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Capsular warning syndrome: successful treatment with loading dose of dual antiplatelets
No full textIntroduction: Capsular Warning Syndrome (CWS) is a rare subtype of transient ischaemic attacks (TIA) that presents with recurrent lacunar syndrome without signs of cortical involvement. Despite its potential to cause permanent disability, there is no consensus on its optimal treatment. Various strategies such as thrombolysis, dual antiplatelet therapy (DAT) and antiplatelet with anticoagulation therapy have been suggested. However, no significant superiority has been established.
Method: We present a case of an adult in his forties with no cardiovascular risk factors. Patient presented with five episodes of recurrent left-sided weakness with facial deviation within a span of three hours. Due to complete neurological recovery between episodes, thrombolysis was not attempted. He was given a loading dose (300 mg) of both aspirin and clopidogrel after the fifth episode and dual antiplatelet for 21 days. He made a full recovery, with no neurological deficit and no further episodes.
Results or details of the case: A 300 mg loading dose of DAT has been used successfully in some cases, preventing symptom progression and achieving functional improvements. However, some cases have reported symptomatic progression and infarctions. It has certainly shown promising results in stuttering lacunar syndrome. Our case demonstrates favourable outcomes in a patient with no previous risk factors presenting with CWS.
Conclusion: Despite lack of consensus on the treatment of CWS, we have demonstrated full resolution of symptoms using a loading dose of dual antiplatelets. This case report underscores the necessity for further research to standardise treatment protocols in order to achieve better patient outcomes internationally
Principle 7 and the development of a Social Value Toolkit for the Co-operative Councils Innovation Network: The potential role of worker-owned co-operatives
No full textThis paper traces the development of the Social Value Toolkit for Cooperative Councils commissioned by the Cooperative Councils’ Innovation Network as part of their development reports in support of the promotion of co-operation and community wealth building for member councils. We argue that a new social value paradigm is required for social change that goes beyond quantification and measurement of social value outcomes and towards a relational theory of social value. In doing so, the paper refers to the wider implications of the application of relationality to social value and the potential synergies with the parallel development of co-operatives as part of the community wealth building project, with particular reference to co-operative Principle 7 – concern for the community. The theory discussed in the paper is supported by data collected from one of the case studies investigated in the design of the toolkit, the case of Westminster City Council. The paper concludes by suggesting that greater attention should be given to the common good implied in a new relational paradigm and how such an approach is incompatible with private gain
DA2MODE: Dynamic Archive with Adaptive Multi-Operator Differential Evolution for numerical optimization
Get PDFThis paper presents Dynamic Archive with Adaptive Multi-Operator Differential Evolution (DA2MODE), a new algorithm that aims to boost the performance of meta-heuristic and evolutionary methods in numerical optimization. DA2MODE introduces a Progressive Adaptive Selector with Exponential Smoothing (PASES), which dynamically updates the selection probabilities of both mutation and crossover operators. Unlike prior approaches that emphasize only mutation operators or rely on short-term success within the current generation, PASES adapts based on cumulative operator performance over time, thus favoring the best-performing operators more reliably. DA2MODE employs an Adaptive Non-Elite Archive Update (ANEAU) mechanism that injects a controlled fraction of non-elite solutions into the archive. ANEAU promotes early exploration, which is gradually reduced to strengthen exploitation. Additionally, the control parameters (crossover probability and mutation factor) are automatically tuned in DA2MODE, allowing full adaptivity of both operator selection and parameter control. Extensive experiments on the CEC2017/2018, CEC2020-2022, and 1000-dimensional CEC2013 benchmarks, along with four real-world engineering design problems, confirm that DA2MODE consistently outperforms 33 competitive algorithms, including CEC winners and recent advanced DE variants. It achieves top performance across all statistical tests, demonstrating superior convergence speed and final accuracy. These results establish DA2MODE as a robust, scalable, and reliable algorithm for solving complex numerical optimization problems. The source code of the DA2MODE algorithm is publicly available at: URL https://github.com/MohamedRedaMu/DA2MODE-Algorithm and URL https://uk.mathworks.com/matlabcentral/fileexchange/182019-da2mode-algorithm
The Effect of Progressively More Unstable Platforms on Standing Postural Control Used in Canine Fitness and Rehabilitation
No full textBackground: Unstable platforms are commonly used in canine fitness and rehabilitation; however, the challenges to postural control they provide are currently unknown. This study evaluated the effect of standing on three commonly used postural exercise platforms on the level of stability of the thoracolumbar and lumbosacral regions.
Materials and Methods: Inertial measurement units (IMUs; Delsys, Natick, USA) were placed on thoracolumbar (T12-L1) and lumbosacral (L7-S1) regions to assess angular velocities in three anatomical planes on nine dogs from the Penn Vet Working Dog Center. Standing postural control exercises were performed on a stable platform, front and rear K9FITbone balance platform and FitPaws TRAX Peanut (60 cm; [Fig. 1]).
Results: Significant incremental increases in stability challenge were seen in the thoracolumbar region in the sagittal (p < 0.001), coronal (p < 0.001) and transverse (p = 0.003) planes, and the coronal and transverse planes of the lumbosacral region (p < 0.001), with only the sagittal plane showing a difference on the Peanut (p < 0.001). Proportional changes for thoracolumbar region instability between stable stance and K9FITbone produced an average increase of 34% with the Peanut producing a further 42% increase, correspondingly the thoracolumbar region showed a 14% increase with the K9FITbone and a further 60% increase with the Peanut ([Fig. 1]).
Conclusion: Standing postural exercises performed on the different platforms provide substantial and incremental increases in postural control challenge which may be useful in progressive rehabilitation exercises. IMUs have the capability of assessing changes in thoracolumbar and lumbosacral stability which may offer useful objective outcome measures of postural control during rehabilitation programs
Access Point Selection and Localization for Cluster‐Based Realization of a Device‐to‐Device Cell‐Free 6G Communications Network
No full textThe increasing demand for ultra‐reliable, low‐latency, and high‐throughput connectivity in dense urban environments presents significant challenges for next‐generation 6G networks. Traditional cellular networks, with their fixed cell boundaries and centralized base station control, are inadequate to meet the dynamic needs of such environments. A promising solution is the cell‐free network architecture, where a distributed set of access points (APs) jointly serve users without fixed cell boundaries. However, efficient access point selection and accurate user localization are crucial to achieving high performance in such networks. This paper presents a decentralized approach using Belief‐Desire‐Intention eXtended (BDIx) agents for dynamic AP selection and localization within a cluster‐based cell‐free 6G communications network. Various clustering algorithms (K‐means, DBSCAN, self‐organizing maps, MeanShift, ClusterGAN, and Autoencoders) are evaluated for their ability to optimize network throughput, energy efficiency, and spectral utilization. A hybrid localization framework, such as centroid‐based, differential circles, and multilateration methods, is employed to achieve accurate user positioning. The results demonstrate that machine learning‐based clustering methods, notably Gaussian mixture model (GMM), self‐organizing map (SOM), and ClusterGAN, offer significant improvements in throughput (up to 46.3%) and power reduction (up to 32.8%) over traditional methods. Regarding localization, deep learning models such as MLP, CNN, and TCN outperform deterministic methods, achieving sub‐meter accuracy with minimal errors (MeanDist 0.999). Overall, the proposed solution enhances system scalability, energy efficiency, and positioning accuracy, establishing a promising foundation for future 6G networks. In our reference implementation, we instantiate the pipeline with a GMM for AP/UE clustering and a multilayer perceptron (MLP) regressor for localization
Changes in knee outcome measures following later-stage exercise interventions implemented ≤12 weeks vs. >12 weeks after total knee arthroplasty: A systematic review and meta-analysis
No full textBackground: Later-stage exercise interventions refer to rehabilitation exercises implemented after the initial healing phase. Following total knee arthroplasty (TKA), patients generally begin these high-intensity exercises at the 2-month mark. Nevertheless, the duration of these exercise programs varies across studies, and the extent to which later-stage exercises contribute to improvements in the knee outcome measures over time remains unclear. This study aims to systematically evaluate the changes in the knee outcome measures following later-stage exercise interventions implemented at ≤12 weeks versus >12 weeks after TKA.
Methods: The PubMed, Scopus, and Web of Science databases were searched through May 2025 to identify the randomized controlled trials evaluating the effects of later-stage exercise interventions on the knee outcome measures. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Additionally, the completeness of the intervention descriptions was evaluated using the Template for Intervention Description and Replication checklist. A subgroup analysis was conducted to compare the outcomes of interventions lasting ≤12 weeks with those lasting >12 weeks. Moreover, the minimal detectable change (MDC) values were referenced to interpret the clinical relevance of the observed changes.
Results: Fifteen studies involving 1,160 TKA patients were included. Across all studies, the sit-to-stand performance was observed to be enhanced by 2.61 s or 2.7 repetitions; the stair climbing duration decreased by 3.35 s; the knee flexor strength increased by 3.36 kg-force; and the knee extension angle reduced by 3.96°. For interventions ≤12 weeks, the timed up-and-go improved by 2.78 s. For interventions >12 weeks, the knee extensor strength increased by 15.59 kg-force, and the knee flexion angle improved by 14.40°. The certainty of evidence ranged from low to moderate, and the intervention descriptions demonstrated moderate completeness.
Conclusion: Many observed changes in the knee outcome measures exceeded the MDC thresholds, indicating clinically meaningful benefits from later-stage exercise interventions post-TKA. The interventions implemented at ≤12 weeks primarily improved the functional performance, whereas those lasting >12 weeks resulted in greater gains in the muscle strength and joint flexibility. Stronger evidence and more detailed intervention descriptions are needed to better integrate these findings into rehabilitation practice
The Implementation of Faricimab in East Lancashire NHS Trust: Highlighting the Real-World Efficacy and Safety in Patients With Neovascular Age-Related Macular Degeneration
No full textPurpose: To report the safety and efficacy of intravitreal faricimab injections (IVTF) in both treatment-naïve and treatment-resistant patients with neovascular age-related macular degeneration (nAMD).
Patients and methods: This study was a retrospective real-world evidence trial where patients with nAMD were given IVTF. Group 1 (treatment-naïve) and group 2 (switch loading dose, SLD) were given a course of four loading doses of IVTF four weeks apart. Group 3 (switch pro re nata, SPRN) was given a single IVTF and then reviewed at eight weeks. The outcome was based on visual acuity (VA) and optical coherence tomography (OCT), showing central retinal thickness (CRT), subretinal, and intraretinal fluid.
Results: A total of 99 eyes from 89 patients were included. A total of 350 IVTF were given. The mean follow-up duration was 6.33 ± 1.11 months (range: 2-8 months). The mean change in CRT at final follow-up was -127.09 ± 97.39 µm (p < 0.001) for naïve eyes, -115.59 ± 145.02 µm (p < 0.001) for SLD, and -57.61 ± 58.06 µm (p < 0.001) for SPRN. The mean VA change was -3.47 ETDRS (Early Treatment Diabetic Retinopathy Study) (p = 0.256) for naïve eyes, -0.79 (p = 0.45) for SLD, and +1.25 (p = 0.304) for SPRN. A total of 48 eyes (48.48%) had better VA, 22 (22.22%) had no change in VA, and 29 (29.29%) had worse VA. One patient developed bilateral sterile intraocular inflammation.
Conclusion: IVTF was associated with an improvement in CRT in both treatment-naive and treatment-resistant nAMD patients. There was no evidence of vasculitis or vein occlusion, highlighting the safety of faricimab in our real-world study
General Exceptions in WTO Law
No full textThe chapter discusses the general exceptions in WTO law. Art. XX of GATT 1994 provides the general exceptions to the general principles of trade in goods. A WTO member may justify a violation of the general trade principles if the measure pursues a legitimate policy objective under Art. XX of GATT 1994 and complies with the chapeau of the same provision, i.e. the measure is not an arbitrary or unjustifiable discrimination, or a disguised restriction on international trade. The chapter discusses the specific policy objectives that WTO members legitimately can pursue under Art. XX of GATT 1994, including the protection of public morals; the protection of human, animal, or plant life or health; and the conservation of exhaustible natural resources. It further discusses the WTO jurisprudence relating to Art. XX of GATT 1994. The chapter also discusses the potential application of Art. XX of GATT 1994 to human rights and climate change problems considering the broader context of international law. Finally, the chapter discusses issues concerning extraterritorial jurisdiction when a WTO member adopts measures in line with the legitimate policies of Art. XX of GATT 1994 that affect the production processes in the exporting state
Exploring lived experiences of body image after stroke and the impact on wellbeing and recovery: A qualitative study
No full textObjective To explore post-stroke body image experience and enhance understanding of its impacts on wellbeing and recovery. Design Cross-sectional qualitative semi-structured interview study with an interpretative phenomenological approach. Setting Interviews conducted in participants’ homes, using video-calls, telephone or in-person. Participants People treated for acute stroke at two UK hospitals were identified at six months post-stroke and purposively sampled for diversity. Participants were 22 adults (55% male), on average 6.3 months post-stroke and aged 48 to 82 years (median 66 years). Results Two main themes were identified: (1) ‘Body now perceived as an ‘obstacle’ to normality’, comprising three subthemes around altered trust in the body, outward presentation of body image and the likening of body image to that of an older person and; (2) ‘Responses to a new body image experience’, comprising five subthemes around the importance of body image, societal pressures, acceptance/adjustment to a changed body image and positivity through experiencing improvements towards a perceived ‘normal’ body image. Conclusions Regaining perceived pre-stroke ‘normal’ body image and ability to adjust to a new one is reported as important in recovery. We have demonstrated negative changes in body image experience, and it is possible this is a normal part of post-stroke adjustment. Further research is required to determine whether body image experience can be positively influenced by brief interventions such as guided self-help or psychological support to ensure that they do not persist long term