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Mitigating chronic respiratory disease through the lens of multimorbidity:the MARES mixed-methods study protocol
Full text linkINTRODUCTION: Chronic respiratory diseases (CRDs), such as asthma and chronic obstructive pulmonary disease (COPD), are among the leading non-communicable diseases (NCDs) worldwide. However, diagnosing CRDs in low-income and middle-income countries (LMICs) remains challenging due to limited access to spirometry and trained professionals. Aggravating the burden, CRDs often coexist with other NCDs, increasing healthcare costs, reducing quality of life and elevating mortality. These challenges highlight the need for simple case-finding approaches for CRDs, such as the COPD in Low-Income and Middle-Income Countries Assessment (COLA-6) questionnaire, to support prompt identification and appropriate care within NCD services in LMICs.OBJECTIVE: To evaluate the discriminative accuracy, feasibility and implementation of the COLA-6 questionnaire in identifying and managing CRDs in Brazilian Primary Healthcare (PHC) services for NCDs.METHODS AND ANALYSIS: The Multimorbidity Approach for REspiratory Solutions (MARES) study consists of three work packages to be conducted in PHC services in São Carlos/SP and São Paulo/SP, Brazil.MARES-1: A cross-sectional observational study enrolling 859 individuals with at least one NCD receiving care in PHC. The COLA-6 questionnaire will be administered by the research team and compared with quality-assured spirometry. The Chronic Airways Assessment Test (CAAT), Asthma Control Questionnaire (ACQ-7) and fractional exhaled nitric oxide (FeNO) will also be assessed. The diagnostic performance of COLA-6 for identifying CRDs-including COPD, asthma, preserved ratio impaired spirometry, restriction and overlaps-will be assessed using area under receiver operating characteristic curves and 95% CIs.MARES-2: A cross-sectional observational study enrolling 20 healthcare professionals (physicians, physiotherapists, community health agents and nurses) from five PHC services. These professionals will apply the COLA-6 during routine NCD care to a total sample of 1000 patients. Qualitative interviews will be conducted to explore barriers and facilitators to the implementation of COLA-6, using deductive thematic analysis.MARES-3: A longitudinal, prospective observational study in which patients from MARES-1 and MARES-2 will be reassessed at 6-month follow-up. A total sample of 473 participants with abnormal spirometry, a diagnosis of CRD or high risk for CRDs is expected. Participants will undergo spirometry, and a subset will be interviewed to explore their healthcare experiences through qualitative thematic analysis. Access to diagnostic and treatment services in Brazil will be assessed. Changes in spirometry values, FeNO, CAAT and ACQ-7 scores from baseline to 6 months in patients from MARES-1 will be analysed.ETHICS AND DISSEMINATION: This study has been approved by the Ethics Committees of Federal University of São Carlos and University of Santo Amaro (UNISA). Ethical approval was also granted by the University College London. Results will be disseminated through peer-reviewed medical journals and presentations at international conferences. Results will improve identification of CRDs, addressing a significant gap in current PHC settings.TRIAL REGISTRATION NUMBER: NCT07050823/NCT07093021/NCT07134855.</p
Organization by regulation:regulatory reform and the creation of National Health Service (NHS) Charities in England and Wales in the 1980s-1990s
Full text linkThis paper employs archival methods to explore the emergence in the 1990s of a group of English and Welsh charities known as National Health Service (NHS) Charities. We provide a detailed discussion of the changing regulatory, political, social, and technical environment in which charities were operating in the 1980s and, drawing on the Strategic Action Fields (SAF) framework, argue that changing managerial norms created new standards for both the Charity Commissioners for England and Wales and the wider charity sector. As a result, concerns about the extant management of charitable funds in the NHS gained traction. Subsequent action by the Commissioners then facilitated the creation of NHS Charities as a specific organizational identity, and, we argue, concurrently constructed the framework for an emerging NHS Charities’ SAF. This case study provides a model of how state regulation – shaped by wider political norms – can impact nonprofit organizational formation and identity
Migraine, associated treatments and risk of miscarriage:a matched cohort study and nested case-control study using the CPRD pregnancy register
Full text linkObjective: To estimate the risk of miscarriage amongst pregnant women with migraine compared to pregnant women without migraine. To compare the odds of miscarriage in women taking medication for migraine to women with migraine who did not take medication and to explore this association with different types of medications.Design: Matched cohort study and nested case-control.Setting: Clinical Practice Research Datalink (CPRD) GOLD pregnancy register. All pregnancies meeting data quality requirements between 2000 and 2019 were eligible for inclusion.Participants: Cohort study: 193,208 pregnancies of women with migraine were matched one-to-one to women without migraine. Nested case-control: 20,778 pregnancies of women with migraine that ended in miscarriage were matched to 40,122 pregnancies of women with migraine that did not end in miscarriage.Main outcome measures: Cohort study: miscarriage recorded in primary care. Nested case-control: odds of miscarriage amongst migraineurs using migraine medication.Results: Miscarriage occurred in 10% (n = 19,233) of women without migraine compared to 10.8% (n = 20,778) of women with migraine. Having migraine was associated with an 8% higher relative risk of miscarriage (risk ratio (RR) 1.08, 95% confidence interval (CI) 1.06–1.10, p < 0.001) and remained significant after adjustment for demographic factors, body mass index (BMI), smoking and comorbidities (aRR 1.06 95% CI [1.04–1.08][p = 0.001]).Of the pregnancies ending in miscarriage, 719 (3.46%), 380 (1.83%), 173 (0.83%) and 733 (3.52%) were exposed to triptans, amitriptyline, beta-blockers and non-steroidal anti-inflammatory drugs (NSAIDs), respectively. Of the matched pregnancies that did not end in miscarriage, 1099 (2.74%), 542 (1.35%), 294 (0.73%) and 780 (1.94%) were exposed to these medications, respectively.Exposure to triptans, amitriptyline and NSAIDs were associated with a significantly higher odds of miscarriage (aORs 1.24 [1.11–1.38][p < 0.001], 1.25 [1.08–1.45][p = 0.003] and 1.74 [1.57–1.93][p < 0.001] respectively). Beta-blockers were not associated with a higher risk of miscarriage.Conclusions: Migraine and triptan, amitriptyline and NSAID exposure were all associated with higher risk of miscarriage. Further work is needed to understand the potential causative mechanisms.</div
Quality over Quantity:Organic Compounds Altering the Antarctic Sea Spray Aerosol Concentrations
Full text linkThe Antarctic coastal zones are among the most biologically productive areas on Earth. The effect of marine microbiota on the emissions of sea spray particles, a critical factor for global climate and clouds, remains an open and actively researched question. Here, by means of in situ ship-borne bubble-bursting SSA production experiments at multiple locations around the Antarctic Peninsula, we show a 2-fold variability in the 10–500 nm size-resolved SSA number concentrations. We observed that the organic chemical composition of seawater (SW) and surface microlayers (SML) clearly impacts SSA number concentrations. SW and SML samples with saccharides, proteins, and N-osmolytes were less efficient at emitting SSA compared with waters rich in biotic material originating from lipids, such as fatty acids and polyols. We found that the dissolved organic carbon (DOC) fraction containing lipid degradation products and polyols indicates higher SSA production. Our results indicate that low concentration organic components, rather than the most abundant classes of biomolecules, influence the ability to be aerosolized, with strong chemical selectivity affecting SSA production
Assessing the performance of rolled vs machined Isogrid structures:microstructural characterisation and mechanical properties
Full text linkIsogrid is a lattice reinforced sheet structure with a proven track-record for improving the mass efficiency of sheet metal components. The isotropic and mass efficient mechanical properties of Isogrid suit a wide range of applications from the aerospace sector to construction. While replacing flat sheet metal with Isogrid has a high potential impact for the reduction of metal usage globally, current production methods (primarily CNC milling of thick plate) are not viable at mass manufacturing scale. Consequently, a novel method has been proposed to enable high volume production of Isogrid via rolling. However, rolling structures with non-constant or periodic cross sections is unorthodox, and the potential effects on the mechanical properties of Isogrid remains unknown. Herein, it is shown that rolling AA1050 into an Isogrid form improves its bending strength by 20% and tensile strength by 15% compared to machining for the same geometry with a more isotropic distribution of mechanical properties. These results demonstrate that rolling is a viable method for Isogrid production at scale and may enable greater resource efficiency in the domain of sheet metal manufacturing and construction.</p
Co-production within community-based services for children with intellectual disabilities and behaviours that challenge in England
Full text linkPurposeDeveloping effective community-based services for children with intellectual disabilities and behaviours that challenge in England is a national priority. Service design and delivery guidelines state services should be co-produced with the children and families/carers accessing them. There are no identified data about how well services are delivering this recommendation. This research paper aimed to describe self-reported co-production activities within such services, and to consider how well these align with co-production definitions.Design/methodology/approachDuring a mapping exercise of community-based services for children with intellectual disabilities and behaviours that challenge in England, staff at 60 services completed an interview including questions concerning co-production. Types of self-reported co-production within services were described. The authors then examined how well these aligned with definitions of co-production.FindingsSix types of self-reported “co-production” activities were identified via content analysis – (i) service planning, (ii) recruitment processes and decisions, (iii) individual case work, (iv) resources used within the service, (v) running training, workshops and groups and (vi) the service’s physical environment. Very few activities met co-production definitions, typically being classified as participation or co-creation.Practical implicationsAll involved in the planning and delivery of services need to better consider how to implement additional activities that meet higher-level co-production definitions.Originality/valueTo the best of the authors’ knowledge, this is the first known assessment of how well community-based services for children with intellectual disabilities and behaviours that challenge are enacting guidance that service design and delivery should be co-produced.</div
Articulation in Motion:Prior-free Part Mobility Analysis for Articulated Objects By Dynamic-Static Disentanglement
Full text linkArticulated objects are ubiquitous in daily life. Our goal is to achieve a high- quality reconstruction, segmentation of independent moving parts, and analysis of articulation. Recent methods analyze two different articulation states and perform per-point part segmentation, optimizing per-part articulation using cross-state cor- respondences, given a priori knowledge of the number of parts. Such assump- tions greatly limit their applications and performance. Their robustness is reduced when objects cannot be clearly visible in both states. To address these issues, in this paper, we present a novel framework, Articulation in Motion (AiM). We infer part-level decomposition, articulation kinematics, and reconstruct an interactive 3D digital replica from a user–object interaction video and a start-state scan. We propose a dual-Gaussian scene representation that is learned from an initial 3DGS scan of the object and a video that shows the movement of separate parts. It uses motion cues to segment the object into parts and assign articulation joints. Subsequently, a robust, sequential RANSAC is employed to achieve part mobility analysis without any part-level structural priors, which clusters moving primitives into rigid parts and estimates kinematics while automatically determining the number of parts. The proposed approach separates the object into parts, each represented as a 3D Gaussian set, enabling high-quality rendering. Our approach yields higher quality part segmentation than all previous methods, without prior knowledge. Extensive experimental analysis on both simple and complex objects validate the effectiveness and strong generalization ability of our approach. Code and implementation details will be made publicly available
Green solvents for the extraction and bioutilisation of metals from coal fly ash by <i>Magnetospirillum gryphiswaldense</i> MSR1
Full text linkCoal fly ash (CFA), a metal-rich byproduct of coal combustion is produced in vast quantities and poses significant ecological risks. CFA also contains abundant technologically relevant metal oxides and trace metals, including rare earth elements (REE), often at higher concentrations than in primary ores. This makes sustainable recovery strategies a major industrial opportunity. Here, green solvent systems were applied to leach metals from CFA, and the resulting leachates were added to cultures of Magnetospirillum gryphiswaldense (MSR1), a model magnetotactic bacterium that biomineralizes iron into membrane-bound magnetic nanoparticles (magnetosomes) and is capable of interacting with non-iron metals through adsorption and biomineralization. Eleven green solvents, including deep eutectic solvents (DES), were tested for extraction efficiency, with six showing performance comparable to a mineral acid control. Copper (Cu) emerged as the primary toxicant to MSR1, prompting selective precipitation with potassium ferrocyanide trihydrate (PFCT) to reduce its concentration. Cu-depleted lactic acid-based leachates supported MSR1 growth and magnetosome formation even without supplemented iron. Nano-XRF and ICP-MS analysis revealed MSR1 interacts with CFA-derived metals, most significantly showing that produced CFA magnetosomes contained a 5.3–6.1-fold increase in Cu compared to controls. As Cu is both a growth inhibitor and a target pollutant, these findings suggest MSR1 may bioaccumulate Cu within magnetosomes as a detoxification strategy. Overall, this study demonstrates a combined chemical–biological route for CFA valorisation, enabling recovery of diverse metals from waste while producing magnetosomes with distinct compositions
Implementation outcomes of a symptom management intervention in ambulatory oncology practices evaluated using a cluster randomized stepped-wedge trial design
Full text linkObjective: To test a package of clinician- and system-level implementation strategies on the adoption and reach of an electronic health record (EHR)-integrated cancer symptom assessment and management program, called cPRO, within a large academic healthcare system. Methods: This hybrid type 2 effectiveness-implementation study used a cluster randomized stepped-wedge trial design to test a package of strategies targeting system operations, clinician practices, and patient experience to support implementation of cPRO. Six clusters, comprised by 26 oncology clinic sites, were randomly allocated to one of six sequences which dictated the time at which each cluster underwent a 6-month implementation preparation period followed by a transition to the post-implementation phase in which 46 discrete implementation strategies were deployed. The primary implementation outcome was patient adoption of cPRO, measured by the proportion of patients completing cPRO assessments. Secondary outcomes included the reach of patient enrollment in the cPRO system and clinician adoption of referrals using an EHR “dot phrase” (snippets of text that can be quickly inserted into patient charts for referrals, orders, etc.) triggered by elevated cPRO scores. Data were analyzed using a cluster-period level analysis (generalized least squares linear regression with fixed cluster effects and adjustment for calendar time). Results: The study included 34,643 unique outpatients receiving cancer treatment at 26 clinics between October 2020 and March 2024. The primary analysis showed no significant difference between the pre- and post-implementation periods on the mean difference in the proportion of patients who complete the assessments (25% vs. 40%). Secondary outcomes indicated that the implementation strategy package did not significantly improve the reach of cPRO enrollment among patients (RR = 1.00, CI: 0.78 to 1.27). Clinician adoption of referrals in response to elevated cPRO symptom scores showed a marginal positive, alebeit non-statistically significant association with the implementation strategy package (RR = 1.66, CI: 0.79 to 3.48), although this varied over time. Conclusions: The implementation strategies tested did not significantly alter patient adoption rates of cPRO when comparing pre- and post-implementation periods, but might improve clinician adoption of the EHR dot phrase function. Future studies should explore strategies to enhance the integration of digital symptom management systems into routine cancer care to improve patient outcomes. Trial registration: ClinicalTrials.gov NCT03988543; registered 8 May 2019 https://clinicaltrials.gov/study/NCT03988543?term=NCT03988543&rank=1
JWST Spectroscopy of GRB 250702B:An Extremely Rare and Exceptionally Energetic Burst in a Dusty, Massive Galaxy at z = 1.036
Full text linkWe present follow-up observations of the day-long, repeating gamma-ray burst (GRB) GRB 250702B with the Near Infrared Spectrograph on board the James Webb Space Telescope. Through the identification of narrow hydrogen emission lines at a consistent redshift of z = 1.036 ± 0.004, we calibrate the distance scale, and therefore the energetics, of this unique extragalactic transient. At this distance, the resulting γ-ray energy release is at least Eγ,iso = 2.2 × 1054 erg. We find no evidence for ongoing transient emission at the GRB position and exclude any accompanying supernova (SN) with a luminosity comparable to the Type Ic broad-line SN 2023lcr, though we are unable to rule out a fainter SN counterpart owing to high extinction. The inferred rate of such events, assuming at most one in the lifetime of Fermi, suggests that such bursts are very rare, with volumetric rates over 1000 times lower than normal high-luminosity long GRBs and >105 times lower than core-collapse SNe, when corrected for beaming. Furthermore, we find that the host galaxy is unique among GRB host galaxies and extremely rare in the general galaxy population, being extremely large and dusty and with high stellar mass. The identification of such an exotic GRB in such an unusual galaxy raises the possibility that the environment was important in the progenitor channel creating GRB 250702B.<br/
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