Long-term follow-up of type II endoleak embolization reveals the need for close surveillance

ObjectiveAneurysm growth after endovascular aneurysm repair (EVAR) in patients with type II endoleak is associated with adverse outcomes. This study evaluated the long-term success of embolization of type II endoleaks in preventing aneurysm sac growth.MethodsWe retrospectively reviewed outcomes of patients who underwent infrarenal EVAR who were treated for a type II endoleak between 2000 and 2008. Computed tomography scans were evaluated for aneurysm sac growth or shrinkage from the time of treatment of the endoleak. The embolization material used, graft type, target vessel embolized, and comorbidities were evaluated for their association with sac growth or shrinkage.ResultsNinety-five patients underwent 140 embolization procedures. The mean time from EVAR to embolization was 26.1 ± 22.2 months, and the average increase in size of the aneurysm sac from EVAR to treatment was 0.7 × 0.5 cm. Patients underwent an average of 1.6 ± 0.8 embolization procedures after EVAR. Thirteen patients underwent initial simultaneous embolization of two targets. Embolization was with glue (61%), coils (29%), glue and coils (7%), and Gelfoam (3%; Pfizer Inc, New York, NY). No abdominal aortic aneurysms (AAA) ruptured. Eight patients (8.4%) underwent graft explant and open repair; 19 (20%) required two or more embolization procedures. There was no difference in the target vessel treated or the treatment used in halting sac expansion (>5 mm). Coil embolization alone resulted in more second procedures. The 5-year cumulative survival was 65% (95% confidence interval [CI], 52%-77%), freedom from explant was 89% (95% CI, 81%-97%), freedom from second embolization was 76% (95% CI, 66%-86%), and freedom from sac expansion >5 mm was 44% (95% CI 30%-50%). Univariable analysis identified continued tobacco use (hazard ratio [HR], 2.30; 95% CI, 1.02-5.13; P = .04) was associated with continued sac expansion, and hyperlipidemia (HR, 9.64; 95% CI, 2.22-41.86) was associated with patients requiring a second embolization procedure.ConclusionsEmbolization of type II endoleaks is successful early in preventing aneurysm sac growth and rupture after EVAR. However, a significant number of patients require more than one procedure, and at 5 years, many patients who underwent embolization of a type II endoleak continued to experience sac growth. Patients with hyperlipidemia who undergo coil embolization are more likely to require a second embolization procedure, and patients who smoke have a higher likelihood of AAA sac expansion after embolization. Continued long-term surveillance is necessary in this cohort of patients

Trends in qualitative research in language teaching since 2000

This paper reviews developments in qualitative research in language teaching since the year 2000, focusing on its contributions to the field and identifying issues that emerge. Its aims are to identify those areas in language teaching where qualitative research has the greatest potential and indicate what needs to be done to further improve the quality of its contribution. The paper begins by highlighting current trends and debates in the general area of qualitative research and offering a working definition of the term. At its core is an overview of developments in the new millennium based on the analysis of papers published in 15 journals related to the field of language teaching and a more detailed description, drawn from a range of sources, of exemplary contributions during that period. Issues of quality are also considered, using illustrative cases to point to aspects of published research that deserve closer attention in future work, and key publications on qualitative research practice are reviewed

A 2017 Horizon Scan of Emerging Issues for Global Conservation and Biological Diversity

We present the results of our eighth annual horizon scan of emerging issues likely to affect global biological diversity, the environment, and conservation efforts in the future. The potential effects of these novel issues might not yet be fully recognized or understood by the global conservation community, and the issues can be regarded as both opportunities and risks. A diverse international team with collective expertise in horizon scanning, science communication, and conservation research, practice, and policy reviewed 100 potential issues and identified 15 that qualified as emerging, with potential substantial global effects. These issues include new developments in energy storage and fuel production, sand extraction, potential solutions to combat coral bleaching and invasive marine species, and blockchain technology.Cambridge Conservation Initiative, funded by the Natural Environment Research Council and the Royal Society for the Protection of Birds, Arcadia, Natural Environment Research Council (Grant ID: NE/N014472/1

The use of work-based learning pedagogical perspectives to inform flexible practice within higher education

The renewed emphasis on developing flexible learning practices in higher education underscores the importance of understanding pedagogies for students who are based in the workplace or undertake significant work-related elements of study. This paper draws on research that explores how work-based learning (WBL) pedagogy operates in UK higher education using three main perspectives that help to conceptualise the existing range of practice: discipline-centred, learner-centred and employer-centred. Data was collected from twenty academic practitioners with expertise in WBL using qualitative interviews, documents and observations at fourteen different institutions from seven regions in England. The research findings suggest that there are both commonalities and distinctive attributes across the range of practice that influence how academics develop and orient their pedagogy. It is argued that the characteristics and discursive features of these WBL perspectives present pedagogical approaches that could be adapted to inform more flexible mainstream provision

A 2018 Horizon Scan of Emerging Issues for Global Conservation and Biological Diversity.

This is our ninth annual horizon scan to identify emerging issues that we believe could affect global biological diversity, natural capital and ecosystem services, and conservation efforts. Our diverse and international team, with expertise in horizon scanning, science communication, as well as conservation science, practice, and policy, reviewed 117 potential issues. We identified the 15 that may have the greatest positive or negative effects but are not yet well recognised by the global conservation community. Themes among these topics include new mechanisms driving the emergence and geographic expansion of diseases, innovative biotechnologies, reassessments of global change, and the development of strategic infrastructure to facilitate global economic priorities

Global REACH 2018: The influence of acute and chronic hypoxia on cerebral haemodynamics and related functional outcomes during cold and heat stress

Real-world settings are composed of multiple environmental stressors, yet the majority of research in environmental physiology investigates these stressors in isolation. The brain is central in both behavioural and physiological responses to threatening stimuli and, given its tight metabolic and haemodynamic requirements, is particularly susceptible to environmental stress. We measured cerebral blood flow (CBF, duplex ultrasound), cerebral oxygen delivery (CDO2), oesophageal temperature, and arterial blood gases during exposure to three commonly experienced environmental stressors –heat, cold and hypoxia –in isolation, and in combination. Twelve healthy male subjects (27±11 years) underwent core cooling by 1.0ºC and core heating by 1.5ºC in randomized order at sea-level; acute hypoxia (PetO2= 50mmHg) was imposed at baseline and at each thermal extreme. Core cooling and heating protocols were repeated after 16±4 days residing at 4330m to investigate any interactions with high altitude acclimatization. Cold stress decreased CBF by 20–30% and CDO2 by 12–19%(both p0.08). The increases in CBF with acute hypoxia during thermal stress were appropriate to maintain CDO2 at normothermic, normoxic values. Reaction time was faster and slower by 6-9%with heating and cooling, respectively(both p<0.01), but central (brain) processes were not impaired by any combination of environmental stressors. These findings highlight the powerful influence of core cooling in reducing CDO2. Despite these large reductions in CDO2 with cold stress, gross indices of cognition remained stable