Disinvestment initiatives in healthcare

Background: Health systems worldwide are increasingly adopting disinvestment initiatives to enhance care quality and maximize value by eliminating ineffective and obsolete interventions. However, removing low-value care (LVC) is challenging and complex, as many were adopted without rigorous evidence of clinical or cost-effectiveness, as well as resistance from healthcare stakeholders due to uncertainty in the outcomes of disinvestment. Inconsistent systems for identifying such technologies exacerbate this issue, along with unclear methodologies to assess these LVC. Existing disinvestment efforts have achieved mixed success, highlighting a critical need for structured, inclusive, and evidence-based approaches to address these gaps and enhance the implementation of the initiatives. Methods: This multi-method study included a scoping review of healthcare disinvestment initiatives, a mixed-method study integrating an online survey and key informant interviews with Malaysian healthcare stakeholders, and triangulation of findings to inform the development of a decision-making framework. Two case studies were conducted to assess LVC candidates, and the proposed framework was pilot-tested in a stakeholder workshop. Results: Stakeholder engagement emerged as pivotal for the success of disinvestment initiatives. Through stakeholder engagement, scoping review, and consultation with experts, this thesis introduces a novel decision-making framework based on the value of de-implementation concept, which incorporates five key domains: health impact, equity considerations, enablers for disinvestment, system readiness, and economic impact. Pilot-testing with Malaysian stakeholders demonstrated the framework’s feasibility and acceptance, supporting its role in promoting a systematic, transparent, and inclusive approach to disinvestment. Implications: Implementing healthcare disinvestment as a policy-driven initiative requires a complex approach of stakeholder engagement and empowerment, as well as systematic and comprehensive methodology. This process is heavily dependent on reliable data and evidence to support the assessment and decision-making process, availability of guidance or framework for decision-making, as well as leadership commitment and resources to ensure the sustainability of the effort. Future work should aim to integrate public and patient perspectives into the decision-making process, with opportunities to refine, evaluate, and validate the proposed framework. Further research is needed in assessing the impact of disinvestment decisions and recommendations, especially in optimising value in health service delivery and transition to higher-value strategies as a result of de-implementing LVC

Conceptualising the Fintech ecosystem: a case study of Kazakhstan

Abstract not currently available

Haptic animation: incorporating touch in expanded animation

This thesis explores the concept of ‘Haptic Animation’, a creative approach to expanding the sensory dimensions of animation beyond the traditional visual focus. Rooted in the exploration of touch, and space, this practice-led question challenges the ocular-centric norms of animation by foregrounding tactile experiences. Drawing on the theoretical framework of Laura U. Marks' concept of haptic visuality (2000), which emphasises the sensory experience of the viewer, the study redefines animation as a multisensory medium through both handcrafted and kinetic approaches. It categorises the practice into two key approaches: frame-based animation, which foregrounds touchable frames to explore the tactile qualities of materials, and kinetic-based animation, which incorporates physical motion through haptic devices and physical interaction. In this kinetic approach, haptic devices powered by Arduino and servo motors are used to simulate real-world movement, adding a layer of physical engagement to the animated experience. Through these combined approaches, the study reimagines animation as a meeting point between sight and touch, where the tactile dimension becomes integral to its creation and reception. The research is structured around three core chapters: ‘Expanding Touch in Animation,’ ‘Touching Sound in Expanded Animation,’ and ‘Creating Space in Expanded Animation.’ Each chapter delves into the theoretical frameworks and practical methodologies that underpin the creation of haptic animation. The study emphasises the importance of haptics in animation, highlighting how tactile engagement can be integrated into animated forms to create embodied experiences. Similarly, the role of sound is investigated as a touchable element, with a focus on its ability to enhance the sensory richness of animation. During the exploration, I produced expanded animations that I have shown in six exhibitions. Two were solo exhibitions shown at the University of Glasgow: Touch and Tell (2021) and Beyond the Screen (2024). The others were shown to the public as part of various collective exhibitions. Walking No.1 (2022) was exhibited in TouchScreen: Rethinking Perception through Sight and Skin at the Centre of Contemporary Art Glasgow in 2022; Walking No.2 (2022) was shown at the ARCadia festival at the Advanced Research Centre in 2022; Kinetic Apple No.1 (2023) was presented in the Tacky Fondue Exhibition at the Salt Space Gallery in 2023, and Kinetic Apple No.2 (2024) was exhibited in the Animation as Art exhibition at the Museum of Texas Tech University in 2024. The thesis culminates in a reflection on the implications of haptic animation for both the practice and understanding of animation. Ultimately, this research contributes to the broader discourse on sensory engagement in art, offering new perspectives on how animation can be experienced through alternative sensory pathways

The effectiveness of simulation-based learning in nursing education

Abstract not currently available

Youth-championing research-practice collaboration as vehicle for collaborative knowledge discovery and stewardship: insights from an exploratory study with four schools in the Western Cape, South Africa

In educational research, interest in collaborative research strategies including research-practice partnerships (RPPs), research-practice collaborations (RPCs) and related approaches has grown significantly over the past decade, expanding beyond RPPs initial roots in the US to an increasingly global footprint. Yet many questions remain about how to engage in collaborative educational research as well as the benefits, ‘impact’, and relevance of doing so for all parties involved. The South African context is one of many - outside the US, UK, and other emerging hot spots - where the potential of these approaches has only been explored sporadically. The core focus of this proof of principle study is how enabling, hospitable spaces for collaborative knowledge discovery and stewardship (CKD&S) can be fostered through RPCs with schools in the Western Cape, SA. RPC is defined as a concept that is closely related to RPPs yet distinct in potentially valuable ways in terms of key challenges that have been identified around the significant investments such partnerships demand. The thesis narrates and interprets four emergent, youth-championing RPCs with schools that ran in parallel over the first two terms of 2023. These RPCs centred on the collaborative prototyping of a developmental intervention for learners in key transitional grades in the SA education system. Drawing on the perspectives of school leaders, staff as well as over 200 learners, the potential of RPCs as vehicles for fostering enabling, hospitable spaces for CKD&S that are tailored to context, allow for differentiated collaborator engagement as well as flexible, distributed, servant leadership, is considered. The discussion augments broader deliberations in the literature on the formative potential of RPCs for researchers and practitioners, as well how the value and transferability of these collaborative research strategies may be assessed. A proposal for first prototype heuristic to support clearer conversations around CKD&S activities is outlined

Addressing data scarcity in autonomous systems through trustworthy counterfactual generation

Autonomous systems often operate in environments where collecting large, diverse, and safety-critical datasets is difficult. This data scarcity limits their reliability, particularly in rare or hazardous scenarios that are hard to capture in the real world. This thesis addresses data scarcity by integrating structural causal models with diffusionbased generative models to produce trustworthy, high-fidelity counterfactual images for “what-if’’ reasoning. Thus, two frameworks are proposed: Causal DiffuseVAE and Causal DiffuseLLM. Both generate images that follow a directed acyclic graph of semantic factors while preserving visual realism. The thesis first outlines key concepts in causal generative modeling and modern deep generative methods, highlighting that existing approaches either provide interpretable causal control with limited fidelity or achieve photorealism without reliable intervention behavior. Causal DiffuseVAE structures the latent space using a causal graph and applies a diffusion decoder for detail reconstruction. Experiments show a 40% reduction in generation time and a 30% improvement in counterfactual accuracy compared with state-of-the art causal diffusion models. Causal DiffuseLLM, which maps language instructions to causal interventions, improves generation accuracy by 15% over its non-LLM baseline and localizes edits to causally affected regions. Overall, this thesis shows that embedding causal reasoning into diffusion pipelines provides a practical path to generating reliable data for autonomous systems operating under limited data conditions

Challenges and opportunities for iodine prophylaxis in the UK

Abstract not currently available

Writing (bitter)sweetness: queer ecologies of the sugar plantation in Caribbean literature

This dissertation takes the works of four queer and lesbian diasporic Caribbean writers to investigate what a queer ecological analysis of Caribbean literature may engender in an age of climate change. Bringing scholarship from queer ecology and Geography to bear on a decolonial and ecofeminist literary analysis, the following investigation takes interdisciplinarity at its fore to reflect the tentacular and interwoven nature of our ecological age and its layers of sedimented histories. It draws on the Haitian creative practice of rasanblaj by which pieces of fabric are brought together to present a complex whole. As a central point in this tapestry, the sugar plantation is used as both metaphor and landscape through which to ask what it means for queer writers to address and reclaim this bittersweetness, building on the work of Omise’eke Natasha Tinsley with ecological and geographical scholarship. Tracing this sugar from the Caribbean, across oceans, and to diasporic cities in the Global North through storytelling, it investigates what it means to write bittersweetness in all its entanglements

Cultural commodities in conflict. An analysis of moral panic in the discourse on antiquities trafficking in newspaper articles in Germany, 2003–2020

This thesis is an analysis of the public discourse about antiquities trafficking from Iraq and Syria in Germany between 2003 and 2020. Germany is a market country for illicit antiquities, with a long-standing market for antiquities from Western Asia. During the researched period, widespread archaeological looting in the wake of the then-current conflicts in Iraq and Syria became public knowledge through reports in news media. At the same time several important changes in the German media's treatment of the German antiquities market can be seen, especially with regards to antiquities from Iraq and Syria. Moreover, in this time, changes in the legislation regulating the antiquities market were adopted in Germany, at the time widely seen as a reaction to the discourse. The development of the public discourse on antiquities trafficking in Germany is analysed in this thesis using the sociological concept of moral panic. To this end, German-language newspaper articles are investigated in detail using news framing analysis. The trends and themes emerging from this media analysis are then contextualised with texts from the lawmaking process of legal changes in Germany in 2007 and 2016, and reactions from the antiquities market. With this methodology, I show that the public discourse on antiquities trafficking rapidly spun into a moral panic between mid-2014 and early 2015, centering the alleged involvement of the terror group Islamic State (IS) in the illicit antiquities trade, and that the following legal change of 2016 was falsely presented to the public as a consequence of the narratives promoted in this moral panic. The thesis concludes with a discussion on the lasting impact of this discourse, the social and intellectual consequences of moral panics and misconceptions about antiquities trafficking, and what this can mean for the future of cultural heritage policies in market countries for antiquities

Essays on mergers and acquisitions

No abstract available