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Rationale and design of a parallel randomised trial of a plant‐based intensive lifestyle intervention for diabetes remission: the REmission of diabetes using a PlAnt ‐based weight loss InteRvention ( REPAIR ) trial
Get PDFAims: As type 2 diabetes (T2D) continues to rise globally and remains a major driver of cardiovascular disease, its remission has emerged as a therapeutic target. Current evidence supports bariatric surgery and low‐calorie diets with meal replacements. No clinical trial to date has evaluated plant‐based dietary alternatives as an intensive lifestyle intervention (ILI) strategy, despite the emphasis on plant‐based diets in current clinical practice guidelines for diabetes and cardiovascular disease. The REmission of diabetes using a PlAnt‐based weight loss InteRvention (REPAIR) trial will assess whether a 52‐week plant‐based ILI targeting ≥15% weight loss is effective for diabetes remission in a multi‐ethnic Canadian population. Materials and Methods: The REPAIR trial is a prospective, randomised, 2‐arm, open‐label, blinded‐endpoint efficacy trial. Participants will include 160 adults with early T2D (<6 years) and living with obesity. They will be randomised to standard of care or a 2‐phase ILI targeting ≥15% weight loss consisting of a 12‐week weight loss phase on a plant‐based total diet meal replacement, followed by a 40‐week weight loss maintenance phase on a plant‐based dietary pattern combined with a 16‐week structured exercise program, and a 52‐week (19‐session) sustainable behaviour change curriculum. The primary outcome is diabetes remission (HbA1c <6.5% without glucose‐lowering medication for ≥3 months) and the key secondary outcome is the proportion achieving ≥15% weight loss at 52 weeks. Conclusions: This trial will provide high‐quality clinical evidence on the use of plant‐based ILIs to address the epidemics of obesity and diabetes to inform public health policies and programs in Canada and beyond
Stability of pressure-driven collapsible-channel flow
Get PDFWe consider the stability of fluid flow along a planar finite-length flexible-walled channel driven by fixed upstream pressure and externally subject to a constant applied pressure. This pressure-driven system admits a steady state that is inflated for low external pressures, but which gradually collapses as the external pressure increases; collapse is accompanied by a reduction in the steady flow rate along the channel. However, for some parameters, this collapse is non-monotonic, and we compute two stable steady states: one with modest flow rate and another with very low flow rate. We show that both branches of steady states can become unstable to self-excited oscillations, where the corresponding neutral stability curve takes the form of a two-branch tongue. For steady solutions with modest flow rate, these oscillations are analogous to those observed in the flux-driven system from a mildly collapsed steady state, where the neutrally stable wall profile takes the form of a standing wave. Conversely, for low steady flow rates, the system instead exhibits violent “slamming” oscillations, where the flexible wall is transiently drawn toward the lower rigid wall for a short interval over every period. We show that both forms of oscillation involve a net increase in the upstream flow rate into the channel, which translates into an increase in the work done by the upstream driving pressure. However, the corresponding net energy flux extracted from the mean flow is significantly smaller and has a different sign between the two cases
Efficacy and safety of the kidney function–based finerenone dosing strategy used in FINEARTS-HF
Get PDFBackground:
Given that mineralocorticoid receptor antagonists have the potential to impair renal function and induce hyperkalemia, close monitoring of estimated glomerular filtration rate (eGFR) and serum potassium levels is essential to ensure the safe administration of this therapy.
Objectives:
In this prespecified analysis, the authors evaluated the efficacy and safety of the kidney function–based finerenone dosing strategy used in the FINEARTS-HF trial.
Methods:
In FINEARTS-HF, patients with an eGFR of 25 to 60 mL/min/1.73 m² at baseline were stratified at randomization to the low-dose group and started on 10 mg of finerenone once daily (titrated to a maximum 20 mg/d) or matching placebo, whereas those with an eGFR >60 mL/min/1.73 m² at baseline were stratified to the high-dose group and started on 20 mg of finerenone once daily (titrated to a maximum 40 mg/d) or matching placebo. The primary outcome was the composite of total (first and recurrent) heart failure events and cardiovascular death.
Results:
Among 5,986 (99.8%) analyzable patients, 3,159 were assigned to the higher eGFR/high-dose stratum and 2,827 to the lower eGFR/low-dose stratum group. The mean ± SD achieved dose was 32.3 ± 9.1 mg (finerenone) and 34.4 ± 7.8 mg (placebo) in the higher eGFR/high-dose stratum, and 15.6 ± 4.3 mg (finerenone) and 16.7 ± 4.0 mg (placebo) in the lower eGFR/low-dose stratum. The effect of finerenone on the primary outcome was consistent across the 2 dosing strata (higher eGFR/high-dose stratum: rate ratio: 0.77 [95% CI: 0.63-0.94] vs lower eGFR/low-dose stratum: rate ratio: 0.87 [95% CI: 0.74-1.03]; P for interaction = 0.34). Consistent benefits were observed for the components of the primary outcome and all-cause death. Safety was also consistent between dosing strata, except for hypokalemia, where the reduction in the odds of hypokalemia with finerenone compared to placebo was greater in the higher eGFR/high-dose stratum (P-interaction < 0.01).
Conclusions:
In FINEARTS-HF, an eGFR-based dosing strategy allowed effective and safe use of finerenone in patients with heart failure with mildly reduced ejection fraction/ heart failure with preserved ejection fraction with a baseline eGFR as low as 25 mL/min/1.73 m2. We recommend that clinicians implement the trial-validated dosing strategy and incorporate appropriate uptitration to the target dose to ensure optimal therapeutic outcomes
An ecological perspective on mentoring: Austrian and Israeli academic depictions of mentor-teachers’ work
No full textThis paper offers a comparative analysis of the Austrian and Israeli academic perspectives on teacher induction mentoring. It applies an ecological perspective to reveal focal points and gaps in mentoring academic discourse. While mentoring research is comprehensive, the authors find some aspects that require further attention, especially cultural contexts in which mentoring processes occur. This article provides valuable insights for educators, policymakers, and researchers seeking to enhance the quality of mentoring programmes for novice teachers, advocating for a more comprehensive approach that encompasses all aspects of the ecological model
Introducing AI Education for Girls and Young Women in Prisons: Mapping to the UN Sustainable Development Goals
Get PDFNo abstract available
Manuscripts & the Mind
No full textWhat’s a book? More than just a series of words on a series of pages, it’s a multisensory experience. Things such as the font, paper quality, illustrations, layout, and overall design all affect our encounters with anything meant to be read.
Since 2019, Professor Garrick Allen, Ph.D., has led a team of theological researchers at the University of Glasgow that’s investigating paratexts — defined as any and every feature that surrounds the main text itself
Teaching migration otherwise: ethics, discomfort, and critical pedagogy in practice
No full textTeresa Piacentini shares lessons for how we might teach migration in the classroom
Cripping desire lines: disabled people, creative walking and the right to walk the city
Get PDFThis article discusses the impact of Covid-19 on disabled people’s experiences of walking in the UK, using survey and interview data from the project Walking Publics/Walking Arts: Walking, Wellbeing and Community During Covid-19 . Built environments are often encountered by disabled people as hostile and exclusionary. Our research identifies ways that this inequality was significantly magnified during the pandemic, including through overcrowded public spaces, increased street furniture and lack of facilities. Alongside attending to everyday walking experiences, we draw upon creative walking tactics and the work of walking artists, which enable imaginative encounters at multiple scales. These demonstrate how creativity can iterate alternative trajectories which embed accessible infrastructures and facilitate different ways of encountering, moving through and being in the city
Neuromorphic photonic processing and memory with spiking resonant tunneling diode neurons and neural networks
Get PDFNeuromorphic computing—modeled after the functionality and efficiency of biological neural systems—offers promising new directions for advancing artificial intelligence and computational models. Photonic techniques for neuromorphic computing hardware are attracting increasing research interest, thanks to their potentials for ultra high bandwidths, low crosstalk, and high parallelism. Among these, approaches based upon resonant tunneling diodes (RTDs) have recently gained attention as potential building blocks for next‐generation light‐enabled neuromorphic hardware, due to their capacity to replicate key neuronal behaviors such as excitable spiking and refractoriness, added to their potentials for high operational speeds, energy efficiency and compact footprints. In particular, their ability to function as opto‐electronic spiking neurons makes them strong candidates for integration into novel event‐based neuromorphic computing systems. This work demonstrates the application of optically triggered spiking RTD neurons to a multiplicity of applications and architectures; these include systems based upon single elements for multimodal (photonic‐electronic) fast rising edge‐detection in time‐series data, the construction of a two‐layer feedforward artificial photonic spiking neural network (pSNN) using RTD neurons as the nonlinear nodes delivering excellent performance in complex dataset classification tasks, and a pSNN comprised of multiple coupled light‐sensitive RTD spiking neurons that supports performance as an adjustable neuromorphic optical spiking memory system with a tunable storage time of spiking patterns
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