Cross-sectional study of the provision of interventional oncology services in the UK

Objective: To map out the current provision of interventional oncology (IO) services in the UK. Design: Cross-sectional multicentre study. Setting: All National Health Service (NHS) trusts in England and Scottish, Welsh and Northern Ireland health boards. Participants: Interventional radiology (IR) departments in all NHS trusts/health boards in the UK. Results: A total of 179 NHS trusts/health boards were contacted. We received a 100% response rate. Only 19 (11%) institutions had an IO lead. 144 trusts (80%) provided IO services or had a formal pathway of referral in place for patients to a recipient trust. 21 trusts (12%) had plans to provide an IO service or formal referral pathway in the next 12 months only. 14 trusts (8%) did not have a pathway of referral and no plans to implement one. 70 trusts (39%) offered supportive and disease-modifying procedures. One trust had a formal referral pathway for supportive procedures. 73 trusts (41%) provided only supportive procedures (diagnostic or therapeutic). Of these, 43 (59%) had a referral pathway for disease-modifying IO procedures, either from a regional cancer network or through IR networks and 30 trusts (41%) did not have a referral pathway for disease-modifying procedures. Conclusion: The provision of IO services in the UK is promising; however, collaborative networks are necessary to ensure disease-modifying IO procedures are made accessible to all patients and to facilitate larger registry data for research with commissioning of new services

Development of a low cost acoustic emission early warning system for slope instability

Slope failures world-wide cause many thousands of deaths each year and damage built environment infrastructure. There is a clear need for low cost instrumentation that can provide an early warning of slope instability to enable evacuation of vulnerable people and timely repair and maintenance of critical infrastructure. Current instrumentation systems are either too expensive for wide scale use or have technical limitations. An approach, Assessment of Landslides using Acoustic Real-time Monitoring Systems (ALARMS), has been developed and demonstrated through research. An approach has been developed using measurement of acoustic emission generated during the onset of slope failure to provide quantitative information on slope displacement rates. Research is in progress to develop low cost acoustic sensors. A unitary acoustic emission slope displacement rate sensor has been designed and is being trialled in an active landslide. Continuous monitored acoustic emission rates show comparable trends to displacement rates measured using an inclinometer. Acoustic emission increase after rainfall events and this is considered to indicate increased displacement rates

Assessment of ground-based monitoring techniques applied to landslide investigations

A landslide complex in the Whitby Mudstone Formation at Hollin Hill, North Yorkshire, UK is periodically re-activated in response to rainfall-induced pore-water pressure fluctuations. This paper compares long-term measurements (i.e., 2009 – 2014) obtained from a combination of monitoring techniques that have been employed together for the first time on an active landslide. The results highlight the relative performance of the different techniques, and can provide guidance for researchers and practitioners for selecting and installing appropriate monitoring techniques to assess unstable slopes. Particular attention is given to the spatial and temporal resolution offered by the different approaches that include: Real Time Kinematic-GPS (RTK-GPS) monitoring of a ground surface marker array, conventional inclinometers, Shape Acceleration Arrays (SAA), tilt meters, active waveguides with Acoustic Emission (AE) monitoring, and piezometers. High spatial resolution information has allowed locating areas of stability and instability across a large slope. This has enabled identification of areas where further monitoring efforts should be focused. High temporal resolution information allowed the capture of S’-shaped slope displacement-time behaviour (i.e. phases of slope acceleration, deceleration and stability) in response to elevations in pore-water pressures. This study shows that a well-balanced suite of monitoring techniques that provides high temporal and spatial resolution on both measurement and slope scale is necessary to fully understand failure and movement mechanisms of slopes. In the case of the Hollin Hill landslide it enabled detailed interpretation of the geomorphological processes governing landslide activity. It highlights the benefit of regularly surveying a network of GPS markers to determine areas for installation of movement monitoring techniques that offer higher resolution both temporally and spatially. The small sensitivity of tilt meter measurements to translational movements limited the ability to record characteristic ‘S’-shaped landslide movements at Hollin Hill, which were identified using SAA and AE measurements. This high sensitivity to landslide movements indicates the applicability of SAA and AE monitoring to be used in early warning systems, through detecting and quantifying accelerations of slope movement

A Perfect Script? Manchester United's Class of ‘92

The Class of ’92 is a documentary film featuring six Manchester United F.C. players who recount their time during a pivotal period for the club, English football and English society. The documentary claims to offer a commentary on Britain in the 1990s, but appears, without acknowledging the fact, to be a promotional vehicle to establish the six men as a brand labeled the Class of ’92 (CO92). Creating this brand necessarily involved presenting a selective account of their time and places with the film being little more than an advertisement, masquerading as an observational documentary. The film draws freely upon the symbolic capital held by the club and the city of Manchester and uses the Busby Babes/Munich chapter and the more recent “Madchester scene” to forge the Class of ’92 brand by editing out those elements that did not accord with this project. The article argues that a more complete representation of ’90s Britain, while disrupting the intended narrative, would acknowledge the significant structural and commercial changes experienced by the club, the sport, and the city in the last decade of the 20th century. We suggest that the Class of ’92 invites the viewer to consider how the documentary film genre can contribute to brand development and promotion

Neural effects of cannabinoid CB1 neutral antagonist tetrahydrocannabivarin (THCv) on food reward and aversion in healthy volunteers

Disturbances in the regulation of reward and aversion in the brain may underlie disorders such as obesity and eating disorders. We previously showed that the cannabis receptor subtype (CB1) inverse agonist rimonabant, an antiobesity drug withdrawn due to depressogenic side effects, diminished neural reward responses yet increased aversive responses (Horder et al., 2010). Unlike rimonabant, tetrahydrocannabivarin is a neutral CB1 receptor antagonist (Pertwee, 2005) and may therefore produce different modulations of the neural reward system. We hypothesized that tetrahydrocannabivarin would, unlike rimonabant, leave intact neural reward responses but augment aversive responses. Methods: We used a within-subject, double-blind design. Twenty healthy volunteers received a single dose of tetrahydrocannabivarin (10mg) and placebo in randomized order on 2 separate occasions. We measured the neural response to rewarding (sight and/or flavor of chocolate) and aversive stimuli (picture of moldy strawberries and/or a less pleasant strawberry taste) using functional magnetic resonance imaging. Volunteers rated pleasantness, intensity, and wanting for each stimulus. Results: There were no significant differences between groups in subjective ratings. However, tetrahydrocannabivarin increased responses to chocolate stimuli in the midbrain, anterior cingulate cortex, caudate, and putamen. Tetrahydrocannabivarin also increased responses to aversive stimuli in the amygdala, insula, mid orbitofrontal cortex, caudate, and putamen. Conclusions: Our findings are the first to show that treatment with the CB1 neutral antagonist tetrahydrocannabivarin increases neural responding to rewarding and aversive stimuli. This effect profile suggests therapeutic activity in obesity, perhaps with a lowered risk of depressive side effects. Keywords: reward, THCv, obesity, fMRI, cannabinoi

Assumption without representation: the unacknowledged abstraction from communities and social goods

We have not clearly acknowledged the abstraction from unpriceable “social goods” (derived from communities) which, different from private and public goods, simply disappear if it is attempted to market them. Separability from markets and economics has not been argued, much less established. Acknowledging communities would reinforce rather than undermine them, and thus facilitate the production of social goods. But it would also help economics by facilitating our understanding of – and response to – financial crises as well as environmental destruction and many social problems, and by reducing the alienation from economics often felt by students and the public

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