Short-term and long-term outcomes in 133 429 emergency patients admitted with angina or myocardial infarction in Scotland, 1990-2000: population-based cohort study

Objective: To analyse short- and long-term outcomes and prognostic factors in a large population-based cohort of unselected patients with a first emergency admission for suspected acute coronary syndrome between 1990 and 2000 in Scotland. Methods: All first emergency admissions for acute myocardial infarction (AMI) and all first emergency admissions for angina (the proxy for unstable angina) between 1990 and 2000 in Scotland (population 5.1 million) were identified. Survival to five years was examined by Cox multivariate modelling to examine the independent prognostic effects of diagnosis, age, sex, year of admission, socioeconomic deprivation and co-morbidity. Results: In Scotland between 1990 and 2000, 133 429 individual patients had a first emergency admission for suspected acute coronary syndrome: 96 026 with AMI and 37 403 with angina. After exclusion of deaths within 30 days, crude five-year case fatality was similarly poor for patients with angina and those with AMI (23.9% v 21.6% in men and 23.5% v 26.0% in women). The longer-term risk of a subsequent fatal or non-fatal event in the five years after first hospital admission was high: 54% in men after AMI (53% in women) and 56% after angina (49% in women). Event rates increased threefold with increasing age and 20–60% with different co-morbidities, but were 11–34% lower in women. Conclusions: Longer-term case fatality was similarly high in patients with angina and in survivors of AMI, about 5% a year. Furthermore, half the patients experienced a fatal or non-fatal event within five years. These data may strengthen the case for aggressive secondary prevention in all patients presenting with acute coronary syndrome

Time trends in survival and readmission following coronary artery bypass grafting in Scotland, 1981-96: retrospective observational study

Improvements in coronary revascularisation techniques and an increase in the use of percutaneous interventions1 have led to a rise in the number of coronary artery bypass grafting operations in older patients with more severe cardiac disease and worse comorbidity and who have previously undergone revascularisation procedures. 2 3 Advances in surgical and anaesthetic techniques have prevented a worsening risk profile from being translated into an increase in perioperative deaths. 2 3 The aim of our study was to examine time trends in major outcomes up to two years after coronary artery bypass grafting

Death in the sun: the bioarchaeology of an early post-medieval hospital in Gibraltar

In 2014, during construction work at the ex-Civil Hospital in Gibraltar, excavations led by the Gibraltar Museum revealed a major, previously unknown burial ground containing more than 200 skeletons. We present the historical, archaeological and radiometric dating evidence from the site alongside the results of initial osteological analyses. The data indicate that the burials pertain to an earlier 16th-century Spanish hospice, and therefore stand to offer new insights into the functioning of this early modern hospital and the health and movements of people at a time of incipient globalization

Implementing structural fuses in CFRP components via microstructurally-engineered crack paths

This study aims to develop and implement actual carbon fibre-reinforced polymer (CFRP) solutions for realising structural fuses in real components. To this end, we have developed various concepts for structural fuses, applied to generic idealised components and aimed at engaging different in-plane and through-the-thickness damage propagation mechanisms. Micro-cut patterns (MCPs) / crack path combinations have been engraved on thin-ply CFRP prepregs (by using a laser cut machine) for manufacturing CFRP specimens. Afterwards, we have carried out a series of experimental studies to evaluate the fracture properties of various MCPs under three-point bending (3PB). Then, 3PB results were used to refine and down-select our concepts, for use in our generic idealised component design to test them under indentation test using a cantilever beam rig. The test results demonstrated that MCPs can provide significant control over the fracture locus and path, additionally allowing the failure initiation load and energy dissipation to be tailored

Prevalence of vitamin D deficiency in Pakistan and implications for the future

Background and aims: Vitamin D deficiency (25-hydroxyvitamin D - VitDD) affects over one billion people worldwide. VitDD results in progression of osteoporosis as well as other conditions. Previous studies have shown high rates of VitDD in Pakistan despite appreciable levels of sunshine. However, none have assessed VitDD across all age groups, genders, incomes and locations to guide future strategies. Methods: Questionnaire and blood sampling among 4830 randomly selected citizens. Results: High levels of VitDD among all age groups, genders, income levels and locations. 53.5% had VitDD, 31.2% had insufficient Vitamin D and only 15.3% normal Vitamin D. Conclusion: High rates of VitDD in Pakistan despite high levels of sunshine and previous Food Acts asking for food fortification with Vitamin D. Public health strategies are needed to address high VitDD rates, including food fortification, i.e. nurture, alongside increasing exposure to sunlight, i.e. nature. This will involve all key stakeholder groups

Heritable functional architecture in human visual cortex

How much of the functional organization of our visual system is inherited? Here we tested the heritability of retinotopic maps in human visual cortex using functional magnetic resonance imaging. We demonstrate that retinotopic organization shows a closer correspondence in monozygotic (MZ) compared to dizygotic (DZ) twin pairs, suggesting a partial genetic determination. Using population receptive field (pRF) analysis to examine the preferred spatial location and selectivity of these neuronal populations, we estimate a heritability around 10–20% for polar angle preferences and spatial selectivity, as quantified by pRF size, in extrastriate areas V2 and V3. Our findings are consistent with heritability in both the macroscopic arrangement of visual regions and stimulus tuning properties of visual cortex. This could constitute a neural substrate for variations in a range of perceptual effects, which themselves have been found to be at least partially genetically determined. These findings also add convergent evidence for the hypothesis that functional map topology is linked with cortical morphology

Characterising and predicting the relationship between translaminar fracture toughness and pull-out length distributions under distinct temperatures

The translaminar fracture toughness reflects the damage tolerance of a fibre-reinforced composite under longitudinal tension, which often governs the final failure of structures. One of the main energy-dissipation mechanisms that contributes to the translaminar toughness of composites is the fibre pull-out process. The present study aims to quantify and model the statistical distribution of fibre pull-out lengths formed on the translaminar fracture surface of composites, for the first time in the literature; this is done under different temperatures, so that the relationship between pull-out length distributions, micromechanical properties and the translaminar fracture toughness can be established. The fracture surfaces of cross-ply compact tension specimens tested under three different temperatures have been scanned through X-ray computed tomography to quantify the extent of fibre pull-out on the fracture surfaces; the distribution of pull-out lengths showed alarger average and larger variability with an increase in temperature, which also lead to an increase in translaminar fracture toughness. A similar trend has been captured by the proposed analytical model, which predicts the pull-out length distribution based on the analysis of quasi-fractal idealizations of the fracture surface, yielding an overall accuracy of more than 85%. This article is part of the theme issue 'Ageing and durability of composite materials'