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Are plastics within the air we breathe a threat to human health?
No full textMicroplastics are ubiquitous within the air we breathe. Evidence from epidemiological studies suggest a threat to human health, confirmed by in vivo and in vitro studies. However, little information is known about the pulmonary deposition and ultimate fate within the respiratory tract. Additionally, water-soluble polymers (WSPs) were recently identified as an underrepresented form of plastic pollution. Again, limited information regarding pulmonary deposition or pulmonary toxicity is reported. This thesis aims to investigate whether these plastic pollutants could threaten human health.Microplastics representative of airborne microplastics were produced whilst WSPs commonly found within household items were purchased. The inhalation of each plastic was assessed using in vitro aerosol particle size distribution tests as described within British and US pharmacopeia’s. For WSPs physiochemical properties relating to inhalation were assessed to investigate their influence. Effects of these particles on human health was determined via MTT assay on two cell lines, A549 lung epithelium and THP-1 macrophages.Inhalation experiments of microplastic showed greatest deposition within upper respiratory tract and conducting airways, suggesting greater exposure in Gastrointestinal tissue (GIT) than lungs. No microplastic induced significant cytotoxicity in THP-1 macrophages, however, cytotoxicity was noted in epithelial cells particularly in fibrous particles. Aerosolization of WSPs varied greatly by polymer with polyacylic acid (PAA) and polyethylene glycol (PEG) showing greatest aerosol production. Most WSPs showed good deposition within respiratory lung regions and good exposure risk. Surface tension and viscosity was shown to have only minimal effects on predicting aerosolization and pulmonary deposition. Some WSPs were found to be highly cytotoxic in both A549 and THP-1 cells, whilst others showed only mild or no cytotoxicity.The main conclusions from this study is that insoluble microplastics represent a low threat to human pulmonary health, however due to high deposition within the upper respiratory system they could accumulate in the GIT and pose a threat there. Secondly the threat on human health posed by WSPs varies greatly dependant on the polymer, with some polymers such as PAA being high risk to human health, whilst polyvinyl alcohol (PVOH) and polyvinylpyrrolidone (PVP) are a low/medium threat.</p
Issues and limitations on the road to fair and inclusive AI solutions for biomedical challenges
No full textObjective: In this paper, we explore the correlation between performance reporting and the development of inclusive AI solutions for biomedical problems. Our study examines the critical aspects of bias and noise in the context of medical decision support, aiming to provide actionable solutions. Contributions: A key contribution of our work is the recognition that measurement processes introduce noise and bias arising from human data interpretation and selection. We introduce the concept of “noise-bias cascade” to explain their interconnected nature. While current AI models handle noise well, bias remains a significant obstacle in achieving practical performance in these models. Our analysis spans the entire AI development lifecycle, from data collection to model deployment. Recommendations: To effectively mitigate bias, we assert the need to implement additional measures such as rigorous study design; appropriate statistical analysis; transparent reporting; and diverse research representation. Furthermore, we strongly recommend the integration of uncertainty measures during model deployment to ensure the utmost fairness and inclusivity. These comprehensive recommendations aim to minimize both bias and noise, thereby improving the performance of future medical decision support systems.</p
Translating guidelines into practice: a multicentre audit of the implementation of ERC survivorship and follow-up recommendations after cardiac arrest
No full textBackground: Survivors of sudden cardiac arrest frequently experience long-lasting problems with fatigue, cognition and mood. European Resuscitation Council (ERC) guidelines recommend functional assessment of physical/non-physical issues prior to discharge, and systematic review within three months covering at least cognition, mood, fatigue, and support for patients and their families. How these recommendations are implemented and what barriers are encountered in routine care remains unknown. Methods: We conducted a multicentric, prospective 6-month audit across four tertiary cardiac-arrest centres in England where temporarily funded follow-up pathways were in place. Five operational criteria were developed based on ERC guidelines. Adherence was quantified, and reasons for non-completion were collected and mapped onto the Theoretical Domains Framework (TDF) to identify behavioural and contextual factors influencing implementation. Results: A total of 143 OHCA survivors were discharged alive. Pre-discharge assessments were offered to 116/143 patients (81%) but only completed in 81 (57%). Reasons for non-completion included early discharge, severe cognitive impairment and, less frequently, patient refusal. Of 132 survivors eligible for follow-up, 108 (82%) were contacted and 87 (66%) attended. Only 25% of follow-ups occurred within the recommended 3-month period (median 185 days, IQR 81–225). Among those seen, assessments were completed for cognition (44%), mood (52%), and fatigue (51%). Reasons for omission included patient refusal, clinical discretion, and time constraints. Survivors’ family members were invited in all cases, but only 45% attended. Conclusions: Adherence to guideline-recommended assessments was variable and dependent on local practices, resource limitations, and patient/clinician-related factors. Key barriers mapped to the TDF domains of ‘Environmental context and resources’, ‘Beliefs about consequences’ and ‘Social influences’. Structural policies excluding out-of-area and non-ICU patients, together with clinician judgement and patient engagement, were major determinants of implementation. These findings can guide targeted service development and support sustainable post-resuscitation care pathways.</p
The Ignored Heritage of Western Law: The Historical and Contemporary Role of Islamic Law in Shaping Law Schools
No full textI will explore the critical historical connections between Islamic law and Western law that have shaped modern legal concepts and finally, share a case study of teaching European Law to demonstrate the damaging effects of a Eurocentric and colonial approach on legal knowledge and the students that learn it.</p
Leisure, hustle, and career: informal skills acquisition in accordion repairing
No full textIn craft careers, where passion and personal commitment are central, development of skills often crosses the boundary between work and life. Although studies of formal employment and serious leisure both use the concept of ‘career’ to understand progressive development of status and skill, little attention has been paid to integrating these perspectives in analyses of transitions between leisure and work. Building on emerging discussions of craft careers, this article examines skills acquisition in contexts lacking formal certification. Drawing on an ethnographic account of The Accordion Repairer School (TARS), organised by an Italian SME, this article explores how participants navigate leisure and professional goals, revealing diverse motivations and orientations to skills, centred on the accordion as an epistemic object and structured through a community of practice. We identify three groups pursuing accordion repair with different orientations to work and leisure, but all developing a ‘career’: serious leisure performers, sustainable solo business owners and side hustlers. The article argues that communities of practice can simultaneously structure professional and leisure careers, intertwining them in social learning processes that steward knowledge of the focal object, support skills development and recognition, and foster identity formation in craft careers.</p
Explainable deep learning for neonatal jaundice classification using uncalibrated smartphone images
No full textHyperbilirubinemia, commonly known as jaundice, is a prevalent condition in newborns, primarily arising from alterations in red blood cell metabolism during the first week of life. While conventional diagnostic methods, such as serum analysis and transcutaneous bilirubinometry, are effective, there remains a critical need for robust, non-invasive, image-based diagnostic tools. In this study, we propose a custom-designed convolutional neural network for classifying jaundice in neonatal images. Image preprocessing and segmentation techniques were systematically evaluated. The optimal workflow, which incorporated contrast enhancement and the extraction of regular skin patches of 144 × 144 pixels from regions of interest segmented using the Segment Anything Model, achieved a testing F1-score of 0.80. Beyond performance, this study addresses numerous shortcomings in the existing literature in this area relating to trust, replicability, and transparency. To this end, we employ fair performance metrics that are more robust to class imbalance, a transparent workflow, share source code, and use Gradient-weighted Class Activation Mapping to visualise and quantify the image regions that influence the classifier’s predictions in pursuit of epistemic justification.</p
The Poor’s Best Friend? Dog Ownership and Companionship in England, c. 1780-1880
No full textIt was once thought that most people owned dogs for their services such as hunting, protection and even entertainment in dog fights. In recent years, research has turned to how people could own dogs and other animals out of companionship and love; however, much of this work has focused on the pets of the well-to-do. Dogs, while technically not ‘objects’ in a sense, were ‘owned’ like other objects and understanding possession of them among the poor and working class is highly important since they were widespread among the group. Accordingly, this chapter argues that although there are ample examples of dog abuse and the affluent bemoaned mass dog ownership, many people saw dogs as allies and affective companions by the late eighteenth century.</p
OA03 Managing dual inflammation: treatment complexity in inflammatory bowel disease-associated arthritis
No full textIntroduction: Enteropathic arthritis is a well-recognised extraintestinal manifestation of inflammatory bowel disease (IBD), presenting as either peripheral or axial spondyloarthritis. Its course often runs parallel to, but may occasionally diverge from, underlying bowel disease activity. Managing enteropathic arthritis is particularly challenging due to the need to control both joint and gastrointestinal inflammation while balancing drug toxicity, immunogenicity, and patient comorbidities. This case explores the complexities of treating a patient with Crohn’s disease and evolving joint involvement, highlighting the need for flexible, multidisciplinary care, shared decision-making, and the careful selection of therapies that address both gut and musculoskeletal disease.</p
Global, regional, and national burden of pharyngeal cancer and projections to 2050 in 185 countries: a population-based systematic analysis of GLOBOCAN 2022
No full textBackground: Pharyngeal cancer has resulted in 3.23 million disability-adjusted life years as of 2019. Based on anatomical site, pharyngeal cancers are categorized into oropharyngeal cancers (OPCs), nasopharyngeal cancers (NPCs), and hypopharyngeal cancers (HPCs). The spatiotemporal distribution of each pharyngeal cancer is related to their respective risk factors. Methods: Using the latest updated GLOBOCAN 2022 and Cancer Incidence in Five Continents database, global, regional, and national age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) of pharyngeal cancer by anatomical site, as well as longitudinal trends since 1998 and future projections to 2050 were investigated across 185 countries and territories. We employed joinpoint regression to assess the average annual percentage change to quantify trends in the ASIR of pharyngeal cancer. We additionally present the mortality-to-incidence ratio as an indicator of disease fatality. Results: In 2022, an estimated 313,091 people were diagnosed with pharyngeal cancer (ASIR, 3.3 per 100,000 person-years) and 166,689 people died from pharyngeal cancer worldwide (ASMR, 1.7 per 100,000 person-years). Regardless of an individual's age and anatomical site, pharyngeal cancer exhibits significantly higher incidence and mortality rates in old males, and the highest number of cases and deaths occur in individuals aged 45–59 years in both sexes. The highest ASIRs per 100,000 person-years were found in Western Europe (2.6) and Northern America (2.6) for OPC, South-Eastern Asia (4.7) for NPCs, South Central Asia (2.1) and Eastern Europe (1.5) for HPC. ASMR per 100,000 person-years were higher for OPC and HPC in Eastern Europe (OPC, 1.1; HPC, 1.0), South Central Asia (OPC, 0.9; HPC, 0.8), and for NPC in South-Eastern Asia (3.1), and Micronesia (2.1). In most countries, the incidence of OPC either increased or remained at a similar level, and NPC remained stable in most countries and HPC decreased or remained unchanged in both sexes. If the ASIR and ASMR of 2022 are maintained, in 2050, the projected number of cases will increase by 63.64% for OPC, 46.40% for NPC, and 64.23% for HPC. Conclusion: Pharyngeal cancer represents a significant burden on global public health, with its disease burden varying across different demographic variables. These variations were closely associated with risk factors such as tobacco and alcohol use, high-risk human papillomavirus, and Epstein-Barr virus infections. To effectively manage the current and future global burden, tailored interventions aligned with unique epidemiological profiles of pharyngeal cancer in diverse populations are required.</p
Blood biomarkers for the prediction of outcome after cardiac arrest: an international prospective observational study within the Targeted Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial
No full textBackgroundPrognostication of recovery in patients who are unconscious following cardiac arrest can be guided by concentrations of brain injury biomarkers in the blood. The optimal biomarker and cutoff concentrations for the prediction of outcome remain unknown. In this study, we aimed to evaluate which biomarker of brain injury is most accurate for predicting functional outcome after cardiac arrest, and to evaluate cutoff levels for the prediction of good and poor outcome.MethodsThis study was a prospective, international, observational biomarker study within the international Targeted Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial including adults aged 18 years or older with a presumed cardiac cause or unknown cause of arrest. Patients were recruited from 24 European hospitals. Serum samples were collected at 0, 24, 48, and 72 h after admission to intensive care units. Concentrations of neuron-specific enolase, S100, neurofilament light, and glial fibrillary acidic protein were analysed with Elecsys electrochemiluminescence immunoassays. The primary outcome was 6-month good (modified Rankin Scale 0–3) or poor (modified Rankin Scale 4–6) functional outcome. Prognostic accuracy was evaluated by the area under the receiver operating characteristic curve (AUROC). The biomarker with the highest AUROC at each timepoint was compared with that of the second highest marker using DeLong's test. As pre-specified, to account for multiple comparisons using Bonferroni correction, a p value of less than 0·0125 was considered statistically significant.FindingsBetween April, 2018, and January, 2020, 113 (12%) of 932 eligible patients were excluded due to death, missed sampling, or missing outcome data. 661 (81%) of 819 included patients were male and 158 (19%) were female, the mean age was 64 years (SD 13), and 418 (51%) had a poor outcome. In patients who were unconscious, neurofilament light predicted functional outcome with AUROCs at 0, 24, 48, and 72 h of 0·77 (95% CI 0·73–0·80), 0·92 (0·90–0·94), 0·93 (0·91–0·95), and 0·93 (0·91–0·95), respectively. Glial fibrillary acidic protein achieved an AUROC of 0·74 (95% CI 0·70–0·77) at 0 h, 0·87 (0·84–0·90) at 24 h, 0·87 (0·84–0·90) at 48 h, and 0·87 (0·84–0·91) at 72 h. Neuron-specific enolase predicted functional outcome with an AUROC of 0·61 (95% CI 0·56–0·65) at 0 h, 0·78 (0·75–0·82) at 24 h, 0·85 (0·81–0·88) at 48 h, and 0·86 (0·82–0·89) at 72 h. S100 achieved an AUROC of 0·74 (95% CI 0·71–0·78) at 0 h, 0·84 (0·81–0·87) at 24 h, 0·79 (0·75–0·82) at 48 h, and 0·78 (0·74–0·82) at 72 h. Neurofilament light had a statistically significantly higher AUROC than the second highest marker, glial fibrillary acidic protein, at 24, 48, and 72 h (pInterpretationNeurofilament light is a highly accurate predictor of long-term outcome after cardiac arrest and superior to other relevant biomarkers evaluated in this study.</p
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