Reference chart derived from post-stent-implantation intravascular ultrasound predictors of 6-month expected restenosis on quantitative coronary angiography

BACKGROUND: Intravascular ultrasound (IVUS)-guided stent implantation and the availability of a reference chart to predict the expected in-stent restenosis rate based on operator-dependent IVUS parameters ma

Hand transplantation: can we balance the risks and benefits?

Asking ‘can we balance the risks and benefits?’ implies that a quantification of both risk and benefit in hand transplantation (here the terms hand transplant and hand transplantation refer to allotransplantation of the human hand or hand and part or all of the upper limb or limbs) is possible. Despite all we have learned in recent years about hand transplantation, much remains unknown. Even if reliable methods for quantification of risk and benefit were available, fundamental issues relating to effective communication across the gulf of lived experience between the (presumably) handed surgeon and the handless patient remain. Inherent complexities mean some consider hand transplantation an unsolved problem, but we believe the medical and technical considerations fall within the ambit of a competent multidisciplinary team, and that psychosocial and ethical challenges are open to management through robust frameworks for assessment and decision making, underpinned by an extended period of assessment and dialogue, with candid acknowledgement where uncertainty remains. This respects the patient’s autonomy while addressing the need for a prolonged period of informing consent

Quantifying regulating ecosystem services with increased tree densities on European Farmland

Agroforestry systems have been compared to agricultural and forestry alternatives, providing a land-use solution for additional environmental benefits while maintaining similar levels of productivity. However, there is scarce research assessing such patterns across a pan-European scale using a common methodology. This study aims to improve our understanding of the role of trees in three different regulating ecosystem services—(1) soil erosion, (2) nitrate leaching and (3) carbon sequestration—in traditional and innovative agroforestry systems in Europe through a consistent modeling approach. The systems’ assessment spans environmentally from the Mediterranean environmental region in Portugal to the Continental environmental region in Switzerland and Germany to the Atlantic environmental region in the United Kingdom. Modeled tree densities were compared in the different land-use alternatives, ranging from zero (agriculture with only crops or pasture) to forestry (only trees). The methodology included the use of a biophysical model (Yield-SAFE) where the quantification of the environmental benefits was integrated. Results show a consistent improvement of regulating ecosystem services can be expected when introducing trees in the farming landscapes in different environmental regions in Europe. For all the systems, the forestry alternatives presented the best results in terms of a decrease in soil erosion of 51% (±29), a decrease of nearly all the nitrate leaching (98% ± 1) and an increase in the carbon sequestration of up to 238 Mg C ha−1 (±140). However, these alternatives are limited in the variety of food, energy and/or materials provided. On the other hand, from an arable or pure-pasture alternative starting point, an increase in agroforestry tree density could also be associated with a decrease in soil erosion of up to 25% (±17), a decrease in nitrates leached of up to 52% (±34) and an increase in the carbon sequestered of 163 Mg C ha−1 (±128) while at the same time ensuring the same levels of biomass growth and an increase in product diversification.We acknowledge the financial support provided by the Portuguese Foundation for Science and Technology (FCT) through the scholarship (SFRH/BD/52691/2014) and the European Community's Seventh Framework Programme under Grant Agreement No. 613520 (Project AGFORWARD). This research was funded by the Forest Research Centre, a research unit funded by Funda??o para a Ci?ncia e a Tecnologia I.P. (FCT), Portugal (UIDB/00239/2020)

Religious diversity, empathy, and God images : perspectives from the psychology of religion shaping a study among adolescents in the UK

Major religious traditions agree in advocating and promoting love of neighbour as well as love of God. Love of neighbour is reflected in altruistic behaviour and empathy stands as a key motivational factor underpinning altruism. This study employs the empathy scale from the Junior Eysenck Impulsiveness Questionnaire to assess the association between empathy and God images among a sample of 5993 religiously diverse adolescents (13–15 years old) attending state maintained schools in England, Northern Ireland, Scotland, Wales, and London. The key psychological theory being tested by these data concerns the linkage between God images and individual differences in empathy. The data demonstrate that religious identity (e.g. Christian, Muslim) and religious attendance are less important than the God images which young people hold. The image of God as a God of mercy is associated with higher empathy scores, while the image of God as a God of justice is associated with lower empathy scores

Dry deposition of air pollutants on trees at regional scale: A case study in the Basque Country

There is increased interest in the role of trees to reduce air pollution and thereby improve human health and well-being. This study determined the removal of air pollutants by dry deposition of trees across the Basque Country and estimated its annual economic value. A model that calculates the hourly dry deposition of NO2, O3, SO2, CO and PM10 on trees at a 1 km x 1 km resolution at a regional scale was developed. The calculated mean annual rates of removal of air pollution across various land uses were 12.9 kg O3 ha-1, 12.7 kg PM10 ha-1, 3.0 kg NO2 ha-1, 0.8 kg SO2 ha-1 and 0.2 kg CO ha-1. The results were then categorised according to land use in order to determine how much each land use category contributed to reducing air pollution and to determine to what extent trees provided pollution reduction benefits to society. Despite not being located in the areas of highest pollutions, coniferous forests, which cover 25% of the land, were calculated to absorb 21% of the air pollution. Compared to other land uses, coniferous forests were particularly effective in removing air pollution because of their high tree cover density and the duration of leaf life-span. The total economic value provided by the trees in reducing these pollutants in terms of health benefits was estimated to be 60 million yr-1 which represented around 0.09% of the Gross Domestic Product of the Basque Country in 2016. Whilst most health impacts from air pollution are in urban areas the results indicate that most air pollution is removed in rural areas. © 2019 Elsevier B.V.Silvestre García de Jalón, Jorge Curiel Yuste and Aline Chiabai acknowledge support from the Basque Government through the BERC 2018-2021 program and from the Spanish Ministry of Science, Innovation and Universities through the BC3 María de Maeztu excellence accreditation ( MDM-2017-0714

Molecular dynamics simulation of the order-disorder phase transition in solid NaNO2_2

We present molecular dynamics simulations of solid NaNO$_2$ using pair potentials with the rigid-ion model. The crystal potential surface is calculated by using an \emph{a priori} method which integrates the \emph{ab initio} calculations with the Gordon-Kim electron gas theory. This approach is carefully examined by using different population analysis methods and comparing the intermolecular interactions resulting from this approach with those from the \emph{ab initio} Hartree-Fock calculations. Our numerics shows that the ferroelectric-paraelectric phase transition in solid NaNO$_2$ is triggered by rotation of the nitrite ions around the crystallographical c axis, in agreement with recent X-ray experiments [Gohda \textit{et al.}, Phys. Rev. B \textbf{63}, 14101 (2000)]. The crystal-field effects on the nitrite ion are also addressed. Remarkable internal charge-transfer effect is found.Comment: RevTeX 4.0, 11 figure

Association between initiation of adjuvant chemotherapy beyond 30 days after surgery and overall survival among patients with triple-negative breast cancer

Delayed time to chemotherapy (TTC) is associated with decreased outcomes of breast cancer patients. Recently, studies suggested that the association might be subtype-dependent and that TTC within 30 days should be warranted in patients with triple-negative breast cancer (TNBC). The aim of the current study is to determine if TTC beyond 30 days is associated with reduced 10-year overall survival in TNBC patients. We identified all TNBC patients diagnosed between 2006 and 2014 who received adjuvant chemotherapy in the Netherlands. We distinguished between breast-conserving surgery (BCS) vs. mastectomy given the difference in preoperative characteristics and outcomes. The association was estimated with hazard ratios (HRs) using propensity-score matched Cox proportional hazard analyses. In total, 3,016 patients were included. In matched patients who underwent BCS (n = 904), 10-year overall survival was favorable for patients with TTC within 30 days (84.4% vs. 76.9%, p = 0.001). Patients with TTC beyond 30 days were more likely than those with TTC within 30 days to die within 10 years after surgery (HR 1.69 (95% CI 1.22–2.34), p = 0.002). In matched patients who underwent mastectomy (n = 1,568), there was no difference in 10 years overall survival between those with TTC within or beyond 30 days (74.5% vs. 74.7%, p = 0.716), nor an increased risk of death for those with TTC beyond 30 days (HR 1.04 (95% CI 0.84–1.28), p = 0.716). Initiation of adjuvant chemotherapy beyond 30 days is associated with decreased 10 years overall survival in TNBC patients who underwent BCS. Therefore, timelier initiation of chemotherapy in TNBC patients undergoing BCS seems warranted

Three dimensional intravascular ultrasonic assessment of the local mechanism of restenosis after balloon angioplasty

OBJECTIVE: To assess the mechanism of restenosis after balloon angioplasty. DESIGN: Prospective study. PATIENTS: 13 patients treated with balloon angioplasty. INTERVENTIONS: 111 coronary subsegments (2 mm each) were analysed after balloon angioplasty and at a six month follow up using three dimensional intravascular ultrasound (IVUS). MAIN OUTCOME MEASURES: Qualitative and quantitative IVUS analysis. Total vessel (external elastic membrane), plaque, and lumen volume were measured in each 2 mm subsegment. Delta values were calculated (follow up - postprocedure). Remodelling was defined as any (positive or negative) change in total vessel volume. RESULTS: Positive remodelling was observed in 52 subsegments while negative remodelling occurred in 44. Remodelling, plaque type, and dissection were heterogeneously distributed along the coronary segments. Plaque composition was not associated with changes in IVUS indices, whereas dissected subsegments had a greater increase in total vessel volume than those without dissection (1.7 mm(3) v -0.33 mm(3), p = 0.04). Change in total vessel volume was correlated with changes in lumen (p < 0.05, r = 0.56) and plaque volumes (p < 0.05, r = 0.64). The site with maximum lumen loss was not the same site as the minimum lumen area at follow up in the majority (n = 10) of the vessels. In the multivariate model, residual plaque burden had an influence on negative remodelling (p = 0.001, 95% confidence interval (CI) -0.391 to -0.108), whereas dissection had an effect on total vessel increase (p = 0.002, 95% CI 1.168 to 4.969). CONCLUSIONS: The mechanism of lumen renarrowing after balloon angioplasty appears to be determined by unfavourable remodelling. However, different patterns of remodelling may occur in individual injured coronary segments, which highlights the complexity and influence of local factors in the restenotic process

Outcome from balloon induced coronary artery dissection after intracoronary beta radiation

OBJECTIVE: To evaluate the healing of balloon induced coronary artery dissection in individuals who have received beta radiation treatment and to propose a new intravascular ultrasound (IVUS) dissection score to facilitate the comparison of dissection through time. DESIGN: Retrospective study. SETTING: Tertiary referral centre. PATIENTS: 31 patients with stable angina pectoris, enrolled in the beta energy restenosis trial (BERT-1.5), were included. After excluding those who underwent stent implantation, the evaluable population was 22 patients. INTERVENTIONS: Balloon angioplasty and intracoronary radiation followed by quantitative coronary angiography (QCA) and IVUS. Repeat QCA and IVUS were performed at six month follow up. MAIN OUTCOME MEASURES: QCA and IVUS evidence of healing of dissection. Dissection classification for angiography was by the National Heart Lung Blood Institute scale. IVUS proven dissection was defined as partial or complete. The following IVUS defined characteristics of dissection were described in the affected coronary segments: length, depth, arc circumference, presence of flap, and dissection score. Dissection was defined as healed when all features of dissection had resolved. The calculated dose of radiation received by the dissected area in those with healed versus non-healed dissection was also compared. RESULTS: Angiography (type A = 5, B = 7, C = 4) and IVUS proven (partial = 12, complete = 4) dissections were seen in 16 patients following intervention. At six month follow up, six and eight unhealed dissections were seen by angiography (A = 2, B = 4) and IVUS (partial = 7, complete = 1), respectively. The mean IVUS dissection score was 5.2 (range 3-8) following the procedure, and 4.6 (range 3-7) at follow up. No correlation was found between the dose prescribed in the treated area and the presence of unhealed disse