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Social prescribing within five European countries: a protocol of a cross-country qualitative analysis
Get PDFIntroductionSocial prescribing is an approach to addressing non-medical issues affecting people's health and well-being (eg, loneliness, housing or financial problems). It has gained international traction over recent years as complementary to medical care. A larger research project, comparing social prescribing across European countries, is considering how to tailor provision for the following groups: (a) LGBTIQ+persons, (b) refugees and first-generation immigrants and (c) older adults living alone. As part of this research, a qualitative study will address the question: What are the enabling and limiting factors associated with implementing social prescribing, across different European countries, from the perspective of key stakeholders? METHODS AND ANALYSIS: Five European countries (Austria, England, Germany, Poland, Portugal) will be involved. Researchers from each country will conduct approximately 20 semi-structured interviews (total number will be 100). Interviewees will be people receiving, delivering, managing and funding/commissioning social prescribing. Interviews will be audio-recorded and transcribed. A cross-country analysis will be undertaken; framework analysis will support this process, with a chart developed in Excel in which data from across the five countries is summarised by the researchers involved. Summaries will be based on a thematic framework that researchers from the five countries develop together after initially analysing their own data.Ethics and disseminationEthical approval was initially secured through the University of Oxford's Medical Sciences Interdivisional Research Ethics Committee (IDREC 1806086) for data collection in England. This approved application was then used to secure ethics approval in Austria (through Ludwig Boltzmann Gesellschaft), Germany (through Bergische Universität Wuppertal), Poland (through Wroclaw Medical University) and Portugal (through NOVA University of Lisbon). Dissemination will include an academic journal article and presentation at relevant conferences. It will also include short videos, written summaries/policy briefs and an infographic.This project has received funding from the European Union's Horizon Europe Research and Innovation Programme under grant agreement No 101155873. Views and opinions expressed are, however, those of the author(s) only and do not necessarily reflect those of the European Union or the European Health and Digital Executive Agency (HADEA). Neither the European Union nor the granting authority can be held responsible for them
The Illusion of Permissive Balancing
Get PDFThe standard view among philosophers of normativity is that practical reasons balance permissively (i.e., when reasons are tied between incompatible actions, either action is rational), while epistemic reasons balance prohibitively (i.e., when reasons are tied between incompatible doxastic attitudes, neither attitude may be rationally formed). Those who disagree, typically epistemic permissivists, think that epistemic reasons behave like reasons for action and that all reasons exhibit permissive balancing. One thing widely agreed on is that a third possibility, that all reasons exhibit prohibitive balancing, is off the table. This paper aims to get that option back on the table. I defend the view that all reasons balance prohibitively, and the apparent permissive balancing of practical reasons is an illusion. What we take to be cases of choosing on the basis of tied practical reasons, actually involve finding extra, tie‐breaking, reasons
Mobile genetic elements in shaping Klebsiella pneumoniae pathogenicity
Get PDFKlebsiella pneumoniae has evolved from an opportunistic pathogen into a formidable global threat, with hypervirulent strains now causing severe infections in healthy individuals and carbapenem-resistant variants achieving mortality rates exceeding 42%. This transformation can be driven by mobile genetic elements including plasmids, integrative conjugative elements (ICE), insertion sequences (ISs), transposons, and integrons. Recent discoveries reveal that these elements employ sophisticated mechanisms: conjugative virulence plasmids dissemination across bacterial populations; ICEs-mediated virulence traits transfer; and hybrid genetic elements simultaneously confer virulence and antimicrobial resistance. Understanding these molecular mechanisms is critical for developing targeted diagnostics and therapeutics that disrupt mobile element mobility, offering promising strategies to combat the convergence of hypervirulence and resistance in this WHO priority pathogen
Quality improvement in degenerative spinal surgery: A systematic review of quality indicators and guideline recommendations: Quality improvement in degenerative spinal surgery: A systematic review
Get PDFDegenerative spinal diseases are among the leading causes of disability worldwide, with a rising prevalence and corresponding increase in treatment demand. Despite this burden, there is a significant variability and uncertainty in surgical decision-making and outcome assessment. There is a growing and compelling need to ensure that care in degenerative spinal surgery is delivered in a patient-centred and value-based manner – and that reliable data is available to prove it. This dissertation constitutes the first systematic review of both existing quality indicators and guideline recommendations in degenerative spinal surgery. The methodology of this systematic review was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO). Despite the comprehensive search strategy and inclusive eligibility criteria, no studies were identified that reported the development, evaluation or use of quality indicators in degenerative spinal surgery. Guidelines and guideline recommendations were systematically identified, catalogued and appraised using validated instruments. A total of 78 guidelines and 1,641 recommendations were extracted. The guidelines were appraised using the Appraisal of Guidelines for Research and Evaluation Global Rating Scale (AGREE GRS) instrument, while the recommendations were categorised according to Donabedian’s framework and appraised using the Appraisal of Guidelines for Research and Evaluation Recommendation Excellence (AGREE REX) instrument. The insights derived from this systematic review are intended to serve as a foundation for the translation of guideline recommendations into quality indicators. Ideally, this should be performed by a multidisciplinary expert panel to ensure methodological rigour and clinical relevance. Additionally, the findings of this review may inform spinal registries and help harmonise data collection, thereby strengthening their role as tools for monitoring practice, driving continuous improvements in care delivery and advancing patient outcomes
'Le siècle s'est éclairé': philosophes, phantoms and fanaticism
Get PDFThe quotation in my title and the three subsequent terms are taken from the most famous scene of Diderot's first play, Le Fils naturel, which has long been judged preachy and dramatically incompetent by critics. Judging by the evidence of the surviving eighteenth-century performance texts, much of it was simply cut. This essay acknowledges the issue but/and contextualizes the scene, reading it as an attempt on the part of the philosophe to manage the aftermath of the attempted assassination of Louis XV in early January, the significance of which was still up for grabs a month or so later when Le Fils naturel was published. Re-injecting some politics into Diderot's bourgeois domestic drama, whose œdipal dynamics have often been noted, the essay explores Diderot's concern with the national family drama of parricide and his mobilization of a discourse on fanaticism
The place of identity formation in the education of children
Get PDFThe place of identity formation in the education of children is a question that concerns parents, educators, and scholars across the academic fields of political philosophy, developmental psychology, identity studies, educational philosophy, and theological ethics, among others. It is an example of the kind of issue of public concern to which Christian ethics has a great deal to offer, both in methodology and substance. This dissertation uses the framework of James Davison Hunter’s “faithful presence” to engage in an interdisciplinary consideration of this question, resulting in practical recommendations as well as a lens of analysis through which to consider why this question is so vexing to modern liberal democracies.The structure of the dissertation is to first map the question of the place of identity formation in the education of children, next to establish the dominant approaches to the question in the United States of America, and finally to outline an alternative. In Chapter One, we consider that basic anthropological assumptions are needed to approach this question, and look to Karl Barth’s theology of baptism. Chapters Two and Three address two dominant errant approaches, which we group under the provocative titles, “The Heresies of Nature” and “The Heresies of Nurture.” Key interlocutors include John Dewey, Lawrence Kohlberg, Kwame Anthony Appiah, Danielle Allen, and Patrick Deneen. Chapter Four outlines an alternative approach, built on the thought of Nicholas Wolterstorff and significant engagement with Alasdair MacIntyre’s theory of the relationship between a social practice and a virtue. The final chapter contains the conclusion that, considered well, the place of identity formation in the education of children leads us to consider a life of learning through the framework of a virtue, which we call always learning
Long-term memory in epithelia: transient IFNγ exposure drives stable repression of TFF1 in gastric epithelial cells via epigenetic changes
Get PDFIntroduction: Interferon-gamma (IFNγ) is a pro-inflammatory cytokine that is transiently produced and typically activates short-lived JAK–STAT1 signaling, yet it can also induce long-term transcriptional changes. During Helicobacter pylori infection, IFNγ persists in the gastric environment, contributing both to host defense and epithelial injury that promotes tumorigenesis. While long-term IFNγ memory has been described in immune cells, its impact on gastric epithelial reprogramming remains unclear. Methods: We exposed gastric epithelial cells to brief IFNγ stimulation and analyzed gene expression, transcription factor involvement, and epigenetic modifications. Chromatin remodeling at the TFF1 locus was assessed through histone modification analyses, and the role of DNA methylation was evaluated using pharmacological inhibitors. Findings were validated in primary gastric mucosoids exposed to inflammatory mediators released by H. pylori-activated immune cells. Results: Transient IFNγ exposure caused stable repression of TFF1, a gastric tumor suppressor frequently lost in H. pylori-associated cancer. This repression persisted after cytokine removal and was mediated by the IFNγ-responsive transcription factor C/EBPβ. Mechanistically, TFF1 silencing was associated with chromatin remodeling, including altered histone H3S10 phosphorylation and H3K9 acetylation at the TFF1 locus. Inhibition of DNA methylation prevented both TFF1 downregulation and C/EBPβ upregulation, indicating that de novo methylation stabilizes the silenced state. Similar durable TFF1 repression was observed in primary gastric mucosoids following exposure to inflammatory mediators. Discussion: Overall, our findings show that transient inflammatory signals cause durable gene silencing through epigenetic remodeling, revealing how chronic inflammation can reprogram epithelial cells and promote cancer, while suggesting strategies to reverse these effects
Cardiac magnetic resonance characteristics and prognostic associations of hypertension-mediated left ventricular hypertrophy
Get PDFAims: Hypertension-mediated left ventricular hypertrophy (LVH) phenotypes: normal left ventricle (LV), LV remodelling, eccentric and concentric LVH have been reported using cardiac magnetic resonance (CMR). Although previous smaller studies have explored associations of these phenotypes with select CMR metrics, large population-based longitudinal data comparing their clinical trajectories are lacking. This study aimed to evaluate CMR characteristics across hypertension-mediated LVH phenotypes and their associations with incident cardiovascular outcomes. Methods and results: In the UK Biobank imaging cohort, 24 463 hypertensives were categorized into LVH phenotypes using CMR. Logistic regression models explored the relationship between phenotypes, setting normal LV as the reference, and CMR parameters as exposures. Cox proportional hazard models evaluated associations with incident major adverse cardiovascular events (MACE) and separately heart failure over a median follow-up of 4.9 years. Among the participants, 23 206 had normal LV, 889 LV remodelling, 253 eccentric and 115 concentric LVH. Hypertensives with eccentric LVH had the most impaired LV function using ejection fraction and strain, and those with concentric LVH had the highest T1 values and maximal wall thickness. Hypertensives with eccentric LVH were associated with a 2.5 times higher rate of MACE (HR 2.5, CI: 1.7–3.8) and 9 times higher heart failure event rates (HR 9.0, CI: 5.7–14.2). Hypertensives with concentric LVH had 4.1 times higher heart failure events rates (HR 4.1, CI: 1.8–9.3), and no association with MACE. Conclusion: In this large population study, we found distinct differences in CMR characteristics between hypertension-mediated LVH phenotypes with eccentric and concentric LVH exhibiting the worst prognosis
Go as we are: the neighbourhood and its political effects
No full textWe might think our local identity is secondary to our other geographic identities, like our national identity. Yet, this is not the case. Many voters consider it as important, or more so, than these higher-order identities. This thesis argues that the `neighbourhood' is one of our foremost geographic identities, that it is a social identity, and that its effects are more widespread than previously understood. Many studies of place-based identity ignore lower-order identities. Those which do not are often not generalisable because they use limited samples or study only one type of identity, such as rurality. Others measure identity using non-survey-based measures, and political science generally focuses only on radical right voting. Over seven chapters, this thesis models neighbourhood identity and its effects on three key areas of political behaviour: participation, affective polarisation, and candidate choice. Firstly, it shows that those factors which influence it are those which most affect how we form social relationships on the neighbourhood level: social homogeneity, physical distance and time. It finds that it predicts some forms of participation, though mostly low-cost behaviours, such as voting. It shows that, while evidence for the effect of geographic sorting on polarisation is mixed, this is because it is, in part, jointly moderated by voters' place-based identity and contact with their in-group. Finally, while many studies have suggested that voters choose candidates who display descriptive localism because of their own place-based identity, this work, for the first time, demonstrates causally that they do. These effects are generally modest, however. To do this, it innovatively primes place-based identity and combines this with a forced-choice conjoint. This thesis brings together diverse data, including novel surveys, panel studies and micro-level voting figures across Britain, Europe and the US, modelling on small geographic units, to provide more credible causal evidence. It raises important questions about how we understand place-based identity, the units and the data we use, and the political effects we study
Virtue, reasons, and moral methodology
Get PDFPhilosophers often fail to be virtuous. So too do ordinary folk. This is a problem for philosophy because moral theories are tested against philosophers’ moral intuitions and the prescriptions of ordinary morality; if these sources of philosophical data are rendered unreliable by the failure of philosophers and ordinary folk to be virtuous, then they will lead our theorising astray. Chapter One motivates and defends a remedy: rather than relying so heavily on these sources of data to provide justification for candidate moral theories, we should aim for our theories to vindicate the testimony of moral exemplars. Listening to moral exemplars can help us correct theoretical errors resulting from the moral failings of morally ordinary folk.
Chapters Two and Three put this methodology to work. Chapter Two notes that ordinary morality seems to contradict the testimony of moral exemplars: while the former tells us that heroic acts of self-sacrifice are morally optional, heroes often believe that such acts are morally required of them. I argue, contrary to both supererogationists and anti-supererogationists, that we can vindicate both datapoints: as what we are morally required to do depends on how virtuous we are, heroes are right to believe that heroic actions are morally required of them, while ordinary folk morality is right that, for ordinary folk, these very same actions are morally optional. I arrive at this conclusion by supplementing the foremost contemporary account of supererogation with two naturally plausible claims about the virtue of selflessness.
Chapter Three begins by noting an intriguing point of moral testimony: moral exemplars tell us that their responses to complex and morally demanding situations are spontaneous rather than deliberative. The aim of this chapter is to argue that the spontaneity of these exemplars’ actions contributes to their moral worth. More specifically, I will argue that fully morally worthy action is action that is both responsive to reasons and spontaneous; while actions performed on the basis of deliberation can be uniquely morally worthy in a way that even spontaneous actions cannot be, deliberative action is nonetheless essentially defective in a way that prevents it from being fully morally worthy.
Chapter Four takes a meta-ethical turn and defends a reductive analysis of normative reasons in terms of motivating reasons and virtue. More specifically, this chapter argues that normative reasons to Q in S are considerations that would motivate a maximally virtuous agent in S to Q in S. This view elegantly accounts for four essential features of normative reasons and should be preferred to its explanationist rivals and Alex Gregory’s “Good Bases” account. This view also explains, in a way that virtue-ethical analyses of deontic properties often struggle to, why less-than-virtuous agents have reasons to improve themselves and control their vice.
Chapter Five defends an analysis of “ought” in terms of reasons and an analysis of reasons against Q-ing in response to arguments recently made by Thomas Schmidt. Schmidt argues that a widely held combination of views—the Balancing View of Ought and the claim that reasons against Q are reasons for not-Q—is extensionally adequate only if it is complemented by two principles of reasons transmission. I present five problems for Schmidt’s package of views and defend a rival package of views—a version of the Balancing View and the claim that reasons against Q are reasons that bear on Q with negative weight—that avoids these problems and secures extensional adequacy without Schmidt’s principles. I conclude that we should prefer my package of views