The sharing of internet memes on online social media is increasingly popular form of expressing opinions and complex sentiments in an easily understood image. Memes have been found to be an effective marketing tool if used appropriately. Marketers need to be aware when a meme’s use has become saturated, and its value is depreciating. As with many consumer uses of online social media, meme sharing is described as market for attention which can display dynamics as with cycle. This analysis models the dynamics of meme attention and estimates these dynamics from a panel of memes scraped from sub-Reddit meme forums and classified using a machine learning algorithm. Empirical analysis reveals patterns consistent with random shocks to meme entertainment value carrying over to the quality and quantity of subsequent expressions of the meme. Estimates indicate that a temporary elevation in attention dissipates within just one to two weeks. However, meme saturation then leads to less spread of the meme. To be effective meme marketers must remain attentive to where the meme they intend to use is within the fad cycle.

The sharing of internet memes on online social media is increasingly popular form of expressing opinions and complex sentiments in an easily understood image. Memes have been found to be an effective marketing tool if used appropriately. Marketers need to be aware when a meme's use has become saturated and its value is depreciating. As with many consumer uses of online social media, meme sharing is described as market for attention that can display fad cycle dynamics. This analysis models the dynamics of meme attention and estimates these dynamics from a panel of memes scraped from Reddit meme forums and classified using a machine learning algorithm. Empirical analysis reveals patterns consistent with random shocks to meme entertainment value carrying over to the quality and quantity of subsequent expressions of the meme. Estimates indicate that a temporary elevation in attention dissipates within just one to two weeks. However, meme saturation then leads to less spread of the meme. To be effective, meme marketers must remain attentive to where the meme they intend to use is within the fad cycle.

Septal artery perforations are an uncommon complication of percutaneous coronary intervention. Unlike epicardial vessels, septal perforations do not result in pericardial effusions but rather produce septal haematomas. While most can be managed expectantly, a small proportion requires active management to prevent rapid haematoma expansion resulting in compromise of right ventricular filling and 'dry tamponade'. We present two cases of septal artery perforation during percutaneous coronary intervention and propose a management approach that takes into account the unique haemodynamic consequences of this complication.

The management of diabetes mellitus and its resultant end organ dysfunction represents a major challenge to global health-care systems. Diabetic cardiac and kidney disease commonly co-occur and are significant contributors to the morbidity and mortality of patients with diabetes, carrying a poor prognosis. The tight link of these parallel end organ manifestations suggests a deeper common underlying pathology. Here, we outline the mechanistic link between diabetic cardiac and kidney disease, providing evidence for the role of endothelial dysfunction in both processes and the potential for cellular therapy to correct these disorders. Specifically, we review the preclinical and clinical evidence for endothelial progenitor cell therapy in cardiac, kidney, and cardio-renal disease applications. Finally, we outline novel approaches to endothelial progenitor cell therapy through cell enhancement and the use of extracellular vesicles, discussing published and future work.

Coronary calcium scores (CCS) are a semi-automated test that has been used to estimate risk of myocardial infarction for patients at intermediate risk for coronary disease. The ability for CCS to predict coronary disease of haemodynamic significance is unclear. We conducted a retrospective cohort study to establish any association between vessel-specific CCS and invasive fractional flow reserve (FFR). We identified patients who had an invasive FFR between 2019 and 2022 at Royal North Shore Hospital and North Shore Private Hospital, and examined medical records to determine if a CCS was performed within a three-month period before the FFR was performed. Data were collected on baseline characteristics, CCS results, angiographic characteristics, and invasive FFR results. Associations between CCS and FFR were analysed using a linear regression analysis. 240 vessels with a CCS and invasive FFR were identified, including LAD (n=208), Cx (n=31) and RCA (n=28). Mean patient age was 67.9 year (±9.9), 29% were female, 62.8% with hypertension, 48.2% smoking history, 39% with dyslipidaemia and 16.5% diagnosed with diabetes-mellitus. 95% of studies were due to either stable angina or cardiovascular risk assessment. There was a linear relationship between CCS and age (R2=0.07, p<0.0001). There was an inverse relationship between CCS and FFR (R=-0.15, p=0.03). There is a clear association between vessel-specific CCS and haemodynamic burden of coronary disease as assessed using invasive FFR.

To assess the impact that coronary anatomy and patient factors have on bypass graft haemodynamic parameters, as assessed by transit time flow measurement (TTFM).

In her law journal article Amazon’s Antitrust Paradox, Lina Khan argued, using Amazon as an example, that current antitrust doctrine cannot identify certain types of anticompetitive conduct in platform and data-driven markets and, consequently, reforming antitrust is necessary to correct these deficiencies. Khan’s analysis of Amazon’s conduct and the conclusions she drew from it are flawed because she ignored or misapplied the economics of two-sided markets, mischaracterized competitive conditions, and did not consider the pro-competitive effects of Amazon’s conduct. In this article, we review the economics of two-sided markets and then assess Khan’s analysis of alleged predation in e-books and in the online sale of diapers, as well as alleged anticompetitive implications of Amazon’s vertical integration into logistics and its use of data. A careful assessment of Amazon’s conduct does not support Khan’s conclusion that antitrust reform is necessary because she has not demonstrated that Amazon’s conduct is anticompetitive.

Glycoprotein IIb/IIIa inhibitors (GPIs) have been demonstrated to improve 30-day outcomes when used as an adjunct to percutaneous coronary intervention (PCI) in acute coronary syndromes (ACS). In the era of routine coronary stenting and potent oral antiplatelet agents, the use of GPIs in stable coronary disease is not well established. A systematic search of PubMed, MEDLINE, CENTRAL, Cochrane and clinicalTrials.gov databases was conducted from inception to October 2022. Randomised trials comparing GPI to placebo in elective PCI were included. Only studies involving stable coronary disease and thienopyridine antiplatelets were included. Outcomes included target vessel revascularisation (TVR) and a composite of TVR, myocardial infarction and death (MACE) at 30-days. Bleeding was assessed using Thrombolysis In Myocardial Infarction bleeding score or equivalent. An aggregate data approach with random-effects model was utilised. 3,430 abstracts were screened, and 23 studies with 10,603 patients were included for analysis. Compared to placebo, GPIs reduced 30-day MACE (5.2% vs 8.6%, RR 0.59, 95% CI: 0.44–0.77, p <0.01), driven by reduction in myocardial infarction without a statistically significant decrease in TVR or stent thrombosis. There was no increase in major bleeding, although there was a significant increase in minor bleeding (2.9% vs 1.7%, RR 1.68, 95% CI: 1.26–2.24, p <0.01). Use of GPIs during elective PCI improves 30-day MACE whilst increasing minor bleeding. These results are consistent with published data from a 2010 meta-analysis. Whether GPIs should be routinely used in revascularisation for stable coronary disease should be further assessed.

Despite variations in coronary anatomy and myocardial supply area, a fractional flow reserve (FFR) threshold for revascularisation of 0.8 is applied to all three major vascular territories. The vessel-specific outcomes of deferred revascularisation are unclear, with published data limited to registries. This study aimed to determine variations in vessel-specific target lesion failure (TLF) based on negative FFR between the left anterior descending (LAD), circumflex (Cx) and right coronary artery (RCA). In this retrospective, observational study, patients who underwent an FFR study at a tertiary referral hospital between January 2014 and December 2020 were screened. Cases with an FFR value of 0.8-0.9 and ≥2 years of electronic medical record follow-up were included. Outcomes assessed included target lesion revascularisation (TLR) myocardial infarction (TLMI), and a composite of target lesion failure (TLF), which included TLR, TLMI and target lesion related death. Two-year outcome data were available for 451 vessels (349 LAD, 49 Cx and 53 RCA). Cases were 32% female and 24% had diabetes. Stable angina was the main indication for FFR assessment in 69%, and ACS non-culprit vessels in 27%. Overall, the two-year incidence of TLF was 6.4% (29/451) with a hazard ratio (HR) of 1.13 (p=0.80) for LAD, 1.34 (p=0.60) for Cx, and 0.59 (p=0.41) for RCA. TLF was symptom-driven in 76% (22/29) of cases and due to TLMI in 24% (7/29). This abstract has been withdrawnstatistically significant variation in two-year TLF between the LAD, Cx and RCA. A larger, prospective study is required for definitive conclusions.

Invasive coronary physiology including fractional flow reserve (FFR), instantaneous wave-free ratio (iFR) and coronary flow reserve (CFR) are guideline-endorsed tools to guide management of coronary disease. Complex factors impact and confound these assessments, and discordance between modalities confuses clinical management. iEquate is a prospective observational trial which combines multi-modality coronary physiology and optical coherence tomography (OCT) to delineate the determinants of pressure-wire derived myocardial ischaemia and iFR-FFR discordance. All patients referred for invasive angiography who met the pre-selection criteria were screened for consent. Patients underwent physiological assessment using iFR and FFR, and CFR performed at the discretion of the operator. OCT was performed on all suitable lesions. Data were collected on baseline demographics, angiographic results, OCT findings, coronary physiology, and procedural details. Multi-variate analysis was performed. Incidence of iFR-FFR discordance was 20.7%, with 48% of these iFR+FFR-. Calcific plaque was independently associated with discordance (OR 6.15 [1.05–36.13]; p=0.04). Other morphological features were not predictive of FFR, iFR or CFR findings. Mean CFR was significantly lower in the iFR+FFR- subgroup compared to FFR+iFR- (1.87 vs 3.01; p<0.01). Lesion length was associated with positive FFR (r=-0.002; p=0.01) and iFR (r =-0.002; p<0.01). iFR-FFR discordance is common, and CFR can provide a real-time explanation for this which may aid in clinical decisions. Calcific plaque is associated with discordance, and clinicians should interpret invasive physiology in this setting with caution. Other OCT-derived plaque morphological characteristics were not associated with invasive coronary physiology findings and cannot predict ischaemia in isolation.

In the 1980 s, a video gamer stereotype emerged as isolated, pale-skinned, white, teen boy in a dark basement single-mindedly mashing buttons. While there may have been a grain of truth to this image, it is also believed that the growth of the video game industry has attracted new audiences and made playing video games more mainstream. Many media scholars have attempted to refute this stereotype with cross- sectional surveys. Rather than examining a snapshot of current gamers, we analyze changes in the characteristics of gamers over close to two decades. Time use data for the US that has been collected consistently for 18 years allow us to identify who the gamers are over time and many of their demographic characteristics. Over this period, video game playing has grown faster among the 19-40 year old, more educated, moderate-income, and non-White demographic groups. Or, it has become more mainstream. On the other hand, some proxies suggest that gaming still attracts an antisocial loner archetype. Gamers are increasingly more likely to live with their parents, remain unmarried, and they increasingly game alone for longer gaming sessions.

Phaeochromocytoma are rare endocrine tumours with a diverse range of presenting symptoms including cardiogenic shock. We describe a case of acute catecholamine cardiomyopathy with rapid circulatory collapse following a dose of intravenous metoclopramide in a patient with undiagnosed phaeochromocytoma.

Atrial fibrillation (AF) results in poorer outcomes after ST-elevation myocardial infarction (STEMI), which may be mediated through endothelial and microvascular dysfunction. Coronary collateralisation, a marker of endothelial function, is associated with improved outcomes following STEMI. We investigated the impact of AF on coronary collateralisation and microvascular function along outcomes in those with STEMI.

A prior history of atrial fibrillation (AF) results in poorer outcomes after ST-elevation myocardial infarction (STEMI). One hypothesis is the adverse impact of AF on coronary endothelial function. Robust coronary collateralisation can provide STEMI patients with alternative myocardial perfusion, thereby improving outcomes. We investigated the influence of a prior history of AF on coronary collateralisation and microvascular function following STEMI.

Increased similarity with one's friends' choices in a social network leads a user to engage further with the social network. Participation is modelled based on user utility derived both from participating in preferred events and from joint participation with friends. The model implies that users will participate more as they learn that they share more interests with their friends. These implications are tested using panel data from an online video gaming network in which users can learn the characteristics of friends' recent game play behaviour. The focal user's time on the platform increases substantially as friend's choices become more similar to the focal user's behaviour. These results are robust to multiple possible sources of endogeneity.

Background: Treating known risk factors for coronary artery disease (CAD) has substantially reduced CAD morbidity and mortality. However, a significant burden of CAD remains unexplained. Immunoglobulin E sensitization to mammalian oligosaccharide galactose-α-1,3-galactose (α-Gal) was recently associated with CAD in a small observational study. We sought to confirm that α-Gal sensitization is associated with CAD burden, in particular noncalcified plaque. Additionally, we sort to assess whether that α-Gal sensitization is associated with ST-segment–elevated myocardial infarction (STEMI) Methods: We performed a cross-sectional analysis of participants enrolled in the BioHEART cohort study. We measured α-Gal specific-immunoglobulin E antibodies in serum of 1056 patients referred for CT coronary angiography for suspected CAD and 100 selected patients presenting with STEMI, enriched for patients without standard modifiable risk factors. CT coronary angiograms were assessed using coronary artery calcium scores and segmental plaque scores. Results: α-Gal sensitization was associated with presence of noncalcified plaque (odds ratio, 1.62 [95% CI, 1.04–2.53], P =0.03) and obstructive CAD (odds ratio, 2.05 [95% CI, 1.29-3.25], P =0.002), independent of age, sex, and traditional risk factors. The α-Gal sensitization rate was 12.8-fold higher in patients with STEMI compared with matched healthy controls and 2.2-fold higher in the patients with STEMI compared with matched stable CAD patients (17% versus 1.3%, P =0.01 and 20% versus 9%, P =0.03, respectively). Conclusions: α-Gal sensitization is independently associated with noncalcified plaque burden and obstructive CAD and occurs at higher frequency in patients with STEMI than those with stable or no CAD. These findings may have implications for individuals exposed to ticks, as well as public health policy. Registration: URL: https://www.anzctr.org.au ; Unique identifier: ACTRN12618001322224.

When a moral panic happens, society believes that a group of people and/or their behaviour is responsible for a threat to society – without any evidentiary basis. How does the target group respond? In the video game context, gamers may fear that their pastime will be blamed for mass shootings leading to social stigma. Group members so threatened are hypothesized to react to protect their group identity. This leads to increased engagement in the activity under threat. In contrast, disasters that do not threaten the group would not affect the amount of video game play. We test these hypotheses by relating the amount of game play to incidents of mass shootings and non-shooting disasters for a large sample of individuals ( N = 170,000). Incidents of mass shootings that threaten the gamer community lead to increases in game playing while incidents of other disasters unrelated to gaming divert time away from gaming.

The long tail hypothesis claims that increased Internet usage will enhance the purchase of obscure items so that, in aggregate, these obscure items will become an important, perhaps primary portion of the market. We test this hypothesis with two analyses. First, using unusually rich data on book sales, we examine the share of niche titles as Internet retailing grew from obscurity to ubiquity. Using relative measurements of concentration, as has been common, provides results contrary to the hypothesis. But we also conclude that it is inappropriate to use relative measures of concentration with these data. Using absolute measures of concentration provides results consistent with the hypothesis’ sign but not with the magnitude. Second, we use the 2011 bankruptcy of the Borders bookstore chain and the resulting sudden shutdown of all its store locations, as a natural experiment. This analysis finds a shift in sales away from the top successful titles. But the major beneficiaries are not the most obscure titles but instead some quite successful titles and some mildly obscure titles. The former is contrary to the hypothesis, and the latter supports the direction but not the size of the hypothesis. Both analyses support, at best, an enfeebled version of the long tail where the share of relatively obscure titles changes from one unimportant small value to a somewhat greater but still unimportant value. Thus, the use in the title of “longish” as a diminutive form of “long.”

As new ICT technologies are developed and adopted, they will be increasingly incorporated into our lifestyles and displacing other activities. Video games, in particular, have greatly risen in popularity and can consume a great deal of time in gamers' lives. I examine the effect of video game time use on the likely activities that it displaces using week-to-week variation in video game popularity to identify causal effects of game quality from selection into gaming. The results indicate that each hour of increased video gaming displaces 26 minutes of human capital accumulating activities.