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Manchester Intermittent Diet in Gestational Diabetes Acceptability Study (MIDDAS-GDM): a two-arm randomised feasibility protocol trial of an intermittent low-energy diet (ILED) in women with gestational diabetes and obesity in Greater Manchester
Get PDFIntroduction The prevalence of gestational diabetes mellitus (GDM) is rising in the UK and is associated with maternal and neonatal complications. National Institute for Health and Care Excellence guidance advises first-line management with healthy eating and physical activity which is only moderately effective for achieving glycaemic targets. Approximately 30% of women require medication with metformin and/or insulin. There is currently no strong evidence base for any particular dietary regimen to improve outcomes in GDM. Intermittent low-energy diets (ILEDs) are associated with improved glycaemic control and reduced insulin resistance in type 2 diabetes and could be a viable option in the management of GDM. This study aims to test the safety, feasibility and acceptability of an ILED intervention among women with GDM compared with best National Health Service (NHS) care.
Method and analysis We aim to recruit 48 women with GDM diagnosed between 24 and 30 weeks gestation from antenatal clinics at Wythenshawe and St Mary’s hospitals, Manchester Foundation Trust, over 13 months starting in November 2022. Participants will be randomised (1:1) to ILED (2 low-energy diet days/week of 1000 kcal and 5 days/week of the best NHS care healthy diet and physical activity advice) or best NHS care 7 days/week until delivery of their baby. Primary outcomes include uptake and retention of participants to the trial and adherence to both dietary interventions. Safety outcomes will include birth weight, gestational age at delivery, neonatal hypoglycaemic episodes requiring intervention, neonatal hyperbilirubinaemia, admission to special care baby unit or neonatal intensive care unit, stillbirths, the percentage of women with hypoglycaemic episodes requiring third-party assistance, and significant maternal ketonaemia (defined as ≥1.0 mmol/L). Secondary outcomes will assess the fidelity of delivery of the interventions, and qualitative analysis of participant and healthcare professionals’ experiences of the diet. Exploratory outcomes include the number of women requiring metformin and/or insulin.
Ethics and dissemination Ethical approval has been granted by the Cambridge East Research Ethics Committee (22/EE/0119). Findings will be disseminated via publication in peer-reviewed journals, conference presentations and shared with diabetes charitable bodies and organisations in the UK, such as Diabetes UK and the Association of British Clinical Diabetologists.
Trial registration number NCT05344066
Impact of consuming zinc-biofortified wheat flour on the growth and morbidity status of children aged 1–5 years: a cluster-randomised, double-blind, controlled trial
No full textWheat biofortification through conventional breeding and/or agronomic methods to increase zinc content may be a promising strategy for addressing zinc deficiency (Reference Gupta, Brazier and Lowe1). However, evidence on the effectiveness of zinc biofortification interventions on health outcomes are lacking. The aim of the present study was to assess the effectiveness of consuming zinc-biofortified wheat flour (Zincol-2016) on growth and zinc-related morbidity among children (aged 1–5 years), living in a rural community in northwest Pakistan.
Households (N = 486) with at least one adolescent girl aged 10–16 years and one child aged 1–5 years (N = 517) near Peshawar were recruited to a double-blind, cluster-randomised controlled trial (BiZiFED2 RCT)(Reference Lowe, Zaman and Moran2,Reference Gupta, Zaman and Fatima3) . During phase 1 of the trial (November 2019 to September 2020), households were provided with locally procured flour from standard wheat varieties (control) to establish a baseline. During phase 2 (September 2020 to March 2021), households received either zinc-biofortified flour or control flour. Anthropometric measurements were collected at the beginning, middle and end of phase 2(Reference Lowe, Zaman and Moran2). Data pertaining to incidence and duration of respiratory tract infection (RTI) and diarrhea in the preceding two weeks were collected fortnightly. Analysis was performed using linear mixed models for continuous variables adjusted for baseline, and Pearson's chi-square test for categorical variables.
No significant effect of the intervention was observed on linear growth (height: control 2.3 ± 1.32 cm vs intervention 2.2 ± 1.41 cm; height-for-age Z scores: control -0.21 ± 0.35 vs intervention -0.21 ± 0.38) and weight gain (control 1.7 ± 1.16 kgs vs intervention 1.5 ± 0.98 kgs; weight-for-age Z scores: control 0.39 ± 0.60 vs intervention 0.29 ± 0.54). Caregiver-reported incidence of RTIs were not significantly different for the two study arms between the baseline and midpoint, but towards the end of the trial a lower incidence of RTIs was reported in the intervention arm compared to the control arm (week 26: control 34.7% vs intervention 17.6%, p = 0.036). However, when the longitudinal prevalence of RTI (cumulative days of sickness as a percentage of total days of observations) was considered, no treatment effects were observed (mid-point: control 16.5% [95% CI: 14.1, 18.9] vs intervention 14.8% [95% CI:12.5, 17.2]; endline: control 14.0% [95% CI: 11.5, 16.4] vs intervention 12.2% [95% CI: 9.9, 14.5]). No intervention effects were reported either on the incidence of diarrhea or its longitudinal prevalence (mid-point: control 4.7% [95% CI: 3.2, 6.1] vs intervention 4.9% [95% CI: 3.5, 6.2]; endline: control 3.2% [95% CI: 2.1, 4.3] vs intervention 2.9% [95% CI: 1.6, 4.2]).
Provision of zinc-biofortified wheat flour for 25 weeks did not have a significant effect on growth or morbidity status of children. Longer term interventions are warranted to monitor changes in functional outcomes in response to the ongoing national scale-up of the release of zinc-biofortified wheat varieties
Organizations and Citizens Building Back Better? Climate Resilience, Social Justice & COVID-19 Recovery in Preston, UK
Get PDFThe impacts of COVID-19 on cities across the United Kingdom were significant and diverse, whilst ongoing climate-related, sustainability and social challenges were highlighted and sometimes amplified. Lessons from organizational and citizen experiences and their responses have the potential to improve local sustainability and resilience to global events, hence they must be examined. We report findings from a project conducted in Preston (UK) exploring how COVID-19 recovery might accelerate organization- and citizen-led action for the wellbeing of people, places and planet. The project used a settings approach to public health and combined qualitative research with conceptual development; the former involved online interviews and group dialogues with members of several local anchor institutions, whilst the latter examined synergy between community wealth building, Doughnut Economics and place-based climate action. We explore two themes 19 anchor institutions’ strategic priorities and plans; ‘building back better’ and its future sustainability implications. These revealed four cross-cutting aspects – wellbeing; tackling societal inequalities; collaborative working; and COVID-19 as a catalyst for transformative change. Informed by ‘Doughnut-Shaped Community Wealth Building’, organizations are encouraged to: embed commitment to equitable and inclusive climate action; consolidate the co-operative approach developed during the pandemic at strategic, operational and grassroots levels; take a nuanced approach to future work policies and practices; and work across anchor institutions to advocate collectively for supportive national-level policy to build a sustainable, wellbeing economy
Bone Proteomics Method Optimization for Forensic Investigations
Get PDFThe application of proteomic analysis to forensic skeletal remains has gained significant interest in improving biological and chronological estimations in medico-legal investigations. To enhance the applicability of these analyses to forensic casework, it is crucial to maximize throughput and proteome recovery while minimizing interoperator variability and laboratory-induced post-translational protein modifications (PTMs). This work compared different workflows for extracting, purifying, and analyzing bone proteins using liquid chromatography with tandem mass spectrometry (LC–MS)/MS including an in-StageTip protocol previously optimized for forensic applications and two protocols using novel suspension-trap technology (S-Trap) and different lysis solutions. This study also compared data-dependent acquisition (DDA) with data-independent acquisition (DIA). By testing all of the workflows on 30 human cortical tibiae samples, S-Trap workflows resulted in increased proteome recovery with both lysis solutions tested and in decreased levels of induced deamidations, and the DIA mode resulted in greater sensitivity and window of identification for the identification of lower-abundance proteins, especially when open-source software was utilized for data processing in both modes. The newly developed S-Trap protocol is, therefore, suitable for forensic bone proteomic workflows and, particularly when paired with DIA mode, can offer improved proteomic outcomes and increased reproducibility, showcasing its potential in forensic proteomics and contributing to achieving standardization in bone proteomic analyses for forensic applications
Entrepreneurial Attributes: Accessing Your Inner Entrepreneur for Business and Beyond
No full textEverybody wants their employer to recognise and value the skills and attributes they have, but not everybody feels those skills are valued. Entrepreneurial Attributes: Accessing Your Inner Entrepreneur for Business and Beyond looks at the link between skills, actions and attributes, and the value they present: value in terms of how an employee can be more valuable to the company they work for – in essence, more employable. The book aims to answer the question: why are entrepreneurial attributes we see in businesspeople valued, but in non-businesspeople they are sometimes not recognised when there is a clear link between entrepreneurial skills and attributes, human capital (effectively your CV) and how successfully a company performs?
Entrepreneurial Attributes: Accessing Your Inner Entrepreneur for Business and Beyond discusses how we currently view skills, actions and attributes, and how those attributes add value to a person in life and to a business that person works for. The author questions whether certain skills and actions are unrecognised or neglected in today’s world, and uses case studies and research methodologies to illustrate how value can be recognised and appreciated within the context of human capital and firm performance. Finally, the book offers tools and strategies which may assist the reader in gaining a better understanding of the way in which their entrepreneurial actions and attributes can enhance their value as a person and also make them more employable. This book also offers businesses tools to better recognise and reward the skills it needs.
The ideal audience for this book are those of us who wish to better evidence the skills and value we can offer a company; Entrepreneurial Attributes: Accessing Your Inner Entrepreneur for Business and Beyond will find an appreciative audience wherever there is a keen interest in the recognition and value of employee skills and attributes
What is the best way to measure earthworm-processed soil? A comparison of common water stable aggregates, the smartphone app MOULDER, and a novel SlakeLight method
Get PDFSoil aggregates are important for soil fertility and earthworms can support aggregate formation and stability during gut passage, burrowing activity and secretion of polysaccharides. To determine these effects in different soil tillage systems, soil properties, and the earthworm community associated with Lumbricus terrestris (Linnaeus, 1758) were evaluated in two long-term field experiments using plough, cultivator, or no-till. The aim was to investigate effects of earthworm populations on soil aggregate stability and to evaluate three methods, namely: water stable aggregate (WSA) index, MOULDER (formerly SLAKES) and SlakeLight. The WSA method wet-sieves aggregates for 3 min in distilled water and records mass of the dispersed aggregates. MOULDER uses a smartphone application to measure an increase in area of dispersed soil submerged in distilled water to measure slaking, while SlakeLight analyses light transmission corresponding to the area covered by the soil material. Soil samples were collected in autumn at three levels: i) middens, ii) 5 cm radius around burrows of L. terrestris (burrow-midden-complex), and iii) in bulk soil without burrows of L. terrestris. All samples were hand-searched for earthworms or air-dried for soil aggregate stability analyses. The hypothesis tested was that there is a gradient of earthworm worked soil, such that the level of earthworm activity away from a L. terrestris burrow decreases so that: midden > burrow-midden-complex > bulk soil. Total earthworm abundance (individuals level−1 ± standard deviation), mostly endogeic earthworms, was 3-times higher in the burrow-midden-complex (4.3 ± 2.7) than bulk soil for cultivator and doubled for burrow-midden-complex under a ploughing regime (3 ± 2.1), while no-till was only slightly increased (4.6 ± 2). With rising earthworm numbers, aggregate stability increased, with a higher effect for bulk soil than for burrow-midden-complex. At both sites, MOULDER identified a more stable soil in middens than in bulk soil, while other methods were not so discriminating in their outcomes of middens. However, WSA was more sensitive to interactions of soil tillage × earthworm abundance than SlakeLight or MOULDER and showed that ploughed soil and bulk soil aggregates stabilised the most with increasing earthworm activity. Comparison of the three methods showed that all can be used for earthworm-processed soil, but that selection of the method should depend on the research questions and on resource availability
Is the integration of health and social care meeting the growing demand?
Get PDFIntegration of health and social care has been suggested as a solution to overcome the increasing financial and service pressures on the UK healthcare system. This commentary aimed to critically appraise a systematic review that investigated the national and international evidence base for the impact of integrating care, both on perceived and actual service delivery outcomes. The authors also aimed to identify the review's implications for practice, policy and future research
Behavioural flexibility in Lumbricus terrestris burrowing
Get PDFLumbricus terrestris is an epi-anecic earthworm, normally occupying a 1–2 m deep, vertical burrow. Some observations suggest that population persistence in much shallower burrows could be possible in a mild and humid climate. This was further investigated at an ex-industrial site in NW England, with a topsoil less than 0.15 m deep, above inert subsoil formed from semi-weathered Leblanc waste. L. terrestris were collected from an adjacent woodland soil and introduced into unoccupied areas. After four days, settlement and survival were studied by targeted sampling of half of the individuals, and depth of burrows were measured by resin casting. After 14 months, the second half of inoculated areas were studied and after another four years a further general survey occurred. After four days, 41 % of targeted worms were recovered, with 0.11 m mean burrow depth and burrows ending at the subsoil interface. After 14 months, all age classes of L. terrestris were present and burrow depth had not changed. After five years, adult, juvenile and hatchling L. terrestris were present, demonstrating establishment of a breeding population. In a parallel laboratory experiment, with site topsoil and subsoil in Evans’ boxes, L. terrestris avoided subsoil and constructed U-shaped burrows. The results show that through flexible burrow construction, L. terrestris can survive above highly constraining subsoil conditions. This is likely to be only possible where severe droughts are uncommon, and topsoil does not freeze in winter
Is there a market for the UltraVision glider?
Get PDFThe UltraVision glider represents a change of paradigm in glider design from maximising the gliding performance to maximising the flying experience. It prioritizes an unobstructed cockpit view over traditional performance-focused considerations. Historically, gliders have been meticulously designed to maximize performance within specified limitations such as material selection, dimensions, weight, manufacturing processes, and cost per unit. The UltraVision challenges this norm by intentionally sacrificing certain performance aspects to elevate the overall flying experience, recognizing that exceptional sightlines are a key driver for attracting pilots to the sport. However, as far as the author knows, this approach has never been followed, raising the question of whether there is a market for a glider that sacrifices performance. To address this question, a series of high-quality renders were created and made viral within the gliding community, generating many reactions. Here, we will systematically analyze these reactions and address the objections to try to answer the question: Is there a market for the UltraVision glider
Promoting Physical Activity for Health Benefits via a 10-week Mobile-Application based Personal Training Programme
Get PDFMobile-application based interventions promoting engagement in regular physical activity have been shown to afford weight loss, although the wider health benefits remain unknown. This exploratory intervention study quantified the effects of a 10-week mobile-application based personal training programme combined with nutritional education content, considering physical and psychosocial health-related outcomes. Eleven healthy individuals completed the intervention, comprising physical activity prescription (resistance and high intensity interval training), nutritional education, a daily step target and online personal trainer support. Outcomes included anthropometrics, circumferential measurements, resting heart rate, blood pressure, aerobic capacity, self-rated health, physical activity enjoyment scale, and the Pittsburgh sleep quality index. Significant reductions in body mass, circumferential measurements and aerobic capacity (p<0.05) were observed amongst participants. Mobile-application based interventions promoting physical activity may elicit improvements in physical health outcomes. Although healthy individuals were recruited for the purpose of this study, further research is now warranted to explore the potential health-related benefits of such mobile-applications amongst targeted groups such as disengaged, inactive populations, or individuals with long-term health conditions