Risk stratification in non-ST elevation acute coronary syndromes: risk scores, biomarkers and clinical judgment

Undifferentiated chest pain is one of the most common reasons for emergency department attendance and admission to hospitals. Non-ST elevation acute coronary syndrome (NSTE-ACS) is an important cause of chest pain, and accurate diagnosis and risk stratification in the emergency department must be a clinical priority. In the future, the incidence of NSTE-ACS will rise further as higher sensitivity troponin assays are implemented in clinical practice. In this article, we review contemporary approaches for the diagnosis and risk stratification of NSTE-ACS during emergency care. We consider the limitations of current practices and potential improvements. Clinical guidelines recommend an early invasive strategy in higher risk NSTE-ACS. The Global Registry of Acute Coronary Events (GRACE) risk score is a validated risk stratification tool which has incremental prognostic value for risk stratification compared with clinical assessment or troponin testing alone. In emergency medicine, there has been a limited adoption of the GRACE score in some countries (e.g. United Kingdom), in part related to a delay in obtaining timely blood biochemistry results. Age makes an exponential contribution to the GRACE score, and on an individual patient basis, the risk of younger patients with a flow-limiting culprit coronary artery lesion may be underestimated. The future incorporation of novel cardiac biomarkers into this diagnostic pathway may allow for earlier treatment stratification. The cost-effectiveness of the new diagnostic pathways based on high-sensitivity troponin and copeptin must also be established. Finally, diagnostic tests and risk scores may optimize patient care but they cannot replace patient-focused good clinical judgment

Supporting regional growth from the higher education community: the Energy Coast Campus Programme in West Cumbria

West Cumbria is a predominantly rural, but post-industrial region undergoing a transition from one that has been dominated by heavy industry over a 200 year period. The regional economy has latterly been dominated by one of the world’s largest nuclear technology hubs, which continues to influence the structure of the economy. The region has aspirations to evolve a high technology manufacturing base, with a continued strong role for nuclear, but with a more diversified economy, including an expanded focus on low carbon and renewable energy generation. The region has aspirations to evolve a high technology manufacturing base, with a continued strong role for nuclear, but with a more diversified economy. As part of this strategy, a large investment has been made to build a higher education community in this largely rural area, to support its strategic objectives to promote innovation through applied research, research demonstration, enterprise, business support, skills and training and other transformational actions. Three case studies are described in detail: the Cumbrian Centre for Health Technologies (CaCHeT), the Sustainable Energy Technology Group and the Knowledge Action Network (KAN). The lessons learned are evaluated and presented, with details of future plans

Non-quantized Dirac monopoles and strings in the Berry phase of anisotropic spin systems

The Berry phase of an anisotropic spin system that is adiabatically rotated along a closed circuit C is investigated. It is shown that the Berry phase consists of two contributions: (i) a geometric contribution which can be interpreted as the flux through C of a non-quantized Dirac monopole, and (ii) a topological contribution which can be interpreted as the flux through C of a Dirac string carrying a non-quantized flux, i.e., a spin analogue of the Aharonov-Bohm effect. Various experimental consequences of this novel effect are discussed.Comment: 4 pages, 3 figures (RevTeX + eps); v2 (revised paper): 4 pages, 4 figure

To engage younger people in voting the UK must provide far more integrated and accessible information about elections

The quality and accessibility of information about elections in the UK needs to be improved in order to enhance voter engagement, especially among young people, argue Democratic Audit’s Richard Berry and Patrick Dunleavy. In an extract from Democratic Audit’s new report, they discuss the weaknesses of existing sources of pre- and post-election information and, drawing on good practice overseas, consider what changes are required

Berry phase, topology, and diabolicity in quantum nano-magnets

A topological theory of the diabolical points (degeneracies) of quantum magnets is presented. Diabolical points are characterized by their diabolicity index, for which topological sum rules are derived. The paradox of the the missing diabolical points for Fe8 molecular magnets is clarified. A new method is also developed to provide a simple interpretation, in terms of destructive interferences due to the Berry phase, of the complete set of diabolical points found in biaxial systems such as Fe8.Comment: 4 pages, 3 figure