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Aortic stenosis (AS) is a complex and progressive condition that can significantly reduce the quality of life and increase the incidence of premature mortality. Transthoracic echocardiography (TTE) is the gold standard imaging modality for the assessment of AS severity. While left ventricular ejection fraction (LVEF) derived from TTE is a very well-understood parameter, limitations such as high inter and intra-observer variability, insensitivity to sub-clinical dysfunction, and influence of loading conditions make LVEF a complicated and unreliable parameter. Myocardial deformation imaging has been identified as a promising parameter for identifying subclinical left ventricular dysfunction, however, this parameter is still afterload dependent. Myocardial Work is a promising novel assessment technique that accounts for afterload by combining the use of myocardial deformation imaging and non-invasive blood pressure to provide a more comprehensive assessment of mechanics beyond LVEF. This review evaluates the evidence for various echocardiographic assessment parameters used to quantify left ventricular function including myocardial work in patients with AS.

African cultural values connote core principles and ideals that maintains good, right, fair and just in African societies. This culture is developed over a long period of time, preserved and promoted by all members of a given group or society. Corruption as a phenomenon on the other hand has been variously described as a societal vice. Though research shows that some levels of corruption exist in almost every human society, it is over accommodated in some societies or nations and as such it has notoriously continued to destroy such societies/nations. This is particular to a number of African nations, with Nigeria being among (if not) the worse corrupt nation(s) in the continent. It is not difficult to understand that the value placed on corruption in Nigeria is synonymous to the way cultural values are cherished by people in some nations of the world. In view of this, there is a serious and immediate need to educate the Nigerian public about the consequences of developing a culture of corruption in the country. It seems that some Nigerians take corruption to be a normal way of life, thereby, equating the vice to acceptable cultural values. Today, many Nigerians are not interested in developing and/or preserving amiable cultural values for the nation. Rather, more attention is focus on the promotion of corrupt practices that enables the destruction of even the good cultural values of the nation that were left behind by our forefathers. Therefore, this paper seeks to unmask the importance of developing and preserving good African cultural values that will guarantee unity, patriotism, social cohesion and sustainable development in Nigeria.

BACKGROUND: In recent years, the increasing popularity of cycling for commuting and leisure has led to a corresponding increase in bicycle-related injuries. However, there is a lack of extensive analysis of bicycle-related injuries to the upper limb in the literature. METHODS: A retrospective review of all patients with conventional bicycle-related injuries of the upper limb was performed. Data on demographics, mechanisms of injury, region of injury, fracture type, management type, and length of hospital stay were extracted and analyzed. RESULTS: A total of 177 of 733(24%) patients with bicycle-related upper limb injuries were identified. The most common mechanism of injury was a collision with another vehicle (60%). Frequently affected regions were the shoulder (48%), hand (19%), and wrist (19%). Eighty-eight (50%) patients sustained bony injuries, while the remainder (50%) had isolated soft tissue injuries. Fifty-three (30%) patients required a mean of 3.9 days of hospitalization, whereas 13 (25%) patients required high dependency or intensive care unit treatment. Surgical interventions were required in 47 (27%) patients. CONCLUSION: Bicycle-related injuries to the upper limb are common and result in significant morbidity. The most common regions affected are the shoulder, wrist, and hand. Most of the injuries were caused by collisions with other vehicles. A third of affected patients required hospitalization, and a quarter required surgical intervention.

Inadvertent endocardial lead malposition is recognized as a rare incident which is usually underreported and if recognized during implantation can be easily corrected. This phenomenon is caused by the ventricular lead unintentionally crossing a pre-existing patent foremen ovale, septal defects (atrial or ventricular) or directly from the aorta via an accidental subclavian puncture resulting in the lead implanting into the left ventricle. While this is a rare occurrence we report, the incidental finding of pacemaker lead malposition during a routine follow-up transthoracic echocardiogram and the benefits of three-dimensional transesophageal echocardiography in this patient prior to lead extraction.

Eustachian tube dysfunction is believed to be involved in the pathogenesis of many middle ear diseases including chronic suppurative otitis media. We aimed to describe a simple and reliable animal model of Eustachian Tube obstruction to further research into middle ear disorders.Prospective cohort study in animals.University laboratory.30 mice C57Bl/6J (n = 15) and CBA/CaJ (n = 15) aged 6-8 weeks received transtympanic Eustachian tube occlusion on left ear trough an acute tympanic membrane perforation using thermoplastic latex used in dental procedures (gutta percha). Control mice (n = 6) received tympanic membrane perforation only. At two and four weeks, the mice were observed for signs of Eustachian tube dysfunction and compared to control ears. ET dysfunction was defined as presence of effusion in the middle ear.100% (n = 30) of the treated ears had otoscopic signs of Eustachian tube dysfunction at two weeks and the endpoint time of four weeks, compared to 0% in control mice (0/6). Temporary head tilt lasting up to 2 days were observed in 3 mice (10%). No other potential adverse events were recorded. No bacterial growth was determined in the middle ear fluid.We describe a technically easy and reliable method for Eustachian tube occlusion in mice with an excellent success rate and minimal morbidity.

Introduction The prevalence of foot osteoarthritis (OA) is less well understood than hip, knee and hand OA. The foot is undoubtedly more complex, and investigators have been challenged in defining which joints to investigate and by the need for improved methodological standardisation across studies. As such, the prevalence and natural history of osteoarthritis and the relevance of co-existing pain in the foot have not yet been widely explored. The aim of this thesis was to improve understanding of foot osteoarthritis by examining techniques used to define foot osteoarthritis and by description of the prevalence, distribution and natural history of radiographic foot osteoarthritis and co-existing foot pain in an established UK population-based cohort of women, ‘The Chingford 1000 Women Study’. Methods Study 1: The author (PMc) undertook training by an experienced radiographer in scoring foot osteoarthritis using a validated foot atlas (The La Trobe Foot Atlas). Employing archived foot radiographs (n = 20 paired feet) Chingford 1000 Women study: year 6, 1995) intra-rater reliability was established for five individual joints in both feet (percentage close agreement ranged from 47.6% to 85.7% for osteophytes and from 33.3% to 81% for joint space narrowing). Subsequently a sample of foot radiographs (n=218) that included all remaining participants in the Chingford 1000 Women Study who returned for the year ‘23’ visit (mean (SD) for age: 75.5 (5.1)) were scored. A range of prevalence estimates of osteoarthritis at the foot and individual joint level were examined that relate to discordance between different techniques of interpretation. The findings from this study supported the use of the La Trobe Foot Atlas (LFA) to identify foot osteoarthritis in existing current and historical radiographs of established large population cohorts. Study 2: A cross-sectional study design was used in which returning participants at year ‘23’ (2013-2015) from the Chingford 1000 Women study were investigated for presence of radiographic foot osteoarthritis and co-existing foot pain. Presence of radiographic foot osteoarthritis was scored according to LFA and self-reported foot pain was primarily defined and assessed using the non-side specific question “have you ever had pain in your feet which has lasted one day or longer?” Data from 332 women were included in this study. Of these 91.3% had radiographic foot osteoarthritis in any joint affecting either foot. When examining individual joints, the rank order of radiographic osteoarthritis was; 2nd cuneo-metatarsal joint (78.9%), 1st cuneo-metatarsal joint

Clinician researchers face the pressures of meeting academic benchmarks combined with advancing new therapies to patients. The vast majority of drug discoveries fail in translation. A new method of meeting the challenges of preclinical therapeutic translation is presented using the example of tympanic regeneration.The key to a design-thinking approach to therapeutic translation is to 'begin with the end in mind' by widening the scope of the problem, with multiple points of view, to not only understand the disease but the context for the patient and the health system in which it occurs. Idea for therapeutics should be tested in relevant models early and once proof of efficacy is established, translational milestones that represent the greatest risk, such as safety and toxicity should be addressed first. It is important to seek the feedback of industry early to understand what milestones should be best addressed next with limited academic resources. Whenever proceeding, guidelines for maintaining scientific reproducibility should be followed to minimize risk of failure during transfer into industry.A Design-thinking approach addresses the potential failures in drug discovery and preclinical translation.

At present there are two recognised guidelines for the echocardiographic assessment of left ventricular diastolic function provided by the British Society of Echocardiography and American Society of Echocardiography/European Association of Cardiovascular Imaging. However, no direct comparison of these guidelines has been performed to establish whether they provide similar diastolic grading. One hundred and eighty-nine consecutive patients in sinus rhythm who underwent transthoracic echocardiography for a primary indication of either heart failure assessment or assessment of left ventricular systolic function were extracted from our database (McKesson Cardiology). Left ventricular diastolic function assessment was performed using both guidelines and the results were compared. Chi-square, Kappa score and one-way ANOVA were used to evaluate the data at a level of P < 0.05. The most frequent outcome was unclassifiable diastolic function with significantly more patients being labelled unclassified with the British compared to American guidelines (47.4 vs 20.5%, P < 0.0001). Having excluded all unclassifiable patients, a significant difference still existed between the two guidelines with a higher proportion of grade one outcomes awarded by the ASE/EACVI guidelines. When grading subcategories were individually compared, there was significantly more grade one diastolic gradings awarded by American compared to the British guidelines (40.7 vs 20.1%, P < 0.0001). In 47% of patients it was not possible to grade diastolic function using the British guidelines, compared to 21% using the American guidelines. For those patients where grading was possible, there was a significant difference in patients classified with normal and grade one diastolic function when using British and American guidelines.

Mucoadhesive microgel compns., which include an active agent (such as HB-​EGF)​, are provided. Aspects of the invention include a microgel comprising a crosslinked poly(ethylene glycol) Me ether methacrylate polymer comprising a mucoadhesive functionality. Also provided are methods of making and using the mucoadhesive microgel compns., e.g., in therapeutic applications. In one embodiment, HB-​EGF loaded mucoadhesive microgel compns. are provided, e.g., for prevention or treatment of mucositis conditions, such as therapy induced oral mucositis conditions.

Age-related hearing loss is a multifactorial condition that affects more than one-third of the aging population. Left untreated it can increase the risk of cognitive decline, dementia, social isolation, depression, and falls. Hearing augmentation devices exhibit improved digital sound processing and Smartphone connectivity. Stigma remains one of the prominent barriers and todays devices offer in the canal models, miniature sizes, and camouflage with the hair or skin color. Although rigorous scientific efforts are made in the research field of inner ear regeneration and some clinical early phase studies do exist, to date, the clinical availability is still some time away.

Tonsillectomy is a commonly performed surgical procedure. Despite this, very little research has been done to study wound healing after tonsillectomy. An Ovid MEDLINE search of the English literature was conducted using the search terms “tonsillectomy” or “tonsil” and “wound healing" from which 31 published studies were included for analysis. This included both limited animal and human models assessing wound healing post tonsillectomy. The majority of current wound healing assessments in humans investigating tonsillectomy wound healing involve serial direct clinical examinations of the oral cavity. Different patient and surgical factors have been shown to affect wound healing and are presented. There is some research to suggest the administration of adjunctive treatment options in the post-operative period may be beneficial to tonsillectomy wound healingand these are discussed in detail.

The VISTA IR Camera has now completed its detailed design phase and is on schedule for delivery to ESO's Cerro Paranal Observatory in 2006. The camera consists of 16 Raytheon VIRGO 2048×2048 HgCdTe arrays in a sparse focal plane sampling a 1.65 degree field of view. A 1.4m diameter filter wheel provides slots for 7 distinct science filters, each comprising 16 individual filter panes. The camera also provides autoguiding and curvature sensing information for the VISTA telescope, and relies on tight tolerancing to meet the demanding requirements of the f/1 telescope design. The VISTA IR camera is unusual in that it contains no cold pupil-stop, but rather relies on a series of nested cold baffles to constrain the light reaching the focal plane to the science beam. In this paper we present a complete overview of the status of the final IR Camera design, its interaction with the VISTA telescope, and a summary of the predicted performance of the system.

We describe the UK participation in the FMOS project to provide multi-object IR spectroscopy for the Subaru telescope. The UK is working on the design of an OH suppression IR spectrograph, this work comprises the optical design, the opto-mechanical layout, spectrograph thermal environment and cryogenics and detector control system. We give a progress report on the current design work.