19683 research outputs found
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Efficacy of Nurse‐Led Digitalized Diabetes Management Program for Community‐Dwelling Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta‐Analysis
No full textPurpose: Despite evidence supporting nurse-led digitalized diabetes interventions, gaps persist in understanding their specific impact on community-dwelling patients with type 2 diabetes mellitus (T2DM). Prior reviews lacked a quantitative synthesis of these interventions' effects on outcomes like self-care, HbA1c, and quality of life (QoL), limiting their applicability to clinical practice. This study aimed to systematically evaluate and quantify the effectiveness of nurse-led digitalized diabetes management programmes for community-dwelling adults with T2DM. Methods: We searched six databases to identify relevant articles from their inception to June 2024. Randomized controlled trials that evaluate the effects of nurse-led digitalized diabetes management programs for community-dwelling patients with T2DM were included. The Cochrane Risk of Bias tool version 2.0 was used to appraise the included studies. The pairwise meta-analysis was performed through the software Comprehensive Meta-Analysis Version 3.0. Results: Eleven RCTs were included, encompassing 2943 participants from various regions. Nurse-led digitalized programs significantly improved self-care behaviors (SMD = 1.15; 95% CI: 0.49 to 1.81), and QoL (SMD = 0.65; 95% CI: 0.37 to 0.94). The interventions also demonstrated a clinically meaningful reduction in HbA1c levels (MD = -0.25%; 95% CI: −0.43 to −0.06), highlighting their potential in improving glycaemic control. Heterogeneity across studies was substantial for self-care but moderate for HbA1c and QoL. Conclusions: Nurse-led digitalised diabetes management programmes effectively enhance self-care behavior, reduce HbA1c levels, and improve QoL among community-dwelling patients with T2DM. These findings underscore the potential of digitalised interventions as scalable and accessible alternatives to traditional diabetes management, particularly in non-institutionalized settings. Clinical Relevance: Nurse-led digitalised diabetes management programmes can empower community-dwelling patients with T2DM to achieve better health outcomes by enhancing self-care and glycaemic control while improving QoL. Their integration into routine clinical practice could address barriers to care, optimize diabetes management, and reduce the long-term burden of the disease. Review Registration: The International Prospective Register of Systematic Reviews (PROSPERO) identifier: CRD42024594874.</p
Perceived Stress Precedes Declines in Well-being: A Prospective Study of Stress, Well-being, Hair Cortisol, and Low-Grade Inflammation in Hospital Employees
No full textObjective: Chronic low-grade inflammation may help explain the relationship between stress, well-being, and disease, but the pathway and temporal order have not yet been tested prospectively. To understand the pathways between perceived stress, well-being, C-reactive protein, and hair cortisol, we investigated the temporal ordering of these variables in a sample of hospital employees.Methods: Random-intercepts cross-lagged panel models were conducted using three 6-monthly waves of data collected from new employees at a German hospital (N = 296, 77.7 % female, M age = 28.59) in a prospective cohort study. Self-reported data on perceived stress and well-being, hair strands for hair cortisol concentration, and capillary blood samples for C-reactive protein were collected for analysis.Results: While our study did not support a causal relationship between changes in stress levels and later changes in either hair cortisol or low-grade inflammation, we provide evidence to suggest that increases in perceived stress led to later decreases in well-being. In contrast, changes in well-being did not predict changes in perceived stress levels.Conclusion: This is the first prospective repeated-measure study to examine the temporal associations between stress, well-being, hair cortisol concentrations, and chronic low-grade inflammation. Our analyses suggest that perceived stress in this sample precedes changes in well-being, highlighting the importance of prevention and early intervention.</p
Strategic battery procurement in new energy vehicle supply chains
No full textWhile New Energy Vehicles (NEVs) cause minimal environmental impact during operation, their battery manufacturing process carries a significant carbon footprint. This environmental impact compels NEV manufacturers to evaluate trade-offs between in-house battery production and outsourcing, balancing R&D investments with fiscal constraints under carbon policy frameworks. Meanwhile, the emergence of Automotive Financial Services (AFS) has fundamentally reshaped market strategies by enabling direct customer access and enhancing product value propositions. This study develops a Stackelberg game-theoretic model to analyze optimal NEV supply chain configurations under varying carbon taxation regimes. Our findings reveal non-monotonic relationships between consumer perception of AFS and key market outcomes. Market demand and wholesale prices initially decline as consumer AFS acceptance increases, then recover and grow substantially beyond a critical threshold. Battery supplier profits exhibit similar non-monotonic patterns, declining through market penetration investments before recovering, while automobile manufacturer profits demonstrate consistent monotonic growth as consumer perception of AFS strengthens. We identify four distinct demand paradigms characterising consumer choice between traditional bank loans and AFS. AFS adoption effectively moderates carbon tax burdens, creating sustainable competitive advantages. This study advances theoretical understanding of AFS integration within NEV supply chains while providing actionable insights for navigating economic-environmental trade-offs and optimising strategic decision-making in sustainable battery procurement.</p
Report on Compulsory Licensing Provisions in the National Patent Legislation of 15 Middle-Income Countries: A Content Analysis and Recommendations
No full textThis study examines compulsory licensing laws in 15 middle-income countries often excluded from voluntary licenses & finds significant untapped policy space to advance access to affordable medicines. It highlights best practices & makes key recommendations to improve patent laws for the use of this important TRIPS flexibility.</p
THE FIRST JUVENILE AND ADDITIONAL ADULT PLEISTO-HOLOCENE HUMAN REMAINS FROM EQUUS CAVE, BUXTON NORLIM LIMEWORKS, NEAR TAUNG, SOUTH AFRICA
No full textAbstract:Equus Cave is a late Pleistocene and Holocene archaeological and fossil-bearing site at the Buxton-Norlim Limeworks, near Taung in South Africa. The Later Stone Age archaeology and fossil material found throughout the deposit suggest a complex use of Equus Cave over time. From the bottom of the Equus Cave sequence to the top, sedimentary units show a general decrease in faunal remains, coupled with an increase in stone tools. The late Pleistocene Units 1B-2B at the base of the sequence suggest carnivore denning activities were mostly responsible for the accumulation of fossil assemblages but with an identifiable human presence (Stammers et al. 2017). The uppermost Holocene-aged Unit 1A contains the densest archaeological assemblage, which suggests increased human activities at the site during this period. This paper describes two new previously undescribed modern human mandibles with teeth from the original 1979 and 80s excavations that add to the 14 dental specimens previously described. This new material consists of a partial adult mandible (EQ-H13) and a partial juvenile mandible (EQ-H14) and associated dentition representing the first deciduous remains described from the site. Unfortunately, there is no provenience information available for these remains. The lack of taphonomic damage on these human remains perhaps suggest affiliation with the Holocene 1A occupation, most likely associated with the Wilton complex of the LSA (Stammers et al. 2017) but an earlier late Pleistocene age cannot be ruled out. Morphological and odontometric comparisons have been made between these new individuals and modern San populations, as well as with broadly contemporaneous individuals from Die Kelders Cave and Diepkloof Rock Shelter.</p
Melting Opportunities: Managing climate change and conflict in the Himalaya
No full textThe Himalayan environment is sometimes compared to a “Third Pole”, but it is also a dazzling patchwork of linguistic and cultural diversity. The natural and human ecosystems of the Himalaya are equally vulnerable. The authors offer a number of considered policy recommendations that underline the importance of both global and non-governmental approaches to managing this fragile region.</p
Knowledge-rich curriculum: towards definitional clarity in the context of reform in Australia and England
No full textThis article examines the theoretical and empirical influences informing the term knowledge-rich curriculum, a concept increasingly central to education policy but often only loosely defined. Drawing on an analysis of the term in Australian and English education policy, the article argues that the concept has been most strongly influenced by two distinct fields: social realist curriculum inquiry and cognitive science. It considers both how these influences may be in tension with each other and the potential implications of this for policymakers and educators. Specifically, it argues that the take up of instructional practices only superficially informed by cognitive science can distort the disciplinary practices valued by social realists. The article emphasises the importance of empirically informed instructional design cohering with disciplinary practice. It further recommends that policymakers and educators emphasise in their curriculum making the types of knowledge their school communities value and embody, in addition to disciplinary knowledge.</p
The queer affective dimensions of gay dating platform-enabled victimisation in India
No full textThis paper discusses a range of affective responses of queer people after experiencing victimisation through gay dating platforms in India. In a queerphobic socio-legal backdrop that mediated these forms of victimisation, queer individuals’ feelings and responses in the aftermath can be studied through the lens of queer affect. Drawing from semi-structured interviews with people who experienced such victimisation, we highlight the spectrum of queer precarity in relation to the social sites and actors of the family, the neighbourhood, and the police, who played a key role in such incidents. In addition, we show how queer resilience emerges as a collective relational affect through aspects of story-sharing in the absence of institutional support. By focusing on the specific socio-cultural contexts undergirding the affective experiences of gay dating app users located in India, this paper offers empirical perspectives from the global South and contributes to a decolonisation of queer criminology and affect studies.</p
Differential effects of acute and chronic fluoxetine on c-Fos expression in specific subpopulations of midbrain dopaminergic neurons
No full textPrevious studies have suggested adaptive changes to dopaminergic activity in the brain may be involved in treatment effects of selective serotonin re-uptake inhibitor antidepressants. However, the relative importance of functionally and anatomically distinct dopaminergic cell subgroups in these effects remains unclear. We therefore used dual-label immunohistochemistry for c-Fos and tyrosine hydroxylase to study effects of acute or chronic administration of fluoxetine in midbrain and pontine dopaminergic cells. Specifically, three groups of female juvenile BALB/c mice (n = 12 each) received either 18 mg/kg/day of fluoxetine in their drinking water for twelve days followed by acute i.p. injection of saline vehicle (chronic group), or received acute i.p. administration of 18 mg/kg of fluoxetine (acute group) or saline (control group). All mice were then subjected to a three-chamber social approach paradigm which induces novelty stress. Immunohistochemistry analysis was conducted in 23 subregions of the ventral tegmental area (VTA), substantia nigra, periaqueductal gray, and dorsal raphe nucleus. The number of activated dopaminergic neurons significantly varied between dopaminergic subnuclei but was not different between the treatment groups in most of the regions. Notable exceptions were the VTA midrostrocaudal interfascicular nucleus, where the number of activated dopaminergic neurons was significantly greater in acute fluoxetine-treated mice compared to controls, and the VTA rostral linear nucleus where this number was reduced in chronic fluoxetine-treated mice. These findings show highly selective effects of fluoxetine on stress-induced cellular activation in a range of dopaminergic cell groups and may provide novel insight into the dopaminergic circuitry involved in its clinical treatment effects.</p