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Daily steps as a public health metric for physical activity monitoring and promotion
Get PDFThis review summarizes the evidence on the number and intensity of steps associated with health benefits. For older adults, 6000-8000 daily steps is associated with substantial cardiovascular disease (CVD) and mortality benefits and taking more than 8000 daily steps appears to be associated with additional benefit. For younger adults, taking 8000-10,000 daily steps is associated with substantial mortality benefit
Are animals – and persons – morally “replaceable”?
Get PDFThis article critically examines Peter Singer’s arguments for two conclusions: first, that non-self-conscious animals are “replaceable” in the sense that the killing of one can be morally offset by the creation of another; and, second, that persons are not replaceable in this sense. Much of the support that Singer provides for the second of these claims is found in his defense of “the debit view of preferences,” which he advanced in response to an earlier critic of his preference utilitarianism. The author argues that the debit view is untenable for several reasons. The author argues further that Singer’s appeal to Parfit’s Non-Identity Problem in support of the replaceability of non-self-conscious individuals is also mistaken. In spite of these problems, however, the author contends that there is a genuine insight in Singer’s “replaceability thesis,” and develops and defends different arguments for both the claim that some animals – and, indeed, some human beings – are replaceable and the claim that persons are not
Surgery versus conservative management for severe pectus excavatum (RESTORE): protocol for a multicentre, randomised, controlled superiority trial
Get PDFIntroduction: Severe pectus excavatum (PE) may impair cardiopulmonary and physical function. The effectiveness of surgical treatment to correct PE and restore physical function is widely debated due to a lack of high-quality comparative evidence. The RESTORE trial aims to determine the clinical and cost-effectiveness of corrective surgery for severe PE compared with conservative management for the first time in a randomised controlled trial (RCT). Methods and analysis: RESTORE is a pragmatic, multicentre, RCT with an embedded observational cohort. 200 participants aged ≥12 years with severe PE will be recruited at around 12 National Health Service cardiothoracic surgical centres in England. Participants will be randomised 1:1 to receive either surgery within 3 months of randomisation (intervention arm) or no surgery until after the primary outcome measurement at 1 year (comparator arm). The primary outcome is change in physical functioning from baseline to 1 year as measured by the Short Form Health Survey (SF-36v2) physical function score. The primary economic outcome is cost-effectiveness. The key secondary outcome is change in % predicted VO2peak at 1 year measured by cardiopulmonary exercise test (CPET). Outcomes will be assessed at 1 year post-randomisation in the comparator arm and 1 year post-surgery in the intervention arm. The primary analyses will be undertaken on an intention-to-treat population using a linear mixed-effects model, adjusted for stratification variables via a binary covariate. Other secondary outcomes will include change from baseline of cardiopulmonary function (CPET and spirometry), health-related quality of life using the EuroQol 5 Dimension 5 Level (EQ-5D-5L) and SF-36v2 questionnaires, Hospital Anxiety and Depression Scale and disease specific symptoms (Phoenix Comprehensive Assessment for Pectus Excavatum Symptoms and Pectus Excavatum Evaluation Questionnaire). Adverse events, complications from surgery and operative technical success (Haller and Compression Indices from preoperative and postoperative CT scans) will also be assessed. Health economic analysis will estimate the incremental cost per quality adjusted life year at 1 year. Ethics and dissemination: The trial was approved by East of Scotland Research and Ethics Service (24/ES/0034). Participants who are ≥16 years of age will be required to provide written informed consent. For participants <16 years of age who are not judged to be Gillick competent, written assent and written informed consent from a parent/guardian will be required. Results will be submitted for publication in peer-reviewed journals and shared with participants, clinicians and commissioners. Trial registration number: ISRCTN11359779
Navigating the Multiplexity of Africa’s Digital Partnerships amidst Global Rivalry
Get PDFDigital development has progressively become a public policy priority for many African governments and occupies an increasingly important place in the continent’s relations with its strategic partners. Despite challenging local contexts and constrained budgets, several African governments are maneuvering to achieve ambitious national priorities in relation to digital transformation. At the local level, private sector actors and national governments are adopting a range of techniques to engage and negotiate different digital collaborations in order to fulfill their objectives despite global geopolitical tensions in the digital sphere, especially between the US and China. As in several other parts of the world, digital rivalries or geopolitics are manifested in Africa by competing partners making rival offers to digitize African economies. Yet the landscape of Africa’s digital partners is marked by the absence of hegemony by a single or a small set of countries or actors. Instead, Africa’s digital partners include a large variety of actors, among which are large and small nations, international and regional organizations, private corporations, and non-state actors. By using multiplexity (instead of multipolarity) as a conceptual framework, this article aims to describe and analyze the dynamic ways in which African governments organize their digital partnerships in a context of global power rivalry and how, despite the persistence of various dependencies, the pluralization of choice allows for the exercise of agency
JADES and BlackTHUNDER: rest-frame Balmer-line absorption and the local environment in a Little Red Dot at z = 5
Get PDFWe present a ‘Little Red Dot’ (LRD) broad-line active galactic nucleus (AGN) at , observed with NIRSpec/MSA (micro-shutter assembly) and NIRSpec/IFU (integral-field unit) by the JADES (JWST Advanced Deep Extragalactic Survey) and BlackTHUNDER (Black holes in THe early Universe aNd their DensE surRoundings) surveys. Combining spatially resolved and high-resolution spectroscopy, we characterize its central engine, host, and environment. H has multiple components, including two broad Gaussians, yielding a black-hole mass , while [O iii]5007 gives a galaxy dynamical mass , suggesting an overmassive black hole relative to the host galaxy. The target is immersed in a 7-kpc wide pool of ionized gas and has three neighbours: a satellite galaxy, a possible satellite/gas cloud, and a tentatively detected spatially detached outflow. H shows strong, rest-frame absorption, deeper than the continuum, ruling out a stellar origin. The velocity and velocity dispersion are and . There is tentative evidence (2.6σ) of temporal variability in the equivalent width of the H absorber over two rest-frame months, suggesting a highly dynamic nucleus. Notably, while the H absorber is clearly visible and even dominant in the high-resolution G395H observations, it is not detected in the medium-resolution G395M data of the same epoch. This implies that the current incidence rate of absorbers in LRDs – and especially of rest-frame absorbers – may be severely underestimated, because most LRDs rely on lower resolution spectroscopy. The high incidence rate of rest-frame absorbers in LRDs may indicate a configuration that is either intrinsically stationary, such as a rotating disc, or that exhibits time-averaged stability, such as an oscillatory ‘breathing mode’ accretion with cyclic expansion and contraction of the gas around the supermassive black hole
Bridging Traditions: Reflection on Nearly Half a Century of JewishOrthodox Christian Dialogue in Cambridge
Get PDFExternal electron injection setup for the advanced wakefield experiment (AWAKE) run 2b
No full textAWAKE is a plasma wakefield acceleration R&D experiment at CERN, where wakefields are driven by relativistic and self-modulated proton bunches. The goal of AWAKE Run 2b is to demonstrate that a correctly placed plasma density step stabilises the wakefield amplitude (after saturation of self-modulation) at a higher value than without the step. This can be demonstrated by accelerating witness particles. It is therefore planned to externally side-inject 19MeV test electrons into the wakefields. In this manuscript, the injection setup for the AWAKE Run 2b experiments is summarised. Challenges on beam transport due to the Earth’s magnetic field upstream of the vapour source entrance are highlighted and uncertainties on the injection location are estimated. Additionally, a new plasma-light-based diagnostic to verify that electrons cross the plasma column is introduced
Development of a set of core outcome measures for ambulant children with cerebral palsy after lower limb orthopaedic surgery
Get PDFAim: To develop consensus on a core set of standardized outcome measures to be applied to each domain of the previously developed core outcome set for lower limb orthopaedic surgery for ambulant children with cerebral palsy (CP). Method: This work consisted of the following three steps: (1) a scoping review of the literature to identify previously used outcome measures to assess lower limb orthopaedic surgery of ambulant children with CP; (2) searching the COnsensus‐based Standards for the selection of health Measurement Instruments (COSMIN) and PubMed databases to assess the quality of the psychometric properties of outcome measures and feasibility criteria; and (3) a consensus meeting with seven healthcare professionals with expertise in CP research and in the assessment of outcome measure psychometric properties was held in September 2021. Consensus on the outcome measures core set was developed through presentation of the evidence and whole‐group discussions. Results: A combination of clinician‐driven and patient‐reported outcome measures was considered the most appropriate way to assess the outcome of orthopaedic surgical interventions. Agreement was reached on seven core outcome measures: three‐dimensional gait analysis, Edinburgh Visual Gait Scale, Gross Motor Function Measure, Gait Outcome Assessment List, Gillette Functional Assessment Questionnaire, Patient‐Reported Outcome Measure Instrument System (pain interference, and fatigue), and Cerebral Palsy Quality of Life for Children questionnaire. Interpretation: This study recommends a set of core outcome measures for use in research on lower limb orthopaedic surgery for ambulant children with CP. Consistent use of this core set would enhance validity and comparability of future research
Investigating the conditions in which women GPs thrive: a realist review protocol
Get PDFBackground Women now make up approximately half of the GP workforce. However, many are leaving the profession. This could be because they experience higher rates of burnout, stress and anxiety, suicide, and lower rates of career progression than men. They also take on a greater load of emotional labour compared with men. Retaining this staff group is one of five priorities for future policy and research.
Aim To synthesise the available evidence on how general practice workplaces can best support women GPs to thrive at work.
Design & setting We propose to undertake a realist review, which seeks to understand why an approach may work in specific contexts. This involves building an understanding of how contextual factors affect the activation of mechanisms (that is, changes in participant reasoning or behaviours) to produce their outcomes.
Method We will locate available evidence on the topic, and, using a realist logic of analysis, develop an understanding as to how, why, for whom, and in what contexts women GPs thrive at work. Evidence will include academic literature, policy documents, media items, and guidelines.
Results Findings will be co-disseminated with public and patient involvement (PPI) and stakeholder members to all key groups, including policymakers, employers, the public, and academic audiences, by a wide variety of means.
Conclusion This review is intended to improve understanding of how working environments affect women GPs. It is anticipated that findings will support the implementation of strategies to better support this group to thrive at work