Balancing Inclusiveness, Rigour and Feasibility: Insights from Participatory Impact Evaluations in Ghana and Vietnam

This paper by Adinda Van Hemelrijck and Irene Guijt explores how impact evaluation can live up to standards broader than statistical rigour in ways that address challenges of complexity and enable stakeholders to engage meaningfully. A Participatory Impact Assessment and Learning Approach (PIALA) was piloted to assess and debate the impacts on rural poverty of two government programmes in Vietnam and Ghana funded by the International Fund for Agricultural Development (IFAD). We discuss the trade-offs between rigour, inclusiveness and feasibility encountered in these two pilots. Trade-offs occur in every impact evaluation aiming for more than reductionist rigour, but the pilots suggest that they can be reduced by building sufficient research and learning capacity.UK Department for International Developmen

An investigation of the mechanica behaviour of carbon epoxy cross ply cruciform specimens under biaxial loading

Abstract: In the present study carbon epoxy cruciform type specimens with a cross ply lay up, were biaxially and uniaxially loaded in their plane using four independent servo-hydraulic actuators. Four different biaxial loading ratios were investigated while the applied load was quasistatic. A comparison between experimental observations for the strain evolution of the biaxially loaded central section of the specimen coming from digital image correlation measurements (DIC) and a three dimensional finite element damage model (FEDM) will be shown. Furthermore the failure loads coming from the load shells of the machine were straightforward compared with the output of the FEDM

Improved resection margins in breast-conserving surgery using Terahertz Pulsed imaging data

New statistical methods were employed to improve the ability to distinguish benign from malignant breast tissue ex vivo in a recent study. The ultimately aim was to improve the intraoperative assessment of positive tumour margins in breast-conserving surgery (BCS), potentially reducing patient re-operation rates. A multivariate Bayesian classifier was applied to the waveform samples produced by a Terahertz Pulsed Imaging (TPI) handheld probe system in order to discriminate tumour from benign breast tissue, obtaining a sensitivity of 96% and specificity of 95%. We compare these results to traditional and to state-of-the-art methods for determining resection margins. Given the general nature of the classifier, it is expected that this method can be applied to other tumour types where resection margins are also critical

Aprotinin reduces cardiac troponin I release and inhibits apoptosis of polymorphonuclear cells during off-pump coronary artery bypass surgery

Objectives: In addition to blood-sparing effects, aprotinin may have cardioprotective and anti-inflammatory effects during cardiopulmonary bypass-assisted cardiac surgery. In this study, the authors examined whether aprotinin had cardioprotective and/or anti-inflammatory effects in patients undergoing off-pump coronary artery bypass grafting. Design: A prospective randomized clinical trial. Setting: University hospital. Participants: Fifty patients were randomized to control (n = 25) or aprotinin treatment (n = 25) groups. Interventions: Aprotinin was given as a loading dose (2 x 10(6) KIU) followed by a continuous infusion at 5 x 10(5) KIU/h until skin closure. Measurements and Main Results: Blood samples for cardiac troponin I; interleukin-6, interleukin-8, and interleukin-10; tumor necrosis factor a; and elastase were taken after anesthesia induction, completion of revascularization, and 6 hours, 12 hours, and 24 hours after revascularization. Blood samples were taken to assess for apoptosis in polymorphonuclear cells. Baseline plasma levels for cardiac troponin I did not differ between groups but were significantly lower in aprotinin-treated patients at the time of revascularization (P = 0.03) and 6 hours (p = 0.004) and 24 hours (p = 0.03) later. Aprotinin significantly reduced apoptosis in polymorphonuclear cells compared with control-treated patients (p = 0.04). There were no differences in plasma cytokine or elastase levels between groups. Conclusions: The authors conclude that aprotinin reduces perioperative cardiac troponin I release and attenuates apoptosis in polymorphonuclear cells but has no significant effects on plasma cytokine levels in patients undergoing off-pump coronary artery bypass graft surgery

What does an explanted PASCAL device look like?

We report the case of a 78-year-old female patient who had a PASCAL device implanted for severe degenerative mitral regurgitation. Intraprocedural echocardiography revealed persistent severe mitral regurgitation due to device dislocation. Implanting another device was not possible. After 8 days, the device was explanted, and the valve was replaced with a biological pro We report the case of a 78-year-old female patient who had a PASCAL device implanted for severe degenerative mitral regurgitation. Intraprocedural echocardiography revealed persistent severe mitral regurgitation due to device dislocation. Implanting another device was not possible. After 8 days, the device was explanted, and the valve was replaced with a biological prosthesis. The PASCAL device and resected mitral valve leaflets were sent for histopathological workup. Keywords: Mitral regurgitation; PASCAL device; Transcatheter therapysthesis. The PASCAL device and resected mitral valve leaflets were sent for histopathological workup

Prostate-specific antigen testing in inner London general practices: are those at higher risk most likely to get tested?

This study was funded by the Guy’s and St Thomas’ Hospital Charity (Fund 201)

The impact of age and sex on in-hospital outcomes in acute type A aortic dissection surgery

Background: Older age and female sex are thought to be risk factors for adverse outcomes after repair of acute type A aortic dissection (AAAD). The aim of this study is to analyze age- and sex-related outcomes in patients undergoing AAAD repair. Methods: Retrospective analysis of patients undergoing emergency AAAD repair. Patients were divided in Group A, patients aged ≥75 years and Group B <75. Intraoperative and postoperative data were compared between groups before and after propensity score matching. Sex differences were analyzed by age group. Results: Between January 2006 and December 2018, 638 patients underwent emergency AAAD repair. Group A included 143 patients (22.4%), Group B 495 (77.6%). More patients in Group A presented with circulatory collapse (Penn C 26.6% vs. 9.7%, P=0.001) while Group B presented with circulatory collapse-branch malperfusion (Penn BC 29.3% vs. 15.4% P=0.001). After propensity score matching, Group B patients received more complex aortic root (33.6% vs. 23.2%, P=0.019) and concomitant bypass surgery (12.3% vs. 6.3%, P=0.042). There was no significant difference in in-hospital mortality between age groups (18% vs. 12% P=0.12). In Group B, in-hospital mortality was significantly higher in females (22.2% vs. 8.2%, P=0.028). Differences in mortality disappeared after the age of 75 (18.3% vs. 19.4% P=0.87). Conclusions: Morbidity and mortality are comparable between patients under and over 75 years after AAAD repair. Female patients <75 had higher in-hospital mortality than their male counterparts. Keywords: Acute type A aortic dissection (AAAD); age; gende