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Background The association between cancer and stroke or bleeding outcomes in atrial fibrillation is unclear. We sought to examine how certain types of cancer influence the balance between stroke and bleeding risk in patients with nonvalvular atrial fibrillation (NVAF). Methods and Results We estimated stroke and bleeding risk among adult patients with NVAF and certain types of cancer (breast, prostate, colorectal, lung, and hematological cancer) from 2009 to 2019 based on data from the UK Clinical Practice Research Datalink GOLD and Aurum databases. The control group included patients with NVAF only. Of 177 065 patients with NVAF, 11379 (6.4%) had cancer (1691 breast, 3955 prostate, 1666 colorectal, 2491 hematological, and 1576 lung). Compared with patients without cancer, stroke risk was higher in patients with breast cancer (adjusted hazard ratio [aHR], 1.20 [95% CI, 1.07–1.35) and with prostate cancer (aHR, 1.11 [95% CI, 1.01–1.12) if diagnosed within 6 months before NVAF. The risk of bleeding was increased in subjects with hematological cancer (aHR, 1.55 [95% CI, 1.40–1.71]), lung cancer (aHR, 1.49 [95% CI, 1.25, 1.77]), prostate cancer (aHR, 1.38 [95% CI, 1.28–1.49]), and colorectal cancer (aHR, 1.36 [95% CI, 1.21–1.53]), but not for subjects with breast cancer. The more recent the cancer diagnosis before NVAF diagnosis (within 6 months), the higher the risk of bleeding. Conclusions Breast and prostate cancer are associated with increased stroke risk, whereas in some cancer types, the risk of bleeding seemed to exceed stroke risk. In these patients, prescribing of oral anticoagulant should be carefully evaluated to balance bleeding and stroke risk.

This paper will analyze the role that U.S. Foreign Policy has had on increasing religious inspired terrorism since 1945. Justifications for the War on Terror after 9/11 were for freedom, democracy, and the eradication of terrorism, yet the interventions that have taken place both in the 20th and 21st centuries have neither spread democracy nor freedom and have even increased terrorism, especially in the Middle East and also internationally. The role that each presidential administration after World War II has played in increasing U.S. power and influence in the Middle East has further increased security threats both towards those in the region and Western states. The significant shift in policy after the attacks of 11 September 2001 allowed for the securitization of religious terrorism and a state of exception in which the United States has broken international law and violated human rights through extraordinary measures. The use of drones, in particular by the Obama administration has allowed the War on Terror to move into the shadows from the overt military interventions of George W. Bush in Afghanistan and Iraq, whilst still having a devastating effect on civilians and the stability of the states it targets. The human rights abuses of the United States both in the Middle East and in Guantanamo Bay Naval Base question the legitimacy of the invasions and aims of the democratic state by breaking the rule of law and have also contributed to the increase in religious inspired terrorism.

The strength of foliations defined by shape preferred orientation of plagioclase in troctolitic cumulates from the Layered Series of the Skaergaard intrusion, and the Rum Eastern Layered Intrusion, increases as the grains become more tabular, due either to the greater propensity of highly non-equant grains to be re-arranged by magmatic currents or tectonic disruption of poorly consolidated mush, or by the effects of a pre-existing shape preferred orientation on final grain shape in fully solidified rocks. The stratigraphic evolution of grain shape, microstructures and fabrics in the lowest 320 m of the Skaergaard Layered Series records the progressive inflation of the chamber to its final size. During the earliest stages of solidification, the extent of in situ nucleation and growth on the chamber floor decreased upward through the stratigraphy, due to the development of a thermally insulating blanket of mush on the floor. An upward increase in foliation strength as the chamber inflated to its final size was a result of the increasing strength of convection of the bulk magma and an increasing contribution to the floor mush of crystals derived from the walls of the enlarging magma chamber. Plagioclase in the troctolites in the open-system magma chamber of the Rum Eastern Layered Intrusion is generally more equant than that in the Skaergaard intrusion, perhaps related to the slower crystal growth on the margins of the continuously replenished Rum chamber. Significant sub-solidus modification of original igneous microstructures is observed in Rum troctolites from parts of the stratigraphy recording frequent replenishment events.

There is increasing evidence demonstrating an association between chronic obstructive pulmonary disease (COPD) and cognitive impairment. We present a narrative review of published studies on the subject and a cross-sectional study investigating domain-specific cognitive impairment in people with COPD compared to people with known Alzheimer's dementia, and controls without known COPD or cognitive impairment. The aim of the study was to compare prevalence and pattern of cognitive impairment between the three groups using the Addenbrooke's Cognitive Examination (ACE)-III tool. A total of 89 participants were recruited (44 with COPD, 17 with Alzheimer's and 28 controls). Patients with COPD had significantly lower total ACE-III scores than controls (p

This paper considers critical reflection as a pedagogical strategy in UK higher education at a moment of an amplification of populist, reactionary discourses. It draws on written reflections of foundation-level students in a case study cohort and offers insights into their lived learning experiences and perceptions of the value of reflection. This is situated within the UK 'Brexit' context, alongside a proliferation of far-right populist voices, emboldened supremacies and rising fascism. Accompanying this has been a normalisation of reactionary 'anti-social justice' discourses. It is vital that HE practitioners recognise, pre-empt and interrupt such discourses, developing pedagogies and curricula in response. Yet there are inherent challenges in a climate of 'post-truth' anti-intellectualism. This paper argues that critical reflection contributes a useful approach to learning, fostering development of students' personal, intellectual and political capacities to navigate this complex socio-political terrain and engage with social justice.

Abstract Background The gut microbiome is a diverse network of bacteria which inhabit our digestive tract and is crucial for efficient cellular metabolism, nutrient absorption, and immune system development. Spinal cord injury (SCI) disrupts autonomic function below the level of injury and can alter the composition of the gut microbiome. Studies in rodent models have shown that SCI-induced bacterial imbalances in the gut can exacerbate the spinal cord damage and impair recovery. In this study we, for the first time, characterized the composition of the gut microbiome in a Yucatan minipig SCI model. We compared the relative abundance of the most dominant bacterial phyla in control samples to those collected from animals who underwent a contusion-compression SCI at the 2nd or 10th Thoracic level. Results We identify specific bacterial fluctuations that are unique to SCI animals, which were not found in uninjured animals given the same dietary regimen or antibiotic administration. Further, we identified a specific time-frame, “SCI-acute stage”, during which many of these bacterial fluctuations occur before returning to “baseline” levels. Conclusion This work presents a dynamic view of the microbiome changes that accompany SCI, establishes a resource for future studies and to understand the changes that occur to gut microbiota after spinal cord injury and may point to a potential therapeutic target for future treatment.

IntroductionThis paper describes an innovative Framework for Remotely Enabled Co-Design with Young people (FREDY), which details an adaptable four-stage process for generating design concepts with children and other key stakeholders in a naturalistic and inclusive way.MethodsRecommendations from existing patient engagement and design methodologies were combined to provide research teams with procedures to capture and analyse end-user requirements rapidly. Resulting insights were applied through iterative design cycles to achieve accelerated and user-driven innovation.ResultsApplying this framework with neurodiverse children within the context of healthcare, shows how creative design methods can give rise to new opportunities for co-creating across diverse geographies, abilities, and backgrounds as well as strengthen co-designer approval of the co-design process and resulting product.DiscussionWe summarise key learnings and principles for fostering trust and sustaining participation with remote activities, and facilitating stakeholder design input through continuous collaboration, as well as highlight the potential benefits and challenges of utilising FREDY with neurotypical populations.

Introduction Actigraphy is commonly used to record free living physical activity in both typically and atypically developing children. While the accuracy and reliability of actigraphy have been explored extensively, research regarding young people’s opinion towards these devices is scarce. This review aims to identify and synthesise evidence relating to the acceptability of actigraphic devices in 5–11 year olds.Methods and analysis Database searches will be applied to Embase, MEDLINE, PsychInfo and Social Policy and Practice through the OVID interface; and Education Resources Information Center (ERIC), British Education Index and CINAHL through the EBSCO interface from January 2018 until February 2023. Supplementary forward and backward citation and grey literature database searches, including Healthcare Management Information Consortium (HMIC) and PsycEXTRA will be conducted. Qualitative and quantitative studies, excluding review articles and meta-analyses, will be eligible, without date restrictions. Article screening and data extraction will be undertaken by two review authors and disagreements will be deferred to a third reviewer. The primary outcome, actigraphic acceptability, will derive from the narrative synthesis of the main themes identified from included qualitative literature and pooled descriptive statistics relating to acceptability identified from quantitative literature. Subgroup analyses will determine if acceptability changes as a function of the key participant and actigraphic device factors.Ethics and dissemination Ethical approval is not required for this systematic review as it uses data from previously published literature. The results will be presented in a manuscript and published in a peer review journal and will be considered alongside a separate stream of codesign research to inform the development of a novel child-worn actigraphic device.PROSPERO registration number CRD42021232466.