Angiosome specific revascularisation: does the evidence support it?

Objective To explain the angiosome concept and explore the practical application of the angiosome literature to a clinical scenario, in this case a tibial angioplasty for critical ischaemia. Methods Clinical vignette with explanation of the decisions made and subsequent clinical results based on the theory of the angiosome concept and the literature on angiosomal revascularisation; in this case the results of our group’s recent update to a systematic review and meta-analysis. Results Endovascular combined or direct angiosomal revascularisation if superior to indirect revascularisation. This was borne out in the clinical scenario, where an indirect peroneal reperfusion of the AT angiosome resulted in major amputation. Open surgery is less dependent on the angiosome concept. The presence of adequate collateralisation into a foot arch seems to be the most important factor predicting success of indirect revascularisation. The evidence for both suffers from selection bias and many of the findings in the literature are wholly due to selection bias. Conclusion The angiosome concept is useful during both open and endovascular tibial revascularisation. However, the runoff in the foot is critical to success and may not follow the ‘classic’ angiosome model in diabetes

Public Health Aspects of the Daugherty Water for Food Institute Strategic Plan

The University of Nebraska College of Public Health is committed to contributing to the research, service and education programs of the Daugherty Water for Food Institute. The College can offer a wide variety of expertise that can contribute to programs related to water, food and health. This document has been written to highlight the areas in which College faculty have particular interests, knowledge and experience to contribute.https://digitalcommons.unmc.edu/coph_reports/1000/thumbnail.jp

Mid-Holocene coastline reconstruction from geomorphological sea level indicators in the Tràng An World Heritage Site, Northern Vietnam

In this paper we present a high resolution palaeo coastline model for the isolated limestone massif of Tràng An, Ninh Bình province, Vietnam. The archaeological and palaeoecological record here comprise rich archives of human activity set within a landscape that was cyclically transformed between inland and archipelagic states under the influence of past sea level changes. These records have become informative proxies in the study of current sea level rise. Well-preserved notches along the vertical limestone cliffs within the study property reveal several phases of prolonged stable sea levels that likely pertain to the Mid-Holocene marine transgression 8 ka BP to 4 ka BP and allow for detailed coastline reconstructions for parts of the Red River Delta (RRD). The resulting coastline model facilitates a closer look at past human responses to landscape and environmental changes at local and individual site-level, which improves our understanding of past human adaptations to climate-change induced sea level rise. These data also stand to inform current coastal vulnerability assessments and climate change response models

Time-efficient physical activity intervention for older adolescents with disability : rationale and study protocol for the Burn 2 Learn adapted (B2La) cluster randomised controlled trial

Introduction Physical activity declines during adolescence, with the lowest levels of activity observed among those with disability. Schools are ideal settings to address this issue; however, few school-based interventions have been specifically designed for older adolescents with disability. Our aim is to investigate the effects of a school-based physical activity programme, involving high-intensity interval training (HIIT), on physical, mental and cognitive health in older adolescents with disability. Methods and analysis We will evaluate the Burn 2 Learn adapted (B2La) intervention using a two-arm, parallel group, cluster randomised controlled trial with allocation occurring at the school level (treatment or waitlist control). Secondary schools will be recruited in two cohorts from New South Wales, Australia. We will aim to recruit 300 older adolescents (aged 15–19 years) with disability from 30 secondary schools (10 in cohort 1 and 20 in cohort 2). Schools allocated to the intervention group will deliver two HIIT sessions per week during scheduled specialist support classes. The sessions will include foundational aerobic and muscle strengthening exercises tailored to meet student needs. We will provide teachers with training, resources, and support to facilitate the delivery of the B2La programme. Study outcomes will be assessed at baseline, 6 months (primary endpoint), and 9 months. Our primary outcome is functional capacity assessed using the 6 min walk/push test. Secondary outcomes include physical activity, muscular fitness, body composition, cognitive function, quality of life, physical literacy, and on-task behaviour in the classroom. We will also conduct economic and process evaluations to determine cost-effectiveness, programme acceptability, implementation, adaptability, and sustainability in schools. Ethics and dissemination This study has received approval from the University of Newcastle (H-2021–0262) and the New South Wales Department of Education (SERAP: 2021257) human research ethics committees. Findings will be published in peer-reviewed journals, and key stakeholders will be provided with a detailed report following the study. Trial registration number Australian New Zealand Clinical Trials Registry Number: ACTRN12621000884808

Prehistoric pathways to Anthropocene adaptation: Evidence from the Red River Delta, Vietnam

Over the past twenty years, government advisory bodies have placed increasing emphasis on the need for adaptive measures in response to the effects of human-induced climate change. Integrated Assessment Models (IAMs), which incorporate macroeconomic and climate variables, feature prominently in advisory content, though they rarely draw on data from outside strictly constrained hypothetical systems. This has led to assertions that they are not well-suited to approximate complex systemic human-environment processes. Modular, interdisciplinary approaches have offered a way to address this shortcoming; however, beyond climate records, prehistoric data continue to be under-utilised in developing such models. In this paper we highlight the contribution that archaeology and palaeoecology can make to the development of the next generation IAMs that are expected to enhance provision for more local and pro-active adaptations to future climate change. We present data from one of Southeast Asia’s most heavily developed river deltas: the Red River (Song Hong) Delta, in Vietnam and localised analysis from the Tràng An Landscape Complex World Heritage Site, on the delta’s southern margin. Comparison is made between Shared Socio-economic Pathways (SSP) 5–8.5 and SSP2–4.5 emission projection models and the Mid-Holocene inundation of the Red River Basin. We highlight the value to taking a scientific long view of coastal evolution through an illustrative set of eight research foci where palaeo-data can bring new and localised empirical data to bear on future risk management planning. We proceed to demonstrate the applicability of palaeoenvironmental, zooarchaeological and historical evidence to management and the development of sustainable conservation strategies using Tràng An as a case study. In so doing, we further highlight the importance of knowledge exchange between scientific, corporate, non-governmental, local, and state stakeholders to achieve tangible results on the ground

Prehistoric pathways to Anthropocene adaptation: Evidence from the Red River Delta, Vietnam

Over the past twenty years, government advisory bodies have placed increasing emphasis on the need for adaptive measures in response to the effects of human-induced climate change. Integrated Assessment Models (IAMs), which incorporate macroeconomic and climate variables, feature prominently in advisory content, though they rarely draw on data from outside strictly constrained hypothetical systems. This has led to assertions that they are not well-suited to approximate complex systemic human-environment processes. Modular, interdisciplinary approaches have offered a way to address this shortcoming; however, beyond climate records, prehistoric data continue to be under-utilised in developing such models. In this paper we highlight the contribution that archaeology and palaeoecology can make to the development of the next generation IAMs that are expected to enhance provision for more local and pro-active adaptations to future climate change. We present data from one of Southeast Asia’s most heavily developed river deltas: the Red River (Song Hong) Delta, in Vietnam and localised analysis from the Tràng An Landscape Complex World Heritage Site, on the delta’s southern margin. Comparison is made between Shared Socio-economic Pathways (SSP) 5–8.5 and SSP2–4.5 emission projection models and the Mid-Holocene inundation of the Red River Basin. We highlight the value to taking a scientific long view of coastal evolution through an illustrative set of eight research foci where palaeo-data can bring new and localised empirical data to bear on future risk management planning. We proceed to demonstrate the applicability of palaeoenvironmental, zooarchaeological and historical evidence to management and the development of sustainable conservation strategies using Tràng An as a case study. In so doing, we further highlight the importance of knowledge exchange between scientific, corporate, non-governmental, local, and state stakeholders to achieve tangible results on the ground

Mitochondria-localising DNA-binding biscyclometalated phenyltriazole iridium(III) dipyridophenazene complexes: syntheses and cellular imaging properties

Two new biscyclometalated complexes [Ir(ptzR)2(dppz)]+ (dppz = dipyridophenazene; ptzRH = 4-phenyl-1-benzyl-1,2,3-triazole (1+) and 4-phenyl-1-propyl-1,2,3-triazole (2+)) have been prepared. The hexafluorophosphate salts of these complexes have been fully characterized and, in one case, the X-ray structure of a nitrate salt was obtained. The DNA binding properties of the chloride salts of the complexes were investigated, as well as their cellular uptake by A2780 and MCF7 cell lines. Both complexes display an increase in the intensity of phosphorescence upon titration with duplex DNA, indicating the intercalation of the dppz ligand and, given that they are monocations, the complexes exhibit appreciable DNA binding affinity. Optical microscopy studies reveal that both complexes are taken up by live cancer cell lines displaying cytosol based luminescence. Colocalization studies with commercial probes show high Pearson coefficients with mitotracker dyes confirming that the new complexes specifically localize on mitochondria

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification