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What Can We Learn Four Years On? A Multi-Centre Service Evaluation Exploring Symptoms, Functional Impact, Recovery and Care Pathways in Long Covid
Get PDFBackground
Long Covid (LC) is associated with long-term health impacts that require ongoing support from healthcare services. We aimed to gain insights into patients' perceptions of their ongoing symptoms of LC, the effect on daily living and vocation, perceptions of what helps with LC recovery, as well as LC care pathways and ongoing care needs.
Methods
An online survey was sent to 513 participants who had used one of three LC services across England and Wales between 2020 and 2024. Participants were invited to share their experiences. We employed a mixed-methods approach for data analysis, synthesising findings from quantitative and qualitative data. All data shared between sites was de-identified.
Results
269 (52.4%) participants completed the survey. The mean age was 52.7 (sd ± 12.0), 69.1% female and 55.0% were White-British. The mean duration since initial SARS-CoV-2 infection was over 3 years (1204.4 ± 275.7 days). The Post-Covid Functional Status (PCFS) scale indicated that most participants (94.1%, n = 253) had not fully recovered. When employing a global rate of change scale, 39.0% (n = 96) of 246 responders indicated they are still making improvements with respect to their recovery; 40.7% (n = 100) had plateaued, and 20.3% (n = 50) reported a worsening trajectory. Those with ongoing symptoms described fatigue 83.0% (n = 210), cognitive dysfunction 58.5% (n = 148) and breathlessness or wheezing 43.9% (n = 111) most frequently. Of those who responded, 20.8% (n = 48) were ‘working as prior to their initial LC infection’ and 25.5% (n = 59) were currently ‘unable to work’. Almost half (44.3%; n = 86) were no longer receiving care whilst also reporting unmet care needs. In total, 62.7% (n = 126) of participants indicated unmet care needs, and qualitative analysis indicated five overarching domains as having an important impact on long-term LC recovery and ongoing healthcare needs. These were Living with LC, LC interventions and recovery, Approach to the delivery of care, Insufficient support and Suggestions and improvement.
Conclusion
This study indicates the extent to which individuals continue to experience ongoing symptoms of LC, including aspects related to recovery and vocational impact, highlighting the potential widening gap between the ongoing need to support those living with LC and the limited provision of care.
Patient or Public Contribution
The survey was co-produced with Experts by Experience, who had previously attended an LC service and members of the Patient Advisory Group within the Locomotion Consortium. Collaboration and involvement continued throughout the study, including analysis, interpretation and writing processes.
Clinical Trial Registration
Study registration details are available at ClinicalTrials.gov: NCT05057260 and ISRCTN: 15022307
The British Society for Rheumatology guideline for the management of foot health in inflammatory arthritis
Get PDFElectrically tunable and enhanced nonlinearity of moiré exciton polaritons in transition metal dichalcogenide bilayers
Get PDFWe develop a microscopic theory for nonlinear optical response of moiré exciton polaritons in bilayers of transition metal dichalcogenides (TMDs). Our theory allows us to study the tunnel-coupled intralayer and interlayer excitonic modes for a wide range of twist angles (θ), external electric field, and light-matter coupling, providing insights into the hybridization regime inaccessible before. Specifically, we account for the umklapp scattering processes of two exciton polaritons responsible for enhanced nonlinearity, and show that it is crucial for describing interactions at strong hybridization. We reveal a regime of attractive nonlinearity for moiré polaritons, stemming from the anisotropic Coulomb interactions, which can explain some of experimental features of optical response in TMD bilayers. Furthermore, within our theory we demonstrate that the attractive nonlinearity can be tuned into repulsive by applying an external electric field. Our findings show that nonlinear moiré polaritons offer a controllable platform nonlinear polaritonic devices
Advancing transportation research: interdisciplinary insights from emerging technologies and diverse perspectives
Get PDFLogistics management
No full textThis entry examines the relationships between business logistics management, transport policy and transport planning with a particular focus on freight transport. Trends in logistics management and in consumption patterns, for instance in the retail sector, have led to increased demand for freight transport movement, which contributes to a range of social and environmental problems. These include congestion as well as carbon and other harmful atmospheric emissions. Various strategies for managing freight and for reducing its negative impacts are discussed, highlighting a range of challenges, not least for timely decarbonisation where despite encouraging recent progress, some significant policy challenges remain
A UK-based consensus on clinical decision flowcharts for managing childhood amelogenesis imperfecta in the permanent dentition
No full textPurpose
Amelogenesis imperfecta (AI) is a rare genetic condition characterised by defective enamel formation, with variable presentations. Diagnosis traditionally involves family history, clinical presentation, with genetic testing being increasingly integrated into clinical practice. Children and young people (CYP) with AI face clinical and psychosocial challenges over extended periods. Given the absence of specific guidelines for AI management in CYP, this project aimed to develop flowcharts to guide dental practitioners in managing the three primary AI phenotypes: hypoplastic, hypocalcified, and hypomaturation. The flowcharts focus on the permanent dentition and provide a structured, yet flexible treatment approach, addressing key clinical issues such as hypersensitivity management, and aesthetic restoration.
Methods
The flowcharts were developed collaboratively by the UK Amelogenesis Imperfecta/Dentinogenesis Imperfecta National Clinical Excellence Network (AI/DI CEN). Expert opinion was sought over a series of meetings with specialists who treat children with amelogenesis imperfecta. Initial drafts of the flowcharts were discussed in two discussion forums until consensus was achieved.
Results
The flowcharts prioritise prevention, minimally invasive treatment, and shared decision-making, adapting interventions to phenotype type and severity as well as individual patient needs.
Conclusion
This guidance is presented to assist dental professionals in delivering comprehensive, empathetic, and effective care for CYP with AI
Physical activity interventions in women treated for endometrial cancer: a scoping review
Get PDFPurpose
Endometrial cancer is the most common gynaecological cancer, with rising incidence contributing to a growing population at risk of long-term health issues post-treatment. Cardiovascular disease is the leading cause of mortality, yet physical activity engagement is low due to physiological and psychosocial barriers. Although guidelines recommend physical activity after cancer, no reviews have synthesised interventions supporting uptake in women treated for endometrial cancer. This review addresses the gap.
Methods
A mixed-methods scoping review was conducted. Medline, EMBASE, Cochrane, Web of Science, PEDro, EThOS, and PsycInfo were systematically searched for studies published from January 2011 to October 2024. Eligible studies recruited adults post-treatment for endometrial cancer and reported interventions supporting physical activity.
Results
Twenty-two papers describing 12 interventions met inclusion criteria. Six (50%) focused on physical activity only, three (25%) combined diet and physical activity, and three (25%) were multicomponent interventions incorporating diet, physical activity, and additional elements such as mindfulness. Most studies were USA-based (77%). One powered RCT and nine pilot or feasibility trials were included. The RCT reported a significant increase in total physical activity minutes post-intervention. Most studies reported improvements in quality of life, physical function, and self-efficacy. Adherence ranged from 36% to 86%, facilitated by social interaction and hindered by pain, fatigue, and caregiving responsibilities.
Conclusion
Early-stage evidence suggests physical activity interventions are feasible in this population
Multi-frequency analysis of the ALMA and VLA high resolution continuum observations of the substructured disc around CI Tau
Get PDFWe present high angular resolution (50 mas) and sensitivity Atacama Large Millimeter/submillimeter Array (ALMA) Band 3 (3.1 mm) and Very Large Array (VLA) Ka band (9.1 mm) observations of the multi-ringed disc around the 3 Myr-old solar-mass star CI Tau. These new data were combined with similar-resolution archival ALMA Band 7 (0.9 mm) and 6 (1.3 mm) observations and new and archival VLA Q (7.1 mm), Ku (2.0 cm), X (3.0 cm), and C band (6.0 cm) photometry to study the properties of dust in this system. At wavelengths ≤3.1 mm, the continuum emission from CI Tau is very extended (≥200 au) and highly substructured (with three gaps, four rings, and two additional gap-ring pairs identified by non-parametric visibility modelling). In contrast, the VLA Ka band data are dominated by a centrally peaked bright component, only partially (≤50%) due to dust emission, surrounded by a marginally detected faint and smooth halo. We fitted the ALMA and VLA Ka band data together, adopting a physical model that accounts for the effects of dust absorption and scattering. For our fiducial dust composition (‘Ricci’ opacities), we retrieved a flat maximum grain size distribution across the disc radius, with ᵃmax = (7.1 ± 0.8) × 10−² cm that we tentatively attributed to fragmentation of fragile dust or bouncing. We tested, for the first time, the dependence of our results on the adopted dust composition model to assess which mixture can best reproduce the observations. We found that ‘Ricci’ opacities work better than the traditionally adopted ‘DSHARP’ ones, while graphite-rich mixtures perform significantly worse. We also show that for our fiducial composition, the data prefer low porosity (≤70%) grains. This is in contrast with recent claims of highly porous aggregates in younger sources, which we tentatively justified by time-dependent compaction at the fragmentation or bouncing barrier. Our results on composition and porosity are in line with constraints from disc population synthesis models and naturally arise from CI Tau’s peculiar spectral behaviour (i.e. the abrupt steepening of its spectral index at wavelengths longer than 3.1 mm), making this disc a unique target to characterise the properties of disc solids and thus ideal for deeper centimetre-wavelength observations and follow-up dust polarisation studies
Stochastic pharmacodynamics of a heterogeneous tumour-cell population
Get PDFStandard pharmacodynamic models are ordinary differential equations without the features of stochasticity and heterogeneity. We develop and analyse a stochastic model of a heterogeneous tumour-cell population treated with a drug, where each cell has a different value of an attribute linked to survival. Once the drug reduces a cell’s value below a threshold, the cell is susceptible to death. The elimination of the last cell in the population is a natural endpoint that is not available in deterministic models. We find formulae for the probability density of this extinction time in a collection of tumour cells, each with a different regulator value, under the influence of a drug. There is a logarithmic relationship between tumour population size and mean time to extinction. We also analyse the population under repeated drug doses and subsequent recoveries. Stochastic cell death and division events (and the relevant mechanistic parameters) determine the ultimate fate of the cell population. We identify the critical division rate separating long-term tumour population growth from successful multiple-dose treatment
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