23343 research outputs found
Sort by
Umbrella review of factors affecting AV fistulae
Get PDFBackground: Clinical practice guidelines endorse arteriovenous fistulae (AVF) as the preferred form of vascular access. Despite recent advancements, concerns persist regarding variable AVF patency rates. This umbrella review aimed to evaluate and synthesize evidence on interventions and strategies associated with improved 12-month patency rates in AVF. Methods: Systematic review and meta-analyses of randomized control trials (RCTs) providing data regarding primary patency (PP) and target-lesion primary patency (TLPP) of AVF (not grafts) were included. Covidence was used for screening and data extraction, while the AMSTAR-2 rating assessed the methodological quality. Credibility assessment followed Papatheodorou’s criteria. Medline, EMBASE, CENTRAL and CINAHL were searched using a bespoke search strategy from inception to December 2024. Results: Twenty-two reviews that included 136 RCTs involving 13,522 patients were included in the final review. Highly suggestive evidence supports functional end-to-side anastomosis (effect estimate (EE) 1.7) for improving PP. Drug-coated balloon angioplasty (DCB) showed varied results across nine reviews, with effect estimates ranging from 0.49 to 2.47. For TLPP, one review reported significant improvement (EE 2.47, 95% CI 1.53-3.99). Suggestive evidence favours flow-based access monitoring (RR 0.51-0.66), antithrombotic medication (EE 0.53), antiplatelet therapy (EE 0.54), far infrared therapy (EE 1.24-1.27) and pre-emptive correction of ‘at-risk’ AVF (EE 0.5) for prolonging PP. Button hole cannulation and side-to-side anastomosis showed mixed or non-significant results. Heterogeneity varied widely across reviews, ranging from 0% to 81%, and AMSTAR-2 ratings ranged from moderate to high. Conclusion: This umbrella review synthesizes evidence on interventions for AVF patency, revealing varying levels of support for different strategies and highlighting areas requiring further investigation
Tin Complexes Derived from the Acids Ph2C(X)CO2H (X = OH, NH2): Structure and ROP Capability
Get PDFInteraction of [Sn(OtBu)4] with the acid 2,2′-diphenylgylcine, Ph2C(X)CO2H (X = NH2), affords the complex {Sn[Ph2C(NH2)(CO2)]4}·2MeCN (1·2MeCN) after work-up, whereas when X = OH (benzilic acid), the complex {Sn[Ph2C(O)(CO2)]2(CH3CO2H)2} (2) is isolated. In 1·2MeCN, the four 2,2′-diphenylglycinate ligands adopt three different coordination modes (two N,O-chelates, an O,O-chelate, and a monodentate carboxylate ligand), whilst in 2, two cis-O,O-chelate ligands are present along with two acetic acid ligands, the latter being derived from hydrolysis of acetonitrile. Both 1 and 2 have been screened as catalysts for the ring opening polymerization of ε-caprolactone and δ-valerolactone; for comparison, the commercial catalyst [Sn(Oct)2], where Oct = 2-ethylhexanoate, and the precursor [Sn(OtBu)4] have been screened under similar conditions. The products were of low to high molecular weight for PCL and low to moderate molecular weight for PVL, with wide Ð values, and they comprised several types of polymer families, including OH-terminated, OH/OMe-terminated, and cyclic polymers. For both monomers, kinetic profiles indicated that [Sn(Oct)2] outperformed 1, 2, and [Sn(OtBu)4], though under certain conditions, 1 and 2 afforded high-molecular weight products with better control
Masculinity and ethnicity in intersection: Implications for men’s health and palliative care services
Get PDFIntroductionThe intersection of masculinity, ethnicity and palliative care highlights an urgent and underexplored area for future research – particularly in understanding how societal and culturally-specific constructs of masculinity shape men’s experiences of serious illness and end-of-life care. While the field of palliative care research has grown, it remains limited in addressing how men from minoritised ethnic groups engage with and experience palliative care services. These gaps extend beyond service engagement to include how illness is understood, how care is sought or resisted and how cultural norms surrounding masculinity and ethnicity influence caregiving, emotional expression and decision-making. This editorial sets out an agenda to address these gaps, arguing for the development of culturally appropriate, masculinity-sensitive interventions that are attuned to the diverse and intersecting identities of men receiving or providing palliative care
Developing a decision support tool for the continuation or deprescribing of antithrombotic therapy in patients receiving end-of-life care: Protocol for a European Delphi study".
Get PDFABSTRACT Introduction: To develop a European shared decision support tool (SDST), a Delphi process will be used to reach consensus about aspects relating to the continuation or deprescribing of antithrombotic therapy (ATT) in cancer patients at the end of life. As part of the SERENITY project, this study corresponds to work package (WP) 4. Methods: Findings from SERENITY WPs 1-3 (realist review, flash mob research, epidemiological and qualitative studies) informed the Delphi study. The WP4 steering committee had two objectives. (1) to build a representative expert panel comprising physicians, pharmacists, nurses and psychologists from eight European countries; and (2) to advise on the content of the Delphi form, divided into four sections: context, content, SDST design and trial outcomes. The form was reviewed by the SERENITY patient and public involvement group to ensure that it met patients’ needs. The Delphi study will take place in three rounds held at 6-week intervals, involving experts from eight countries. Consensus will be reached on items with at least 70% agreement. The steering committee will review and validate the results across the different rounds. Results: Through this Delphi study, the following aspects will be defined: characterisation of candidate patients for discussion about ATT deprescribing; healthcare team roles in ATT decision-making; specific information and communication requirements for patients when making deprescribing decisions; SDST content priorities; and optimal outcomes for the planned clinical trial. Conclusion: This study will feed directly into the development and evaluation of the SDST, aimed at reducing complications and improving quality-of-life in end-of-life cancer patients receiving ATT
“You can't tee them up for retirement because we have to go out and win gold medals…”: a Foucauldian exploration of Olympic coaching logic and athletic retirement
Get PDFIntroduction: Despite decades of research into the phenomena of athletic retirement, many modern athletes continue to report difficulties in adjusting to life beyond sport. As a result, the issue of athletic retirement has become a significant concern for those working within high-performance settings. However, there remains a distinct lack of critical attention regarding how key actors within athletes' lives (e.g., coaches) shape and impact upon their capacities to adjust to post-sport life. Methods: In this paper, we address this gap in research by presenting qualitative data from interviews with eight coaches working in the context of Olympic sport in the United Kingdom to examine their perspectives regarding the athlete retirement process. Results and Discussion: Drawing upon Foucault's conceptualization of disciplinary power-knowledge, our analysis illustrates how Olympic coaches' perspectives and experiences of athletic retirement can be linked to the modernist logic and normalizing pressures that characterize Olympic level coaching environments
Mapping the Nearest Ancient Sloshing Cold Front in the Sky with XMM-Newton
Get PDFThe Virgo Cluster is the nearest cool core cluster that features two well-studied sloshing cold fronts at radii of r ≈ 30 kpc and r ≈ 90 kpc, respectively. In this work, we present results of XMMNewton mosaic observations of a third, southwestern, cold front at a radius of r ≈ 250 kpc, originally discovered with Suzaku. All three cold fronts are likely to be parts of an enormous swirling pattern, rooted in the core. The comparison with a numerical simulation of a binary cluster merger indicates that these cold fronts were produced in the same single event – likely the infall of M49 from the northwest of Virgo and it is now re-entering the cluster from the south. This outermost cold front has probably survived for 2 – 3 Gyr since the disturbance. We identified single sharp edges in the surface brightness profiles of the southern and southwestern sections of the cold front, whereas the western section is better characterized with double edges. This implies that magnetic fields have preserved the leading edge of the cold front, while its western side is beginning to split into two cold fronts likely due to Kelvin-Helmholtz instabilities. The slopes of the 2D power spectrum of the X-ray surface brightness fluctuations, derived for the brighter side of the cold front, are consistent with the expectation from Kolmogorov turbulence. Our findings highlight the role of cold fronts in shaping the thermal dynamics of the intracluster medium beyond the cluster core, which has important implications for cluster cosmology. Next-generation X-ray observatories, such as the proposed AXIS mission, will be ideal for identifying and characterizing ancient cold fronts
Fork to farm: reverse engineering a food system
Get PDFUsing two new common (Phaseolus) dry bean varieties developed for UK growing conditions, the BeanMeals project explored how to pursue ‘fork to farm’ systemic innovation in the food system to transform institutional catering and home-cooking towards healthier diets with lower environmental impact while also enhancing local and national enterprise. Action research, underpinned by a new systems thinking framework, centred on six primary schools and ten households in Leicester and Leicestershire (UK), set against a review of city-, county- and national-level school food policies. Three demand scenarios were developed, based on increasing UK average daily consumption from 8.5g to either 17g, 34g or 50g, together with three enterprise opportunities (‘Community Enterprise’, ‘Artisanal Entrepreneurs’ and ‘Food Giants’) to satisfy these demands in different ways. The benefits and trade-offs of scaling UK beans were analysed, including assessments of overall benefits to health, benefits to the environment (which depend on the methods of land conversion and weed management used), and economic benefits (which depend on the scaling method employed)
Pirtobrutinib in Chronic Lymphocytic Leukemia: Navigating Resistance and the Personalisation of BTK-Targeted Therapy
Get PDFBackground/Objectives: Covalent Bruton’s tyrosine kinase (BTK) inhibitors (ibrutinib, acalabrutinib, zanubrutinib) improve outcomes in advanced chronic lymphocytic leukemia (CLL) but resistance, largely driven by BTK C481 mutations, and adverse events limit long-term benefit. Noncovalent BTK inhibitors (e.g., pirtobrutinib) reversibly inhibit the BTK ATP-binding pocket independent of C481, potentially overcoming resistance and reducing toxicity. This review summarizes clinical evidence for pirtobrutinib in CLL. Methods: A PubMed search of articles through July 2025 was conducted, focusing on clinical trials of pirtobrutinib. We extracted efficacy, safety, and resistance data, emphasizing the BRUIN CLL-321 phase 3 trial and related studies. Results: Pirtobrutinib demonstrates activity against BTK resistance mutations with a favorable safety profile, partly due to high kinase selectivity. In BRUIN CLL-321, pirtobrutinib achieved an overall response rate (ORR) of 62% and a median progression-free survival (PFS) of 20 months in heavily pretreated patients, including those with resistance mutations. Yet, resistance mechanisms—such as alternative pathway activation and additional BTK mutations—emerge in a subset. Baseline genetic features, including BTK mutation status and cytogenetics, influence response durability and outcomes. Ongoing phase 3 trials comparing pirtobrutinib with covalent BTK inhibitors will clarify its potential as a first-line option and its integration into treatment algorithms. In relapsed/refractory CLL, noncovalent BTK inhibitors may be incorporated into personalized pathways, including bridging to CAR-T therapy, to optimize long-term disease control. Conclusions: Pirtobrutinib offers a promising strategy to address resistance and potentially improve durable disease control in CLL. Definitive trials will define its role relative to covalent BTK inhibitors and its utility across treatment lines within personalized, multimodal regimens
Different association patterns of emotion regulation and heart rate variability in older and younger adults
Get PDFSeveral mental health conditions seen in older people are associated with impaired emotion regulation. Heart rate variability (HRV) may be an index of emotion regulation capacity, but it is unclear whether and how aging influences this association. Early neurodegenerative processes, such as Alzheimer's disease-related reduction of locus coeruleus (LC) integrity, may play a role, as LC modulates both HRV and self-regulatory networks. We pre-registered a cross-sectional study to investigate the relationship between measures of emotion regulation, HRV and LC structural MRI integrity in a lifespan sample of cognitively normal healthy adults (n = 678, aged 18-88 years, 51% female), recruited between 2010 and 2012 as part of the Cambridge Centre for Ageing and Neuroscience (Cam-CAN) cohort. We hypothesized that age-related differences in the HRV-emotion regulation relationship could be attributed to reduced LC integrity in older versus younger adults. Exploratory analyses incorporated alternative and novel measures of emotionality and LC rostro-caudal functional connectivity gradients from more recent Cam-CAN studies. In contrast to younger adults, we found an inverse relationship between resting HRV and measures of emotion regulation performance in older adults. There was no evidence that LC integrity influenced this relationship. A more 'old-like' LC rostro-caudal functional connectivity gradient, but not LC signal intensity, was related to lower HRV and worse reappraisal outcomes. We identify complexity in the association between HRV and emotion regulation with age and gaps in understanding of the relationship between different measures of LC integrity. Future studies should explore compensatory mechanisms underlying age-related differences in autonomic and emotion regulation