11237 research outputs found
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An analysis and projection of diabetes prevalence in East England region
No full textBackground: Diabetes prevalence continues to rise in England, placing increasing pressure on primary and specialist healthcare services. This study examined how demographic, socioeconomic, and healthcare access factors influence Diabetes Mellitus register size across six Integrated Care Systems (ICSs) in the East of England and generated scenario based projections of future diabetes burden and specialist workforce requirements. Methods: A longitudinal panel design was applied using annual data (2012–2021) for six ICSs. Descriptive trend analysis summarised changes in diabetes registers, GP practice numbers, GP list size, deprivation (IMD scores), and population density. The association between these factors and Diabetes Mellitus register size was quantified using a fixed effects panel regression model , selected through F-tests, Breusch–Pagan LM tests, and Hausman specification testing. Future diabetes registers (2023–2027) were estimated using a regression based deterministic projection framework integrating: (i) model based forecasting, (ii) four scenario models based on plausible changes in population growth, deprivation, and GP capacity, and (iii) linear trend extrapolation of endocrinology consultant workforce numbers. Results: Diabetes registers increased across all ICSs, with the region experiencing a 13% rise between 2012 and 2021. Regression findings showed that higher deprivation strongly predicted larger diabetes registers ( , p Conclusion: Demographic growth, rising deprivation, and pressures in primary care are key drivers of the increasing diabetes burden in the East of England. Projection results indicate that several ICSs may face widening gaps between patient demand and specialist capacity. Strengthening consultant staffing, directing resources toward more deprived areas, and supporting primary care resilience will be essential to maintain equitable diabetes care in future years.</p
Cost-utility analysis of the British Cardiovascular Interventional Society conveyance algorithm for patients with out-of-hospital cardiac arrest
No full textBackground: Out-of-hospital cardiac arrest is associated with high mortality and substantial healthcare costs. The British Cardiovascular Interventional Society's conveyance algorithm prioritises direct transfer of patients with an initial shockable rhythm to specialist Cardiac Arrest Centres to support access to advanced cardiac intervention, neurocritical care, and structured rehabilitation. This study evaluated the cost-effectiveness of implementing the conveyance algorithm in a large regional population.Methods: A hybrid decision-analytic model, combining a decision tree and Markov model was developed to assess the cost-effectiveness of the algorithm, compared with standard of care over a lifetime horizon. Model inputs were derived from a contemporary, observational pilot study. Health outcomes were expressed in quality-adjusted life years, and healthcare costs were discounted at an annual rate of 3.5%. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio and net monetary benefit.Results: The conveyance algorithm was cost-effective, with an incremental cost-effectiveness ratio of £2,926 per quality-adjusted life year gained. Reductions in intensive care, hospital ward, post-assessment, and ambulance costs were partially offset by slightly higher costs related to admission, neuroprognostication, and longer-term care. Probabilistic analysis showed an 86.0% probability of cost-effectiveness at a willingness-to-pay threshold of £35,000 per quality-adjusted life year.Conclusion: Selective rhythm-based transfer to specialist cardiac arrest centres improved resource efficiency with minimal additional cost. Although clinical outcome differences remain exploratory due to observational data, this economic evaluation supports further prospective, multi-centre evaluation to confirm broader clinical and health system benefits.</p
Belonging Beyond the Organisation: Situated Learning and Identity in Liminal Boundary Roles
No full textAbstract: This paper explores how learning occurs within the liminal spaces inhabited by university business incubator managers, whose roles require continual negotiation of institutional, spatial and social boundaries. Drawing on situated learning theory and the concept of communities of practice, the study examines how learning is socially constructed across shifting contexts rather than within a single, stable environment to determine how incubator managers learn to negotiate organisational and institutional boundaries and how and where such learning occurs. Using a longitudinal, ethnographically informed study of twelve incubator managers, a three-stage process was identified: learning about, learning by doing, and recognising knowledge. These stages illustrate how individuals develop liminality competences that enable navigation of competing institutional logics. The findings show that liminality competence is not a static capability but a developmental learning trajectory; that learning and identity reconstruction are mutually reinforcing during sustained liminality; and that belonging forms where learning occurs, not necessarily where one is employed. Learning was most actively situated in external communities such as science parks, business associations and regional networks, which became the primary locus of expertise and identification contributing to research on liminality, workplace learning and identity. This study introduces the “Trajectory of Boundary-Spanning Learning” framework.</p
Retraction notice to “Cryptocurrencies as a financial asset: A systematic analysis” [FINANA 62 (2019) 182–199]
No full textThis article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/policies-and-standards/article-withdrawal). Elsevier's Research Integrity and Publishing Ethics team, with guidance from an impartial field expert acting in the role of an independent Publishing Ethics Advisor, conducted an investigation and determined that the article should be retracted. Review of this submission was overseen, and the final decision was made, by the Receiving Editor Brian Lucey, despite his role as a co-author of the manuscript. This compromised the editorial process and breached the journal's policies. The authors disagree with retraction and dispute the grounds for it.</p
Effects of energy-matched low- versus high-carbohydrate diets on glycaemic control, lipid profile, and body composition in healthy adults: a systematic review and meta-analysis of randomised controlled trials
No full textBackground: The comparative effects of energy-matched low-carbohydrate (LC) versus high-carbohydrate (HC) diets on metabolic and anthropometric outcomes in healthy adults remain unclear. Objective: To evaluate the effects of LC diets (≤ 44% of total daily caloric intake [TDCI] from carbohydrate) versus HC diets (≥ 45% TDCI) on fasting glycaemia, insulinaemia, blood lipids, and body composition in non-medicated, disease-free adults under energy-matched conditions. Methods: Randomised controlled trials (RCTs) were identified through systematic searches of PubMed and secondary sources up to April 2025. Eligible studies compared energy-matched dietary interventions and reported pre- and post-intervention data for fasting blood glucose (FBG), fasting insulin (FINS), blood lipids (total cholesterol [TC], HDL-cholesterol [HDL-C], LDL-cholesterol [LDL-C], triglycerides [TAG]), and/or body composition. Pooled effect sizes (Hedges’ g) and 95% confidence intervals (CIs) were calculated using a random-effects model. Results: Eighteen RCTs involving 905 participants met the inclusion criteria. LC diets produced greater reductions in FBG ( g = − 0.364; 95% CI − 0.709 to − 0.019; P Conclusion: Under energy-matched conditions, LC confers modest advantages for glycaemia, HDL-C, and TAG, whereas HC better lowers LDL-C. Most effects do not depend on exercise status, offering evidence to guide carbohydrate intake recommendations in diets where total caloric intake remains unchanged.</p
Vitamin B6 nutrition, metabolism, and the relationship of diseases: current concepts and future research
No full textVitamin B6, a vital micronutrient acquired through dietary intake, plays a crucial role in numerous enzymatic reactions within the human body. Despite its significance, deficiencies in vitamin B6 remain prevalent and are linked to a spectrum of chronic and acute diseases. This review explored the intricate relationships between vitamin B6 metabolism and various diseases, focusing on cancer, diabetes, cardiovascular conditions, neurodegenerative disorders, and COVID-19-related complications. We highlighted the mechanistic roles of pyridoxal 5′-phosphate, the active form of vitamin B6, in processes such as inflammation modulation, homocysteine regulation, and oxidative stress mitigation. By synthesizing recent advances in both clinical and preclinical studies, this paper underscores the therapeutic potential of vitamin B6 while advocating for personalized nutritional interventions tailored to individual health profiles. Our findings aim to inform future research, foster targeted disease prevention strategies, and optimize the safe use of vitamin B6 as part of a balanced nutritional approach.</p
Potential pathways and solutions to acute food system crisis in the UK
No full textThere is increasing concern in many advanced economies about the risks of disruption and crises in agri-food systems. Government departments and non-governmental organisations are working to identify and understand specific risks but struggle to take broad, holistic perspectives and therefore underestimate the potential for civil unrest. In the interests of helping move from understanding to action, we convened a group of experts through a Delphi process to map out potential pathways to acute UK food system crises and identify interventions that would build resilience and sustainability. To this end, we consulted 31 experts, carrying out 15 expert interviews, followed by three surveys and two workshops with a further 16 experts. The experts highlighted the many existing chronic issues creating a tinderbox for an acute risk to lead to a food crisis in the UK. These chronic issues include climate change, poor policy implementation, rising inequality, food supply chain consolidation and the risks from just-in-time supply of food. They voted to include three acute triggers—(a) cyber-attack, (b) a major extreme weather event and (c) a major new international conflict—and described how any combination of these could lead to (d) a UK food availability and/or price shock that could result in widespread fear of unsafe or inadequate food, leading to violence. A total of 7 system-wide interventions were prioritised to help address these pathway elements together and build sustainability, and a further 21 were identified to address elements individually.</p
Establishing global standards on wearable technology for measuring mobility in ageing populations: an international consensus exercise
No full textBackground: Mobility, defined as movement in all its forms, is a hallmark of healthy ageing. As wearable technologies become increasingly integrated into population health surveillance and ageing research, the absence of standardised terminology, measurement protocols and reporting practices presents a major barrier to progress. This consensus exercise aimed to establish minimum standards for measuring mobility with wearable technology in ageing populations and set priorities for future research in the field. Methods: A two-day, in-person consensus meeting was convened with 24 international experts in ageing, mobility and digital health. Using a modified nominal group technique facilitated by a trained moderator, participants engaged in structured small-group brainstorming, followed by iterative large-group discussions. Consensus was achieved through anonymised digital voting on proposed measures, principles and priorities. Findings: Consensus (≥80% agreement) was reached on 20 core device-derived mobility measures and 30 guiding principles for the optimal use of wearable technology in older populations. Experts also identified and ranked 16 priority areas for future research, with the top five including: (i) longitudinal studies and data collection, (ii) digital biomarkers and health outcomes, (iii) contextual data capture, (iv) algorithm development and validation and (v) integration with healthcare systems. Interpretations: These consensus-based standards provide a foundational framework for the consistent and transparent use of wearable devices in ageing research and practice. They can inform the development of regulations and guidelines, support harmonisation across studies and chart a path for future research to enhance the utility and impact of wearable technologies in ageing populations.</p
Nicotine-free electronic vape fluid stimulates angiogenic processes in vitro through ARF6-mediated oxidative stress
No full textIntroduction: The increase in e-cigarette use in the population has led to substantial interest in the health impacts associated with e-cigarette smoking. E-cigarette smoking represents a key external environmental cell stressor. Whilst there have been several studies to investigate the effect of nicotine-containing e-cigarette fluid, there is still a significant lack of understanding of how nicotine-free e-cigarette smoking can impact individuals. However, preliminary studies indicate that nicotine-free e-cigarette smoking can cause impaired endothelial function in humans. Materials and Methods: In the present study, we therefore used a common brand of nicotine-free e-cigarette and human umbilical vein endothelial cells to assess angiogenic processes in vitro . Results: We observed a significant upregulation in endothelial cell adhesion, migration and new tube formation with exposure to nicotine-free e-cigarette condensate (eVape) which was abrogated with exposure to the antioxidant, N-acetyl cysteine. Proteome analysis demonstrated that eVape exposure increased expression of the pro-angiogenic factors, angiogpoeitin-2, endoglin (CD105), PIGF and VEGF, as well as the ADP ribosylation factor, ARF6, and ARF6-GEF, ARNO. Chemical inhibition of ARNO reduced eVape-induced oxidative stress, angiogenic processes, and release of angiogpoeitin-2, endoglin (CD105) and VEGF. Discussion: These findings demonstrate that nicotine-free eVape causes aberrant upregulated angiogenesis in an in vitro model of the human endothelium through ARNO-dependent signalling. This study is the first to demonstrate the molecular mechanisms in response to the cellular stressor, nicotine-free eVape which underlie impaired vascular function.</p
IndiSegNet: real-time semantic segmentation for unstructured road scenes in intelligent transportation systems
No full textAutonomous driving in developing regions demands perception systems that can operate reliably in unstructured road environments marked by heterogeneous traffic, weak or missing lane geometry, frequent occlusions, and strong appearance variability. Existing semantic segmentation models, although successful in structured Western datasets, exhibit poor generalization to such chaotic conditions and are often too computationally heavy for real-time deployment on low-power edge hardware. To address these gaps, this paper focuses on the challenge of achieving fast, accurate, and resource-efficient segmentation tailored to complex Indian road scenes. We propose IndiSegNet, a lightweight architecture designed explicitly for this setting. The model introduces two novel components—Multi-Scale Contextual Features (MSCF) for capturing irregular object scales and Encoded Features Refining (EFR) for enhancing thin-structure and boundary detail, resulting in a more stable representation for unstructured environments. IndiSegNet achieves 67.2% mIoU on IDD, 78.9% on Cityscapes, and 74.6% on CamVid, while sustaining 112 FPS on Jetson Nano, outperforming standard baselines by 12%–18% IoU on safety-critical classes such as pedestrians, riders, and vehicles. Real-world evaluation across urban, monsoonal, rural, and mountainous regions shows less than 2.5% variance in mIoU with consistent inference speeds above 108 FPS. These results demonstrate that IndiSegNet offers a practical and hardware-efficient solution for high-speed autonomous navigation in the challenging traffic conditions of developing regions.</p
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