Michelle Miller

Objective: Early case series using a synthetic bilayer biodegradable matrix (BTM) for diabetes-related neuropathic and neuroischemic foot wounds have shown encouraging outcomes. This study reports results from a single-centre randomised controlled trial evaluating its efficacy in a diabetes-related foot wound cohort. Methods: Participants with moderate-to-severe post-surgical diabetes-related foot wounds (Society of Vascular Surgery WIfI grade 3 or 4) were randomised to BTM plus usual standard of care (USOC) or USOC alone. Primary outcomes were complete wound healing and amputation rates at 12 months; secondary outcomes included time to healing, wound surface area reduction, and infection rates. (Ethics approval 2021/HRE00214, ACTRNNo. 12621001613897). Results: Between May 2022 and September 2024, 64 participants were enrolled (31 BTM + USOC, 30 USOC alone; three did not complete treatment). At 12 months, complete healing occurred in 64.5% of BTM-treated wounds versus 56.7% of USOC wounds (p = 0.53, non-significant), with no significant difference in amputation rates. Post hoc Kaplan–Meier analysis of wounds with a starting surface area greater than 10 cm² showed significantly faster healing in the BTM group (median 219 days) versus USOC alone (312 days, log-rank p = 0.037). A multivariate Cox proportional hazards regression, adjusting for WIfI score, age and starting wound area, confirmed this effect (HR 2.67, 95% CI 1.04–6.86, p = 0.04), with large BTM-treated wounds healed approximately 2.7 times faster than USOC alone. Conclusions: In this exploratory, post hoc analysis, BTM was associated with a reduction in time to complete healing in large post-surgical diabetes-related foot wounds compared with USOC. Given the post hoc nature of this finding, confirmation in a prospectively powered trial is warranted.

Nature‐based solutions (NbS) have gained prominence as an integrated approach to addressing climate change and biodiversity loss while supporting sustainable development. Yet, their implementation across Southeast Asia remains fragmented and often contested. This paper uses qualitative documentary analysis of regional and national policy documents, complemented by five comparative case studies spanning forests, peatlands and coastal ecosystems. It investigates how carbon‐dense ecosystems in Southeast Asia are being positioned within evolving global frameworks for NbS and carbon market mechanisms. Our analysis is guided by two questions: (1) How do international definitions and discourses shape regional and national NbS policies? (2) How are governance arrangements structured across scales? The findings from these questions inform our broader discussion of the extent to which these emerging governance regimes aimed at conserving, restoring, or sustainably developing carbon‐dense ecosystems consider issues of equity and justice. We find that NbS framings are increasingly visible in Southeast Asian policy discourses, but operationalisation remains uneven. Whereas some projects align closely with national climate goals (e.g., Vietnam's REDD+ programme), others remain detached from the relevant Nationally Determined Contribution to emissions reduction (project case studies from Indonesia, Lao PDR, Malaysia, and Thailand). In such cases, nested governance structures are weakly institutionalised, and Indigenous and local communities are often excluded from benefit‐sharing mechanisms, undermining both legitimacy and equity. These findings underscore the need for more integrated, transparent and inclusive approaches to scaling NbS within the region.

Older adults with pre-frailty and frailty are vulnerable to malnutrition, yet often lack access to tailored, credible, and accessible nutrition education. Digital health tools offer a scalable solution, but little is known about how older adults with pre-frailty and frailty engage with them. This study explored the experiences of community-dwelling older adults with pre-frailty and frailty when engaging with an online nutrition educational resource to help people prevent and manage frailty. A qualitative study was conducted with community-dwelling older adults (≥ 65 years) who were screened as pre-frail or frail using the FRAIL scale. Participants were given access to an online nutrition educational resource for 2-4 weeks. Semi-structured interviews exploring participants' general interest in nutrition, their perspectives regarding the content, layout and usability of the online resource, and their learning preferences were conducted. Interviews were transcribed verbatim and analysed using codebook thematic analysis. 19 participants (mean age: 73.7 years) participated in this study, of which 14 were pre-frail (73.7%) and five were frail (26.3%). Six themes were identified: (1) using the resource, (2) drawing on lived experiences and dietary beliefs, (3) connecting nutrition and frailty, (4) tailoring nutrition and learning, (5) learning in different ways, and (6) empowering older adults. While these themes extend beyond resource usability alone, they collectively reflect the broader experiential and contextual factors that shape how participants engaged with and interpreted the online nutrition resource. Participants valued personalisation, multimodal learning formats, and the integration of lived experience. While some participants reported positive dietary changes after engaging with the resource, others described reflective learning without immediate behaviour change. Participants reported that digital literacy and personal learning goals and preferences influenced their experience of engaging with the online resource. Older adults with pre-frailty and frailty value online nutrition education but require resources that are personalised, credible, and accessible across diverse learning needs. Findings highlight opportunities to embed consumer voices in resource design and provide future directions for refining the current online nutrition resource. This research contributes to evidence on consumer-informed digital nutrition education to support autonomy, dietary self-management, and healthy ageing.

Meeting global climate change mitigation targets will require enhanced nature‐based carbon sequestration, in which forest carbon schemes play a major role. This is despite criticisms of forest carbon schemes' efficacy, social impacts, and downgrading of other forest functions and services. Against this backdrop, we reviewed existing social science research on the governance of terrestrial forest carbon schemes in Southeast Asia, a forest‐rich region with high deforestation rates that is in many respects representative of the wider tropics. Our narrative review focused on four themes: (i) finance and the political economy; (ii) knowledge; (iii) implementation; and (iv) inclusivity, equity, and justice for local communities. We found that forest carbon schemes have been unable to compete with large‐scale drivers of deforestation, tend to privilege scientific and expert knowledge in relation to carbon accounting and geospatial analyses, are significantly limited by national and local governance issues, and have often not provided the intended benefits for local communities. The literature reviewed largely focuses on donor‐supported and project‐scale REDD+. However, forest carbon governance is rapidly changing. We thus make the case for a governance research agenda that focuses on jurisdictional approaches, increasing levels of private sector investment, the diversification of forest interventions, and efforts to restore the legitimacy of forest carbon credits. These directions for future research are essential for ensuring that forest carbon schemes contribute to effective climate change mitigation and the conservation of forest ecosystems in just and equitable ways that benefit local communities in Southeast Asia and tropical latitudes more widely. This article is categorized under: Policy and Governance > Multilevel and Transnational Climate Change Governance

Coastal vegetated ecosystems such as mangrove forests, seagrass meadows, and tidal marshes provide a wide array of ecosystem services. They also play a vital role in climate change mitigation through carbon sequestration. However, they are among the most threatened ecosystems globally. This study addresses a key knowledge gap by conducting a systematic review of academic literature on sectoral perceptions of these ecosystems. Through content analysis, we identified common research themes across regions and examined how members of the public, private, and civil society sectors perceive coastal vegetated ecosystems. The results reveal regional differences: Asian countries tend to emphasize utilization and economic benefits, while North America and Europe focus more on conservation and management. Several studies explored perceptions of climate change mitigation. Our findings highlight gaps in perception between the private and government agencies. Understanding these diverse sectoral perspectives can inform policy interventions to enhance conservation efforts and strengthen governance strategies.

A prospective observational study was conducted in a cohort of older adults ≥65 years (n = 329), admitted to the acute medical unit (AMU) of a tertiary hospital, to describe and compare characteristics including frailty status and clinical outcomes. Multivariable models compared older adults with and without a history of cancer to determine characteristics associated with frailty and pre-frailty. An adjusted Poisson regression model was used to compare the length of hospital stay (LOS) between the two groups. About one-fifth (22%) of the cohort had a history of cancer. The most common cancer types were prostate (n = 20), breast (n = 13), lung (n = 8) and gastrointestinal (n = 8). There was no difference in the prevalence of pre-frailty/frailty among patients with or without a history of cancer (58% vs. 57%, p > 0.05). Pre-frailty/frailty was associated with polypharmacy (OR 8.26, 95% CI: 1.74 to 39.2) and malnutrition (OR 8.91, 95% CI: 2.15 to 36.9) in patients with a history of cancer. Adjusted analysis revealed that the risk of having a longer LOS was 24% higher in older adults with a history of cancer than those without (IRR 1.24, 95% CI 1.10 to 1.41, p < 0.001). Clinicians in the AMU should be aware that older adults with a history of cancer have a higher risk of a longer LOS compared to those without.