Advances in enteropathogen control throughout the meat chicken production chain.

Enteropathogens, namely Salmonella and Campylobacter, are a concern in global public health and have been attributed in numerous risk assessments to a poultry source. During the last decade, a large body of research addressing this problem has been published. The literature reviewed contains review articles on certain aspects of poultry production chain; however, in the past decade there has not been a review on the entire chain-farm to fork-of poultry production. For this review, a pool of 514 articles were selected for relevance via a systematic screening process (from >7500 original search articles). These studies identified a diversity of management and intervention strategies for the elimination or reduction of enteropathogens in poultry production. Many studies were laboratory or limited field trials with implementation in true commercial operations being problematic. Entities considering using commercial antienteropathogen products and interventions are advised to perform an internal validation and fit-for-purpose trial as Salmonella and Campylobacter serovars and biovars may have regional diversity. Future research should focus on nonchemical application within the processing plant and how a combination of synergisticinterventions through the production chain may contribute to reducing the overall carcass burden of enteropathogens, coupled with increased consumer education on safe handling and cooking of poultry.

On the future of transportation in an era of automated and autonomous vehicles.

Automated vehicles (AVs) already navigate US highways and those of many other nations around the world. Current questions about AVs do not now revolve around whether such technologies should or should not be implemented; they are already with us. Rather, such questions are more and more focused on how such technologies will impact evolving transportation systems, our social world, and the individuals who live within it and whether such systems ought to be fully automated or remain under some form of direct human control. More importantly, how will mobility itself change as these independent operational vehicles first share and then dominate our roadways? How will the public be kept apprised of their evolving capacities, and what will be the impact of science and the communication of scientific advances across the varying forms of social media on these developments? We look here to address these issues and to provide some suggestions for the problems that are currently emerging.

Cratonic basins as effective sediment barriers in continent-scale sediment routing systems of Paleozoic North America.

Provenance studies demonstrate the important control of plate boundary mountain building on continental sediment routing systems. Less well understood is if subsidence and uplift in cratons also has the potential to affect the organization of sediment routing systems on continental scales. New detrital zircon provenance data from the Michigan Basin in the Midcontinent of North America preserve evidence of intrabasin provenance heterogeneity in Cambrian, Ordovician, and middle Devonian strata. These results suggest that cratonic basins serve as effective sediment barriers that prevent mixing within and across basins from 10 to 100 s of millions of years. Internal sediment mixing, sorting, and dispersal may be achieved by a combination of sedimentary processes and inherited low relief topography. These observations are consistent with provenance data sets from eastern Laurentian Midcontinent basins that show locally and regionally variable provenance signatures during the early Paleozoic. By the late Devonian, provenance signatures throughout the basins homogenized, consistent with the emergence of transcontinental sediment transport systems associated with Appalachian orogenesis at the plate margin. These results demonstrate the importance of cratonic basins on local and regional sediment routing systems suggesting that these features may impede the integration of continental-scale sediment routings systems, particularly during periods of plate margin quiescence.

Simple Zn(ii) complexes for the production and degradation of polyesters.

Nine new complexes based on thioether appended iminophenolate (ONS) ligands have been prepared and fully characterized in solution by NMR spectroscopy. Solid-state structures were also obtained for seven complexes. In solution, all complexes were monomeric. The complexes were highly active for the polymerization of purified rac-lactide ([M] : [Zn] : [BnOH] = 10 000 : 1 : 30 at 180 °C) reaching TOF values up to 250 000 h-1. The kinetics of the polymerization have been probed by in situ Raman spectroscopy. The rate of reaction was dramatically reduced using technical grade rac-lactide with increased initiator loading. To move towards a circular economy, it is vital that catalysts are developed to facilitate chemical recycling of commodity and emerging polymeric materials. In this vein, the complexes have been assessed for their ability to break down poly(lactic acid) and poly(ethylene terephthalate). The results from both the polymerization and degradation reactions are discussed in terms of ligand functionality.

The Impact of a Dedicated Chronic Total Occlusion PCI Program on Heart Team Decision Making.

BACKGROUND: Guidelines endorse a heart team (HT) approach to standardize the decision-making process for patients with complex coronary artery disease (CAD). With percutaneous treatment options for complex CAD increasing, we hypothesized that practice had changed over the past decade-and that more individuals, previously deemed too high risk for intervention, would now be referred for either surgical or percutaneous revascularization. METHODS: This observational study was conducted at St Thomas' Hospital (London, United Kingdom). All patients discussed at HT meetings were recorded and treatment recommendations audited. A subset of historic cases was selected for blinded, repeat discussion. RESULTS: From April 2018 to 2019, a total of 52 HT meetings discussing 375 cases were held. Patients tended to be male, with a majority demonstrating multivessel CAD in the context of preserved left ventricular function. SYNTAX scores were balanced across the tertiles. Thirty-five percent of patients had at least 1 chronic total occlusion (mean J-CTO, 3 [interquartile range, 2-3]), affecting the right coronary artery in 60%. Fifteen historic patients with isolated CTOs were re-presented an average of 8 years later; only 3 patients received the same outcome, with 80% now receiving a recommendation for revascularization over medical therapy. CONCLUSIONS: A dedicated program supporting complex coronary intervention is associated with a change in treatment recommendations issued by the local HT. In line with international guidelines, this might indicate that any complex or multivessel CAD should be discussed at HT meetings with, ideally, the presence of CTO operators.

Disproportionate Mitral Regurgitation Determines Survival in Acute Heart Failure.

Objectives: To assess the prevalence and impact of mitral regurgitation (MR) on survival in patients presenting to hospital in acute heart failure (AHF) using traditional echocardiographic assessment alongside more novel indices of proportionality. Background: It remains unclear if the severity of MR plays a significant role in determining outcomes in AHF. There is also uncertainty as to the clinical relevance of indexing MR to left ventricular volumes. This concept of disproportionality has not been assessed in AHF. Methods: A total of 418 consecutive patients presenting in AHF over 12 months were recruited and followed up for 2 years. MR was quantitatively assessed within 24 h of recruitment. Standard proximal isovelocity surface area (PISA) and a novel proportionality index of effective regurgitant orifice/left ventricular end-diastolic volume (ERO/LVEDV) >0.14 mm2/ml were used to identify severe and disproportionate MR. Results: Every patient had MR. About 331/418 (78.9%) patients were quantifiable by PISA. About 165/418 (39.5%) patients displayed significant MR. A larger cohort displayed disproportionate MR defined by either a proportionality index using ERO/LVEDV > 0.14 mm2/ml or regurgitant volumes/LVEDV > 0.2 [217/331 (65.6%) and 222/345 (64.3%), respectively]. The LVEDV was enlarged in significant MR-129.5 ± 58.95 vs. 100.0 ± 49.91 ml in mild, [p < 0.0001], but remained within the normal range. Significant MR was associated with a greater mortality at 2 years {44.2 vs. 34.8% in mild MR [hazard ratio (HR) 1.39; 95% CI: 1.01-1.92, p = 0.04]}, which persisted with adjustment for comorbid conditions (HR; 1.43; 95% CI: 1.04-1.97, p = 0.03). Disproportionate MR defined by ERO/LVEDV >0.14 mm2/ml was also associated with worse outcome [42.4 vs. 28.3% (HR 1.62; 95% CI 1.12-2.34, p = 0.01)]. Conclusions: MR was a universal feature in AHF and determines outcome in significant cases. Furthermore, disproportionate MR, defined either by effective regurgitant orifice (ERO) or volumetrically, is associated with a worse prognosis despite the absence of adverse left ventricular (LV) remodeling. These findings outline the importance of adjusting acute volume overload to LV volumes and call for a review of the current standards of MR assessment. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT02728739, identifier NCT02728739.

Primary prevention of cardiovascular disease: Updated review of contemporary guidance and literature.

Cardiovascular disease remains a substantial concern in terms of global mortality and morbidity, while prevalence of cardiovascular disease is increasing as treatment modalities improve survival. With an ageing population and increasing costs of chronic medical care, primary prevention of cardiovascular disease is an important target for healthcare providers. Since the previous iteration of this paper, new international guidelines have been produced regarding hypertension and lipid lowering therapies, whilst there is a growing body of evidence and new therapies emerging in other areas of lifestyle and pharmacotherapeutic intervention. This review outlines emerging evidence in the field and compares and contrasts contemporary recommendations from European and American guidelines.

The synthesis, characterisation and application of iron(iii)-acetate complexes for cyclic carbonate formation and the polymerisation of lactide.

Herein, we report the preparation, characterisation and catalytic applications of air-stable Fe(iii)-acetate complexes consisting of salan, salen and salalen ligand frameworks. Owing to the simple synthetic protocol employed, a wide range of complexes have been prepared and structure-activity-relationships investigated. X-ray diffraction confirmed the solid-state structures for eight of the complexes. These represent the first Fe(iii)-acetate complexes applied for the selective coupling of CO2/epoxide and lactide polymerisation. The coupling of CO2 and challenging cyclohexene oxide substrate was performed under mild, solvent-free conditions (80 °C, 10 bar CO2) to selectively form the cis-cyclohexene carbonate as the exclusive product (selectivity >99%) with a metal loading of 0.08 mol%. A reduced aminopiperidine ligand backbone was found as the most active catalyst, and after investigating four co-catalysts, showed high functional group tolerance and robustness when applied to a broad, commercially available, terminal epoxide substrate scope with high conversions observed. The ring-opening polymerisation of rac-lactide was achieved using the Fe(iii)OAc complexes using triethylamine and benzyl alcohol for initiation, interestingly isoselectivity was observed in some cases.

Aluminium-catalysed isocyanate trimerization, enhanced by exploiting a dynamic coordination sphere.

Main-group metals are inherently labile, hindering their use in catalysis. We exploit this lability in the synthesis of isocyanurates. For the first time we report a highly active catalyst that trimerizes alkyl, allyl and aryl isocyanates, and di-isocyanates, with low catalyst loadings under mild conditions, using a hemi-labile aluminium-pyridyl-bis(iminophenolate) complex.

Case report of a mysterious myocardial mass: an aetiological conundrum.

INTRODUCTION: Atypical chest pain is frequently an aetiological conundrum, and missing a diagnosis of underlying cardiac disease can have detrimental consequences. The investigation of this may rule out cardiac disease but often provides no clear answers to the underlying pathology. CASE PRESENTATION: An 80-year-old man with a background of bilateral inguinal hernia repairs but no cardiac disease presented to his general practitioner with intermittent chest pain of approximately 15 min duration, felt inside his chest under his right nipple. His episodes of chest discomfort had increased in frequency, occurring both at rest and upon exertion. He was seen by the cardiology team at his local hospital and reassured following normal coronary angiography and outpatient echocardiography. The pain persisted, so cardiac magnetic resonance imaging (MRI) was arranged to exclude the underlying myocardial disease. This demonstrated a mass within the right ventricular free wall, which MRI was unable to characterize. Follow-up cardiac computed tomography showed this to be a metallic object within the right ventricular wall, but despite thorough examination of his medical and social history, there remains no obvious explanation to its aetiology other than potentially due to clip migration from his hernia repair. DISCUSSION: Metallic foreign bodies within the myocardium are described in case reports but almost entirely in the setting of intentional self-injury. There is no previous case evidence of migration of distal surgical clips to the heart, but there appears to be no other clear aetiology for this gentleman's pathology, thus representing a novel description of iatrogenic injury.

Non-genetic and genetic risk factors for adult cerebral venous thrombosis.

INTRODUCTION: A wide variety of non-genetic and genetic factors have been shown to associate with increased risk for cerebral venous thrombosis (CVT). However, there is a paucity of risk factor data and conclusions about their impact are often conflicting. Herein, we quantified the associations of non-genetic and genetic risk factors for CVT in adults. MATERIALS AND METHODS: Electronic databases were searched up to January 2017. Meta-analyses were performed (RevMan v5.3) to determine pooled odds ratios (ORs and 95% CIs) for risk factors, interstudy heterogeneity and publication bias. RESULTS: Twenty non-genetic (n = 2314) and 33 genetic (n = 2117) studies up to January 2017 met the selection criteria. For non-genetic factors, CVT risk increased in the presence of glucocorticosteroid therapy by 18.3-fold (3.3-102.6), alcohol consumption 2.7-fold (1.8-3.9), infection 7.5-fold (2.6-21.6), surgery 9.6-fold (1.1-83.5), hypercholesterolaemia 2.4-fold (1.3-4.4), hyperhomocysteinaemia 3.1-fold (2.1-4.6), antiphospholipid antibodies 7.0-fold (2.1-23.6), autoimmune diseases 5.6-fold (2.3-13.6), anaemia 4.0-fold (2.1-7.9), malignancy 3.2-fold (1.4-7.1) and pregnancy/puerperium 11.4-fold (5.7-24.3). Smoking, hypertension and diabetes did not associate with CVT risk. For genetic factors, CVT risk increased in the presence of factor V Leiden (G1691A) by 2.5-fold (1.9-3.3), protein C deficiency 10.7-fold (3.1-37.7), protein S deficiency 5.7-fold (1.4-22.4), antithrombin deficiency 3.8-fold (1.0-13.8), prothrombin (G20210A) 5.5-fold (4.0-7.27) and TAFI gene variant (C1040T) 1.6-fold (1.0-2.4). Prothrombin G20210A and factor V Leiden polymorphisms tended to have higher ORs for CVT than for ischaemic stroke. CONCLUSIONS: We provide quantitative data supporting a strong basis for genetic and non-genetic risk factors in CVT. Its genetic liability seems higher when compared with sporadic ischaemic stroke.

Primary prevention of cardiovascular disease: A review of contemporary guidance and literature.

Cardiovascular disease is a significant and ever-growing problem in the United Kingdom, accounting for nearly one-third of all deaths and leading to significant morbidity. It is also of particular and pressing interest as developing countries experience a change in lifestyle which introduces novel risk factors for cardiovascular disease, leading to a boom in cardiovascular disease risk throughout the developing world. The burden of cardiovascular disease can be ameliorated by careful risk reduction and, as such, primary prevention is an important priority for all developers of health policy. Strong consensus exists between international guidelines regarding the necessity of smoking cessation, weight optimisation and the importance of exercise, whilst guidelines vary slightly in their approach to hypertension and considerably regarding their approach to optimal lipid profile which remains a contentious issue. Previously fashionable ideas such as the polypill appear devoid of in-vivo efficacy, but there remain areas of future interest such as the benefit of serum urate reduction and utility of reduction of homocysteine levels.