Quantitative SPECT/CT parameters of myocardial 99mTechnetium-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) uptake in suspected cardiac transthyretin amyloidosis

Background: 99mTc-labelled bisphosphonates are used for imaging assessment of patients with transthyretin cardiac amyloidosis (ATTR). Present study evaluates whether quantitative SPECT/CT measurement of absolute myocardial 99mTc-labelled 3,3-diphosphono-1,2-propanodicarboxylic acid (Tc-DPD) uptake can diagnose patients with suspected ATTR. / Methods: Twenty-eight patients (25 male, age 80.03 ± 6.99 years) with suspected ATTR referred for Tc-DPD imaging had planar and SPECT/CT imaging of the chest. Three operators independently obtained Tc-DPD myocardial SUVmax and SUVmean above threshold (SMaT) (20, 40 and 60% of SUVmax), using a semi-automated threshold segmentation method. Results were compared to visual grading (0–3) of cardiac uptake. / Results: Twenty-two patients (78%) had cardiac uptake (2 grade 1, 15 grade 2, 5 grade 3). SUVmax and SMaT segmentation thresholds enabled separating grades 2/3 from 0/1 with excellent inter- and intra-reader correlation. Cut-off values 6.0, 2.5, 3 and 4 for SUVmax, SMaT20,40,60, respectively, separated between grades 2/3 and 0 /1 with PPV and NPV of 100%. SMaT20,40,60(cardiac)/SUVmean (liver) and SMaT20,40,60(cardiac)/SUVmean(liver/lung) separated grades 2 and 3. / Conclusion: Quantitative SPECT/CT parameters of cardiac Tc-DPD uptake are robust, enabling separation of patients with grades 2 and 3 cardiac uptake from grades 0 and 1. Larger patient cohorts will determine the incremental value of SPECT/CT quantification for ATTR management

Estimated glucose disposal rate as a candidate biomarker for thrombotic biomarkers in T1D: a pooled analysis

Purpose To determine the utility of estimated glucose disposal rate (eGDR) as a candidate biomarker for thrombotic biomarkers in patients with type 1 diabetes (T1D). Methods We reanalysed baseline pretreatment data in a subset of patients with T1D from two previous RCTs, consisting of a panel of thrombotic markers, including fibrinogen, tissue factor (TF) activity, and plasminogen-activator inhibitor (PAI)-1, and TNFα, and clinical factors (age, T1D duration, HbA1c, insulin requirements, BMI, blood pressure, and eGDR). We employed univariate linear regression models to investigate associations between clinical parameters and eGDR with thrombotic biomarkers. Results Thirty-two patients were included [mean ± SD age 31 ± 7 years, HbA1c of 58 ± 9 mmol/mol (7.5 ± 0.8%), eGDR 7.73 ± 2.61]. eGDR negatively associated with fibrinogen (P < 0.001), PAI-1 concentrations (P = 0.005), and TF activity (P = 0.020), but not TNFα levels (P = 0.881). We identified 2 clusters of patients displaying significantly different characteristics; 56% (n = 18) were categorised as ‘higher-risk’, eliciting significantly higher fibrinogen (+ 1514 ± 594 μg/mL; P < 0.001), TF activity (+ 59.23 ± 9.42 pmol/mL; P < 0.001), and PAI-1 (+ 8.48 ± 1.58 pmol/dL; P < 0.001), HbA1c concentrations (+ 14.20 ± 1.04 mmol/mol; P < 0.001), age (+ 7 ± 3 years; P < 0.001), duration of diabetes (15 ± 2 years; P < 0.001), BMI (+ 7.66 ± 2.61 kg/m2; P < 0.001), and lower mean eGDR (− 3.98 ± 1.07; P < 0.001). Conclusions Compared to BMI and insulin requirements, classical surrogates of insulin resistance, eGDR is a suitable and superior thrombotic risk indicator in T1D. Trial registration ISRCTN4081115; registered 27 June 2017

Charity Fundraising Project:A Team-Based Project for Developing Problem-Structuring Skills

Increasingly, graduates of business schools will face business and organizational situations with a high degree of complexity and ambiguity. In this context, teaching and learning strategies need to develop students’ abilities in problem structuring and complex problem solving. This article describes a team-based project set to teams of four or five students, who are required to design and deliver a fundraising event for their chosen charity. The goal of the fundraising activity is to raise as much money as they can in a 24-hour period. Using ideas from problem-based learning (PBL), students learn frameworks and tools to increase their confidence in these situations. This article describes this activity and will be of interest to teachers of final-year undergraduate and master’s programs looking for a fun and inspiring activity to do with students.Increasingly, graduates of business schools will face business and organizational situations with a high degree of complexity and ambiguity. In this context, teaching and learning strategies need to develop students’ abilities in problem structuring and complex problem solving. This article describes a team-based project set to teams of four or five students, who are required to design and deliver a fundraising event for their chosen charity. The goal of the fundraising activity is to raise as much money as they can in a 24-hour period. Using ideas from problem-based learning (PBL), students learn frameworks and tools to increase their confidence in these situations. This article describes this activity and will be of interest to teachers of final-year undergraduate and master’s programs looking for a fun and inspiring activity to do with students

Spheres of Practice for the Co-design of Wearables

As expectations within the area of smart textiles increasingly become informed and driven by technological developments, the disciplinary boundaries and relationship between user and technological innovation will unavoidably transform. The authors venture that new paradigms of collaborative practice will inevitably develop between design and science, to more fully realize both the opportunities and contexts that wearable textiles offer. Drawing on previous work by the authors namely Molecular Imprinted Textiles (MIT - 2009/10), Future Textile Visions (FTV - 2010/11), Design Specks: Connecting People with Speckled Computing (2012/13), Second Skin (2013/14), and The S*** Word: Designing the Empathic Underwardrobe (2014), a model is proposed to more clearly understand and navigate between design, technology and application, and more importantly, between our cultural understanding of the user and the wearer. This paper reflects on a series of projects that inform a methodological approach: a process of asking questions; developing scenarios; exploring materials and making; generating concepts and building prototypes. Each project involved collaborations between design, academics, users and industry, and a form of co-design, where knowledge exchange was central, design was the intermediary, and the goal was to understand the drivers and the stakeholders. Simultaneously, this research sought to better understand and communicate the development of more empathic textile and fashion artifacts, and solutions. Co-design in this context is seen as a core approach to shifting the balance from technology as merely adjunct, or as a hook for marketers and users, to a more informed and harmonised position, where technology sits proximally and comfortably. The notion of interdisciplinary understanding, which tracks across domains of product, fashion and textiles, presents an approach where the application is still emerging. Through analysis of this progressive series of projects, the authors suggest that there is an opportunity to explore the inherent connectedness that textiles might offer for the integration and embedding of technology within material as a means to embrace these affordance opportunities. Central to this notion is the realisation of opportunities arising from dialogue and collaborative making (i.e. co-design), and for exploring the transformative notions of the user and the wearer. This paper led the authors to pose a set of questions that align to a four stage design process: Research, Define, Develop, Reflect, to frame findings and insights, and to outline the potential for future opportunities of working with technology to achieve the making and wearing of desirable materializations on the body

Distortion Product Otoacoustic Emissions Evoked by Tone Complexes

Distortion product otoacoustic emissions (DPOAEs) are traditionally evoked by two-tone stimuli. In this study, emission data from Mongolian gerbils are reported that were obtained with stimuli consisting of six to 10 tones. The stimuli were constructed by replacing one of the tones of a tone pair by a narrowband multitone complex. This produced rich spectra of the ear canal sound pressure in which many of the third-order DPOAEs originated from the interaction of triplets of stimulus components. A careful choice of the stimulus frequencies ensured that none of these DPOAE components coincided. Three groups of DPOAEs are reported, two of which are closely related to DPOAEs evoked by tone pairs. The third group has no two-tone equivalent and only arises when using a multitone stimulus. We analyzed the relation between multitone-evoked DPOAEs and DPOAEs evoked by tone pairs, and explored the new degrees of freedom offered by the multitone paradigm

Omega-3 polyunsaturated fatty acid supplementation versus placebo on vascular health, glycaemic control, and metabolic parameters in people with type 1 diabetes: a randomised controlled preliminary trial

Background: The role of omega-3 polyunsaturated fatty acids (n-3PUFA), and the potential impact of n-3PUFA supplementation, in the treatment and management of type 1 diabetes (T1D) remains unclear and controversial. Therefore, this study aimed to examine the efficacy of daily high-dose-bolus n-3PUFA supplementation on vascular health, glycaemic control, and metabolic parameters in subjects with T1D. Methods: Twenty-seven adults with T1D were recruited to a 6-month randomised, double-blind, placebo-controlled trial. Subjects received either 3.3 g/day of encapsulated n-3PUFA or encapsulated 3.0 g/day corn oil placebo (PLA) for 6-months, with follow-up at 9-months after 3-month washout. Erythrocyte fatty acid composition was determined via gas chromatography. Endpoints included inflammation-associated endothelial biomarkers (vascular cell adhesion molecule-1 [VCAM-1], intercellular adhesion molecule-1 [ICAM-1], E-selectin, P-selectin, pentraxin-3, vascular endothelial growth factor [VEGF]), and their mediator tumor necrosis factor alpha [TNFα] analysed via immunoassay, vascular structure (carotid intima-media thickness [CIMT]) and function (brachial artery flow mediated dilation [FMD]) determined via ultrasound technique, blood pressure, glycosylated haemoglobin (HbA1c), fasting plasma glucose (FPG), and postprandial metabolism. Results: Twenty subjects completed the trial in full. In the n-3PUFA group, the mean ± SD baseline n-3PUFA index of 4.93 ± 0.94% increased to 7.67 ± 1.86% (P  0.05). Conclusions: This study indicates that daily high-dose-bolus of n-3PUFA supplementation for 6-months does not improve vascular health, glucose homeostasis, or metabolic parameters in subjects with T1D. The findings from this preliminary RCT do not support the use of therapeutic n-3PUFA supplementation in the treatment and management of T1D and its associated complications. Trial Registration ISRCTN, ISRCTN40811115. Registered 27 June 2017, http://www.isrctn.com/ISRCTN40811115

Professional Occupations, Knowledge-Driven Firms, And Entrepreneurship: A National And Regional Analysis

The worldwide dominance of Western nations in commercial knowledge-intensive services has declined between 1995 and 2010, but the slippage in revenue was only from 88 to 79 percent. The European Union and North America remain the two largest regions in consumption and in exporting. Four professional service sectors—accounting, law, engineering, and management consultancy—have shown stability or even growth in the past decade. Entry and expansion requirements in these fields, at home and abroad, constitute barriers for both individual professionals and companies. Entrepreneurship is evident in these sectors, as small and medium size enterprises have maintained their viability against large firms. Only accountancy shows a high degree of concentration, but competition in this sector, too, is expected from the emerging economies, especially China. Professional service firms of the West have forged strong linkages with both domestic and foreign clients via relationship marketing. Technology is an important factor via automation. Although each of the four sectors is facing both external and internal challenges, they continue to grow and appear to be meeting the challenges in part by more innovation and transparency

Omega-3 polyunsaturated fatty acids favourably modulate cardiometabolic biomarkers in type 2 diabetes: a meta-analysis and meta-regression of randomized controlled trials

BACKGROUND: Randomized controlled trials (RCTs) suggest that supplementation with omega-3 polyunsaturated fatty acids (n-3PUFAs) may favourably modify cardiometabolic biomarkers in type 2 diabetes (T2DM). Previous meta-analyses are limited by insufficient sample sizes and omission of meta-regression techniques, and a large number of RCTs have subsequently been published since the last comprehensive meta-analysis. Updated information regarding the impact of dosage, duration or an interaction between these two factors is therefore warranted. The objective was to comprehensively assess the effect of n-3PUFAs supplementation on cardiometabolic biomarkers including lipid profiles, inflammatory parameters, blood pressure, and indices of glycaemic control, in people with T2DM, and identify whether treatment dosage, duration or an interaction thereof modify these effects. METHODS: Databases including PubMed and MEDLINE were searched until 13th July 2017 for RCTs investigating the effect of n-3PUFAs supplementation on lipid profiles, inflammatory parameters, blood pressure, and indices of glycaemic control. Data were pooled using random-effects meta-analysis and presented as standardised mean difference (Hedges g) with 95% confidence intervals (95% CI). Meta-regression analysis was performed to investigate the effects of duration of supplementation and total dosage of n-3PUFAs as moderator variables where appropriate. RESULTS: A total of 45 RCTs were identified, involving 2674 people with T2DM. n-3PUFAs supplementation was associated with significant reductions in LDL [ES: - 0.10, (95% CI - 0.17, - 0.03); p = 0.007], VLDL (ES: - 0.26 (- 0.51, - 0.01); p = 0.044], triglycerides (ES: - 0.39 (- 0.55, - 0.24; p ≤ 0.001] and HbA1c (ES: - 0.27 (- 0.48, - 0.06); p = 0.010]. Moreover, n-3PUFAs supplementation was associated with reduction in plasma levels of TNF-α [ES: - 0.59 (- 1.17, - 0.01); p = 0.045] and IL-6 (ES: - 1.67 (- 3.14, - 0.20); p = 0.026]. All other lipid markers, indices of glycaemic control, inflammatory parameters, and blood pressure remained unchanged (p > 0.05). CONCLUSIONS: n-3PUFAs supplementation produces favourable hypolipidemic effects, a reduction in pro-inflammatory cytokine levels and improvement in glycaemia. Neither duration nor dosage appear to explain the observed heterogeneity in response to n-3PUFAs. Trial registration This trial was registered at http://www.crd.york.ac.uk as CRD42016050802

Developing Student Engagement in China Through Collaborative Action Research

As its market and society open up, China has transformed itself from a closed agrarian socialist economy to an urban state and an economic force. This has released accumulated tourism demand, led to the development of a diversified industry, and the spread of university and vocational courses in this field. However, the industry faces challenges to recruit and retain staff, with tourism education in higher education blamed for the shortfall in numbers and quality of candidates with suitable purpose, knowledge, and passion to serve. This chapter provides a background to the development of and problems facing tourism education in China, and suggests how to support student engagement and hence the future workforce