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The dark side of illegitimate tasks: How revenge motives and moral identity shape deviant silence
Full text linkAn EACVI survey assessing the awareness of cardiovascular imaging's environmental impact among cardiovascular imagers.
Full text linkAIMS: Climate change poses a major threat to global health, with implications for cardiovascular disease. Cardiovascular imaging warrants attention due to its environmental footprint. Despite recognition of the need for climate-conscious healthcare, awareness and implementation of sustainable practices among cardiovascular imagers remain unclear. This study aims to assess current awareness, knowledge, and attitudes regarding climate change and sustainable cardiovascular imaging. METHODS AND RESULTS: An anonymous 2-month online survey was disseminated via European Association of Cardiovascular Imaging newsletters, social media, and direct invitations. It explored: (i) general environmental consciousness, (ii) knowledge of climate-cardiovascular links, (iii) perceived barriers, strategies, incentives, and communication tools, and (iv) the survey's potential influence on practice. A total of 218 participants from 41 countries responded (51% female; 91% cardiologists; and 84% Europe). Only 11% had received formal education on climate or sustainable healthcare. Self -reported environmental consciousness was low in 12%, moderate in 65%, and high in 23%. While 90% acknowledged healthcare professionals' responsibility in addressing climate change, 60% rarely considered environmental impact when requesting imaging. Knowledge was limited: only 63% correctly answered ≥4 of 7 questions. Main barriers were the lack of awareness (47%) and institutional or medico-legal pressures encouraging frequent imaging (33%). Reducing unnecessary imaging and improving education were seen as the most effective strategies to address these barriers (50%). After completing the survey, 84% reported greater inclination to consider sustainable practice. CONCLUSION: This international survey highlights a gap between environmental concern and its integration into cardiovascular imaging. Education, institutional support, and system-level strategies are needed to foster sustainable practice
Advanced Characterisation and Modelling of Nitrile Butadiene Rubber Aged in Thermal and Chemical Environments
Full text linkThis thesis develops and validates new approaches for understanding and predicting how nitrile butadiene rubber (NBR) compounds degrade when exposed to the extreme thermal, chemical, and mechanical conditions encountered in oil and gas applications. Conventional test standards treat swelling, temperature, and ageing processes in isolation, leading to excessive and sometimes misleading characterisation requirements. In contrast, this work establishes a cohesive framework that links viscoelasticity, fracture mechanics, and chemical stress relaxation to provide faster, more reliable predictions of service performance. Baseline studies quantify how ageing in air, nitrogen, and water-based mud (WBM) alters crosslink density, viscoelastic response, and fracture resistance. Building on these insights, dynamic mechanical analysis (DMA) is shown to predict modulus, hysteresis, and tear resistance across temperatures and swelling states using a single temperature sweep. A unified crack growth model is introduced that captures slow, transition, and fast fracture regimes with fewer parameters than current models, enabling accurate predictions from a single test regime. By extending time–temperature superposition to tearing energy and demonstrating alignment between high-strain DMA and fracture shift factors, fracture behaviour is linked directly to viscoelastic data for the first time. An improved dual network model is introduced for modelling the impact of chemical stress relaxation, and a practical finite element method is created that incorporates this model without complex coding. The influence of pressure on additive loss during ageing is also uncovered, showing how elevated pressures suppress evaporation during service but accelerate delayed loss on depressurisation. Finally, a case study applies the developed framework to assess rubber compound performance during rapid gas decompression, illustrating how the combined experimental and modelling advances can be directly implemented in industrial evaluation. Together, these contributions provide an experimental and modelling toolkit that reduces testing demands while capturing the essential mechanisms that govern the durability of NBR, and other rubbers, in extreme environments
Automatic Mixing for Teleconferencing, Gaming, and Live-Streaming
No full textThis PhD thesis focuses on automatic mixing in multiple-speaker scenarios, including gaming, teleconferencing, and livestreaming. In such environments, it is hard to get all the information from each source when several people speak simultaneously. Information loss due to overlapping audio sources presents challenges for comprehension. To address this, the first study presents an automatic mixing system aimed at improving speech enhancement in teleconferencing. This system employs cross-adaptive audio effects, ITU-R BS.1770 loudness balances, and a novel force-directed spatialization model, achieving competitive performance against manual mixes by sound engineers. Building on this, the second study develops a Web Audio-based system. The system evaluates auditory masking using the ITU-R BS.1387 Perceptual Evaluation of Audio Quality (PEAQ) model along with ideal mask ratio metrics. To achieve optimal results, a combined iterative Harmony Search algorithm and integer optimization are used, applying audio effects to minimize masking. Objective and subjective listening tests demonstrate that the proposed system performs competitively against mixes created by professional sound engineers and surpasses existing auto-mixing systems. The third study investigates user preferences for Masker-to-Signal Ratio (MSR) in multi-speaker content through subjective experiments. Based on the experiment, this research's findings suggest that maintaining an MSR value less than -10 and a minimum loudness difference of around 14 ± 4 Loudness Units Full Scale (LUFS) between the target track and other tracks is necessary to preserve the prominence of the target track. Additionally, an MSR close to 0, coupled with a loudness difference of around 10 ± 4 LUFS, will improve clarity between the target track and multiple tracks. In the investigation, nearly half of the participants maintained a positive attitude towards multi-track audio. Finally, the fourth study explores a multi-modal Audio-Visual Spatial Audio Parameter Generator, integrating YOLOv8, depth estimation, and spatial audio techniques. Objective evaluations indicate that the proposed system achieves better audio quality and more accurate audiovisual alignment, particularly in speech scenarios. This thesis contributes new insights and practical tools for perceptually optimized mixing, with implications for both multimedia content creation and communication technologies
Factors Associated With Hormone Replacement Therapy Use: A Systematic Review and Meta-Analysis.
Full text linkOBJECTIVE: To identify factors associated with HRT uptake among women. DESIGN: A systematic review and meta-analysis to identify factors associated with HRT uptake. SETTING: Retrospective and prospective cohort studies, case-control studies and cross-sectional studies from any country and in any language. POPULATION: The study population was women aged 40-60 years old. METHODS: We searched Medline, Embase, CINAHL and Cochrane databases to identify studies reporting associations between demographic, behavioural or health-related factors and HRT uptake. Studies were selected if they reported numbers or odds ratios of the factors and HRT uptake. Studies were combined for meta-analysis, reporting odds ratios and 95% confidence intervals. Quality assessment was performed to quantify the risk of bias. MAIN OUTCOME MEASURES: HRT uptake, defined as 'ever' versus 'never' users. RESULTS: 5124 papers were identified for title and abstract screening; 136 full texts were screened; 53 were included in meta-analyses. HRT uptake was 53% lower in Black (OR 0.47, 0.30-0.73) compared to White women. Diabetes, obesity and history of stroke or venous thromboembolism were associated with lower HRT uptake (OR 0.71, 0.59-0.85; 0.67, 0.56-0.81; 0.75, 0.63-0.89; 0.78, 0.74-0.0.83 respectively). Osteoporosis and depression were associated with higher HRT uptake (OR 1.64, 1.10-2.45 and 1.69, 1.17-2.43, respectively). CONCLUSIONS: There are differences in HRT uptake by ethnicity and health characteristics. However, findings are not generalisable globally. Our results could aid healthcare professionals and policymakers to address the gaps in HRT uptake and promote healthcare equity
Hydrogels Incorporating Donor-Acceptor Stenhouse Adducts as a Platform for Photoinduced, On-Off Switchable Release of Small Molecule Cargos.
Full text linkModulating biomaterial properties using light holds great promise for biomedical applications, such as drug delivery, as it is non-invasive and offers both spatial and temporal control. Visible light is particularly salient for stimulation of cell-interfacing materials, as it is cyto-compatible; however, this limits the number of photoswitches appropriate for these applications. In this work, we use donor-acceptor Stenhouse adduct (DASA) functionalized polymers comprising poly(ethylene glycol)-b-poly(hexyl methacrylate) to make visible light-responsive polymersomes, and use these to encapsulate a model drug cargo. We demonstrate that release of the model cargo can be triggered using visible light when the polymersomes are loaded into poly(ethylene glycol) hydrogels. Moreover, ON/OFF switchable cargo release was demonstrated by modulating the light stimulation of the hydrogel. We envisage this could be used to dynamically modulate hydrogel properties in clinically relevant applications for controlled delivery of small molecule therapeutic agents, such as advanced in vitro tissue models and implantable drug-eluting scaffolds
Rational and design of EACVI-MMVD study: an international registry on multimodality imaging for mixed and multiple valvular heart disease.
Full text linkAIMS: Multiple and mixed valvular heart disease (MMVD) are frequent situations in clinical practice. Despite a high prevalence, comprehensive insights into their clinical presentation, management strategies, impact of multimodality imaging, and outcomes are not well established, due to a lack of dedicated studies. METHODS AND RESULTS: The 'EACVI-MMVD Study' will be a large prospective, multicentre, observational cohort study led by the Heart Imagers of Tomorrow of the European Association of Cardiovascular Imaging (EACVI). It will assess the proportion, management, and prognosis of MMVD over a 1-year period of follow-up. All consecutive patients diagnosed with MMVD using transthoracic echocardiography will be recruited over a 6-month recruitment period in 88 centres from 24 different countries. Baseline evaluation will be determined by physicians and encompass the whole spectrum of multimodality imaging including transthoracic and transoesophageal echocardiography, stress echocardiography, computed tomography, and cardiovascular magnetic resonance. Centres will have the opportunity to send cardiovascular imaging data for core laboratory analysis and to extend recruitment throughout a 5-year follow-up period. CONCLUSION: The EACVI-MMVD study will be the largest international multicentre study evaluating the prevalence of MMVD in clinical routine and determining the impact of multimodality cardiovascular imaging in MMVD patients.Clinical Trial Registration: NCT06235385 URL: https://classic.clinicaltrials.gov/ct2/show/NCT06235385
Treatment-related Outcomes and Patterns of Relapse in Secondary CNS Involvement by Large B-cell Lymphoma.
No full textSecondary central nervous system (CNS) large B-cell lymphoma (SCNSL) occurs in the de novo setting, as a CNS-isolated relapse, or synchronous (concomitant CNS and systemic) relapse. SCNSL is a devastating event without therapeutic consensus. Thus, we aimed to evaluate treatment outcomes in an international cohort. Progression-free survival (PFS), overall survival (OS) and cumulative incidence of relapse (CIR, estimated using competing-risk models) were reported. Prognostic factors were identified in a 6-month landmark multivariate analysis. Outcomes following thiotepa autologous stem cell transplant (ASCT) and chimeric antigen receptor T-cell therapy (CAR-T) delivered at relapse were compared following propensity score matching (PSM). A total of 1139 patients were included in the analysis (de novo: 537; relapsed SCNSL: 602). 2-year PFS estimates were 40.4%, 43.9% and 16.2% for de novo SCNSL, CNS-isolated relapse, and synchronous relapse respectively. Patients with CNS-isolated relapse demonstrated low rates of systemic recurrence (24-month CIR 6%). Thiotepa-ASCT correlated with longer survival in de novo SCNSL (PFS: HR=0.57; P=0.005; and OS: HR=0.62; P=0.023) and CNS-isolated relapses (PFS: HR=0.55; P=0.002; and OS: HR=0.39; P<.0001) in 6-month multivariable landmark analysis. ASCT (thiotepa or non-thiotepa) also associated with improved survival in synchronous relapses (PFS: HR=0.57; P=0.023; and OS: HR=0.48; P=0.019). Higher survival with thiotepa-ASCT compared to CAR-T was observed in survival analyses following PSM (PFS: HR=0.45; P=0.005 and OS: HR=0.41; P=0.014). These data support thiotepa-ASCT in eligible patients, particularly de novo disease and CNS-isolated relapses. CNS-isolated relapse was infrequently associated with systemic recurrence, supporting treatment regimens adopted from primary CNS lymphoma
Systematic Review and Meta-Analysis: Effectiveness of Intensive Community Care Services and Psychosocial Interventions for Adolescents With Severe Mental Health Problems.
No full textOBJECTIVE: We conducted a systematic review and meta-analysis to assess the effectiveness of Intensive Community Care and Services (ICCS) compared with treatment as usual (TAU), including inpatient care, and to synthesize common psychosocial interventions used within ICCS. METHOD: We searched 14 databases from Jan 1, 1999, to May 30, 2025, for quantitative studies of ICCS for adolescents predominantly (aged 12-18 years) with mental health problems. We used a random-effects meta-analysis of randomized controlled trials (RCTs) comparing ICCS versus TAU (and inpatient care only), on psychosocial functioning, mental health and cost-effectiveness outcomes. We used a narrative synthesis with an adapted Delphi approach to identify common psychosocial interventions and theoretical mechanisms. The protocol was registered in PROSPERO. RESULTS: We included 48 publications on 35 unique ICCS evaluations (N=6917 adolescents; median age 14.5 years) involving admission avoidance/home treatment, assertive outreach and family preservation models. Meta-analysis of 11 unique RCTs (range: 297-1176 participants per outcome) showed that, compared with TAU, ICCS yielded statistically significant improvements in psychosocial functioning (Hedges' g= 0.15, 95% CI=0.04, 0.26; 9 RCTs), reductions in inpatient admission days (-0.48 -0.82, -0.15; 4 RCTs), total emotional and behavioral problems (-0.15, -0.30, -0.01; 5 RCTs), and externalizing symptoms (-0.18, -0.30,-0.06; 6 RCTs) post-treatment. The effect for psychosocial functioning increased and remained significant when comparing ICCS with inpatient care only (0.25, 0.04, 0.46; 5 RCTs). No significant differences were found for internalizing symptoms, family functioning, or total costs. The narrative synthesis showed that psychosocial interventions consistently included enhanced engagement strategies, cognitive behavioral therapy, family systems approaches, and dialectical behavior therapy skills. CONCLUSION: For adolescents with severe mental health problems, ICCS yielded small but significant improvements in psychosocial functioning, reductions in inpatient days and emotional and behavioral symptoms, while achieving comparable effects for other outcomes. Findings support the expansion of ICCS as a viable alternative to inpatient care. Future research should prioritize multisite RCTs and developing and evaluating standardized psychosocial intervention guidelines to enhance treatment fidelity and outcomes
Alterations in the brain lipidome of Alzheimer's disease donors with rare TREM2 risk variants.
No full textTriggering Receptor Expressed on Myeloid Cells 2 (TREM2) is a microglial receptor, sensitive to Phospholipids and Sphingomyelins, associated with neurodegeneration. Hypomorphic variants in the TREM2 gene significantly increase the risk of developing Alzheimer's disease (AD). The aim of this study was to characterize networks of lipids in post-mortem brain tissue from AD and Control donors, and to identify lipids associated with AD and impacted by dysfunctional TREM2. We studied human post-mortem brain tissue from the hippocampus and Brodmann area 9 (BA9) from 102 brains. Brain tissue from BA9 was available from n = 55 donors (14 Ad donors with a non-synonymous TREM2 risk variant [AD(TREM2+)], 20 Ad donors with no TREM2 risk variants [Ad(TREM2-)] and 21 Control donors), and brain tissue from the Hippocampus was available for n = 47 brain donors (7 Ad[TREM2+], 20 Ad[TREM2-] and 20 Control donors). Mass Spectrometry was performed to obtain lipidomic signatures spanning 99 lipid species that included the following lipid classes: Ceramides, Sphingomyelins, Phosphatidic acids, Phosphatidyl-cholines, Phosphatidyl-ethanolamines, Phosphatidyl-glycerols, Phosphatidyl-inositols, Phosphatidyl-serines and Triglycerides. Weighted gene co-expression network analysis (WGCNA) was used to identify highly correlated lipid modules and hubs in each brain region. Generalized least squares and linear regression analyses, adjusted for age at death, biological sex, number of Apolipoprotein E (APOE) ε4 alleles, and post-mortem delay, were used to assess the associations of lipid modules and hubs with AD and TREM2, in combined analyses across regions and in each region separately. Four lipid modules were relatively well-preserved between the two brain regions, and three of these modules were altered in AD donors and/or in AD TREM2 carriers. Levels of the BA9 'turquoise' module ('blue' hippocampus module), enriched in Sphingolipids and Phospholipids, were elevated in AD donors and particularly in AD TREM2 carriers [AD(TREM2+)]. The hub lipid of the BA9 'turquoise'/hippocampus 'blue' module, Phosphatidyl-serine [PS(32:1)], was increased in AD versus Control donors (beta = 0.677, 95% CI 0.28-1.08, P = 1.14E-03), and in AD(TREM2+) versus Control donors (beta = 1.00, 95% CI 0.53-1.48, P = 5.57E-03), whereas the strongest association was observed with Ceramide [Cer(d38:1)] increased in AD versus Control donors (beta = 0.929, 95% CI 0.46-1.40, P = 1.67E-04) and in AD(TREM2+) versus Controls donors (beta = 1.31, 95% CI 0.78-1.84, P = 4.35E-06). The consistent increase in TREM2 ligands such as Ceramides and Phosphatidyl-serines in the brains of AD donors, particularly TREM2 risk variants carriers, could reflect the presence of AD-associated damage signals in the form of stressed or apoptotic cells and damaged myelin