Transitional labour markets : a social investment and risk mitigation strategy for social policy

Drawing on transitional labor market (TLM) theory, this introductory chapter highlights major themes, overviews the contributions to this volume and suggests a future agenda for policy makers. The focus of applied research projects has been the impact of post-modem social transformations on systems of social protection, looking through the lens of the labor market and shifts in household and family structure. The Transitional Labor Market project uses the TLM model as a means of developing new thinking on how flexibility and innovation might be paired with social investment and new forms of social protection. TLM theory emphasizes the importance of institutions and of the links between different institutions which frequently operate as policy silos, rather than integrated systems to buffer risks and support capability and enhance employability. The great advantage of the TLM model is that it draws attention to the right places for strategic reform. It does not offer a standard set of institutions to facilitate transitions however.<br /

Combination GLP-1 and Insulin Treatment Fails to Alter Myocardial Fuel Selection Versus Insulin Alone in Type 2 Diabetes

Context Glucagon-like peptide-1 (GLP-1) and the clinically available GLP-1 agonists have been shown to exert effects on the heart. It is unclear whether these effects occur at clinically used doses in vivo in humans, possibly contributing to CVD risk reduction. Objective To determine whether liraglutide at clinical dosing augments myocardial glucose uptake alone or in combination with insulin compared to insulin alone in metformin-treated Type 2 diabetes mellitus. Design Comparison of myocardial fuel utilization after 3 months of treatment with insulin detemir, liraglutide, or combination detemir+liraglutide. Setting Academic hospital Participants Type 2 diabetes treated with metformin plus oral agents or basal insulin. Interventions Insulin detemir, liraglutide, or combination added to background metformin Main Outcome Measures Myocardial blood flow, fuel selection and rates of fuel utilization evaluated using positron emission tomography, powered to demonstrate large effects. Results We observed greater myocardial blood flow in the insulin-treated groups (median[25th, 75th percentile]: detemir 0.64[0.50, 0.69], liraglutide 0.52[0.46, 0.58] and detemir+liraglutide 0.75[0.55, 0.77] mL/g/min, p=0.035 comparing 3 groups and p=0.01 comparing detemir groups to liraglutide alone). There were no evident differences between groups in myocardial glucose uptake (detemir 0.040[0.013, 0.049], liraglutide 0.055[0.019, 0.105], detemir+liraglutide 0.037[0.009, 0.046] µmol/g/min, p=0.68 comparing 3 groups). Similarly there were no treatment group differences in measures of myocardial fatty acid uptake or handling, and no differences in total oxidation rate. Conclusions These observations argue against large effects of GLP-1 agonists on myocardial fuel metabolism as mediators of beneficial treatment effects on myocardial function and ischemia protection

Thinking Outside the Box? Applying Design Theory to Public Policy

Design involves an account of expertise which foregrounds implicit, heuristic skills. Most models of policy making have a stronger interest in structural and exogenous pressures on decision making. Research suggests that high-level experts develop unique capacities to process data, read a situation, and see imaginative solutions. By linking some of the key attributes of a design model of decision making to an account of expertise, it is possible to formulate a stronger model of public policy design expertise. While other approaches often concern themselves with constraints and structural imperatives, a design approach has a focus upon the capacities of individual actors such as policy experts. Such an approach rests upon central propositions in regard to goal emergence, pattern recognition, anticipation, emotions engagement, fabulation, playfulness, and risk protection. These provide a starting point for further research and for the professional development of policy specialists

Feasibility of Development of Flood Resiliency Clearinghouse Program

[Introduction] House Bill 2187i, introduced by Delegate Keith Hodges in the 2021 session of the Virginia General Assembly, directed the Commonwealth Center for Recurrent Flooding Resiliency (CCRFR), a partnership between Old Dominion University, the Virginia Institute of Marine Science (VIMS) and the William & Mary Law School’s Virginia Coastal Policy Center (VCPC) established by Virginia Chapter 440 of the 2016 Acts of Assembly (HB 903), to evaluate the development of a Flood Resiliency Clearinghouse Program (henceforth Clearinghouse). The bill stipulated that the Center should work with the Department of Conservation and Recreation (DCR) to evaluate solutions that manage both water quality and flooding and emphasize naturebased solutions. Further, it states that the CCRFR and DCR shall evaluate solutions that include both “approved and not-yet-approved stormwater best management practices”. The intent of HB 2187 to provide an easily accessible resource to aid policymakers, state agencies, localities, businesses, and the public in implementing flood protection practices that are protective of water quality is clear. Less clear is the geographic and the programmatic/jurisdictional scope of the best management practices (BMPs) to be considered and the specific roles that the Clearinghouse would play beyond being a repository for information on existing BMPs ranging from shoreline erosion control to stormwater management. This report takes the approach of assuming that the intent of the bill is for the Clearinghouse to be a statewide resource, but much of the analysis is focused on the coastal zone where jurisdictional and regulatory structures include additional levels of complexity. While there are currently best management practices (BMPs) approved in the Commonwealth for the management of stormwater quantity and quality, these practices were not designed to withstand flooding impacts and have not been evaluated for flood control in the riparian and littoral zones. There is a need in Virginia for innovative shoreline strategies that manage water quality and flooding and protect the coastline from erosion related to rising sea levels and storm surge. A Flood Resiliency Clearinghouse could be a resource to promote resilient shoreline solutions and could provide the cross-agency collaboration needed to evaluate and approve solutions that manage both water quality and flooding. The Clearinghouse could fill the need in the Commonwealth for a one-stop location to identify BMPs for a particular activity intended to provide flood protection while being protective of water quality

From Entitlement to Experiment: Industry Report on Case Studies of high performing providers

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Three-dimensional food printing: Its readiness for a food and nutrition insecure world

Three-dimensional (3D) food printing is a rapidly emerging technology offering unprecedented potential for customised food design and personalised nutrition. Here, we evaluate the technological advances in extrusion-based 3D food printing and its possibilities to promote healthy and sustainable eating. We consider the challenges in implementing the technology in real-world applications. We propose viable applications for 3D food printing in health care, health promotion and food waste upcycling. Finally, we outline future work on 3D food printing in food safety, acceptability and economics, ethics and regulations. .

Challenges of developing robust AI for intrapartum fetal heart rate monitoring

Background: CTG remains the only non-invasive tool available to the maternity team for continuous monitoring of fetal well-being during labour. Despite widespread use and investment in staff training, difficulty with CTG interpretation continues to be identified as a problem in cases of fetal hypoxia, which often results in permanent brain injury. Given the recent advances in AI, it is hoped that its application to CTG will offer a better, less subjective and more reliable method of CTG interpretation. Objectives: This mini-review examines the literature and discusses the impediments to the success of AI application to CTG thus far. Prior randomised control trials (RCTs) of CTG decision support systems are reviewed from technical and clinical perspectives. A selection of novel engineering approaches, not yet validated in RCTs, are also reviewed. The review presents the key challenges that need to be addressed in order to develop a robust AI tool to identify fetal distress in a timely manner so that appropriate intervention can be made. Results: The decision support systems used in three RCTs were reviewed, summarising the algorithms, the outcomes of the trials and the limitations. Preliminary work suggests that the inclusion of clinical data can improve the performance of AI-assisted CTG. Combined with newer approaches to the classification of traces, this offers promise for rewarding future development

Development of a theory-informed implementation intervention to improve the triage, treatment and transfer of stroke patients in emergency departments using the Theoretical Domains Framework (TDF): The T3 Trial

Background: Theoretical frameworks and models based on behaviour change theories are increasingly used in the development of implementation interventions. Development of an implementation intervention is often based on the available evidence base and practical issues, i.e. feasibility and acceptability. The aim of this study was to describe the development of an implementation intervention for the T3 Trial (Triage, Treatment and Transfer of patients with stroke in emergency departments (EDs)) using theory to recommend behaviour change techniques (BCTs) and drawing on the research evidence base and practical issues of feasibility and acceptability. Methods: A stepped method for developing complex interventions based on theory, evidence and practical issues was adapted using the following steps: (1) Who needs to do what, differently? (2) Using a theoretical framework, which barriers and enablers need to be addressed? (3) Which intervention components (behaviour change techniques and mode(s) of delivery) could overcome the modifiable barriers and enhance the enablers? A researcher panel was convened to review the list of BCTs recommended for use and to identify the most feasible and acceptable techniques to adopt. Results: Seventy-six barriers were reported by hospital staff who attended the workshops (step 1: thirteen TDF domains likely to influence the implementation of the T3 Trial clinical intervention were identified by the researchers; step 2: the researcher panellists then selected one third of the BCTs recommended for use as appropriate for the clinical context of the ED and, using the enabler workshop data, devised enabling strategies for each of the selected BCTs; and step 3: the final implementation intervention consisted of 27 BCTs). Conclusions: The TDF was successfully applied in all steps of developing an implementation intervention for the T3 Trial clinical intervention. The use of researcher panel opinion was an essential part of the BCT selection process to incorporate both research evidence and expert judgment. It is recommended that this stepped approach (theory, evidence and practical issues of feasibility and acceptability) is used to develop highly reportable implementation interventions. The classifying of BCTs using recognised implementation intervention components will facilitate generalisability and sharing across different conditions and clinical settings

A Reduced Pancreatic Polypeptide Response is Associated With New-onset Pancreatogenic Diabetes Versus Type 2 Diabetes

PURPOSE: Pancreatogenic diabetes refers to diabetes mellitus (DM) that develops in the setting of a disease of the exocrine pancreas, including pancreatic ductal adenocarcinoma (PDAC) and chronic pancreatitis (CP). We sought to evaluate whether a blunted nutrient response of pancreatic polypeptide (PP) can differentiate these DM subtypes from type 2 DM (T2DM). METHODS: Subjects with new-onset DM (\u3c3 \u3eyears\u27 duration) in the setting of PDAC (PDAC-DM, n = 28), CP (CP-DM, n = 38), or T2DM (n = 99) completed a standardized mixed meal tolerance test, then serum PP concentrations were subsequently measured at a central laboratory. Two-way comparisons of PP concentrations between groups were performed using Wilcoxon rank-sum test and analysis of covariance while adjusting for age, sex, and body mass index. RESULTS: The fasting PP concentration was lower in both the PDAC-DM and CP-DM groups than in the T2DM group (P = 0.03 and CONCLUSIONS: Fasting PP concentrations and the response to meal stimulation are reduced in new-onset DM associated with PDAC or CP compared with T2DM. These findings support further investigations into the use of PP concentrations to characterize pancreatogenic DM and to understand the pathophysiological role in exocrine pancreatic diseases (NCT03460769)