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Feeding vascular health: role of nutrition in peripheral artery disease prevention and management
No full textPeripheral artery disease (PAD) is a prevalent and progressive atherosclerotic condition associated with high cardiovascular and limb-related morbidity and mortality. While pharmacological and revascularisation strategies form the cornerstone of PAD management, the role of nutrition is less clearly defined despite its well-established effects in coronary artery disease and cardiovascular prevention. In this narrative review, we explore the current evidence linking diet and nutrition to the prevention and management of PAD across its clinical spectrum, from asymptomatic disease to chronic limb-threatening ischaemia.We summarise findings on dietary patterns (e.g. Mediterranean diets), food groups, nutrients, fibre, and bioactives such as flavonoids. The available evidence supports that healthy dietary patterns may reduce PAD risk and improve outcomes, with effect sizes comparable to some pharmacological interventions. Most people with asymptomatic and symptomatic PAD do not adhere to healthy dietary patterns. Undernutrition as captured by indices such as the Geriatric Nutritional Risk Index is prevalent in advanced PAD and independently associated with complication and poor postoperative outcome.Despite this, most PAD patients do not receive dietary counselling, and few clinical studies have directly evaluated nutritional interventions in PAD populations. Given its low cost, safety, and potential for meaningful impact, dietary modification represents an underused but promising strategy in PAD prevention and treatment. Future research should prioritise PAD-specific dietary intervention trials and strategies for integrating nutrition into vascular care pathways
Feasibility of glycated haemoglobin target-setting in adults with diabetes: A mixed-methods study
Get PDFBackgroundHbA1c targets guide diabetes management to reduce complications, yet their psychological effects are poorly understood. This feasibility study evaluated the practicality of conducting a definitive trial evaluating the impact of explicit HbA1c target-setting in adults with diabetes.MethodsWe conducted a randomised mixed-methods feasibility study. Adults with diabetes were allocated 1:1 to receive an explicit HbA1c target set 5 mmol/mol above (Group A) or below (Group B) their current HbA1c. Biomedical (HbA1c, blood pressure, BMI) and psychometric patient-reported outcomes were measured at baseline and 3 months. Quantitative data were analysed in SPSS using independent-sample t-tests or Mann-Whitney U tests for between-group comparisons, and paired t-tests or Wilcoxon signed-rank tests for within-group changes. Qualitative data from semi-structured interviews with patients and healthcare professionals were analysed using the Framework Method of thematic analysis in NVivo. Acceptability was assessed via interview, and mixed-methods findings were integrated through triangulation to enhance validity.ResultsFifty participants were recruited; 34% withdrew. Though not powered to determine statistical significance, no between-group differences were observed in HbA1c or patient-reported outcomes. Across groups, diabetes distress decreased, self-efficacy improved, and HbA1c improved. Interviews indicated high acceptability and identified key motivators (target achievability, hypoglycaemia avoidance) and demotivators (limited understanding, perceived unattainability).DiscussionA randomised mixed-methods approach to HbA1c target-setting is feasible and acceptable, providing methodological insights for a definitive trial.Trial registrationThe study is registered with the ISRCTN (registration number: 12461724; date registered: 11th June 2021)
Adapting PRIMM to a Primary (K-5) Computing Setting
Get PDFPRIMM (Predict-Run-Investigate-Modify-Make) is an approach to teaching programming that focuses on code comprehension as well as providing a structure for lessons. Little research has investigated how PRIMM can be used in primary education. This paper describes a small-scale practitioner inquiry project whereby PRIMM was used to teach 8-9 year-old students in a school in England. Two teachers implemented the practice using a series of adapted lessons which incorporated actions for the children to help them remember the PRIMM stages. Analysis of qualitative data from pupils and teachers showed that pupils developed a sense of agency from learning the actions and that the teachers were able to readily assess student progress. Further work could explore the use of PRIMM at the primary level in a wider range of schools
Returning to Nature: Humanity, Environment and Creative Writing
No full textAs writers who in practice and in theory are concerned with the natural world and the contested age of the Anthropocene, we are drawn to considering our relation to and with nature. Generally, we are of the opinion that ‘to exist as a human is to be in nature’ (Canton 2024), though as has been made clear (Soper 1995), terms such as ‘nature’ and ‘natural’ are put to use in multiple and often contradictory ways that can simultaneously cast the human as within and without its bounds. As contemporary practitioners, we acknowledge ourselves as writers who have turned away from the postmodernist emphases of epistemological scepticism, irony and the social construction of existence, towards a qualified realism informed by ‘an urgent sense of ecological destruction, rainforest devastation and species-extinction’ (Ebdon 2019). We are situated, culturally and spatially, in a Western sphere where species die- outs and climate catastrophe are being witnessed, and acknowledge this context inevitably informs our interests as writers and scholars. While we of course operate creatively within our engagement with the natural world through literary forms, we are acutely aware that ‘the brute physicality of the material world reasserts itself as a reminder that stuff cannot be outmanoeuvred completely; the “real” real is non-negotiable’ (Lea 2016: 20). With this in mind, we explore some of the ethical issues that arise from consideration of the tasks, tensions and limits of writing about nature and the natural world. Particularly, we are concerned to explore how the concept of that most human of qualities—empathy—relates to the writing of nature and the natural, particularly if we accept that ‘we’ are part of nature in a non-trivial sense that resists the ‘man’ and ‘nature’ polarity
Instruction during lifting: How analogy and explicit instruction influence performance and motor control
Get PDFThis study aimed to examine the effects of analogy (ANA) and explicit (EXP) verbal instruction on motor performance and muscle activation during a weightlifting task. Traditional coaching strategies often rely on explicit cues; however, recent research suggests that analogy-based instructions may offer a more efficient route to motor learning by promoting implicit control. Twenty novice participants were randomly assigned to one of three conditions (ANA, EXP, or control), with the sequence of conditions counterbalanced across three consecutive days. Day 1 involved familiarization; Day 2 included the control and first experimental condition; and Day 3 completed the second experimental condition. Participants performed both isometric and dynamic lifting tasks while muscle activity (EMG), force production, and declarative knowledge were assessed using a within-participant design. Results revealed significant alterations in lower limb EMG activity following both instructional strategies (p < 0.05), indicating a reorganization of motor control. Moreover, the EXP group exhibited significantly lower rate of force development within the first 200 ms compared to the control (p < 0.05). Overall force output was also higher in the control group. These findings suggest that avoiding verbal instruction may benefit maximal force production. However, analogy instructions appear to maintain performance levels while altering neuromuscular strategies. Clinical trial register number ANZCTR (code: 386738). [Abstract copyright: Copyright © 2026. Published by Elsevier Ltd.
Unsupervised Disentanglement of Brain Heterogeneity for Identifying Subtypes of Alzheimer’s Disease
Get PDFNeuroanatomical heterogeneity in Alzheimer's disease (AD) hinders precision diagnosis and treatment, as distinct brain phenotypes may correspond to different disease subtypes. However, MRI-based subtype classifications are often confounded by co-occurring pathologies and non-AD factors, such as genetic predisposition and environmental influences, limiting their clinical interpretability. We propose 3D-DisAD, an unsupervised deep learning framework that disentangles AD-specific neuroanatomical variations from unrelated influences and clusters patients into subtypes with homogeneous brain phenotypes. The framework comprises two synergistic networks: (1) Contrastive Disentanglement Network, which separates AD-specific variations from those shared by AD patients and healthy controls; and (2) Transformation Generation Network, which refines these disease-specific variations by transforming healthy brain representations into realistic, pathology-consistent anatomies via diffusion-based generative modeling. Evaluated on four public datasets, 3D-DisAD reveals strong correlations between the disentangled AD-specific variations and diverse clinical and biological profiles, validating their relevance. Using these variations, we identify four AD subtypes with significant differences in biomarkers, cognitive trajectories, and genetic signatures, and uncover distinct longitudinal progression patterns that suggest potential windows for early intervention. By disentangling AD-specific variations, our method enables more precise patient stratification and personalized treatments, particularly in the early stage of AD. Code is available at: https://github.com/cnuzh/3D-DisAD
Understanding how to maintain paramedic simulation-based education quality: a qualitative study
Get PDFBackground: Simulation-Based Education (SBE) is an essential component of paramedic training, offering a structured environment for students to develop clinical skills and decision-making capabilities. Despite the existence of SBE quality frameworks, such as those from the Association for Simulated Practice in Healthcare (ASPiH) and the International Nursing Association for Clinical Simulation and Learning (INACSL), the application of these frameworks in maintaining paramedic SBE quality remains inconsistent. This study explores paramedic educators' perceptions of SBE quality, the challenges in applying SBE quality frameworks, and potential strategies for improvement.Methods: An exploratory qualitative research design was employed, utilising semi-structured interviews with eight paramedic educators from five higher education institutions in the East Midlands, UK. Data were analysed using template analysis to identify key themes related to maintaining paramedic SBE quality. Results: Participants were aware of the importance of quality in SBE, yet demonstrated limited awareness and inconsistent application of formal quality frameworks, often relying more on informal, experience-driven approaches. Psychological safety and student engagement were emphasised as crucial to effective SBE, yet institutional constraints, including financial limitations, staffing shortages, inadequate faculty training, hindered quality assurance efforts. There were also challenges in standardising simulation scenarios and debriefing practices, with educators highlighting the need for greater institutional support and structured training in simulation pedagogy.Conclusions: The study highlights significant opportunities to enhance the integration of quality frameworks in paramedic SBE, emphasising the need for improved faculty training, increased institutional investment, and structured quality assurance mechanisms. Addressing these barriers is essential to ensure consistency, effectiveness, and sustainability in paramedic SBE.<br/
Interactions of composite magnetic skyrmion-superconducting vortex pairs in ferromagnetic superconductors
Get PDFWe study composite topological excitations in ferromagnetic superconductors consisting of bound states of magnetic spin textures (skyrmions) and superconducting vortices. Using a Ginzburg--Landau framework with Zeeman coupling between the magnetization and superconducting magnetic field, we demonstrate that skyrmion-vortex pairs (SVPs) form energetically stable bound states. By analyzing their asymptotic interactions, we identify regimes in which SVPs exhibit both short-range repulsion and long-range attraction, leading to clustering phenomena. Our results provide a field-theoretical basis for understanding suggest pathways for controlling hybrid topological matter through long-range interactions
The digital platform assessment matrix: developing a framework for evaluating digital platforms and systems for children and young people’s mental health support
No full textPurposeDigital platforms and systems (DPS) are increasingly used as effective resources to help address the mental health needs of children and young people (CYP). However, appropriate assessment tools to evaluate the quality of DPS remain limited. This study aims to develop a comprehensive evaluation framework for DPS that provides access to mental health support for CYP, with the goal of identifying their strengths and weaknesses and promoting best practices.Design/methodology/approachThe authors used a four-step multi-method approach comprising: an extensive literature review and content analysis of existing guidelines; the identification of essential qualities and characteristics of effective DPS; consultation with over 50 stakeholders to ensure the applicability of the evaluation framework; and pilot testing on 53 DPS to refine its structure and functionality.FindingsThe resulting evaluation framework, referred to as the digital platform assessment matrix (DPAM), comprises 65 criteria for assessing the functional, technical and social features of DPS. The authors propose both a comprehensive version of the DPAM and a shortened version, allowing for flexible use across different contexts and stakeholder groups. Future testing and iterations are also explored.Originality/valueThe DPAM offers the first comprehensive and operational framework for evaluating DPS that facilitates access to mental health services and resources for CYP in the UK. Its multiple criteria ensure that digital platforms can best serve their users, be compatible with existing health systems and sustainable over time. The DPAM also underpins the development of the new digital platform, which aims to provide CYP with streamlined access to place-based arts initiatives that support their mental health.[No data were created or analysed for this paper
Pain score distribution expert elicitation for distal humerus hemiarthroplasty and total elbow arthroplasty using a validated numerical patient rated outcome measure in trauma.:PEDANT study
No full textAbstractAimsWith equal numbers of adults with unreconstructable distal humerus fractures undergoing total elbow arthroplasty (TEA) and distal humerus hemiarthroplasty (DHH) a randomized trial is needed to compare the interventions. Patients have identified pain as the key outcome. There is no data on pain outcomes using a validated pain instrument to plan a trial. This study aims to use expert elicitation to produce probability distributions for the Patient Rated Elbow Evaluation Pain (PREE pain) score at 12 months in adults undergoing TEA or DHH for trauma.MethodsUsing the Sheffield Expert Elicitation Framework (SHELF) seven experts were recruited and provided with a summary of current knowledge on pain outcomes from a systematic review. They were asked to consider their median of the PREE pain score at 12 months after a TEA for acute trauma, their difference in the median PREE pain scores between TEA and DHH, and their standard deviation of the PREE pain score after TEA and DHH. The Rational Independent Observer concept was used to achieve consensus. ResultsThe elicited median value for the PREE pain at 12 months after TEA for acute trauma was 13.6/50 (IQR 10.6 to 16.8). The estimated median of the difference in PREE pain scores was 3.4 (IQR -0.3 to 7.1). The elicited standard distribution of PREE pain scores was 9 (standard deviation (SD) 2.2), and after DHH was 12 (SD 3.0).ConclusionExpert elicitation can be a useful tool for synthesizing unknown probabilities. Experts’ consensus is that PREE pain scores at 12 months in patients treated with elbow arthroplasty for acute trauma would be higher following DHH than TEA, and that the pain scores for DHH patients would exhibit greater variance than patients having TEA. This difference is estimated to be small but should be tested in a randomized trial