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Sudev Sheth. Bankrolling empire: family fortunes and political transformation in Mughal India
No full textSudev Sheth. Bankrolling Empire: Family Fortunes and Political Transformation in Mughal India. Cambridge University Press, 2023. Pp. 379. Paper $39.99
Reducing stigma towards incarcerated populations: a systematic review of intervention studies
Get PDFTo evaluate the effectiveness of interventions aimed at reducing stigma or discrimination against people with lived experience of incarceration (PLEIC), and to assess the role of 'Key Active Ingredients (KAI)' in influencing changes in stigma-related knowledge, attitudes and behaviours. Systematic review (registered with PROSPERO CRD42024508685). MEDLINE, Emcare, EMBASE, PsycINFO, HeinOnline, Sociology Source Ultimate and Web of Science were searched from January 2010 to September 2024. Included studies were intervention-based, published in English from 2010 to present, where at least one primary or secondary outcome was stigma-related. There were no restrictions on context, type or level of stigma or study populations. We adapted the KAI model for effective anti-stigma interventions as an a priori framework. An 'Active Ingredient Score (AIS)' was developed to measure the impact of KAIs on each anti-stigma intervention. Quality assessment was conducted using the Cochrane Collaboration's Risk of Bias and the Joanna Briggs Institute Meta-Analysis of Statistical Assessment and Review Instrument. 3926 articles were screened, of which 16 were included, covering 8815 participants across five countries. No studies from low or middle-income countries were found. 12 studies investigated the post-intervention impact on knowledge (positive=11), 12 investigated the impact on attitude (positive=10) and 8 investigated the impact on behaviour (positive=2) towards PLEIC. Of the eight KAIs, only 'myth-busting' correlated with greater post-intervention effects on knowledge and attitudes. Both online and face-to-face interventions were equally effective. Overall, study methods were strong for the included randomised control trials (n=3), but weak to moderate for the non-randomised interventions (n=13). Anti-stigma interventions are highly effective at impacting stigma-related knowledge and attitudes towards PLEIC, with myth-busting emerging as an important component. More research, particularly involving women and adolescents, is needed to identify ways to achieve positive impacts on stigma-related behaviour, with longer study follow-up durations
Civilizationism in the European Union beyond the far right: a morphological approach
Get PDFBoth far-right and liberal EU elites increasingly speak about the need to defend European civilization. However, research on far-right ‘civilizationism’ is more advanced because the term remains theoretically tied to the study of far-right discourses, from where it originally emerged. In this article, we present a framework for studying civilizationism in the EU beyond the far right. First, drawing on the work of Michael Freeden, we conceptualise civilizationism as an ideological element of Europeanisms, understood as a regional family of ideologies that includes both liberal and far-right varieties. Second, we theorise that civilizationism is most likely to manifest as a thin ideology that supports the conceptual arrangements of various Europeanisms. Third, we show empirically how liberal civilizationism emerged during the refugee crisis (2014–2019) and consolidated during the Ukraine crisis (2022–2023) due to wider morphological shifts. Overall, the article contributes to the literature on political ideologies in the EU
HTA155 From license to reimbursement: a slot-based ML framework for seamless MA to HTA alignment
No full textObjectives Small changes to wording in marketing authorisation labels and HTA approved therapeutic indications can dramatically restrict which patients can access novel therapies. This study leverages LLMs and ML techniques to (i) create an interpretable pipeline that captures differences in therapeutic indication text between marketing authorisation label and HTA recommendations; ii) identify the most frequent sources of mismatch (e.g., biomarker, line of therapy); iii) facilitate identification of attributes benefiting most from human-in-the-loop feedback. Methods A working dataset of 730 NICE assessments were pulled from the HTA-Hive database. Each corresponding MA and HTA indication were decomposed into seven predefined slots: therapy type, intended use, disease, disease stage, line of therapy, biomarker expression, and population. The extract slot values were populated with rule-based patterns, with off the shelf Large Language Models (LLMs) utilised when rule confidence fell below 0.6. Slot-level similarity metrics (e.g., SapBERT cosine, ordinal distance) were combined with Siamese-BioBERT full indication text similarity and fed into a binary classifier. Cross-validation evaluated binary “match/no-match” performance, while slot-level F1 scores, SHAP values, and template-based rationales clarified the specific sources of agreement or disagreement. Results In an initial pilot on 50 manually annotated MA-HTA pairs, 23 HTA recommended indications covered the same patient population as the MA label, while 27 had additional restrictions applied. The hybrid model achieved significantly higher accuracy at identifying differences than a TF-IDF methodology using similarity score cut-offs. Early error analysis suggests biomarker wording and line-of-therapy qualifiers are the most common drivers of mismatch. Conclusions Hybrid ML/LLM approaches, including slot-based mix of rules, biomedical embeddings and LLM prompts can improve analysis and detection of population restrictions in HTA outcomes. Scaling this approach across additional geographic settings could facilitate broader understanding of differences in access to medicines across settings
EE163 Cost-effectiveness analysis of ribociclib with endocrine therapy for treatment with premenopausal women with HR positive HER2 negative early breast cancer in the UK
No full textObjectives Ribociclib and endocrine therapy has been showing promising clinical results for treating HR+, HER2- early breast cancer patients. This cost-effectiveness evaluation uses a recent clinical trial (NATALEE) data to evaluate the cost-effectiveness of using ribociclib and endocrine therapy as a first line treatment in premenopausal women with HR+, HER2- Early Breast Cancer in the UK. Methods A Markov model with five stages was developed from the UK health systems perspective over a lifetime horizon (49 years). Clinical parameters are obtained from the NATALEE trial and survival curves are extrapolated beyond trial period. Costs are derived from previous NICE technology appraisals with similar patient group and UK based data sources, utilities are sourced from literature or previous appraisals with similar patient groups. One way sensitivity analysis and probabilistic analyses are conducted. Cost are inflated using the NHS cost inflation index, and a discount rate of 3.5% was applied to both costs and outcomes as per NICE reference case. Results This study finds an incremental cost-effectiveness ratio (ICER) of 106,420 pounds per quality adjusted life year, which is above the National Institute for Health and Care Excellence (NICE) threshold of 30,000. Sensitivity analyses shows that ICER is most responsive to ribociclib drug discounts, but results remain robust against all other parameter testing which include uncertainties in costs, utilities, and probabilities. Conclusions At its current list price, ribociclib and endocrine therapy is unlikely to be a cost-effective intervention compared to endocrine therapy in the UK
P58 An evaluation framework for healthcare professionals’ digital health and AI technologies: evidence-based policy recommendations
No full textObjectives Health systems continue to face mounting challenges for which digital health and AI technologies (DHAITs) can lend a helping hand. However, the lack of consensus on a taxonomy for digital health technologies along with the absence of appropriate value assessment frameworks, particularly for professional-facing solutions, inhibit their value to tackling health system challenges. In this study, we propose a comprehensive evidence-based taxonomy for professional-facing DHAITs, review existing evidence frameworks, highlight their shortcomings and present robust recommendations to evaluate these technologies. Methods The study draws on scoping reviews and thematic analyses to develop a structured taxonomy that reflects the key characteristics of professional-facing DHAITs. It also examines evaluation frameworks put forward by six countries—UK, France, Germany, USA, South Korea, and Canada—to assess their current classification and evaluation proposals. A group of 9 experts were consulted to fine-tune the overall results of the study. Results The proposed taxonomy includes seven core dimensions: interoperability, access platform, driving technology, data inputs, intended impact, intended use case, and intended beneficiary. The consolidated review results in eight policy recommendations stressing the need to align classification with evidence standards, expand HTA frameworks to include system-level impacts, and foster international regulatory cooperation. These recommendations target HTA agencies, notified bodies, international regulatory networks, payers, health ministries and developers, to facilitate remedies required to effectively evaluate these technologies and improve their impact in health systems. Conclusions The proposed taxonomy and review of existing evaluation frameworks contribute to the existing evidence gaps and ongoing work to define the best approach to evaluating DHAITs. Ultimately, properly evaluating DHAITs would ensure that they deliver on their promise to help tackle health system challenges
Competition in the cloud gaming market: proposing the innovation-creativity dichotomy
No full textCloud gaming technologies are reshaping the relationships between players, developers and platforms, raising questions about market dynamics and regulatory priorities. This article explores the development of cloud gaming technology and its regulation by competition law authorities by scrutinizing the concept of ‘innovation’ employed in recent high-profile inquiries, including the Microsoft/Activision Blizzard merger. In particular, the article argues that authorities’ focus on innovation overlooks the collaborative and iterative nature of creativity essential to the game industry’s diversity and growth. The article illustrates the potential risks to creativity in the cloud gaming market through two exemplary case studies. First, the article illustrates that through legal and technological restrictions, the scope for users to modify (‘mod’) cloud-based games and develop new post-release products is severely curtailed. Second, the article evidences how these limitations are heightened in developing virtual worlds (including the metaverse), forcing questions of interoperability and openness in business models. In both case studies, it is evident that the problems facing the sector go beyond those of monopoly to more fundamental issues of market dynamics and definitions. The article concludes by advocating for a recalibration of the values of competition law to account for the dynamic and process-orientated nature of creativity
What Detty December reveals about joy, nostalgia, and the work of pride beyond the holidays
Get PDFEvery year, thousands of people in the diaspora return home. It’s a time of celebration and reunion, but, as Tosin Adebisi writes, it’s an expression of pride and power in culture that can have a powerful impact throughout the rest of the year
The deepfake blindspot in AI governance
Get PDFDeepfakes are no longer just a novelty or disinformation threat — they’re reshaping digital trust. Despite mounting evidence of their harms in multiple domains, regulatory responses remain fragmented and misaligned with the actual threats. MSc Development Management candidate Rachel Ntow argues that this governance gap is systematically eroding the accountability and digital credibility that institutions rely on
Parks as a source of health and well-being
Get PDFPolicymakers usually think about the value of parks and green spaces in instrumental terms. But as Alexandra Gomes and Stefano Cavazzi argue, people value parks for much more than their economic and environmental upsides. Recognizing that parks contribute to people’s well-being, overall health, and sense of belonging can be the source of better policy decisions