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TCT-516 Cumulative Plaque Burden Analysis for Phenotyping Epicardial Coronary Artery Disease
No full textBackground
Intravascular ultrasound (IVUS) shows the location and burden of coronary plaques. However, plaque analyses are typically limited to the segment level, preventing the characterization of vessel-level CAD patterns based on plaque distribution, which impacts clinical outcomes. We aimed to characterize and correlate the morphologic and physiologic patterns of CAD through quantitative IVUS analysis.
Methods
In this ASET JAPAN trial subanalysis, pre– and post–percutaneous coronary intervention (PCI) ultrasonic flow ratio (UFR) was analyzed. The percentage plaque burden (PB) of each millimeter on pre-PCI IVUS was quantified, and the cumulative plaque burden (CPB) curves were created. To characterize coronary morphologic patterns, the CPB index (CPBi) was calculated, based on the filtered CPB curves (PB <40%) (Figure 1A).
Results
A total of 130 vessels (8,101 mm) from 123 patients were analyzed. The CPBi of 0.45 (Q1-Q3: 0.32-0.58) correlated well with the UFR-derived pressure pullback gradient index (PPGi) of 0.42 (Q1-Q3: 0.34-0.52; r = 0.64; P < 0.001; Figure 1B). Compared with vessels in the first tertile of CPBi (<0.36), vessels within the third tertile CPBi (≥0.56) had significantly higher percentage atheroma volume (0.54 [Q1-Q3: 0.50-0.59] vs 0.43 [Q1-Q3: 0.39-0.48]; P < 0.001) and received longer stents (28.0 mm [Q1-Q3: 24.0-34.0] vs 20.0 mm [Q1-Q3: 16.0-28.0]; P < 0.001). ROC curve analysis showed that the CPBi was numerically superior to PPGi for predicting post-PCI UFR ≥0.91 (Figure 1C).
Conclusions
CPB analysis offers clinicians an individualized tool to guide PCI based on CAD morphologic patterns
Strengthening Africa’s response to Mpox (monkeypox): insights from historical outbreaks and the present global spread
Get PDFMpox, formerly known as Monkeypox, is a viral zoonotic disease endemic to Central and West Africa that has posed significant public health challenges since its identification in 1970. Despite decades of experience in managing outbreaks, the 2022–2024 Mpox outbreaks exposed substantial gaps in global preparedness and response, leading the World Health Organization (WHO) to declare the outbreak a Public Health Emergency of International Concern (PHEIC) in 2022. The resurgence of cases in Europe in 2022 and the more recent emergence of the virulent clade Ⅰb in the Democratic Republic of the Congo (DRC) in 2024 have highlighted a critical need for improved proactive and response strategies to curb the epidemic. This narrative review examines the historical and recent epidemiology of Mpox in Africa and explores the factors that have limited effective management. These include objective influences such as viral mutations, zoonotic transmission patterns, and environmental changes like deforestation, as well as subjective factors, including delayed responses, limited vaccine availability, cessation of smallpox vaccinations, and inequitable access to healthcare. In particular, the review emphasizes the ongoing disparities in global health equity, as wealthier nations have been able to secure vaccines and therapeutics quickly, while endemic regions in Africa continue to struggle with limited resources. The review also discusses how socioeconomic and cultural factors, combined with weak public health infrastructure and inadequate surveillance systems, perpetuate cycles of outbreak in vulnerable populations. Furthermore, the emergence of clade Ⅰb in 2024, with its higher virulence and mortality rates among children, particularly in rural areas, underscores the urgency of addressing the evolving epidemiological landscape of Mpox. In response to these challenges, this review recommends strengthening healthcare infrastructure, enhancing surveillance systems, ensuring equitable access to vaccines and treatments, and integrating environmental management into public health strategies. Global collaboration remains essential to provide African countries with the resources and support needed to manage and prevent future outbreaks effectively. Without these measures, the world risks a prolonged public health crisis with far-reaching consequences for both Africa and the global community
Navigating the road to recovery after stroke
Get PDFThis article considers the patient experience of rehabilitation after stroke, the current situation and how things might be in the future. It draws on presentations given at the European Stroke Organisation's conference this year in Switzerland, and draws conclusions about unmet needs, and health and social care services
How 3D printing technologies could undermine law enforcement strategies targeting the production and distribution of designer drugs
Get PDFCountering the supply of counterfeit and designer drug pills laced with fentanyl or its analogues has long been a challenge with the potency of the drug and the ease with which it can be obtained impacting greatly on families and the wider society. The introduction of legislative measures to restrict access to the machinery that allows the production of the pills has yielded considerable gains with numerous seizures of pill presses reported. However, the increasing availability of bench top milling machines and advances in 3D printing could render this a short term victory where the technology may be set to outpace the capabilities of conventional law enforcement. While pill presses were once born from high specification industrial machining, low cost mills and 3D printing systems are already at the stage of producing small format presses within the domestic home. Here, a spotlight is trained on fentanyl (and its analogues) from the perspective of pill manufacture and their supply. An overview of pill press mechanics and the approaches presently taken to counter distribution is provided and the potential influence that both milling systems and 3D printing technologies could have in the future is critically evaluated
Development of a Fire Safety Assessment Test for External Cladding Systems
Get PDFIn the context of increasing façade fires, especially in the UK, where combustible cladding systems are approved for high-rise buildings, this study addresses concerns related to fire testing cladding systems. Key developments include:
1. Comprehensive Database of BS 8414 Tests: A database was compiled, analysing various cladding systems and their subsequent fire performance. It highlights certain systems' unrealistic construction methods, which aren’t replicated in real buildings. It also raises concerns around thermocouple criteria and placement relative to the fuel load. Test results were analysed to estimate the impact of changing the evaluation criteria.
2. Material Fingerprinting: A method for characterising cladding products was developed, using microscale combustion calorimetry and infrared spectroscopy to assess chemical composition and properties relating to fire performance.
3. RISC 501 Development: This study proposes a new fire test method and assessment criteria for external cladding systems, called RISC 501, which can be conducted alongside the existing BS 8414 test method, allowing conference with the BR 135 performance criteria. While BR 135 is focused on life safety, RISC 501 specifies enhanced performance criteria to focus on property protection. It incorporates revised requirements for the test construction, material characterisation, temperature criteria, and mechanical performance criteria. It also includes gas sampling methods to assess potential smoke toxicity produced by a burning cladding system.
4. Validation Tests: Validation tests confirm RISC 501's effectiveness in distinguishing between combustible and non-combustible cladding systems, offering a clearer performance differentiation compared to the BR 135 criteria. The proposed gas sampling method effectively distinguishes between combustible and non-combustible systems and provides insights into predicting the Fractional Effective Dose for incapacitation.
In summary, this study produces research to aid the development of a fire test and assessment for external cladding systems and then uses that research to develop RISC 501 – Fire Safety Assessment Test for External Cladding Systems
Responding to Disclosure: A Study to Explore the Preparation of Trainee Teachers to Operationalise Safeguarding Policy in the Context of Adolescent Sexting Behaviour
Get PDFThis professional doctorate explores the content and efficacy of safeguarding training for secondary computer science trainee teachers, referred to as trainees or computing teachers. The research focuses on the preparation of trainees to operationalise safeguarding policy in the context of disclosures of online Aggressive Adolescent Sexting Behaviours (AASB) in secondary schools located in North-West England. The researcher studies key stakeholders and trainees, seeking to answer three research questions: How do trainees define sexting behaviours? How should trainee teachers plan to respond to AASB? How do trainees plan to respond to AASB? This study uses Kincheloe and Berry’s (2004) conceptualisation of Bricolage methodology and Quinlan and Cross’s (2020) adaptation of Papert’s (1993) Computational Thinking (CT) that informed the theoretical and conceptual framework to structure this research investigation. Lipsky’s (1980) ‘Street Level Bureaucracy’ was applied to explore simulated trainee policy enactment. This research uses three methods to elicit data:
• Vignettes containing sexting incidents derived from Wolak and Finkelhor’s (2011) study, ‘Sexting a Typology’, combine vignettes with trainee participant surveys.
• A trainee focus group.
• Semi-structured interviews with participant experts. Text-based thematic analysis identifies emergent themes using Braun and Clarke’s (2022) thematic analysis.
Preliminary findings indicate a trainee knowledge gap regarding constructing comprehensive definitions of sexting behaviours and identifying the constituents of AASB. Trainees expressed apprehension concerning encountering AASB pupil disclosures in schools and discussed limited exposure to training and support. Practitioner experts and consultants state that trainees should know who school safeguarding officers are and should be able to use school safeguarding reporting systems confidently. Furthermore, practitioner and consultant experts expect trainees to possess skillsets that support and reassure AASB victims and specifically know how to help and direct pupils regarding removing imagery from the Internet. The Office for Standards in Education (OFSTED, 2021b) identifies the need to address sexually aggressive behaviour in schools. Therefore, the recommendations here stress the need for trainees to experience consistent AASB training. Further findings indicate that current training resources to address AASB and cyberbullying behaviours in schools are inadequate for novice teachers, and this study recommends updating these resources
Inspiring recruitment to paediatric neurology- an inspiring educational event
No full textIntroduction Paediatric neurology is an important subspecialty, to which medical students have very limited exposure. Given ever-growing demand for paediatric neurologists, targeted interventions to improve awareness and recruitment into the specialty is necessary. We (The Neurology and Neurosurgery Interest Group (NANSIG)) organised a single-day high-yield webinar in collaboration with the British Paediatric Neurology Association.
Methods A 1-day webinar was organised with three keynote speakers from different stages of paediatric neurology training. Feedback was captured through a robust iteratively designed questionnaire, with data analysed descriptively. Our primary aim were to improve awareness of a career in paediatric neurology through this single-day intervention.
Results Survey response rate was 24/25 (96%), with 83.3% of respondents being medical students. We demonstrate significant improvement in awareness of the role of a paediatric neurologist (22/24 individuals were ‘not at all’/‘somewhat’ aware prior to the webinar, with 21/24 being ‘very aware’ or ‘extremely aware’ after the webinar). Interestingly, 9/24 individuals mentioned this event has likely could influence their future career as a paediatric neurologist.
Conclusion Our findings demonstrate the significant impact of single-day, high-yield, educational interventions in improving awareness of niche subspecialties. These findings are potentially transferable to improving awareness of other smaller subspecialties in neurology
Eccentric Strength Training for Improving Horizontal Deceleration Ability: The use of the Braking Performance Framework
No full textIn a previous post, written for Science of Multi-Directional Speed, I highlighted the very high forces that are generated across very short time frames (i.e., impulse) when decelerating rapidly. I also highlighted the necessity to be able to skilfully attenuate and distribute these forces throughout the muscles and connective tissue structures of the lower limbs to help reduce likelihood of tissue damage and neuromuscular fatigue. This could be done by enhancing two key modifiable factors 1) horizontal deceleration skill and 2) horizontal deceleration specific strength qualities (Harper & Kiely, 2018). A notable strength quality that could help to increase the ability to generate braking impulse and mitigate extent of tissue damage and neuromuscular fatigue is eccentric strength (Harper, McBurnie, et al., 2022). The importance of this strength quality for attaining faster reductions in whole-body momentum, whilst maintaining neuromuscular control and stability of the knee joint during the preparatory deceleration phase of a sharp change of direction (COD), has also been highlighted. Therefore, understanding how eccentric strength can be developed is significantly important to a range of athletes involved in multi-directional sports and for sport science and medicine practitioners who are tasked with the responsibility of ensuring optimal preparation of athletes to meet the demands of competition
Probing the Complexities of ‘Simple’ Stellar Populations in Compact Stellar Systems
Get PDFIn this Thesis, we present an unprecedentedly large sample of compact stellar system integrated light spectra and spectral line measurements, much of which has been obtained for this thesis through new observations or reduced for the first time with custom reduction pipelines. We present the results of the analysis of the stellar populations of several hundred compact stellar systems ranging in size from globular clusters to massive compact ellipticals and beyond. We adopt previously used analysis techniques as well as developing our own with the aim to recover “simple” parameters such as age, metallicity and alpha abundance. Based on comparison with resolved star studies of Milky Way globular clusters, we find that age is poorly constrained while metallicity is returned accurately and [α/Fe] is returned reliably under specific conditions.
Problems with age measurements are a common problem in integrated light studies of compact stellar systems, usually manifested in globular clusters as an underestimation in age. We suggest this is due to populations of hot blue horizontal branch stars at low metallicity ([Fe/H] ≤ -1.0) and blue straggler stars (for higher metallicities of [Fe/H] ≥ -1.0) which are unaccounted for in standard simple stellar population models. In order to better constrain the ages of the predominately metal-rich, massive, compact stellar system population, we therefore create a new set of models using a simple algorithm to add a fraction of younger star light to sMILES models to account for blue straggler stars. We find that these models produce better age estimations for Milky Way globular clusters and increase age measurements in general for all objects in our sample, while having minimal effect on metallicity or alpha measurements. Under the assumption that all compact stellar systems host populations of blue stragglers we therefore suggest the common usage
of such models when studying at least compact stellar populations, if not galaxies in general
We explore other parameters of compact stellar systems including relations between their mass and metallicity and dive into specific chemical abundances in the form of nitrogen enhancements. We suggest possible formation scenarios for many objects based on their derived star formation histories, metallicity spreads, measured ages and metallicities. We find nitrogen enhancement in many objects from globular clusters to the most massive galaxies hinting at a possible nitrogen - density correlation. We also identify another UCD which, based on its position in the mass-size plane, high metallicity, and high integrated velocity dispersion, is highly likely to host a supermassive black hole. Finally we identify potential signatures of star formation in a red and dead red nugget galaxy and signatures of potentially the first active galactic nucleus in a compact elliptical galaxy
Social Abstractionism: Abstract Objects, Abstract Space, Sociological Potentialities
Get PDFArthur Schopenhauer once stated, "we human beings always lead a second, abstract life alongside our concrete life”. When we separate life into that which is concrete and that which is abstract, abstract being that which has no concrete existence, we find that most social life is lived out via the abstract. With the intent of making a founding contribution to a new mode of sociological thought based on this notion, this purely theoretical thesis will explore the possibilities of social abstractionism. Social abstractionist principles will be outlined and demonstrated through utilising two concepts loosely based on Platonist philosophy and the work of Henri Lefebvre: abstract objects and abstract space, respectively. Regarding Platonism, I adopt and adjust the concept of abstract objects. In Platonist thinking, abstract objects have no spatiotemporality, are indestructible, and cannot be changed. Social abstractionism demonstrates that socially produced abstract objects are, in fact, spatial, temporal, malleable, destructible, and fictional. Furthermore, I refashion Henri Lefebvre’s concept of abstract space through a social abstractionist lens to show how abstract objects produced socially dominate abstract spaces. Both concepts, as foundational principles of social abstractionism, are then utilised to demonstrate a hierarchised abstract world through levels of abstract objects which I term the ‘Echelons of
Abstracta’ referring to the notion of each echelon being evermore socially exclusive. As many abstract objects are bureaucratic in nature, I theorise that these abstract objects, whilst not only dominating their own abstract space, also create abstract spaces for the individual which I term interstices. In turn, these interstices create a state of interstitiality through which our lives are imprisoned under a false consciousness of reified abstract objects; an objectively abstract fictional reality. Consequentially, interstitiality induces liminality, our experience of navigating abstract barriers and borders of the interstice. I see social abstractionist principles as contributing towards a mode of thinking capable of both reformulating existing foci of sociology across all areas, and as having significant potential to uncover many new areas of knowledge across the interdisciplinary landscape