History Roundtable on US Universities and the State: Episodes from the Twentieth Century

This roundtable explores four historical episodes in the history of state–university relations in the United States. In doing so, it addresses issues that also figure prominently in present-day debates, including questions of academic freedom and free speech, the state's role in research funding as well as the international features of higher education. Convened by the journal's editor, the roundtable features individual contributions from four historians, each of whom focuses on a particular document and moment in time: a 1912 report from the US Commissioner of Education, Philander Claxton, that indicated a shift towards an internationalization strategy (Charlotte Lerg); a 1915 statement on academic freedom by the American Association of University Professors (Tomás Irish); Vannevar Bush's 1945 report on Science – the Endless Frontier (Christopher Loss); and a ‘Joint Statement on Rights and Freedoms of Students’ from 1967 (Kate Ballantyne). Taken together, these pieces point to a wider question – namely the role and public value that different political and academic actors attribute to academic research and higher education – and to the institutions and individuals that are engaged in it

Enhanced Stress-Resilience Training (ESRT) for graduate-entry medical students: a randomised-controlled, mixed-method investigation

BackgroundMedical students face demanding academic requirements, fierce competition, self-doubt and financial concerns contributing to high rates of depression, anxiety, stress, sleep problems and burnout, highlighting a need for effective interventions. We explored an intervention called Enhanced Stress-Resilience Training (ESRT), a modified form of mindfulness training adapted for clinicians, that was applied to medical students for the first time.MethodsGraduate-entry medical students (N = 118) were randomised to ESRT or an active control condition as part of a registered trial (ISRCTN16324994). A 3 (Time: pre-, post-, and six-month follow-up) × 2 (Group: ESRT, control) mixed design was used to assess changes in psychological flexibility, resilience, and stress reactivity. Due to attrition (T3 n = 47), additional sensitivity analyses, including intention-to-treat and subgroup analyses based on baseline resilience, were conducted. Qualitative data from exit evaluations (n = 25), interviews (n = 12), and focus groups (n = 11) underwent reflexive thematic analysis to explore student experience and contextualise quantitative findings.ResultsESRT users demonstrated increased psychological flexibility scores at post-intervention (p = .001, d = 0.62) and six-months follow-up (p = < 0.001, d = 0.96), and these findings were confirmed in intention-to-treat analysis. Exploratory analyses revealed that those with low baseline resilience who underwent ESRT displayed increased resilience (p = < 0.001, d = 1.86) and decreased stress reactivity (p = < 0.001, d = 1.58) at the six-month follow-up. Qualitative findings highlighted high acceptability, perceived value, and a strong desire for curricular integration, while also revealing barriers to engagement, particularly time constraints.ConclusionsThis study offers new evidence that ESRT may enhance psychological flexibility and resilience, and decrease stress reactivity, especially among more vulnerable students. Sustained effects and positive qualitative feedback suggest that curricular integration could improve feasibility and reach

Examining the health literacy and health behaviours of children aged 8–11 in Wales, UK

Childhood is a period of significant formative development where knowledge, skills, and capacities for adequate health literacy are acquired, particularly within school settings. The new Curriculum for Wales (CfW), phasing in from September 2022 for learners aged 3–16 years, places statutory focus on health and well-being and school-level curriculum design, providing unprecedented opportunities to empower children as agents in making health-enhancing decisions. Designing, tracking, and evaluating impacts of the CfW on children’s health literacy requires scalable monitoring tools; however, research efforts have focused on adolescent populations. This national-scale scoping and pilot study, the first to explore children’s health literacy in Wales, piloted the Health Literacy for School-Aged Children (HLSAC-5) within the existing nationwide Health and Attainment of Pupils in Primary EducatioN (HAPPEN-Wales) health and well-being survey to examine the health literacy of children aged 8–11 (n = 2607) and explore associations between health literacy and health behaviours. Children’s health literacy was categorized as low (22.6%), moderate (50.4%), and high (27.0%). Multinomial logistic regression analyses suggest high health literacy compared to low health literacy was associated with higher sleep [relative risk ratio (RRR): 1.08, 95% CI 1.01–1.15], higher weekly physical activity (RRR: 1.13, 95% CI 1.03–1.25), fewer sedentary days per week (RRR: 0.89, 95% CI 0.81–0.99), and higher health-related well-being (RRR: 1.35, 95% CI 1.27–1.44). This study offers a sustainable measure of pre-adolescent children’s health literacy and health behaviours and tracking of CfW impacts. This enables efforts to be tailored to person-centred (understanding children’s health literacy needs), place-based (examining specific organizational health literacy context within schools and CfW design), and policy-focused approaches (re-energizing health literacy within current/emerging policies in Wales including the CfW)

Mapping Molecular Pathways of Multiple Sclerosis: A Gene Prioritization and Network Analysis of White Matter Pathology Transcriptomics

ObjectivesRapid advances in transcriptomics have driven efforts to identify deregulated pathways in multiple sclerosis (MS) tissues, though many detected differentially expressed genes are likely false positives, with only a small fraction reflecting actual pathological events. Robust, integrative methods are essential for accurately understanding the molecular mechanisms underlying MS pathology.MethodsWe conducted a gene prioritization analysis of MS white matter pathology transcriptomic studies. Articles were sought in Scopus and PubMed up to July 31, 2024. Potentially eligible publications were those that provided either transcriptomics datasets (deposited in GEO) or lists of differentially expressed genes comparing MS white matter to control white matter.ResultsApplying a vote-count strategy to search for the intersection of genes reported in multiple independent studies with a consistent fold-change direction, followed by a Monte Carlo simulation, we identified 528 highly significant differentially expressed multi-study genes (p < 0.0001; 10,000 simulations). Functional enrichment analysis revealed deregulation of the folate pathway in MS normal-appearing white matter, and tumor necrosis factor (TNF) -related and complement-related pathways in active and chronic active lesions, respectively. Network analysis identified 6 key signaling hubs: PTPRC, HLA-B, MYC, MMP2, COL11A2, MAG. The major nodes identified revealed mechanistic concordance with published in vivo MS models, supporting their value as potential therapeutic targets.InterpretationOur strategy provides a robust framework for integrating gene expression data, effectively identifying the intricate pathways altered in human diseased tissues. This method holds potential for translating findings into drug development strategies. ANN NEUROL 202

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

Can ChatGPT-4o Really Pass Medical Science Exams? A Pragmatic Analysis Using Novel Questions

ChatGPT apparently shows excellent performance on high-level professional exams such as those involved in medical assessment and licensing. This has raised concerns that ChatGPT could be used for academic misconduct, especially in unproctored online exams. However, ChatGPT has previously shown weaker performance on questions with pictures, and there have been concerns that ChatGPT’s performance may be artificially inflated by the public nature of the sample questions tested, meaning they likely formed part of the training materials for ChatGPT. This led to suggestions that cheating could be mitigated by using novel questions for every sitting of an exam and making extensive use of picture-based questions. These approaches remain untested. Here, we tested the performance of ChatGPT-4o on existing medical licensing exams in the UK and USA, and on novel questions based on those exams. ChatGPT-4o scored 94% on the United Kingdom Medical Licensing Exam Applied Knowledge Test and 89.9% on the United States Medical Licensing Exam Step 1. Performance was not diminished when the questions were rewritten into novel versions, or on completely novel questions which were not based on any existing questions. ChatGPT did show reduced performance on questions containing images when the answer options were added to an image as text labels. These data demonstrate that the performance of ChatGPT continues to improve and that secure testing environments are required for the valid assessment of both foundational and higher order learning

The Future of Conversation is Evolving from Human Dialogue to Hybrid Human-Agentic Discourse

In an era increasingly dominated by artificial intelligence (AI), the essence of human conversation is undergoing significant transformation. Once exclusively human, conversation is now increasingly mediated by AI agents, voice assistants, and digital platforms. This paper critically explores this profound shift, examining the nature and implications of hybrid human machine discourse. Addressing three fundamental questions, we interrogate what constitutes genuine conversation when one party lacks consciousness and emotion; how traditional norms of human dialogue translate into human-machine interactions; and what considerations developers and governance frameworks must prioritize in this evolving context. Building upon Nass and Brave’s (2005) concept of "voice activation," which demonstrates humans’ inherent social responses toward artificial speech, this study identifies the dual promise and peril of conversational AI, emphasizing the risks of confusion, over-trust, and emotional misdirection. Arguing that AI-driven dialogue is not merely automation but a profound cultural and ethical shift, this research advocates for new literacies, ethical frameworks, and a re-evaluation of what authentic communication entails. By tracing the philosophical roots and current technological practices of conversation, the study underscores the urgency of rethinking communication ethics, literacy, and practice in our increasingly hybrid human-machine conversational landscap