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This study aims to identify critically important features of digital type two diabetes mellitus (T2DM) prevention interventions. A stakeholder mapping exercise was undertaken to identify key end-user and professional stakeholders, followed by a three-round Delphi procedure to generate and evaluate evidence statements related to the critical elements of digital T2DM prevention interventions in terms of product (intervention), price (funding models/financial cost), place (distribution/delivery channels), and promotion (target audiences). End-user (n = 38) and professional (n = 38) stakeholders including patients, dietitians, credentialed diabetes educators, nurses, medical doctors, research scientists, and exercise physiologists participated in the Delphi study. Fifty-two critical intervention characteristics were identified. Future interventions should address diet, physical activity, mental health (e.g. stress, diabetes-related distress), and functional health literacy, while advancing behaviour change support. Programs should be delivered digitally or used multiple delivery modes, target a range of population subgroups including children, and be based on collaborative efforts between national and local and government and non-government funded organisations. Our findings highlight strong support for digital health to address T2DM in Australia and identify future directions for T2DM prevention interventions. The study also demonstrates the feasibility and value of stakeholder-led intervention development processes.

BackgroundBovine colostrum (COL) has been advocated as a nutritional countermeasure to exercise-induced immune dysfunction, but there is a lack of research with clinically relevant in vivo measures.AimTo investigate the effects of COL supplementation on in vivo immunity following prolonged exercise using experimental contact hypersensitivity (CHS) with the novel antigen diphenylcyclopropenone (DPCP).MethodsIn a double-blind design, 31 men were randomly assigned to COL (20 g/day) or placebo (PLA) for 58 days. Participants ran for 2 h at 60% maximal aerobic capacity on day 28 and received a primary DPCP exposure (sensitisation) 20 min after. On day 56, participants received a low-dose-series DPCP challenge to elicit recall of in vivo immune-specific memory (quantified by skinfold thickness 24 and 48 h later). Analysis of the dose–response curves allowed determination of the minimum dose required to elicit a positive response (i.e., sensitivity).ResultsThere was no difference in summed skinfold thickness responses between COL and PLA at 24 h (p = 0.124) and 48 h (p = 0.405). However, sensitivity of in vivo immune responsiveness was greater with COL at 24 h (p < 0.001) and 48 h (p = 0.023) with doses ~ twofold greater required to elicit a positive response in PLA.ConclusionsCOL blunts the prolonged exercise-induced decrease in clinically relevant in vivo immune responsiveness to a novel antigen, which may be a mechanism for reduced illness reports observed in the previous studies. These findings also suggest that CHS sensitivity is highly relevant to host defence.

Sensitive photodetectors that operate at a wavelength of 2 μm are required for applications in sensing and imaging but state-of-the-art devices are severely limited by high dark current density (Jdark). The narrow-bandgap materials required for mid-infrared (2–5 µm) detection are plagued by carrier recombination and band-to-band tunnelling; as a result, detectors must be operated at cryogenic temperatures. HgCdTe is currently the most commonly used materials system for these applications and has achieved Jdark = 3 × 10−4 A cm–2 at a gain of 10 while operating at 125 K. Here, we report the details and results for avalanche photodiodes for 2-μm detection based on a separate absorption, charge, and multiplication design in the AlxIn1–xAsySb1–y materials system. We achieve comparable Jdark between 200–220 K and demonstrate very low excess noise (k ≈ 0.01) and gain >100 at room temperature. Such avalanche photodiodes could prove useful for receivers for eye-safe light imaging, detection and ranging.Highly sensitive avalanche photodiodes that operate at near-infrared wavelengths of up to 2 μm could prove useful for eye-safe light imaging, detection and ranging, and other applications.

The UK livestock industry urgently needs to reduce greenhouse gas (GHG) emissions to contribute to ambitious climate change policy commitments. Achieving this requires an improved understanding of emission sources across a range of production systems to lower the burden associated with livestock products. Life cycle assessment (LCA) methods are used in this study to model milk production from two genetic merits of Holstein Friesian cows managed in two novel and two conventional UK dairy systems. Select merit cows sired by bulls with high predicted transmission for fat plus protein yield are compared with Control merit animals sired from UK average merit bulls. Cows were managed in conventional housed and grazed dairy systems with novel Byproduct and Homegrown feeding regimes. A LCA was used to quantify the effect of allocation and management of feed components on the carbon footprint of milk production. Natural variation in nutritional quality of dairy system rations was investigated to quantify uncertainty in the carbon footprint results. Novel production system data are used to assess the effect of introducing home grown legumes and co-product feeds. Control merit footprints across each of the management regimes were significantly higher (p<0.001) in comparison with a high production Select merit, on average by 15%. Livestock emissions (enteric, manure management and deposition) and embedded emissions (purchased feeds, fertiliser, and pesticides) were also significantly higher from control merit cows (p<0.01). Mass and economic allocation methods, and land use functional units, resulted in differences in performance ranking of the dairy systems, with larger footprints resulting from mass allocation. Pairwise comparisons showed GHG's from the systems to be significantly different in total and source category emissions, with significant differences in mean embedded emissions found between most management systems (p<0.05). Monte Carlo simulated system footprints considering the effect of variation in feed digestibility and crude protein also differed significantly from system footprints using standard methods ( p < 0.001). Dairy system carbon footprint results should be expressed using multiple units and where possible calculations should incorporate variation in diet digestibility and crude protein content.

Background There is emerging evidence that exercise training could positively impact several of the cardiovascular risk factors associated with sudden cardiac death amongst patients on haemodialysis. The primary aim of this study is to evaluate the effect of an intradialytic exercise programme on left ventricular mass. Method and design Prospective, randomised cluster open-label blinded endpoint clinical trial in 130 patients with end stage renal disease on haemodialysis. Patients will be randomised 1:1 to either 1) minimum of 30 min continuous cycling thrice weekly during dialysis or 2) standard care. The primary outcome is change in left ventricular mass at 6 months, assessed by cardiac MRI (CMR). In order to detect a difference in LV mass of 15 g between groups at 80 % power, a sample size of 65 patients per group is required. Secondary outcome measures include abnormalities of cardiac rhythm, left ventricular volumes and ejection fraction, physical function measures, anthropometric measures, quality of life and markers of inflammation, with interim assessment for some measures at 3 months. Discussion This study will test the hypothesis that an intradialytic programme of exercise leads to a regression in left ventricular mass, an important non-traditional cardiovascular risk factor in end stage renal disease. For the first time this will be assessed using CMR. We will also evaluate the efficacy, feasibility and safety of an intradialytic exercise programme using a number of secondary end-points. We anticipate that a positive outcome will lead to both an increased patient uptake into established intradialytic programmes and the development of new programmes nationally and internationally. Trial registration number ISRCTN11299707 (registration date 5 th March 2015).

We examined the short-term movements of a small temperate fish, the painted comber Serranus scriba (Linnaeus 1758), within the marine protected area (MPA) of Palma Bay (NW Mediterranean) using passive acoustic telemetry. Fifteen adults were surgically implanted with acoustic transmitters and monitored between July 2007 and February 2008 for periods of up to 36 d. Interindividual variability was detected for both spatial and temporal patterns. There were 2 principal movement behaviours that were recorded, with some individuals showing high site fidelity and others showing a more mobile behaviour, moving out from the monitoring area. Observation-area curves indicated that a period between 3 and 5 d was required to determine home ranges of the sedentary fish. Home range sizes were small, with a minimum shift of core areas occurring on a daily basis. Total minimum convex polygon (MCP) areas ranged between 0.102 and 0.671 km super(2), whereas 95% kernel utilization distributions (KUD) ranged between 0.760 and 1.333 km super(2). Core areas (50% KUD) ranged between 0.175 and 0.294 km super(2). There were no significant differences in home range patterns between day and night periods. However, the use of the continuous wavelet transform (CWT) revealed diel rhythms on the detection pattern that could be related to a resting behaviour at night. Estimation of home ranges of S. scriba agrees with the sedentary habits of the Serranidae family and suggests the potential use of MPAs for the sustainable development of the fishery of this small Serranid.

Cardiovascular disease in patients with end-stage renal disease (ESRD) is driven by a different set of processes than in the general population. These processes lead to pathological changes in cardiac structure and function that include the development of left ventricular hypertrophy and left ventricular dilatation and the development of myocardial fibrosis. Reduction in left ventricular hypertrophy has been the established goal of many interventional trials in patients with chronic kidney disease, but a recent systematic review has questioned whether reduction of left ventricular hypertrophy improves cardiovascular mortality as previously thought. The development of novel imaging biomarkers that link to cardiovascular outcomes and that are specific to the disease processes in ESRD is therefore required. Postmortem studies of patients with ESRD on hemodialysis have shown that the extent of myocardial fibrosis is strongly linked to cardiovascular death and accurate imaging of myocardial fibrosis would be an attractive target as an imaging biomarker. In this article we will discuss the current imaging methods available to measure myocardial fibrosis in patients with ESRD, the reliability of the techniques, specific challenges and important limitations in patients with ESRD, and how to further develop the techniques we have so they are sufficiently robust for use in future clinical trials.

The fast development of mid-wave infrared photonics has increased the demand for high-performance photodetectors that operate in this spectral range. However, the signal-to-noise ratio, regarded as a primary figure of merit for mid-wave infrared detection, is strongly limited by the high dark current in narrow-bandgap materials. Therefore, conventional mid-wave infrared photodetectors such as HgCdTe require cryogenic temperatures to avoid excessively high dark current. To address this challenge, we report an avalanche photodiode design using photon-trapping structures to enhance the quantum efficiency and minimize the absorber thickness to suppress the dark current. The device exhibits high quantum efficiency and dark current density that is nearly three orders of magnitude lower than that of the state-of-the-art HgCdTe avalanche photodiodes and nearly two orders lower than that of previously reported AlInAsSb avalanche photodiodes that operate at 2 µm. Additionally, the bandwidth of these avalanche photodiodes reaches ~7 GHz, and the gain–bandwidth product is over 200 GHz; both are more than four times those of previously reported 2 µm avalanche photodiodes.We demonstrate an avalanche photodiode design using photon-trapping structures to enhance the quantum efficiency and minimizing the absorber thickness, yielding high quantum efficiency, suppressed dark current density and bandwidth of ~7 GHz.

In 1982, Capasso and co-workers proposed the solid-state analogue of the photomultiplier tube, termed the staircase avalanche photodiode. Through a combination of compositional grading and small applied bias, the conduction band profile is arranged into a series of steps that function similar to the dynodes of a photomultiplier tube, with twofold gain arising at each step via impact ionization. A single-step staircase was previously reported but did not demonstrate gain scaling through cascading multiple steps or report noise properties. Here we demonstrate gain scaling of up to three steps; measurements show the expected 2N scaling with the number of staircase steps, N. Furthermore, measured noise increased more slowly with gain than for photomultiplier tubes, probably due to the lower stochasticity of impact ionization across well-designed heterojunctions as compared with the secondary electron emission from metals. Excellent agreement was found between the experiments and Monte Carlo simulations for both gain and noise.A three-step staircase avalanche diode was demonstrated and pre-cited gain scaling was confirmed. The technology may be considered as a solid-state analogue to the photomultiplier tube.