Utility and safety of invasive (fractional flow reserve) and non-invasive (cardiac magnetic resonance imaging) diagnostic tests in patients with NSTEMI

A prospective randomised controlled clinical trial of treatment decisions informed by invasive functional testing of coronary artery disease severity compared with standard angiography-guided management was implemented in 350 patients with a recent non-ST elevation myocardial infarction (NSTEMI) admitted to 6 hospitals in the National Health Service. The main aims of this study were to examine the utility of both invasive fractional flow reserve (FFR) and non-invasive cardiac magnetic resonance imaging (MRI) amongst patients with a recent diagnosis of NSTEMI. In summary, the findings of this thesis are: (1) the use of FFR combined with intravenous adenosine was feasible and safe amongst patients with NSTEMI and has clinical utility; (2) there was discordance between the visual, angiographic estimation of lesion significance and FFR; (3). The use of FFR led to changes in treatment strategy and an increase in prescription of medical therapy in the short term compared with an angiographically guided strategy; (4) in the incidence of major adverse cardiac events (MACE) at 12 months follow up was similar in the two groups. Cardiac MRI was used in a subset of patients enrolled in two hospitals in the West of Scotland. T1 and T2 mapping methods were used to delineate territories of acute myocardial injury. T1 and T2 mapping were superior when compared with conventional T2-weighted dark blood imaging for estimation of the ischaemic area-at-risk (AAR) with less artifact in NSTEMI. There was poor correlation between the angiographic AAR and MRI methods of AAR estimation in patients with NSTEMI. FFR had a high accuracy at predicting inducible perfusion defects demonstrated on stress perfusion MRI. This thesis describes the largest randomized trial published to date specifically looking at the clinical utility of FFR in the NSTEMI population. We have provided evidence of the diagnostic and clinical utility of FFR in this group of patients and provide evidence to inform larger studies. This thesis also describes the largest ever MRI cohort, including with myocardial stress perfusion assessments, specifically looking at the NSTEMI population. We have demonstrated the diagnostic accuracy of FFR to predict reversible ischaemia as referenced to a non-invasive gold standard with MRI. This thesis has also shown the futility of using dark blood oedema imaging amongst all comer NSTEMI patients when compared to novel T1 and T2 mapping methods.

The public interest of sports at non-profi t sports organizations that are supported by the government

This paper analyses the concept of public interest in sport and the criteria that must be taken into consideration in terms of Government support to clubs and sports associations. The data was collected through semi structured interviews that were applied to nine sports directors with board responsibilities: seven of them from sport clubs and sport associations, and two of them from public administration. The directors pointed out that sport is considered to be of public interest when: it is developed in the concept of “sport for all”, provides health benefi ts and serves as a means of education and social development. Regarding advantages used with public utility status, tax benefi ts and partnerships with the sports system organizations were the most mentioned aspects. Given a better use of fi nancial resources provided by public administration to clubs and associations, sport directors believe that the Government should have a strategy focused on setting priorities and ranking fi nancing criteria for sport. If the government had that strategy, the development of sports results would be much better. The participants also suggest that the Government should conduct an assessment of the social role of sport clubs and associations, according to the public and social interest of sport. In conclusion, sport and physical activity should be considered as public interest activities, provided that: are able to ensure positive effects on health plans and wellness, provide a qualitative and sustainable sport development, improve economic and social development of a population.

Efecto del consumo concomitante de inhibidores de bomba protones y levotiroxina : revisión sistemática y metaanálisis

Estudios afirman que la acidez gástrica es importante en la absorción de levotiroxina (LT4) con resultados controversiales sobre la interacción entre inhibidores de bomba de protones (IBP) y LT4. El objetivo del estudio fue establecer el efecto del uso concomitante de LT4 e IBP en los niveles de TSH en pacientes adultos con hipotiroidismo primario. Se realizó una revisión sistemática mediante búsqueda en Medline, Embase, Lilacs, Bireme, Scielo, Cochrane y Universidad de York, Access Pharmacy, Google Scholar, Dialnet y Opengray. La búsqueda no se limito por lenguaje. Se evaluó el efecto en la diferencia de medias de TSH luego del consumo de LT4 y luego del consumo concomitante con IBP. Se hizo un metaanálisis, análisis de subgrupos y análisis de sensibilidad utilizando el programa Review Manager 5.3. Se eligieron 5 artículos para el análisis cualitativo y 3 para el metaanálisis. La calidad de los estudios fue buena y el riesgo de sesgos bajo. La diferencia de medias obtenida fue 0.21 mUI/L (IC95%: 0.02-0.40; p=0.03; I2:0%). En el análisis de subgrupos en pacientes mayores de 55 años la diferencia de medias fue 0.21 mUI/L (IC95%: 0.01-0.40; p=0.27; I2:19%). En el análisis de sensibilidad se excluyo el estudio con mayor muestra y la diferencia de medias fue 0.49 mUI/L (IC95%: -0.12 a 1.11; p=0.12; I2:0%). La diferencia de medias de TSH luego del consumo concomitante no se considera clínicamente significativa pues no representa riesgo para el paciente. Son necesarios estudios clínicos aleatorizados y evaluar el efecto en los niveles de T4 libre.

Physical soil attributes of Conilon coffee (Coffea canephora) under organic and conventional management systems.

Coffea sp. is cultivated in large areas, using both conventional and organic management. However, information about the sustainability of these two management systems is still deficient. The objective of the present study was to evaluate the physical properties of soil cultivated with Conilon coffee (C. canephora) under organic and conventional management. Two areas cultivated with Conilon coffee (under organic and conventional management) and a fragment of Atlantic forest, used as a reference, were selected for the experiment. Soil granulometry, hydraulic conductivity, water retention curve, resistance to penetration, porosity, optimal hydric interval, and other physical characteristics were measured at depths of 0 to 10 and 10 to 20 cm. The data was submitted to multivariate and descriptive statistical analyses. Higher similarity was observed between the soil cultivated with Conilon coffee under organic management and the Atlantic forest soil. Soil resistance to penetration at 10, 30, 100, 500 and 1500 kPa, macro porosity, density and total porosity were the main physical properties that differentiated both management systems studied. The non-use of agricultural machinery and the addition of organic matter may be the main reasons for higher soil sustainability observed under organic management when compared with the conventional system.

Development of methodologies supporting the sustainable and safe integration of offshore conventional and renewable energy production

Against a backdrop of rapidly increasing worldwide population and growing energy demand, the development of renewable energy technologies has become of primary importance in the effort to reduce greenhouse gas emissions. However, it is often technically and economically infeasible to transport discontinuous renewable electricity for long distances to the shore. Another shortcoming of non-programmable renewable power is its integration into the onshore grid without affecting the dispatching process. On the other hand, the offshore oil & gas industry is striving to reduce overall carbon footprint from onsite power generators and limiting large expenses associated to carrying electricity from remote offshore facilities. Furthermore, the increased complexity and expansion towards challenging areas of offshore hydrocarbons operations call for higher attention to safety and environmental protection issues from major accident hazards. Innovative hybrid energy systems, as Power-to-Gas (P2G), Power-to-Liquid (P2L) and Gas-to-Power (G2P) options, implemented at offshore locations, would offer the opportunity to overcome challenges of both renewable and oil & gas sectors. This study aims at the development of systematic methodologies based on proper sustainability and safety performance indicators supporting the choice of P2G, P2L and G2P hybrid energy options for offshore green projects in early design phases. An in-depth analysis of the different offshore hybrid strategies was performed. The literature reviews on existing methods proposing metrics to assess sustainability of hybrid energy systems, inherent safety of process routes in conceptual design stage and environmental protection of installations from oil and chemical accidental spills were carried out. To fill the gaps, a suite of specific decision-making methodologies was developed, based on representative multi-criteria indicators addressing technical, economic, environmental and societal aspects of alternative options. A set of five case-studies was defined, covering different offshore scenarios of concern, to provide an assessment of the effectiveness and value of the developed tools.

Synthesis of new non-fullerene acceptors based on indacenodithiophene core for organic solar cells

Due to the low cost, lightness and flexibility, Polymer Solar Cell (PSC) technology is considered one of the most promising energy technologies. In the past decades, PSCs using fullerenes or fullerene derivatives as the electron acceptors have made great progress with best power conversion efficiency (PCE) reaching 11%. However, fullerene type electron acceptors have several drawbacks such as complicated synthesis, a low light absorption coefficient and poor tuning in energy levels, which prevent the further development of fullerene-based PSCs. Hence the need to have a new class of electron acceptors as an alternative to conventional fullerene compounds. Non-fullerene acceptors (NFAs) have developed rapidly in the last years and the maximum PCEs have exceeded 14% for single-junction cells and 17% for double-junction tandem cells. By combining an electron-donating backbone, generally with several fused rings with electron-withdrawing units, we can simply construct NFA of the acceptor–donor–acceptor type (A–D–A). Versatile molecular structures have been developed using methods such as acceptor motif engineering and donor motif engineering. However, there are only a few electron-donating backbones that have been proved to be successful. Therefore, it is still necessary to develop promising building blocks to further enrich the structural diversity. An indacenodithiophene (IDT) unit with just five fused rings has a sufficiently rigid coplanar structure, which has been regarded as one of the promising electron-rich units to design high-performance A–D–A NFAs. In this work, performed at the King Abdullah University of Science and Technology in Saudi Arabia, a new nine-cyclic building block (TBIDT) with a two benzothiophene unit was synthesized and used for designing new non-fullerene electron acceptors.

Sex differences in coronary artery disease severity and mortality: the impact of conventional cardiovascular risk factors

It is still unknown whether traditional risk factors may have a sex specific impact on the severity of coronary artery disease (CAD) and subsequent mortality in acute coronary syndromes (ACS). We identified 14 793 patients who underwent coronary angiography for acute coronary syndromes in the ISACS-TC (NCT01218776) registry from 2010 to 2019. The main outcome measure was the association between conventional risk factors and severity of CAD and its relationship with 30-day mortality. Risk ratios (RRs) and 95% CIs were calculated from the ratio of the absolute risks of women versus men using inverse probability of weighting. Severity of disease was categorized as obstructive (≥50% stenosis) versus nonobstructive CAD, specifically Ischemia and No Obstructive Coronary Artery disease (INOCA) and Myocardial Infarction with Non obstructive Coronary Arteries (MINOCA). The RR ratio for obstructive CAD in women versus men among people without diabetes mellitus was 0.49(95%CI,0.41–0.60) and among those with diabetes mellitus was 0.89(95% CI,0.62–1.29), with an interaction by diabetes mellitus status of P =0.002. Exposure to smoking shifted the RR ratios from 0.50 (95% CI, 0.41–0.61) in nonsmokers to 0.75 (95%CI, 0.54–1.03) in current smokers, with an interaction by smoking status of P=0.018. There were no significant sex-related interactions with hypercholesterolemia and hypertension. Women with obstructive CAD had higher 30-day mortality rates than men (RR, 1.75; 95% CI, 1.48–2.07). No sex differences in mortality were observed in patients with INOCA/MINOCA. In conclusion, obstructive CAD in women signifies a higher risk for mortality compared with men. Current smoking and diabetes mellitus disproportionally increase the risk of obstructive CAD in women. Achieving the goal of improving cardiovascular health in women still requires intensive efforts toward further implementation of lifestyle and treatment interventions.

Magnetic Resonance Imaging-Derived biomarkers of Isocitrate-Dehydrogenase mutation in diffuse gliomas: a conventional MR and Diffusion Weighted Imaging study.

The introduction of molecular criteria into the classification of diffuse gliomas has added interesting practical implications to glioma management. This has created a new clinical need for correlating imaging characteristics with glioma genotypes, also known as radiogenomics or imaging genomics. Whilst many studies have primarily focused on the use of advanced magnetic resonance imaging (MRI) techniques for radiogenomics purposes, conventional MRI sequences still remain the reference point in the study and characterization of brain tumours. Moreover, a different approach may rely on diffusion-weighted imaging (DWI) usage, which is considered a “conventional” sequence in line with recently published directions on glioma imaging. In a non-invasive way, it can provide direct insight into the microscopic physical properties of tissues. Considering that Isocitrate-Dehydrogenase gene mutations may reflect alterations in metabolism, cellularity, and angiogenesis, which may manifest characteristic features on an MRI, the identification of specific MRI biomarkers could be of great interest in managing patients with brain gliomas. My study aimed to evaluate the presence of specific MRI-derived biomarkers of IDH molecular status through conventional MRI and DWI sequences.