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Randomized investigation of heart failure therapy in patients with advanced cancer at risk of cardiac wasting: rationale and design of the EMPATICC trial
Get PDFAims:
End‐stage cancer may resemble a heart failure (HF)‐like phenotype marked by cardiac wasting, dysfunction, and symptoms such as dyspnoea, congestion, and impaired physical function. The EMPATICC (EMPower the heArt of patients with TermInal Cancer using Cardiac medicines) trial evaluates the safety and efficacy of optimized HF therapy in patients with advanced cancer to improve self‐care ability.
Methods:
EMPATICC is a multicentre, investigator‐initiated, randomized, double‐blind, controlled, proof‐of‐concept trial employing a joint cardio‐oncology care approach. Patients were randomized 1:1 to optimized HF therapy (sacubitril/valsartan, empagliflozin, ivabradine, ferric carboxymaltose) plus usual care, or usual care alone, for 30 days, followed by a 30‐day open‐label extension. Eligible patients had stage IV solid tumours (per Union for International Cancer Control), were receiving palliative care, had a 1–6 month life expectancy, and were on optimized analgesia. At baseline, first patients had to meet ≥2 criteria of the following indicating cardiovascular risk: heart rate ≥70 bpm, N‐terminal pro‐B‐type natriuretic peptide ≥600 pg/ml, elevated high‐sensitivity troponin, left ventricular ejection fraction <55%, left ventricular mass loss >15%, transferrin saturation <20%, or moderate/high likelihood of HF with preserved ejection fraction (based on the HFA‐PEFF score); and they had to meet at least one criterion of the following indicating functional limitation: ≥6 s to walk 4 m, inability to wash ≥3 days of the last 7 days, or symptoms of dyspnoea at rest. Enrolment ended 30 January 2025; 93 patients completed randomization. The primary endpoint is a hierarchical composite (analysed by win ratio): (1) days alive and able to wash, (2) 4 m walking ability, and (3) patient global assessment of well‐being.
Conclusions:
EMPATICC evaluates whether HF therapy can improve function and well‐being in advanced cancer, potentially reshaping care in this population
Community development, resistance and integration: reflections on practice and theory
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A hybrid analytical and machine learning model of BioFETs for the detection of peptides
Get PDFBioFETs have been employed to detect a wide range of biological analytes by sensing changes in surface potential, translating them into electrical response. While analytical models such as the Gouy–Chapman–Stern and site-binding models successfully describe surface charge and protonation equilibria of these analytes, they do not capture the sequence-dependent chemistry, steric hindrance, and conformational variability intrinsic to peptides and other biomolecules that define the sensor response. We propose a hybrid molecular-analytical model to address these limitations, augmenting previous BioFET simulation frameworks with modelled molecular parameters including dissociation constants and topological surface areas. While this work focuses on peptides, including post-translational and synthetic modifications, the framework extends to diverse analytes and immobilization chemistries relevant to biosensing. We validate the model against experimental values and molecular modelling studies, confirming the physical fidelity of our hybrid model. Simulations with three representative peptides demonstrate the model's capacity to resolve fine chemical variations, providing a practical tool to guide experimental design and contribute to the development of BioFETs
Modelling Railway Networks with Bigraphs: Electrification, Failures, and Optimisation
No full textUpgrading rail network infrastructure involves complex system design decisions that can be informed by suitably abstract models. Ideally, the modelling techniques support formal analysis e.g. of safety, security, resilience, and performance, the models are extensible, and they are accessible to both railway engineers and policy makers. We propose using bigraphs—a diagrammatic formal model with userdefined entities and rewrite rules—as a visual and intuitive approach to extensible railway system modelling. An example is presented: electrification rollout and the adoption of battery-powered trains that includes the impact of (probabilistic) power blackouts and supports system-level optimisation e.g. selecting which track segments to electrify, without resorting to constraint programming languages. Formal analysis via model checking is used throughout. This work represents a shift in the use of formal methods in railway engineering: from verifying isolated components such as signalling, to supporting formal, system-level design and decision-making
Efficient data harvesting in urban IoT networks: DRL for RIS-UAV communications
No full textThe next generation of wireless communication networks is expected to utilise unmanned aerial vehicles (UAVs) and reconfigurable intelligent surfaces (RISs) to enhance spectrum and energy efficiency. This work establishes a theoretical foundation for RIS-assisted UAV implementation, capitalising on the passive beamforming capabilities of RIS alongside the adaptable deployment and dynamic mobility of UAVs to enhance internet-of-things (IoT) network performance. A comprehensive framework for RIS-assisted UAV IoT data collection is represented and optimised to enhance critical performance metrics, including the quantity of served IoT devices and achievable data rates. This framework is instrumental in urban IoT networks, such as smart cities, where blockages and fading channels hinder reliable communication. The optimisation strategy deploys a deep reinforcement learning (DRL) algorithm to fine-tune UAV trajectories and IoT device scheduling decisions, complemented by a codebook for RIS beamforming to optimise the RIS phase shift matrix. This integrated approach addresses the ever-increasing demand for efficient data collection in wireless IoT networks, providing a scalable and reliable solution for efficient data collection under dynamic urban environments channel conditions. Simulation results show substantial improvements in system performance, demonstrating the efficiency of the proposed algorithm. By coordinating the RIS phase shift matrix and UAV trajectory planning, the proposed framework achieves improvements in terms of the number of served IoT devices and achievable data rates. For example, compared to baseline methods, our approach outperforms benchmark scenarios by over 50% in terms of the number of served devices. The results reveal the potential of RIS-assisted UAV solutions in meeting the increasing demands of wireless IoT networks
Real-world persistence and characteristics of type 2 diabetes patients prescribed semaglutide in Scotland
Get PDFNo abstract available
Validation of a parent-reported outcome measure for young boys with a condition affecting sex development (PRO-CSD)
No full textObjective: To validate a short parent-reported outcome (PRO) questionnaire in young boys with conditions affecting sex development (PRO-CSD).
Design: Consecutive sample cross-sectional study.
Setting: A single tertiary children’s hospital in Glasgow, UK.
Patients: A total number of 98 parents of 98 affected boys with a median age of 3.1 years (10th, 90th: 0.7, 5.4).
Interventions: Completion of recently developed brief PRO-CSD consisting of a parent proxy-report (PPR) and a parent self-report (PSR).
Main outcomes: The study assessed test–retest reliability in 41 cases as intraclass correlation coefficients (ICCs) and group construct validity in 98 by exploring associations with seven demographic and clinical features.
Results: The median ICC for all items was 0.8 (0.6, 0.9). On the PSR, parents of boys with an external masculinisation score (EMS) of less than 7 out of 12 were more concerned about their child’s genitalia compared with those with an EMS of greater than 10.5 (p=0.01). An association with EMS was also observed for questions on future social concerns (p<0.01), future relationships (p<0.01) and stress on receiving the diagnosis (p=0.03). This association with EMS was maintained following adjustment for surgical history, parental age and education level. EMS was the only significant independent determinant of the overall PSR score. In the PPR analysis, parents in the lower socioeconomic grouping and those without tertiary education reported more concerns on the physical functioning of their children.
ConclusionsL The psychometric properties of the PRO-CSD tool demonstrate its utility for the screening of parent-reported, condition-specific health-related quality of life outcomes in young boys with a CSD
Data Hazards: an open-source vocabulary of ethical hazards for data-intensive projects
Get PDFUnderstanding the potential for downstream harms from data-intensive technologies requires strong collaboration across disciplines and with the public. Having shared vocabularies of concerns reduces the communication barriers inherent in this work. The Data Hazards project (datahazards.com) contains an open-source, controlled vocabulary of 11 hazards associated with data science work, presented as ‘labels’. Each label has (i) an icon, (ii) a description, (iii) examples, and, crucially, (iv) suggested safety precautions. A reflective discussion format and resources have also been developed. These have been created over three years with feedback from interdisciplinary contributors, and their use evaluated by participants (N=47). The labels include concerns often out-of-scope for ethics committees, like environmental impact. The resources can be used as a structure for interdisciplinary harms discovery work, for communicating hazards, collecting public input or in educational settings. Future versions of the project will develop through feedback from open-source contributions, methodological research and outreach
Plasmon–exciton polaritonic emission lifetime dynamics under strong coupling
Get PDFIn this study, we investigate the contribution of resonant and non-resonant excitation conditions on the polariton decay dynamics of strongly coupled rhodamine 6G (R6G) and surface plasmon polariton (SPP). We showed proof of strong coupling between SPP and R6G exciton from the dispersion relations measured by total internal reflection ellipsometry (TIRE). From these it was determined that the coupling strength reaches g ≈ 200 meV. Further fluorescence methods were employed to demonstrate the emission from the lower polariton branch (LP). The fluorescence lifetime and back focal plane imaging techniques were implemented to study radiative polariton decay, for resonant and non-resonant excitation conditions. Fluorescence decay measurements of plasmonic strong coupling regime showed considerably longer (ps) than expected lifetime values (fs). In our case the measured lifetimes cannot be explained without the influence of additional energy level in emission dynamics, such as incoherent transition from exciton reservoir to lower polaritonic branch. The fundamental understanding of coherent energy exchange dynamics has potential importance for development of quantum optical nanodevices, polaritonic lasers, polariton condensation
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