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Radiotherapy for oesophageal cancer in the United Kingdom: patterns of practice & quality indicators
Get PDFAims
There is limited guidance relating to the provision of radiotherapy for patients with oesophageal cancer. Given this, we sought to assess variation in patterns of care in the UK and to devise quality improvement metrics to support future treatment standardisation.
Materials and Methods
We undertook a cross-sectional survey using a bespoke online survey to explore geographical variation in radiotherapy use for oesophageal cancer across the United Kingdom (UK) National Health Service (NHS). These data were combined with an observational registry analysis using the National Disease Registration Service Radiotherapy Dataset to explore temporal variation in radiotherapy utilization from January 2020 – June 2024.
Results
Survey responses were received from 75% (n = 45/60) of UK centres. These demonstrate considerable variation in the interpretation of radiotherapy indications, particularly in the non-curative setting, as well as in radiotherapy technique; with, for instance, one third (n = 15/45) of centres reporting that they do not use motion management strategies for lower third or junctional tumours. Induction chemotherapy use differs between centres and by concurrent regimen, with 93–96% (n = 42–43/45) of centres using induction treatment prior to concurrent platinum/fluoropyrimidine and 56–62% (n = 25–28/45) using it prior to concurrent platinum/taxane. Post-treatment surveillance and follow-up measures also differed with little evidence for more intensive surveillance in patients fit for salvage resection. Most centres reported the use of intensity modulated or volumetric arc therapy (IMRT/VMAT) for radical plans, which was supported by NDRS data demonstrating that the median proportion of patients in each centre treated using IMRT/VMAT increased from 60% (range 14.3–100%) in January-June 2020 to 91.7% (range 16.7–100%) in January-June 2024.
Conclusions
There is substantial variation in the radiotherapy-based care of patients with oesophageal cancer in the UK. Formal national guidance is required to build on the quality metrics outlined here
Uneven development and the geographies of energy transition in Mozambique
Get PDFIn Mozambique, sustainable energy access is an increasing priority for a diverse range of actors seeking to improve livelihoods and stimulate economic development—particularly in rural areas where energy infrastructure remains limited. Drawing on field research conducted as part of a comparative three-year project examining the potential of community energy systems to foster inclusive, just, and clean energy transitions in Southern and East Africa, this paper develops a critical, policy-relevant and geographically grounded analysis of Mozambique’s energy transitions, which are unfolding across multiple fronts. Our analysis addresses both the move away from conventional or ‘traditional’ energy sources to ‘modern’ energy services, and the shift toward renewable energy technologies. We argue that while Mozambique has taken important steps toward a cleaner energy future there remain significant constraints to progress and that it is crucial to consider the advancement of renewable energy in relation to the country’s embedded resource and extractive geographies that shape the directions, possibilities, and spatial dynamics of transition. We examine the broader policy environment, focusing on the state’s energy transition strategy and its implications for energy justice, spatial inequality, and economic opportunity. Particular attention is given to the role and potential of decentralized, off-grid energy systems, emphasizing the need for greater community participation in both policy design and implementation. Finally, we develop a political economy framework to analyse the influence of state institutions, international donors, and private capital in shaping Mozambique’s energy transitions, and assess their impacts on energy poverty and the goal of equitable, sustainable energy access
GDF15 is a putative biomarker for distinguishing pulmonary veno-occlusive disease and pulmonary arterial hypertension
Get PDFUnderstanding the role of cultural learning in the emergence of first impressions from facial appearance
No full textThe transitional kinetics between open and closed Rep structures can be tuned by salt via two intermediate states
No full textDNA helicases undergo conformational changes; however, their structural dynamics are poorly understood. Here, we study single molecules of superfamily 1A DNA helicase Rep, which undergo conformational transitions during bacterial DNA replication, repair and recombination. We use time-correlated single-photon counting (TCSPC), fluorescence correlation spectroscopy (FCS), rapid single-molecule Förster resonance energy transfer (smFRET), Anti-Brownian ELectrokinetic (ABEL) trapping and molecular dynamics simulations (MDS) to provide unparalleled temporal and spatial resolution of Rep’s domain movements. We detect four states revealing two hitherto hidden intermediates (S2, S3), between the open (S1) and closed (S4) structures, whose stability is salt dependent. Rep’s open-to-closed switch involves multiple changes to all four subdomains 1A, 1B, 2A and 2B along the S1→S2→S3→S4 transitional pathway comprising an initial truncated swing of 2B which then rolls across the 1B surface, following by combined rotations of 1B, 2A and 2B. High forward and reverse rates for S1→S2 suggest that 1B may act to frustrate 2B movement to prevent premature Rep closure in the absence of DNA. These observations support a more general binding model for accessory DNA helicases that utilises conformational plasticity to explore a multiplicity of structures whose landscape can be tuned by salt prior to locking-in upon DNA binding
Rethinking growth model analysis: A life cycle and state-centric relational approach
No full textThis article offers a critique of both the overall focus and key substantive arguments associated with growth model analysis and, in particular, of Baccaro and Pontusson's account of how and why governments adopt policies favourable to the promotion of particular growth models. Our critique centres upon two arguments. First, existing work downplays the role of the state in the politics and governance of growth models and, conversely, overstates the significance of producer coalitions and business actors. Second, we introduce a life cycle account of growth models and argue that current growth model analysis focuses almost exclusively upon the functioning of existing and established growth models, neglecting two other stages in their life cycle relating to their initial establishment and eventual decline or termination. We argue that the relations between producer groups and states vary across these different stages of growth model dynamics. Our ‘state-centric relational’ account emphasises how state actors, while they may sometimes find it in their interests to work with business interests, should not, by default, be viewed as being subservient to them
Memory consolidation during sleep:a facilitator of new learning?
No full textSleep plays a crucial role in consolidating recently acquired memories and preparing the brain for learning new ones, but the relationship between these two processes is currently unclear. According to the prominent Active Systems Consolidation model, memory representations that are initially reliant on the hippocampus are redistributed to neocortex during sleep for long-term storage. An indirect assumption of this model is that sleep-associated memory processing paves the way for next-day learning by freeing up hippocampal encoding resources. In this review, we evaluate two central tenets of this ‘resource reallocation hypothesis’: (i) sleep-associated memory consolidation reduces hippocampal engagement during retrieval, and (ii) this reduction in hippocampal burden enhances the brain's capacity for new learning. We then describe recent work that has directly tested the relationship between sleep-associated memory processing and next-day learning. In the absence of clear evidence supporting the resource reallocation hypothesis, we consider alternative accounts in which efficient learning is not contingent on prior overnight memory processing, but rather that sleep-associated consolidation and post-sleep learning rely on overlapping or independent mechanisms. We conclude by outlining how future research can rigorously test the resource reallocation hypothesis
‘Too aggressive’ or ‘slay queens’: gendered attacks, threats and disinformation in Kenyan elections
Get PDFDisinformation has become a key feature of electoral campaigns globally, shaping political narratives and influencing voter perceptions – an emerging trend which is also evident in African elections. In Kenya, gendered disinformation was identified as a prominent theme in the attacks and threats levelled against women in politics during the 2017 and 2022 elections. These attacks, ranging from online trolling to explicit threats of gender-based violence, including genital mutilation, represent a significant barrier to women’s political participation. While previous studies have examined the broader context of political violence surrounding Kenyan elections, limited research has focused specifically on the attacks and threats faced by women politicians, especially in the digital space. To address this gap, this exploratory study draws on semi-structured interviews with eleven individuals working in areas related to gendered attacks, threats and disinformation in Kenya, including journalism, digital rights, academia and civic society organisations that focus on women’s empowerment. These are complemented by an analysis of secondary news media content to illustrate some of the examples mentioned by the interviewees. Our findings reveal the complex intersection of disinformation, gendered political violence and digital harassment faced by Kenyan women politicians
What Makes a Person Accessible? Exploring the Characteristics of ‘Accessible People’ From the Perspective of Adults With Learning Disabilities
Get PDFBackground
Previous research has investigated the factors that promote or reduce accessibility for people with learning disabilities. However, the role of people in facilitating accessible spaces, experiences and services and the characteristics on individuals that make them ‘accessible’ has been under-considered.
Methods
The present study reports on the findings from a participatory action doctoral research project. Seven people with learning disabilities were recruited and trained as co-researchers on the project. Co-researchers investigated the concept of ‘Accessible People’ via group discussion, drawings and poetry.
Findings
People were considered to positively or negatively influence accessibility in a range of contexts. Thematic analyses revealed 10 characteristics of Accessible People. Characteristics included interpersonal qualities (such as being open-minded, friendly and welcoming and helpful and supportive) and competency-based qualities (including knowledge of learning disabilities and being easy to communicate with).
Conclusions
Accessible people were reported to play a crucial role in supporting the accessibility of spaces, activities and experiences. Embodiment of the characteristics of accessible people may enhance accessibility for people with learning disabilities in a variety of contexts
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