Fabrication and characterization of coated ceramic membranes from natural sources for water treatment applications

This study aimed to fabricate ceramic membranes for water treatment applications using natural and costeffective materials. This is the first-time white clay, Arabic gum, and marble powder were used in ceramic membranes. Two ceramic membranes were fabricated using an extrusion process: substrate A and substrate B. The JMP software (Version 15) was used to obtain the optimal recipes for the two substrates, which were white clay (62.7 %), silica flour (32.3 %), and Arabic gum (5 %) for substrate A and white clay (63 %), silica flour (26.8 %), and marble powder (10.2 %) for substrate B. Additionally, the effect of waste glass in the coating layer on the separation rate was examined. The ceramic membranes were analysed using various techniques, including X-ray fluorescence (XRF), X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FT-IR), laser diffraction particle size analysis, thermogravimetric analysis (TGA), and a universal testing machine. The morphologies of the membranes were observed using scan electron microscopy (SEM), and their chemical resistances were evaluated. The flux across the substrates was measured using a crossflow filtration system, and it was found that substrate B had a higher flux (116 L/m2 h) than substrate A (77 L/m2 h). This was probably due to its higher porosity (34 %) compared to substrate A (29 %). Substrate A, with a coating layer (CO-2), exhibited the highest removal efficiency of approximately 99.2 % for synthetic feed water composed of tap water and bentonite clay, with an average particle size of 1.1 μm and turbidity of 13 ± 0.2 NTU. The costs of ceramic membranes A and B were estimated to be approximately 51 and 47 USD/m2 , respectively. Their cost-effectiveness results from the use of low-cost materials that do not require high sintering temperatures. This study demonstrates that these ceramic membranes are not only affordable but also possess desirable properties for water treatment applications

Rhegmatogenous retinal detachment in choroidal melanoma: clinical features and surgical outcomes

Purpose: To describe the clinical features, prognostic factors, safety and rate of success of surgery and visual outcomes in patients with rhegmatogenous retinal detachment (RRD) and choroidal melanoma (CM).// Methods: A retrospective, observational case-series of 21 patients with rhegmatogenous retinal detachment or combined tractional-rhegmatogenous retinal detachment in patients with choroidal melanoma over a period of 20 years.// Results: Nineteen patients were included in the final analysis. The mean elevation of CM was 4.0 mm and the mean largest diameter was 11.0 mm. RRD occurred after the CM treatment in 14 eyes at a mean interval of 44.2 months. The RRD was macula-on RRD in 6 eyes, there was posterior vitreous detachment (PVD) in 15 and PVR in 7 eyes. BCVA at presentation was 0.71 logMAR and final was 1.5 logMAR (p = 0.01). The primary surgical success rate was 59%. No intraocular or extraocular tumour dissemination occurred. Mean follow-up was 66 months.// Conclusion: RRD in patients with CM is uncommon but requires multidisciplinary management. Anatomical results are favourable but visual outcomes are poor due to a combination of factors related to melanoma treatment, macular retinal detachment and PVR. Vitrectomy as a surgical intervention for RRD in treated CM appears to be safe in terms tumour dissemination

Emilia Pardo Bazán, folletinista and 'noveladora moral': La dama joven and Mujer

This article seeks to understand how Emilia Pardo Bazán engaged with and utilized two iterations of creative writing - the folletín and the didactic novel - repudiated by her male peers in Spain's Restoration literary scene. It does so by engaging closely with La dama joven through publication history and close reading of the novella itself. It does likewise with the later novella, Mujer, while situating the discussion with a broad field of recent criticism on both the period and Pardo Bazán herself

A Qualitative Exploration of the impact of the COVID-19 Pandemic on teacher Perceptions of their Stress and Job Role: Giving a voice to teachers

Teacher stress has been a long standing and growing concern over the past few decades in many countries owing to multiple challenges within the educational landscape and the teacher’s role. The Covid-19 pandemic has brought about unprecedented challenges within the Education sector. Specifically, teachers faced new challenges in a pre-existing stressful occupation. This study sheds light on a timely and critical research area: What is the impact of the Covid-19 pandemic on teachers’ perception of stress, and what do they identify as needed to support them in their role in the aftermath of the pandemic?  The current study has adopted a qualitative research approach, utilising semi-structured interviews to interview seven secondary school teachers. All interviews took place during the pandemic in 2021. Teachers shared their lived experiences, providing insight into the challenges they faced in their job role and the support they would like in the aftermath of the pandemic.  The four emergent themes from the current study are as follows: 1) The need for Compassion, 2) Connections, Communication and Consistency; 3) Evolving Professional Competencies: Bridging the gap between teacher skills and student needs; 4) fostering a supportive ecosystem in education.  Finally, the themes are discussed in relation to Kyriacou’s and Sutcliffe’s (1978a) stress model and the Bioecological systems model. The study underlines the pivotal role of Educational Psychologists in identifying and fostering support systems around the teacher and their job role to reduce their perceived stress

Machine Learning for Protein Engineering Using Molecular Dynamics Simulation Data

Protein therapies and enzymes have revolutionised the pharmaceutical and biotechnology industries. However, the scalability and labour intensity of evolutionary methods for protein engineering impede progress and still present ongoing challenges. Molecular Dynamics (MD) simulations are invaluable in researching protein properties; however, MD data require careful and subjective interpretation. Concurrently, Machine Learning (ML) algorithms have successfully elucidated cause-and-effect relationships in data, but their performances are bound by data quality and volume. This thesis delves into developing a pipeline that leverages the synergistic potential of MD simulations as a data source for ML algorithms. For this purpose, variant structures were generated, validated, and used to produce more than 1600 trajectories of 312 enterokinase variants to serve as data for ML algorithms. MD simulations were shown to be sensitive to mutations and provided comparable information across diverse simulation lengths. After selecting and validating optimal simulation parameters, datasets were constructed using MD simulation-derived data, sequence information, and structural features. These datasets were then used to test and refine over 40 supervised ML algorithms. An iterative process revealed that incorporating MD simulations enhanced the predictive capabilities of supervised ML. Interpretability techniques allowed for the identification of important features, paving the way for more targeted experimental rounds in protein engineering and setting a new standard in protein development research. As the final step, the MD data were used to build graph neural networks, and the performances of these deep learning algorithms were compared with the previously constructed ML models. Overall, the pipeline presented here, constructed by combining the strengths of MD simulations and ML techniques, served to predict protein functions. These findings present valuable insights with the potential to reduce costs and time in protein engineering campaigns, thereby exemplifying the immense potential of ML leveraged with information-rich data such as those derived from MD simulations

A simulation-based framework for collective intelligence in strategic healthcare planning

Strategic health planning of Integrated Care Systems remains a significant challenge for the English NHS despite its prioritisation in the NHS constitution. The first contribution of this thesis is to identify three problem causes through literature surveys and semi-structured interviews. A culture of organisational silos leads to conflicting interests and a lack of mutual understanding. A rigid, linear planning process leads to protracted planning timescales and promotes short-termism. Moreover, inadequate tools and methodologies prevent healthcare collectives from working across organisational and discipline boundaries. To address these issues, the research proposes a simulation-based framework integrating clinical, workforce, infrastructure, economic and financial planning at system-wide scale. The framework is designed as a fast-paced, iterative process supported by a prototype complex systems simulation model. It is estimated that the collaborative environment generated by the framework would lead to new opportunities for collective action across discipline and organisational boundaries. In this regard, the research proposes an experimental methodology to measure the framework’s impact on group performance. The main experiment activity is called the Integrated Care Game. It is a facilitated serious game where participants must collaboratively plan a fictional Integrated Care System by operating with the simulation model. The aim is to balance improvements across four system aspects: patient outcomes, patient experience, resource utilisation, and financial affordability. The game aims to maximise the overall score without triggering a Game Over. The micro-level interactions within the group are analysed using a hybrid methodology to identify collective behaviour patterns. Preliminary results from three workshops have shown that the framework positively impacted the group’s collective intelligence, improving group performance over time. The iterative planning process produces a group reinforcement learning effect that stimulates participants to self-organise, focus on the common goal, and aggregate shared strategies

Automated Generation of Hospital Discharge Summaries Using Clinical Guidelines and Large Language Models

Discharge summaries are essential yet time-consuming documents doctors write at the end of a patient's hospital stay. They are the primary form of communication between hospital and community care teams. The automatic generation of summaries could reduce the administrative burden on doctors. We propose to use large language models, few-shot prompted by clinical guidance, to perform this task. Unlike previous supervised approaches, our method does not require a large training dataset, can accept full-length physician notes as inputs and is explicitly guided by clinical best practice. We implemented such a system using Royal College of Physicians London guidelines, GPT-4-turbo and MIMIC-III physician notes. 53 summaries were evaluated by 10 clinicians and found to have a micro accuracy of 0.81. Finally, we discuss methodical limitations and the required future improvements to the evaluation framework

Feasibility randomised controlled trial of face-to-face counselling and mobile phone messages compared to usual care for smokeless tobacco cessation in Indian primary care: Project CERTAIN

Introduction Smokeless tobacco (SLT) use in low- and middle-income countries has adverse health consequences. We hypothesize that it is feasible to test an intervention of mobile phone messages and face-to-face counseling sessions for SLT cessation in India. Aims and Methods We conducted an exploratory, individual parallel two group, randomized controlled trial (RCT), with baseline and end-point (3 months from randomization) assessments in urban primary health centers in Odisha, India. A total of 250 current (i.e., users in the last 3 months) SLT users or dual users (ie, smokers and SLT users) were recruited to the trial (125 in each group). Participants were randomized to either routine care, face-to-face counseling, and reminder mobile messages or routine care only. The primary outcomes were to assess the feasibility of running a full RCT including recruitment, compliance, and retention. Results A total of seven (77.8%) out of nine primary care centers took part in the trial. Out of the 315 SLT users invited to participate, 250 provided consent and were randomized [79.4% (95% CI: 74.5, 83.7)]. Out of the 250 randomized SLT users, 238 [95% (95% CI: 91.8, 97.5)] were followed up at 3 months (117 in the intervention group and 121 in the control group). Of the participants in the intervention group, 74 (63.8%) reported that they received the mobile messages. Conclusions This exploratory trial demonstrated the feasibility of delivering and evaluating an intervention of mobile phone messages and face-to-face counseling for SLT users in Indian primary care in a full randomized trial Implications This study found that combining mobile messages with face-to-face counseling for smokeless tobacco users visiting primary health care settings in India is feasible in terms of recruitment of users, compliance with the intervention, and retention of study participants within the trial. The biochemically verified smokeless tobacco abstinence rate was higher in the intervention group compared with the control group. There was poor agreement between self-reported tobacco cessation and the measured salivary cotinine in smokeless tobacco users. The findings support the feasibility and acceptability of the intervention signaling the need for a larger clinical trial to test the effectiveness of the intervention

Moderation of the real-world effectiveness of smoking cessation aids by mental health conditions: A population study

Objective: To examine whether the real-world effectiveness of popular smoking cessation aids differs between users with and without a history of mental health conditions. // Design: Nationally-representative cross-sectional survey conducted monthly between 2016–17 and 2020–23. // Setting: England. // Participants: 5,593 adults (2,524 with a history of ≥1 mental health conditions and 3,069 without) who had smoked regularly within the past year and had attempted to quit at least once in the past year. // Main outcome measures: The outcome was self-reported abstinence from quit date up to the survey. Independent variables were use of the following cessation aids during the most recent quit attempt: prescription nicotine replacement therapy (NRT), NRT over-the-counter, varenicline, bupropion, vaping products, face-to-face behavioural support, telephone support, written self-help materials, websites, hypnotherapy, Allen Carr’s Easyway, heated tobacco products, and nicotine pouches. The moderator was history of diagnosed mental health conditions (yes/no). Covariates included sociodemographic characteristics, level of cigarette addiction, and characteristics of the quit attempt. // Results: Relative to those without, participants with a history of mental health conditions were significantly more likely to report using vaping products (38.8% [95%CI 36.7–40.8] vs. 30.7% [28.9–32.5]), prescription NRT (4.8% [3.9–5.7] vs. 2.7% [2.1–3.3]), and websites (4.0% [3.2–4.8] vs. 2.2% [1.6–2.7]). Groups did not differ significantly in their use of other aids. After adjusting for covariates and use of other cessation aids, those who used vaping products (OR = 1.92, 95%CI 1.61–2.30), varenicline (OR = 1.88, 95%CI 1.19–2.98), or heated tobacco products (OR = 2.33, 95%CI 1.01–5.35) had significantly higher odds of quitting successfully than those who did not report using these aids. There was little evidence that using other cessation aids increased the odds of successful cessation, or that the user’s history of mental health conditions moderated the effectiveness of any aid. // Conclusions: Use of vaping products, varenicline, or heated tobacco products in a quit attempt was associated with significantly greater odds of successful cessation, after adjustment for use of other cessation aids and potential confounders. There was no evidence to suggest the effectiveness of any popular cessation aid differed according to the user’s history of mental health conditions