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Experiences and Management of Distress and the Use of Music, Including Music Therapy, on NHS Inpatient Mental Health Dementia Wards: A Qualitative Study
No full textBackground: Inpatient mental health dementia wards in the National Health Service (NHS) provide specialist care for people with dementia experiencing acute levels of distress. There is little research exploring how best to manage and prevent distress. Music therapy may be feasible to deliver and reduce the prevalence of distress behaviours.AimsTo further understanding of experiences of distress in inpatient mental health dementia NHS wards, how distress is managed and ways music and music therapy is used.MethodsSemi‐structured focus groups and interviews were co‐designed and conducted with people with dementia, families, staff, music therapists and managers with experience of this setting. Data were transcribed and analysed using reflexive thematic analysis, with findings corroborated with participants, a co‐design group and experts‐by‐experience.Results49 people took part from 17 wards. Three overarching themes were identified, with 10 subthemes. The first theme highlighted the complex physical and mental health care needs of people on these wards, including high levels of distress. Secondly, staff and families aimed to personalise care to manage and prevent distress. Thirdly, music, including music therapy, could support the delivery of personalised care and help prevent and deescalate distress behaviours, potentially reducing the need for restrictive interventions. However, managers, staff, families and patients reported that care provision did not always meet patient need and resource limitations often prevented delivery of personalised care.ConclusionsNHS mental health dementia wards provide specialist care for people with dementia experiencing high levels of distress. Personalised care, including the use of music, was essential for preventing and managing distress, and could be enhanced through specialist support from a music therapist. Findings should inform best practice guidelines for NHS inpatient mental health dementia wards, including the use of music and music therapy, to support the prevention and management of distress for this client group.</p
Critical evaluation of credit risk management within defects liability period of infrastructure projects in UAE banks
No full textThe study critically evaluates credit risk management within the defects liability period (DLP) of infrastructure projects in the UAE banking industry. Earlier literature suggests that credit risk peaks at the inception of construction projects and diminishes as projects progress. Contrary experiential evidence indicates that significant defaults occur during the DLP, necessitating an enhanced focus on this period.This research aims to bridge the literature gap by introducing a modern conceptual framework that incorporates the insights of technical specialists into traditional credit risk management practices, with respect to managing credit risk during the DLP. The study also seeks to develop a project-failure predictive model combining financial and technical engineering aspects of risk management. Fulfilment of this aim is accomplished by answering 3 research questions: (1) What elements in the existing models contributed to infrastructure project failures within the DLP in the UAE? (2) To what extent can bank engineer’s assessment enhance the predictive capabilities of traditional financial scoring techniques? (3) How can the role of bank engineers be promoted to mitigate unforeseen risks in the absence of trade unions in the UAE?A mixed-methods research approach was employed, incorporating data from 133 completed questionnaires and 6 interviews with key credit risk management professionals across the UAE banking sector. This was supported by case studies and an analysis of credit policies and standard procedures. The collected data were analysed using non-parametric statistical tests for quantitative data, alongside thematic and content analysis for qualitative data.The study introduces a new predictive model for failure of infrastructure contracting companies, incorporating both financial and technical indicators, providing a comprehensive risk management tool. The findings highlight the importance of continuous risk monitoring during the DLP and propose practical measures for integrating engineering expertise into the traditional financial analysis framework of UAE banks. This integration is shown to enhance the predictive accuracy of failures and improve overall credit risk management.This research contributes to both academic knowledge and practical business practices by offering a robust framework for managing credit risk in infrastructure projects, emphasizing the critical role of the DLP. The proposed model and recommendations aim to mitigate risks and support banks in achieving more reliable and efficient project financing outcomes.The practical implications of this research are significant for both banking and infrastructure sectors. The study provides a framework for enhancing early detection of project failures, supporting banks in proactively managing credit risk during the DLP. It also offers a systematic approach for integrating engineering assessments into credit decision-making, which can improve risk prediction accuracy and reduce financial losses.</p
AI Makes Political Views More Acceptable: Right or Wrong
No full textPolitics, especially at election time, is an opportunity for politicians to have missteps that are deliberate, forced or accidental. In the past, these missteps were not able to be corrected in real time, but now, with the advent of social media and AI, missteps can be exposed “immediately” or criticism of the missteps will draw comments from social media networks. The fake news syndrome has always been with us in the media but now AI can do the fact checking at speed and accurately. Does this mean politicians will make fewer missteps or is the political mileage too much to not generate fake news. Can AI or the threat of AI algorithms that can fact check deter politicians from making untrue statements? The challenge is how misinformation from governments, leaders and messages in political campaigns are not mischaracterised as freedom of speech when they are really misinformation or fake news.</p
Film, narrative agency, and the politics of care in veteran Britain
No full textFilm offers untapped potential for making critical interventions in world politics, particularly in ways that harness people’s capacity to narrate stories that creatively empower their communities. Combining International Relations scholarship on visual politics with narrative theory and feminist scholarship on care, this paper presents film as a means of exploring and expressing narrative agency; that is, the power to tell stories that represent people’s experiences in ways that disrupt hegemonic narratives. Dialectics of care and narrative agency are explored in the context of military-to-civilian ‘transition’ in Britain. We argue that the landscape of transition for military veterans is dominated by a preoccupation with employment and economic productivity, resulting in a ‘care deficit’ for veterans leaving the military. Through the Stories in Transition project, which used co-created film to explore narrative agency in the context of three veterans’ charities, we argue that the act of making care visible constitutes a necessary intervention in this transitional landscape. Grounding this intervention within feminist care ethics and the related notion of care aesthetics, we highlight the potential for film to reveal in compelling audio-visual narratives an alternative project of transition which might better sustain life and hope in the aftermath of military service.</p
Thickness, depth and temporality: the paradoxical workings of the grid in painting
No full textThis practice-led research project reconsiders the grid in painting as a painterly object, implicit in the structuring of pictorial space and entwined in the thickness of the painted surface. At the forefront of the project has been the need to answer questions about how the grid functions and performs in my practice, and how it might be used to prompt a significant shift in the relationship between the work and the space in which it is situated. Since Rosalind Krauss’s 1979 essay, Grids, there has not been an in-depth critical reappraisal of the grid in painting. In this thesis I address this gap, examining the more unlikely and paradoxical operations of the grid. I use Hubert Damisch’s assertion that the condition of modernist painting is one of ‘thickness’ and reconsider the grid in light of this, extending Damisch’s suggestion that the grid might be a deep form in painting, and developing this notion to propose that the grid structures temporal experience in painting. The practice interrogates the grid through a body of work in which it is both the structure for organising and producing space on a material surface, and the rationale for how the work is encountered. This study concludes that a new interpretation of the grid is possible, that implicates it in the affirmation and negation of the subject and in constructing pictorial space. I reclaim the grid as a form in painting outside of its paradigmatic ties to modernism, and establish it as an arbiter of the subjective exchange that defines the reception of painting. The thesis demonstrates the grid as a form intertwined with–and inseparable from–the material and procedural actualities of the medium. The grid is demonstrated as a form that builds temporality into the structures of painting; it is, in itself, a temporal thickening.</p
Interventions for cognitive frailty: developing a Delphi consensus with multidisciplinary and multisectoral experts
No full textIntroductionThe conjunction of physical frailty and cognitive impairment without dementia is described as Cognitive Frailty (CF). Indications that CF is potentially reversible have led to proposals that risk factors, symptoms or mechanisms of CF would be appropriate targets for interventions for prevention, delay or reversal. However, no study has brought experts together across sectors to determine targets, content or mode of interventions, and most resources on interventions are from the perspective of academic or clinical researchers only. This international Delphi consensus study brings together experts from academic and clinical research, lay people with lived experience of CF, informal carers, and professional care practitioners/clinicians.MethodsThree rounds of Delphi study were held to discern which factors and statements were agreed upon by the whole sample and which generated different views in those with differing expertise. A scoping review and Round 1 (29 participants) were used to gather initial statements. In Round 2, 58 people responded to statements and open text items, comprising 7 lab-based researchers, 27 researchers working with people, 14 people with lived experience or informal family carers, and 10 professional carers/clinicians. Percent agreement and qualitative responses were analyzed to provide a final set of statements which were checked by 38 respondents in Round 3.ResultsAnalysis of Round 2 quantitative data provided 74 statements on which there was at least 70% agreement and qualitative data produced a further 24 statements. These were combined to provide 90 statements for Round 3. There was Consensus for 89 of the statements. A few differences between the groups were observed at both stages.Discussion and conclusionThe consensus for statements associated with CF interventions provides a useful first step in defining health promotion activities and interventions. Given the prevalence and potential disability caused by CF in older populations, the consensus statements represent expert opinion that is inter-sectoral and will inform public health policies to support implementation of evidence-based prevention and intervention plans. This study is an important step toward changing current approaches, by including all stakeholders from the outset. Outcomes can be used to feed into co-creation of interventions for cognitive frailty.</p
Generative Self-Supervised Learning for Cyberattack-Resilient EV Charging Demand Forecasting
No full textThe Electric Vehicle (EV) market is experiencing unprecedented growth. Accurate prediction of EV charging demand is essential for transportation system operations, such as real-time traffic management, route optimization, and station utilization planning. However, Cyber threats can compromise the accuracy of charging demand predictions, leading to significant disruptions in transportation services, e.g., suboptimal station management, unexpected congestion at charging facilities, and degraded service quality for EV users. This study introduces Generative Multi-task Self-supervised Learning for Prediction (GenS2-P), a cyberattack-resilient framework designed to ensure reliable charging demand predictions under adversarial conditions. GenS2-P incorporates a Denoising/Reconstruction AutoEncoder (DRAE) and a spatio-temporal prediction model to tackle the dual challenges of data poisoning and DoS attacks. By leveraging generative self-supervised learning and multi-task learning, GenS2-P effectively extracts spatio-temporal patterns to denoise and reconstruct data corrupted by cyberattacks. Experimental evaluations using real-world EV charging data demonstrate that GenS2-P significantly reduces prediction errors and mitigates cyberattack-induced disruptions. This improved prediction reliability enables more effective charging infrastructure management and supports robust transportation system operations even under adverse conditions.</p
Becoming, being and belonging: the development of the allied health professional identity
No full textThere are 14 individual professions in the NHS in England identified collectively as Allied Health Professionals (AHPs). Despite national strategy bringing these professions together for greater influence in healthcare, understanding of their collective identity and how it develops is under-researched. The purpose of this research is therefore to explain how an AHP identity develops, if at all.Using a grounded theory methodology, through a constructivist lens, the study involved semi-structured interviews with 22 clinically practising AHPs from across England, representing 11 of the 14 professions. The transcripts were analysed using grounded theory methods, leading to the construction of the substantive theory ‘Becoming, Being and Belonging: The development of the Allied Health Professional identity’.Findings show an AHP’s foundational identity is their uni-profession identity, formed through training and professional registration. AHPs may hold multiple identities, but not all develop a collective AHP identity, particularly those registered for five years or less. The collective identity can be experienced as something imposed upon AHPs through NHS structures. It can also be claimed by the AHPs for actionable change, to overcome shared challenges. The AHP identity is formed predominantly post registration through interaction with other AHPs. Without this connection, the identity may not develop. The AHP identity can also form as a consequence of perceived threats to the uni-profession identity, whether arising from external forces or within the AHP collective itself, namely being undervalued or perceiving inequality. Leadership is necessary to facilitate opportunities for AHPs to connect and encourage the behaviours that cultivate the identity. Without effective leadership the AHP identity may not form or may be diminished.Active development of the AHP identity requires change at organisational and policy levels. Recommendations include early AHP identity development during pre-registration training, enhancing AHP leadership and supporting behaviours that sustain AHP identity while mitigating threats to the uni-profession identity. Integrating these factors into AHP education, practice, and policy can realise the full potential of the collective AHP identity for ultimate workforce and patient benefit.</p
Identification of the top 15 drugs associated with anaphylaxis: a pharmacovigilance study
No full textBackground: Drug-associated anaphylaxis is a common condition with significant risks if not promptly addressed. Yet, systematic research on the distribution of associated drugs and risk comparison across drug classes is limited. This study aims to identify frequently reported drugs and evaluate the strength of their signal detections with drug-associated anaphylaxis.Methods: This study employed a global pharmacovigilance database to identify reports of drug-associated anaphylaxis. Reports classified as anaphylaxis were analysed using the drug record number used in global pharmacovigilance database, leading to the identification of 15 frequently associated drugs. A disproportionality analysis was conducted to estimate signal detections between these selected drugs and anaphylaxis, utilising two metrics: the information component (IC) with a threshold of IC0.25 and the reporting odds ratio (ROR) with 95% confidence intervals (CI). To account for the acute onset of anaphylaxis, a sensitivity analysis focused on reports with a time to onset of less than a day.Results: We identified 15 drugs frequently associated with anaphylaxis, with diclofenac recording the highest number of reports at 34,413. The drug indicating the strongest signal detection with anaphylaxis was cefuroxime (ROR, 40.89 [95% CI, 40.18–41.61]; IC, 5.14 [IC0.25, 5.11]), followed by levofloxacin, ibuprofen, COVID-19 vaccine, ceftriaxone, lidocaine, omalizumab, cefuroxime, benzylpenicillin, clindamycin, amoxicillin/clavulanate, cefazolin, ciprofloxacin, metronidazole, and paclitaxel. Sensitivity analysis indicated that the signal detection between the COVID-19 vaccine and anaphylaxis was stronger than in the primary analysis (ROR, 2.49 [95% CI, 2.45–2.53]; IC, 1.23 [IC0.25, 1.21]). While most drugs reported that the majority of drug-associated anaphylaxis reports occurred within 2.5 h, omalizumab was often associated with reactions occurring after 24 h.Conclusion: All drugs frequently reported in association with anaphylaxis indicated a significant signal detection, but the strength of these signal detections did not align with the number of reports. Time-to-onset analysis showed distinct patterns for certain drugs, suggesting different mechanisms of anaphylaxis. Due to the limitations of spontaneous reporting databases with disproportionality analysis, our findings do not permit for causal inference.</p
Signal detection between 5-alpha reductase inhibitors and the risk of suicidality and depression: an international pharmacovigilance analysis
No full textObjective: This study aims to investigate the signal detection between the use of finasteride and dutasteride and the occurrence of suicidality, including suicidal ideation, attempts, and completed suicide, as well as the development of depression.Methods: This study utilized data from a global pharmacovigilance database encompassing over 35 million adverse event reports from more than 140 countries. Suicidality and depression were defined by MedDRA terms version 26.0. To analyze the data, two well-established pharmacovigilance indicators were applied: the information component (IC) and the reporting odds ratio (ROR).Results: A total of 395 and 1299 reports of suicidality and depression, respectively, were identified in signal detection with finasteride and dutasteride. Reporting trends showed that cases first emerged in 1992, with a notable increase after 2010. The main analysis identified signal detections between finasteride use and both suicidality (ROR, 7.28 [95% CI, 6.57–8.06]; IC, 2.82 [IC0.25, 2.65]) and depression (ROR, 28.18 [95% CI, 26.57–29.89]; IC, 4.68 [IC0.25, 4.58]), whereas dutasteride showed no significant signal for suicidality and a weaker signal with depression (ROR, 3.23 [95% CI, 2.61–4.00]; IC, 1.66 [IC0.25, 1.30]). In subgroup analysis, younger individuals (18–44 years) had particularly strong signals for suicidality (IC, 3.54 [IC0.25, 3.27]), and depression (IC, 5.25 [IC0.25, 5.05]) associated with finasteride, suggesting a heightened susceptibility in this age group. The time to onset of suicidality and depression was predominantly reported after 3 months of drug administration, with suicidality occurring at an average of 114.92 days and depression at 93.31 days.Conclusions: Although our study does not imply causality, this findings suggest a statistically significant disproportionality in reports of suicidality and depression associated with finasteride use and increased signal risks of suicidality and depression highlighting the need for further large-scale epidemiological studies to confirm these findings and investigate the underlying mechanisms.</p
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