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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
No full textBackground
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
Quantifying the Impact of High Emitters on Vehicle Emissions: An Analysis of Ecuador’s Inspection and Maintenance Program
No full textOn-road vehicles are a primary source of urban air pollution. It is known that high-emitting vehicles represent a fraction of the fleet but contribute significantly to the total emissions. Usually, road transportation emission inventories do not capture the impact of these types of vehicles, underestimating emissions. This study introduces a simple method to refine vehicle emission inventories by incorporating data from Ecuador’s Inspection and Maintenance (I/M) program. We analyzed I/M data from Quito to develop a correction factor for the Vehicular Emissions INventory (VEIN) model, accounting for the higher emissions from vehicles that fail inspection. Our analysis shows that while less than 10% of gasoline and 20% of diesel vehicles failed inspection, their emissions were substantially higher; for instance, accounting for reproved vehicles produced 60% more Carbon Monoxide (CO), 18% more Non-Methanic Volatile Organic Compounds (NMVOC), 40% more Particulate Matter with aerodynamical diameter of 2.5 µm or less (PM2.5), and 34% more or lower than 10 µm (PM10). These findings demonstrate that incorporating I/M data is crucial for accurately quantifying vehicular pollution. The proposed methodology offers a way to create more accurate emission estimates, providing a tool for policymakers to manage air quality
Quantum-enabled optical large-baseline interferometry: applications, protocols and feasibility
No full textOptical Very Long Baseline Interferometry (VLBI) offers the potential for unprecedented angular resolution in both astronomical imaging and geodesy measurements. Classical approaches face limitations due to photon loss, background noise, and their need for dynamical delay lines over large distances. This review surveys recent developments in quantum-enabled optical VLBI that address these challenges using entanglement-assisted protocols, quantum memory storage, and nonlocal measurement techniques. While its application to astronomy is well known, we also examine how these techniques may be extended to geodesy–specifically, the monitoring of Earth’s rotation. Particular attention is given to quantum-enhanced telescope architectures, including repeater-based long-baseline interferometry and quantum error-corrected encoding schemes, which offer a pathway toward high-fidelity optical VLBI. To aid the discussion, we also compare specifications for key enabling technologies to current state-of-the-art experimental components. By integrating quantum technologies, future interferometric networks may achieve diffraction-limited imaging at optical and near-infrared wavelengths, surpassing the constraints of classical techniques and enabling new precision tests of astrophysical and fundamental physics phenomena
Enhanced Stability of O/W Pickering Emulsions Driven by Interfacial Adsorption of Whey Protein Nanogels
No full textWhey protein is valued for its health and emulsifying benefits, yet its intrinsic instability limits its effectiveness as an emulsifier under food processing conditions. To address the need for physically stable emulsions, this study developed O/W Pickering emulsions stabilised by nanogel WPI (GWEs) and investigated their stability under common food processing conditions, including thermal treatment, pH adjustment, and cold storage. For comparison, emulsions stabilised by non-heated (NWEs) and heat-treated WPI (HWEs) were also prepared. The results showed that while the oil droplet size of GWEs (12.2 ± 1.16 µm) was comparable to NWEs (13.6 ± 0.26 µm), HWEs exhibited significantly larger droplets (18.0 ± 0.16 µm). GWEs demonstrated the highest protein adsorption at the oil–water interface (68.7%). TEM further revealed that whey nanogels achieved nearly full monolayer coverage of oil droplets. By contrast, only partial protein coverage and exposed interfaces were observed in NWEs and HWEs. Additionally, GWEs exhibited superior stability under food processing conditions, with minimal changes in emulsion capacity, droplet size, viscosity, and flow behaviour when subjected to heat (up to 90 °C), acidification (pH down to 3), and storage for up to 3 days, confirming the potential of nanogel WPI as an advanced stabiliser in emulsion-based formulations
Doxorubicin induces bone loss and modifies multiple cell populations in vivo – Implications for modelling of bone metastasis
No full textDoxorubicin (DOX), commonly used to treat breast cancer, is associated with cardiotoxicity and has negative effects on other organ systems, including the skeleton. DOX-induced bone damage has been demonstrated in murine models; however, results are conflicting due to the use of different doses, schedules, and rat/mouse strains. As DOX is used to limit tumour progression in models of skeletal metastasis, it is paramount to determine how the agent affects the bone microenvironment in the relevant mouse strains, to enable correct interpretation of DOX effects in tumour studies. We have therefore investigated the effects of DOX on bone structure and a range of bone and bone marrow cell populations, comparing immunocompetent and immunocompromised mice.
Groups of 7-week-old female BALB/c and BALB/c Nude mice were treated with either saline (control), 4 or 6 mg/kg DOX weekly for four weeks. Effects on bone volume and structure was determined using ex vivo µCT, a panel of bone marrow cell populations were quantified by flow cytometry and osteoblast/osteoclast numbers were assessed using bone histomorphometry.
DOX caused trabecular bone loss, with immunocompetent BALB/c mice being more sensitive to DOX than the immunocompromised BALB/c nude counterparts. The 6 mg/kg dose of DOX altered the ratio of bone marrow immune and haematopoietic cell populations in both groups, increasing the numbers of hematopoietic cells and progenitors, decreasing B cells and increasing the number of neutrophils. Bone marrow macrophage and monocyte numbers were increased following DOX treatment in BALB/c nude mice only. Our data demonstrate that DOX impacts a number of cell types in the bone microenvironment, highlighting the importance of considering treatment-induced bone effects when using DOX in models of bone metastasis
Debye‐scale bipolar structures and their role in the electron trajectory instability at the bow shock
No full textA number of mechanisms have been suggested to operate within the terrestrial bow shock to redistribute energy contained in the incoming solar wind flow. The majority of mechanisms involve the generation of turbulence while some are based on particle motion alone. In this paper, we investigate the possible occurrence of the Electron Trajectory Instability, that results from short scale electric field gradients. Spike-like bipolar features in electric field measurements are a commonly observed signature within the terrestrial bow shock. They are usually associated with the passage of electrostatic solitary waves associated with phase space holes in the particle distribution. Using electric field measurements, we compare different interferometric methods to determine the propagation direction, velocity, and spatial scale of these features. Based on these results, it appears that the instability criterion for the Electron Trajectory Instability is fulfilled and the electron trajectories will diverge in the presence of these structures
An investigation of the interaction and pH-activity relationship of ceria nanoparticles with a model membrane
No full textUsing rapid cyclic voltammetry (RCV) and an established electrochemical sensor, we clarify the interactions of in-house synthesised and well characterised cerium (IV) oxide (ceria) nanoparticles and nanocubes (NPs) with phospholipid membranes. The RCV results reveal that the interaction of ceria NPs with the phospholipid depends not only on the dispersion media and the particle coating, but also on the pH. No interaction was observed with the phospholipid layer when ceria NPs were dispersed in phosphate buffered saline (PBS) at pH 7.4 or in citric acid/citrate buffers (CCB) at pH values ≥4. However, a clear interaction was observed when ceria NPs were dispersed in acidic media. Notably, CeO2 NPs dispersed in either a glycine buffer at pH 3.0 (GLY 3.0) or CCB at pH 3.0, when in contact with the phospholipid monolayer, exhibited similar interaction behaviours to soluble Ce (+III) ions dispersed in the same media. However, both RCV responses also showed an increase in the background current (a semiconductor effect) indicative of the direct interaction of the nanoparticles with the uncoated electrode. In contrast, PBS-incubated ceria NPs did not produce an interaction with the phospholipid monolayer when dispersed in CCB 3.0 or GLY 3.0. Together, these findings suggest that the dispersion medium plays an important role in the interaction of CeO2 NPs either impeding or promoting interaction by changing the characteristics of the NP surface. In particular, we conclude that the interaction of ceria NPs with the phospholipid layer at acidic pH is facilitated by Ce(+III) ions or their complexes on the surface of the nanoparticles
Parent reports of eating behaviour and feeding practices: effects of parent and child sex
No full textResearch on parental feeding practices has focused on mothers, often overlooking fathers' perspectives and the influence of child sex. This study examined (1) differences between fathers' and mothers' own eating behaviours, their use of feeding practices, and perceptions of their children's eating behaviours, and (2) the role of child sex in these perceptions and practices. Parents (N = 784; 145 fathers and 639 mothers) of preschoolers (3–5 years, 51.3 % female) from the UK completed an online survey assessing their eating behaviours and feeding practices, and their child's eating behaviours. There were significant sex differences in parents' eating behaviours, with mothers reporting more emotional overeating, hunger, satiety responsiveness, and slowness in eating. Mothers and fathers did not differ in their reports of children's eating behaviours. Girls were reported to have higher levels of satiety responsiveness than boys. When exploring the interaction of parent and child sex in reports of eating behaviour, fathers reported that girls had more desire to drink. Mothers and fathers differed in their reported use of some feeding practices. Both mothers and fathers reported greater use of food for emotion regulation with girls than boys. Fathers used more encouragement of balance and variety with boys. These findings highlight distinct patterns in feeding practices and eating behaviours, influenced by both parent and child sex, suggesting that girls may be at greater risk of receiving feeding practices that contribute to the development of emotional eating. These results emphasize the need to consider the role of sex in future research and the development of tailored feeding guidance
Judith Shklar’s ethos of skeptical vigilance
No full textJudith Shklar’s negative brand of liberalism is sometimes thought to have little to say about the ethical character required of citizens in liberal democracies, beyond the injunction to avoid cruelty. In this article, however, we argue that Shklar’s negative liberalism prescribes four distinctively political virtues—rational empathy, a healthy apprehension of state power, self-restraining tolerance, and being a good loser—that, taken together, constitute an ethos of skeptical vigilance. We survey Shklar’s criticisms of republican and communitarian accounts of civic virtue to clarify her concerns about attempts by the liberal state to cultivate these virtues and analyze the case of passive injustice to highlight tensions between active citizenship and liberal values. We conclude with some reflections on how Shklar’s political theory attempts to persuade her readers of the importance of adopting and practicing an ethos of skeptical vigilance