Altered in-stent hemodynamics may cause erroneous upgrading of moderate carotid artery restenosis when evaluated by duplex ultrasound

ObjectiveTo assess the influence of stent application on in-stent hemodynamics under standardized conditions.MethodsOvine common carotid arteries before and after stent (6 × 40 mm, sinus-Carotid-RXt, combined open-closed cell design; Optimed, Ettlingen, Germany) application were used. Plastic tubes, 10 mm in length, simulating stenosis were placed in the middle of the applied stent to induce different degrees of stenosis (moderate 57.8% and severe 76.4%). Flow velocity and dynamic compliance were, respectively, measured with ultrasound and laser scan; proximal, in-stent, and distal to the stented arterial segment (1 cm proximal and distal) in a pulsatile ex vivo circulation system.ResultsStent insertion caused the in-stent peak systolic velocity to increase 22% without stenosis, 31% with moderate stenosis, and 23% with severe stenosis. Stent insertion without stenosis caused no significant increase in in-stent end-diastolic velocity (EDV) but a 17% increase with moderate stenosis. In severe stenosis, EDV was increased 56% proximal to the stenosis. Compliance was reduced threefold in the middle of the stented arterial segment where flow velocity was significantly increased.ConclusionsWith or without stenosis, stent introduction caused the in-stent peak systolic velocity to become significantly elevated compared with a nonstented area. EDV was also increased by stent insertion in the case of moderate stenosis. The stent-induced compliance reduction may be causal for the increase in flow velocity since the stent-induced flow velocity elevation appeared in the stented area with low compliance. Because of altered hemodynamics caused by stent introduction when measured by duplex ultrasound, caution is prudent in concluding that carotid artery stenting is associated with a higher restenosis rate than carotid endarterectomy. Mistakenly upgrading moderate to severe restenosis could result in unnecessary reintervention.Clinical RelevanceClinical experience and prior studies support the supposition that restenosis after carotid artery stenting in carotid lesions displays erroneously elevated velocity when evaluated by duplex ultrasound (DUS), thus contributing to misleading interpretation of the degree of stenosis. This study, in contrast to studies of other groups, employs exactly the same conditions to measure flow with DUS in an unstented and then stented section of the carotid artery. Since DUS is the first-choice tool for carotid artery evaluation, knowledge about inexactness of the method is essential to avoid errors in treatment or follow-up decisions

Reply to Comment on Maani Hessari, N.; van Schalkwyk, M.C.; Thomas, S.; Petticrew, M. Alcohol Industry CSR Organisations: What Can Their Twitter Activity Tell Us about Their Independence and Their Priorities? A Comparative Analysis. Int. J. Environ. Res. Public Health 2019, 16, 892.

We are grateful for the opportunity to respond to the letter from the DrinkAware medical advisory panel [...]

Alcohol Industry CSR Organisations: What Can Their Twitter Activity Tell Us about Their Independence and Their Priorities? A Comparative Analysis.

There are concerns about the accuracy of the health information provided by alcohol industry (AI)-funded organisations and about their independence. We conducted a content analysis of the health information disseminated by AI-funded organisations through Twitter, compared with non-AI-funded charities, to assess whether their messages align with industry and/or public health objectives. We compared all tweets from 2016 from Drinkaware (UK); Drinkaware.ie (Ireland); and DrinkWise (Australia), to non-AI-funded charities Alcohol Concern (UK), Alcohol Action Ireland, and FARE (Australia). Industry-funded bodies were significantly less likely to tweet about alcohol marketing, advertising and sponsorship; alcohol pricing; and physical health harms, including cancers, heart disease and pregnancy. They were significantly more likely to tweet about behavioural aspects of drinking and less likely to mention cancer risk; particularly breast cancer. These findings are consistent with previous evidence that the purpose of such bodies is the protection of the alcohol market, and of the alcohol industry's reputation. Their messaging strongly aligns with AI corporate social responsibility goals. The focus away from health harms, particularly cancer, is also consistent with previous evidence. The evidence does not support claims by these alcohol-industry-funded bodies about their independence from industry

Managing complex issues through evolutionary learning laboratories

Policy makers, managers and leaders in organizations, governments and business institutions are under increasing pressure to make the right management decisions in the face of a continually changing political and socio-economic landscape. To make matters more challenging, the complex environmental, socio-economic, business-financial issues that decision makers need to deal with tend to transcend the jurisdictions and capacities of any single organization. There is a multitude of difficult, long-term global challenges ahead, almost all of which are coupled with the most pressing concerns of different countries at national and local levels. Despite many efforts to deal with these complex issues facing our society, the solutions so far have seldom been long lasting, because 'treating the symptoms' and 'quick fixes', using traditional linear thinking, are the easiest way out, but do not deliver the solutions. This paper describes the processes for unravelling complexity through participatory systems analysis and the interpretation of systems structures to identify leverage points for systemic interventions. It further demonstrates the promotion of effective change and the enhancement of cross-sectoral communication and collaborative learning. This learning focuses on finding solutions to complex issues by applying an iterative, systems-based approach, both locally-Evolutionary Learning Laboratory (ELLab)-and globally-Global Evolutionary Learning Laboratory (GELL). A generic framework and processes for implementing and institutionalizing ELLabs are described, and how these become part of the GELL for managing complex issues is explained. Four case studies are used to demonstrate diverse examples of the application and implementation of the ELLab approach. © 2013 John Wiley & Sons, Ltd.Ockie J. H. Bosch, Nam C. Nguyen, Takashi Maeno and Toshiyuki Yasu

‘Nothing can be done until everything is done’: the use of complexity arguments by food, beverage, alcohol and gambling industries

Background - Corporations use a range of strategies to dispute their role in causing public health harms and to limit the scope of effective public health interventions. This is well documented in relation to the activities of the tobacco industry, but research on other industries is less well developed. We therefore analysed public statements and documents from four unhealthy commodity industries to investigate whether and how they used arguments about complexity in this way. Methods - We analysed alcohol, food, soda and gambling industry documents and websites and minutes of reports of relevant health select committees, using standard document analysis methods. Results - Two main framings were identified: (i) these industries argue that aetiology is complex, so individual products cannot be blamed; and (ii) they argue that population health measures are ’too simple’ to address complex public health problems. However, in this second framing, there are inherent contradictions in how industry used ’complexity’, as their alternative solutions are generally not, in themselves, complex. Conclusion - The concept of complexity, as commonly used in public health, is also widely employed by unhealthy commodity industries to influence how the public and policymakers understand health issues. It is frequently used in response to policy announcements and in response to new scientific evidence (particularly evidence on obesity and alcohol harms). The arguments and language may reflect the use of a cross-industry ’playbook’, which aims to undermine effective public health policies—in particular to undermine effective regulation of profitable industry activities that are harmful to the public’s health

WHO global research priorities for antimicrobial resistance in human health

The WHO research agenda for antimicrobial resistance (AMR) in human health has identified 40 research priorities to be addressed by the year 2030. These priorities focus on bacterial and fungal pathogens of crucial importance in addressing AMR, including drug-resistant pathogens causing tuberculosis. These research priorities encompass the entire people-centred journey, covering prevention, diagnosis, and treatment of antimicrobial-resistant infections, in addition to addressing the overarching knowledge gaps in AMR epidemiology, burden and drivers, policies and regulations, and awareness and education. The research priorities were identified through a multistage process, starting with a comprehensive scoping review of knowledge gaps, with expert inputs gathered through a survey and open call. The priority setting involved a rigorous modified Child Health and Nutrition Research Initiative approach, ensuring global representation and applicability of the findings. The ultimate goal of this research agenda is to encourage research and investment in the generation of evidence to better understand AMR dynamics and facilitate policy translation for reducing the burden and consequences of AMR

The ecological-economic possibilities of a non-rapid energy transition

With signs and symptoms of climate change continuing to worsen, it is widely accepted that A) our economic systems must shift away from carbon-emitting sources of energy and B) this transition must be rapid. In 2022, the US congress passed two major spending bills aimed at facilitating such a transition through expansion of renewable energy and electric vehicle charging infrastructure. While plenty of studies show that a rapid energy transition is both physically possible and environmentally justified, the speed of this transition is rarely examined for its secondary economic effects. Based on previous studies we have shown that the higher the speed of the transition, the greater the extractive capacity (materials per unit time) would be needed. We are thus motivated to ask: What are the ecological possibilities of a non-rapid transition? Methods: We first establish a method for defining and measuring the extraction rates required to enable a rapid transition of vehicle fueling and electricity generation/transmission infrastructure. Here, we build on our existing work forecasting EV infrastructure scale-up requirements. Then we pair this information with existing data on material intensities and established knowledge about the useful life of various critical material extraction facilities, providing an estimate of the total resource extraction enabled by the transition. We build a probabilistic model of total material footprint enabled by the energy transition, meant as a proof of concept regarding the importance of energy infrastructure transition rate. Results and Discussion: Accepting a rapid transition may lead to an unsustainable level of demand lock-in, compared to a slower one. It could also lead to further delays in taking united, global-scale policy action to set and enforce resource demand limits. These second-order effects alone represent reasons to be skeptical, not about the need for energy transition, but about its rapidity

Alcohol industry CSR organisations: what can their twitter activity tell us about their independence and their priorities? A comparative analysis.

There are concerns about the accuracy of the health information provided by alcohol industry (AI)-funded organisations and about their independence. We conducted a content analysis of the health information disseminated by AI-funded organisations through Twitter, compared with non-AI-funded charities, to assess whether their messages align with industry and/or public health objectives. We compared all tweets from 2016 from Drinkaware (UK); Drinkaware.ie (Ireland); and DrinkWise (Australia), to non-AI-funded charities Alcohol Concern (UK), Alcohol Action Ireland, and FARE (Australia). Industry-funded bodies were significantly less likely to tweet about alcohol marketing, advertising and sponsorship; alcohol pricing; and physical health harms, including cancers, heart disease and pregnancy. They were significantly more likely to tweet about behavioural aspects of drinking and less likely to mention cancer risk; particularly breast cancer. These findings are consistent with previous evidence that the purpose of such bodies is the protection of the alcohol market, and of the alcohol industry’s reputation. Their messaging strongly aligns with AI corporate social responsibility goals. The focus away from health harms, particularly cancer, is also consistent with previous evidence. The evidence does not support claims by these alcohol-industry-funded bodies about their independence from industry