The Clinical Application of Cardiac Doppler Ultrasound

The aim of this thesis is to investigate the accuracy of Doppler ultrasound in specific types of cardiac disease and more particularly, to establish its clinical role in cardiovascular diagnosis in conditions where it is likely to confer additional advantage over clinical examination and conventional non-invasive techniques, and thereby have its most major clinical impact

The Social Context of Cannibalism in Migratory Bands of the Mormon Cricket

Cannibalism has been shown to be important to the collective motion of mass migratory bands of insects, such as locusts and Mormon crickets. These mobile groups consist of millions of individuals and are highly destructive to vegetation. Individuals move in response to attacks from approaching conspecifics and bite those ahead, resulting in further movement and encounters with others. Despite the importance of cannibalism, the way in which individuals make attack decisions and how the social context affects these cannibalistic interactions is unknown. This can be understood by examining the decisions made by individuals in response to others. We performed a field investigation which shows that adult Mormon crickets were more likely to approach and attack a stationary cricket that was side-on to the flow than either head- or abdomen-on, suggesting that individuals could reduce their risk of an attack by aligning with neighbours. We found strong social effects on cannibalistic behaviour: encounters lasted longer, were more likely to result in an attack, and attacks were more likely to be successful if other individuals were present around a stationary individual. This local aggregation appears to be driven by positive feedback whereby the presence of individuals attracts others, which can lead to further crowding. This work improves our understanding of the local social dynamics driving migratory band formation, maintenance and movement at the population level

Foreign investment in Scotland

A significant feature of the UK economy throughout the post-war period has been the growth in direct foreign investment in manufacturing industries. For the host nation the main benefits are employment creation, income generation and import reduction or export expansion. Scotland has been particularly successful in attracting the lion's inward investment for example in the period 1945- 1965 a total of 108,500 jobs were created by foreign firms setting up manufacturing units in the despite its size, obtained 46,221 (42.6%), whereas the second most SE England, gained only 16,926 (15.6%). The reasons for this success have been attributed primarily to a combination of the availability of labour in Scotland, the financial inducements offered by central government as part of regional policy and, the undoubted attraction of the environment, notably of course golf courses, for foreign businessmen. This brief paper explores the nature of Scotland's direct foreign investment and the reasons for its success

The tax and price index

A feature of this year's Budget was the shift in emphasis from direct taxation to indirect taxation. The annual yield of income tax has been reduced by £4½ billion while that of direct taxes was increased by a similar amount. It must be acknowledged that the new tax and price index has a number of deficiencies. It is only applicable to a proportion of the population, namely those who pay tax and whose gross income is less than £10,000 per annum. It takes no account of the social wage, nor of changes in benefits, such as the recent restructuring of child allowance. It smoothes out tax payments over a full year even though, for administrative reasons, these may fluctuate widely from month to month. This brief paper explores some of these deficiencies in more detail and assess their impact on taxation

Functional polymorphism in ABCA1 influences age of symptom onset in coronary artery disease patients

ATP-binding-cassette-transporter-A1 (ABCA1) plays a pivotal role in intracellular cholesterol removal, exerting a protective effect against atherosclerosis. ABCA1 gene severe mutations underlie Tangier disease, a rare Mendelian disorder that can lead to premature coronary artery disease (CAD), with age of CAD onset being two decades earlier in mutant homozygotes and one decade earlier in heterozygotes than in mutation non-carriers. It is unknown whether common polymorphisms in ABCA1 could influence age of symptom onset of CAD in the general population. We examined common promoter and non-synonymous coding polymorphisms in relation to age of symptom onset in a group of CAD patients (n = 1164), and also carried out in vitro assays to test effects of the promoter variations on ABCA1 promoter transcriptional activity and effects of the coding variations on ABCA1 function in mediating cellular cholesterol efflux. Age of symptom onset was found to be associated with the promoter − 407G > C polymorphism, being 2.82 years higher in C allele homozygotes than in G allele homozygotes and intermediate in heterozygotes (61.54, 59.79 and 58.72 years, respectively; P = 0.002). In agreement, patients carrying ABCA1 haplotypes containing the −407C allele had higher age of symptom onset. Patients of the G/G or G/C genotype of the −407G > C polymorphism had significant coronary artery stenosis (>75%) at a younger age than those of the C/C genotype (P = 0.003). Reporter gene assays showed that ABCA1 haplotypes bearing the −407C allele had higher promoter activity than haplotypes with the −407G allele. Functional analyses of the coding polymorphisms showed an effect of the V825I substitution on ABCA1 function, with the 825I variant having higher activity in mediating cholesterol efflux than the wild-type (825V). A trend towards higher symptom onset age in 825I allele carriers was observed. The data indicate an influence of common ABCA1 functional polymorphisms on age of symptom onset in CAD patient

Effect of COVID-19 on presentations of decompensated liver disease in Scotland

BACKGROUND AND AIMS: SARS-CoV-2 and consequent pandemic has presented unique challenges. Beyond the direct COVID-related mortality in those with liver disease, we sought to determine the effect of lockdown on people with liver disease in Scotland. The effect of lockdown on those with alcohol-related disease is of interest; and whether there were associated implications for a change in alcohol intake and consequent presentations with decompensated disease. METHODS: We performed a retrospective analysis of patients admitted to seven Scottish hospitals with a history of liver disease between 1 April and 30 April 2020 and compared across the same time in 2017, 2018 and 2019. We also repeated an intermediate assessment based on a single centre to examine for delayed effects between 1 April and 31 July 2020. RESULTS: We found that results and outcomes for patients admitted in 2020 were similar to those in previous years in terms of morbidity, mortality, and length of stay. In the Scotland-wide cohort: admission MELD (Model for End-stage Liver Disease) (16 (12–22) vs 15 (12–19); p=0.141), inpatient mortality ((10.9% vs 8.6%); p=0.499) and length of stay (8 days (4–15) vs 7 days (4–13); p=0.140). In the Edinburgh cohort: admission MELD (17 (12–23) vs 17 (13–21); p=0.805), inpatient mortality ((13.7% vs 10.1%; p=0.373) and length of stay (7 days (4–14) vs 7 days (3.5–14); p=0.525)). CONCLUSION: This assessment of immediate and medium-term lockdown impacts on those with chronic liver disease suggested a minimal effect on the presentation of decompensated liver disease to secondary care