Adipogenic Differentiation of hMSCs is Mediated by Recruitment of IGF-1r Onto the Primary Cilium Associated With Cilia Elongation

Funded by Marie Curie Intra European Fellowship (GENOMICDIFF) Wellcome Trust 08471

Does a 'direct' transfer protocol reduce time to coronary angiography for patients with non-ST-elevation acute coronary syndromes? A prospective observational study.

OBJECTIVE: National guidelines recommend 'early' coronary angiography within 96 h of presentation for patients with non-ST elevation acute coronary syndromes (NSTE-ACS). Most patients with NSTE-ACS present to their district general hospital (DGH), and await transfer to the regional cardiac centre for angiography. This care model has inherent time delays, and delivery of timely angiography is problematic. The objective of this study was to assess a novel clinical care pathway for the management of NSTE-ACS, known locally as the Heart Attack Centre-Extension or HAC-X, designed to rapidly identify patients with NSTE-ACS while in DGH emergency departments (ED) and facilitate transfer to the regional interventional centre for 'early' coronary angiography. METHODS: This was an observational study of 702 patients divided into two groups; 391 patients treated before the instigation of the HAC-X pathway (Pre-HAC-X), and 311 patients treated via the novel pathway (Post-HAC-X). Our primary study end point was time from ED admission to coronary angiography. We also assessed the length of hospital stay. RESULTS: Median time from ED admission to coronary angiography was 7.2 (IQR 5.1-10.2) days pre-HAC-X compared to 1.0 (IQR 0.7-2.0) day post-HAC-X (p<0.001). Median length of hospital stay was 3.0 (IQR 2.0-6.0) days post-HAC-X v 9.0 (IQR 6.0-14.0) days pre-HAC-X (p<0.0005). This equates to a reduction of six hospital bed days per NSTE-ACS admission. CONCLUSIONS: The introduction of this novel care pathway was associated with significant reductions in time to angiography and in total hospital bed occupancy for patients with NSTE-ACS

Transforaminal endoscopic surgery for symptomatic lumbar disc herniations: a systematic review of the literature

The study design includes a systematic literature review. The objective of the study was to evaluate the effectiveness of transforaminal endoscopic surgery and to compare this with open microdiscectomy in patients with symptomatic lumbar disc herniations. Transforaminal endoscopic techniques for patients with symptomatic lumbar disc herniations have become increasingly popular. The literature has not yet been systematically reviewed. A comprehensive systematic literature search of the MEDLINE and EMBASE databases was performed up to May 2008. Two reviewers independently checked all retrieved titles and abstracts and relevant full text articles for inclusion criteria. Included articles were assessed for quality and outcomes were extracted by the two reviewers independently. One randomized controlled trial, 7 non-randomized controlled trials and 31 observational studies were identified. Studies were heterogeneous regarding patient selection, indications, operation techniques, follow-up period and outcome measures and the methodological quality of these studies was poor. The eight trials did not find any statistically significant differences in leg pain reduction between the transforaminal endoscopic surgery group (89%) and the open microdiscectomy group (87%); overall improvement (84 vs. 78%), re-operation rate (6.8 vs. 4.7%) and complication rate (1.5 vs. 1%), respectively. In conclusion, current evidence on the effectiveness of transforaminal endoscopic surgery is poor and does not provide valid information to either support or refute using this type of surgery in patients with symptomatic lumbar disc herniations. High-quality randomized controlled trials with sufficiently large sample sizes are direly needed to evaluate if transforaminal endoscopic surgery is more effective than open microdiscectomy

Risk-Driven Design Processes: Balancing Efficiency with Resilience in Product Design

Current design methods and approaches focus on increasing the efficiency of the product design system by, for example, eliminating waste and focusing on value creation. However, continuing failures in the development of complex, large scale products and systems point towards weaknesses in the existing approaches. We argue that product development organizations are hindered by the many uncertainties that are inherent in the process. Common management heuristics ignore uncertainty and thus overly simplify the decision making process. Creating transparency regarding uncertainties and the associated risks (i.e. effect of uncertainties on design objectives) is not seen as an explicit priority. Consequently organizations are unable to balance risk and return in their development choices. Product development processes do not emphasize reduction of risks, particularly those risks that are apparent early in the process. In addition, the resilience of the PD system, i.e. its ability to deliver on-target results under uncertainty, is not deliberately designed to match the level of residual uncertainty. This chapter introduces the notion of Risk-Driven Design and its four principles of 1. Creating transparency regarding design risks; 2. Risk-driven decision making; 3. Minimizing uncertainty; and 4. Creating resilience.Massachusetts Institute of Technology. Lean Advancement InitiativeCenter for Clean Water and Clean Energy at MIT and KFUP

Transforaminal endoscopic surgery for lumbar stenosis: a systematic review

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Postoperative phlegmasia caerulea dolens: a case report and consideration of potential iatrogenic factors

While the haemorrhagic consequences of anti-coagulants are well and frequently described in the surgical literature, the paradoxical prothrombotic tendencies of these drugs tend to be under-recognised due, perhaps, to their clinical infrequency. However, when these effects pertain, their consequences can be devastating. Here, we present a postoperative oncology patient who suffered a massive recrudescence of his lower limb venous thrombosis immediately after discontinuation of his heparin infusion, despite seemingly being adequately anticoagulated by warfarin therapy (INR > 2.0). We intend this case to graphically illustrate the theoretical considerations that must govern the perioperative use of these drugs in high-risk patients

Entrepreneurial sons, patriarchy and the Colonels' experiment in Thessaly, rural Greece

Existing studies within the field of institutional entrepreneurship explore how entrepreneurs influence change in economic institutions. This paper turns the attention of scholarly inquiry on the antecedents of deinstitutionalization and more specifically, the influence of entrepreneurship in shaping social institutions such as patriarchy. The paper draws from the findings of ethnographic work in two Greek lowland village communities during the military Dictatorship (1967–1974). Paradoxically this era associated with the spread of mechanization, cheap credit, revaluation of labour and clear means-ends relations, signalled entrepreneurial sons’ individuated dissent and activism who were now able to question the Patriarch’s authority, recognize opportunities and act as unintentional agents of deinstitutionalization. A ‘different’ model of institutional change is presented here, where politics intersects with entrepreneurs, in changing social institutions. This model discusses the external drivers of institutional atrophy and how handling dissensus (and its varieties over historical time) is instrumental in enabling institutional entrepreneurship

The Main Belt Comets and ice in the Solar System

We review the evidence for buried ice in the asteroid belt; specifically the questions around the so-called Main Belt Comets (MBCs). We summarise the evidence for water throughout the Solar System, and describe the various methods for detecting it, including remote sensing from ultraviolet to radio wavelengths. We review progress in the first decade of study of MBCs, including observations, modelling of ice survival, and discussion on their origins. We then look at which methods will likely be most effective for further progress, including the key challenge of direct detection of (escaping) water in these bodies

The tumbling rotational state of 1I/‘Oumuamua

The discovery of 1I/2017 U1 (1I/‘Oumuamua) has provided the first glimpse of a planetesimal born in another planetary system. This interloper exhibits a variable colour within a range that is broadly consistent with local small bodies, such as the P- and D-type asteroids, Jupiter Trojans and dynamically excited Kuiper belt objects. 1I/‘Oumuamua appears unusually elongated in shape, with an axial ratio exceeding 5:1. Rotation period estimates are inconsistent and varied, with reported values between 6.9 and 8.3 h. Here, we analyse all the available optical photometry data reported to date. No single rotation period can explain the exhibited brightness variations. Rather, 1I/‘Oumuamua appears to be in an excited rotational state undergoing non-principal axis rotation, or tumbling. A satisfactory solution has apparent lightcurve frequencies of 0.135 and 0.126 h−1 and implies a longest-to-shortest axis ratio of ≳5:1, although the available data are insufficient to uniquely constrain the true frequencies and shape. Assuming a body that responds to non-principal axis rotation in a similar manner to Solar System asteroids and comets, the timescale to damp 1I/‘Oumuamua’s tumbling is at least one billion years. 1I/‘Oumuamua was probably set tumbling within its parent planetary system and will remain tumbling well after it has left ours

Exocomets from a Solar System Perspective

Exocomets are small bodies releasing gas and dust which orbit stars other than the Sun. Their existence was first inferred from the detection of variable absorption features in stellar spectra in the late 1980s using spectroscopy. More recently, they have been detected through photometric transits from space, and through far-IR/mm gas emission within debris disks. As (exo)comets are considered to contain the most pristine material accessible in stellar systems, they hold the potential to give us information about early stage formation and evolution conditions of extra solar systems. In the solar system, comets carry the physical and chemical memory of the protoplanetary disk environment where they formed, providing relevant information on processes in the primordial solar nebula. The aim of this paper is to compare essential compositional properties between solar system comets and exocomets to allow for the development of new observational methods and techniques. The paper aims to highlight commonalities and to discuss differences which may aid the communication between the involved research communities and perhaps also avoid misconceptions. The compositional properties of solar system comets and exocomets are summarized before providing an observational comparison between them. Exocomets likely vary in their composition depending on their formation environment like solar system comets do, and since exocomets are not resolved spatially, they pose a challenge when comparing them to high fidelity observations of solar system comets. Observations of gas around main sequence stars, spectroscopic observations of “polluted” white dwarf atmospheres and spectroscopic observations of transiting exocomets suggest that exocomets may show compositional similarities with solar system comets. The recent interstellar visitor 2I/Borisov showed gas, dust and nuclear properties similar to that of solar system comets. This raises the tantalising prospect that observations of interstellar comets may help bridge the fields of exocomet and solar system comets