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'Small benefits and a certain risk':Media representations of novel treatments for Alzheimer's disease
Get PDFThe media is a key site for developing and communicating public understanding of Alzheimer’s disease. Alzheimer’s disease is a leading cause of dementia, and a condition that is prominent in public perceptions of ageing and cognitive decline. Novel disease-modifying treatments (DMTs) are the first innovation in Alzheimer’s disease treatment for two decades, and have the potential to change how society thinks about Alzheimer’s disease. This study investigates representation of risks and uncertainties of DMTs in articles published within the five highest circulation US newspapers between November 2020 and May 2024. This was a period of focused media attention on DMTs in the US, including reporting on Food and Drug Administration (FDA) review and approval processes and debates over public funding of these treatments through the Medicare program. The analysis finds that the media associated risks with the relative efficacy of the medications in comparison to the costs of these treatments. We further find that media representations highlight institutional challenges for the FDA in managing these uncertainties, within a situation characterized by expert contestation of the evidentiary basis for DMTs and patient hope for the promise that DMTs hold
A novel approach to assessing the potential of electronic decision support systems to improve the quality of antenatal care in Nepal
No full textIntroduction: Good-quality antenatal care (ANC) is critical to reducing maternal and perinatal mortality in Nepal. Electronic decision-support systems (EDSS) aim to improve quality of care through adherence to evidence-based guidelines. Our project assessed the potential of two EDSS (the ‘mIRA’ EDSS and the World Health Organization EDSS) to improve the quality of ANC in primary-level healthcare facilities in Nepal. This paper reports integrated results of the evaluation.Methods: We conducted a theory-driven, mixed-methods evaluation in 19 facilities with eight types of data collection: health-facility survey; ANC clinical observations; longitudinal case studies and validation workshop; in-depth interviews; monitoring visits; fieldworker debriefing meetings; healthcare provider attitude survey and stakeholder engagement and feedback meetings. Results from the different data sources were integrated using concurrent triangulation to develop explanations about the implementation process and the effects observed. Results: We identified nine themes on implementation challenges which hindered the EDSS from generating the desired improvements to ANC quality. Facility readiness and provider confidence in using the EDSS was mixed. It was not always used, or used as intended, and the approach to ANC provision did not change. EDSS inflexibility did not reflect how staff made decisions about pregnant women’s needs, or ensure tests were done at the right time. There was mixed evidence that ANC staff believed that the EDSS benefited their work. The EDSS did not become fully integrated into existing health systems. Engagement of essential stakeholders fell short.Discussion: Different understandings of, and inconsistent use of the EDSS highlighted the need for increased training and support periods, greater stakeholder engagement, and further integration into existing health systems. Our novel approach to integrating findings from multiple mixed-methods sub-studies in one paper offers uniquely valuable insights into the many factors needed for successful implementation of an EDSS to improve quality of ANC in Nepal.<br/
The Future of the European Respiratory Society: Strategy Update 2025
Get PDFThe European Respiratory Society (ERS) is a leading medical organisation in the respiratory field, with a growing membership of over 35 000 professionals representing more than 160 countries. Focusing on its mission to promote respiratory health and alleviate suffering from respiratory disease, the ERS communicates and supports cutting-edge research and science, provides state-of-the-art education, and translates scientific evidence for healthcare professionals, policy makers and patients. The ERS also advocates for all aspects of respiratory health, working closely with the European Lung Foundation (ELF) and its network of patients and patient organisations. To maintain and enhance its success and to adapt and respond to global challenges and trends in healthcare and technology, the ERS leadership performed an in-depth review and update of the society's strategy. The extended core management group (President, Past President, President-elect, Secretary General, Treasurer) as well as the Executive Director and heads of the ERS departments convened several times over the year for extensive discussion – seeking input from the respective Science, Education, Advocacy and ELF Council Chairs, where appropriate.<br/
Explaining how a psychosocial intervention (PROACTIVE) based on behavioural activation improved outcomes of depression in older adults living in deprived regions of Brazil:The mediating roles of reduced loneliness and stepped care
Get PDFBackground: The PROACTIVE trial was a task-shared, stepped and collaborative care, psychosocial intervention based on psychoeducation and behavioural activation in 715 participants (60–94 years; mean (SD) 68·6 (6.9) years; 74·1 % female), that was highly effective at improving recovery from depression among older adults in Brazil. Here we investigate mediators of the intervention's effectiveness. Methods: Causal mediation analysis using interventional indirect effects, simultaneously decomposed the total effect of PROACTIVE on recovery from depression (PHQ-9 < 10) into multiple indirect effects including: dose of intervention (numbers of sessions and activities completed); social support (Luben Social Network Scale); perceived loneliness (UCLA questionnaire); and additional sessions offered to participants who did not respond during the initial phase of the stepped care intervention. Results: Of the intervention's total effect (difference in probability of recovery from depression between the intervention and control arms 0·216 [bias-corrected 95 % CI: 0·149, 0·291]): 13 % was mediated through reduced loneliness (0·028 [0·013, 0·046]); and 25 % through attending additional sessions for participants who did not initially respond to the intervention (0·055 [0·007, 0·102]). Limitations: Due to limitations in our sample size our study may lack power to detect some nuances such as interactions between different mediators. Conclusions: Our findings emphasise the importance of a home-based intervention to improve depression outcomes where participants are encouraged to self-select activities to mitigate against loneliness. Importantly, our findings suggest that the intervention's stepped-care component offering additional sessions to participants who did not experience an early response shows promise in ensuring a sustained recovery from depression.</p
On the printability and inter-layer adhesion in 3D printing of continuous carbon fibre reinforced PEEK composite using tape and filament
Get PDFThis study, for the first time, investigates using a 3D printing nozzle instead of a compression roller to print sliced width of continuous carbon fibre-reinforced PEEK composite tape. Pultrusion of sliced tape was performed to further enhance the printability and inter-layer adhesion of curved raster, highlighting the significance of this approach towards 3D printing of complex parts. Peel and shear delamination tests of curved and straight rasters, printed using tape and filament was performed. The delamination tests were conducted at room temperature, 150 °C and 300 °C to elaborate the influence of 3D printing feedstock geometry on the printed part performance. It was found that pultruded filaments can delaminate at up to 40 % higher force as compared to tape for curved paths and vice-versa, as delamination strength corresponds to fibre alignment in the rasters. This study proves the applicability of using ATP graded small tapes (with a width of 1 mm) for 3D printing, and instead of introducing expensive additives to the composites, the feedstock geometry could significantly impact the inter-layer adhesion and facilitate complex part manufacturing
Muslim employees’ religious and intersectional identities as sources of discrimination:How deeper understanding can improve managerial practice
Get PDFPurpose: This study aims to explore how intersecting identities shape experiences of workplace discrimination faced by Muslim employees in Catalonia, Spain. We seek to understand the interplay of religion, ethnicity, gender and age in their employment experiences in order to improve managerial practices. Design/methodology/approach: The research employs a qualitative approach, conducting in-depth interviews with 39 diverse Muslim employees in Catalonia through convenience and snowball sampling to support an intersectional analysis. Findings: Findings reveal that Muslim employees navigate a workplace environment where their experiences of discrimination are shaped by intersecting identities including religion, age, gender and ethnicity which become salient at various stages of their careers, prompted by HRM practices such as recruitment, selection and promotion. Their experiences as recipients of these practices illuminate the complex ways in which intersecting identities shape the experiences of discrimination. The study reveals the hiding of their religious identity, giving up on traditional career paths, seeking social support from other Muslims and emphasizing privileged identities, to deal with discrimination. Originality/value: This study deepens understanding of the complexity of religious identity in minorities and explores its role in workplace discrimination. In particular, the research sheds light on the psychological impact in the form of feelings of guilt and shame which arise from coping strategies such as concealing religious markers which are adopted by these employees in response to organizational and managerial practices. Lastly, the paper stresses the need for intersectional approaches in order to improve effectiveness of HR policies and managerial practices.</p
[Review of] The Culpable Corporate Mind. Edited by Elise Bant. [Oxford: Hart Publishing, 2023. xlvii + 471 pp. Hardback £108.00. ISBN 978-1-50995-238-0.]
Get PDFCancer incidence among people with a prior hospital record of depression in Scotland, 1991-2019: a cohort study
Get PDFObjectiveCurrent evidence on the association between depression and cancer risk is conflicting, with little understanding of how associations vary by time period or sociodemographic factors. We aimed to compare cancer incidence in people with versus without a previous hospital admission record for depression, by sociodemographic factors and over time. MethodsWe conducted a cohort study using national linked data in Scotland from 1991-2019. We calculated sex-stratified age standardized incidence rates for all cancers, lung, female breast, colorectal and prostate cancer and used quasi-Poisson regression models to obtain sex-specific estimates of cancer incidence and relative risks of cancer in those with versus without a prior hospital admission record of depression. ResultsThere were 128,654 people with a hospital record of depression with 12,802 incident cancers and 847,656 cancers among those without depression. Age-standardised cancer incidence rates were higher in both males and females with versus without depression. Depression was associated with a 20-30% increased risk of all cancers combined, a difference that did not vary by sex, age or deprivation and persisted over three decades. Depression was associated with higher risks of lung (RR 1.79, 95% CI 1.70-1.88) and colorectal cancer (RR 1.12, 95% CI 1.05-1.19), but not breast or prostate cancer.ConclusionsWe identified an entrenched disparity in cancer incidence by depression status. Further research should identify underlying mechanisms and inform cancer prevention strategies in this vulnerable group. Meanwhile, health care professionals have a key role to play in optimizing physical health care for people with depression. <br/
Fouling mitigation and wastewater decontamination in UV treatment systems
Get PDFThis work applied the photo-Fenton process to mitigate quartz fouling in ultraviolet-A (UVA) wastewater treatment. The impacts of the pH, iron and phosphorus concentration in synthetic wastewater were explored. It was observed that the photo-Fenton process (5 mg/L of Fe 2+, 10 mg/L of H 2O 2) mitigated quartz fouling and achieved 33% of chemical oxygen demand (COD) removal. It was also found that the presence of UVA irradiation and/or acidic conditions substantially decreased fouling formation. X-ray diffraction as well as energy-dispersive spectroscopy measurements showed that fouling consisted mainly of Fe, Ca, P, and Na. Increasing P concentration in wastewater from 5 to 40 mg/L enhanced fouling formation as well as COD removal from 35% to 51%, respectively. This work provides insight, for the first time, into the role of Fenton reaction in mitigating quartz fouling, one of the technical challenges in upscaling photocatalytic treatment.</p
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