A Pilot Randomized Controlled Trial Testing the Feasibility and Acceptability of Helping Ease Anxiety and Depression after Stroke (HEADS: UP): An Online Mindfulness-Based Intervention for Stroke Survivors

Objectives The purpose of this study was to assess feasibility and acceptability of a stroke-specific mindfulness-based intervention called Helping Ease Anxiety and Depression after Stroke (HEADS: UP). Method This study was a mixed-methods pilot randomized controlled trial comparing HEADS: UP to treatment as usual (TAU). HEADS: UP is a 9-week mindfulness intervention for stroke survivors. UK (United Kingdon)-based stroke survivors were recruited and attended HEADS: UP Online. Psychological functioning outcomes measures and other data were collected online at pre-intervention (Week 0), post-intervention (Week 9), and follow-up (months 3 and 6). Participants were randomized 1:1 to either HEADS: UP or TAU. Results Sixty-two participants completed baseline questionnaires and were randomized to HEADS: UP (n = 30) or TAU (n = 32). Retention rates were as follows: HEADS: UP (n = 25, 83.30%) versus TAU (n = 25, 78.10%) at post-intervention, HEADS: UP (n = 24, 80%) versus TAU (n = 26, 81.30%) at 3-month follow-up, and HEADS: UP (n = 20, 66.70%) versus TAU (n = 25, 78.10%) at 6-month follow-up. The mean age for HEADS: UP was 56.0 years versus 56.80 for TAU. The HEADS: UP group was 30% male, while the TAU group was 56% male. Depression Anxiety Stress Scales (DASS)-21 total mean score for HEADS: UP improved in the direction of expected effect (baseline 46.20, SD (standard deviation) = 24.00; post-intervention 24.00, SD = 16.10) indicating recovery versus no reliable change for TAU (baseline 36.10, SD = 18.70; post-intervention 31.60, SD = 20.40). HEADS: UP and TAU scores continued to improve over time. Between-group effect sizes (Cohen’s d) at post-intervention were large for BAI (Beck Anxiety Inventory) (d = 0.91), DASS-21 total (d = 0.89), and BDI (Beck Depression Inventory)-II (d = 0.86), highlighting the potential of HEADS: UP for improving depression and anxiety symptoms. At the six-month follow-up, the attrition rate was higher in the HEADS: UP group (33.30%) compared with TAU (21.90%). Conclusions HEADS: UP is feasible and acceptable and has potential to improve depression and anxiety symptoms for stroke survivors. Preregistration ClinicalTrials.gov: NCT04985838

QCA: Quantum Computational Approach for Internet of Things with 5G Connectivity

In this paper, the need for a quantum computing approach is analyzed for IoT applications using the 5G resource spectrum. Most of the IoT devices are connected for data transmission to end users with remote monitoring units, but there are no sufficient data storage units, and more data cannot be processed at minimized time periods. Hence, in the proposed method, quantum information processing protocols and quantum algorithms are integrated where data transmissions are maximized. Further, the system model is designed in such a way for checking the external influence factors that prevent the IoT device from transmitting data to end users. Therefore, with corresponding signal and noise power, it is essential to process the transmissions, thereby increasing data proportions at end connectivity. Once quantum computations are performed, then it is crucial to normalize IoT data units, thus establishing control over entire connected nodes that create a gateway for achieving maximum throughput. The combined system model is tested under four cases where the comparative outcomes prove that with reduced queue reductions of 12%, it is possible to achieve a maximum throughput of 99%

Disparity in Anterior Cruciate Ligament injury management: A case series review across six National Health Service Trusts

Background Effective management of anterior cruciate ligament (ACL) injuries requires a comprehensive approach, from initial assessment, through treatment, rehabilitation, and discharge, however no gold standard care pathway exists to help guide clinicians. This case series provides an overview of current ACL injury management processes in six National Health Service (NHS) Trusts. Methods This study utilised a retrospective case series design within six NHS Trusts in the Yorkshire region of the United Kingdom. Using a standard operating procedure, each Trust selected ten consecutive ACL injured patients (≥ 16 years), managed either surgically or non-surgically. Data relating to the patient injury journey, patient and injury characteristics, key pathway events, rehabilitation management, outcome measures, and discharge, were collected. Data was anonymised and analysed using descriptive statistics. Results Reviews covered 55 patients, median age 25.5 years, (41 males, 14 females). Median time to specialist assessment from injury was 12 days (Interquartile Range [IQR] 6 to 20 days), with 43 patients managed operatively, and 12 non operatively. The median number of physiotherapy sessions was 21 (IQR 9 to 29.5), with outcome measures being variably used across Trusts. Trusts using patient reported outcome measures (PROMS) consistently with their patients provided more physiotherapy appointments (34.5 and 27) and achieved higher return to sport (RTS) rates. Time from injury to discharge varied with a median of 421 (IQR 249 to 546) days. Discharge criteria were applied inconsistently across Trusts, with 31% of cases not using specific criteria. However, Trusts using standardised discharge criteria showed better RTS outcomes, with 27 (61%) patients successfully returning to sport. Conclusions This case series review highlighted some good practice in initial ACL management across six NHS Trusts in the Yorkshire region. However, from time to MRI diagnosis to discharge, substantial variation in care is observed. Whether treated operatively or non-operatively, for patients aiming to RTS, this was achieved with greater consistency when more physiotherapy appointments were undertaken, outcome measures and PROMs were used, and specific discharge criteria was utilised. Future larger pathway investigation studies incorporating causative and predictive analysis studies on a national scale are required to determine whether similar trends are observed in a wider ACL injured population, which could help to improve national pathways for patients and clinicians working towards ensuring more positive and standardised patient-related ACL injury outcomes

The use of hybrid service delivery to support adults with learning disabilities and autism

Background Hybrid service delivery (HSD), involving the utilisation of both in-person and remote delivery for service provision, has been noted as a way of improving quality and affordability, increasing access and reducing inequalities. While HSD has facilitated the provision of services for people with learning disabilities and/or autism across the voluntary, community and social enterprise sector (VCSE), it is not apparent how HSD has been used, what worked well or not well, for whom, and in what circumstances. This study aimed to explore how VCSE organisations could effectively use digital technologies alongside or instead of in-person activity to provide social care services to adults with learning disabilities and/or autism. Methods A participatory realist review methodology was utilised. Programme theories and propositions about the phenomenon and related concepts were identified utilising preliminary literature searches and co-production workshops with service providers and service users. The developed statements were used to guide the database and the identification of evidence. This evidence was used to test and refine the statements. Results 141 records were used to produce 13 areas of interest. While there was strong evidence supporting the use of digital technology to improve social connections and independence, this was only the case when the technology was used correctly, implemented in a suitable setting and ‘fit’ the person using it. Evidence indicated that the development or adaptation of technology which were co-produced with adults with learning disabilities and/or autism were associated with better service delivery. Conclusions Supporting adults with learning disabilities and autism to use technology can improve their independence and life skills. However, the technology needs to be implemented in the right setting, as well as co-production being used to ensure the technology and the delivery is suitable and accessible. Key messages • There is evidence that digital technologies can be used to support people with learning disabilities and autistic people, but only if it is used correctly and in the right setting. • Utilise co-production to shape tech-enabled services. Consider language use, visuals and technology delivery. Listen to their ideas, so the technology delivers what they want and need

Climate policy uncertainty and ESG performance of energy firms: The moderating effect of cloud computing technology

This study examines the impact of climate policy uncertainty (CPU) on the environmental, social, and governance (ESG) performance of energy firms, as well as the moderating role of cloud computing technology (CCT). Building on an integrated theoretical framework that combines resource dependence and dynamic capability perspectives, we conceptualize CPU as a dual-pressure that constrains both risk and resource access. Our findings show that CPU deteriorates ESG performance by increasing external risks and limiting resource access. However, energy firms with higher CCT adoption exhibit greater resilience to CPU, sustaining ESG investments in the face of CPU. Additional heterogeneity analyses indicate that the negative impact of CPU on ESG performance is especially acute among non-state-owned, smaller, and less resource-rich energy firms. This study extends existing theory by integrating resource dependence and dynamic capability perspectives into a unified framework. The findings underscore the strategic importance of CCT in maintaining ESG performance amid policy uncertainty, providing practical guidance for managers and policymakers

Developing a core health outcomes set for voluntary and community sector activity in West Yorkshire

Background This project arose from discussions between the NHS Intgrated Care Board, Leeds City Council and Universities in West Yorkshire, UK which recognised the need to develop a core outcome set to capture the impact of voluntary and community sector organisations’ (VCSO) activities on health and wellbeing, in a way that can be routinely integrated with existing datasets on health and care activity across the region. This is a public health priority because the reach and impact of community organisations is a crucial mechanism in tackling health inequalities, and the NHS Long term plan includes a shift to health provision in community settings. Methods Following public engagement workshops, and community conversations held between the WYICB Research Engagement Network community research champions and members of the public, a World Café event was held in a community venue to collect views from a range of stakeholders: academic, policy, health and care services, VCSOs and community champions. Discussions were grouped around 6 table themes: Administrative burden; Core data & outcomes; Relationships of trust; What would good look like; Measures into intelligence; Next steps for action and feedback. Discussions were recorded, transcribed and analysed using thematic analysis. Results 71 stakeholders attended from a range of sectors. Following line by line coding the data was organised under the following themes: Administrative burden; Appropriateness of outcome measures; Language issues; Data security concerns; Diversity and inclusiveness; Training; Infrastructure; Community engagement; Power dynamics; Communication; Ownership of the data. Conclusions If a core outcomes set for VCSO activity in West Yorkshire is to be successful, community organisations must be supported to collect, manage and share ownership of the data. The data itself must be relevant, appropriate and of value to communities, and the reasons for collecting it must be clearly explained. Key messages • Involving community organisations as equal partners in developing core outcomes sets to monitor their impact on health and wellbeing gives valuable insights into concerns of underrepresented groups. • Co-developing a core outcome set with community organisations that is relevant, appropriate, shared and easy to explain may increase response rates and fill in knowledge gaps in diverse communities

Making sense of metal in the United Kingdom and the future of metal music studies: A case study of Wytch Hazel and Arð

Heavy metal in the United Kingdom, as in many countries around the world, is thriving and has become a respectable form of popular culture, and its fans and musicians are seen everywhere. The same position of respectability has been gained by academics and the once-mocked subject field of metal music studies. In this article, I try to map metal in the United Kingdom today through a case study of Wytch Hazel and Arð, two bands located in the north of England. I will argue that metal in the United Kingdom is still a space for resistance to the commodification of the mainstream and the construction of imaginary, imagined communities. I will then argue that the future of metal music studies depends on whether metal itself continues to thrive as a place of polyvalent identities, as well as whether academics can negotiate their own epistemological and ontological uncertainties in the marketplace of higher education

Banned for doping: Using composite vignettes to portray rugby players’ experiences of anti-doping rule violations

Objective: Understanding the lived experiences of athletes who have been sanctioned for violating anti-doping rules presents the opportunity to listen and learn. Yet, the academic field seldom draws on the voices of those affected when considering doping in sport. Our aim was to illuminate important aspects of sanctioned athletes’ experiences and highlight opportunities for prevention and rehabilitation. Design: A semi-structured interview research design was used, and data informed the development of composite vignettes, a form of creative non-fiction. Method: Semi-structured interviews were conducted with two elite rugby players sanctioned for violating the anti-doping rules within rugby league (n=1) and rugby union (n=1). Three composite vignettes were created illuminating player experiences before, during and after the violations. Findings: The vignettes highlight in participants’ own words the multiple impacts of sport demands and drug use: (1) Leading up to the violation: ‘You’re just treading water, you’re surviving’ (2) ‘There’s just this massive amount of social pressure in rugby, not just on the game, but on who you’re supposed to be’ (3) ‘It was like being hit by a train’. The ADRV aftermath. Conclusions: The role of social identity in the transitions experienced by a rugby player following a critical incident (e.g., serious injury) was a key influencing factor for doping. Alongside addressing the demands of the sport, the need for early intervention and evidence-based support for players experiencing critical incidents (e.g., injury) and transitions was evident to prevent doping violations

Lessons learnt in other people's classrooms

Third Angel was a theatre company born out of interdisciplinary practice, and created by theatre graduates Rachael Walton and myself, who then trained as teacher and film-maker, respectively. Without identifying it as interdisciplinary, what we were interested in from the outset was collaboration. Drawing on the expertise and experience of a varied group of practitioners, our stated aim was to make something none of us would have made on our own. Something more than the sum of its parts. Our unstated (at the time) aim was to demonstrate that theatre was more than plays. We were interested in cross-art form work – ‘multi-media’ was the in phrase at the time; when an idea reminded us of a film or novel, it seemed worth pursuing; if it reminded us of a piece of theatre we had seen, it would often get forgotten about. This chapter reflects on two decades of collaboration between Third Angel and a number of scientists and specialists from other disciplines. These collaborations produced projects in theatre, live art, film, video, and participation, which were presented throughout the UK and internationally. We did not specifically set out to make interdisciplinary work: we followed our curiosity and discovered that ethos as we travelled. We were believers in the value of serendipity in a devising process, and recognised that we did not know what we did not know. We were always interested in collaborating with people with different approaches, born out of different experiences to our own. When we wanted to learn more about a subject, we approached people who knew more than us and, always fascinated by other people’s workshops and studios, we asked if we could go and visit them in the place they worked. We began to value spending time, literally and metaphorically, in other people’s classrooms

Evaluating the Probability of Head-Acceleration Events in Elite Men’s and Women’s Rugby Union Match-Play: The Impact of Tackle Height and Body Position

Background Head acceleration events (HAEs) are an increasing concern in collision sports owing to potential negative health outcomes. Objectives The objective of this study is to describe the probabilities of HAEs in tackles of differing heights and body positions in elite men’s and women’s rugby union. Methods Instrumented mouthguards (iMGs) were worn in men’s (n = 24 teams, 508 players, 782 observations) and women’s (n = 26 teams, 350 players, 1080 observations) rugby union matches. Tackle height (i.e. point of contact on ball-carrier) and body positions of tacklers and ball-carriers were labelled for all tackles in which a player wore an iMG. HAEs from the initial impact were identified. Mean player, tackler and ball-carrier exceedance probabilities for various peak linear and angular acceleration thresholds were estimated from ordinal mixed-effects models. Results Contact with ball-carriers’ head/neck resulted in the highest mean HAE probabilities for both sexes. The probability of an HAE to the ball-carrier decreased as tackle height lowered. The highest probability for the tackler was initial contact to the ball-carriers upper leg. Body position influenced the probability of HAEs, with falling/diving ball-carriers resulting in higher mean probabilities. When a player, regardless of role, was bent-at-waist, elevated HAE probabilities were observed in men’s competitions. Women’s data demonstrated similar probabilities of an HAE for all body positions. Conclusions Initial contact to the ball-carrier’s head/neck had the highest chance of an HAE, whilst role-specific differences are apparent for different tackle heights and body positions. Future player-welfare strategies targeting contact events should therefore consider HAE mechanisms along with current literature