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Pulmonary rehabilitation healthcare professionals understanding and experiences of the protected characteristics of service users: A qualitative analysis
No full textBackground Health inequalities can affect access and uptake to pulmonary rehabilitation (PR). An individual’s protected characteristics (age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation) may contribute to health inequalities. Healthcare professionals (HCPs) experiences of the inclusivity and representativeness of PR services and knowledge of protected characteristics are unknown, however are vital for the identification and resolution of health inequalities. This qualitative study explored HCPs understanding of protected characteristics and their perception of the inclusivity, representativeness and equitable benefit of their PR services. Methods Semi-structured qualitative interviews were conducted in person or via videoconferencing with HCPs involved in PR from two healthcare providers. Interviews were analysed using reflexive thematic analysis. Results 12 interviews were conducted with physiotherapists ( n = 6), occupational therapists ( n = 2), nurses ( n = 2) and exercise physiologists ( n = 2). Participants had a median (IRQ) age of 43 (13) and 75% ( n = 9) were female. Four themes were generated. 1: ‘I don’t really know as much as I should’ [about protected characteristics]; 2: It’s uncomfortable collecting protected characteristics…; 3: ‘I don’t think [service users] are as representative as they could be’; 4: A conventional rehabilitation programme does not meet the needs of all. Conclusions This study highlighted several challenges in HCPs understanding of protected characteristics and the representativeness of PR that must be addressed to ensure equity. Strategies, to understand barriers in accessing PR that limit representativeness should be explored.</p
Rotor Topology Optimization for Interior Permanent Magnet Machines Considering Manufacturability
No full textRotor topology optimization becomes a critical tool in interior permanent magnet (IPM) machine design for better performance and material utilization. Existing optimization methods mainly focus on electromagnetic performance, neglecting manufacturability during the optimization process. In this paper, a novel derivative-free design method is proposed for rotor topology geometrical optimization of IPM machines, which can consider manufacturability robustness. Explicitly expressed elementary components (ECs) are developed for the representation of the material distribution. Projective transformation and Boolean operations are employed to improve the diversity of material distribution. Geometrical constraints are applied to guarantee the manufacturability without introducing additional computational burden. The comparison between optimized results obtained from the proposed and conventional NGnet methods verify that the proposed method can effectively enhance electromagnetic performance of IPM machines while securing manufacturability, using finite element analysis. A prototype has been manufactured and experimentally tested for validation.</p
SliceSemOcc: Vertical Slice–Based Multimodal 3D Semantic Occupancy Representation
No full textDriven by autonomous driving’s demands for precise 3D perception, 3D semantic occupancy prediction has become a pivotal research topic. Unlike bird’s-eye-view (BEV) methods, which restrict scene representation to a 2D plane, occupancy prediction leverages a complete 3D voxel grid to model spatial structures in all dimensions, thereby capturing semantic variations along the vertical axis. However, most existing approaches overlook height-axis information when processing voxel features. And conventional SENet-style channel attention assigns uniform weight across all height layers, limiting their ability to emphasize features at different heights. To address these limitations, we propose SliceSemOcc, a novel vertical-slice–based multimodal framework for 3D semantic occupancy representation. Specifically, we extract voxel features along the height-axis using both global and local vertical slices. Then, a global–local fusion module adaptively reconciles fine-grained spatial details with holistic contextual information. Furthermore, we propose the SEAttention3D module, which preserves height-wise resolution through average pooling and assigns dynamic channel attention weights to each height layer. Extensive experiments on nuScenes-SurroundOcc and nuScenes-OpenOccupancy datasets verify that our method significantly enhances mean IoU, achieving especially pronounced gains on most small-object categories. Detailed ablation studies further validate the effectiveness of the proposed SliceSemOcc framework.</p
Disaster Preparedness Training Relevance for Organizational Response Effectiveness: A Healthcare Executive Perspective.
No full textGOAL: Prior to the COVID-19 pandemic, numerous studies had described gaps in hospital preparedness for natural and man-made disasters and public health emergencies. These gaps were especially evident during the COVID-19 pandemic and recent catastrophes, such as hurricanes, earthquakes, wildfires, and cyberattacks, highlighting the lack of organizational preparedness and response. This study aims to understand the training that healthcare executives should receive in order to prepare for future disasters and health emergencies. METHODS: We developed a survey based on existing literature and insights from healthcare executives and disaster medicine experts, all of whom had gained expertise while responding to prior disasters. Our exploratory study also targeted individuals with executive positions in hospitals. Respondents had varying levels of executive responsibility, including C-suite positions, operations directors, clinicians, and those in other strategic analytic roles. PRINCIPAL FINDINGS: Our survey found that scenario planning, using either a tabletop exercise or active role-playing-a simulation-based training method in which participants assume specific roles to act out realistic or hypothetical disaster scenarios-was found to be the most relevant type of training, while setting up an emergency operations center was the least relevant. Healthcare executives perceive that they are better prepared for disasters when the training they receive is relevant to them. This signifies that believing in oneself as being prepared leads healthcare executives to perceive that their organizations can implement more comprehensive emergency response activities, and that those activities are deemed to be more effective. PRACTICAL APPLICATIONS: Assessing how healthcare executives perceive their personal preparedness for public health emergencies, such as pandemics and natural disasters, is crucial for enhancing leadership and overall organizational effectiveness in future crises. Organizations and leaders need to be proactive to ensure they effectively respond to increasingly unpredictable crises.</p
Exploring Barriers and Enablers to Implementing a digital mental health crisis risk mitigation pathway in acute paediatric care: A multi-site, exploratory mixed-methods study
No full textNo description supplied</p
Becoming Glocal: Glocalization And The Study Of Villa Pavements In Hispania Baetica (2nd Century Ad - 4th Century Ad)
No full textThe widespread development of the Roman villa across the different territories of the Roman world has been understood as a seemingly globalized phenomenon with regional variations. My thesis investigates how such a phenomenon occurred in the province of Hispania Baetica from the late Republic to Late Antiquity and centring on the 2nd to 4th centuries. Drawing on the varied range of fragmented evidence from this Hispano-Roman province, I examine four key aspects associated to such a global phenomenon: the types of villa spaces, their associated architectural features, types of pavements displayed and the character of choice of subject matter in the selection of certain types of iconographies.To achieve my aims, I first characterise and quantify Baetican villa spaces, their architectural features and the types of pavements displayed in these spaces. I then interpret them through the lens of the glocalization framework, defined by Roudometof as the refraction of the global through the local. I employ the concept of ‘social refraction’, adapted from Roudometof’s concept of ‘refraction’, to allow the application of this framework to past historical periods and acknowledges the agency of the local as the core aspect of the diversity resulting from globalization processes. This provides a better understanding of the global-local coupling present in globalization studies.My thesis demonstrates that it is possible to characterise how the phenomenon of the Roman villa occurred in Hispania Baetica. My thesis shows that there existed provincial, regional and local trends of this phenomenon across the territories of Hispania Baetica. This thesis also demonstrates the influence of local agency in the adoption and development of global processes and the regional based character in the inclusion of certain architectural features, types of pavements and iconographic scenes.</p
PremPath Policy Briefing
No full textThe PremPath study was funded by the National Institute for Health and Care Research Policy Research Programme (NIHR204242) between April 2023 and June 2025. The perinatal optimisation pathway brings together a number of evidence-based interventions to reduce the risk of neonatal death and associated preterm morbidities. This project was commissioned to examine how the pathway is working in practice. We aimed to explore how multiple clinical teams work together to make decisions about the optimisation and stabilisation of preterm infants and to explore the experiences of staff delivering the pathway, and parents and families receiving care. This resource comprises our Implications for Policy and Practice.</p
Associations between impaired awareness of hypoglycaemia and mental health in insulin-treated type 2 and type 1 diabetes in the Hypo-METRICS study.
No full textAIMS: The mental health impact of impaired awareness of hypoglycaemia (IAH) in people with type 2 diabetes (T2D) is not known. We explored this in people with insulin-treated T2D and type 1 diabetes (T1D). METHODS: Hypo-METRICS was a 10-week cross-sectional observation of hypoglycaemia experience, collecting data on glucose and activity. Participants (325 insulin-treated T2D, 277 T1D) completed questionnaires scoring depression (PHQ-9), anxiety (GAD-7), diabetes distress (PAID) and fear of hypoglycaemia (HFS-II [worry]) at baseline. IAH was defined as a Gold score ≥4. Relationships between IAH and mental health scores were explored using unadjusted and adjusted generalised linear regression analyses. Age, sex, race, diabetes duration, level of education, employment status, continuous glucose monitoring (CGM) use, hypoglycaemia, use of anti-depressants and use of anti-anxiety medications were covariates in the adjusted regression. RESULTS: In unadjusted regression in insulin-treated T2D, IAH was associated with higher PHQ-9 (6.4% [1.5%-11.3%]; p = 0.011), GAD-7 (7.6% [2.1%-13%]; p = 0.006) and HFS-II (worry) (7.4% [2.8%-12%]; p = 0.002) scores, with no differences in PAID (p = 0.655). After adjustment, IAH was associated with higher HFS-II (worry) (5.3% [0.3%-10.6%]; p = 0.048) only. In T1D, IAH was associated with higher PHQ-9 (6.2% [1.3%-10.8%]; p = 0.012), GAD-7 (6.1% [0.1%-12.2%]; p = 0.046) and HFS-II (worry) (6.1% [0.06%-11.5%]; p = 0.029) scores, but not PAID (p = 0.654), all unadjusted. These relationships remained after adjustment, which also showed higher PAID (8.43% [2.62%-14.24%]; p = 0.005). CONCLUSION: Our data demonstrated associations between IAH and a greater mental health burden in both insulin-treated T2D and T1D. Addressing these mental health challenges should be an important part of the holistic care of people with IAH and insulin-treated diabetes.</p
Determining the Magnetopause Location with SMILE-SXI using a Constrained solar wind independent SWCX model
No full textThe soft X-ray imager (SXI) on the SMILE mission promises to revolutionize our understanding of the magnetopause by observing solar wind charge exchange emission from the magnetosheath on a global scale. The primary goal of this instrument is to infer the position and shape of the magnetopause from these images. One method involves devising a 3D X-ray emissions model through which an image can be simulated and adjusted to match a real image. The magnetopause position can be extracted from the fitted 3D model. Previous work by Wharton et al. (2025b), https://doi.org/10.1029/2025ja033837 showed this method was effective with noisy SXI images if solar wind data was used to initialize their Cusp and Magnetosheath Emissivity Model (CMEM1). This study develops CMEM2, a constrained and simplified model that does not require solar wind data for initialization but uses information in the image instead. It can also be fitted by a range of fitting algorithms, which we thoroughly compare. CMEM2 is shown to perform as accurately as CMEM1. We also test this method for the first time on realistic scenarios with changing solar wind conditions. We find the method struggles during median solar wind conditions when the magnetosheath is dim and largely out of the expected FOV of SMILE-SXI. However, during active conditions, the method tracks the movement of the magnetopause well and produces errors within the 0.5requirement for the SMILE mission, providing that the initialization of CMEM2 is reasonably accurate.</p
Spatially variable response of Antarctica’s ice sheets to orbital forcing during the Pliocene
No full textVariations in Earth’s orbit pace global ice-volume and sea-level changes, but the variability in the response for different sectors of the Antarctic Ice Sheet to orbitally forced climate change remains unclear. Here we present geological records of iceberg-rafted debris and other proxies from locations adjacent to the West Antarctic Ice Sheet (WAIS) with comparisons to an existing East Antarctic Ice Sheet (EAIS) record over the time interval ~3.3–2.3 million years ago. Iceberg calving events from the WAIS recorded in Ross Sea sediment cores show a linear response to orbital forcing at timescales corresponding to obliquity (~40,000 years) and precession (~23,000–19,000 years) modulated by eccentricity (~100,000 years). This contrasts with an existing record adjacent to the EAIS, which does not contain obliquity pacing. Combined with ice-sheet model sensitivity tests, the geological data show that the WAIS is highly dynamic and responsive to oceanic melt driven by changes in Southern Ocean circulation, together with atmospheric forcing through variations in local insolation. Conversely, the EAIS appears less responsive to oceanic forcing, despite being the dominant source of meltwater to the global ocean during the mid-Pliocene. Our results imply a substantial role for atmospheric warming on mid-Pliocene sea-level from both WAIS and EAIS.</p