Assessment of acute myocardial infarction: current status and recommendations from the North American society for cardiovascular imaging and the European society of cardiac radiology

There are a number of imaging tests that are used in the setting of acute myocardial infarction and acute coronary syndrome. Each has their strengths and limitations. Experts from the European Society of Cardiac Radiology and the North American Society for Cardiovascular Imaging together with other prominent imagers reviewed the literature. It is clear that there is a definite role for imaging in these patients. While comparative accuracy, convenience and cost have largely guided test decisions in the past, the introduction of newer tests is being held to a higher standard which compares patient outcomes. Multicenter randomized comparative effectiveness trials with outcome measures are required

Treatments for people who use anabolic androgenic steroids: a scoping review.

BACKGROUND: A growing body of evidence suggests that anabolic androgenic steroids (AAS) are used globally by a diverse population with varying motivations. Evidence has increased greatly in recent years to support understanding of this form of substance use and the associated health harms, but there remains little evidence regarding interventions to support cessation and treat the consequences of use. In this scoping review, we identify and describe what is known about interventions that aim to support and achieve cessation of AAS, and treat and prevent associated health problems. METHODS: A comprehensive search strategy was developed in four bibliographic databases, supported by an iterative citation searching process to identify eligible studies. Studies of any psychological or medical treatment interventions delivered in response to non-prescribed use of AAS or an associated harm in any setting were eligible. RESULTS: In total, 109 eligible studies were identified, which included case reports representing a diverse range of disciplines and sources. Studies predominantly focussed on treatments for harms associated with AAS use, with scant evidence on interventions to support cessation of AAS use or responding to dependence. The types of conditions requiring treatment included psychiatric, neuroendocrine, hepatic, kidney, cardiovascular, musculoskeletal and infectious. There was limited evidence of engagement with users or delivery of psychosocial interventions as part of treatment for any condition, and of harm reduction interventions initiated alongside, or following, treatment. Findings were limited throughout by the case report study designs and limited information was provided. CONCLUSION: This scoping review indicates that while a range of case reports describe treatments provided to AAS users, there is scarce evidence on treating dependence, managing withdrawal, or initiating behaviour change in users in any settings. Evidence is urgently required to support the development of effective services for users and of evidence-based guidance and interventions to respond to users in a range of healthcare settings. More consistent reporting in articles of whether engagement or assessment relating to AAS was initiated, and publication within broader health- or drug-related journals, will support development of the evidence base

Pan-cancer analysis of whole genomes

Cancer is driven by genetic change, and the advent of massively parallel sequencing has enabled systematic documentation of this variation at the whole-genome scale(1-3). Here we report the integrative analysis of 2,658 whole-cancer genomes and their matching normal tissues across 38 tumour types from the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium of the International Cancer Genome Consortium (ICGC) and The Cancer Genome Atlas (TCGA). We describe the generation of the PCAWG resource, facilitated by international data sharing using compute clouds. On average, cancer genomes contained 4-5 driver mutations when combining coding and non-coding genomic elements; however, in around 5% of cases no drivers were identified, suggesting that cancer driver discovery is not yet complete. Chromothripsis, in which many clustered structural variants arise in a single catastrophic event, is frequently an early event in tumour evolution; in acral melanoma, for example, these events precede most somatic point mutations and affect several cancer-associated genes simultaneously. Cancers with abnormal telomere maintenance often originate from tissues with low replicative activity and show several mechanisms of preventing telomere attrition to critical levels. Common and rare germline variants affect patterns of somatic mutation, including point mutations, structural variants and somatic retrotransposition. A collection of papers from the PCAWG Consortium describes non-coding mutations that drive cancer beyond those in the TERT promoter(4); identifies new signatures of mutational processes that cause base substitutions, small insertions and deletions and structural variation(5,6); analyses timings and patterns of tumour evolution(7); describes the diverse transcriptional consequences of somatic mutation on splicing, expression levels, fusion genes and promoter activity(8,9); and evaluates a range of more-specialized features of cancer genomes(8,10-18).Peer reviewe

Harnessing horses in social pedagogy : Equine-assisted social education in a school context

This article introduces a school-based social pedagogical programme using horses to support pupils’ educational development, social and emotional skills and self-esteem. These are essential for pupils’ well-being, to reduce the risk of developing emotional disorders in youth and later life. In terms of academic outcomes, these social-emotional skills, character strengths and health benefits are recognised in the Finnish educational agenda. Equine-assisted social education (EASE) differs from recreational riding programs by its frame of reference in social pedagogy and in the human–equine bond it features, positioning horses as co-educators to improve interaction and collaboration. This human–equine communication supports both human and equine welfare if applied with attention, respect and empathy. Furthermore, the stables environment provides a setting for enhancing the pedagogical relationship and trust between pupils and their teacher. This equine activity practice, like other educational interventions, has physical, behavioural, social and emotional intentions. In addition, as social pedagogy is a complex and innovative discipline, EASE represents a ground-breaking practice within this discipline. The purpose is to respond to individual and social difficulties with preventive and problem-solving practice. As Finnish social pedagogy emphasises educational dialogue and communication, EASE facilitates non-verbal communication and positive behaviour. Additionally, it consists of factors improving collaboration through experiences, activities and dialogue.This article introduces a school-based social pedagogical programme using horses to support pupils’ educational development, social and emotional skills and self-esteem. These are essential for pupils’ well-being, to reduce the risk of developing emotional disorders in youth and later life. In terms of academic outcomes, these social-emotional skills, character strengths and health benefits are recognised in the Finnish educational agenda. Equine-assisted social education (EASE) differs from recreational riding programs by its frame of reference in social pedagogy and in the human–equine bond it features, positioning horses as co-educators to improve interaction and collaboration. This human–equine communication supports both human and equine welfare if applied with attention, respect and empathy. Furthermore, the stables environment provides a setting for enhancing the pedagogical relationship and trust between pupils and their teacher. This equine activity practice, like other educational interventions, has physical, behavioural, social and emotional intentions. In addition, as social pedagogy is a complex and innovative discipline, EASE represents a ground-breaking practice within this discipline. The purpose is to respond to individual and social difficulties with preventive and problem-solving practice. As Finnish social pedagogy emphasises educational dialogue and communication, EASE facilitates non-verbal communication and positive behaviour. Additionally, it consists of factors improving collaboration through experiences, activities and dialogue.Peer reviewe