Personalisation at the Core of Success: Process Evaluation of the LISTEN Randomised Controlled Trial Evaluating a Personalised Self‐Management Support Intervention for People Living With Long Covid

Background: The development and evaluation of rehabilitation interventions designed to support people with Long Covid (LC) remains an important ongoing priority. Many people with LC experience episodic, debilitating symptoms that can reduce their ability to engage in all areas of activity. The Long CovId personalised Self‐managemenT support co‐design and EvaluatioN (LISTEN) trial co‐designed and evaluated a personalised self‐management support intervention to build confidence and support people to live better with LC. This paper describes the context, implementation, mechanisms of impact and impacts from the LISTEN intervention, in comparison with usual LC services accessed within the National Health Service (NHS). Methods: A mixed methods process evaluation was nested within the LISTEN pragmatic, multi‐site, randomised controlled trial. Data were collected from sites in England and Wales between September 2022 and January 2024. Observations and focus groups with healthcare practitioners (HCPs) delivering the intervention were conducted to assess fidelity. Standardised implementation measures, focussed on intervention feasibility, acceptability and appropriateness, were gathered from HCPs and intervention participants. Semi‐structured interviews were undertaken with a subset of participants across both trial arms. Data were analysed independently using descriptive statistics, or reflexive thematic analyses, and subsequently integrated, drawing upon the Consolidated Framework for Implementation Research v2. Findings: Thirty‐six HCPs participated in the process evaluation, and 197 intervention participants completed standardised implementation measures. Across both trial arms, 49 participants took part in semi‐structured interviews. Six integrated themes were constructed from all data sources describing and illustrating links between the context, implementation, mechanisms of impact and impacts: ‘Delivery during uncertainty and ambiguity’, ‘Diversity and consistency of usual care’, ‘Drivers for self‐care and the impact of self‐generated expertise’, ‘Appropriate if unexpected support’, ‘Personalisation at the core of success’ and ‘A spectrum of change’. Conclusion: The LISTEN intervention is an appropriate, feasible intervention for participants and HCPs. The intervention can be delivered to a high level of fidelity following training and with ongoing HCP support. Access, receipt and perceptions of NHS LC services were variable. Personalised, relational interventions, such as LISTEN, can foster favourable impacts on confidence, knowledge and activity and are acceptable and strongly recommended within LC rehabilitation services. Patient or Public Contribution: The study was supported by a patient and public involvement and engagement (PPIE) group from project conception to study end. Using their lived expertise, seven people with LC supported accessible recruitment (e.g., materials), data collection (e.g., topic guides), data interpretation (e.g., theme construction and reviewing findings) and dissemination activities (e.g., online webinars). Trial Registration: ISRCTN36407216, registered 27/01/2022

Exploring South Korean Foreign Direct Investment Motives and State-Level Location Decisions: US Evidence 1995-2008

This study uses a novel application of panel fuzzy-set qualitative comparative analysis (fsQCA) in the international management field. utilizing a unique database capturing reasons for foreign direct investment (FDI), and state-level location, we explain location decisions of high-technology South Korean (henceforth Korean) multinational enterprises (MNEs), when first entering the United States of America (henceforth US), from 1995 until the 2008 financial crisis. Various home country conditions, combined with a desire for technological upgrading, encouraged firms to seek locational advantages. Additionally, rather than assuming FDI to be driven by a single purpose over time, the addition of regional characteristics allows a typology of reasons for Korean FDI to be developed. We show evolving Korean FDI trends in the US with home country and regional perspectives interacting to attract FDI into US states with different characteristics, arguing this is consistent with US policy seeking to attract inward investment to foster economic development

Enhancing Fairness, Justice and Accuracy of Hybrid Human-AI Decisions by Shifting Epistemological Stances

From applications in automating credit to aiding judges in presiding over cases of recidivism, deep-learning powered AI systems are becoming embedded in high-stakes decision-making processes as either primary decision-makers or supportive assistants to humans in a hybrid decision-making context, with the aim of improving the quality of decisions. However, the criteria currently used to assess a system’s ability to improve hybrid decisions is driven by a utilitarian desire to optimise accuracy through a phenomenon known as ‘complementary performance’. This desire puts the design of hybrid decision-making at odds with critical subjective concepts that affect the perception and acceptance of decisions, such as fairness. Fairness as a subjective notion often has a competitive relationship with accuracy and as such, driving complementary behaviour with a utilitarian belief risks driving unfairness in decisions. It is our position that shifting epistemological stances taken in the research and design of human-AI environments is necessary to incorporate the relationship between fairness and accuracy into the notion of ‘complementary behaviour’, in order to observe ‘enhanced’ hybrid human-AI decisions

Interrogating green social prescribing in South Wales; A multi-stakeholder qualitative exploration

As an umbrella term, social prescribing offers varied routes into society which promise to support, enhance, and empower individual citizens to take control of their own health and wellbeing. Globally healthcare systems are struggling to cope with the increasing demands of an ageing population and the NHS (UK) is no exception. Social prescribing is heralded as a means to relieve the burden on primary care and provide support for the 20% of patients whose needs are non-medical. As such an increasing array of schemes are available, spanning five sub-sets: creative or nature-based referrals, welfare services, exercise referrals, education programmes or befriending support. Green social prescription offers significant potential to promote wellbeing and improve health outcomes. However limited research has explored this emergent sub-set

Maternal physiological parameters and routine laboratory tests to screen for maternal sepsis: an observational cohort study

Maternal sepsis can lead to poor outcomes for the mother and neonate, and early diagnosis and treatment of infection is important to prevent sepsis. Current guidance to recognise maternal sepsis includes assessment of physiological markers, however normal physiological changes of pregnancy can hinder the diagnosis of sepsis. This study investigated the utility of routine clinical variables, including laboratory tests, in screening for maternal sepsis. Patients considered at risk of obstetric sepsis were recruited into a single centre cohort study. Microbiological, histological and clinical data categorised patients into three diagnostic groups: 'infection confirmed', 'infection unknown' and 'infection unlikely'. Differences in physiological and routine laboratory variables were investigated. Between November 2020 and December 2022, 154 pregnant patients were recruited. Comparison between 'infection confirmed' (n=58) and 'infection unlikely' (n=17) showed statistical differences in temperature (P <0.001), neutrophil count (P =0.003) and leukocyte count (P =0.004) at the time of recruitment. Temperature was the best discriminator with an area under the receiver operating characteristic curve (AUC-ROC) of 0.82 (95% CI 0.70 to 0.94, P <0.0001) with an optimal threshold of ≥37.5°C. This observational cohort study demonstrated that maternal temperature ≥37.5°C (rather than the threshold of 38°C found in most screening tools) may be important in screening patients at risk of developing maternal sepsis. When temperature ≥37.5°C persists, medical care should be expedited and maternal infection considered

Unravelling the origin of enhanced CO2 selectivity in amine-PIM-1 during mixed gas permeation

Previously, it has been reported that amine-PIM-1, a polymer of intrinsic microporosity obtained by reduction of nitrile groups of PIM-1 to primary amine groups, shows enhanced CO2 selectivity during mixed gas permeation studies with respect to single gas measurements for gas pairs involving CO2. This distinct and potentially useful behaviour was ascribed to the affinity of CO2 for the polymer amine groups. Here, we demonstrate that enhanced selectivity originates from both CO2 physisorption and chemisorption. A combination of 13C and 15N solid-state NMR spectroscopic analyses of a CO2-loaded amine-PIM-1 membrane allowed the identification and quantitative determination of both chemisorbed and physisorbed species and the characterization of polymer-CO2 interactions. Experiments with 13C isotopically enriched CO2 unequivocally demonstrated the conversion of 20% of the NH2 groups into carbamic acids at 298 K and a CO2 pressure of 1 bar. Chemisorption was supported by the strong heat of CO2 adsorption for amine-PIM-1 that was estimated as 50 kJ mol−1. Molecular dynamics simulations with models based on the experimentally determined polymer structure gave a detailed description of intra- and interchain hydrogen bond interactions in amine-PIM-1 after chemisorption, as well as of the effect of chemisorption on polymer porosity and physisorption

Oxygen isotope dendrochronology allows dating of historical timbers across a wide geographical region

We explore the applicability and geographic reach of two northwest European stable oxygen isotope (δ18O) chronologies for the precision dating of annually resolved δ18O series developed from late 15th-century oak (Quercus sp.) roof timbers from St. James’ Church in Bruges, Belgium. In doing so this study assesses ring-width dendrochronology and provenance analysis alongside oxygen isotope dendrochronology in Belgium and its surrounding regions.The δ18O-series of the historical timbers display a high internal coherence, allowing the construction of a mean isotope series (1325 to 1468 CE). Cross-dating against master chronologies for Central England, U.K. and Fontainebleau, France, provide reliable matches that surpass statistical thresholds and quality control measures, corroborating the dating results obtained from conventional ring-width dating.Oxygen stable isotope dendrochronology emerges as a valuable tool for precise dating of historical timber structures. This pilot study demonstrates the applicability of existing reference chronologies beyond their core regions and underscores its significance in cultural heritage studies. Despite the demanding nature of the technique in terms of time and expertise, the potential benefits warrant continued investment in expanding the temporal and geographic coverage of well-replicated oxygen isotope reference chronologies

Evaluation of a caesium fountain frequency standard for antihydrogen spectroscopy

The performance of a caesium fountain frequency reference for use in precision measurements of trapped antihydrogen in the ALPHA experiment at CERN is evaluated. A description of the fountain is provided together with a characterisation of systematic effects. The impact of the magnetic environment in the Antimatter Factory, where the fountain is installed, on the performance of the fountain is considered and shown to be insignificant. The systematic fractional frequency uncertainty of the fountain is 3.0 × 10−16. The short-term frequency stability of the measured frequency from the ALPHA-HM1 maser is 1.5 × 10−13τ−1/2, whereas the fountain itself shows a stability limit of 4.7 × 10−14τ−1/2. We find a fractional frequency difference of (1.0 ± 2.2 (stat.) ± 6.5 (syst.)) ×10−16 in a comparison with Terrestrial Time via a GNSS Common View satellite link between January 2023 and June 2024. The fountain enables a significant increase in frequency precision in antihydrogen spectroscopic measurements, and paves the way for improved limits on matter–antimatter comparisons

Sex‐Dependent Influence of Major Histocompatibility Complex Diversity on Fitness in a Social Mammal

Parasite infections affect males and females differently across a wide range of species, often due to differences in immune responses. Generally, females tend to have stronger immune defences and lower parasite loads than males. The major histocompatibility complex (MHC) plays a crucial role in the adaptive immune response, and extensive research has explored how variation in this region influences infection and fitness outcomes. However, studies of sex‐specific relationships between MHC variation and infection are scarce, perhaps because MHC genes are located on the autosomes, which are shared by both sexes. Here, we provide evidence of sexually antagonistic selection in a wild, group‐living mammal—the banded mongoose. Using genetic and life history data collected from over 300 individuals across 25 years, we found that both MHC class I (MHC‐I) and MHC class II (MHC‐II) diversity influence lifetime reproductive success differently in males and females. Specifically, higher MHC diversity is linked to increased fitness in males but decreased fitness in females. Furthermore, MHC diversity did not differ between the sexes, indicating an unresolved genetic sexual conflict. Our findings demonstrate that sexually antagonistic selection acts on the MHC and may operate across both MHC classes but differently. This study contributes to the growing body of evidence that sex is a significant factor in shaping host immunity and fitness