Search Results (6,327)

The ordinary Portland cement (OPC) manufacturing process is highly resource-intensive and contributes to over 5% of global CO₂ emissions, thereby contributing to global warming. In this context, researchers are increasingly adopting geopolymers concrete due to their environmentally friendly production process. For decades, industrial byproducts such as fly ash, ground-granulated blast-furnace slag, and silica fume have been used as the primary binders for geopolymer concrete (GPC). However, due to uneven distribution and the decline of coal-fired power stations to meet carbon-neutrality targets, these binders may not be able to meet future demand. The UK intends to shut down coal power stations by 2025, while the EU projects an 83% drop in coal-generated electricity by 2030, resulting in a significant decrease in fly ash supply. Like fly ash, slag, and silica fume, natural clays are also abundant sources of silica, alumina, and other essential chemicals for geopolymer binders. Hence, natural clays possess good potential to replace these industrial byproducts. Recent research indicates that locally available clay has strong potential as a pozzolanic material when treated appropriately. This review article represents a comprehensive overview of the various treatment methods for different types of clays, their impacts on the fresh and hardened properties of geopolymer concrete by analysing the experimental datasets, including 1:1 clays, such as Kaolin and Halloysite, and 2:1 clays, such as Illite, Bentonite, Palygorskite, and Sepiolite. Furthermore, this review article summarises the most recent geopolymer-based prediction models for strength properties and their accuracy in overcoming the expense and time required for laboratory-based tests. This review article shows that the inclusion of clay reduces concrete workability because it increases water demand. However, workability can be maintained by incorporating a superplasticiser. Calcination and mechanical grinding of clay significantly enhance its pozzolanic reactivity, thereby improving its mechanical performance. Current research indicates that replacing 20% of calcined Kaolin with fly ash increases compressive strength by up to 18%. Additionally, up to 20% replacement of calcined or mechanically activated clay improved the durability and microstructural performance. The prediction-based models, such as Artificial Neural Network (ANN), Multi Expression Programming (MEP), Extreme Gradient Boosting (XGB), and Bagging Regressor (BR), showed good accuracy in predicting the compressive strength, tensile strength and elastic modulus. The incorporation of clay in geopolymer concrete reduces reliance on industrial byproducts and fosters more sustainable production practices, thereby contributing to the development of a more sustainable built environment. Full article

Long-term effects of concussions, particularly in contact sport athletes, have been linked to changes in neuronal health. Lipid dysregulation has emerged as a potential contributor to neuronal injury and may serve as a measurable biomarker of brain pathology. This study investigated cognitive scores and serum lipid biomarkers in retired rugby players with a history of concussion to assess their association with concussion exposure. Serum levels of 24-hydroxycholesterol (24-HC), 25-HC, 27-HC, total triglycerides, and ceramide were compared between retired rugby players with a history of repeated concussions (n = 26) and non-contact sport controls (n = 19). ELISA-based quantification and statistical analyses identified significant group differences. Concussed athletes exhibited significantly lower serum 24-HC and significantly higher levels of 27-HC, triglycerides, and ceramide compared to controls, while no significant difference was observed for 25-HC. These findings indicate that repeated concussion is associated with reductions in cognitive performance and persistent alterations in serum lipid profiles. The observed lipid changes, particularly in 24-HC, 27-HC, ceramide, and triglycerides, may serve as measurable biomarkers of concussion-related biochemical alterations, providing a foundation for future studies aimed at monitoring neurological health in at-risk populations. Full article

Background: Metabolic syndrome (MetS) is a significant global health burden and a known risk factor of cardiovascular disease and diabetes. Growing evidence also links MetS to cancer development, likely via chronic inflammation, insulin resistance, and hormone disruption. However, its association with laryngeal cancer remains largely unclear and underexplored. Methods: For this review, we thoroughly searched PubMed/MEDLINE, Scopus, and Web of Science for observational studies investigating associations of MetS with laryngeal or head and neck cancers (HNCs) until 1 August 2025. Five large population-based studies were found to meet inclusion criteria, and risk of bias was assessed using the Joanna Briggs Institute checklist (JBI). Results: Three Korean cohort studies consistently found that MetS increased the risk of laryngeal cancer (HR 1.13–1.32), independent of smoking and alcohol use. Hypertension and hyperglycemia were the most consistent components associated with increased risk, and chronic MetS conferred the highest hazard. In contrast, analyses from the UK Biobank (HNC) and SEER-Medicare (HNSCC) cohorts showed null and inverse associations, respectively. Additional findings included dose–response effects with increasing MetS components, U-shaped associations for HDL-C and waist circumference and increased risk associated with elevated C-reactive protein. Conclusions: Current evidence suggests a possible association between MetS and risk of laryngeal cancer, although the direction and strength of effect vary across populations. Findings from Korean cohorts provide consistent signals of increased risk, whereas Western datasets have not replicated this pattern. Overall, the certainty of evidence is low to moderate, warranting cautious interpretation and further validation in diverse populations before inferring causality. Full article

Background/Objectives: Ear, nose, and throat (ENT) presentations are common across the UK healthcare system and are often managed initially by junior doctors on call. Short, structured teaching interventions (e.g., boot camps and simulation workshops) have been introduced to improve confidence and preparedness. This review evaluated evidence published since 2015 on such ENT teaching interventions for junior doctors, examining effectiveness, study design, and outcome measures. Methods: Five databases were searched (January 2015–July 2025). Eligible studies assessed ENT-specific courses for junior doctors and reported outcomes on confidence, preparedness, knowledge, or performance. Study quality was appraised using the Medical Education Research Study Instrument (MERSQI). Owing to heterogeneity, findings were narratively synthesised in line with Synthesis Without Meta-analysis (SWiM) guidance. Results: Eleven studies (n = 591) met inclusion criteria: nine single-group pre–post studies, one two-group comparative study, and one randomised controlled trial (RCT). Most studies reported increased confidence after the interventions, while three also showed gains in knowledge. A minority reported improvement using blinded performance assessments. Overall methodological quality assessed using MERSQI scores was moderate (mean 10.0/18). Limitations included reliance on self-reported outcomes, limited use of control groups, and generally short follow-up periods. Conclusions: Short, structured ENT courses for junior doctors are associated with immediate improvements in confidence and knowledge, with some evidence of objective performance gains. However, the predominance of single-arm designs and brief follow-up limits causal inference and conclusions regarding retention, workplace behaviour, and patient outcomes. More robust comparative studies with blinded assessment and longitudinal follow-up are needed to determine sustained impact. Full article

Objectives: The aim of this study was to determine which color imaging facilitated easier detection of the persistent avascular retina (PAR) in ultra-widefield (UWF) fundus imaging in children undergoing retinopathy of prematurity (ROP). Methods: A total of 20 eyes of 10 children aged between 6 and 9 who underwent diagnostic and therapeutic procedures for ROP were included. Fundus images were obtained using Optos confocal scanning laser ophthalmoscopy (cSLO; Optos PLC, Daytona, Dunfermline, UK). The images were divided and recorded into three groups as original imaging (composite), red reflectance imaging, and green reflectance imaging. These images were prepared as a slideshow for 10 ophthalmology specialists and they were surveyed to determine in which color imaging the peripheral avascular area was more easily detected. The results were evaluated. Results: The rate of detecting the PAR in green reflectance imaging by the participants included in the study was found to be statistically higher compared to other colors of imaging (composite 0.63 ± 0.09 (0.5–0.8), red 0.12 ± 0.05 (0.05–0.2), and green 0.94 ± 0.06 (0.85–1), p < 0.0001). All respondents reported that the boundaries of the peripheral avascular area were more clearly defined in the UWF (Optos PLC, Daytona, Dunfermline, UK) green reflectance imaging. Conclusions: Each color imaging used in UWF fundus imaging helps to visualize different layers of the retina. Our study showed that retinal vascular endings appear more distinct due to the lower penetration of the green laser into the choroidal vessels. Based on these findings, we believe that UWF fundus green reflectance imaging is more useful for detecting and monitoring PAR. Full article

Introduction: Evaluating cardiovascular function is crucial in the care of critically ill patients. Recent advancements in continuous cardiac output (CO) monitoring have led to the emergence of several arterial pulse contour devices. To effectively compare the accuracy of these devices, a comprehensive assessment is necessary. However, no experimental studies were found that have evaluated these devices in a controlled setting. Methods: In this innovative bench study, we used a Donovan mock circulatory system in conjunction with a total artificial heart (TAH-t) to simultaneously generate several comparable arterial waveforms and compared CO estimates from three different pulse contour devices: FloTrac™ (Vigileo™, v1.8 4th generation, Edwards LifeSciences, Irvine, CA, USA), proAQT™ (PulsioFlex™, Pulsion Medical Systems, Munich, Germany), and LiDCO™ Plus (LiDCO™, LidCO Ltd., Cambridge, UK). These devices underwent several hemodynamic challenges (HCs), including decreased preload, decreased afterload, and increased heart rate. To evaluate the degree of agreement between the devices, we performed a Bland–Altman analysis for the paired devices. The interclass comparison, error percentage, and variation coefficient for each device were also assessed. Results: The present study first tested the comparability between the three additional arterial line waveforms, and the arterial control line was simultaneously generated with the hemodynamic simulation bench. Comparing the reference values of the dP/dt and sAUC pulse pressure, we found no clinically significant difference between the simultaneously generated arterial waveforms. The different pulse contour devices were then each connected to the arterial lines, with the performance of HCs. HC1 with a decreased preload revealed that CO estimates significantly decreased compared to the baseline values: 3.2 ± 0.06 L.min⁻¹, 4.7 ± 0.05, 4.3 ± 0.07, and 4.0 ± 0.05 for reference methods FloTrac™, PulsioFlex™, and LiDCO™, respectively. HC2 with an increased heart rate revealed CO estimates with FloTrac™, PulsioFlex™, and LiDCO™—6.0 ± 0.03, 6.6 ± 0.06, and 6.0 ± 0.05 L.min⁻¹, respectively—when the CO estimate was 5.6 ± 0.2. HC3 with a decreased afterload that significantly increased CO estimates compared to the baseline with FloTrac™, PulsioFlex™, and LiDCO™—7.0 ± 0.18, 6.6 ± 0.15, and 7.1 ± 0.30 L.min⁻¹, respectively—when the CO estimate with the reference method did not change significantly (from 5.90 ± 0.13 to 5.94 ± 0.11 p = 0.26). The devices’ degree of agreement was estimated with Bland–Altman analysis. Conclusions: The Donovan Mock Circulatory System with SynCardia TAH-t can be used as an innovative experimental hemodynamic simulation bench. It was proven to be stable, accurate, and reliable in generating several controlled pulse pressure waveforms, while many parameters could be changed, such as the preload, heart rate, or afterload. This enables a simultaneous evaluation of different pulse contour devices submitted to several HCs. This is of interest for clinicians to better understand the underlying principles and realistically compare the performance and potentially inherent limitations of pulse contour devices experimentally in a controlled simulated environment. Full article

Background: Endocrine autoimmune diseases (AIDs) exhibit special polygenic characteristics in human leucocyte antigen (HLA) region. Current understanding of their association with lipid metabolism remains constrained by imprecise polygenic risk score (PRS) modeling. Advanced analytical approaches are needed to elucidate the association between genetic susceptibility and lipid metabolic dysregulation. Methods: We proposed a genetic distance-based clumping gPRS to account for linkage disequilibrium in the HLA region. gPRS and pathway gPRS were constructed for individuals diagnosed with type I diabetes (T1D), Graves’ disease (GD), Hashimoto thyroiditis (HT) and Addison’s disease (AD) in the UK Biobank, with sex considered as a stratification factor. Latent correlations between gPRS and phenotypes were explored using Kendall’s tau test, two-trait LD score regression (LDSC) and gene annotation. Results: Lipid metabolism served an important function through immune and inflammatory biomarkers across multiple traits. Males with low genetic risk tended to have lower high-density lipoprotein cholesterol level, while the correlation presented the opposite pattern in females. Increased genetic susceptibility to AIDs was associated with elevated levels of low-density lipoprotein cholesterol, triglycerides in low-density lipoprotein (LDL) and very-low-density lipoprotein (VLDL) across all traits. Moreover, levels of polyunsaturated fatty acids, including omega-3 and omega-6, decreased with higher PRS in males and females, while those of monounsaturated fatty acids exhibited an increasing trend. Conclusion: Our study constructed more precise polygenic risk scores of AIDs, highlighting inflammation-mediated lipid metabolism as a potential pathogenic mechanism in endocrine AIDs, offering valuable insights into shared etiology for future comprehensive investigations. Full article

This paper examines the stock market reaction to company investment decisions with and without a sustainability objective. Abnormal returns are estimated using a standard event study methodology for a sample of 517 investment announcements for listed UK firms for the period 2013 to 2021. Using a sample of 90 sustainable investments and 427 non-sustainable investments, we test whether 90 announcements with a sustainability agenda are more positively viewed by market participants than 427 announcements without a sustainability agenda. This study documents significant positive stock market reactions to both sets of investments, but abnormal returns are higher for investments without a sustainability agenda. The difference in abnormal returns between both sets of investments is not statistically significant. The findings reported in this study suggest that classifying corporate investment decisions according to information content indicative of a sustainability agenda contains price-sensitive information. This has implications for information made available to the market and will therefore promote price discovery, reducing the information asymmetry between informed and uninformed investors and allowing improved market efficiency in categorizing investment decisions according to investment objectives. In a market-based system, the positive valuation of investments associated with sustainability undertakings has implications for allocative efficiency, because firms become more attractive regarding the future allocation of funds to investment projects that address sustainability concerns, indicating that new sustainable investments should be encouraged. Full article

The persistent fragmentation of the architecture, engineering, and construction (AEC) industry drives the pursuit of advanced and unified construction solutions. This study investigated the limited understanding and adoption of one of these solutions, the platform approach to design for manufacturing and assembly (P-DfMA) within the AEC industry. Semi-structured interviews were conducted with 14 design professionals from China and the UK to understand how they utilize this approach. Governmental policy documents were also analyzed to examine how they hinder or facilitate the adoption of P-DfMA. The results were mapped using the technology–organization–environment (TOE) framework. Challenges and adoption considerations were identified by a thematic analysis, supported by text-mining results from Voyant Tools, with the most frequent keywords visualized in charts. The findings indicate that P-DfMA adoption is conceptually fragmented within the AEC industry, with a gap between theory and practice. Technical limitations in organizational structuring and environmental misalignment hinder adoption. Challenges and considerations span five domains: design, digital, financial and procurement, organizational, and sustainability. This research offers novel insights gained by integrating multi-layered analyses of construction practice interviews and policy perspectives within the TOE framework, along with timely insights into the socio-technical dynamics shaping the future of the industry. Full article

AI-based educational chatbots can expand access to learning, but many remain limited to text-only interfaces and fixed infrastructures, while purely generative responses raise concerns of reliability and consistency. In this context, we present ROboMC, a portable and multimodal system that combines a validated knowledge base with generative responses (OpenAI) and voice–text interaction, designed to enable both text and voice interaction, ensuring reliability and flexibility in diverse educational scenarios. The system, developed in Django, integrates two response pipelines: local search using normalized keywords and fuzzy matching in the LocalQuestion database, and fallback to the generative model GPT-3.5-Turbo (OpenAI, San Francisco, CA, USA) with a prompt adapted exclusively for Romanian and an explicit disclaimer. All interactions are logged in AutomaticQuestion for later analysis, supported by a semantic encoder (SentenceTransformer—paraphrase-multilingual-MiniLM-L12-v2’, Hugging Face Inc., New York, NY, USA) that ensures search tolerance to variations in phrasing. Voice interaction is managed through gTTS (Google LLC, Mountain View, CA, USA) with integrated audio playback, while portability is achieved through deployment on a Raspberry Pi 4B (Raspberry Pi Foundation, Cambridge, UK) with microphone, speaker, and battery power. Voice input is enabled through a cloud-based speech-to-text component (Google Web Speech API accessed via the Python SpeechRecognition library, (Anthony Zhang, open-source project, USA) using the Google Web Speech API (Google LLC, Mountain View, CA, USA; language = “ro-RO”)), allowing users to interact by speaking. Preliminary tests showed average latencies of 120–180 ms for validated responses on laptop and 250–350 ms on Raspberry Pi, respectively, 2.5–3.5 s on laptop and 4–6 s on Raspberry Pi for generative responses, timings considered acceptable for real educational scenarios. A small-scale usability study (N ≈ 35) indicated good acceptability (SUS ~80/100), with participants valuing the balance between validated and generative responses, the voice integration, and the hardware portability. Although system validation was carried out in the eHealth context, its architecture allows extension to any educational field: depending on the content introduced into the validated database, ROboMC can be adapted to medicine, engineering, social sciences, or other disciplines, relying on ChatGPT only when no clear match is found in the local base, making it a scalable and interdisciplinary solution. Full article

The United Kingdom (UK) government continues exploring ways to externalise its border controls to deter people from travelling to its shores. States, including the UK, use externalised border controls to reduce responsibility and avoid legal obligations through distance-creation in a manifestation of ‘irresponsibilisation’. They argue that extraterritorial border controls do not trigger their obligations under international refugee and human rights law, which are primarily territorial in scope. Were such claims true, they would create accountability gaps, allowing states to evade responsibility through cooperation and offshoring their legal duties. This paper challenges this view. It introduces a ‘responsibility spectrum’ applicable to the UK and other states’ actions involving externalised border controls, especially offshore processing of asylum claims or returns. The argument demonstrates that responsibility can arise for breaches of negative obligations, aiding and assisting a state, or violations of positive obligations. It emphasises that, despite the difficulties posed by ‘irresponsibilisation’, international law will ensure the UK is held accountable for any breaches it facilitates through any future externalisation policies. Full article

Objectives: This study aims to assess differences in analgesia prescribing in UK primary care between individuals with osteoarthritis who have a recorded exposure to cannabis use and those who do not. Methods: This population-based retrospective cohort study included opioid-naïve patients with osteoarthritis (aged 25–85 years) who were active in Clinical Practice Research Datalink Aurum between 1 January 1995 and 15 December 2023. Patients with osteoarthritis who had current or historic cannabis use recorded were matched to two unexposed individuals by age, sex, smoking status, and health authority. Patients were followed up to assess prescriptions of analgesia. Cox regression was performed adjusted for age, sex, and ethnicity. Results: 662 exposed patients were matched to 1319 unexposed patients. Cannabis-exposed individuals were more likely to be prescribed opioids (adjusted hazard ratio (HR): 2.06; 95% confidence interval (CI): 1.74–2.43; p < 0.001), gabapentinoids (HR: 3.31; 95% CI: 2.34–4.67; p < 0.001), non-steroidal anti-inflammatory drugs (HR: 1.99; 95% CI: 1.72–2.31; p < 0.001), tricyclic antidepressants (HR: 2.64; 95% CI: 2.03–3.44; p < 0.001), other antidepressants (HR: 7.22; 95% CI: 5.24–9.94; p < 0.001), and paracetamol (HR: 3.30; 95% CI: 2.43–4.48; p < 0.001). Conclusions: This study suggests there is an association between coded exposure to cannabis in UK primary care records and increased prescribing of analgesia. Given the relative scarcity of recorded cannabis use relative to its prevalence in the general population, these findings must be interpreted cautiously. The increased hazard of using analgesia and mortality within the cannabis-exposed cohort may be confounded by socioeconomic status and a higher likelihood of coding cannabis use in those experiencing adverse effects after consumption or cannabis misuse disorder. Full article

Teaching in a globalised world offers opportunities to reduce barriers, enhance understanding, and expand access for diverse learners. Blended approaches, combining in-person and online delivery, can encourage learning communities across geographical boundaries. However, disparities in access to technology, internet reliability, and conducive study environments highlight inequalities and varied learner experiences. While digital networks may support identity and belonging, some students report feeling distracted or disengaged in online settings. This study explores the experiences of first-year doctoral candidates completing the final taught module of their Doctorate in Business Administration (DBA) at the University of Gloucestershire, UK. Participants, mostly international students now based in the UK, are engaged in both in-person classes and online staff-led webinars. Data was gathered through four in-person focus groups. Engeström’s Cultural-Historical Activity Theory was applied as an analytical framework, conceptualising teaching and learning as an activity system mediated by Tools, Rules, Community, and Division of Labour. This enabled a comparison of students’ experiences in online and in-person contexts. The findings revealed contradictions within the system, identifying barriers to engagement and adaptation, and offering insights into the evolving pedagogical demands of blended doctoral education. Full article

Short-term traffic flow prediction is a critical component of efficient management in Intelligent Transportation Systems (ITS), providing real-time travel guidance for commuters and supporting informed decision-making by transportation authorities. To address the current challenges of insufficient prediction accuracy and excessive reliance on time-series features, we propose a spatio-temporal feature-integrated short-term traffic flow prediction model named KAN-CNN-BiLSTM. In this model, traffic flow data from the target road segment and its two adjacent segments are jointly fed into the model to fully leverage spatio-temporal features for prediction. Subsequently, a Convolutional Neural Network (CNN) extracts spatial features from the combined traffic flow data. To overcome the limitation of traditional LSTMs, which can only process unidirectional time series, we introduce a bidirectional long short-term memory network (BiLSTM) with symmetric time series extraction capability. This enables simultaneous capture of historical and future traffic flow dependencies. Finally, we replace the conventional fully connected network with a Kolmogorov–Arnold network (KAN) to enhance the representation of complex nonlinear features. Experimental results using traffic flow data from the UK Highways Agency website demonstrate that the KAN-CNN-BiLSTM model outperforms existing mainstream methods, achieving superior prediction accuracy and minimal error. The model’s MAE, RMSE, MAPE, and R² values are 27.4696, 40.3923, 8.65%, and 0.9615, respectively. Full article

(1) Background: Medication shortages have become increasingly common in the UK. However, there is limited evidence regarding the experiences of people with epilepsy and their caregivers during these shortages. The aim of this study is to explore the extent and impact of ASM shortages on people with epilepsy and their caregivers across the UK. (2) Methods: A cross-sectional online survey was distributed between January and April, 2024 by epilepsy charities. Participants included people with epilepsy and caregivers. The survey collected demographic information, types of ASM respondents were prescribed, experiences of shortages, and the impact of shortages. Data were analysed descriptively, and subgroup analyses were conducted by medication type. (3) Results: A total of 1549 responded, of whom 1312 were people with epilepsy and their carers who were included in the analysis with a mean age of 43 years. A total of 941 respondents (71.7%) reported difficulty obtaining their prescribed ASM in the past year. Shortages were most frequently reported for sodium valproate (60.8%), lamotrigine (65.2%), carbamazepine (92.6%), clobazam (82.6%), topiramate (81.5%), zonisamide (74.0%), levetiracetam (62.8%), lacosamide (71.0%), and brivaracetam (70.5%). A total of 529 (40.4%) of the participants reported that stress and/or anxiety caused by medication shortages was associated with recurrent seizures. We did not ask whether patients missed medications because of these difficulties. (4) Conclusions: ASM shortages are a widespread issue for people with epilepsy in the UK, leading to treatment disruptions and psychological distress. Addressing supply change limitations and identifying effective approaches to preventing the substitution of ASMs brands by clinicians may potentially reduce this problem. Full article