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Off-pump Coronary Artery Bypass Grafting (OPCAB) experienced a resurgence in the 1980s -2000s and developed steadily with improvement of the instrumentation and techniques. However questions about graft patency and long-term survival of OPCAB patients still exist. This review attempts to explore the current relevance of OPCAB.

Background Lifestyle risk behaviours are key risk factors for non-communicable diseases. Some disadvantaged groups face particularly poor health outcomes, which may be exacerbated by high prevalence of risk behaviours. The aim of this scoping review was to identify and bring together evidence from systematic reviews on reducing risk behaviours in these groups and highlight where there is insufficient evidence to inform policy. Methods MEDLINE and Embase were searched up to October 2020 for English language reviews, with supplementary searching in Epistemonikos and Health Systems Evidence. Systematic reviews reporting behavioural outcomes of interventions targeting smoking, alcohol use, diet or physical inactivity in nine disadvantaged groups were eligible. Reviews of population-level policies reporting differential effects for these groups and qualitative reviews of barriers or facilitators to change were included. Literature was mapped based on the group and behaviour targeted. Results Ninety-two systematic reviews were included. The majority (n = 68) focused on low income or socio-economic status. Fewer reviews were identified that included prisoners (n = 14), deprived areas (n = 12), homeless people (n = 10), people with learning disabilities (n = 9), unemployed people (n = 3) and refugees or asylum seekers (n = 2). We identified no reviews on care leavers or Gypsies, Travellers or Roma. In total only 11 reviews targeted alcohol use. There were some gaps for specific group and behaviour combinations and no intervention reviews on refugees. Conclusions A number of gaps were identified, highlighting where new syntheses or primary studies could add value. For example, reviews on interventions in refugees, Gypsies, Travellers and Roma, and care leavers could be useful for policy-making. Other useful contributions might include an overview of the perceptions of disadvantaged groups allowing common barriers to behaviour change to be identified as well as factors unique to specific groups. Key messages Nearly 100 systematic reviews focused on reducing risk behaviours in disadvantaged groups; they addressed different combinations of behaviours and groups. Gaps in the literature were identified where new syntheses could make a useful contribution to developing programmes and policies.

The July 2008 Vulcanian Explosion at Soufrière Hills Volcano (SHV), Montserrat, was preceded by one of the largest seismic swarms observed since the start of the eruption. We analyse spectral and waveform properties of the earthquakes in this swarm and compare these observations to models of sub-surface volcanic processes. We observe an initial Volcano-Tectonic (VT) swarm, followed by a large LowFrequency (LF) swarm. We observe that the spectral content of LF events changes over time to carry more energy at lower frequencies. This shift to a lower frequency spectral content is concurrent with an increase in LF event rates. Ash-venting occurred a few hours before peak event rate. There was a subsequent increase in the higher frequency energy component of LF events, concurrent with a decrease in event rates. Seismic quiescence occurred in the final seven hours before the Vulcanian Explosion. Our observations of VT seismicity are consistent with a model of decoupled gas ascent prior to magma emplacement. Changes in spectral properties and event rates suggest changes in conduit properties and/or pressure changes during magma ascent and stalling in the few days before the explosion. This interpretation is supported by previous petrological observations. Our analysis of repeating earthquakes suggests that Hybrid and Long-Period (LP) events are part of the same source process and should not be considered separate classifications, at least at SHV. Our analysis highlights the potential of using simple spectral and waveform analysis for understanding changes in the magmatic system during transitions between quiescence and eruption.

This paper presents a summary of the evidence review group (ERG) report into the clinical effectiveness and cost-effectiveness of alitretinoin for the treatment of adults with severe chronic hand eczema refractory to topical steroid treatment in accordance with the licensed indication, based upon the evidence submission from Basilea Pharmaceuticals Ltd to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal process. The clinical evidence came from a single placebo-controlled randomised controlled trial of daily treatment with alitretinoin for 12–24 weeks, with follow-up for a further 24 weeks, in patients with severe chronic hand eczema (CHE) unresponsive to topical steroids. A statistically significantly greater proportion of patients using alitretinoin achieved the primary end point of clear or almost clear hands by week 24 than did those with placebo. Dose-dependent headache was the most commonly reported adverse event in patients treated with alitretinoin. Serious adverse events were rare, but alitretinoin was associated with increases in both total cholesterol and triglycerides, which has implications for risks of future cardiovascular events. The manufacturer submitted a de novo decision analytic model to estimate, over a time horizon of 3 years, the cost-effectiveness of alitretinoin versus the other relevant comparators identified by NICE. In response to the points of clarification put to it by the ERG regarding the initial submission, the manufacturer provided additional evidence and a revised decision analytic model with a ‘placebo’ arm. In the manufacturer’s original submission to NICE, the base-case incremental cost-effectiveness ratios (ICERs) reported for alitretinoin were £8614 per quality-adjusted life-year (QALY) versus ciclosporin, –£469 per QALY versus psoralen + UVA (with alitretinoin dominant) and £10,612 per QALY versus azathioprine. These ICERs decreased as the time horizon was extended in sensitivity analyses. In patients with hyperkeratotic CHE and in women of child-bearing potential, the ICER remained below £20,000. When the health-related quality of life (HRQoL) values used in the model were replaced with those derived from an alternative study, these ICERs increased significantly (to £22,312 per QALY for alitretinoin versus azathioprine). In the revised model, alitretinoin was reported to have an ICER of £12,931 per QALY gained versus supportive care (placebo). However, the model underestimates the costs of treatment associated with alitretinoin. The manufacturer assumed that patients receiving alitretinoin visited the dermatologist every 4 weeks and ceased treatment as soon as they responded to it. If, in practice, patients would receive treatment for longer than this, then the manufacturer’s model will have significantly underestimated the costs to the NHS. Additional analyses undertaken by the ERG produced ICERs close to £30,000 per QALY gained for alitretinoin versus supportive care. This was largely due to uncertainty surrounding the impact of alitretinoin on HRQoL. The placebo-controlled trials conducted to date have established that alitretinoin can be efficacious for the treatment of severe CHE refractory to topical steroids, but longer term follow-up of trials or the implementation of registries is required to better establish the longer term efficacy or safety of alitretinoin. NICE recommended the use of alitretinoin for patients with severe CHE and a Dermatology Life Quality Index (DLQI) score of at least 15. Treatment was recommended to be stopped as soon as an adequate response was observed, or if CHE remained severe at 12 weeks, or if response was inadequate at 24 weeks.

The opportunity to obtain an independent legal consultation on a case protects the forensic mental health expert against being manipulated by the retaining lawyer. Such manipulation—also articulated as attorney seduction/intimidation—presents a serious threat to the integrity of the forensic process. A case study is presented to show how the independent legal consultation can save the forensic expert from being misled. The case comes from a workplace in which the availability of a legal consultant is built in. Some speculations are offered regarding the extension of this concept to settings not so endowed.

Land application of dairy slurry can result in incidental losses of phosphorus (P) to runoff in addition to increased loss of P from soil as a result of a buildup in soil test P (STP). An agitator test was used to identify the most effective amendments to reduce dissolved reactive phosphorus (DRP) loss from the soil surface after land application of chemically amended dairy cattle slurry. This test involved adding slurry mixed with various amendments (mixed in a beaker using a jar test flocculator at 100 rpm), to intact soil samples at approximate field capacity. Slurry/amended slurry was applied with a spatula, submerged with overlying water and then mixed to simulate overland flow. In order of effectiveness, at optimum application rates, ferric chloride (FeCl(2)) reduced the DRP in overlying water by 88%, aluminium chloride (AlCl(2)) by 87%, alum (Al(2)(SO(4))(3)center dot nH(2)O) by 83%, lime by 81%, aluminium water treatment residuals (Al-WTR; sieved to < 2 mm) by 77%, flyash by 72%, flue gas desulphurization by-product by 72% and Al-WTR sludge by 71%. Ferric chloride (euro4.82/m3 treated slurry) was the most cost-effective chemical amendment. However, Al compounds are preferred owing to stability of Al-P compared with Fe-P bonds. Alum is less expensive than AlCl(2) (euro6.67/m3), but the risk of effervescence needs further investigation at field-scale. Phosphorus sorbing materials (PSM) were not as efficient as chemicals in reducing DRP in overlying water. The amendments all reduced P loss from dairy slurry, but the feasibility of these amendments may be limited because of the cost of treatment.

This report summarizes the activities of the SM and NLO Multileg Working Group of the Workshop "Physics at TeV Colliders", Les Houches, France 8-26 June, 2009.

A stratified sand filter column, operated in recirculation mode and treating synthetic effluent resembling high-strength dairy wastewaters was studied over a 342-d duration. The aim of this paper was to examine the organic, total suspended solids (TSS) and nutrient removal rates of the sand filter, operated in recirculation mode, under incrementally increasing hydraulic and organic loading rates and to propose a field filter-sizing criterion. Best performance was obtained at a system hydraulic loading rate of 10 L m(-2) d(-1); a higher system hydraulic loading rate (of 13.4 L m(-2) d(-1)) caused surface ponding. The system hydraulic loading rate of 10 L m(-2) d(-1) gave a filter chemical oxygen demand (COD), TSS, and total kjeldahl nitrogen (TKN) loading rate of 14, 3.7, and 2.1 g m(-2) d(-1), respectively, and produced consistent COD and TSS removals of greater than 99%, and an effluent NO(3)-N concentration of 42 mg L(-1) (accounting for an 86% reduction in total nitrogen (Tot-N)). As the proportional surface area requirement for the sand filter described in this study is less than the recommended surface area requirement of a free-water surface (FWS) wetland treating an effluent of similar quality, it could provide an economic and sustainable alternative to conventional wetland treatment.

The energy and electron transfer processes taking place in binuclear polypyridine complexes of ruthenium and osmium based on the tetrapyrido[3,2- a:2¢,3¢- c:3¢¢,2¢¢- h:2¢¢¢-3¢¢¢- j]phenazine bridging ligand (tpphz) have been investigated by ultrafast absorption spectroscopy. In the binuclear complexes, each chromophore is characterized by two spectrally distinguishable metal-to-ligand charge transfer (MLCT) excited states: MLCT1 (with promoted electron mainly localized on the bpy-like portion of tpphz, higher energy) and MLCT0 (with promoted electron mainly localized on the pyrazine-like portion of tpphz, lower energy). In the homodinuclear complexes Ru(II)-Ru(II) and Os(II)-Os(II), MLCT1 f MLCT0 relaxation (intraligand electron transfer) is observed, with strongly solvent-dependent kinetics (ca. 10-10 s in CH2Cl2, ca. 10-12 s in CH3CN). In the heterodinuclear Ru(II)-Os(II) complex, *Ru(II)-Os(II) f Ru(II)-*Os(II) energy transfer takes place by two different sequences of time-resolved processes, depending on the solvent: (a) in CH2Cl2, ruthenium-to-osmium energy transfer at the MLCT1 level followed by MLCT1 f MLCT0 relaxation in the osmium chromophore, (b) in CH3CN, MLCT1 f MLCT0 relaxation in the ruthenium chromophore followed by osmium-to-ruthenium metal-to-metal electron transfer. In the mixed-valence Ru(II)-Os(III) species, the *Ru(II)-Os(III) f Ru(III)-Os(II) electron transfer quenching is found to proceed by two consecutive steps in CH3CN: intraligand electron transfer followed by ligand-to-metal electron transfer. On a longer time scale, charge recombination leads back to the ground state. Altogether, the results show that the tpphz bridge plays an active mechanistic role in these systems, efficiently mediating the transfer processes with its electronic levels.

This report summarizes the activities of the SM and NLO Multileg Working Group of the Workshop "Physics at TeV Colliders", Les Houches, France 8-26 June, 2009., 169 pages, Report of the SM and NLO Multileg Working Group for the Workshop "Physics at TeV Colliders", Les Houches, France 8-26 June, 2009