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A cluster randomised controlled trial, process and economic evaluation of two large-scale quality improvement interventions embedded with a national clinical audit to improve the care for young adults with type 2 diabetes (EQUIPD2): study protocol
Get PDFBackground
Young adults (18–39 years) with type 2 diabetes have an increased loss of life expectancy and a greater risk of complications such as retinopathy, sexual health problems and foot disease than people diagnosed with type 2 diabetes later in life. Globally, there are increasing numbers of young adults with type 2 diabetes. Evidence describes both care (for example, prescribing) and improvement practices (for example, case management) that improve outcomes for people with type 2 diabetes.
The National Diabetes Audit (NDA) provides feedback describing variation in both care and outcomes in young adults. Feedback facilitation can increase the effectiveness of audit feedback. Working collaboratively between researchers, audit providers, patients, clinicians and policy-makers, we have developed two feedback facilitation interventions deliverable at scale across England. We will evaluate whether theory-informed virtual educational materials with email support (low-intensity intervention) and / or virtual workshops (medium-intensity intervention) improve outcomes for young adults with type 2 diabetes.
Methods
An efficient, pragmatic cluster randomised controlled trial using routine data with a theory-informed process and economic evaluation. The interventions will be delivered alongside the NDA to primary care networks (small groups of general practices) across England. Our primary outcome will be HbA1c level at 16-months post-randomisation in young adults with type 2 diabetes and baseline HbA1c ≥ 58 mmol/mol. Secondary outcomes assess the proportion with an HbA1c below recommended thresholds, prescription consistent with recommendations and delivery of recommended care processes. We will investigate impacts on equity. We will explore implementation, engagement and fidelity through interviews, observations, documentary analysis and surveys. An economic evaluation will estimate cost-effectiveness and budget impact.
Discussion
Our study embeds a further evaluation within the NDA, strengthening its role as a national diabetes learning health system. Our findings will have implications for intervention providers and funders seeking improvement in care and outcomes, and for our understanding of large-scale implementation strategies
An exploration of patient and family carers’ views of dietary intervention for psychosis care and management
Get PDFPsychosis greatly impacts affected individuals and their families. Current pharmacological treatments are not fully efficacious and are associated with a range of metabolic side-effects. As a result, patients and their families seek alternative interventions, including managing their diet. Psychosis treatment guidelines recommend dietetic support as part of psychosis treatment, however this has not become embedded within routine practice. The aim of this study was to determine the views of patients and their families on the value of dietary intervention in their psychosis care and management. Study participants (n = 14) were either accessing psychosis treatment services (n = 8) or were familial carers (n = 6). Data were collected via individual semi-structured interviews and were thematically analysed resulting in four themes: 1) ‘What constitutes a healthy diet?’, 2) ‘The connection between diet, the brain and symptoms’, 3) ‘Empowerment gained from finding my own self-management strategies’ and 4) ‘How we envision dietary management for psychosis’. Findings suggest participants would value having access to a diet intervention to aid their management of psychosis, delivered by knowledgeable health care practitioners within mental health services. Participants wanted the dietary intervention to be evidence-based, accessible and have outcomes which including improved dietary knowledge and skills. The principal recommendation following this research is to further develop a dietary intervention for psychosis care and management that is co-designed with health staff, people with psychosis and their familial carers, mental health service commissioners and academics responsible for educating health care practitioners' curricula
A demand response to line planning
Get PDFAs a linking factor between supply and demand, line planning is a crucial aspect of long-term railway planning. It aims to create a viable line system that optimises specific objectives by determining stop patterns and service frequencies to meet the predicted passenger demand. In the proposed model, railway operators can choose from different line plan designs based on line planning outcomes. The objective functions include economic objectives, focusing on either cost or capacity. We introduce a model to examine how demand responds to different line plans. This study focuses on stop patterns and service frequencies as the primary factors of line plan-related service quality. The model is intended as a tool for policymaking and evaluating attractiveness through metrics including generalised journey time (GJT) and/or generalised cost. The changes in demand for different line plan designs are simulated using the proposed metrics until equilibrium between the assignment and demand model is reached. This proposed model represents a significant advancement, providing reliable line plans for decision-making. It applies a similar approach commonly used for timetable-related service quality, enhancing railway planning effectiveness. To validate the model, we present a case study of a small-scale future network for Indonesia’s Jakarta-Surabaya semi-high-speed train
Real-time terahertz spectroscopy of a deuterium exchange in the vapor phase utilizing a room-temperature 8 × 8 TeraFET detector array
No full textWe have demonstrated real-time terahertz (THz) sensing using a 3.4-THz quantum-cascade laser (QCL) source and a fast 8×8 TeraFET detector array. We show that the 15-MHz detector bandwidth enables swept scan measurements across a ~2 GHz spectroscopic tuning range at a rate of 230 spectra/s, or single-frequency continuous monitoring of methanol vapor diffusion at 150k samples/s. Taking advantage of the high sample speeds, a deuterium exchange between methanol and deuterium oxide was monitored in real time using an integration time constant of 10 ms
Introduction: Evaluating the Intellectual Project of Critical Military Studies: The First Decade in Review
No full textThis Special Issue presents a timely critical reflection on the intellectual project of the journal Critical Military Studies at its 10th anniversary of publication during 2025. Within this article we provide an introduction which responds to the original question ‘what is critical military studies?’ (Basham et al. 2015) and outline some of its now established critiques. We then consider ‘encounters’ (Bulmer and Hyde 2015) with the military within Critical Military Studies (CMS); a key complexity at the centre of some CMS scholarship. This Special Issue then follows with a selection of interdisciplinary scholars, at differingoss the academic career stages, providing unique contributions discussing their work within CMS, established practices within the CMS field, and reflections on the progress and potential future of its namesake journal. This unique and opportune intervention in the history and scholarship of the journal Critical Military Studies is addressed across three key themes: reflecting on ‘criticality’, conceptual thinking, and spaces in-between
Alleviating cosmological tensions with a hybrid dark sector
Get PDFWe investigate a cosmological model inspired by hybrid inflation, where two scalar fields representing dark energy (DE) and dark matter (DM) interact through a coupling that is proportional to the DE scalar field 1/�. The strength of the coupling is governed solely by the initial condition of the scalar field, ��, which parametrizes deviations from the standard Λ cold dark matter (ΛCDM) model. In this model, the scalar field tracks the behavior of DM during matter domination until it transitions to DE while the DM component decays quicker than standard CDM during matter domination, and is therefore different from some interacting DM-DE models which behave like phantom dark energy. Using Planck 2018 CMB data, Dark Energy Spectroscopic Instrument baryonic acoustic oscillations measurements and Pantheon+supernova observations, we find that the model allows for an increase in �0 that can help reduce the Hubble tension. In addition, we find that higher values of the coupling parameter are correlated with lower values of ��, and a mild decrease of the weak-lensing parameter �8, potentially relevant to address the �8 tension. Bayesian model comparison, however, reveals inconclusive results for most datasets, unless S�0ES data are included, in which case a moderate evidence in favor of the hybrid model is found
Expanding the olfactory implant paradigm through recent advances in brain-computer interface technology.
No full textThe international opinion paper by Whitcroft et al. provides invaluable guidance for the emerging field of olfactory implants (1). While the authors thoroughly address clinical considerations and current technological approaches, we would like to expand upon Statements 9.1 and 9.3 regarding electrode technology limitations and highlight recent advances in brain-computer interface (BCI) technology that could address key technological challenges around electrode longevity and biocompatibility
Evaluating SWOTT toolkits as a change mechanism: from managerial to critical reflective supervision
Get PDFCritical reflection underpins effective and ethical social work practice. However, mechanisms for embedding critical reflection within practice are not consistent nor clearly established across all fields of social work. This study evaluated the Social Work Online Team Training (SWOTT) toolkit as a mechanism for change from a model and culture of managerial supervision to one rooted to critical reflection within adult social care services in a local government agency in England. A SWOTT toolkit is an integrated team-based resource for Continuous Professional Development (CPD) activity based on a peer learning pedagogy. For the study, a total of 18 study participants were recruited through adult social care services, to participate in focus group discussions, including workforce development leads (n = 3), team managers (n = 5) and social care practitioners (n = 10). Team managers described behavior change as using SWOTT toolkits enabled them to embed critical reflection within their individual and team practices and culture. Practitioners noted the benefits of supervision and learning as a team, both in terms of the learning itself, sharing existing practice knowledge and team-building; collective benefits that could be gleaned for teams in all fields of social work practice
Mapping ActEarly:Using a child health map to evaluate a City Collaboratory programme on early promotion of good health and wellbeing
Get PDFAbstract Background Public health is increasingly being viewed as the result of numerous interrelated elements within intricate systems. A systems mapping approach highlights the potential direct and indirect impacts of public health programmes, the contexts within which they take place and the relations between the multiple factors at play. We report on an approach to evaluate the extent to which a city-wide programme of interventions, delivered in two locations to improve child health (ActEarly) provided activities across the child health system and addressed early-life core outcomes which were selected based on priorities identified by key stakeholders. Methods Data from an ‘ActEarly project log’ and other information sources were used to gather a detailed picture of 68 projects that were delivered within the programme. We then used a matrix approach to map these activities against activities and outcomes from an existing child health map (CHM) of the determinants of child health inequalities and a project specific public health core outcome set (COS), developed by community and policy maker input, for systems-wide promotion of early life health and wellbeing. This was conducted alongside the creation of a new systems map and a network analysis to highlight how ActEarly operated across the children’s health system (scaled in proportion to the number of projects). Results and conclusions The map showed substantial ActEarly activity across all six CHM domains (95/139 factors) with most projects targeting the service and governance domains. There was a focus on service/governance areas of the child health system, rather than individual behaviour change, which aligned with ActEarly’s objective of influencing structural barriers to health. Projects also mapped well onto 32 of the 35 outcomes across the COS domains, with the exception of Adult Obesity, Safety at Home, and Domestic Abuse. This suggests that ActEarly aligned well with the priority outcomes from local representatives, partners and community groups
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