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Background: Lipoprotein(a) (Lp(a)) is now established as a causal risk factor for cardiovascular disease (CVD) and accurate laboratory measurement is of pivotal importance in reducing Lp(a) associated risk. The consensus statement by HEART UK in 2019 included recommendations to improve standardisation of clinical laboratory measurement and reporting of Lp(a). Methods: A 16 question, electronic audit survey was circulated to 190 accredited clinical biochemistry laboratories to assess the adoption of these recommendations in the UK. Results: Responses were received from 65 of 190 laboratories (34%). Only 5 (8%) did not offer Lp(a) measurement. Of those providing the test, 23% (n = 14) offered an in-house service (IHS), the remaining laboratories (77%; n = 46) used an external referral service (ERS). The majority (10 of 14 or 71%) of IHS laboratories responded with details of their method, stating whether it minimised sensitivity to the effect of Lp(a) isoform size and used calibrators certified for traceability to the WHO/IFCC reference material, however, only a minority ERS laboratories (13 of the 46 or 28%) were able to specify the method used by their referral laboratory. Of the laboratories who specified their reporting units, 6 of 10 IHS and 7 of 23 ERS laboratories reported in nmol/L. Among the 60 laboratories who responded, the HEART UK recommendations appear to have been adopted in full by only 3 IHS laboratories. Conclusions: Further efforts are needed to standardise the measurement and reporting of Lp(a) so that results and interpretation are comparable across clinical biochemistry laboratories in the UK. [ABSTRACT FROM AUTHOR]

Obesity affects one in four people in the United Kingdom and costs the National Health Service (NHS) -£6.5 billion annually. The glucagon-like peptide-1 (GLP-1) receptor analogues, such as once-daily subcutaneous Liraglutide 3.0 mg (Saxenda®) and once-weekly subcutaneous Semaglutide 2.4 mg (Wegovy®), were approved by the National Institute of Health and Care Excellence (NICE) as a treatment for obesity and funded by the NHS for 2 years. Our local data shows that Saxenda is effective at reducing body weight and glycaemia in people with obesity and diabetes; however, the supply issues of GLP-1 receptor analogues have contributed to the unavailability of Saxenda and Wegovy in our service. Our patients are devastated that they cannot access NICE-approved GLP-1 receptor analogues for obesity. The 2-year GLP-1 receptor analogue treatment limit for obesity alongside a lack of funded NHS services and supply issues represent barriers to treatment for people living with obesity who have clear medical indications. [ABSTRACT FROM AUTHOR]

Flow-induced vibrations of reactor core components have been a major cause of failure of reactor internals in many nuclear power plants. To address this issue international standards (viz., ASME-OM-05) require monitoring of structural integrity of reactor core in nuclear power plants. A reactor internals vibration monitoring system (IVMS) has been developed for nuclear power plant surveillance. The system detects the core barrel motion and flow-induced vibrations of reactor internals by analyzing the inherent fluctuations (reactor noise) present in the neutron flux signals from ex-core neutron detectors. Before application of the IVMS in nuclear power plants the system hardware and methodology/software has been extensively tested on the research reactor through a series of reactor noise measurements. In the noise measurements the neutron flux signals were correlated with the signals from vibration sensors mounted on reactor structure and control rods drive mechanisms. The frequency spectra of reactor power signals obtained with IVMS had shown small oscillations in the neutron flux signals at well-defined frequencies. There was a strong correlation of these fluctuations with the establishment of coolant flow through the core. With the help of elaborate experiments using the IVMS the cause of oscillations in neutron flux signals was attributed to the flow-induced vibrations of control rods, and the particular vibrating control rod was identified. The magnitude of the displacement of vibrating control rod was calculated from the measured power spectral density of neutron power signals. It has been shown that ex-core neutron noise measurements are more sensitive in determining the dynamic behavior of reactor internals than the vibration sensors mounted at remote, out-of-the core locations. Index Terms--Control rod, data acquisition, flow induced vibration, neutron noise, temperature fluctuations.

Obesity is a complex chronic disease and requires a long-term multimodal approach. The current treatment algorithm for treatment of obesity mainly consists of a stepwise approach, which starts with a lifestyle intervention followed by or combined with medication treatment, whereas bariatric surgery is often reserved for the last option. This article provides an overview of the currently available conservative medicinal treatment regimens and the currently approved medications as well as medications currently undergoing approval studies with respect to the efficacy and possible side effects. Special attention is paid to the importance of combination treatment of pharmacotherapy and surgery in the sense of a multimodal treatment. The data so far show that using a multimodal approach an improvement in the long-term weight loss and metabolic benefits can be achieved for the patients., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)