Direct observation of magnetic phase coexistence and magnetization reversal in a Gd0.67_{0.67}Ca0.33_{0.33}MnO3_{3} thin film

We have investigated the ferrimagnetic domain structure in a Gd$_{0.67}$Ca$_{0.33}$MnO$_{3}$ thin film using magnetic force microscopy. We observe clear signs of phase separation, with magnetic islands embedded in a non-magnetic matrix. We also directly visualize the reversal of magnetization of ferrimagnetic domains as a function of temperature and attribute it to a change in the balance of magnetization of anti-aligned Mn and Gd sublattices.Comment: 4 pages, 3 figure

Evolution of microstructure, strain and physical properties in oxide nanocomposite films

We, using LSMO:ZnO nanocomposite films as a model system, have studied the effect of film thickness on the physical properties of nanocomposites. It shows that strain, microstructure, as well as magnetoresistance strongly rely on film thickness. The magnetotransport properties have been fitted by a modified parallel connection channel model, which is in agreement with the microstructure evolution as a function of film thickness in nanocomposite films on sapphire substrates. The strain analysis indicates that the variation of physical properties in nanocomposite films on LAO is dominated by strain effect. These results confirm the critical role of film thickness on microstructures, strain states, and functionalities. It further shows that one can use film thickness as a key parameter to design nanocomposites with optimum functionalities

Use of a carbon dioxide laser for environmentally beneficial generation of distressed/faded effects on indigo dyed denim fabric: Evaluation of colour change, fibre morphology, degradation and textile properties

Denim garments are particularly popular with the younger population of adults. Distressed or worn out effects have been and will continue to be popular with this market sector. These faded or worn effects have been achieved using a range of physical, chemical and mechanical finishes. Both wet and dry finishing of denim fabrics and garments pose severe environmental and health risks. Recently, environmentally beneficial decolourisation/ablation methods for denim fabrics have been investigated. Such methods have included plasma, laser, and ozone treatments. Researchers in this field have highlighted the potential of CO2 laser treatment of 100% cotton denim, however the textile performance post-treatment has not been properly investigated. In this study, light, medium and heavy weight indigo dyed 100% cotton denim fabrics were exposed to a CO2 laser at a range of power and intensity levels. Colour change was investigated using a Spectrophotometer, morphological structural analysis was carried using Scanning Electron Microscopy, and attenuated total reflectance Fourier transform Infrared spectroscopy (ATR-FTIR) was used to monitor the loss of indigo dye and degradation of the cellulose fibres. The thermal-oxidative degradation behaviour of fabrics was also studied using differential scanning calorimetry to obtain oxidation onset temperature. In addition, several fabric performance assessments were carried to evaluate tensile strength, colour fastness, air permeability and thickness. Findings reveal that the grayscale rating, which is the tone density and hence laser power affected the colour change and as the grayscale increased, the colour fading was higher and affected the fabric performance across all fabric weights. Based on this, the research recommends an optimum set of laser processing parameters to produce stressed or faded denim effects without compromising the fabric performance. This research demonstrates that faded effects on denim can be produced with low environmental and health risks

Implementation of a diabetes in pregnancy clinical register in a complex setting: findings from a process evaluation

Background: Rates of diabetes in pregnancy are disproportionately higher among Aboriginal than non-Aboriginal women in Australia. Additional challenges are posed by the context of Aboriginal health including remoteness and disadvantage. A clinical register was established in 2011 to improve care coordination, and as an epidemiological and quality assurance tool. This paper presents results from a process evaluation identifying what worked well, persisting challenges and opportunities for improvement. Methods: Clinical register data were compared to the Northern Territory Midwives Data Collection. A cross-sectional survey of 113 health professionals across the region was also conducted in 2016 to assess use and value of the register; and five focus groups (49 healthcare professionals) documented improvements to models of care. Results: From January 2012 to December 2015, 1,410 women were referred to the register, 48% of whom were Aboriginal. In 2014, women on the register represented 75% of those on the Midwives Data Collection for Aboriginal women with gestational diabetes and 100% for Aboriginal women with pre-existing diabetes. Since commencement of the register, an 80% increase in reported prevalence of gestational diabetes among Aboriginal women in the Midwives Data Collection occurred (2011-2013), prior to adoption of new diagnostic criteria (2014). As most women met both diagnostic criteria (81% in 2012 and 74% in 2015) it is unlikely that the changes in criteria contributed to this increase. Over half (57%) of survey respondents reported improvement in knowledge of the epidemiology of diabetes in pregnancy since establishment of the register. However, only 32% of survey respondents thought that the register improved care-coordination. The need for improved integration and awareness to increase use was also highlighted. Conclusion: Although the register has not been reported to improve care coordination, it has contributed to increased reported prevalence of gestational diabetes among high risk Aboriginal women, in a routinely collected jurisdiction-wide pregnancy dataset. It has therefore contributed to an improved understanding of epidemiology and disease burden and may in future contribute to improved management and outcomes. Regions with similar challenges in context and high risk populations for diabetes in pregnancy may benefit from this experience of implementing a register.Renae Kirkham, Cherie Whitbread, Christine Connors, Elizabeth Moore, Jacqueline A. Boyle, Richa Richa, Federica Barzi, Shu Li, Michelle Dowden, Jeremy Oats, Chrissie Inglis, Margaret Cotter, Harold D. McIntyre, Marie Kirkwood, Paula Van Dokkum, Stacey Svenson, Paul Zimmet, Jonathan E. Shaw, Kerin O'Dea, Alex Brown, Louise Maple-Brown, on behalf of the Northern Territory Diabetes in Pregnancy Partnershi

Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) study

Abstract Background: Diabetes in pregnancy carries an increased risk of adverse pregnancy outcomes for both the mother and foetus, but it also provides an excellent early opportunity for intervention in the life course for both mother and baby. In the context of the escalating epidemic of chronic diseases among Indigenous Australians, it is vital that this risk is reduced as early as possible in the life course of the individual. The aims of the PANDORA Study are to: (i) accurately assess rates of diabetes in pregnancy in the Northern Territory (NT) of Australia, where 38% of babies are born to Indigenous mothers; (ii) assess demographic, clinical, biochemical, anthropometric, socioeconomic and early life development factors that may contribute to key maternal and neonatal birth outcomes associated with diabetes in pregnancy; and (iii) monitor relevant post-partum clinical outcomes for both the mothers and their babies. Methods/Design: Eligible participants are all NT women with diabetes in pregnancy aged 16 years and over. Information collected includes: standard antenatal clinical information, diagnosis and management of diabetes in pregnancy, socio-economic status, standard clinical birth information (delivery, gestational age, birth weight, adverse antenatal and birth outcomes). Cord blood is collected at the time of delivery and detailed neonatal anthropometric measurements performed within 72 hours of birth. Information will also be collected regarding maternal postpartum glucose tolerance and cardio-metabolic risk factor status, breastfeeding and growth of the baby up to 2 years post-partum in the first instance. Discussion: This study will accurately document rates and outcomes of diabetes in pregnancy in the NT of Australia, including the high-risk Indigenous Australian population. The results of this study should contribute to policy and clinical guidelines with the goal of reducing the future risk of obesity and diabetes in both mothers and their offspring

Pregnancy and Neonatal Diabetes Outcomes in Remote Australia (PANDORA) study

Abstract Background: Diabetes in pregnancy carries an increased risk of adverse pregnancy outcomes for both the mother and foetus, but it also provides an excellent early opportunity for intervention in the life course for both mother and baby. In the context of the escalating epidemic of chronic diseases among Indigenous Australians, it is vital that this risk is reduced as early as possible in the life course of the individual. The aims of the PANDORA Study are to: (i) accurately assess rates of diabetes in pregnancy in the Northern Territory (NT) of Australia, where 38% of babies are born to Indigenous mothers; (ii) assess demographic, clinical, biochemical, anthropometric, socioeconomic and early life development factors that may contribute to key maternal and neonatal birth outcomes associated with diabetes in pregnancy; and (iii) monitor relevant post-partum clinical outcomes for both the mothers and their babies. Methods/Design: Eligible participants are all NT women with diabetes in pregnancy aged 16 years and over. Information collected includes: standard antenatal clinical information, diagnosis and management of diabetes in pregnancy, socio-economic status, standard clinical birth information (delivery, gestational age, birth weight, adverse antenatal and birth outcomes). Cord blood is collected at the time of delivery and detailed neonatal anthropometric measurements performed within 72 hours of birth. Information will also be collected regarding maternal postpartum glucose tolerance and cardio-metabolic risk factor status, breastfeeding and growth of the baby up to 2 years post-partum in the first instance. Discussion: This study will accurately document rates and outcomes of diabetes in pregnancy in the NT of Australia, including the high-risk Indigenous Australian population. The results of this study should contribute to policy and clinical guidelines with the goal of reducing the future risk of obesity and diabetes in both mothers and their offspring

Symptom-based stratification of patients with primary Sjögren's syndrome: multi-dimensional characterisation of international observational cohorts and reanalyses of randomised clinical trials

Background Heterogeneity is a major obstacle to developing effective treatments for patients with primary Sjögren's syndrome. We aimed to develop a robust method for stratification, exploiting heterogeneity in patient-reported symptoms, and to relate these differences to pathobiology and therapeutic response. Methods We did hierarchical cluster analysis using five common symptoms associated with primary Sjögren's syndrome (pain, fatigue, dryness, anxiety, and depression), followed by multinomial logistic regression to identify subgroups in the UK Primary Sjögren's Syndrome Registry (UKPSSR). We assessed clinical and biological differences between these subgroups, including transcriptional differences in peripheral blood. Patients from two independent validation cohorts in Norway and France were used to confirm patient stratification. Data from two phase 3 clinical trials were similarly stratified to assess the differences between subgroups in treatment response to hydroxychloroquine and rituximab. Findings In the UKPSSR cohort (n=608), we identified four subgroups: Low symptom burden (LSB), high symptom burden (HSB), dryness dominant with fatigue (DDF), and pain dominant with fatigue (PDF). Significant differences in peripheral blood lymphocyte counts, anti-SSA and anti-SSB antibody positivity, as well as serum IgG, κ-free light chain, β2-microglobulin, and CXCL13 concentrations were observed between these subgroups, along with differentially expressed transcriptomic modules in peripheral blood. Similar findings were observed in the independent validation cohorts (n=396). Reanalysis of trial data stratifying patients into these subgroups suggested a treatment effect with hydroxychloroquine in the HSB subgroup and with rituximab in the DDF subgroup compared with placebo. Interpretation Stratification on the basis of patient-reported symptoms of patients with primary Sjögren's syndrome revealed distinct pathobiological endotypes with distinct responses to immunomodulatory treatments. Our data have important implications for clinical management, trial design, and therapeutic development. Similar stratification approaches might be useful for patients with other chronic immune-mediated diseases. Funding UK Medical Research Council, British Sjogren's Syndrome Association, French Ministry of Health, Arthritis Research UK, Foundation for Research in Rheumatology

Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Dimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome