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The high burden of HIV in sub-Saharan Africa places significant demands on health care services. Interventions such as HIV self-testing, and pre- and post-exposure prophylaxis (PrEP and PEP) could empower individuals to determine their HIV status and prevent HIV acquisition. In 2018, the World Health Organization disseminated an online, anonymous, global values and preferences survey to adults 18 years of age and older. The survey aimed to inform guidance on awareness, use, and preferences around self-care interventions for sexual and reproductive health. We conducted a cross-sectional analysis using Pearson's chi-squared test to compare awareness of HIV self-testing, PrEP and PEP across five global regions. Our analysis included 814 participants from 110 countries. We noted that respondents from Africa reported higher awareness of HIV interventions than participants from Europe, Latin America and the Caribbean, North America, and Asia. Our finding highlights an opportunity to expand self-care interventions for HIV prevention and management in Africa.

Unconventional computing, such as mechanical1 and microfluidic logic circuits2, quantum gates3, and mechanical metamaterials4 create opportunities for embedded computation, which overcome the power5, package size, and environmental limitations of conventional electronics. Emerging micro-manufacturing capabilities6 with environmentally robust materials enable mechanical logic circuits miniaturization. Kinematically, bistable logic propagates binary signals through cascading gate displacement transitions. Energetically, the inter- and intra- node compliances are tuned for re-programmable signal propagation. Applications need computational architectures which integrate resettable signal propagation7–10, logical operation11–16, and signal storage17–19. While many researchers explore aspects of these elements1, 20–23, none consider energetic limits and propagation dynamics to evaluate and advance the field. Here, we show a generalized model and metrics, validated by experimental results, that enables the design of scale-independent, resettable, mechanical logic circuits. By studying propagation energy flows, we identified non-dimensional operating regimes in which signals propagate and resettable logic is possible. We provide deterministic design methods to evaluate future divergent topologies for displacement-based mechanical logic structures. Our results demonstrate the framework for designing densely integrated mechanical computation systems which harvest available ambient energy to propagate computational cascades. This logic responds to multi-dimensional environmental inputs and thus enables re-programmable, powerless, and embedded computation.

Organic electrochemical transistors (OECTs) for bioelectronic applications require the design of conjugated polymers that are stable in aqueous environments and afford high energy efficiency and good performance in OECTs. Polymers based on poly(ethylenedioxythiophene) (PEDOT) are promising in this area due to their low oxidation potential and reversible redox, but they often require cross-linking to prevent dissolution and yield OECTs operating in the less efficient depletion mode. In this work, a new conjugated polymer PEDOT-Phos is presented, which combines a conjugated poly(ethylenedioxythiophene) (PEDOT) backbone with alkyl-protected phosphonate groups. PEDOT-Phos exhibits a low oxidation onset potential (-0.157 V vs Ag/AgCl) and its nanoporous morphology affords it a high volumetric capacitance (282 ± 62 F cm–3). Without any cross-linking, additives, or post-treatment, PEDOT-Phos can be used in aqueous OECTs with efficient accumulation mode operation, long-term stability when immersed in aqueous media, low threshold voltages (-0.161 ± 0.005 V), good transconductances (9.3 ± 1.8 mS), and ON/OFF current ratios (618 ± 54) comparable to other PEDOT-based materials in OECTs. These results highlight the great promise of PEDOT-Phos as a stand-alone channel material for energy-efficient, bioelectronic devices.

This note provides a short summary of analysis which was undertaken at the James Hutton Institute to distribute funding (£11.6m in total, £7.6m of which was allocated by this analysis) which was made available for Community Led Local Development (CLLD) in 2022-23 in Scotland.

In this paper, we introduce a complete set of numerical algorithms to find the principal twists of all freedom spaces given an arbitrary set of desired twists without explicitly constructing the reciprocal constraint space. Principal twists, sometimes referred to as the canonical basis, are the set of twists closest to being mutually orthogonal and reciprocal within the twist space. They can be used to categorize and identify freedom spaces by comparing their relative pitches and angles to that of the canonical forms for each space. The identification of freedom spaces (i.e., twist spaces) has been a central problem in screw theory since its conception. Until now, there has been no autonomous computational tool that can identify, locate, and orient a freedom space defined by any set of desired degree-of-freedom motions (i.e., twists). The authors are developing this tool as part of an Add-in for SolidWorks to guide users in designing compliant mechanisms via the freedom and constraint topologies (FACT) synthesis approach. The specific contributions of this paper, which were necessary to create this tool, are the following: (i) existing analytical methods are converted to complete numerical solutions, (ii) existing numerical tools are made more concise and efficient, (iii) new methods are derived to identify principal twists, and (iv) loose definitions within the field of screw theory are fortified.

Homelessness is a global issue that is often associated with substance use. Research on this relationship in low- to middle-income countries (LMIC) is limited. We aimed to explore which factors are associated with substance use through secondary data analysis of a sample of 472 adults who attended services for homeless individuals in Cape Town, South Africa. Logistic regression was utilized to investigate if length of homelessness was associated with current alcohol and drug use respectively, after accounting for other factors. Current drug use (44.9%) was higher than current alcohol use (22.7%) and the most prevalent lifetime drug was methamphetamine (32.6%). After adjusting for lifetime substance use, and source of income, length of homelessness was not significantly associated with current alcohol use (less than on year: OR = 2.60; 95% CI: 0.78-8.66; one or more years: OR = 0.90; 95% CI: 0.32-2.57) or current drug use (less than one year: OR = 0.78; 95% CI: 0.41-1.47; one year or more: OR = 1.04; 95% CI: 0.56-1.93). These results highlight the need to further investigate other factors that may influence current alcohol or drug use among populations at risk of being homeless, and to utilize validated measures of substance and other mental health conditions.

Background: Abdominal aortic aneurysm (AAA) repair in patients with organ transplant remains a challenge. We looked at AAA repair in patients with organ transplants at our tertiary liver and kidney transplant unit. Methods: A retrospective analysis of a prospectively maintained database was undertaken from January 2008 to July 2018. We looked at patient demographics, type of repair, and technical success including reinterventions, perioperative transplant organ function, and 30-day and 1-year survival rate. Eight of 662 patients who underwent AAA repair had a solid organ transplant. Of these, 5 were kidney transplants, 2 liver transplants, and 1 had kidney and liver transplant; 75% were male; and average age was 63.4 (range: 49-83). All patients had asymptomatic AAAs, and 6 were treated with standard endovascular repair, 1 standard repair with iliac branch device, and 1 open repair. Adjunctive techniques such as CO2 angiograms, deployment of main body through contralateral iliac, low-profile sheaths, custom-made stent grafts, and temporary axillo-femoral shunting were used to protect transplant organs. Thirty-day survival was 100% with 1 death at 5 months from liver failure, and 1 patient has a persistent type-2 endoleak 3 years after the procedure. Conclusion: Abdominal aortic aneurysm repair in patients with organ transplants can be undertaken using adjunctive endovascular and open surgical techniques.

Background Self-care interventions are influencing people’s access to, expectation and understanding of healthcare beyond formal health delivery systems. In doing so, self-care interventions could potentially improve health-seeking behaviours. While many men proactively engage in maintaining and promoting their health, the focus on men’s health comes from the recognition, at least partially, that male socialization and social norms can induce men and boys to have a lower engagement in institutionalized public health entities and systems around their sexual and reproductive health and rights, that could impact negatively on themselves, their partners and children. Main text A research agenda could consider the ways that public health messaging and information on self care practices for sexual and reproductive health and rights could be tailored to reflect men’s lived realities and experiences. Three examples of evidence-based self-care interventions related to sexual and reproductive health and rights that men can, and many do, engage in are briefly discussed: condom use, HIV self-testing and use of telemedicine and digital platforms for sexual health. We apply four core elements that contribute to health, including men’s health (people-centred approaches, quality health systems, a safe and supportive enabling environment, and behaviour-change communication) to each intervention where further research can inform normative guidance. Conclusion Engaging men and boys and facilitating their participation in self care can be an important policy intervention to advance global sexual and reproductive health and rights goals. The longstanding model of men neglecting or even sabotaging their wellbeing needs to be replaced by healthier lifestyles, which requires understanding how factors related to social support, social norms, power, academic performance or employability conditions, among others, influence men’s engagement with health services and with their own self care practices.

Background and Aims: The management of persistent type II endoleaks (T2E) is often problematic for the endovascular specialist, with a lack of clear evidence for the best approach for embolization. The aim of this study was to evaluate the safety and efficacy of translumbar embolization (TLE) for T2E following endovascular aneurysm repair (EVAR). Methods: This retrospective review included 27 embolizations performed on 23 patients with a median age of 78 (range 67-94 years; male: female 15:9), during the period September 2006 to July 2018. Primary outcome was freedom from aneurysm sac growth defined as Results: The initial technical success rate was 100%, with complete “on table” embolization of the T2E on fluoroscopy; however, 4 (15%) patients needed repeat TLE due to persistent endoleak identified on follow-up computed tomography or because of further sac expansion. Satisfactory stasis was achieved in these 4 cases following a second embolization. The mean volume of embolic injected was 7.4 mL per case. Feeding vessels were identified on angiography in all cases; the nidus was supplied by lumbar branches in 21 cases, by the inferior mesenteric artery in 1 case and by both in a further 5 cases. Freedom from aneurysm sac growth (defined as < 2 mm) following 1 or 2 separate TLE was achieved in 18 (78%) and 20 (86%) patients, respectively. The major complication rate was Conclusion: The translumbar approach is a safe and effective technique to treat T2E, as evidenced by the low complication and reintervention rate.

Aqueous solutions (∼0.01–0.2%) of long chain polymers are used during gravity thickening to aggregate particle suspensions. These polymers are often dosed into turbulent flow through submerged pipes (sparges) to maximise their distribution. At high concentrations, these viscoelastic solutions mix poorly with surrounding flows unless highly diluted. If varying the bluff body sparge shape can enhance mixing, such dilution may be avoided. Turbulent mixing of concentrated (0.2%) polymer solutions sparged into turbulent flows within a transparent channel was captured using high-speed imaging to understand the complex mixing phenomena. Square and round sparges were investigated at 0 or 180° to the channel flow. At 0°, vortex shedding from square sparge edges enhanced mixing, but the 180° orientation produced better overall mixing. Image analysis gave the first quantification of flow past bluff bodies issuing viscoelastic fluid jets at industrial flow regimes, from which more appropriate turbulence model closures for fluid dynamics modelling of the process may be derived.

Climate smart farming requiresfood productionto sit alongside practices which sequestergreenhouse gas emissions. Given the requirement to meet netzero emissionsby the middle of the century, agricultural policies are now seeking to embed climate smart approaches within future support schemes. Path dependency, the influence of past choices on decision making, has been found to constrain future growth pathways. We apply this concept within a survey of 2494 farmers in Scotland to understand their intentions towards uptake of two prominent climate smart approaches, namely forestry expansion and on-farm renewable energy. We employ a bivariate probit model to estimate the single and joint dependences ofthese two activities within a farm decision making framework. Factors such as succession planning, the level ofagricultural diversificationand risk seeking perceptions were found to be positively related to influencing uptake. However, the strongest predictors for uptake were past expansion of these activities and, conversely, a limiting factor for those who did not intend to increase activities. This provides some evidence that path dependencies will limit large scale adoption to meet a net zero target. We argue for a dual approach to intervention which differentiates between past adopters and those who are reluctant to adopt. More targetted support for these two cohorts would address these high level policy ambitions.

The connection between HIV and sexual and reproductive health and rights (SRHR) is widely recognised along with the benefits of linking them at the legal/policy, health systems, and service delivery levels. However, despite increased rhetoric about the need for this three-tiered approach, integrated service delivery has not been fully addressed at the legal/policy level through national strategies. Thus a review of HIV and SRHR strategies was conducted for 60 countries, determining the extent to which they reflected the intersections between HIV and SRHR. Each HIV strategy was scored on whether five key SRHR components were incorporated and had an associated measurable target. SRHR strategies were similarly assessed for incorporation of five HIV components and associated targets. HIV strategies had a higher level of inclusion of SRHR components with a global average of 6.6/10 compared to 3.7/10 for SRHR strategies. The highest scoring component was the elimination of mother-to-child transmission of HIV (EMTCT) and the lowest was SRHR of people living with HIV. Countries with higher scores in one strategy tended to have higher scores in the other but there was no difference over time. Whilst there has been increased global commitment since 2004 to link SRHR and HIV, insufficient headway has been made in linking related national strategies. Although EMTCT is included with targets in the majority of HIV and SRHR strategies, the broader SRHR needs of women living with HIV are not. Also, condoms are not being considered an effective triple protection tool. HIV and SRHR strategies provide direction and targets which ultimately may influence funding and vice versa. Therefore, it is essential that these strategies are right-based and incorporate the key connections between SRHR and HIV with measurable targets to realise the full benefits of a joint response.

In this paper, we assess the recent and anticipated changes on Scotland’s livestock-producing crofts, using a representative survey of Scottish farmers undertaken in 2013. We find that crofters are...

Integration of services for sexual and reproductive health (SRH) and HIV has been widely promoted globally in the belief that both clients and health providers benefit through improvements in quality, efficient use of resources, and lower costs, helping to maximize limited health resources and provide comprehensive client-centered care. This article builds on the growing body of research on integrated sexual SRH and HIV services. It brings together critical reviews on issues within the wider SRH and rights agenda and synthesizes recent research on integrated services, drawing on the Integra Initiative and other major research. Unintended pregnancy and HIV are intrinsically interrelated SRH issues, however broadening the constellation of services, scaling up, and mainstreaming integration continue to be challenging. Overcoming stigma, reducing gender-based violence, and meeting key populations' SRH needs are critical. Health systems research using SRH as the entry point for integrated services and interaction with communities and clients is needed to realize universal health coverage.

Increasing woodland area in the United Kingdom is strongly supported in policies, but there is evidence of low rates of new planting, infrequent uptake of farm forestry, and negative attitudes to woodland among farmers. Additionally, there is a wider context of increasing farm diversification, and a need for greater understanding of farmers' attitudes and behaviour related to afforestation. This paper uses a representative survey of Scottish farmers (survey year: 2013, respondents used in analysis: 1735) to compare farmers who intended to expand forestry in future and farmers with alternative combinations of intended and past behaviour in relation to forestry. Overall, we find that certain characteristics: already operating forestry, reporting types of non-farming activities, involvement in environmental schemes, having a high education level, having a relatively high number of employees, and being relatively recent entrants to holdings, were more frequently found among farmers intending to increase forestry in future than farmers described as ‘non-increasers’ who did not intend to increase forestry and also had not expanded it in the past. Farmers with these characteristics could be a useful focus in attempts to expand woodland at larger scales, and encouraging small-scale tree planting could be an effective policy approach.

The research for this paper was supported by the Scottish Government RESAS Strategic Research Programme 2011–2016.

Background The novel Coronavirus SARS CoV-2 (COVID-19) outbreak was complicated by the lack of diagnostic testing kits. In early March 2020, leadership at Beaumont Hospital, Royal Oak Michigan (Beaumont) identified the need to develop high capacity testing modalities with appropriate sensitivity and specificity and rapid turnaround time. We describe the molecular diagnostic testing experience since initial rollout on March 16, 2020 at Beaumont, and results of repeat testing during the peak of the COVID-19 pandemic in MI. Methods Beaumont is an 1100 bed hospital in Southeast MI. In March, testing was initially performed with the EUA Luminex NxTAG CoV Extended Panel until March 28, 2020 when testing was converted to the EUA Cepheid Xpert Xpress SARS-CoV-2 for quicker turnaround times. Each assay was validated with a combination of patient samples and contrived specimens. Results During the initial week of testing there was > 20 % specimen positivity. As the prevalence grew the positivity rate reached 68% by the end of March (Figure 1). Many state and hospital initiatives were implemented during the outbreak, including social distancing and screening of asymptomatic patients to increase case-finding and prevent transmission. We also adopted a process for clinical review of symptomatic patients who initially tested negative for SARS-CoV-2 by a group of infectious disease physicians (Figure 2). This process was expanded to include other trained clinicians who were redeployed from other departments in the hospital. Repeat testing was performed to allow consideration of discontinuation of isolation precautions. During the surge of community cases from March 16 to April 30, 2020, we identified patients with negative PCR tests who subsequently had repeat testing based on clinical evaluation, with 7.1% (39/551) returning positive for SARS- CoV2. Of the patients who expired due to COVID-19 during this period, 4.3% (9/206) initially tested negative before ultimately testing positive. Figure 1 BH RO testing Epicurve Figure 2: Screening tool for repeat COVID19 testing and precautions Conclusion Many state and hospital initiatives helped us flatten the curve for COVID-19. Our hospital testing experience indicate that repeat testing may be warranted for those patients with clinical features suggestive of COVID-19. We will further analyze these cases and clinical features that prompted repeat testing. Disclosures All Authors: No reported disclosures

Introduction: The aim of this study was to assess the durability of superficial femoral artery (SFA) stents and factors that affect stent patency. Methods: A retrospective assessment of 214 SFA stent procedures between 2003 and 2012 was conducted from a prospectively compiled database. Patency rates and patient outcomes were compiled from case notes and computerized records. Stent patency was confirmed by either duplex scan or clinical examination (palpable distal pulse). Survival and patency were compared across a range of factors using Kaplan-Meier plots and log-rank tests. Factors found to be significant were further assessed by Cox regression models. Results: Data were analyzed for 214 limbs in 205 patients. Inclusion criteria included those patients who received an SFA stent for treatment of claudication or critical limb ischemia (CLI) with follow-up data. This gave a study group of 151 limbs divided into 76 claudicant and 75 patients with CLI (male–female ratio = 103:48, mean age 71 years, standard deviation 11.7). Seventy-one percent of procedures were elective and 29% were emergency procedures; 53% of procedures were carried out on a day case basis. Median follow-up was 11 months (range 1 day-89 months). Patency was significantly worse for patients with CLI ( P = .009), with a 1- and 3-year patency of 63% and 34% compared to 79% and 60% in patients with claudication. Significant factors associated with patency included oral therapy controlled diabetes ( P = .003), lesions located in either the mid-SFA ( P = .029) or the mid-popliteal ( P = .013), and periprocedural complications ( P = .005). There was no significant difference in patency rates between insulin-dependent and nondiabetic patients (hazard ratio: 1.0, 95% confidence interval: 0.4-5.6, P = .983). The overall amputation rate for the total study group was 5%. Patients with 1- and 3-year survival were 98% and 96% in the claudication group and 74% and 51%, respectively, in the CLI group. Conclusion: SFA stents have superior outcomes in claudicants. Patency is related to severity of disease, diabetes, and location of disease.

Embodiments of the present invention provide programmable materials capable of real-time, significant adjustment in their mechanical response. When combined with autonomous sensing and control strategies, these materials can be used in a new series of structural components with enhanced static and dynamic efficiency. An embodiment of the present invention provides an apparatus comprising an array of one or more unit cells, formed from a material, each cell defining a shape; and links coupled to the unit cells, at least a subset of the links enabling changing of an elasticity of at least a subset of the unit cells or at least a sub- array of the unit cells as a function of a state of the at least a subset of the links, the state including ON and OFF states.

Purpose: Previous reports have suggested higher periprocedural complications after ipsilateral antegrade femoral arterial access (AA). We looked at a contemporary series comparing complication rates between AA and contralateral retrograde femoral arterial access (RA) for femoropopliteal angioplasty. Method: A prospective review of all cases between 2010 and 2015 in a United Kingdom tertiary vascular center. Demographical and procedural data were obtained for those undergoing percutaneous femoropopliteal angioplasty. The primary outcome looked at periprocedural complications including retroperitoneal hematoma, pseudoaneurysm, hematoma requiring transfusion, arteriovenous fistulation, and surgical intervention. Secondary outcomes included contrast and radiation doses in addition to procedural failure leading to major amputation. Results: A total of 556 (66% male) patients underwent femoropopliteal angioplasty, 461 (82%) via AA. Groups were of comparable age, sex, comorbidity, and symptomatology. AA patients had a lower body mass index, 26 versus 29 ( P = .005). No significant difference was seen in periprocedural (15.8% AA vs 11.6% RA; P = 0.292) or access site complications (3.7% AA vs 1.1% RA; P = 0.186). There was less need for a closure device, 40.3% AA vs 73% RA ( P < .01), less contrast, 94 mL AA: 114 mL RA ( P < .001), and less radiation, 3487 cGy cm2 AA: 9697 cGy cm2 RA ( P < .001). Arterial access was also associated with greater technical success of 83.8%: 73.3% RA ( P = .002). Conclusions: Arterial access is associated with higher technical success and reduced contrast/radiation doses with no significant difference in complications compared to RA contrary to previous reports.

Integration of services for sexual and reproductive health (SRH) and HIV has been widely promoted globally in the belief that both clients and health providers benefit through improvements in quality, efficient use of resources, and lower costs, helping to maximize limited health resources and provide comprehensive client‐centered care. This article builds on the growing body of research on integrated sexual SRH and HIV services. It brings together critical reviews on issues within the wider SRH and rights agenda and synthesizes recent research on integrated services, drawing on the Integra Initiative and other major research. Unintended pregnancy and HIV are intrinsically interrelated SRH issues, however broadening the constellation of services, scaling up, and mainstreaming integration continue to be challenging. Overcoming stigma, reducing gender‐based violence, and meeting key populations’ SRH needs are critical. Health systems research using SRH as the entry point for integrated services and interaction with communities and clients is needed to realize universal health coverage.

Internationally, a wide set of measures are being considered to reduce flood risk: natural flood management (NFM) is one of them. NFM includes a broad range of measures that alter, restore or use landscape features to manage flood risk. By working with catchment-wide hydrological and morphological processes, NFM aims to manage the sources and pathways of floodwaters. NFM can nevertheless conflict with other land uses, in particular agricultural food production. Our research aimed to explore farmers' perceptions of NFM and identify the criteria influencing decision making in implementation. Using findings from a workshop, qualitative interviews and a national survey carried out in Scotland, this paper identifies six key criteria that farmers consider when implementing NFM: economics, availability of advice and support, public perception, joined-up policy, catchment planning and traditions. While a number of these criteria are consistent with the agri-environment literature and other flood management studies, our study makes some novel findings regarding farmer perceptions and how NFM affects the farm business. We conclude that NFM installation could be encouraged through one-to-one advice from a trusted facilitator and long-term financial incentives that compliment other farm payments. This should be combined with a catchment approach to flooding, which highlights shared responsibility for reducing flood risk.

There has been a growing role for both diagnostic and interventional radiology (IR) in all types of trauma affecting different areas of the body, with imaging becoming an integral part of the multidisciplinary approach to modern trauma care. This article is intended to assess the role of radiology in peripheral trauma and highlight some of the indications, contraindications and treatment options available. It will also touch upon other associated problems encountered by the trauma patient in particular the increased risk of thromboembolic disease. We review some of the common peripheral vascular injuries in our experience in a large trauma hospital.

Inferior vena cava (IVC) filters are a controversial mechanical adjunct in the prevention of pulmonary embolism, the most serious result of venous thromboembolism. Despite modern IVC filters being in clinical use for more than 45 years, there is still uncertainty amongst many radiologists about the indications for IVC filter placement and their removal, particularly the more recent prophylactic use in patients without confirmed deep vein thrombosis (DVT) or pulmonary embolism (PE). Recently published guidelines on filter use from the National Institute of Health and Clinical Excellence (NICE) and other professional bodies are discussed. The vast majority of IVC filters in the UK are inserted by interventional radiologists, so radiologists may be the first point of contact for information requested by other clinicians. The increasing use of filters means that radiologists will encounter filters increasingly often during abdominal cross-sectional imaging. Awareness of common filter-related complications, such as tilting, thrombosis, and caval perforation, is useful to reassure or alert other clinicians. The potential role of filters in upper extremity DVT and requirement for concomitant anticoagulation is discussed.

Introduction. We describe a case of aortouniiliac (AUI) endovascular aortic aneurysm repair (EVAR) using combined iliac limb and bifurcated body stent graft modular system. Case report. This technique is demonstrated in a 58-year-old man with a 6-cm abdominal aortic aneurysm suitable for EVAR. The patient has a functioning cadaveric renal transplant anastamosed to the mid right external iliac artery, an occluded left iliac system and stenosed right iliac system. The renal allograft was protected with minimal passage across the transplant artery origin using this modified approach. The patient was successfully treated with a bifurcated main body deployed within a contralateral limb endoprosthesis. Subsequent scans confirmed no endoleaks or stent migration. Conclusions. The AUI conversion from existing Gore excluder stent graft system is safe and should be considered when faced with challenging anatomy of a pelvic renal transplant, slender access, and contralateral iliac occlusion.

Aim Occlusion or severe stenosis of pedal and plantar arteries limits surgical options for critical limb ischaemia (CLI). Below-the-ankle (BTA) angioplasty is potentially useful as an adjunct to proximal angioplasty. In this study, the feasibility and outcome of this procedure were explored, as they have not been evaluated previously. Methods Patients' demographics, indications, procedures and outcomes were recorded. Outcomes were determined by technical success, primary patency, limb salvage and amputation-free survival (AFS) rates. Results Between 2004 and 2008, 42 cases of BTA angioplasty were performed for 39 patients. Forty cases (95.2%) had CLI. Technical success was achieved in 88% of cases. At 6, 12 and 24 months, AFS was 70.7%, 60.9% and 57.1%, limb salvage was 84.9%, 81.9% and 81.9% and patient survival was 83.3%, 73.8% and 67.3, respectively. Seven major amputations (16.6%) were performed, four of which had failed angioplasty. Two patients required re-intervention. Univariate analysis showed insulin-dependent diabetics, occlusive lesions, failure of angioplasty and state of the run off to be the predictors of limb loss. Conclusions BTA angioplasty for pedal and plantar arterial occlusive disease is technically feasible. It has good medium-term clinical outcome and limb salvage in a group of patients with poor surgical options.

Pelvic fractures secondary to blunt trauma are associated with a significant mortality rate due to uncontrolled bleeding. Interventional radiology (IR) can play an important and central role in the management of such patients, offering definitive minimally invasive therapy and avoiding the need for high-risk surgery. Rapid access to whole-body computed tomography has been shown to improve survival in polytrauma patients and allows rapid diagnosis of vascular injury and assessment of suitability for endovascular therapy. IR can then target and treat the specific area of bleeding. Embolisation of bleeding pelvic arteries has been shown to be highly effective and should be the treatment of choice in this situation. The branches of the internal iliac artery (IIA) are usually involved, and these arteries are accessed by way of IIA catheterisation after abdominal aortography. Occasionally these arteries cannot be accessed by way of this conventional route because of recent IIA ligation carried out surgically in an attempt to stop the bleeding or because (in the rare situation we describe here) these vessels are excluded secondary to previous aortoiliac repair. In this situation, knowledge of pelvic arterial collateral artery pathways is important because these will continue to supply pelvic structures whilst making access to deep pelvic branches challenging. We describe a rare case, which has not been previously reported in the literature, in which successful embolisation of a bleeding pelvic artery was carried out by way of the collateral artery pathways.

The Brampton kame belt represents one of the largest glaciofluvial complexes within the UK. It is composed of an array of landform-sediment assemblages, associated with a suite of meltwater channels and situated within a palimpsest landscape of glacial features in the heart of one of the most dynamic parts of the British–Irish Ice Sheet. Glacial geomorphological mapping and sedimentological analysis have allowed a detailed reconstruction of both the morphological features and the temporal evolution of the Brampton kame belt, with processes informed by analogues from modern ice margins. The kame belt demonstrates the development of a complex glacier karst typified by the evolution of subglacial meltwater tunnels into an englacial and supraglacial meltwater system dominated by ice-walled lakes and migrating ice-contact drainage networks. Topographic inversion led to the extensive reworking of sediments, with vertical collapse and debris flows causing partial disintegration of the morphology. The resultant landform comprises a series of kettle holes, discontinuous ridges and flat-topped hills. The Pennine escarpment meltwater network, which fed the Brampton kame belt, is composed of an anastomosing subglacial channel system and flights of lateral channels. The Brampton kame belt is envisaged to have formed during the stagnation of ice in the lee of the Pennines as ice retreated westwards into the Solway Lowlands. The formation of the Brampton kame belt also has particular conceptual resonance in terms of constraining the nature of kame genesis, whereby an evolving glacier karst is a key mechanism in the spatial and temporal development of ice-contact sediment-landform associations.

Objectives To study the safety and efficacy of bare and covered stents in infrainguinal vein grafts after failure of PTA for treating graft stenoses. Methods An analysis of a prospective database of all patients who underwent stenting of infrainguinal vein bypass grafts at this institution between 1 January 2008 and 31 December 2012 was carried out. The main outcome considered was primary patency, which was reported at 1, 6 and 12 months. Results A total of 18 patients with a mean age of 73 years (range: 56 to 86) were included. The indications for stent placement were significant recoil (7, 39%), graft rupture (6, 33%), residual vein cusps (3, 17%) and aneurysmal degeneration (2, 11%). There was a high overall technical success rate of 94% (17/18) and arrest of haemorrhage was achieved in all cases of graft rupture. The primary patency at 1, 6 and 12 months was 89%, 71% and 59%, respectively. Conclusion The use of bare and covered stents in infrainguinal vein grafts appears safe and effective. They are an excellent bail-out option for the treatment of graft rupture and give acceptable short-term results.

The United Kingdom has experienced several exceptional summer flash floods in recent years and there is growing concern about the frequency of such events and the preparedness of the population. This paper uses a case study of the upper Ryedale flash flood (2005) and questionnaire and interview data to assess local perceptions of upland flash flooding. Experience of a major flash flood may not be associated with increased flood risk perception. Despite local residents' awareness of a trend towards wetter summers and more frequent heavy rainfall, the poor maintenance of rivers was more frequently thought to be a more significant factor influencing local flood risk than climate change. Such findings have important implications for the potential success of contemporary national flood policies, which have put greater emphasis on public responsibility for responding to flooding. This study recommends, therefore, the use of fresh participatory approaches to redistribute and raise awareness of locally-held flood knowledge.

Evidence from past studies supports the proposition that air ambulance crews are at risk for musculoskeletal injury. We evaluated the association between musculoskeletal discomfort and lifting tasks in air ambulance crews, through the use of a body map discomfort survey and a 25-question demographic/lifting activities questionnaire. Male and female full-time employees of two hundred seventy-one air ambulance services throughout the continental United States were surveyed. Participants self-reported discomfort levels for twenty-five body locations. Data for seven of these locations indicated pain with an average value greater than three on a 10-point scale, and 39 (19.6%) of the two hundred participants had been diagnosed with discogenic back pain. Eighty-seven (44.3%) stated they had lifted over 50 pounds of distributed weight more than six times in the last thirty days. Sixty-two (31.2%) reported that their air ambulance service used no mechanical lifting aids. Furthermore, 28 (45.2%) of those with no lifting aids observed a particularly challenging lifting task within the past 30 days. There is considerable evidence that air ambulance crews experience body discomfort related to their lifting tasks. Potential ergonomic improvements are discussed.

The authors present two children with Reye's syndrome who were studied with serial computerized tomographic (CT) scanning. Scans performed with contrast enhancement during the acute phase of this disease showed evidence of pathological cerebral vasodilatation. The possible mechanism for this vasodilatation and the increased intracranial pressure (ICP) seen in Reye's syndrome are discussed.

A reliable method of total pinealectomy in sheep without a resulting significant neurological deficit has been developed and is described. The known effect of light on sheep gonadotropin levels helps validate these studies of its pineal gland. Special attention is given to delineation of the surgical anatomy of the gland and its relationship under magnification to the central draining veins of the brain. In this large mammal this relationship differs considerably from that of humans. The application of an intrahemispheric occipital exposure using magnification, as well as the preoperative administration of steroids and osmotic agents, helped to minimize the effects of retraction and resultant cerebral edema. We have thus been able to increase the rate of successful pinealectomy to 83%, allowing the development of groups of animals suitable for studies of the neuroendocrine function of the pineal and pituitary glands.

In this study we determined whether the pineal is required for the photoperiodic control of reproduction in ewes and, if so, whether its effect is mediated via negative feedback effects of estradiol on LH. Two groups of Suffolk ewes were pinealectomized and challenged with 90-day alternations between long (16 h of light, 8 h of darkness) and short (8 h of light, 16 h of darkness) photoperiods for 2 yr. One group of pinealectomized ewes had intact ovaries; the other was ovariectomized and implanted with estradiol to monitor feedback inhibition of LH. Reproductive effects of pinealectomy were correlated with elimination of the nighttime rise of serum melatonin. In pineal-intact control ewes, reproductive function was readily manipulated by photoperiod. Long days inhibited ovarian cyclicity and increased the negative feedback potency of estradiol regardless of time of year; short days had stimulatory effects on both variables. In most animals, pinealectomy abolished both the inductive effects of short days and the inhibitory effects of long days, and eliminated the nighttime rise in serum melatonin. Although seasonal changes in reproductive function persisted after pinealectomy, the timing of these changes coincided most closely with that of pineal-intact animals housed outdoors. With the passage of time after pinealectomy, however, these seasonal fluctuations became progressively damped. These results document pineal mediation of the photoperiodic control of seasonal breeding in ewes and indicate that the pineal exerts its effect, at least in part, by changing the capacity of estradiol to inhibit LH secretion. Furthermore, the pineal mediates the response to both stimulatory and inhibitory photoperiods. Finally, ewes that are unresponsive to photoperiod remain seasonal, either in response to other environmental cues or owing to the expression of an endogenous circannual rhythm of reproduction.