suicide risk and recovery factors, including potential psychological distinctions between proximal/distal risk and potential psychological distinctions between men with thoughts of suicide and men who have attempted suicide; 3) Explore the barriers men who are suicidal experience in seeking professional support; and 4) Develop an agenda of research priorities to guide the next iteration of male suicide research.
Methods:
This thesis is comprised of 4 empirical chapters. It begins in Chapter 3, with a systematic review and meta-synthesis of qualitative literature, conducted to investigate male suicide risk and recovery factors (N = 78 studies). Chapter 4 was a global cross-sectional study to explore psychosocial differences between men who have attempted suicide, men with suicidal ideation and men with no suicidal history. Chapter 5 was a qualitative thematic analysis of the barriers men who are suicidal experience in accessing professional support. The thesis concludes with a Delphi study (Chapter 6) working with lived experience experts to develop an agenda of research priorities to progress the field of male suicide.
Results:
Findings from Study 1, the systematic review, revealed a potential association between norms of masculinity and suicide risk in 96% of studies. Masculine norms related to male emotional suppression, failing to meet standards of male success and the devaluing of men’s interpersonal needs appeared to 1) increase men's psychological pain, and 2) diminish men's ability to regulate that pain, which we suggested elevates distal/proximal suicide risk. Findings were synthesized into two novel models to help better understand male suicide risk and recovery, the ‘3 ‘D’ Model of Masculine Norms and Male Suicide Risk’ (3 ‘D’ Risk) and ‘3’R’ Model of Male Suicide Recovery’ (3 ‘R’ Recovery). We made 22 recommendations for future male suicide research and 7 recommendations for theoretical exploration.
Findings from Study 2 suggested that dysregulation in the domains of emotions, self and interpersonal connections increased progressively between men who are not suicidal, men who have thoughts of suicide and men who have attempted suicide. Findings indicated that higher levels of loneliness and having a mental health diagnosis (MHD) increased the odds of suicidal ideation category membership compared to controls. Higher levels of having a MHD, and being non-heterosexual increased the odds of suicide attempt category membership compared to controls. Finally, higher levels of financial strain, having a MHD, being nonheterosexual, more restrictive attitudes to emotional expression, and lower levels of mattering to others, increased the odds of suicide attempt group membership compared to suicidal ideation.
Findings from Study 3 emphasized the significance of exploring how male gender interacts with men's help-seeking behaviours. The cultural suppression of men's emotions appeared to contribute to a lack of psychological capacity within some men to seek and utilize support. Some men perceived help-seeking as socially transgressive which is potentially linked to societal expectations for men to exhibit strength and suppress their pain. Masculine norms of self-reliance meant some men appeared to prefer to self-manage their distress. Concerns about potential negative consequences of seeking help - such as hospitalization - seemed to weigh heavily on the minds of men experiencing suicidal despair and who felt conditioned to maintain control and achieve success. Based on our findings we made 21 recommendations for services and public health messaging to increase men's help-seeking behaviours.
Study 4 utilized the expertise of 242 lived-experience suicide experts and 10 international academic/clinical male suicide experts to develop a research agenda of 22 priorities for male suicide work. Questions related to ten thematic domains: 1) Relationships with others, 2) Relationship with self, 3) Relationship with emotions, 4) Mental Health, 5) Suicidal behaviours, 6) Early life experiences, 7) Structural challenges, 8) Cultural challenges, 9) Atrisk groups, and 10) Support and recovery.
Conclusion:
This thesis contributes four empirical studies to the male suicide evidence-base, including one of the first literature reviews of its kind - a qualitative meta-synthesis and systematic review of male suicide risk and recovery factors - as well as a cross-sectional, qualitative, and modified Delphi study. From these studies, eight recommendations for male suicide theory development and 60 recommendations for future research, prevention, and intervention are made. Male suicide rates indicate that certain men face profound challenges in accessing a fulfilling and meaningful life. Our research findings emphasize the importance of adopting a gender sensitive approach to suicide prevention and research that acknowledges the impact masculine norms may have on male behaviour and how male distress is perceived and addressed by others. Given the complexity of male suicide, interventions may be necessary at various levels, ranging from individual men to cultural shifts. It is crucial to approach this work without demonizing or pathologizing masculinity. Instead, the insights gained from this thesis suggest that enhancing our understanding of cultural norms of masculinity and how they may increase some men’s exposure to psychological pain, their tools to regulate that pain, and how that pain is read and responded to by others, are potentially critical
Using Virtual Reality to explore individual differences in perception due to neurodiversity
Get PDFThe aim of this thesis is to contribute to our understanding of individual differences in visual perception, specifically in autistic and ADHD traits as well as associated diagnosed groups; and explore the use of Virtual Reality (VR) environments to enhance communication and creative expression for these individuals. The thesis begins by introducing autism and ADHD, emphasizing the perceptual differences associated with the conditions. It also highlights the importance of a person-centric approach in research and introduces the use of drawing as a research method, as it allows the capture of subjective experiences. We do so to better understand how VR as a research platform can help us study individual differences. Previous research neglects perceptual and cognitive aspects of neurodivergence in VR research and lacks clear systemized, theoretical and methodological standards; as we demonstrate in three consecutive literature reviews on VR applications in autism research. Using mixed methods and arts-based research we provide a more comprehensive understanding of the topic. Feasibility studies investigate perceptual differences in local and global processing, using the Rey Osterrieth Complex Figure (ROCF) task and free drawing. We demonstrate a link between attention-related traits and performance on visual tasks, such as ROCF. Moreover, we introduce novel methodology for evaluating two-dimensional and three-dimensional drawings and triangulating this information with qualitative thematic analysis. Furthermore, our free drawing task reveals that simplistic immersive virtual environments are viewed favorably by autistic individuals, and participants often share their thought processes spontaneously, potentially suggesting reduction in the power imbalance between the researchers and the participants. The significance of this study is that we provide evidence for the feasibility of a new methodological approach (drawing in VR) to understand perceptual differences associated with neurodiversity
The effects of obesity on asthma and a randomised controlled trial assessing a total diet replacement programme in people with difficult-to-treat asthma and obesity
Get PDFIn this thesis, three studies are reported in patients with difficult-to-treat asthma. The primary focus is a randomised controlled study assessing a weight management programme in participants with difficult-to-treat asthma and obesity compared to usual care. The other two are retrospective analyses: one, a study to assess if any correlation or relationship exists between obesity and markers of type 2 inflammation in asthma, the other assessing if there is any difference in sleep parameters using wearable technology between participants with mild and difficult-to-treat asthma.
Obesity-associated asthma is a complex phenotype on the rise often characterised by more difficult-to-treat disease, increased morbidity and mortality and great economic burden. Previous studies assessing weight loss in asthma suggest a benefit in asthma control and quality of life but have issues with heterogeneity in populations and interventions studied, lack controls or robustness. In excess, adipose organ dysfunction results in an imbalance in adipokine-mediated pro-inflammatory and anti-inflammatory markers favouring airway inflammation and hyperresponsiveness. Additionally, a few studies have suggested an inverse effect of increasing obesity on markers of type 2 inflammatory markers potentially limiting their use in this cohort. Complicating matters, sleep breathing disorders, common in obesity, such as obstructive sleep apnoea syndrome are known to increase asthma exacerbation severity. Robust and well-constructed trials assessing conservative options for weight management in people with obesity and asthma are needed. The CounterweightPlus weight management programme is one such option, with an evidence base in type 2 diabetes mellitus. We hypothesised that use of this dietitian-supported total diet replacement weight management programme would result in improved asthma control and quality of life in people with difficult-to-treat asthma and obesity.
We performed a single-centre, open-label randomised controlled trial assessing the Counterweight-Plus programme (CWP) against usual care (UC) in people with difficult-to-treat asthma and obesity. This programme entails a 12-week c850 calorie/day total diet replacement phase followed by a food re-introduction and then weight maintenance phase up to one-year with dietitian input. Follow-up visits occurred at 16-weeks (the primary outcome) and 52-weeks. Primary outcome assessed the change in Asthma Control Questionnaire (ACQ6) scores at 16-weeks between groups and key secondary outcomes included change in Asthma Quality of Life (AQLQ) scores at 16-weeks, comparing proportions of people experiencing minimal clinically important difference (MCID) in ACQ6 and AQLQ, and assessing these outcomes again at one-year.
Thirty-three participants attended at 16-weeks for primary outcome assessment. Weight-loss was greater with CWP compared to UC (mean difference –12kg [95%CI –17, -7kg]; p < 0.001). ACQ6 and AQLQ scores improved with CWP compared to UC (mean difference –0.7 [95%CI –1.4, 0.0], p = 0.048; mean difference 0.8 [95%CI 0.2, 1.3], p = 0.013 respectively) and a greater proportion of participants achieved MCID in ACQ6 with CWP and UC (53 vs 19%, p = 0.041) at 16-weeks.
Twenty-nine participants attended at 52-weeks with weight-loss sustained with CWP (median weight change –14kg [IQR –15, -9kg]) compared to UC (median 2kg [IQR –7, 8]; p = 0.015). The 53% achieving MCID in ACQ6 at 16-weeks sustained this at 52-weeks (compared to UC 25%, p = 0.101). A higher proportion of participants achieved MCID in AQLQ with CWP compared to UC (71 vs 6%, p < 0.001), including AQLQ symptom domain (71 vs 31%; p = 0.024), activity domain (53 vs 19%; p = 0.041) and environmental domain (65 vs 19%; p = 0.008). Furthermore, CWP resulted in a reduction in number of prednisolone courses from 4 (IQR 2, 5) at baseline to 0 (0, 2) at 52-weeks (p<0.001).
Interpretations from this data are limited by considerable missing data, primarily because of the COVID-19 pandemic restrictions. No significant conclusions can therefore be drawn regarding effects of weight loss on lung function, markers of inflammation or activity levels. The study was underpowered at the one-year time-point limiting conclusions about effects of weight loss on asthma control and quality of life.
Additionally, we performed a retrospective analysis assessing the effects of obesity on type 2 biomarkers in mild (n = 51) and difficult-to-treat (n = 102) asthma from two datasets of recent in-house trials. We assessed body mass index (BMI) against fractional exhaled nitric oxide (FeNO) and peripheral eosinophil count. When stratified by BMI tertile, we observed reduced FeNO levels in the highest BMI tertile compared to the lowest (18 vs 25ppb respectively, p = 0.014) and, within the difficult-to-treat group only, reduced eosinophils in the highest BMI tertile compared to the lowest (0.2x109/L vs 0.3x109/L respectively; p = 0.020). Adjusted linear regression (corrected for age, sex, smoking status, atopic status, rhinitis and both inhaled and oral corticosteroid use) showed BMI was a predictor of FeNO (β= −2.848, p = 0.019). Interpretation of these results must be with caution as numerous limitations must be acknowledged including unequal weighting of groups, possible effects of both confounder and collider bias, and the retrospective nature of this study. A dedicated prospective trial is warranted based on these findings.
Accelerometers have been validated against polysomnography to assess sleep metrics in general and asthma populations. We hypothesised that accelerometer-derived sleep parameters would differ between healthy BMI mild and obesity-associated difficult-to-treat asthma groups and conducted a retrospective analysis on overnight accelerometer data derived from two recent in-house trials. Participants in these trials wore accelerometer devices twentyfour hours a day for seven days. Data from 124 participants (80 difficult-to-treat, 24 mild asthma) showed broadly comparable results in sleep window time, sleep time, sleep efficiency and wake onset time with a clinically unclear difference of roughly forty minutes in median sleep onset time. Results were also similar to general population results from previous studies. This retrospective study also had unequal weighting of groups, lacked corroboration from sleep diaries or objective assessments of sleep quality or sleep-disordered breathing, limiting its clinical effectiveness.
In summary, effects of obesity on asthma are not fully understood, in particular with relevance to airway inflammation and type 2 biomarkers. Use of a total diet replacement weight management programme results in improved asthma control and quality of life in the short term with encouraging longer-term signals in asthma quality of life and frequency of exacerbation. Further research is needed to elucidate mechanisms underlying obesity-mediated asthma and to assess effects of this weight management programme on lung function and inflammation. A larger sample size is needed to definitively assess effects of the Counterweight Plus programme on asthma outcomes at one-year
Water drinking is a complex health behaviour: implications for theory and intervention development
Get PDFAcross four projects, I aimed to develop an in-depth understanding of how water drinking behaviour is performed in real-life settings and what influences its performance to inform more effective interventions. Specifically, I aimed to define what steps are involved in water drinking and identify and explain how relevant constructs hinder and facilitate water drinking in daily life. In Project 1, I conducted a mixed-method survey study to assess what influences different water intake patterns (i.e., high versus low intake), focusing on constructs like value, reward, self-identity, and habitualness. I quantitatively (N = 400) established differences in participants' water drinking behaviour and qualitatively assessed what influences might explain these differences (N = 101). In Project 2, I conducted a mixed-method intervention study to assess what influences attempts at increasing water intake (N = 95). I quantitatively assessed the impact of implementation intentions on water intake over a five-day follow-up and qualitatively assessed what hindered and facilitated participants' attempts to increase water intake during this time. In Project 3, I conducted an observational quantitative study to establish the association and predictive ability of various influences of water drinking (e.g., taste) regarding future intake over a three-day follow-up (N = 213). In Project 4, I reviewed emerging water drinking research and generated a theoretical overview of how water drinking should be defined and what influences its performance in daily life. I then assessed the implications of this overview regarding the wider theoretical considerations in behavioural research as well as applied implications, limitations, and future directions for water drinking research. Water drinking is a complex behaviour facilitated by numerous lower-order behaviours (e.g., preparation) that must be repeated multiple times throughout the day to obtain adequate water intake. Additionally, underlying this behaviour is a complex interplay of external (e.g., water availability, toilet access) and internal (e.g., reward, habitualness) influences that can hinder or facilitate water intake depending on their nature and emergence throughout daily life. Comprehensive theories of behaviour should be used to guide water drinking research, and intervention development may benefit from a complex intervention approach
Taxation, sovereignty and just cooperation: realizing a model for distributive justice in global tax governance
Get PDFThis thesis is intended to explore the normative questions surrounding the pursuit of global tax justice, through the lens of its conflicting demands of just cooperation and state sovereignty. Among the many pressing global problems which require cooperation between states, coordination on taxation presents particularly acute challenges. It is designed to protect tax sovereignty within the interdependence and interaction of diverse tax systems, while also requiring ever closer cooperation to secure this task for all countries. Considering the extent to which the international tax regime’s commitment to sovereignty preservation has enabled a framework which restricts the autonomy of developing countries and produces inequitable outcomes, it is argued that reconciling this conflict requires a normative commitment to principles of global distributive justice.
The thesis pursues this argument by exploring the relational account given by John Rawls, which places duties of distributive justice as central to ensuring just forms of social cooperation, but argues that its applicability is limited to sovereign states. Seeking to account for the central problems of relational power and inequitable treatment within global tax cooperation, and utilizing the relational model of global justice as freedom from domination within republican theory, the thesis builds a normative account of global tax justice which reframes sovereignty as a reciprocal and collective value, in which the exercise of autonomy is constrained by commitments to the freedom of all states. Within this framework, it is argued, there are duties of distributive justice which can direct the aims of global tax governance to provide more genuinely equitable participation and a just distribution of power
Combining T2K with other experiments to better constrain oscillation parameters
Get PDFThis thesis presents an analysis of T2K data using a new external reactor constraint from Daya Bay instead of the regular one-dimensional Gaussian provided by the Particle Data Group (PDG). Both the PDG and Daya Bay data sets can be used to update the prior of given parameters in the T2K analyses. Applying Daya Bay’s two-dimensional constraint on the mixing angle θ₁₃ and mass splitting Δm² ₃₂ improves the constraint on the mass splitting parameter by 25% in normal hierarchy and 18% in inverted hierarchy compared to using the PDG external prior. Furthermore, denoted with a Bayes factor value which compares two hypotheses using the posterior results, it was found that there was a small increase in the preference for normal hierarchy over inverted hierarchy, B(NH/IH): PDG = 2.77 and Daya Bay = 2.79. There was a slightly larger increase for the upper octant in the octant degeneracy, B(UO/LO): PDG = 2.27 and Daya Bay = 2.38. The thesis also describes development work towards the first full joint-fit between two long baseline experiments, T2K and NOvA, showcasing the increase in statistical sensitivity for the oscillation parameters and the potential to solve some of the current degeneracies limiting the sensitivity of both experiments. Finally, there is an introductory insight into an alternate parameterisation of neutrino oscillations that could be used to better understand the constraint from the T2K data
Assessing the impact of immunosuppressive therapies on the risk of hypertension
Get PDFBackground
Although it has a significant impact on morbidity and mortality, hypertension is a major global health concern that is frequently neglected. Despite its prevalence, the role of inflammation in hypertension is often overlooked. However, earlier research suggested a link between hypertension and specific inflammatory biomarkers, proposing that these biomarkers may play a pivotal role in the development and progression of hypertension. This was initially observed through the effects of immunosuppressive therapies, which were found to affect development of hypertension. This led to a growing interest in the role of inflammation in hypertension and its potential as a therapeutic target.
Inflammation is now recognised as an important contributor to the development and progression of hypertension. The immune system plays a key role in regulating inflammation and dysregulation of the immune response can lead to chronic low-grade inflammation that can contribute to hypertension and target organ damage. As a result, there is a growing interest in developing anti-inflammatory drugs to treat hypertension, particularly in patients who have not responded to traditional blood pressure-lowering medications.
Methodology for answering the research questions: Systematic review and meta-analysis of randomised-control trials (RCTs). It aimed to assess pre-specified outcomes including hypertension risk and evaluated particular pre-specified subgroups of patients, including drug subclasses, comparator drugs, population clinical setting and follow-up duration. This analysis was designed to investigate the differential varying benefits and risks when comparing different classes of immunosuppressive therapies.
Results
The thesis is divided into seven main results chapters (Chapters 4 to 10) based on the immunosuppressive therapies classes evaluated for risk of hypertension in the systematic review and meta-analysis. Risk was assessed in comparison to placebo or separately to other active drugs used to treat immune/inflammatory disorders. Altogether, the qualitative and quantitative analysis includes 141 RCTs that enrolled 60,580 participants in total with an average follow-up of 3.5 years.
Methotrexate (MTX) and risk of hypertension: This meta-analysis found that when Methotrexate (MTX) was compared to the placebo, there was no significant difference in the risk of hypertension (RR = 0.93, 95% CI, 0.61; 1.44, P = 0.75). Meanwhile, low and nonstatistically significant heterogeneity between studies (I2 = 14%, P = 0.33). When MTX was compared to other active drugs, MTX reduced the hypertension risk (RR = 0.47, 95% CI, 0.34; 0.65, P = 0.00001), while heterogeneity was observed between studies (I2 = 29%, P = 0.11). These findings suggest that compared to other active drugs, MTX may reduce the risk of hypertension, but no significant difference was found when it was compared to a placebo.
Tumornecrosis factor inhibitors (Anti-TNF) and risk of hypertension: The findings for anti-TNF inhibitors were significantly different. The risk of hypertension was elevated for participants on anti-TNF inhibitors compared to those given a placebo (RR = 1.31, 95% CI 1; 1.73, P = 0.05); however, low heterogeneity was observed between studies (I2 = 2%, P = 0.43). Meanwhile, when compared with other active drugs, the hypertension risk did not significantly differ (RR = 1.14, 95% CI 0.73; 1.78, P = 0.56) and minimal heterogeneity was observed between studies (I2 = 38%, P = 0.11). These results suggest that while the use of anti-TNF inhibitors may increase the risk of hypertension compared to a placebo, this difference is not statistically significant when compared to other active drugs.
Interleukin – 17 inhibitors (Anti-IL17) and risk of hypertension: This study’s meta-analysis showed that the risk of hypertension was not significantly different between Anti-IL17 and a placebo drug (RR = 1.09, 95% CI 0.75, 1.58, P = 0.65). Similarly, the risk of hypertension was not significantly different between Anti-IL17 and other active drugs (RR = 0.89, 95% CI 0.60, 1.31, P = 0.54). This analysis observed low heterogeneity between studies comparing Anti-IL17 to a placebo drug (I2 = 9, P = 0.34), as well as between studies that compared AntiIL17 to other active drugs (I2 = 9, P =0.33). The present study’s findings suggest that Anti-IL17 drugs do not significantly increase the risk of hypertension compared to placebo or other active drugs.
Interleukin – 6 inhibitors (Anti-IL6) and risk of hypertension: In the Anti-IL6 group, the results of the meta-analysis found no statistically significant difference in the risk of hypertension between Anti-IL6 and a placebo (RR = 1.2, 95% CI 0.82; 1.73, P = 0.35) also finding no heterogeneity between studies (I2 = 0%, P = 0.89). When Anti-IL6 was compared to other active drugs, this study found no statistically significant difference in the risk of hypertension between groups (RR = 1.48, 95% CI 0.97; 2.25, P = 0.07) and observed low heterogeneity between studies (I2 = 7%, P = 0.37). Thus, this study’s results showed that in both groups (placebo and active drugs), there was no significant increase in the risk of hypertension.
Purine and Pyrimidine synthesis inhibitors and risk of hypertension: There was no statistically significant difference in the risk ratio when the results of the Purine and Pyrimidine synthesis inhibitors groups were compared to the placebo group (RR = 1.37, 95% CI 0.78; 2.44, P = 0.28) and no heterogeneity was observed between studies (I 2= 0%, P = 0.96). However, Purine and Pyrimidine synthesis inhibitors can reduce the hypertension risk when compared to other active drugs (RR = 0.81, 95% CI 0.65; 0.99, P = 0.04), while substantial heterogeneity could be observed between studies (I2 = 76%, P = 0.00001). These findings suggest that Purine and Pyrimidine synthesis inhibitors may be effective in reducing the risk of hypertension when compared to other active drugs, although no significant difference was found when compared to a placebo.
Interleukin 1 Beta inhibitors (Anti-1B) and risk of hypertension: The results of this paper’s analysis for Anti-IL 1B showed that compared to the placebo group, the risk of hypertension was not significantly different between the groups (RR = 0.74, 95% 0.35; 1.6, P = 0.45) and no heterogeneity was observed between studies (I2 = 0%, P = 0.87). These findings suggest that the use of anti-IL 1B drugs does not significantly affect the risk of hypertension compared to a placebo.
Colchicine and risk of hypertension : The present study compared the impact of colchicine and the placebo on the risk of hypertension and found no significant differences between the groups (RR = 0.50, 95% CI 0.10; 2.38, P = 0.38), also finding no heterogeneity between studies (I2 = 0%, P = 0.96). When colchicine was compared to other active drugs, the present study did not observe any statistically significant differences in the risk of hypertension between groups (RR = 0.44, 95% CI 0.09; 2.11, P = 0.31) and found low heterogeneity between studies (I2 = 35%, P = 0.21). These results suggest that the use of colchicine does not significantly affect the risk of hypertension compared to either a placebo or other active drugs.
Conclusions
The overall risk of hypertension associated with each of the seven groups of drugs differs, with anti-Interlukin-6 agents, anti-Interlukin17, anti-Interleukin-1beta and colchicine appearing not to affect the risk of the occurrence of hypertension when compared to either a placebo or other active drugs. In contrast, both Methotrexate and Purine and Pyrimidine synthesis inhibitors appear to reduce the risk of hypertension in comparison to other anti-inflammatory treatments. Anti-TNF medications, in turn, may borderline increase the risk of developing hypertension compared to placebo. The groups also differ in their heterogeneity with some having very low heterogeneity, while others have significant internal differences; nevertheless, most are highly homogeneous, with the results of similar studies being almost identical. These findings have important implications for clinical practice, suggesting that when healthcare professionals select immunosuppressive therapies for their patients, they should take into account the hypertensive effect those therapies have. Medications that inhibit the synthesis of purine and pyrimidine or methotrexate might be suitable choices for patients who have an elevated higher risk of hypertension. Further research is needed to understand the long-term effects and clinical significance of these findings, as well as to explore mechanisms, patient-specific factors, and the potential benefits or risks associated with specific populations or treatment durations. Overall, this study contributes valuable insights that may guide clinical decision-making, as well as stimulate further research in the fields of immunosuppression therapies and hypertension
Blockchain-based secure Unmanned Aerial Vehicles (UAV) in network design and optimization
Get PDFUnmanned Aerial Vehicles (UAVs) have emerged as transformative technologies with wide ranging applications, including surveillance, mapping, remote sensing, search and rescue, and disaster management. As sophisticated Unmanned Aerial Vehicle (UAV) increasingly operate in collaborative swarms, joint optimization challenges arise, such as flight trajectories, scheduling, altitude, Aerial Base Stations (ABS), energy harvesting, power transfer, resource allocation, and power consumption. However, the widespread adoption of UAV networks has been hindered by challenges related to optimal Three-Dimensional (3D) deployment, trajectory optimization, wireless and computational resource allocation, and limited flight durations when operating as ABSs. Crucially, the broadcast nature of UAV-assisted wireless networks renders them susceptible to privacy and security threats such as Distributed Denial-of-Service (DDoS) replay, impersonation, message injection, spoofing, malware infection, eavesdropping, and line of-interference attacks.
This study aims to address these privacy and security challenges by leveraging blockchain technology’s potential to secure data and delivery in UAV communication networks. With amalgamation of blockchain, this study seeks to harness its inherent immutability and cryptographic properties to ensure secure and tamper-proof data transmission, promote trust and transparency among stakeholders, enable automated Smart Contract (SC) for secure delivery, and facilitate standardization and interoperability across platforms. Specifically, blockchain can secure UAV network privacy and security through data privacy and integrity, secure delivery and tracking, access control, identity management, and resilience against cyber-attacks.
Furthermore, this study explores the synergies among blockchain, UAV networks, and Federated Learning (FL) for privacy-preserving intelligent applications in healthcare and wireless networks. FL enables collaborative training of Machine Learning (ML) models without sharing raw data, ensuring data privacy. By integrating FL with blockchain-assisted UAV networks, this study aims to revolutionize future intelligent applications, particularly in time-sensitive and privacy-critical domains. Overall, this thesis contributes to the field by providing a comprehensive analysis of integrating blockchain, FL, and UAV networks, beyond Fifth-Generation (5G) communication networks. It addresses privacy and security concerns related to data and delivery, thereby enabling secure, reliable, and intelligent applications in various sectors
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