St George's, University of London

Cocaine is the second most popular traditional illicit drug in the European Union, after cannabis, and its high potential for addiction makes it a significant public health concern. Therefore, monitoring trends in the content and purity of street samples can provide valuable information to support harm reduction strategies. This study analysed a selection of 160 street cocaine samples collected at a large British summer festival between 2014 and 2024. A comparison between a low-cost, transportable 60 MHz benchtop nuclear magnetic resonance (NMR) instrument and a more expensive, larger laboratory-based 400 MHz NMR device was used to assess variations in composition and purity levels. Despite a lower signal-to-noise ratio and signal overlap causing some differences in values, the benchtop NMR produced almost identical results to those of the 400 MHz system. Until 2014, cocaine samples were highly adulterated; their purity increased sharply from 2015 onwards, with levels ranging from 80% to 98%, before showing a downward trend in 2024. The most commonly detected cutting agents were benzocaine, levamisole, caffeine, phenacetin, and lactose. Overall, this work demonstrates that low-field NMR can be effectively used to quantify cocaine in street samples. This could be especially beneficial on-site for guiding and enhancing harm reduction services and law enforcement.

For patients with atrial fibrillation, the use of oral anticoagulant therapy to prevent stroke is limited by the risk of bleeding. Left atrial appendage closure is considered for patients who are unsuitable candidates for long-term anticoagulation, but its role in patients who are eligible for anticoagulants has not been established. In this ongoing, prospective, international, randomized trial involving patients with atrial fibrillation who were suitable candidates for anticoagulation, we randomly assigned patients in a 1:1 ratio to receive either device-based left atrial appendage closure (device group) or non-vitamin K antagonist oral anticoagulant (NOAC) therapy (anticoagulation group). The primary efficacy end point - a composite of death from cardiovascular causes, stroke, or systemic embolism - was tested for noninferiority (noninferiority margin, 4.8 percentage points) after 3 years of follow-up. The primary safety end point, non-procedure-relatedbleeding, was tested for superiority. Of the 3000 patients who underwent randomization, 1499 were assigned to the device group and 1501 to the anticoagulation group. The mean (±SD) age of the patients was 71.7±7.5 years, 31.9% of the patients were women, and the mean CHA2DS2-VASc score was 3.5±1.3. At 3 years, a primary efficacy end-point event had occurred in 81 patients (Kaplan-Meier estimate, 5.7%) in the device group and in 65 patients (Kaplan-Meier estimate, 4.8%) in the anticoagulation group (difference, 0.9 percentage points; 95% confidence interval [CI], -0.8 to 2.6; P<0.001 for noninferiority). Non-procedure-related bleeding occurred in 154 patients (Kaplan-Meier estimate, 10.9%) in the device group and in 260 patients (Kaplan-Meier estimate, 19.0%) in the anticoagulation group (hazard ratio, 0.55; 95% CI, 0.45 to 0.67; P<0.001 for superiority). Among patients with atrial fibrillation who were candidates for anticoagulation, device-based left atrial appendage closure was noninferior to NOAC therapy with respect to a composite of death from cardiovascular causes, stroke, or systemic embolism and was superior to NOAC therapy for non-procedure-related bleeding at 3 years. (Funded by Boston Scientific; CHAMPION-AF ClinicalTrials.gov number, NCT04394546.).

ABSTRACT This study develops a novel multivariate stochastic framework for assessing systemic risks, such as climate and nature‐related shocks, within production or financial networks. By embedding a linear stochastic fluid network, interpretable as a generalized vector Ornstein–Uhlenbeck process, into the production network of interdependent industries, the model captures how physical shocks (e.g., extreme climate events or geopolitical disruptions) propagate through input–output (IO) linkages and affect sectoral price dynamics. The framework extends traditional IO models with advanced stochastic and dynamic features, enabling a quantification of both direct and indirect transmission channels of supply‐cost shocks to production prices. Contributing to the literature on stochastic IO and Markovian networks, the model introduces the concept of divisible shocks, allowing for finer‐grained simulation of adaptation responses and resilience across sectors. Empirical calibration leverages real‐world economic data, including IO tables and historical industrial price indices. Sensitivity analyses are conducted using distributional risk measures, offering new tools for climate stress testing and medium to long‐term risk assessment. Our findings support the optimal design of supply risk management strategies, including policy interventions and decentralized adaptation incentives for systemic stability under environmental stress.

Abstract Introduction GLOBALSTAR is a registry of 1587 FEVAR cases from 15 UK centres (2003–2022), established by BSET. Aims were to report long-term outcomes for FEVAR. Methods Study design: retrospective cohort study of GLOBALSTAR. Inclusion criteria: aneurysmal pathology and custom-made FEVAR alone. Data were collected according to a standardised protocol. Time-to-event analyses were conducted for all-cause survival, aneurysm-related mortality and re-intervention. Log-rank sub-analyses were conducted for octogenarians and sexes. Results 1587 patients across 15 centres were included. Median age = 75 years [69–79,IQR] and male = 87.9%. Patients were co-morbid with 45.0% IHD and 73.3% hypertension. All-cause survival at 3, 5 and 10 years was 79.5% [95% c.i., 77.6–81.6%], 64.2% [61.8–66.7%] and 30.3% [27.4–33.4%] with median survival = 6.9 years [6.6–7.2]. Aneurysm-related mortality cumulative incidence = 6.7% at 10 years [5.4–8.1%]. Secondary sac rupture was rare with 4.0 events/1000 patient-years. Cumulative incidence of re-intervention at 3, 5 and 8 years was 20.2% [18.2–22.3%], 24.4% [22.2–26.7%] and 27.7% [25.3–30.2%]. Graft-related complications accounted for 73.8% of re-interventions. Women had significantly worse 2-year survival (80.4%, [75.0- 86.3%]) than men (86.4%, [84.6–88.3%]) (P &amp;lt; 0.05), driven by peri-operative mortality. Beyond 2 years, differences in survival were not significant. Octogenarians had equivalent survival (89.6% [86.5–92.7%]) to non-octogenarians (92.2% [90.7–93.7%]) up to 1 year (P = 0.098). Beyond 1 year, survival differences were significant. Octogenarians' median survival = 5.4 years [5.0–6.1]. Conclusions Long-term outcomes for FEVAR appear acceptable, with low rates of secondary sac rupture. FEVAR carries risk, especially of re-intervention- driven by graft-related complications, highlighting the importance of surveillance. Peri-operative mortality was significantly higher in women, warranting further investigation.

Abstract Linear error-correcting codes form the mathematical backbone of modern digital communication and storage systems, but identifying champion linear codes (linear codes achieving or exceeding the best known minimum Hamming distance) remains challenging. By training a transformer to predict the minimum Hamming distance of a class of linear codes and pairing it with a genetic algorithm over the search space, we develop a novel method for discovering champion codes. This model effectively reduces the search space of linear codes needed to achieve champion codes. Our results present the use of this method in the study and construction of error-correcting codes, applicable to codes such as generalised toric, Reed–Muller, Bose–Chaudhuri–Hocquenghem, algebrogeometric, and potentially quantum codes.

Women of Global Majority ethnicities have an increased risk of developing and sustaining perinatal mental health problems in the UK. This is partially explained by the ethnic inequalities experienced at an individual, societal and systemic level. Previous research highlights the benefits of engaging with participatory music-based interventions to alleviate symptoms of postnatal depression, stress and anxiety, but current provision lacks cultural inclusivity. This qualitative study focuses on fourteen women of African, Caribbean and Mixed heritages living in South East London to explore how their perinatal experiences, coping strategies and preferences regarding music-based support could inform a future culturally inclusive perinatal mental health participatory music intervention. Participants took part in either an online focus group or interview, led by a local community leader. An inductive reflexive thematic analysis identified four overarching themes: (1) supportive mechanisms during the perinatal period, (2) the overwhelming pressures and expectations of motherhood, (3) systemic barriers to accessing perinatal mental healthcare and (4) suggestions for future perinatal mental health music-based support groups. This study reveals the individual experiences of the perinatal period for women of African, Caribbean and Mixed heritages, exploring themes of sociocultural pressures, barriers to care and individual activities used to support mental health. The sociocultural, logistical and musical considerations outlined in this study highlight gaps in current community provision and offer practical suggestions for facilitating inclusive music-based interventions for perinatal mental health in South East London.

How do minorities come to be seen as security threats? This paper examines the case of the large Russian-speaking minority in Estonia and Latvia in the context of neighbouring conflict activities driven by the minority’s alleged kinstate. The paper focuses on the trend of securitization experienced by the minority within the area of public life participation. This dynamic takes place through domestic laws linked to the decision-making sphere and self-governance opportunities. How this occurs is researched through primary fieldwork data from semi-structured interviews with Russian-speaking minority elites, whose perspectives are often overlooked in research addressing the particularities of the region. The fieldwork data complements the legal analysis and finds effects of securitization on public participation of minorities, regardless of whether they were successful in entering into governing coalitions or remained in the opposition within the State legislature. While some of those inefficiencies are caused by governing coalition agreements, other obstacles are created by divisions within the minority. Furthermore, the minority group experienced negative effects on their public participation opportunities through limited prospects facilitated by consultative bodies and self-governance arrangements. Finally, the perceived association with the alleged kinstate shapes the minority to the extent of essentially securitizing them.