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Closing the Gap:Why Liver Health Must Be Central to the United Nations Political Declaration on Non-Communicable Diseases
No full textThe Journey to First-Line Nursing Management:A Qualitative Study in a Spanish University Hospital
Get PDFAim: To explore nurse managers' perceptions at first-line, middle and executive levels regarding their transition to first-line management in two divisions of a highly specialised university hospital in Spain. Design: A qualitative descriptive study. Method: A purposive sampling technique was employed to conduct four focus groups and two semi-structured interviews with 31 nurse managers across three hierarchical levels in two divisions of a highly specialised university hospital in Spain. Participants included two Chief Nursing Officers, four Nursing Directors and 25 first-line nurse managers. Data were analysed thematically.Results: Three themes emerged: ‘Bridging the Readiness Gap: Training, Role Clarity, and Institutional Alignment’, revealing the lack of structured transition plans, role ambiguity and gaps in managerial skills, such as human resources, financial management and leadership; ‘Fighting Loneliness: A Common Challenge in Care Management’, highlighting the isolation of first-linenurse managers due to the absence of structured mentorship and peer support; ‘Clinical Expertise as a Cornerstone: The Role of Prior Experience in Nurse Management’, examining how clinical expertise facilitates leadership transitions but also presents challenges, particularly for managers promoted within their teams, where authority negotiation and role redefinition become critical.Conclusions: Findings underscore the need for structured training and mentorship to address role ambiguity, enhance managerial competencies and support nurse managers' transitions through targeted education.Implications for Profession and Patient Care: Structured transition programmes focusing on role clarity, training and institutional alignment can ease transitions, boost leadership confidence and enhance peer collaboration. Providing mentoring and training tailored to first-line nurse managers can improve team dynamics, support professional integration and strengthen organisational cohesion. Impact: Tailored educational interventions are essential in supporting nurse managers' transitions. Structured mentorship and targeted training enhance leadership readiness, adaptability and institutional alignment, strengthening healthcare leadership, efficiency and patient care quality. Patient and Public Contribution: No patient or public contribution
Cart before the Horse? <i>BSH Hausgeräte v Electrolux</i> and Exclusive Jurisdiction over Patent Validity
Get PDFIn a much-anticipated judgment, the Grand Chamber of the CJEU in BSH Hausgeräte GmbH v Electrolux AP reshaped the landscape of cross-border patent litigation in the EU. The case concerned the interpretation of Article 24(4) of Regulation 1215/2012 (Brussels Ia), under which the courts of the European Member State of deposit or registration have exclusive jurisdiction “in proceedings concerned with the registration or validity of patents, trade marks, designs, or other similar rights required to be deposited or registered, irrespective of whether the issue is raised by way of an action or as a defence”. In its judgment, the Court of Justice clarified that a court seised of an infringement claim relating to a patent registered in a EU Member State does not lose jurisdiction merely because the defendant has challenged validity. It also confirmed that Article 24(4) does not apply to patents registered in third States, and – crucially – permitted courts to assess the validity of such patents inter partes. This note examines the practical implications of this landmark ruling, identifies unresolved questions, and criticises the inconsistency it introduced between patents registered inside and outside the EU
Effectiveness of Mobile Health-Delivered Cognitive Behavioural Therapy for Insomnia in Adults: A Systematic Review and Meta-Analysis of Randomised Controlled Trials
Get PDFAims: To determine the treatment effectiveness associated with mobile health-delivered cognitive behavioural therapy for insomnia (mCBT-I) interventions for adults with insomnia and to identify the potential characteristics associated with better treatment outcomes. Design: A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Methods: Seven English- and two Chinese-language databases were searched, without restrictions on publication dates, up to July 2024. Reference lists of relevant reviews and grey literature were included in the search. Randomised controlled trials evaluating mCBT-I in adults with insomnia and published in either English or Chinese were included in this meta-analysis. A random-effects model was used for data analysis, accompanied by additional subgroup analyses and meta-regression. Results: Sixteen studies involving 2146 participants were included in this meta-analysis. mCBT-I interventions were associated with significantly reduced insomnia symptoms and improved sleep quality at post intervention, at 1–3-month follow-up, and at 4–6-month follow-up. Interventions that included five components of CBT-I, were delivered for 6 weeks or longer, and were conducted in a group format were linked to better treatment outcomes; the differences in other subgroup categories were not statistically significant. Studies involving participants with comorbid conditions showed a greater effect in reducing insomnia symptoms than those without such participants. In addition, mCBT-I interventions delivered by healthcare professionals resulted in statistically larger effect sizes for improving sleep quality than self-help regimens. Conclusions: The systematic review and meta-analysis identified the effectiveness of mCBT-I in reducing insomnia symptoms and improving sleep quality and offered practical implications for the development of effective mCBT-I interventions in clinical practice. However, future robust studies are needed to explore the long-term effects of mCBT-I interventions. Patient or Public Contribution: No patient or public contribution. Trail Registration: PROSPERO CRD: 42023454647.</p
Acceptability of active and sham home-based transcranial direct current stimulation in major depression:mixed methods qualitative analysis in a randomised controlled trial
No full textPURPOSE: Transcranial direct current stimulation (tDCS) is a novel non-invasive brain stimulation therapy that is a potential treatment for major depressive disorder (MDD). Acceptability impacts patient preference, treatment adherence and outcomes, however, it has typically been assessed through measures of attrition, self-reported satisfaction levels, or adverse events. We sought to explore participant acceptability using structured questionnaires and individual interviews.METHODS: Acceptability was assessed in a fully remote, multisite, double-blind, placebo-controlled, randomized superiority trial of a 10-week course of home-based tDCS for MDD. Questionnaires were conducted at baseline and at the 10-week end of treatment. Participants were 174 adults (120 women) with MDD in a current depressive episode of at least moderate severity. Active or sham tDCS was self-administered over 10 weeks with remote supervision at regular intervals. A thematic analysis was conducted.RESULTS: Four themes were revealed: acceptability, ease of use, side effects, and trial participation. The themes indicated generally high acceptability of tDCS as a treatment of MDD in both the active and sham treatment groups. Some participants noted concerns about the technical functionality of the device and the impact of side effects.CONCLUSIONS: The first three themes are central to understanding participant perspectives of tDCS and its feasibility as a treatment option. In addition, the theme of trial participation highlights the value of participant support when introducing a new treatment, which may underscore treatment options in general. Furthermore, acceptability is a dynamic concept as participant views changed during treatment.TRIAL REGISTRATION: NCT05202119, registered on 9th January 2022.</p
Price optimization for round trip car sharing
No full textCar sharing, car clubs and short-term rentals could support the transition toward net zero but their success depends on them being financially sustainable for service providers and attractive to end users. Dynamic pricing could support this by incentivizing users while balancing supply and demand. We describe the usage of a round trip car sharing fleet by a continuous time Markov chain model, which reduces to a multi-server queuing model where hire duration is assumed independent of the hourly rental price. We present analytical and simulation optimization models that allow the development of dynamic pricing strategies for round trip car sharing systems; in particular identifying the optimal hourly rental price. The analytical tractability of the queuing model enables fast optimization to maximize expected hourly revenue for either a single fare system or a system where the fare depends on the number of cars on hire, while accounting for stochasticity in customer arrival times and durations of hire. Simulation optimization is used to optimize prices where the fare depends on the time of day or hire duration depends on price. We present optimal prices for a given customer population and show how the expected revenue and car availability depend on the customer arrival rate, willingness-to-pay distribution, dependence of the hire duration on price, and size of the customer population. The results provide optimal strategies for pricing of car sharing and inform strategic managerial decisions such as whether to use time- or state-dependent pricing and optimizing the fleet size.</p
Frequency-Domain-Based Function Generation Synthesis for Planar Multi-Loop Mechanisms
Get PDFThis article presents a novel frequency domain-based approach for function generation synthesis in planar multiloop mechanisms featuring two independent kinematic loops. To our knowledge, this is the first extension of frequency domain-based synthesis to planar multiloop mechanisms. Leveraging the orthogonality of trigonometric functions, the system of equations is derived using a frequency domain physical interpretation and reformulated into an optimization problem that balances constraint accuracy and numerical stability. This formulation enables the direct acquisition of multiple, defect-free solutions. Unlike time domain methods, the proposed approach greatly reduces circuit and branch defects without requiring complex singularity or defect analysis. In contrast to existing frequency domain methods limited to four-bar mechanisms with full-cycle crank inputs, it supports both revolute and prismatic joints and allows motion profiles such as trapezoidal and S-curve planning. The method also avoids explicit trajectory specification for each loop by treating the Fourier coefficients of the shared passive joint as unknowns, while using linear constraints and coefficient symmetry to reduce complexity. Its effectiveness is demonstrated through two novel multiloop finger mechanisms, the Watt II mechanism, and a comparison with a time domain method, highlighting its practicality and broad applicability.</p
Muscle sparing through differential nutritional control of three muscle growth mechanisms:how zebrafish larvae deal with starvation
Get PDFHow vertebrate skeletal muscle size is regulated and balanced with body size over the life-course is unclear, but is important for human health and quality of life. Muscle growth occurs by increase in myofibre number (hyperplasia) and enlargement of existing fibres (hypertrophy). Fibre enlargement reflects either hypernucleation, an increase in myofibre nuclei, and/or hyperoidy, an increase in nuclear domain size (NDS), the volume of myofibre per myonucleus. Quantitative time lapse imaging of muscle cellularity indicates that myotome growth in early larval zebrafish is dominated by hyperoidy, with lesser contribution by hypernucleation. Addition of small new myofibres makes a quantitatively even smaller contribution to growth. During neonatal mouse muscle growth a distinct balance of different growth mechanisms occurs, but yields quantitively similar hyperoidy. In zebrafish, the number of myofibres and myonuclei continue to increase in the absence of independent feeding, whereas NDS shrinks and whole body growth falters without adequate food intake from 5 days post-fertilisation, despite the continued availability of yolk. The persistent accrual of myonuclei while fibres undergo atrophy in response to starvation we term muscle sparing. Myofibre volume increases more than myofibril content during growth. During atrophy, in contrast, cytoplasmic puncta containing sarcolemmal markers become associated with autophagosomes, and lysosomes and myofibrils fill a larger fraction of the remaining sarcoplasm. These observations lead us to propose a ‘shopping bag’ hypothesis for myofibre hyperoidy and atrophy, whereby change in sarcolemmal area and myofibre volume (the ‘bag’) precede, and may be required for, changes in the myofibril content (the ‘shopping’). The distinct regulation of three muscle growth mechanisms in developing vertebrate models predict similar controls on human muscle growth which, given the importance of skeletal muscle for whole body metabolic health, are of potential relevance to the developmental origins of human health and disease
Longitudinal Testing of Exploratory Behaviour in Mice Reveals Stable Cognitive Traits Across the Adult Lifespan
Get PDFIn human populations, cognitive performance in early life has been identified as a strong predictor of future dementia risk. If cognitive ability were a stable trait across the adult lifespan of mice, then this species would provide an excellent framework for understanding the biology underlying this modifiable risk factor. To address this issue, longitudinal cognitive testing was performed in female C57BL/6J mice aged between 4 and 18 months of age. By tracking individuals, we were able to demonstrate that the cognitive performance of an animal in specific tasks at 4 months of age was a remarkably reliable indicator of performance at 18 months of age. Variability in the performance of individuals was not associated with differences in macroscopic brain structure, but single-cell recording from neurons of the prefrontal cortex did identify age-related changes in membrane excitability. Most importantly, this study demonstrated that strategies adopted early in life to explore a nine-arm radial maze were maintained across the adult lifespan and learning effects associated with repeated exposure to a test contribute to this stability. Overall, our results demonstrate that, like humans, cognitive ability in mice is a stable trait and the cognitive reserve necessary for healthy brain ageing is established early in life.</p