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Differential effects of dual antiplatelet and dual antithrombotic therapy on hemostasis in chronic coronary syndrome patients: the DEFINE CCS study
Get PDFOptimal long term antithrombotic treatment in high-risk chronic coronary syndrome (CCS) patients remains uncertain. Both ticagrelor (60 mg BID) and low-dose rivaroxaban (2.5 mg BID) in addition to low-dose aspirin resulted in significant reductions in major cardiovascular events in high-risk patients at the expense of increased bleeding risk. We aimed to compare the effects of both strategies on bleeding time, fibrin clot lysis time and inflammatory biomarkers in CCS patients with history of acute coronary syndrome. Twenty aspirin-treated patients were recruited into a randomized crossover study to receive ticagrelor 60 mg BID in 1 week and rivaroxaban 2.5 mg BID in the other with a 2-week washout period in between. Outcome measures were determined at the start and end of each treatment week. Two-way ANOVA was used to determine difference in treatment effect. Data are presented as mean ± SD. At baseline, there was no significant difference in any studied outcome measure. Bleeding time was significantly longer with ticagrelor compared to rivaroxaban (Ticagrelor: 897 ± 481secs vs. Rivaroxaban: 440 ± 184 secs; p = .0001). Fibrin clot lysis time was not impacted by ticagrelor but significantly dropped post treatment with rivaroxaban (Ticagrelor: 5743 ± 2590 secs vs. Rivaroxaban: 4309 ± 2308 secs; p = .0049). Neither treatment had an impact on levels of high-sensitivity CRP or white cell count. In conclusion, ticagrelor 60 mg BID has greater impact on bleeding time compared to rivaroxaban 2.5 mg BID. Whereas rivaroxaban, positively modulates fibrin clots, rendering them more prone to lysis
Molecular architecture of thylakoid membranes within intact spinach chloroplasts
Get PDFThylakoid membranes coordinate the light reactions of photosynthesis across multiple scales, coupling the architecture of an elaborate membrane network to the spatial organization of individual protein complexes embedded within this network. Previously, we used in situ cryo-electron tomography (cryo-ET) to reveal the native thylakoid architecture of the green alga Chlamydomonas reinhardtii (Engel et al., 2015) and then map the molecular organization of these thylakoids with single-molecule precision (Wietrzynski et al., 2020). However, it remains to be shown how generalizable this green algal blueprint is to the thylakoids of vascular plants, which possess distinct membrane architecture subdivided into grana stacks interconnected by non-stacked stromal lamellae. Here, we continue our cryo-ET investigation to reveal the molecular architecture of thylakoids within intact chloroplasts isolated from spinach (Spinacia oleracea). We visualize the fine ultrastructural details of grana membranes, as well as interactions between thylakoids and plastoglobules. We apply AI-based computational approaches (Lamm et al., 2024) to quantify the organization of photosynthetic complexes within the plane of the thylakoid membrane and across adjacent stacked membranes. Our analysis reveals that the molecular organization of thylakoid membranes in vascular plants and green algae is strikingly similar. We find that PSII organization is non-crystalline and has uniform concentration both within the membrane plane and across stacked grana membranes. Similar to C. reinhardtii, we observe strict lateral heterogeneity of PSII and PSI at the boundary between appressed and non-appressed thylakoid domains, with no evidence for a distinct grana margin region where these complexes have been proposed to intermix. Based on these measurements, we support a simple two-domain model for the molecular organization of thylakoid membranes in both green algae and plants
Patient perceptions of advance care planning within primary care: a systematic review of facilitators and barriers
Get PDFBackground
Advance care planning is a key aspect of palliative care and aims to establish patient preferences for future care, benefiting patients and their families. Palliative care, including advance care planning, is often provided by primary care physicians. Levels of advance care planning, however, remain low internationally. We aimed to conduct a systematic literature review to understand the barriers and facilitators encountered by patients when considering advance care planning conversations within the primary care setting.
Methods
Five electronic databases (Ovid MEDLINE, PubMed, PsycINFO, CINAHL and Scopus) and grey literature were searched in April 2025. Quantitative and qualitative data were extracted and synthesised using a convergent, integrated approach. The Mixed Methods Appraisal Tool was used to assess study quality.
Results
From 2495 articles, 48 studies were included. Barriers and facilitators can each be categorized into three themes, with further subthemes: 1) Professional factors, which encompassed the relationship between patient and healthcare professional, the skills and attributes of the healthcare professional, and the specific role of the healthcare professional in the advance care planning process; 2) Patient factors, including perceptions of self, family role, personal and religious views of advance care planning, and personal characteristics; 3) Features of the advance care planning conversation.
Conclusions
To enhance advance care planning uptake, there should be protection of relationships between healthcare professional and patient, adequate time for face-to-face conversations, and relevant training for healthcare professionals. More widely, increasing public awareness of these topics is vital. It is essential to balance standardisation to encourage and support these conversations, whilst maintaining an individualised approach
Diversity in Femvertising: An Experimental Investigation
Get PDFDiversity in femvertising—advertising that empowers women through inclusive representation—has gained significant traction in recent times. Yet consumer perceptions of its authenticity and effectiveness remain underexplored. This study examines the impact of diverse representation in femvertising on brand attitudes, purchase intentions, and consumer behavior. Findings from four experimental studies reveal that diversity enhances brand perceptions and purchase intentions, mediated by perceived brand authenticity. However, political orientation moderates these effects; liberals respond more positively to diverse advertisements while conservatives prefer homogeneous representations. These insights highlight the importance of authenticity in femvertising and the potential risks of tokenism and political polarization. The research contributes to advertising knowledge by incorporating intersectionality, examining behavioral outcomes, and addressing the ideological divide in consumer responses. Practical implications suggest that brands should balance diversity with authenticity to foster inclusivity without alienating key audiences. Future research should explore the optimal level of diversity, long-term effects on brand loyalty, and the role of AI-driven personalization in diverse advertising
Constructing a single market for pharmaceuticals in the EU: what’s the price?
Get PDFThe European Union (EU) is currently overhauling its pharmaceutical regulations, seeking to mature a single market for medicines as part of a ‘European Health Union’. We reflect on the interactions between regulations and markets in these reforms and investigate what this single market for medicines may mean in practice. We note how the proposed reforms aim to ensure equitable access to innovative treatments, yet at the same time, tie this access directly to regulatory exclusivities, limiting price competition. The reforms also do not seek full pricing transparency: prices will remain largely opaque and be set at the national levels rather than created through market exchange and open competition at the EU level. The envisioned single market for medicines thus remains a market that operates without direct reference to price − a situation not addressed head-on by the proposed reforms
Focus on community energy and infrastructure resilience
Get PDFThis focus issue on community energy and infrastructure resilience compiles six contribution that seek to put into context projects that aim to put people at the core of energy development. The promises of community energy are multifold, from facilitating the democratization of energy systems to allowing for the development of decentralized and off-grid networks, which may accelerate the adoption of renewables. However, community energy also faces challenges. In this case, the special issue focused on challenges related to infrastructure resilience, whether they are linked to building resilience in community energy projects or to the contributions that community energy projects make to advance sustainability transitions. This focus issue makes five key thematic contributions: the importance of community engagement in building resilience, analytical tools to understand the multi-dimensional nature of infrastructure resilience, the need to incorporate place-based concerns into policy, the development of tools to evaluate different aspects of resilience, and the explicit consideration of gender equality and social inclusion to facilitate project sustainability
Participatory Q: a collaborative approach to Q-methodology
Get PDFParticipatory research continues to attract attention across academia, civil society, policymaking, and research funding landscapes. Yet Q methodology has not fully explored the full potential of participatory practice, despite its well-recognised democratic characteristics. In this article, we introduce ‘Participatory Q’, a co-productive reimagining of Q methodology, offered not as a prescriptive roadmap for a perfectly participatory approach (if such a thing were even possible), but as a research orientation that challenges researchers to work more collaboratively and reflexively. We propose Participatory Q as both a methodological and epistemological intervention, one that aims to de-centre dominant knowledge systems rooted in the colonial legacy of the Academy, and to foreground pluralistic, community-informed ways of knowing. Drawing on the Queering Shelter project - which explored the meanings of ‘shelter’, ‘safe space’, and ‘home’ among LGBTQ + communities in England, UK - we describe how participatory principles were integrated across all stages of the Q methodology process: from study design and concourse development to analysis and output creation. The aim for this article is to serve as a useful starting point on which others can build, in order to advance Q methodology practice in ways that are not only participatory in technique but also disruptive of epistemic hierarchies
The Influence of Rising Infant Mortality on falling/stalling Life Expectancy (brief report)
Get PDFIn the post-2010 period in England, largely attributable to austerity measures, two unexpected demographic trends emerged. Infant mortality rates rose and life expectancy at best stalled, and at worse fell. Various analyses of life expectancy trends have unpicked the age-specific mortality rates but without a focus on deaths to infants aged less than one year of age. Since this age-group is the first age in life expectancy calculations, it is possible that changes in infant mortality rates form part of changes in life expectancies. This brief report investigates time trends in infant mortality and life expectancy (LE) at birth between the years 2000 and 2019 by Index of Multiple Deprivation 2015 (income) quintile. Using 2014 as the ‘jump off’ year as this was when infant mortality began to rise, alternative scenarios for the first year of life in LE calculations are used to reveal whether any differences in LE at birth occur, including if the downward trends in infant mortality observed prior to 2014 had continued to 2019. Even though the trend-based model estimates an excess of nearly 1,400 infant deaths occurred, the results show no significant impact on the life expectancy at birth calculations between the observed and scenario-based infant mortalities. This is important for researchers to know since anyone seeking to understand pre-pandemic falling / stalling life expectancies can concentrate on other aspects to determine key reasons. Further work on infant mortality is required since, post-pandemic, rates have risen again
‘Beating the App’ or Pyrrhic Victories?:Gamification, Workaholism and FoMO in UK Food-Delivery Platforms
Get PDFThis article examines the relationship between the gamification of platform food-delivery work and workaholism. Drawing on a qualitative study, our findings suggest that while financial needs act as a ‘push’ factor, encouraging workers to enter off-line platform work, gamification serves as a ‘pull’ factor - driving an introjected motivation that draws couriers into the compulsive behaviours associated with workaholism. The more exposure that couriers have with these gamified apps, the more likely they are to think that they can ‘beat the app’. However, the algorithm is always one step ahead, resulting in illusory wins or pyrrhic victories for couriers. While gamified apps limit couriers’ choice architecture and the possibilities for counter-gamification, they also reduce couriers’ rational self-reflection, driving couriers to work excessively and compulsively, with couriers exhibiting Clarke et al.’s (2020) four dimensions of workaholism: motivational, behavioural, cognitive, and, in particular, the emotional dimension - the fear of missing out (FoMO)
Delivering the Best Start in Life strategy: Planning and data for local context
Get PDFThe government’s Early Years strategy for England ‘Giving every child the best start in life’, outlines Local Authority funding to ensure children are ready to start school at age 5. The use of data to understand local needs and what works is essential to deliver targeted investments. In this policy brief we set out guidance for Local Authorities to develop their data use, drawing on best practice. We also give a series of recommendations to Local Authorities and the Department for Education on the steps needed to improve how data is used to inform strategic investment under the government's Best Start Strategy
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