Invasive and non-invasive assessment of chronic coronary syndromes

Non-invasive and invasive diagnostic tests are available to assess the presence and the severity of coronary artery disease. These tests can provide information on anatomy and functional severity of coronary artery disease and can guide treatment decisions regarding medical treatment and revascularization. Each diagnostic test has its advantages and limitations. The cardiologist has to consider which diagnostic test or combination of tests is optimal for the individual patient. In patients with low and intermediate pre-test probability, non-invasive tests can rule-out or rule-in coronary artery disease. Non-invasive anatomical tests are able to rule-out obstructive coronary artery disease. Non-invasive functional tests have better accuracy in ruling-in coronary artery disease. In patients with a high pre-test probability or a positive non-invasive test, an invasive coronary angiography can be performed to assess stenosis severity and to define feasibility of revascularization. The aim of this thesis was to study the clinical value and possible pitfalls of several cardiac imaging techniques, used in the assessment of chronic coronary syndromes in a real-world every day clinical setting. Specifically, the impact of different patient characteristics and the influence on the interpretation of either invasive of non-invasive diagnostics were studied

Quality of Life in Inflammatory Bowel Disease: When IBD goes beyond the gut

This thesis aimed to provide more insight into clinical and biological factors influencing the quality of life of Inflammatory Bowel Disease patients. As clinicians and researchers, we tend to focus more on disease specific symptoms and objective disease markers and less on the quality of life which is one of the most important outcomes for patients. Therefore, little knowledge regarding determinants of quality of life are available and much remains unknown. In particular the pathophysiology of subjective symptoms such as fatigue, sleep and mood and their relation to IBD is unclear. This thesis started with exploring the current knowledge of the disabling symptom of fatigue in IBD patients followed by the assessment of the effect of new biological therapies on psychosocial symptoms such as fatigue, sleep and mood. The last part of this thesis used newly developed research technologies, known as ‘omics research, to investigate the underlying mechanism of fatigue in IBD and to identify the impact of family history on the natural history of IBD

The Genius of Dunstable

n/

I. Synthesis and Reactivity of Novel β-Diketiminato-cadmium Complexes, II. Synthesis of Lead Selenide Nanoparticles for Use in Solar Cells

Rising levels of carbon dioxide (CO₂) in the atmosphere has led to metal amide and alkoxide complexes being explored as potential CO₂ activators. A wide variety of M–O and M–N bonds have been shown to activate CO₂, however to date there are no examples with cadmium. A range of novel cadmium amide and alkoxide complexes have been synthesised, using the β-diketiminato ligand (BDI) as an ancilliary ligand. Initial reactivity studies have suggested CO₂ activation may be possible, although no products were isolated. Homonuclear metallic bonding (M–M) has been explored since the 1950’s and complexes containing M–M bonds are known for almost all transition and main group metals. There are only two reported Cd–Cd bonds, both using sterically bulky monoanionic ligands, like the β-diketiminato ligand. A novel β-diketiminato-cadmium chloride complex was synthesised and treated with a range of different reducing agents to generate a Cd–Cd bond. Different reactivities were observed for the reducing agents, however evidence of a Cd–Cd bond was not obtained. Group 14-16 materials, such as lead selenide, are p-type semi-conductors and have the potential to replacing silicon as a photon acceptor in solar cells. Lead selenide nanoparticles display quantum confinement effects, which allows one to tailor the band gap energies to maximise their absorbance of solar energy. The synthesis of PbSe nanoparticles is described in this study from the reaction between selenium and the lead complex [(BDIph)₂Pb], as well as from the decomposition of [(BDIdipp)PbSeP{Se}Cy₂]. Differences in the size and shapes of the nanoparticles was observed, highlighting the need for controlled nucleation and growth conditions

Continuation of Liraglutide during Fasting is not Associated with Hypoglycaemia

Liraglutide, a glucagon-like peptide-1 (GLP-1) analog, is increasingly used in obese patients with type 2 diabetes mellitus (T2DM) in doses of up to 3.0 mg/day because of its attractive pharmacological profile. It is currently not known how to proceed with this medication during fasting for surgery. Discontinuation is likely to result in hyperglycaemia, while continuation might lead to hypoglycaemia, but, in view of its mode of action, continuation of GLP-1 analogs is likely to be safe. However, as evidence-based guidelines on GLP-1 management during perioperative fasting are not available, the safety of either policy needs to be confirmed on an individual basis. We therefore decided to perform a preoperative assessment of the glucose response to fasting during continuation of GLP-1 before giving a recommendation in individual cases. So far, 12 severely obese T2DM patients scheduled for bariatric surgery have been evaluated preoperatively by measuring glucose and insulin levels during a 32-hour fast with continuation of liraglutide. Hypoglycaemia was not observed. This suggests that liraglutide in doses of up to 3.0 mg can be safely continued during surgery without risking hypoglycaemia

Education and the emotions.

This thesis is concerned with the question of emotions: whether emotions are of interest, or concern to the educator; whether they require specific educational attention; what, if anything, our educational aims with regards to emotions, are; whether emotions pose any special problems for the educator; and so on. The first chapter looks at the nature of emotions, and attempts to draw some sort of conceptual map of the class of things we call 'emotions'. The second chapter discusses the ways in which we can he more, and less, rational about our emotions, and a number of specific educational aims are outlined. The third chapter argues that educators influence children’s emotions. This influence cannot be undone simply by an adherence to rationality, and leaves the educator facing some difficult questions about the direction and nature of that influence. To a degree he can answer this with reference to mental health, human happiness, and a necessary minimal social morality. But though this may provide him with general guidelines, it will not justify the specific influence he has on children's emotions. The fourth chapter attempts to provide some answers to this problem. The argument is that just as comprehensive knowledge and rational thinking protects us from being indoctrinated with regards to our beliefs, so comprehensive knowledge and understanding of the emotions and values of other people (something gained through the ability to empathize) protects us from being indoctrinated with regards to our emotions. The final chapter looks briefly at the skills needed to understand our own emotions, and to empathize with other people: the ability to express and communicate our feelings effectively