Industry-Informed Workshops to Develop Graduate Skill Sets in the Circular Economy Using Systems Thinking.

Increasing demand for chemicals worldwide, depleting resources, consumer pressure, stricter legislation, and the rising cost of waste disposal are placing increasing pressure on chemical and related industries. For any organization to survive in the current arena of growing climate change laws and regulations, and increasing public influence, the issue of sustainability must be fundamental to the way it operates. A sustainable manufacturing approach will enable economic growth to be combined with environmental and social sustainability and will be realized via collaboration between a multidisciplinary community including chemists, biologists, engineers, environmental scientists, economists, experts in management, and policy makers. Hence, employees with new skills, knowledge, and experience are essential. To realize this approach, the design and development of a series of workshops encompassing systems thinking are presented here. After close consultation with industry, an annual program of interactive workshops has been designed for graduate students to go beyond examining the "greening" of chemical reactions, processes, and products, and instead embed a systems thinking approach to learning. The workshops provide a valuable insight into the issues surrounding sustainable manufacturing covering change management, commercialization, environmental impact, circular economy, legislation, and bioresources incorporating the conversion of waste into valuable products. The multidisciplinary course content incorporates industrial case studies, providing access to real business issues, and is delivered by experts from academic departments across campus and industry.

Experience With an On-Site Coronary Computed Tomography-Derived Fractional Flow Reserve Algorithm for the Assessment of Intermediate Coronary Stenoses.

Fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) is a new technique for the diagnosis of ischemic coronary artery stenoses. The aim of this prospective study was to evaluate the diagnostic performance of a novel on-site computed tomography-based fractional flow reserve algorithm (CT-FFR) compared with invasive FFR as the gold standard, and to determine whether its diagnostic performance is affected by interobserver variations in lumen segmentation. We enrolled 44 consecutive patients (64.6 ± 8.9 years, 34% female) with 60 coronary atherosclerotic lesions who underwent coronary CTA and invasive coronary angiography in 2 centers. An FFR value ≤0.8 was considered significant. Coronary CTA scans were evaluated by 2 expert readers, who manually adjusted the semiautomated coronary lumen segmentations for effective diameter stenosis (EDS) assessment and on-site CT-FFR simulation. The mean CT-FFR value was 0.77 ± 0.15, whereas the mean EDS was 43.6 ± 16.9%. The sensitivity, specificity, positive predictive value, and negative predictive value of CT-FFR versus EDS with a cutoff of 50% were the following: 91%, 72%, 63%, and 93% versus 52%, 87%, 69%, and 77%, respectively. The on-site CT-FFR demonstrated significantly better diagnostic performance compared with EDS (area under the curve 0.89 vs 0.74, respectively, p <0.001). The CT-FFR areas under the curve of the 2 readers did not show any significant difference (0.89 vs 0.88, p = 0.74). In conclusion, on-site CT-FFR simulation is feasible and has better diagnostic performance than anatomic stenosis assessment. Furthermore, the diagnostic performance of the on-site CT-FFR simulation algorithm does not depend on the readers' semiautomated lumen segmentation adjustments.

Computed tomography versus invasive coronary angiography: design and methods of the pragmatic randomised multicentre DISCHARGE trial.

OBJECTIVES: More than 3.5 million invasive coronary angiographies (ICA) are performed in Europe annually. Approximately 2 million of these invasive procedures might be reduced by noninvasive tests because no coronary intervention is performed. Computed tomography (CT) is the most accurate noninvasive test for detection and exclusion of coronary artery disease (CAD). To investigate the comparative effectiveness of CT and ICA, we designed the European pragmatic multicentre DISCHARGE trial funded by the 7th Framework Programme of the European Union (EC-GA 603266). METHODS: In this trial, patients with a low-to-intermediate pretest probability (10-60 %) of suspected CAD and a clinical indication for ICA because of stable chest pain will be randomised in a 1-to-1 ratio to CT or ICA. CT and ICA findings guide subsequent management decisions by the local heart teams according to current evidence and European guidelines. RESULTS: Major adverse cardiovascular events (MACE) defined as cardiovascular death, myocardial infarction and stroke as a composite endpoint will be the primary outcome measure. Secondary and other outcomes include cost-effectiveness, radiation exposure, health-related quality of life (HRQoL), socioeconomic status, lifestyle, adverse events related to CT/ICA, and gender differences. CONCLUSIONS: The DISCHARGE trial will assess the comparative effectiveness of CT and ICA. KEY POINTS: • Coronary artery disease (CAD) is a major cause of morbidity and mortality. • Invasive coronary angiography (ICA) is the reference standard for detection of CAD. • Noninvasive computed tomography angiography excludes CAD with high sensitivity. • CT may effectively reduce the approximately 2 million negative ICAs in Europe. • DISCHARGE addresses this hypothesis in patients with low-to-intermediate pretest probability for CAD.

A comparison of Diamond Forrester and coronary calcium scores as gatekeepers for investigations of stable chest pain.

To determine if calcium scores (CS) could act as a more effective gatekeeper than Diamond Forrester (DF) in the assessment of patients with suspected coronary artery disease (CAD). A sub-study of the Cardiac CT for the Assessment of Chest Pain and Plaque (CAPP) study, a randomised control trial evaluating the cost-effectiveness of cardiac CT in symptomatic patients with stable chest pain. Stable pain was defined as troponin negative pain without symptoms of unstable angina. 250 patients undergoing cardiac CT had both DF scores and CS calculated, with the accuracy of both evaluated against CT coronary angiogram. Criteria given in UK national guidelines were compared. Of the 250 patients, 4 withdrew. 140 (57 %) patients were male. The mean DF was 47.8 and mean CS 172.5. Of the 144 patients with non-anginal pain 19.4 % had significant disease (>50 % stenosis). In general the DF over estimated the presence of CAD whereas the CS reclassified patients to lower risk groups, with 91 in the high risk DF category compared to 26 in the CS. Both receiver operating curve and McNemar Bowker test analysis suggested the DF was less accurate in the prediction of CAD compared to CS [Formula: see text] Projected downstream investigations were also calculated, with the cost per number of significant stenoses identified cheaper with the CS criteria. Patients with suspected stable CAD are more accurately risk stratified by CS compared to the traditional DF. CS was more successful in the prediction of significant stenosis and appears to be more effective at targeting clinical resources to those patients that are in need of them.