Breaking the Path Dependency of the Internal Combustion Engine.

The dominance of the internal combustion engine appears to be waning. Recognition that oil, the driving force behind the internal combustion engine, is a limited and therefore unsustainable resource has provided the impetus for the development of alternative powertrains. In this paper we consider how the internal combustion engine controls the market, while identifying the barriers for change, and, finally, examine the potential replacement of the internal combustion engine with a sustainable alternative

Breaking the Path Dependency of the Internal Combustion Engine.

The dominance of the internal combustion engine appears to be waning. Recognition that oil, the driving force behind the internal combustion engine, is a limited and therefore unsustainable resource has provided the impetus for the development of alternative powertrains. In this paper we consider how the internal combustion engine controls the market, while identifying the barriers for change, and, finally, examine the potential replacement of the internal combustion engine with a sustainable alternative

Evaluation of a digital system to predict unplanned admissions to the intensive care unit: A mixed-methods approach

Background We have developed the Hospital Alerting Via Electronic Noticeboard (HAVEN) which aims to identify hospitalised patients most at risk of reversible deterioration. HAVEN combines patients’ vital-sign measurements with laboratory results, demographics and comorbidities using a machine learnt algorithm. Objectives The aim of this study was to identify variables or concepts that could improve HAVEN predictive performance. Methods This was an embedded, mixed methods study. Eligible patients with the five highest HAVEN scores in the hospital (i.e., ‘HAVEN Top 5′) had their medical identification details recorded. We conducted a structured medical note review on these patients 48 hours post their identifiers being recorded. Methods of constant comparison were used during data collection and to analyse patient data. Results The 129 patients not admitted to ICU then underwent constant comparison review, which produced three main groups. Group 1 were patients referred to specialist services (n = 37). Group 2 responded to ward-based treatment, (n = 38). Group 3 were frail and had documented treatment limitations (n = 47). Conclusions Digital-only validation methods code the cohort not admitted to ICU as ‘falsely positive’ in sensitivity analyses however this approach limits the evaluation of model performance. Our study suggested that coding for patients referred to other specialist teams, those with treatment limitations in place, along with those who are deteriorating but then respond to ward-based therapies, would give a more accurate measure of the value of the scores, especially in relation to cost-effectiveness of resource utilisation

Breaking the Path Dependency of the Internal Combustion Engine.

The dominance of the internal combustion engine appears to be waning. Recognition that oil, the driving force behind the internal combustion engine, is a limited and therefore unsustainable resource has provided the impetus for the development of alternative powertrains. In this paper we consider how the internal combustion engine controls the market, while identifying the barriers for change, and, finally, examine the potential replacement of the internal combustion engine with a sustainable alternative

Proton spectroscopy provides accurate pathology on biopsy and in vivo

In the last 25 years, MR spectroscopy (MRS) has moved from being a basic research tool into routine clinical use. The spectroscopy method reports on those chemicals that are mobile on the MR time scale. Many of these chemicals reflect specific pathological processes but are complicated by the fact that many chemicals change at one time. There are currently two clinical applications for spectroscopy. The first is in the pathology laboratory, where it can be an adjunct to, and in some cases replacement, for difficult pathologies like Barrett's esophagus and follicular adenoma of the thyroid. The spectroscopy method on a breast biopsy can also report on prognostic indicators, including the potential for spread, from information present in the primary tumor alone. The second application for spectroscopy is in vivo to provide a preoperative diagnosis and this is now achievable for several organs including the prostate. The development of spectroscopy for clinical purposes has relied heavily on the serially-sectioned histopathology to confirm the high accuracy of the method. The combination of in vivo MRI, in vivo MRS, and ex vivo MRS on biopsy samples offers a modality of very high accuracy for preoperative diagnosis and provision of prognostic information for human cancers

MR spectroscopy in the breast clinic is improving

Early studies suggested that in vivo proton MR spectroscopy could be added as an adjunct to dynamic contrast-enhanced MRI of the breast and increase the specificity. Today there have been a wide range of results ranging from excellent to bad. It becomes obvious that these outcomes are dependent on the local clinical culture, hardware manufacturer and experience of the local MR team. Even when all aspects are covered the results are currently only acceptable for tumors 1cm 3 and above

Evaluation of a digital system to predict unplanned admissions to the intensive care unit: A mixed-methods approach

Background We have developed the Hospital Alerting Via Electronic Noticeboard (HAVEN) which aims to identify hospitalised patients most at risk of reversible deterioration. HAVEN combines patients’ vital-sign measurements with laboratory results, demographics and comorbidities using a machine learnt algorithm. Objectives The aim of this study was to identify variables or concepts that could improve HAVEN predictive performance. Methods This was an embedded, mixed methods study. Eligible patients with the five highest HAVEN scores in the hospital (i.e., ‘HAVEN Top 5′) had their medical identification details recorded. We conducted a structured medical note review on these patients 48 hours post their identifiers being recorded. Methods of constant comparison were used during data collection and to analyse patient data. Results The 129 patients not admitted to ICU then underwent constant comparison review, which produced three main groups. Group 1 were patients referred to specialist services (n = 37). Group 2 responded to ward-based treatment, (n = 38). Group 3 were frail and had documented treatment limitations (n = 47). Conclusions Digital-only validation methods code the cohort not admitted to ICU as ‘falsely positive’ in sensitivity analyses however this approach limits the evaluation of model performance. Our study suggested that coding for patients referred to other specialist teams, those with treatment limitations in place, along with those who are deteriorating but then respond to ward-based therapies, would give a more accurate measure of the value of the scores, especially in relation to cost-effectiveness of resource utilisation

Neuro 2D correlated spectroscopy identifies neuro deregulation in soldiers exposed to blast prior to discernible changes by conventional imaging

This pilot study reports clear deregulation in the neurochemistry of defense personnel exposed to repeated blast. The changes recorded are different to those reported for mTBI, PTSD and chronic pain. No differences between blast exposed and healthy were recorded by MRI sequences T1WI, FLAIR or SWI. In vivo neuro 2D spectroscopy recorded deregulation with PC and GPC, NAA and GABA all decreased compared to the healthy non exposed brain. We we did not observe any changes in the fucosolated glycans, which are reflective of pain, repetitive brain injury and/or cognitive deficit