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Impact of Coronary Artery Disease Patterns Assessed with Pullback Pressure Gradient on Clinical Outcomes: Meta-analysis
No full textBackground and aims Diffuse coronary artery disease (CAD) impacts patients’ outcomes; however, its definition is not objectively established and varies across studies. Pullback pressure gradient (PPG) is a novel physiological index for quantitatively evaluating the pattern of CAD; nevertheless, its clinical utility has not been fully elucidated. This study aims to comprehensively assess the PPG prognostic impact on clinical and physiological outcomes. Methods The EMBASE, Medline, and PubMed databases were searched, following the PRISMA guidelines. Studies reporting pre-percutaneous coronary intervention (PCI) PPG measurements and post-PCI physiological indices or clinical outcomes were included. Data on clinical events were extracted at the longest reported follow-up. The primary endpoint for this meta-analysis was the composite of clinical events (major adverse cardiovascular events [MACE] or target vessel failure [TVF]). Results Thirteen studies were included in the analyses. In five studies, pullbacks were performed using an invasive approach, whilst eight used an angio-based method. The correlation between PPG and post-PCI fractional flow reserve (FFR) values was moderate (r=0.44, 95%CI:0.34-0.52, p<0.001). Compared to focal lesions, diffuse lesions had significantly lower post-PCI FFRs (mean difference = -0.05, -0.07 – -0.04, p<0.001) and significantly more frequent (RR = 1.93, 95%CI:1.76-2.11, p<0.001) suboptimal post-PCI physiological results (defined as low post-PCI FFR). Diffuse lesions were significantly associated with the composite of clinical events (RR=1.71, 1.34-2.20, p<0.001), MACE, TVF, myocardial infarction, and target vessel revascularization. Conclusions The pattern of coronary artery disease, as defined using PPG, significantly impacts physiological results post-PCI and the risk of cardiovascular events
Identifying innovative models of urgent care in rural coastal areas in England: the Elevate study - a mixed-methods protocol
No full textIntroduction
Urgent and emergency care (UEC) systems in England face unprecedented pressures, with record accident and emergency attendances, persistent breaches of ambulance response targets and poorer outcomes for time-sensitive conditions. National UEC recovery plans have introduced multiple innovations—such as same-day emergency care, virtual wards and specialty hubs—to manage these pressures and improve patient flow. Rural coastal areas are particularly vulnerable to excessive demand due to higher levels of deprivation, older populations with complex health needs, seasonal surges that generate unpredictable demand and challenges in attracting and retaining staff. Following the Chief Medical Officer’s 2021 Annual Report, funding research and developing bespoke solutions to manage UEC demand and address geographical disparities has been recognised as a national priority. The Elevate study responds to this priority by identifying and evaluating innovative models of UEC in rural coastal communities in England.
Methods and analysis
The Elevate study is a 30-month, mixed-methods evaluation that comprises three interlinked work packages: (1) National service mapping —outlining provision of innovative models of UEC in rural coastal areas of England. This will be developed through document review and interviews with regional and national service leaders. (2) Quantitative analysis —quasiexperimental and longitudinal approaches will use National Health Service (NHS) England’s Emergency Care Data Set and linked routine NHS datasets to evaluate the impact of UEC models on health and process outcomes. Standard and bespoke metrics will be developed and used to assess performance. (3) Qualitative case studies —up to 12 case studies of UEC models in rural coastal communities. Interviews with patients and staff and non-participant observation will explore how and why different UEC models influence patient experience, clinical outcomes, resource use and the workforce. Findings will be integrated using the Consolidated Framework for Implementation Research to identify components of UEC models that are effective, scalable and sensitive to local context,
Ethics and dissemination
Ethical approval for qualitative components was granted by the North of Scotland Research Ethics Committee (25/NS/0099). Dissemination will include peer-reviewed publications, policy briefs, creative media and community engagement activities to ensure findings are communicated inclusively and effectively to policymakers, health and social care practitioners and the public.
Trial registration number
Research Registry (researchregistry11126)
Medical education in Gaza: navigating disruption during the 2023–2025 Israeli military assault and beyond
No full textBefore October 2023, Gaza’s medical education, offered by Al-Azhar University and the Islamic University, enrolled around 2500 students and played a vital role in training local physicians despite the blockade-related challenges. The ongoing military assault has since devastated both the educational and healthcare infrastructure. Medical schools and hospitals have been damaged, destroyed, or militarized, while students and faculty have faced displacement, resources scarcity, and severe psychological distress. Education has been further disrupted by power outages, internet restrictions, unsafe travel and harsh living conditions. Despite these obstacles, students and faculty continue to adapt. Many have completed courses online, relocated abroad, or even managed to fulfill graduation requirements. Yet credentialing barriers and mental health burdens persist. Urgent global collaboration is needed to restore Gaza’s medical education. Key priorities include expanding online programs, offering diverse training opportunities, creating safe learning environments, and supporting mental health. Recognizing Gazan medical students’ frontline volunteering experience is also essential. This paper documents the state of medical education in Gaza before and during the 2023–2025 assault, examines its disruptions, and outlines recovery strategies drawing from available reports and academic literature
The Meanders of Populism and Antipopulism in Polish Contemporary Cinema
No full textThis article explores populist cinema in Poland after the Second World War, in the context of changes in Polish politics. Of particular interest is the period after 2015, when the term ‘populism’ entered into wide use in Poland and when we observe the production of a large number of films which can be described as ‘antipopulist’, mainly by female directors. The article focuses on two such films, directed by Agnieszka Holland: Spoor/Pokot (2017) and Zielona granica/Green Border (2023), trying to dissect their ideology. It argues that Holland in these films uses strategies associated with socialist realism, to discredit her ideological opponents, most importantly conservative Catholic provincials
Cancer diagnoses, referrals, and survival in people with a learning disability in the UK: a population-based, matched cohort study
No full textBackground
People with a learning disability (LD, also known as intellectual disability) face poorer health outcomes, yet the burden of cancer in this population is poorly understood. This study investigated cancer-related outcomes in people with a LD compared to the general population.
Methods
A matched cohort study was conducted using linked primary care, hospital, mortality, and cancer registry data from Clinical Practice Research Datalink (CPRD) Aurum. In total, 180,911 individuals with a LD were matched with 3,405,467 controls. Outcomes included urgent suspected cancer (USC) referrals, cancer diagnoses, treatment within six months, and overall survival (OS) post-diagnosis.
Findings
Individuals with a LD had fewer USC referrals within 28 days of possible cancer symptoms (adjusted risk ratio [aRR] 0.52, 95% confidence interval [CI] 0.49–0.55). LD was associated with several cancers, including sarcoma (adjusted hazard ratio [aHR] 1.98, 1.65–2.39), central nervous system (aHR 3.42, 2.99–3.90), testicular (aHR 2.06, 1.61–2.62), and uterine cancers (aHR 1.69, 1.40–2.05) as well as cancer before age 50 years (aHR 1.74, 1.63–1.86). Absolute incidence was lower in individuals with a LD compared to without (3396 [1.9%] vs 67,506 [2.0%]) due to increased all-cause mortality (aHR 3.19, 3.12–3.27). LD was associated with fewer diagnoses via USC referrals (aRR 0.81, 0.76–0.86), fewer treatments within six months (aRR 0.83, 0.80–0.85) and shorter OS (median 4.4 years, 95% CI 3.9–5.1 vs 9.1 years, 8.8–9.5; aHR 1.73, 1.65–1.83). Melanoma, breast, and prostate cancers were less common but had up to a fourfold increased risk of death after diagnosis in individuals with a LD.
Interpretation
Individuals with a LD have higher cancer risk, more diagnoses outside USC pathways, fewer treatments, and poorer prognosis. Fewer diagnoses of some cancers, alongside worse outcomes, may indicate under-investigation. As premature all-cause mortality improves, cancer burden in this population may rise disproportionately
Impact of environmental pollution on acne: a systematic review
No full textIn an increasingly urbanized world, environmental pollution is recognized for its adverse effects on both systemic and skin health. While its role in conditions such as atopic dermatitis and psoriasis is well documented, its impact on acne vulgaris remains less clear. This review aims to evaluate existing literature examining the association between environmental pollutants – such as particulate matter (PM2.5, PM10), nitrogen oxides (NO2, NOx) and traffic-related emissions – and the development, severity or exacerbation of acne. A systematic search of peer-reviewed English-language studies published between 2010 and 2025 was conducted using PubMed. Search terms included ‘air pollution’, ‘particulate matter’, ‘PM2.5’, ‘PM10’, ‘NO2’, ‘NOx’, ‘environmental pollution’, ‘traffic pollution’, ‘acne’ and ‘acne vulgaris’. Studies were included if they investigated the relationship between environmental pollutants and acne in human populations. Of the 27 studies identified, 17 met inclusion criteria. Systematic reviews were also incorporated to provide broader context. Several studies demonstrated significant associations between pollutant exposure and acne exacerbation. A time-series study in China involving 71 625 outpatient visits found that each 10 μg m–3 increase in SO2 and NO2 correlated with 1.02% and 2.13% increases in acne-related visits, respectively. Other studies appear to show pollutants being associated with increased sebum production and reduction of antioxidants. Proposed mechanisms include oxidative stress, microbiome disruption and follicular hyperkeratinization. However, study heterogeneity, lack of diversity and limited control for confounders limit generalizability. Longitudinal research is needed to clarify pollution’s role in acne and inform targeted prevention strategies
Factors differentiating change of direction performance in NCAA power 4 male basketball athletes
Get PDFThe aim of this study was to investigate COD performance in an elite basketball cohort to determine which phase specific qualities are most strongly associated with COD performance. One hundred and twenty-four male basketball athletes (age = 20.9 ± 1.23 years, height = 195 ± 14.3 cm, body mass = 89.9 ± 10.2 kg) from 10 different NCAA Power 4 basketball programs participated in this study. COD performance was assessed using a modified 505 (m505) COD test with phase specific and overall COD performance times measured via a portable motorized resistance device. Multiple linear regression was used to explore how total time to complete the m505 was influenced by the different phase-specific outcome measurements and differences between bigs ( n = 54) and guards ( n = 70) calculated using independent t-tests and Cohen's effect size. Four phase specific COD metrics significantly associated with m505 COD time to completion, including: time phase 1a ( r = 0.90, p < 0.001), time phase 1b ( r = 0.77, p < 0.001), maximal acceleration 1a ( r = -0.73, p < 0.001) and maximal deceleration ( r = −0.42, p < 0.001). These findings highlight the importance of phase specific outcome measures when assessing COD performance in elite basketball athletes
Growth-related injuries in children and youth soccer players
No full textThis review examines growth-related injuries in children and youth football players, emphasising the importance of a biopsychosocial approach to injury prevention and rehabilitation. It highlights the physiological differences between young and adult athletes, outlines specific injury types associated with growth phases, and explores key rehabilitation factors, including nutrition, sleep, and mental well-being
From Chaos to Clarity: How Leaders Leverage the Value and Impact of the Multi-Disciplinary Team in Elite Sport.
No full textPurpose/Rationale
This study explores how leaders in elite sport environments maximise the impact of multidisciplinary teams (MDTs) to enhance athlete performance and drive organisational success. It addresses a gap in the existing literature on leadership's role in leveraging the value of MDTs in complex high-performance sporting contexts.
Design/Methodology/Approach
The research employs a qualitative methodology using semi-structured interviews with eight (n = 8) leaders from diverse sports backgrounds. A reflexive thematic analysis was applied to capture rich, contextual insights and to construct a model of leadership strategies for optimising MDT functioning.
Findings
Leaders attend to two interrelated domains: the people domain, which focuses on fostering professional intimacy, establishing high-performance climates and enabling collaboration; and the context domain, which involves navigating complexity, exercising good judgement and solving performance problems. Effective leadership requires balancing these domains while exhibiting confidence and adaptability in high-stakes environments.
Practical Implications
The findings provide a framework for leaders and sport organisations to enhance and extract the value of MDT performance through structured problem-solving, clear communication and alignment of diverse expertise.
Research Contribution
This study contributes to understanding leadership of MDTs in elite sport, offering new insights into how leaders leverage MDTs and attempt to transform inherently complex systems into clarity.
Originality/Value
This study introduces a novel model that identifies what leaders do and what they attend to when leveraging the expertise within MDTs, presenting strategies to manage the complexity and uncertainty that exists in these contexts effectively
Impact of Chronic Kidney Disease on Outcomes With Drug‐Coated Balloons Versus Drug‐Eluting Stents: Insights From the REC‐CAGEFREE I Trial
No full textBackground
Data regarding the efficacy and safety of drug‐coated balloons (DCBs) versus drug‐eluting stents (DES) in patients with chronic kidney disease (CKD) remains limited.
Aims
To assess the prognosis of DCB versus DES in patients with and without CKD.
Methods
REC‐CAGEFREE I was an investigator‐initiated, non‐inferiority trial conducted at 43 sites in China, which randomized 2272 patients to paclitaxel‐coated balloons with the option of rescue stenting (DCB group) or second‐generation sirolimus‐eluting stents (DES group) for treating de novo lesions, regardless of vessel diameter. In this pre‐specified subgroup analysis, patients were stratified based on the presence of CKD (kidney damage or estimated glomerular filtration rate < 60 mL/min per 1.73 m²) at baseline. The primary outcome was the device‐oriented composite endpoint (DoCE; including cardiovascular death, target vessel myocardial infarction, and clinically and physiologically‐indicated target lesion revascularization) at 2 years.
Results
Of 2272 patients enrolled, 203 (8.9%) had CKD, with 95 and 108 treated with DCB and DES, respectively. At 2 years, the risk of DoCE was significantly higher in CKD versus non‐CKD patients (22/203 [10.9%] vs . 88/2069 [4.3%], HR IPTW : 2.14, 95% CI: 1.13−4.07, p = 0.022). There was no significant interaction between CKD and treatment allocation ( p interaction = 0.352). Among CKD patients, DoCE occurred in 12/95 (12.7%) and 10/108 (9.3%) patients in the DCB and DES groups (HR IPTW : 1.57, 95% CI: 0.66−3.71, p = 0.317), respectively. Among non‐CKD patients, DoCE occurred in 60/1038 (5.8%) versus 28/1031 (2.7%) patients in the DCB and DES groups (HR IPTW : 2.27, 95% CI: 1.38−3.72, p = 0.002), respectively.
Conclusion
Patients with CKD had worse outcomes compared to those without. DCBs were associated with a higher risk of DoCE than DES, irrespective of CKD status.
Trial Registration
Unique Identifier: NCT04561739; URL: https://www.clinicaltrials.gov