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In the UK, the sustainability agenda for housebuilding is now over ten years old, dating from the 2006 launch of the Code for Sustainable Homes as the benchmark for the reduction of carbon emissions in all new housing. The government’s 2015 decision however, to dismantle the Code for Sustainable Homes and remove the 2016 Zero Carbon targets, has meant that with little warning, the sustainability industry has had to start fending for itself. Without the incentive of tariffs to focus the minds of the developers, the sustainability industry is now looking vulnerable, and the realities of having to be financially viable are coming home to roost. But our statutory requirement to reach an 80% carbon reduction by 2050 has not changed, and neither have the reasons for achieving it. During that time, the sustainability agenda was a key driver for innovation within the housebuilding industry. However, rather than focusing on the many benefits that innovation can bring, in this paper the authors look at the barriers to adoption of innovation and asks whether these barriers have been fully understood by those who are accusing the housing industry of complacency for its failure to reinvent itself. The main method used for investigating what these barriers might be was a series of industry interviews, carried out across all the sectors defined as being part of that decision-making process, in order to better understand how their motivations might differ, and if so whether this disconnect could be preventing the progress that all individually profess to want but none appear able to deliver. The findings suggest that a more informed approach to promoting or considering any innovative product within the housebuilding industry could avoid many of the barriers currently being confronted head on.

Abstract Background Cardiac amyloidosis (CA) is an under‐recognized cause of heart failure. Left atrial (LA) myopathy contributes to a worse prognosis in heart failure and is a feature of transthyretin (ATTR) and light‐chain (AL) CA. LA mechanical dispersion (LA‐MD) is a novel marker of intra‐atrial dyssynchrony implicated in LA myopathy and the future development of atrial fibrillation (AF). Aims This study aimed to determine the characteristics and prognostic value of LA myopathy in ATTR and AL cardiomyopathy through a comprehensive LA echocardiographic evaluation. Methods ATTR (n = 86) and AL (n = 86) CA patients were compared with hypertensive heart disease (HHT) patients (n = 58). Transthoracic echocardiographic measurements including LA strain and LA‐MD were obtained with patient follow‐up for mortality. Results ATTR and AL patients had a median follow‐up of 66 months, with 26 mortality events. Left ventricular (LV) mass, diastolic function (average‐e′ and E/e′), LV global longitudinal strain, and LA volume and function (LA function index and strain) were more impaired in ATTR versus AL; these echocardiographic parameters were more impaired in both amyloid groups compared to HHT patients (P

We describe a case of autochthonous human Babesia divergens infection in an immunocompetent woman in England. The patient had fever, hemolysis, multiorgan failure, and 18% parasitemia. We confirmed B. divergens by 18S rDNA PCR and sequencing. Clinicians should consider babesiosis as a differential diagnosis in patients with unexplained hemolysis.

Abstract Aims Anthracycline chemotherapy (AC) for breast cancer can cause cancer therapy‐related cardiac dysfunction (CTRCD) with resultant heart failure, traditionally defined as a reduction in left ventricular (LV) ejection fraction on echocardiography. In recent years, global longitudinal systolic strain (GLS) has been used to identify subclinical cardiac dysfunction prior to development of overt CTRCD. Recent harmonized guidelines have incorporated GLS into definitions for CTRCD to identify cardiac dysfunction and inform decisions regarding cardioprotective strategies. Methods and results We evaluated subclinical dysfunction in breast cancer patients treated with AC and determined the echocardiographic and patient factors associated with significant GLS changes. One hundred fourteen HER2 negative patients treated with AC were prospectively recruited and underwent serial echocardiograms (LVEF and LVGLS) at three time points (prior to AC, 3 months, and 1 year). CTRCD was defined as an asymptomatic reduction in LVEF of 10% or symptomatic drop of 5% to LVEF

The Qazaq Aqbas beef breed is the most important in Kazakhstan. The breed is very well adapted to the harsh conditions in Central Asia. Other more productive breeds need additional costs to ensure their survival and productivity. However, their production levels are lower than other beef breeds globally. It may be possible to improve this by selecting bulls that have greater feed efficiency. This case study reports analyses of feed intakes and weight gains by this breed on farms in Kazakhstan. Twenty-nine bulls were selected, and fed using the GrowSafe system that measures and records intakes and weights. The ranking by Residual feed intakes (RFI) identified those bulls that were most efficient regarding weight gains compared to their feed intakes. While there was a positive correlation between ADG and DMI (P = 0.011), there was no correlation between RFI and ADG. Relying simply on weight gains for breeding decisions is therefore not supported by this evidence. The daily feed intakes of the breed recorded (11.03 kg/d) were similar to those of non-native popular beef breeds, while the weight gains (0.95 kg/d) were smaller. Therefore, the selection for breeding of beef bulls could focus on feed efficiency and not only feed intakes or daily weight gains.

Abstract We present an exploration of the unpolarized isovector proton generalized parton distributions (GPDs) H u−d (x, ξ, t) and E u−d (x, ξ, t) in the pseudo-distribution formalism using distillation. Taking advantage of the large kinematic coverage made possible by this approach, we present results on the moments of GPDs up to the order x 3 — including their skewness dependence — at a pion mass m π = 358 MeV and a lattice spacing a = 0.094 fm.

Objective To examine the effects of an empowerment-based interprofessional lifestyle intervention program among people at risk of type 2 diabetes on knowledge, skills, and confidence in self-management, health, psychological well-being, and lifestyle characteristics, and to explore the participants’ perceptions of participating in the intervention.Design and methods In line with the Medical Research Council complex interventions research methods framework, we conducted a randomized controlled trial with embedded qualitative interviews in primary healthcare clinics in Norway between 2019–2021. Of the patients at risk (The Finnish Diabetes Risk Score Calculator (FINDRISC) ≥15 or Body Mass Index (BMI) ≥30) 142 accepted the invitation, and 14 participants from the intervention group participated in individual interviews after the 12-month follow-up. Our primary outcome was the Patient Activation Measure (PAM-13). Secondary outcomes were EQ-5D-5L, EQ-VAS, WHO-Overall health, WHO-Overall QOL, weight, height, waist circumference, and regularity of physical activity. We used thematic analysis to analyse the qualitative data.Results There was no clinically relevant differences of neither the primary nor the secondary endpoints between intervention and control group. As to the qualitative data, we identified two distinct features: ‘Meaningful perspectives on lifestyle changes’ and ‘Lifestyle change is not a linear process due to challenges faced along the way’ putting ownership of their choices in life into picture.Conclusion The negative results of the RCT stand in contrast to the findings given by the participants voices, perceiving the intervention as a key eye opener placing their health challenges in perspective. How to interpret these seemingly conflicting findings of participants being seen, heard, and understood, helping them to take more conscious ownership of their choices in life, and at the same time demonstrating no improvements in symptoms or measures, is a dilemma that needs further exploration. We should be careful to implement interventions that do not demonstrate any effects on the quantitative outcomes.

Abstract Background Cardiac rehabilitation has been identified as having the most homogenous clinical exercise service structure in the United Kingdom (UK), but inconsistencies are evident in staff roles and qualifications within and across services. The recognition of Clinical Exercise Physiologists (CEPs) as a registered health professional in 2021 in the UK, provides a potential solution to standardise the cardiac rehabilitation workforce. This case study examined, in a purposefully selected cardiac exercise service that employed registered CEPs, (i) how staff knowledge, skills and competencies contribute to the provision of the service, (ii) how these components assist in creating effective service teams, and (iii) the existing challenges from staff and patient perspectives. Methods A multi-method qualitative approach (inc., semi-structured interviews, observations, field notes and researcher reflections) was employed with the researcher immersed for 12-weeks within the service. The Consolidated Framework for Implementation Research was used as an overarching guide for data collection. Data derived from registered CEPs (n = 5), clinical nurse specialists (n = 2), dietitians (n = 1), service managers/leads (n = 2) and patients (n = 7) were thematically analysed. Results Registered CEPs delivered innovative exercise prescription based on their training, continued professional development (CPD), academic qualifications and involvement in research studies as part of the service. Exposure to a wide multidisciplinary team (MDT) allowed skill and competency transfer in areas such as clinical assessments. Developing an effective behaviour change strategy was challenging with delivery of lifestyle information more effective during less formal conversations compared to timetabled education sessions. Conclusions Registered CEPs have the specialist knowledge and skills to undertake and implement the latest evidence-based exercise prescription in a cardiac rehabilitation setting. An MDT service structure enables a more effective team upskilling through shared peer experiences, observations and collaborative working between healthcare professionals.

Background. Pulmonary embolism (PE) is a common and potentially life-threatening diagnosis when a certain amount of thrombotic mass obstructs blood flow through the pulmonary circulation. The finding of acute and subacute ischaemic foci on magnetic resonance imaging (MRI) of the brain in a group of patients with this diagnosis in whom we demonstrate the presence of patent foramen ovale (PFO) by transoesophageal echocardiography (TEE) is surprisingly high. Methods. A total of 129 patients with a diagnosis of pulmonary embolism (confirmed by computed tomography with contrast agent, CTA) who consented to further examination were examined by transthoracic echocardiography (TTE) and transoesophageal echocardiography (TEE) with contrast agent, underwent magnetic resonance imaging of the brain according to a specific protocol, and underwent a comprehensive baseline laboratory examination. Results. In our group of 129 patients, we found the presence of PFO in 36.4% (n=47) of them. A total of 5.4% (n=7) patients had asymptomatic acute and subacute ischaemic changes on brain MRI; 6 of them had concomitant PFO. The statistically significant correlation between troponin levels and the presence of pathological findings on MRI and the trend of a similar correlation for NT-proBNP values is also very interesting finding. Conclusions. The association between the presence of PFO and the occurrence of symptomatic or asymptomatic findings on brain MRI is a well-known fact (the issue of paradoxical embolism) but the high frequency of acute and subacute lesions on brain MRI in the group of patients with a diagnosis of acute PE is surprising.

The shared pathobiological mechanisms driving progressive fibrosis in interstitial lung diseases (ILDs) remain unclear. Neutrophils, the most common immune cells in the human body, contain an extensive array of proteinases that are important for cell function, including tissue repair and remodelling. Increasing observational studies have reported elevated neutrophil counts in the respiratory tract and circulation of patients with ILD and suggest a role as a biomarker of disease severity. Neutrophils and their contents (including the formation of neutrophil extracellular traps (NETs)) are present in fibrotic lung tissue. Proteinases and NETs may drive fibrogenesis in animal and in vitro models and may impact transforming growth factor-β1 activation. However, the effect of neutrophil action, whether reparative or pathologically destructive to the delicate lung architecture, has yet to be determined. This review aims to summarise the current literature surrounding the potential role of the neutrophil as a biomarker and contributor to the pathogenesis of ILD. There is currently a paucity of treatment options in ILD driven by the knowledge gap underlying the overall disease mechanisms. This review concludes that neutrophils warrant further evaluation as manipulation of recruitment and function could provide a novel and much needed therapeutic strategy.