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Real-World Accuracy of Continuous Glucose Monitoring During Intensive Hematological Care: A Prospective Study
No full textBackground: Patients treated for a hematological malignancy are susceptible to hyperglycemia, which can negatively affect treatment outcomes. Therefore, close monitoring of glucose levels is crucial. Data demonstrated that capillary measurement methods underreport hyperglycemic episodes compared with continuous glucose monitoring (CGM). However, the accuracy of CGM during intensive hematological treatments, and the associated metabolic and hemostatic imbalances, is unknown, which we aim to investigate in the current study. Methods: For the analysis, data collected during a prospective study that compared CGM with capillary point-of-care (POC) glucose measurements in adult patients hospitalized for intensive hematological care with three different treatment modalities, namely chimeric antigen receptor T-cell therapy, allogeneic stem cell transplantation (allo-SCT), or autologous stem cell transplantation (auto-SCT), were used. POC and CGM measurements were performed concurrently. Accuracy was assessed using mean and median absolute relative difference (MARD), Diabetes Technology Society (DTS) Error Grid analysis as well as percentages of values within 15%/15, 20%/20, and 30%/30 mg/dL. Results: A total of 60 patients (28% female, median age 64 [58-68] years and 10% with a history of diabetes mellitus) were included, yielding 1999 matched measurement pairs. The overall mean ARD was 21.5%, whereby the lowest mean ARD was observed during allo-SCT (18.3%) and the highest mean ARD during auto-SCT (27.1%). The percentages of glucose values within 15%/15, 20%/20, and 30%/30 mg/dL agreements were 38.1%, 51.1%, and 75.1%. The DTS Error Grid analysis showed good clinical accuracy with 99.6% of pairs within zone A + B. Conclusions: Despite the relative high MARD, the use of CGM is unlikely to result in harmful insulin dosing errors and seems feasible to use during intensive hematological care.</p
Fast X-ray transient EP240315A from a Lyman-continuum-leaking galaxy at z ≈ 5
No full textThe nature of the minute-to-hour-long fast X-ray transients localized by telescopes such as Chandra, Swift and XMM-Newton remains mysterious, with numerous models suggested for the events. Here we report multi-wavelength observations of EP240315a, a 1,600-s-long transient detected by the Einstein Probe, showing it to have a redshift of z = 4.859. We measure a low column density of neutral hydrogen and directly detect leaking ionizing Lyman continuum. The observed properties are consistent with EP240315a being a long-duration gamma-ray burst, and these observations suggest a possible interpretation in which a substantial fraction of the X-ray-transient population are lower-luminosity examples of similar events. If correct, then sensitive narrow-field searches could be a powerful complementary probe to traditional wide-field transient detection in the identification of samples of gamma-ray-burst-like events into the epoch of reionization.</p
Race and Gender in a ‘Local’ Boxing and Exercise Gym in the East Midlands
No full textAmateur boxing gyms can serve as valuable assets to individuals and local communities. They often attract people from diverse backgrounds and provide social functions that extend beyond sport and leisure. This thesis is a sociological case study of an urban boxing gym in Leicester, United Kingdom. The aim of the thesis is to gain a deeper understanding of the social role(s) that this sporting space plays in the lives of its young working class, ethnic minority users. It utilises an ethnographic and interview-based approach to examine some of the social functions that this gym possesses. More specifically, it focusses on how the gym can impact both the racialised and gendered identities of young people. The data was collected using a combination of observations and semi-structured interviews with twenty-seven participants. The findings revealed that: (1) cultural resistance was being exercised in various forms. Gym members challenged colonial stereotypes and negative ideas of racialised masculinities and femininities. (2) The gym environment facilitated the creation of strong social networks among ethnic minorities, empowering users through mutual support, solidarity, and a collective advocacy. (3) Distinct forms of masculinity emerged, defined by a philosophy rooted in discipline, aggression, toughness, strength, and violence. These forms were further embodied and expressed through the development and display of strong, physically sculpted bodies. The thesis concludes that boxing gyms, as such, when understood as socially and politically significant entities, can be seen as a tool for positive identity formation, resistance, and change – especially when set against culturally oppressive and racist forces.</p
Genetics of Interstitial Lung Diseases: A State-of-the-Art Review
No full textAdvancements in genetics and genomics continue to further our understanding of their contributions to the development of interstitial lung diseases. This state-of-the-art clinical review synthesizes current knowledge of the contribution of genetics when evaluating patients suspected to have ILD. We consider highly penetrant Mendelian disorders as well as common variants conferring smaller risk that act in concert with other genetic and acquired risk factors. Additionally, gene-by-environment and pharmacogenomic interactions are discussed to highlight their impact on disease course. Lastly, the approach to genetic ILDs is reviewed from available testing to future directions.</p
Determining how phase variation contributes to host colonisation andextraintestinal spread of Campylobacter jejuni
No full textCampylobacter jejuni is the leading cause of human acute gastroenteritis worldwide. On commercial intensive and free-range chicken farms C. jejuni is endemic and transmitted primarily via the faecal-oral route between chickens. Colonisation typically occurs in the caeca, large intestine, and cloaca, but the bacterium can also translocate across the intestinal epithelium into deeper tissues including the liver and spleen. The mechanisms underlying this extraintestinal spread remain poorly understood. This thesis investigated the role of phase variation (PV) in chicken colonisation and dissemination of C. jejuni by performing genomic analyses on experimental data of two generalist and three chicken-specialist strains. Individual PV gene switching was investigated between inoculum and tissue-site isolates (caeca, ileum, liver, and spleen), and six-gene phasotype analyses were used to compare phasotype distributions across tissue sites. Bottleneck simulation models were also applied to diversity and divergence values to identify potential bottleneck events that had occurred during transmission and colonisation. Limited evidence of selective bottlenecks was available for certain PV loci including those associated with flagellar function in spleen and liver isolates. However, the findings of this work suggest that non-PV genes may play a critical role in tissue-specific colonisation and are likely important targets of selection within the chicken host. Improved understanding of C. jejuni and its contribution to within-(chicken)host colonisation and extraintestinal spread will provide valuable insights for development of strategies to limit human exposure through the food chain; ultimately reducing the economic burden of campylobacteriosis.</p
Every cloud has a silver lining: climate risk and stock price informativeness
No full textThis study investigates how climate risks, exemplified by extreme rainfall, influence stock price informativeness by catalysing firms' adaptive strategies and capital market responses. Using data from Chinese A-share listed companies between 2009 and 2019, we find that extreme rainfall significantly enhances stock price information efficiency, and this result remains robust after addressing a series of endogeneity concerns. This effect is attributable to both heightened information demand and enhanced information supply. Specifically, the increased information demand from institutional investors, particularly those with a short-term focus, combined with greater analyst coverage, strengthens corporate governance and improves information efficiency. Meanwhile, firms with greater exposure to extreme rainfall respond by adopting strategic adjustments, including increased transparency and more comprehensive climate risk disclosures. Further evidence suggests that favourable institutional environments enable credible disclosure, whereas elevated financial and operational risks strengthen firms' incentives to enhance transparency. Our study highlights that climate risks shape market information efficiency through firm adaptation and investor responses.</p
Correlating electronic properties of a nickel polymerisation catalyst with the branching density of a polyethylene
No full textThis work investigates how the electronic properties of a nickel ethylene polymerisation catalyst can be used to exert control on key polymerisation steps namely chain walking and chain propagation and in turn affect branching and polymer molecular weight. Specifically, a series of sterically enhanced 2-(imino)-4-R-pyridine–nickel complexes (R = OMe Ni1, Me Ni2, H Ni3, Br Ni4, CF 3 Ni5, NO 2 Ni6) that differ only in the electronic properties of the para-R substituent have been prepared and fully characterised. Under activation with EASC (ethyl aluminium sesquichloride), all nickel catalysts exhibited high activities for ethylene polymerisation and produced branched polyethylenes (BPE: branching density range: 61–99/1000 Cs) with a range of molecular weights (4.89–15.4 kg mol −1 ); the relative order of catalytic activity being: Ni5 (CF 3 ) > Ni4 (Br) > Ni1 (OMe) > Ni6 (NO 2 ) > Ni3 (H) > Ni2 (Me). Additionally, cyclovaltametry measurements performed on Ni1–Ni6 have been used to measure half-wave potentials (E 1/2 ) that can serve as a quantitative descriptor of the electronic effect. Moreover, good correlations exist between E 1/2 and i) the degree of branching and ii) the polymer molecular weight. Importantly, this study highlights the potential of E 1/2 as a predictive tool for rational design of catalysts to make tailored BPE's.</p
Reasonable Prophet: Moses in Eighteenth-Century Britain, 1700-c.1780
No full textMoses was an important and frequently discussed figure in the intellectual and civic discourse of eighteenth-century Britain. This thesis is the first scholarly study to identify the major engagements with Moses in the eighteenth century. Surveying the many mentions of Moses in the printed sermons, pamphlets and polemical theological tracts of the period, the project explores the significant role of Moses in British intellectual life, showing that he was regularly seen as both a revered symbol and a point of controversy. References to Moses were pervasive in civic literature: he was held up as a model for political leadership as well as being seen as a pillar of constitutional thought. He was also the subject of vigorous debate. Divines struggled with the figure of Moses as they grappled with the place of the Old Testament law within British Protestantism. This was mirrored by ongoing virulent debates about the authority of revealed religion, in which discussions over Moses’ role as a prophet and historian played a major part. He could be the subject of both subtle and irreverent attacks from deists and sceptics, while also being passionately and creatively defended by orthodox churchmen. As the century progressed, Moses’ traditional authority was increasingly challenged, with an overall decline of deference and more frequent criticisms of the traditional understanding of revelation. However, the thesis also shows that Moses was adapted for the eighteenth century to suit contemporary sensibilities and the evolving intellectual landscape, with writers such as William Warburton and John Fletcher of Madeley highlighted as key examples of this practice. The thesis therefore argues that there was much more continuity with the Hebraism and biblicism of the seventeenth century than is usually assumed, while also documenting the changing complexion of religious thought in the era of the Enlightenment.</p
REMOTE Study: Feasibility and Effectiveness of Telemedicine-based Echocardiography Mentoring in Intensive Care
No full textObjective: To evaluate the feasibility, effectiveness, and user experiences of real-time remote mentoring for echocardiography in intensive care settings using the Remote Education, Augmented Communication, Training and Supervision (REACTS) telemedicine platform. Design: Single center, mixed-methods feasibility study with convergent parallel design. Setting: Adult intensive care unit at Glenfield Hospital, University Hospitals of Leicester NHS Trust. Participants: Fifteen practitioners (12 novices, 3 accredited) participated between June 2020 and June 2021. Interventions: Implementation of the REACTS platform for remote echocardiography mentoring with the Philips Lumify handheld ultrasound device. Measurements and Main Results: Quantitative analysis demonstrated consistently high mean image quality scores (1.57-2.00/2.00) and mean report accuracy (1.86-2.00/2.00) across all echocardiographic views. All planned sessions were successfully completed with minimal connectivity interruptions. The teaching effectiveness evaluation consistently yielded high mean scores (5.87-6.00/6.00). Thematic analysis revealed four key themes: “accessibility of expertise,” “educational value,” “technical considerations,” and “implementation challenges.” Conclusions: Real-time remote mentoring for critical care echocardiography is technically feasible and educationally valuable in the intensive care setting. Although implementation challenges exist, particularly regarding technical infrastructure and scheduling, these appear surmountable with appropriate planning. Remote mentoring shows promise as a potential strategy to address current disparities in echocardiography training and supervision.</p
Co-design and development of a Personalised Exercise-based Rehabilitation and self-management programme FOR people with Multiple long-term conditions: The PERFORM intervention
No full textBackground
Exercise and self-management support may be clinically effective and cost-effective treatments for a range of individual long-term conditions (LTCs), as they activate multiple beneficial physiological and psychological mechanisms. We aimed to develop a complex intervention to deliver exercise and self-management support for people with multiple LTCs (MLTCs).
Methods
Following the Person Based Approach to intervention development, we conducted ten co-development workshops with people with MLTCs, family and friends; healthcare providers; service commissioners and policymakers. The workshops iteratively identified the unmet needs of people with MLTCs and informed a programme theory outlining theoretical mechanisms of change and intervention strategies to change the targeted behaviours. They also identified ideas for efficient delivery and service providers’ training needs. Mixed methods feedback from the Personalised Exercise-Rehabilitation FOR people with Multiple long-term conditions (PERFORM) feasibility study (reported elsewhere) informed intervention refinement.
Results
A diverse group of stakeholders (26 people with MLTCs/supporters, 13 service providers, 16 experts in chronic illness and 14 service commissioners) helped to develop the PERFORM intervention. This included 16 supervised exercise sessions and 16 ‘Health and Wellbeing’ self-management support sessions, delivered in hospital or community settings over eight weeks, plus check-in sessions at four and six months. The self-management sessions covered maintenance of exercise/physical activity, healthy eating and managing common symptoms (pain, fatigue, breathlessness, stress).
Conclusion
The PERFORM intervention is a comprehensive, evidence-informed, theoretically driven self-management and exercise-based rehabilitation intervention, co-developed with people with MLTCs, service providers and service commissioners. PERFORM is now ready for evaluation regarding clinical effectiveness and cost-effectiveness.</p