Pressures and influences on school leaders as policy makers during COVID-19

Pressure and influences on school leaders as school policy makers during COVID-19 have made the task of interpreting, translating and implementing guidance more a complex and essential operation. School leaders need to prioritise and balance ever-changing government policy advice, against limitations of school buildings, the welfare of students and staff as well as the needs of the communities their schools serve. By surveying and interviewing headteachers, senior leaders and governors, this paper identifies the inputs school leaders have had to react and respond to when creating policy in the context of COVID-19. The paper addresses the nature of, and factors affecting, pressures school leaders feel in authoring policy. The considerable challenges school-based policy makers face in implementing social distancing policy are non-trivial and increase tension to what is already highly stressful work. The report draws on data collected from a randomised, stratified sample of primary and secondary school leaders from across England in early June 2020, during the time of social distancing and school closure for most students. Findings suggest quality, quantity and frequency of top-down communication have contributed to school leader stress, while horizontal communication and collaboration between school leaders and across school communities helped to support leaders during rapid change. We recommend government and the education sector address communication, collaboration and change, to harness the challenges and opportunities identified by school leaders during the COVID-19 pandemic

Perforation and abscess formation after radiological placement of a retrievable plastic biliary stent

<p>Abstract</p> <p>Introduction</p> <p>Retrievable plastic biliary stents are usually inserted endoscopically. When endoscopic placement fails, radiological percutaneous transhepatic placement is indicated. We report the occurrence of a case of delayed duodenal perforation with abscess formation after radiological placement of a plastic stent. To the best of our knowledge, this is the first report of this complication after radiological stenting.</p> <p>Case presentation</p> <p>A 58-year-old Caucasian man had a mass 30 mm in size in the head of the pancreas and obstructive jaundice. He was referred for radiological insertion of plastic biliary stents after a failed endoscopic attempt. The procedure was uneventful, and the patient was discharged. Two weeks after the procedure, the patient presented with an acute abdomen and signs of sepsis. Computed tomography revealed erosion of the posterior duodenal wall from the plastic stent, and a large retroperitoneal abscess. The abscess was drained under computed tomography guidance, and the migrated stent was removed percutaneously with a snare under fluoroscopic guidance. Our patient had an uneventful recovery and was discharged after a week.</p> <p>Conclusion</p> <p>Late retroperitoneal duodenal perforation is a very rare but severe complication of biliary stenting with plastic stents. Gastroenterologists, surgeons and radiologists should all be aware of its existence, clinical presentation and management.</p

Use of Analog and Human Insulin in a European Hemodialysis Cohort With Type 2 Diabetes: Associations With Mortality, Hospitalization, MACE, and Hypoglycemia

RATIONALE & OBJECTIVE: Poor glycemic control may contribute to the high mortality rate in patients with type 2 diabetes receiving hemodialysis. Insulin type may influence glycemic control, and its choice may be an opportunity to improve outcomes. This study assessed whether treatment with analog insulin compared with human insulin is associated with different outcomes in people with type 2 diabetes and kidney failure receiving hemodialysis. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: People in the Analyzing Data, Recognizing Excellence and Optimizing Outcomes (AROii) study with kidney failure commencing hemodialysis and type 2 diabetes being treated with insulin within 288 dialysis facilities between 2007 and 2009 across 7 European countries. Study participants were followed for 3 years. People with type 1 diabetes were excluded using an established administrative data algorithm. EXPOSURE: Treatment with an insulin analog or human insulin. OUTCOME: All-cause mortality, major adverse cardiovascular events (MACE), all-cause hospitalization, and confirmed hypoglycemia (blood glucose<3.0mmol/L sampled during hemodialysis). ANALYTICAL APPROACH: Inverse probability weighted Cox proportional hazards models to estimate hazard ratios for analog insulin compared with human insulin. RESULTS: There were 713 insulin analog and 733 human insulin users. Significant variation in insulin type by country was observed. Comparing analog with human insulin at 3 years, the percentage of patients experiencing end points and adjusted hazard ratios (AHR) were 22.0% versus 31.4% (AHR, 0.808 [95% CI, 0.66-0.99], P=0.04) for all-cause mortality, 26.8% versus 35.9% (AHR, 0.817 [95% CI, 0.68-0.98], P=0.03) for MACE, and 58.2% versus 75.0% (AHR, 0.757 [95% CI, 0.67-0.86], P<0.001) for hospitalization. Hypoglycemia was comparable between insulin types at 14.1% versus 15.0% (AHR, 1.169 [95% CI, 0.80-1.72], P=0.4). Consistent strength and direction of the associations were observed across sensitivity analyses. LIMITATIONS: Residual confounding, lack of more detailed glycemia data. CONCLUSIONS: In this large multinational cohort of people with type 2 diabetes and kidney failure receiving maintenance hemodialysis, treatment with analog insulins was associated with better clinical outcomes when compared with human insulin. PLAIN-LANGUAGE SUMMARY: People with diabetes who are receiving dialysis for kidney failure are at high risk of cardiovascular disease and death. This study uses information from 1,446 people with kidney failure from 7 European countries who are receiving dialysis, have type 2 diabetes, and are prescribed either insulin identical to that made in the body (human insulin) or insulins with engineered extra features (insulin analog). After 3 years, fewer participants receiving analog insulins had died, had been admitted to the hospital, or had a cardiovascular event (heart attack, stroke, heart failure, or peripheral vascular disease). These findings suggest that analog insulins should be further explored as a treatment leading to better outcomes for people with diabetes on dialysis

Regional Labour Markets and Job Accessibility in City Network Systems in Germany

Spatial labour markets are subjected to the forces of regional economic activity and competing network effects. Commuting is, therefore, an important equilibrating vehicle in a City Network constellation. Cities act as attractors of commuters, as most economic activity occurs in cities, thus providing a high share of attractive workplaces. Cities that are centrally connected in a network may act as both centripetal and centrifugal forces in the whole system. The present paper focuses on what is named the City Network (CN) approach. A central idea is the accessibility concept, which is interpreted here as the potential of opportunity for interaction, which has a positive impact on economic growth. In our paper, the accessibility concept and the CN concept are linked together by positioning accessibility in the CN system. Since accessibility measures give geographical insights into the distribution of economic activities and the related (dis)equilibrium of regional development patterns, the connection with the labour market is evident, and, therefore, a second focus of our analysis. In an applied setting, our paper aims to investigate spatial accessibility patterns in the main CN in Germany. The 17 districts which belong to the country's CN were chosen from the 439 German labour market districts on the basis of three criteria: (a) their connection to the high speed railway network; (b) the most accessible districts according to previous results (2002); (c) relevant districts for the German economy. Our applied modelling research concerns home-to-work commuters travelling between the selected districts belonging to the German CN, for both 2003 and 2007. Here, a comparative analysis of the ranking of the most accessible districts - also for different intra-zonal travel times - is carried out in order to map out the changes in accessibility between 2003 and 2007, especially in the light of new high speed connections and commuting flow dynamics. © 2010 Elsevier Ltd

A framework for using self-organising maps to analyse spatiotemporal patterns, exemplified by analysis of mobile phone usage

We suggest a visual analytics framework for the exploration and analysis of spatially and temporally referenced values of numeric attributes. The framework supports two complementary perspectives on spatio-temporal data: as a temporal sequence of spatial distributions of attribute values (called spatial situations) and as a set of spatially referenced time series of attribute values representing local temporal variations. To handle a large amount of data, we use the self-organising map (SOM) method, which groups objects and arranges them according to similarity of relevant data features. We apply the SOM approach to spatial situations and to local temporal variations and obtain two types of SOM outcomes, called space-in-time SOM and time-in-space SOM, respectively. The examination and interpretation of both types of SOM outcomes are supported by appropriate visualisation and interaction techniques. This article describes the use of the framework by an example scenario of data analysis. We also discuss how the framework can be extended from supporting explorative analysis to building predictive models of the spatio-temporal variation of attribute values. We apply our approach to phone call data showing its usefulness in real-world analytic scenarios

Targeted mitochondrial therapy using MitoQ shows equivalent renoprotection to angiotensin converting enzyme inhibition but no combined synergy in diabetes.

Mitochondrial dysfunction is a pathological mediator of diabetic kidney disease (DKD). Our objective was to test the mitochondrially targeted agent, MitoQ, alone and in combination with first line therapy for DKD. Intervention therapies (i) vehicle (D); (ii) MitoQ (DMitoQ;0.6 mg/kg/day); (iii) Ramipril (DRam;3 mg/kg/day) or (iv) combination (DCoAd) were administered to male diabetic db/db mice for 12 weeks (n = 11-13/group). Non-diabetic (C) db/m mice were followed concurrently. No therapy altered glycaemic control or body weight. By the study end, both monotherapies improved renal function, decreasing glomerular hyperfiltration and albuminuria. All therapies prevented tubulointerstitial collagen deposition, but glomerular mesangial expansion was unaffected. Renal cortical concentrations of ATP, ADP, AMP, cAMP, creatinine phosphate and ATP:AMP ratio were increased by diabetes and mostly decreased with therapy. A higher creatine phosphate:ATP ratio in diabetic kidney cortices, suggested a decrease in ATP consumption. Diabetes elevated glucose 6-phosphate, fructose 6-phosphate and oxidised (NAD+ and NADP+) and reduced (NADH) nicotinamide dinucleotides, which therapy decreased generally. Diabetes increased mitochondrial oxygen consumption (OCR) at complex II-IV. MitoQ further increased OCR but decreased ATP, suggesting mitochondrial uncoupling as its mechanism of action. MitoQ showed renoprotection equivalent to ramipril but no synergistic benefits of combining these agents were shown

Spatial heterogeneity in Bayesian disease mapping

© 2018, The Author(s). Disease mapping applications generally assume homogeneous regression effects and use random intercepts to account for residual spatial dependence. However, there may be local variation in the association between disease and area risk factors. We consider implications for model fit, estimated regression coefficients, and substantive inferences of allowing spatial variability in impacts of area risk factors. An application to suicide in 6791 English small areas shows that average regression coefficients and substantive inferences (e.g. about relative risk) may be considerably affected by allowing spatially varying predictor effects, while fit is improved

Identification of six new susceptibility loci for invasive epithelial ovarian cancer.

Genome-wide association studies (GWAS) have identified 12 epithelial ovarian cancer (EOC) susceptibility alleles. The pattern of association at these loci is consistent in BRCA1 and BRCA2 mutation carriers who are at high risk of EOC. After imputation to 1000 Genomes Project data, we assessed associations of 11 million genetic variants with EOC risk from 15,437 cases unselected for family history and 30,845 controls and from 15,252 BRCA1 mutation carriers and 8,211 BRCA2 mutation carriers (3,096 with ovarian cancer), and we combined the results in a meta-analysis. This new study design yielded increased statistical power, leading to the discovery of six new EOC susceptibility loci. Variants at 1p36 (nearest gene, WNT4), 4q26 (SYNPO2), 9q34.2 (ABO) and 17q11.2 (ATAD5) were associated with EOC risk, and at 1p34.3 (RSPO1) and 6p22.1 (GPX6) variants were specifically associated with the serous EOC subtype, all with P < 5 × 10(-8). Incorporating these variants into risk assessment tools will improve clinical risk predictions for BRCA1 and BRCA2 mutation carriers.COGS project is funded through a European Commission's Seventh Framework Programme grant (agreement number 223175 ] HEALTH ]F2 ]2009 ]223175). The CIMBA data management and data analysis were supported by Cancer Research.UK grants 12292/A11174 and C1287/A10118. The Ovarian Cancer Association Consortium is supported by a grant from the Ovarian Cancer Research Fund thanks to donations by the family and friends of Kathryn Sladek Smith (PPD/RPCI.07). The scientific development and funding for this project were in part supported by the US National Cancer Institute GAME ]ON Post ]GWAS Initiative (U19 ]CA148112). This study made use of data generated by the Wellcome Trust Case Control consortium. Funding for the project was provided by the Wellcome Trust under award 076113. The results published here are in part based upon data generated by The Cancer Genome Atlas Pilot Project established by the National Cancer Institute and National Human Genome Research Institute (dbGap accession number phs000178.v8.p7). The cBio portal is developed and maintained by the Computational Biology Center at Memorial Sloan ] Kettering Cancer Center. SH is supported by an NHMRC Program Grant to GCT. Details of the funding of individual investigators and studies are provided in the Supplementary Note. This study made use of data generated by the Wellcome Trust Case Control consortium, funding for which was provided by the Wellcome Trust under award 076113. The results published here are, in part, based upon data generated by The Cancer Genome Atlas Pilot Project established by the National Cancerhttp://dx.doi.org/10.1038/ng.3185This is the Author Accepted Manuscript of 'Identification of six new susceptibility loci for invasive epithelial ovarian cancer' which was published in Nature Genetics 47, 164–171 (2015) © Nature Publishing Group - content may only be used for academic research