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Prediabetes remission and cardiovascular morbidity and mortality:post-hoc analyses from the Diabetes Prevention Program Outcome study and the DaQing Diabetes Prevention Outcome study
Get PDFBACKGROUND: Prediabetes is associated with increased risk of cardiovascular disease and heart failure. Multicomponent lifestyle interventions, including diet and physical activity targeting weight loss are recommended for prediabetes management, although their long-term impact on cardiovascular outcomes remains unclear. Reaching prediabetes remission by restoring normal glucose regulation has been shown to profoundly reduce future type 2 diabetes risk outlasting the time of lifestyle intervention. We aimed to investigate whether prediabetes remission is associated with a lower incidence of cardiovascular death or hospitalisation for heart failure compared with non-remission, with a long-term legacy effect.METHODS: Post-hoc analyses were performed from two landmark diabetes prevention trials, the US Diabetes Prevention Program Outcomes Study (DPPOS) and the Chinese DaQing Diabetes Prevention Outcomes Study (DaQingDPOS). Remission was assessed using the American Diabetes Association criteria after 1 year (DPPOS) or 6 years (DaQingDPOS) of intervention. The primary endpoint was cardiovascular death or hospitalisation for heart failure over 20 and 30 years, respectively. In DPPOS, inverse probability of treatment weighting adjusted for baseline differences. A unifying meta-analysis was calculated across both data sets for the primary endpoint and all-cause mortality.FINDINGS: For DPPOS, follow-up time is reported from the start of the original Diabetes Prevention Program trial, July 31, 1996, to the end of DPPOS phase 3, Feb 23, 2020. In total, 2402 participants were included in DPPOS and 540 in DaQingDPOS. In DPPOS, 275 (11·5%) of 2402 participants reached remission after 1 year of intervention compared with 2127 (88·5%) of 2402 not reaching remission. In DPPOS, after a median follow-up of 20 years, the event rate for cardiovascular death or hospitalisation of heart failure was 1·74 (95% CI 0·87-3·48) per 1000 person-years in participants who reached remission versus 4·17 (95% CI 3·55-4·89) in those without remission (p=0·013) with a fully adjusted hazard ratio of 0·41 (95% CI 0·20-0·84; p=0·014). Results remained robust after adjustment, were confirmed in DaQingDPOS (primary endpoint: HR 0·49 [95% CI 0·28-0·84]; p=0·010), and were supported by a pooled meta-analysis. Results were stable when analysing the composite endpoint in those reaching remission at least once during follow-up, with a HR of 0·43 (0·29-0·63; p<0·0001).INTERPRETATION: Reaching prediatbetes remission is linked to a decades-long benefit, halving the risk of cardiovascular death or hospitalisation for heart failure in diverse populations. Targeting remission might represent a new approach to cardiovascular prevention.FUNDING: German Center for Diabetes Research via the German Federal Ministry of Research, Technology and Space; Ministry of Science, Research, and the Arts Baden-Württemberg; Helmholtz Munich; the Helmholtz Young Investigators Groups funding programme; the Cluster of Excellence EXC-2124; and the German Research Foundation (DFG). For DaQIng: Centers for Disease Control and Prevention, WHO, the China-Japan Friendship Hospital, and Da Qing First Hospital and Fuwai Hospital, Chinese Academy of Medical Sciences. For DPPOS: National Institute of Diabetes and Digestive and Kidney Diseases.TRANSLATIONS: For the German and Chinese translation of the abstract see Supplementary Materials section.</p
Prescribing of high-cost targeted therapies in England is diverging by region
No full textObjectives To examine regional variation in the prescribing of targeted therapies for chronic inflammatory disorders in England between 2019 and 2025. Study design Retrospective observational study. Methods This study analysed Secondary Care Medicines Data from all NHS hospitals in England to evaluate time-trends in prescribing rates of targeted therapies by Integrated Care Board (ICB). Results Substantial and increasing regional variation in prescribing rates for targeted therapies was observed between 2019 and 2025. The disparity between the highest and lowest prescribing ICBs increased over time, with rates ranging from 2.0 to 6.5 per 1000 people in 2019 and 3.4 to 14.2 per 1000 people in 2025. Conclusions There is marked and growing regional variation in the prescribing of targeted therapies across England. Further research should explore the reasons for this divergence to ensure equitable access to these highly effective treatments for patients with chronic inflammatory disorders, irrespective of geography.</p
Stretchable wideband dipole antenna using machine learning assisted optimization for soft electronics
No full textIn this paper, we present a machine learning-assisted optimization approach, combining artificial neural networks (ANN) with particle swarm optimization (PSO), for the design of a stretchable wideband dipole antenna tailored for soft electronics. The stretchable antenna is critical for next-generation wearable and flexible devices, where maintaining stable electromagnetic (EM) performance during deformation is challenging. To address the complex nonlinear coupling between EM performance and mechanical behavior, we propose a tri-branch ANN as a surrogate model to decouple the interdependencies between EM and mechanical properties, thereby improving prediction accuracy and reliability. Furthermore, the PSO algorithm is integrated to optimize the geometric parameters of the antenna, ensuring robust mechanical performance and stable EM characteristics. This optimization is achieved through an integrated co-simulation using an EM simulator, a mechanical simulator, and Python. The proposed method not only demonstrates significant improvements in efficiency, automation, and time savings over traditional design techniques but also offers a scalable solution for developing high-performance stretchable electronics.</p
Differential Motor Signatures in Isolated and Narcolepsy-related REM Sleep Behavior Disorder: A Preliminary Study
No full text3D Whole-Heart Joint T<sub>1</sub>/T<sub>1ρ</sub> Mapping and Water-Fat Imaging on a Clinical 0.55-T Low-Field Scanner
Get PDFMyocardial maps are conventionally acquired in 2D breath-hold single-parameter scans that are slow and have limited heart coverage. To overcome limitations associated with 2D breath-hold mapping sequences, we develop a novel free-breathing 3D joint (Formula presented.) / (Formula presented.) mapping sequence with Dixon encoding to provide co-registered 3D (Formula presented.) and (Formula presented.) maps and water-fat volumes with isotropic spatial resolution in a single scan for comprehensive contrast-agent free myocardial tissue characterization and visualisation of the whole-heart anatomy on a clinical 0.55-T MR scanner. The proposed sequence acquires four interleaved 3D volumes with preparation modules to provide (Formula presented.) and (Formula presented.) encoding, with data acquired with a two-echo Dixon readout and 2D image navigators to enable (Formula presented.) respiratory scan efficiency. Images were reconstructed with nonrigid respiratory motion-corrected iterative SENSE with multi-dimensional low-rank patch-based denoising, and maps generated by matching with simulated dictionaries. The proposed sequence was tested in phantoms, 11 healthy subjects and 1 patient, and compared with conventional techniques. For phantoms, the proposed 3D (Formula presented.) and (Formula presented.) measurements showed good correlation with 2D spin-echo reference measurements. For healthy subjects, septal myocardial tissue mapping values were (Formula presented.) and (Formula presented.) for the proposed sequence, against (Formula presented.) and (Formula presented.) for 2D modified Look-Locker inversion recovery and 2D (Formula presented.) respectively. Promising results were obtained when the proposed mapping was compared to 2D late-gadolinium enhancement imaging in a patient. The proposed approach enables simultaneous 3D whole-heart joint (Formula presented.) / (Formula presented.) mapping and water-fat imaging at 0.55 T in a single scan of (Formula presented.) min, demonstrating good agreement with conventional techniques in phantoms and healthy subjects, and promising results in a patient.</p
Acceptability, Feasibility, and Perceived Effectiveness of Video-Based Patient Records for Supporting Care Delivery to Older Adults With Frailty:Nonrandomized Mixed Methods Pilot Study
Get PDFBackground:Frailty constitutes a growing challenge for health and social care systems around the world. In England, 35% of adults aged 65 years and older live with frailty, with international estimates indicating that almost half of all hospital inpatients within the same age group are frail. This population often experiences multimorbidity and frequent care transitions. Written documentation and verbal handovers may lack the precision and nuance required to understand an older adult’s presentation and support needs. Video recordings of individual patients, capturing aspects of their functional abilities and condition, may help to enhance multidisciplinary team communication and care continuity, yet little is known about their use in the care of older inpatients with frailty.Objective:We aimed to evaluate the acceptability, feasibility of implementation, and perceived effectiveness of video-based patient records (the Isla Health Digital Pathway Platform) for supporting the assessment and care of older inpatients with frailty within the acute hospital setting.Methods:A nonrandomized mixed methods pilot study was conducted within 3 acute medicine wards for older adults. The video-based patient records intervention, permitting videos to be embedded securely within the electronic patient record, was implemented over a 3-month period alongside usual care. Patient enrollment and retention figures; qualitative interviews with patients, carers, and clinical staff; and video capture and view metrics were used to address the study objectives. The Theoretical Framework of Acceptability of Healthcare Interventions was applied to the framework analysis of interview data, capturing concepts such as intervention ethicality, burden, and coherence. Patient and public involvement and engagement informed each research stage.Results:Twenty-nine patients were enrolled (56.9%); 1 patient withdrew before receiving the intervention. Modal reasons given by patients for nonparticipation included not wanting to take part in research (n=8) or feeling too unwell (n=2). Staff identified multiple opportunities for capturing patient videos, including documentation of mobility assessments or seizures. The intervention was considered acceptable on the grounds that safeguards were always in place, including secure data storage and upholding of patient dignity. Implementation barriers and facilitators were identified; factors such as difficulties in capturing videos within busy ward environments and scheduling issues were voiced by participants. Video view metrics and data from interviews collectively suggested low rates of engagement with videos by clinical staff once captured. Potential intervention impacts included perceived enhancements to clinical assessment and person-centered care.Conclusions:Our findings suggest that the intervention is largely acceptable to patients, carers, and clinical staff. Conclusions as to intervention feasibility were mixed, with limited engagement with videos suggesting further work is required to promote sufficient uptake among staff. Finally, this research presents promising patient, carer, and clinical opinion as to the potential effectiveness of video-based patient records for improving aspects of patient care
The Adult Social Care Outcomes Toolkit Easy Read for Older People (ASCOT-ER OP):An exploratory factor analysis and Rasch validation study
Get PDFPurposeASCOT easy read for older people (ASCOT-ER OP) is an adaptation of the Adult Social Care Outcomes Toolkit (ASCOT-SCT4) that was co-produced with older adults and their families to improve accessibility and feasibility of completion. This study aimed to examine the structural validity of ASCOT-ER OP using exploratory factor analysis (EFA) and Rasch analysis.MethodsData were collected by British Red Cross (BRC) as part of short-term support for adults living at home, post-crisis or hospital discharge (‘Support at Home’). ASCOT-ER OP was collected at initial assessment (baseline) and at the end of support (follow-up), typically no longer than 12 weeks later. Only follow-up data were analysed in this study. EFA was conducted to assess structural validity against the single factor structure of ASCOT-SCT4. Overall fit to the Rasch model was examined alongside assessment of unidimensionality, local independence, item fit, response threshold ordering and differential item functioning (DIF) by age group (18-64 and 65+ years).ResultsASCOT-ER OP had a single factor structure in EFA. There was good fit to the Rasch model without significant breach of assumptions. Item fit was satisfactory. There was no evidence of disordered thresholds, but suboptimal distinguishability between response categories at some thresholds. These aligned to instances of <10 ratings per category and/or were consistent with the properties of the ASCOT-SCT4. There was evidence of DIF by age group for two items: Personal Safety and Home comfort and cleanliness.ConclusionsEFA and Rasch support the structural validity of ASCOT-ER OP as a unidimensional measure
More Than Bargaining Chips:How Jabhat Al-Nusra and Islamic State Kidnapped and Used Hostages in Lebanon
Get PDFThis paper presents an empirical examination of the Arsal hostage crisis in Lebanon, when Jabhat Al-Nusra and Islamic State kidnapped over 35 soldiers and police officers in 2014. Following interviews with 30 hostages’ families and analysis of the jihadists’ propaganda, three themes emerge. First, the hostage-taking had intrinsic emotional value for the jihadists and was not only a means to secure extrinsic concessions. Second, the crisis was often shaped by local, micro-level factors that guided how and when violence was used against hostages. Third, the jihadists coerced the captives’ families, leveraging them against the Lebanese State and local communities