Social capital and modern language initiatives in times of policy uncertainty

Language professionals across the United Kingdom have long been apprehensive about low levels of participation in language learning, as well as disparities in gender and social class of language learners. However, the distinct policy contexts in England and in Scotland have led to divergent [re]actions with regard to this common concern. This article traces the policy paths taken by the respective governments since the start of the 21st century. The development and impact of a major funding programme in England, the ‘Routes into Languages’ initiative, are outlined, assessed and contrasted with the situation in Scotland. Using Putnam’s notion of social capital (durable networks between people from different social groupings) as a powerful means to implement change the authors demonstrate that in England considerable and beneficial links across previous educational divides have developed as part of the ‘Routes’ initiative, despite the continuing threat of transient policy contexts. In Scotland, the implementation phase of the new 1+2 languages policy might provide the impetus to develop a comparable initiative to ‘Routes’. Arguably, a sea change in attitudes to language learning is unlikely to happen without durable and sustainable social capital between staff in school and university

Monitoring markers of oxidative stress in acute coronary syndrome

It is estimated that there are around 80,000 hospital admissions in the UK each year due to acute coronary syndrome (ACS). The term ACS refers to clinical presentation characterised by chest pain, which may be due to an acute myocardial infarction (AMI) or unstable angina. AMI (or heart attack) arises due to cardiovascular disease (CVD), in which the blood supply to the heart muscle is decreased leading to ischemia and ultimately myocardial death. Thus, diagnosing AMI in a timely manner is essential. Currently, high-sensitive cardiac troponin (hs-cTn) is the gold standard biomarker for AMI diagnosis, since hs-cTn is released by myocardial cells immediately following an AMI. Whilst hs-cTn has high sensitivity and specificity for diagnosing AMI, there are limitations. For example, hs-cTn at diagnosis does not predict readmission. There are also challenges with diagnosing certain demographics i.e., young females. Moreover, hs-cTn levels at diagnosis have no prognostic value for patient readmissions following percutaneous coronary intervention (PCI). Given the negative impact associated with AMI readmissions, identifying novel biomarkers that can predictive is attractive. Since AMI is caused by ischemia, oxidative stress in a prominent pathological feature. During acute and chronic oxidative stress, biomarkers reflecting this such as thioredoxin (TRX), thioredoxin reductase (TRXr), peroxiredoxin-2 (PRDX-2) and peroxiredoxin-4 (PRDX-4) may be elevated. Therefore, evaluating these in AMI patients at diagnosis and during recovery may allow predictions regarding prognosis e.g., readmission probability. Therefore, the aim of this study was to evaluate TRX, TRXr, PRDX-2 and PRDX-4 in AMI patients at diagnosis and follow-up. A total of 145 participants were recruited into this study, which included 80 AMI patients along with 65 healthy donor controls. Blood plasma was subsequently analysed by ELISA for TRX, TRXr, PRDX-2 and PRDX-4. The data presented illustrate for the first time that, healthy volunteers had significantly lower plasma levels of PRDX-4, TRX and TRXr compared with the AMI cohort (p0.80 discriminative for AMI. Stratification of patients according to biomarker concentration and culprit lesion during PCI demonstrated that, plasma TRX >13.40 ng/ml at screening was associated with a higher readmission risk (p=0.009), whereas patients with plasma TRXr >2.00 ng/ml had significantly lower risk of readmission overall (p30.60 ng/ml at first follow-up (1-3 months) was associated with an increased risk of readmission (p=0.009) and was most apparent when culprit lesion was the LAD. This information may inform clinical outcome which in turn may highlight strategies to improve ACS readmission rates in England, e.g., recombinant PRDX-2 therapy for when culprit lesion during PCI is the LAD. Taken together, the findings of this study could significantly benefit the diagnosis and risk stratification of AMI, as well as inform clinical decisions

Abstracts from the NIHR INVOLVE Conference 2017

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Percutaneous revascularization for ischemic left ventricular dysfunction: Cost-effectiveness analysis of the REVIVED-BCIS2 trial

BACKGROUND: Percutaneous coronary intervention (PCI) is frequently undertaken in patients with ischemic left ventricular systolic dysfunction. The REVIVED (Revascularization for Ischemic Ventricular Dysfunction)-BCIS2 (British Cardiovascular Society-2) trial concluded that PCI did not reduce the incidence of all-cause death or heart failure hospitalization; however, patients assigned to PCI reported better initial health-related quality of life than those assigned to optimal medical therapy (OMT) alone. The aim of this study was to assess the cost-effectiveness of PCI+OMT compared with OMT alone. METHODS: REVIVED-BCIS2 was a prospective, multicenter UK trial, which randomized patients with severe ischemic left ventricular systolic dysfunction to either PCI+OMT or OMT alone. Health care resource use (including planned and unplanned revascularizations, medication, device implantation, and heart failure hospitalizations) and health outcomes data (EuroQol 5-dimension 5-level questionnaire) on each patient were collected at baseline and up to 8 years post-randomization. Resource use was costed using publicly available national unit costs. Within the trial, mean total costs and quality-adjusted life-years (QALYs) were estimated from the perspective of the UK health system. Cost-effectiveness was evaluated using estimated mean costs and QALYs in both groups. Regression analysis was used to adjust for clinically relevant predictors. RESULTS: Between 2013 and 2020, 700 patients were recruited (mean age: PCI+OMT=70 years, OMT=68 years; male (%): PCI+OMT=87, OMT=88); median follow-up was 3.4 years. Over all follow-ups, patients undergoing PCI yielded similar health benefits at higher costs compared with OMT alone (PCI+OMT: 4.14 QALYs, £22 352; OMT alone: 4.16 QALYs, £15 569; difference: −0.015, £6782). For both groups, most health resource consumption occurred in the first 2 years post-randomization. Probabilistic results showed that the probability of PCI being cost-effective was 0. CONCLUSIONS: A minimal difference in total QALYs was identified between arms, and PCI+OMT was not cost-effective compared with OMT, given its additional cost. A strategy of routine PCI to treat ischemic left ventricular systolic dysfunction does not seem to be a justifiable use of health care resources in the United Kingdom

Arrhythmia and death following percutaneous revascularization in ischemic left ventricular dysfunction: Prespecified analyses from the REVIVED-BCIS2 trial

BACKGROUND: Ventricular arrhythmia is an important cause of mortality in patients with ischemic left ventricular dysfunction. Revascularization with coronary artery bypass graft or percutaneous coronary intervention is often recommended for these patients before implantation of a cardiac defibrillator because it is assumed that this may reduce the incidence of fatal and potentially fatal ventricular arrhythmias, although this premise has not been evaluated in a randomized trial to date. METHODS: Patients with severe left ventricular dysfunction, extensive coronary disease, and viable myocardium were randomly assigned to receive either percutaneous coronary intervention (PCI) plus optimal medical and device therapy (OMT) or OMT alone. The composite primary outcome was all-cause death or aborted sudden death (defined as an appropriate implantable cardioverter defibrillator therapy or a resuscitated cardiac arrest) at a minimum of 24 months, analyzed as time to first event on an intention-to-treat basis. Secondary outcomes included cardiovascular death or aborted sudden death, appropriate implantable cardioverter defibrillator (ICD) therapy or sustained ventricular arrhythmia, and number of appropriate ICD therapies. RESULTS: Between August 28, 2013, and March 19, 2020, 700 patients were enrolled across 40 centers in the United Kingdom. A total of 347 patients were assigned to the PCI+OMT group and 353 to the OMT alone group. The mean age of participants was 69 years; 88% were male; 56% had hypertension; 41% had diabetes; and 53% had a clinical history of myocardial infarction. The median left ventricular ejection fraction was 28%; 53.1% had an implantable defibrillator inserted before randomization or during follow-up. All-cause death or aborted sudden death occurred in 144 patients (41.6%) in the PCI group and 142 patients (40.2%) in the OMT group (hazard ratio, 1.03 [95% CI, 0.82–1.30]; P =0.80). There was no between-group difference in the occurrence of any of the secondary outcomes. CONCLUSIONS: PCI was not associated with a reduction in all-cause mortality or aborted sudden death. In patients with ischemic cardiomyopathy, PCI is not beneficial solely for the purpose of reducing potentially fatal ventricular arrhythmias. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01920048

Evidencing continual professional development : maximising impact and informing career planning

Continuing professional development (CPD) is essential for radiographers to maintain and update their specialised knowledge base in light of constant professional changes. CPD is the continuous and systematic maintenance, improvement, and broadening of knowledge and skills and the development of personal qualities necessary for the execution of professional and technical duties. Professional and regulatory bodies are increasingly relying on proof of CPD through a variety of learning opportunities to provide evidence of clinical competence. Importantly, CPD has been linked not only to competence but also to motivation and job satisfaction. However, for CPD to be embraced fully, the individual needs to see how activity can be planned and recorded in a way that is meaningful to them in the context of their career aspirations. This article will review basic principles of why evidence is needed for CPD, what constitutes evidence (direct and indirect), and how that evidence can be presented. This will be discussed in the context of having a longer-term career vision, and embedded within Donner and Wheeler’s five-phase career planning and development model

Plasma concentrations of thioredoxin, thioredoxin reductase and peroxiredoxin-4 can identify high risk patients and predict outcome in patients with acute coronary syndrome: a clinical observation

Background: Oxidative stress is a pathological feature of acute coronary syndrome (ACS), a complex disease with varying clinical outcomes. Surrogate biomarkers of oxidative stress including, peroxiredoxin-2 (PRDX2), PRDX4, thioredoxin (TRX) and thioredoxin reductase (TRXR) were measured in ACS patients at presentation and follow-up, to assess their clinical utility in diagnosis and risk stratification. Methods: Plasma from 145 participants (80 ACS and 65 healthy) at diagnosis, 1-3 month (first) and 6-month follow-up (second) was analysed by ELISA. ACS patients were monitored for 12-months. Results: ACS patients at diagnosis had significantly higher concentrations of TRX (p55 years) at diagnosis (p13.40 ng/ml at second follow-up were at high risk of readmission (p<0.05), as were patients with TRXR of <1000 pg/ml at diagnosis having PCI to the LAD (p<0.05). Conclusion: This study indicates that TRX, TRXR and PRDX4 may have clinical utility for ACS stratification