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Exploring the impact of different definitions of level 1 and level 2 sensor‐detected hypoglycaemia upon frequency of hypoglycaemia and time below range: The Hypo‐ METRICS study
No full textContinuous glucose monitoring (CGM) systems are now standard of care for people with insulin-treated diabetes, with time below range (TBR) and frequency of sensor-detected hypoglycaemia (SDH) accepted metrics quantifying hypoglycaemic exposure and risk, in research outcomes and for clinical purposes.1 Whilst much interest is focused on TBR as a cumulative summary of hypoglycaemia exposure, recent work has highlighted the impact of the frequency of hypoglycaemic episodes, with up to 65% being asymptomatic whilst many symptomatic ones are not associated with a low sensor value.</p
Adjudications and deliberate self-harm in prisons during COVID-19: A three-year longitudinal analysis of the Offender Personality Disorder Pathway in England and Wales
No full textBackgroundThe effects of pandemic-related restrictions on people in prisons who tend to have multiple complex health needs are not well understood.AimsWe aimed to measure changes in adjudications and self-harm among people in prisons before and during the pandemic.MethodWe examined effects of time and demographic characteristics on odds and counts of adjudications and self-harm over a three-year period, starting one year before the COVID-19 pandemic, in 861 individuals from 21 Offender Personality Disorder Pathway prison sites.ResultsThe odds of adjudicating were lower in people of older age (odds ratio 0.98 (95% CI: 0.96–0.99)), and during COVID-19 year one (odds ratio 0.37 (95% CI: 0.23–0.60)) and year two (odds ratio 0.40 (95% CI: 0.25–0.65)) compared to pre-COVID-19. Being of White ethnicity was associated with increased odds (odds ratio 4.42 (95% CI: 2.06–9.47)) and being older was associated with reduced odds (odds ratio 0.97 (95% CI: 0.95–0.99)) of self-harm. The odds of self-harm were significantly reduced during COVID-19 year two (odds ratio 0.45 (95% CI: 0.26–0.78)), but not during COVID-19 year one (odds ratio 0.68 (95% CI: 0.40–1.14)), compared with the 12 months before COVID-19.ConclusionsAlthough adjudications and self-harm were generally lower during the pandemic, younger people showed increased odds of adjudications and self-harm compared with older people, while White people showed increased odds of self-harm compared with people of the global majority. Our findings highlight the importance of considering potential health inequities and environmental effects of lockdowns for people in prisons.</p
From the few to the many: scaling up sustainability-oriented supplier development projects
No full textPurpose
To understand how sustainability-oriented supplier development (SSD) can be translated from a small-scale pilot project into a large-scale implementation across the supply base.
Design/methodology/approach
The research studies an exploratory single case of a social SSD project on occupational health and safety management. The pilot involved 4 suppliers, expanding to 100 suppliers (and up to 400 factories) in the scale-up phase. The research applies actor-network theory (ANT), focusing on translation (problematisation, interessement and enrolment), and integrates three medical science scale-up frameworks: the mechanistic, complexity-informed and social science-driven approaches.
Findings
Scaling up SSD project implementation requires a process view and a systemic approach that integrates elements of all three scale-up frameworks. Meanwhile, both the pilot and scale-up stages go through a translation process of (re-)problematisation, (re-)interessement and (re-)enrolment, whereby roles, responsibilities, and implementation actions are refined. A strong and sufficient interessement strategy is essential for aligning and engaging key actors throughout the project. To ensure long-term commitment and sustainability, inscription and irreversibility mechanisms must also be established.
Research limitations/implications
The research furthers our understanding of how sustainability practices can be cascaded to the supply base. By investigating a two-stage SSD project, the research substantiates the translation process that is central to ANT, demonstrating how it can recursively occur across stages. Meanwhile, the research highlights the need for a comprehensive approach that integrates both direct and indirect SSD practices.
Practical implications
Focal firms in supply chains should follow a processual and systemic approach to cascading sustainability practices while carefully selecting the most appropriate intermediary partner for delivering an SSD initiative. Moreover, a tailored strategy for engaging workers at different organisational levels of factories is needed.
Originality/value
The research contributes to the ANT literature by providing empirical evidence on how different groups of actors interact with and collectively affect project implementation. Moreover, the research sheds new light on the scale-up process for SSD projects that seek to engage with and impact the entire supply base, introducing scale-up frameworks that support a more process-oriented and systemic approach.</p
BioSocial Walking: Digital and Embodied Methods for Understanding Migrant Belonging
No full textWalking in urban environments can foster a sense of belonging; for migrants, everyday urban walks can trigger emotional attachments, linking memories of their places of origin to new cities. Despite increasing recognition of the importance of mobility and its effect in migration studies, less scholarly attention remains on how belonging and urban walking are registered physiologically or how embodied and emotional responses shape experiences of migrant belonging in practice. This paper addresses this gap by integrating biosocial and digital approaches to explore the embodied dimensions of migrant urbanism in the context of settlement. Using biosensing wristbands, a smartphone qualitative data application, and walking interviews, we examine how migrant’s experiences of urban walking in Leicester (UK) and Stockholm (Sweden). Our analysis demonstrates how the meaning and significance of walking vary across different urban contexts, shaped by the socio-spatial conditions migrants encounter. It also highlights how walking cultivates spatial confidence over time, though experiences remain mediated by embodied difference, shaped through gender, migratory status, and urban inequality. By bringing together physiological, qualitative, and spatial perspectives within a biosocial approach, this paper extends existing debates on migrant belonging and the embodied dimensions of urban life.</p
Aldehyde Hydrosilylation with Ethylzinc Complexes of Bulky β-Thioketiminate Ligands
No full textThe synthesis of a novel β-thioketiminate ligand, H-SacNacAr* (3), featuring a bulky 2,6-bis(benzhydryl)-4-methylphenyl substituent, and its zinc ethyl complex [(SacNacAr*)ZnEt] (4), is reported. Complex 4 catalyzes the hydrosilylation of benzaldehyde with PhSiH3, showing enhanced activity relative to the less bulky analogue [(SacNacDipp)ZnEt] 2, particularly upon addition of MeOH as an activator. Under these conditions, 4 exhibits high selectivity toward dialkoxysilane product (B), over monoalkoxysilane (A) or trialkoxysilane (C) products. Density functional theory calculations support a mechanism involving precatalyst activation by MeOH to form a zinc alkoxide intermediate, followed by σ-bond metathesis with PhSiH3 affording a catalytically active zinc hydride complex. The results highlight the role of ligand sterics and alcohol activators in tuning catalytic activity and offer insights into the design of new zinc-based hydrosilylation catalysts.</p
The effect of SARS-CoV-2 and influenza vaccination on endemic coronavirus-related mortality: A retrospective cohort study in Brazil
No full textEndemic coronaviruses (eCoVs) cause the common cold in humans, particularly affecting children, the elderly, and individuals with comorbidities, who are prone to infection-related hospitalization. While vaccination remains the most effective preventative strategy against infections, vaccines against eCoVs are not available. This study investigates the association between SARS-CoV-2 and influenza vaccination and reduced eCoV-related mortality risk. Data from Brazil’s nationwide hospital database included patients PCR-positive for one of four eCoV strains, with known admission and clinical endpoint dates, and either vaccinated against SARS-CoV-2 and/or influenza or unvaccinated. Cox regression assessed the vaccines’ effectiveness in reducing 90-day in-hospital all-cause mortality. Of 4,283,391 registered cases, 2,636 were eCoV infections. Influenza vaccination, primarily inactivated formulations, was associated with a 39% lower mortality hazard. Conversely, SARS-CoV-2 vaccination showed no significant mortality reduction. This disparity may stem from SARS-CoV-2 vaccines targeting the spike protein, which differs markedly from eCoV spike proteins, limiting cross-protection. In contrast, inactivated influenza vaccines may reduce eCoV mortality through trained innate immunity and cross-reactive cellular responses, offering broader protective effects against these viruses.</p
Time below range alone is insufficient to identify severe hypoglycaemia risk in type 1 diabetes—the critical role of hypoglycaemia awareness: results from the SFDT1 study
No full textAims/hypothesis: Severe hypoglycaemia events (SHE) remain frequent in people with type 1 diabetes despite advanced diabetes technologies. We examined whether time below range (TBR) 3.9 mmol/l (70 mg/dl; TBR70) or 3.0 mmol/l (54 mg/dl; TBR54) is associated with future SHE risk and whether impaired awareness of hypoglycaemia (IAH) modifies this relationship. Methods: We analysed data from participants in the Study of the French-speaking Society of Type 1 Diabetes (SFDT1) who used continuous glucose monitoring. IAH was assessed using the Gold Score (≤2, no IAH; 3, undetermined; ≥4, IAH). SHE frequency was self-reported 12 months after inclusion. We analysed associations between TBR and SHE using logistic regression models adjusted for age, sex, social vulnerability and insulin treatment, including TBR–IAH interactions. We performed spline analyses to explore non-linear patterns. Results: One-year incidence of SHE was 11.7% among 848 participants (mean ± SD age 41.6 ± 13.3 years; 53.8% female sex, HbA1c 57.2 ± 10.9 mmol/mol [7.4 ± 1.0%]). Incidence by TBR70 was 12.1% for ≤1%, 10.2% for 1.1–3.9%, 10.6% for 4–6%, and 14.6% for >6%. Only those with TBR70 >6% and IAH had a significantly higher SHE risk (OR 3.32 [95% CI 1.40, 7.82]) compared with TBR70 ≤1% and no IAH. For TBR54, SHE incidence was 11.0% and 13.3% for categories </p
Strong ENSO Forcing of Wet Season Rainfall Extremes in the Eastern Amazon
No full textRecent years have seen strong droughts and floods in the Amazon basin, the largest center of atmospheric convection on land. To assess to what degree these events are extreme in a historical perspective requires accurate and long-term climate data, which are generally lacking for this part of the world. Here, we developed a 131-year oxygen isotope chronology from exactly dated tree rings of Cedrela odorata from the eastern Amazon Basin. The chronology (1885–2016) correlates strongly with observed wet-season rainfall totals (r = −0.71, 1951–2016) and stream discharge over the eastern equatorial Amazon. In contrast to oxygen isotope chronologies further inland that record basin-wide rainfall, our new record provides a good rainfall proxy for the eastern Amazon basin alone and shows that extreme precipitation events are also driven by ENSO.</p
Addressing methodological challenges in multiple long-term conditions research: A stakeholder workshop using a nominal group technique method
No full textBackground
Multiple long-term conditions (MLTC) - which refer to the coexistence in an individual of two or more long-term conditions - are a growing global concern, causing significant strain on healthcare systems and increasing care costs. Research into MLTC is a strategic priority for healthcare services, policymakers and research funders.
Methods
To address these complexities, the UK’s National Institute for Health and Care Research (NIHR) established the MLTC Cross-NIHR Collaboration (MLTC CNC) programme, to foster interdisciplinary collaboration and address key gaps in MLTC research. As part of this initiative, the Methodologies Workstream organised a two-day stakeholder workshop in March 2024 aimed at identifying current methodological challenges in MLTC research, prioritising key areas for improvement, and developing strategies to enhance research methodologies. The workshop employed a participatory and iterative approach, using structured presentations, facilitated group work, and the Nominal Group Technique (NGT) to promote cross-disciplinary collaboration and achieve consensus on key research priorities for MLTC.
Results
Twenty-three delegates attended the workshop from a range of institutions and sectors, including representatives from data science, epidemiology, clinical trials, quality improvement, social sciences, healthcare management, clinical practice, industry, patient advocacy groups, policymakers, patients, carers, and public representatives. The workshop identified critical knowledge gaps in MLTC research methodologies, including challenges with disease classification, data integration, analytical approaches, and the inclusion of diverse population subgroups.
Conclusion
By addressing these methodological gaps and fostering collaboration across disciplines, the MLTC research community can generate more rigorous, inclusive, and impactful evidence, ultimately improving healthcare delivery and patient outcomes.</p