Fragmented Frontiers: Three Approaches to Understanding Irregular Warfare

This article surveys current thinking, both academic and doctrinal, on the subject of irregular warfare. It argues that from a western perspective the debate has essentially resulted in three competing forms of understanding, what this paper terms the maximal, traditional, and competition-disruption models. Conceptually, all have certain strengths but also a number of highly significant weaknesses. It nevertheless proposes that the last of these, particularly when articulated as a form of ‘strategic disruption’, offers the most coherent vision of irregular warfare. Even then, significant gaps in reasoning still exist. Ultimately, the ability of western thinkers and doctrine writers to agree a common understanding of irregular warfare remains an inherently fragile endeavor

The Lived Experiences of Individuals with Type 2 Diabetes Mellitus with Poor Glycaemic Control in Nigeria:A Qualitative Study

Background:Many individuals living with type 2 diabetes mellitus (T2DM) struggle to maintain optimal glycaemic control. Reports from Nigeria show particularly high rates of poor glycaemic control, increasing the risk of microvascular and macrovascular complications. Little research has explored the lived experiences of individuals living with T2DM with poor glycaemic control in Nigeria, particularly in secondary healthcare settings, to guide improvements in care.Objective:This study explored the experiences of individuals living with T2DM with poor glycaemic control.Method:A qualitative research design was used. Semi-structured, individual interviews were conducted with 14 participants, aged 35 to 74 years, recruited from 3 secondary healthcare institutions in Lagos, Nigeria.Results:Four key themes were generated: (1) Beyond the T2DM diagnosis, which captures the perceptions of T2DM, the financial burden of the condition, and the onset of physical health issues associated with T2DM; (2) Psychological impact of T2DM, which highlights mental health difficulties and experiences of stigma; (3) Managing and living with T2DM, which describes the use of traditional medicine, the influence of religious beliefs and the importance of community and social networks and (4) Diabetes care at secondary healthcare institutions, which highlights patient-provider interactions and the gaps in information and education.Conclusion:The findings provide valuable insight into the lived experiences of individuals with T2DM with poor glycaemic control and underscore the importance of addressing knowledge gaps and providing psychological support as integral components of comprehensive diabetes care

Omnidirectional and Multi-Material In Situ 3D Printing Using Acoustic Levitation

Additive manufacturing is critical in modern production with advanced applications across various domains. However, achieving omnidirectional printing that can adapt to varying substrate geometries is still a challenge. Moreover, multi-material in situ printing without cross-contamination presents another hurdle. In this study, an acoustophoretic 3D fabrication system capable of omnidirectional and multi-material in situ 3D printing is reported using acoustic levitation. This system harnesses a phased array of transducers (PAT) to finely tune the ultrasonic field, generating acoustophoretic forces that levitate and transport objects in mid-air. It allows omnidirectional in situ printing of materials onto complex substrates with diverse orientations in a contactless and voxel-by-voxel manner. It is capable of manipulating a broad spectrum of materials, including liquids with zero-shear viscosities from 1 to 5,000,000 mPa·s, as well as solids. AcoustoFab has successfully printed structural, conductive, and biological materials in varying directions on complex substrates. Additionally, the contactless approach enables in situ printing safely on a delicate surface, as demonstrated by printing on a human hand. The flexibility and versatility of this approach demonstrate promising applications in areas ranging from biomedical engineering to industrial manufacturing.</p

Socioeconomic diversity of doctors in the United Kingdom:a cross-sectional study of 10 years of Labour Force Survey social mobility data

OBJECTIVES: To estimate the association between socioeconomic background (derived from household main earner occupation when the survey respondent was aged 14 years old) and likelihood of working as a doctor in adulthood in the UK, and estimate how associations varied over time for respondents who turned 18 years old in different decades.DESIGN: Observational study of 10 years of pooled data from a nationally representative government survey.SETTING: The United Kingdom (UK).PARTICIPANTS: 358 934 respondents to the UK Office for National Statistics Labour Force Survey between July 2014 and September 2023. Respondents aged 22 years old or below or retired respondents aged 65 years old and above were excluded.MAIN OUTCOME MEASURES: Whether the respondent was currently working as a medical practitioner (doctor).RESULTS: 2772 respondents were currently working as doctors (0.8% of respondents). 13% of doctors were from working-class backgrounds (National Statistics Socio-economic Classification 5-8), compared with 43% of non-doctor respondents, while 69% of doctors came from professional backgrounds (vs 32% of non-doctors) (unadjusted proportions). From multivariable Poisson regression models adjusting for year of survey, the year the respondent turned 18, sex, country of birth and ethnic group, the likelihood of being a doctor varied largely according to socioeconomic background, with those from professional backgrounds 3 times and 6 times more likely to become doctors than those from intermediate backgrounds and working class backgrounds, respectively (average predicted probability: 1.6% vs 0.5% vs 0.3%). Respondents growing up in households where the main earner was a doctor were by far the most likely to themselves report working as a doctor (average predicted probability: 10.1%), 15-fold more likely than all respondents with non-doctor backgrounds (risk ratio=15.0, 95% CIs 13.4 to 16.7), and between 3 times and 100 times more likely when compared with other specific occupation groups. Stratified analyses suggested socioeconomic inequalities were highly stable over time among respondents who turned 18 between the 1960s and the 2000s, and then weak evidence of decreasing diversity from 2010 to 2018.CONCLUSIONS: There are large, persistent and potentially widening inequalities in the socioeconomic background of doctors working in the UK between 2014 and 2023, leading to doctors being highly socioeconomically unrepresentative of the general UK population. New data collections on the socioeconomic background of working doctors are needed to monitor this inequality and understand its effects on patient care. Increased and/or alternative efforts may be needed to address this entrenched inequality and improve social mobility into medicine.</p

Perinatal outcomes after selective third-trimester ultrasound screening for small-for-gestational age:prospective cohort study nested within DESiGN randomized controlled trial

Objective: In screening for small-for-gestational age (SGA) using third-trimester antenatal ultrasound, there are concerns about the low detection rates and potential for harm caused by both false-negative and false-positive screening results. Using a selective third-trimester ultrasound screening program, this study aimed to investigate the incidence of adverse perinatal outcomes among cases with (i) false-negative compared with true-positive SGA diagnosis and (ii) false-positive compared with true-negative SGA diagnosis. Methods: This prospective cohort study was nested within the UK-based DESiGN trial, a prospective multicenter cohort study of singleton pregnancies without antenatally detected fetal anomalies, born at &gt; 24 + 0 to &lt; 43 + 0 weeks' gestation. We included women recruited to the baseline period, or control arm, of the trial who were not exposed to the Growth Assessment Protocol intervention and whose birth outcomes were known. Stillbirth and major neonatal morbidity were the two primary outcomes. Minor neonatal morbidity was considered a secondary outcome. Suspected SGA was defined as an estimated fetal weight (EFW) &lt; 10th percentile, based on the Hadlock formula and fetal growth charts. Similarly, SGA at birth was defined as birth weight (BW) &lt; 10th percentile, based on UK population references. Maternal and pregnancy characteristics and perinatal outcomes were reported according to whether SGA was suspected antenatally or not. Unadjusted and adjusted logistic regression models were used to quantify the differences in adverse perinatal outcomes between the screening results (false negative vs true positive and false positive vs true negative). Results: In total, 165 321 pregnancies were included in the analysis. Fetuses with a false-negative SGA screening result, compared to those with a true-positive result, were at a significantly higher risk of stillbirth (adjusted odds ratio (aOR), 1.18 (95% CI, 1.07–1.31)), but at lower risk of major (aOR, 0.87 (95% CI, 0.83–0.91)) and minor (aOR, 0.56, (95% CI, 0.54–0.59)) neonatal morbidity. Compared with a true-negative screening result, a false-positive result was associated with a lower BW percentile (median, 18.1 (interquartile range (IQR), 13.3–26.9) vs 49.9 (IQR, 30.3–71.7)). A false-positive result was also associated with a significantly increased risk of stillbirth (aOR, 2.24 (95% CI, 1.88–2.68)) and minor neonatal morbidity (aOR, 1.60 (95% CI, 1.51–1.71)), but not major neonatal morbidity (aOR, 1.04 (95% CI, 0.98–1.09)). Conclusions: In selective third-trimester ultrasound screening for SGA, both false-negative and false-positive results were associated with a significantly higher risk of stillbirth, when compared with true-positive and true-negative results, respectively. Improved SGA detection is needed to address false-negative results. It should be acknowledged that cases with a false-positive SGA screening result also constitute a high-risk population of small fetuses that warrant surveillance and timely birth.</p

Replicating a COVID- 19 study in a national England database to assess the generalisability of research with regional electronic health record data

Objectives: To assess the degree to which we can replicate a study between a regional and a national database of electronic health record data in the UK. The original study examined the risk factors associated with hospitalisation following COVID-19 infection in people with diabetes.Design: A replication of a retrospective cohort study.Setting: Observational electronic health record data from primary and secondary care sources in the UK. The original study used data from a large, urbanised region (Greater Manchester Care Record, Greater Manchester, UK-2.8 m patients). This replication study used a national database covering the whole of England, UK (NHS England's Secure Data Environment service for England, accessed via the BHF Data Science Centre's CVD-COVID-UK/COVID-IMPACT Consortium-54 m patients).Participants: Individuals with a diagnosis of type 1 diabetes or type 2 diabetes prior to a positive COVID-19 test result. The matched controls (3:1) were individuals who had a positive COVID-19 test result, but who did not have a diagnosis of diabetes on the date of their positive COVID-19 test result. Matching was done on age at COVID-19 diagnosis, sex and approximate date of COVID-19 test.Primary and secondary outcome measures: Hospitalisation within 28 days of a positive COVID-19 test.Results: We found that many of the effect sizes did not show a statistically significant difference, but that some did. Where effect sizes were statistically significant in the regional study, then they remained significant in the national study and the effect size was the same direction and of similar magnitude.Conclusions: There is some evidence that the findings from studies in smaller regional datasets can be extrapolated to a larger, national setting. However, there were some differences, and therefore replication studies remain an essential part of healthcare research

“Back on the road”: Exploring experiences of driving resumption in patients recovering from critical illness

BackgroundRecovery after critical illness is complex, with physical, cognitive, and psychological sequelae. Driving a vehicle involves the intricate interaction of physical, cognitive, visuospatial, and psychosocial components. Any, or all, of these can be impacted by critical illness. Driving resumption and experiences surrounding this activity remain largely unknown from the evidence-to-date.ObjectivesTo explore the experiences of returning to driving in patients recovering from critical illness and to identify barriers and enablers to driving resumption.MethodsThis was an exploratory qualitative study. Focus groups were conducted with patients recovering from critical illness enrolled in a one-year prospective study of supported driving resumption. Focus groups were held face-to-face at a driving mobility centre in the UK or virtually via Microsoft Teams. Each focus group lasted around 1.5 hours. Audio recordings were transcribed verbatim. Data analysis was guided by the principles of reflexive thematic analysis described by Braun and Clarke.FindingsEight individuals participated across two focus groups. Three themes were derived from the data: complexities of recovery and returning to driving after critical illness, reclaiming life through driving, influential external factors in driving behaviour and recovery. Participants reflected on the adverse effects of critical illness on physical and cognitive ability, resulting in reduced confidence and readiness to drive. Driving resumption was commonly self-directed with limited guidance from healthcare professionals. Greater information and support were desired by survivors. Driving resumption was considered of great importance and was often viewed synonymously with independence and normality. External factors including job roles, public transport and family perceptions influenced driving resumption and behaviour. ConclusionsFindings from this study highlight the importance attributed to driving resumption and the challenges associated with this activity for individuals recovering from critical illness. The need for improved guidance and support to enable safe and timely return to driving was advocated.<br/

Field theories of active particle systems and their entropy production

Active particles that translate chemical energy into self-propulsion can maintain a far-from-equilibrium steady state and perform work. The entropy production measures how far from equilibrium such a particle system operates and serves as a proxy for the work performed. Field theory offers a promising route to calculating entropy production, as it allows for many interacting particles to be considered simultaneously. Approximate field theories obtained by coarse-graining or smoothing that draw on additive noise can capture densities and correlations well, but they generally ignore the microscopic particle nature of the constituents, thereby producing spurious results for the entropy production. As an alternative we demonstrate how to use Doi-Peliti field theories, which capture the microscopic dynamics, including reactions and interactions with external and pair potentials. Such field theories are in principle exact, while offering a systematic approximation scheme, in the form of diagrammatics. We demonstrate how to construct them from a Fokker-Planck equation and show how to calculate entropy production of active matter from first principles. This framework is easily extended to include interaction. We use it to derive exact, compact and efficient general expressions for the entropy production for a vast range of interacting conserved particle systems. These expressions are independent of the underlying field theory and can be interpreted as the spatial average of the local entropy production. They are readily applicable to numerical and experimental data. In general, the entropy production due to any pair interaction draws at most on the three point, equal time density; and an n-point interaction on the ( 2 n − 1 ) -point density. We illustrate the technique in a number of exact, tractable examples, including some with pair-interaction as well as in a system of many interacting Active Brownian Particles.</p

Spleen tyrosine kinase inhibition mitigates hemin-induced thromboinflammation in an organ-specific manner in sickle cell mice

BACKGROUND: Sickle cell disease (SCD) is a challenging genetic disorder characterized by hemolytic anemia, vaso-occlusive crises (VOC), and progressive organ damage. Despite its severity, effective treatments are limited. The recent withdrawal of promising therapies, such as the anti-P-selectin antibody Crizanlizumab and the hemoglobin polymerization inhibitor Voxelotor, highlights the urgent need for innovative approaches to alleviate vaso-occlusion and thromboinflammation. METHODS: In this study, we used advanced techniques, including intravital microscopy, laser speckle contrast imaging, and histological analysis, to examine the role of syk (spleen tyrosine kinase) in platelet and neutrophil recruitment, and blood perfusion in the lung, kidney, liver, and spleen of SCD mice. RESULTS: In the Berkeley SCD model, hemin-induced vaso-occlusion and impairment in pulmonary blood perfusion were independent of red cell congestion and fibrin deposition. Hypoperfusion was driven by adhesion of neutrophils and platelets in the microcirculation and exacerbated by pulmonary emboli. Hemin-induced cell adhesion and hypoperfusion were also observed in the renal microcirculation, whereas it was limited in the liver and spleen of SCD mice, suggesting that organ-specific mechanisms drive hypoperfusion and vaso-occlusion. To explore therapeutic options, we investigated the potential of Syk inhibition in improving blood perfusion and reducing thrombo-inflammation in different organs. Selective Syk inhibition, using BI-1002494, reduced cellular adhesion in the pulmonary and renal microvasculature, effectively restoring blood perfusion and reducing thrombo-inflammation. Low-dose Syk inhibitor was effective in reducing neutrophil adhesion and improving blood perfusion without inducing bleeding. Increasing the dose exacerbated hemin-induced bleeding in the lungs, likely due to off-target activity againt other kinases, including Src. CONCLUSIONS: These findings underscore the critical role of Syk in platelet and neutrophil mediated-thrombo-inflammation and hypoperfusion in SCD, suggesting that Syk inhibition is a promising strategy to reduce organ-specific vaso-occlusion, improve renal and pulmonary perfusion, and reduce organ damage.</p