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The National Institute for Health and Care Excellence referral guidelines prompting urgent two-week referrals were updated in 2015. Additional symptoms with a lower threshold of 3 per cent positive predictive values were integrated. This study aimed to examine whether current pan-London urgent referral guidelines for suspected head and neck cancer lead to efficient and accurate referrals by assessing frequency of presenting symptoms and risk factors, and examining their correlation with positive cancer diagnoses.
The risk factors and symptoms of 984 consecutive patients (over a six-month period in 2016) were collected retrospectively from urgent referral letters to University College London Hospital for suspected head and neck cancer.
Only 37 referrals (3.76 per cent) resulted in a head and neck cancer diagnosis. Four of the 23 recommended symptoms demonstrated statistically significant results. Nine of the 23 symptoms had a positive predictive value of over 3 per cent.
The findings indicate that the current referral guidelines are not effective at detecting patients with cancer. Detection rates have decreased from 10–15 per cent to 3.76 per cent. A review of the current head and neck cancer referral guidelines is recommended, along with further data collection for comparison.
To characterise the dissemination patterns of uropathogenic Escherichia coli (UPEC) in a community, we conducted a study utilising molecular and fundamental descriptive epidemiology. The subjects, consisted of women having community-acquired acute urinary tract infection (UTI), were enrolled in the study from 2011 to 2012. UPEC isolates were subjected to antibacterial-susceptibility testing, O serogrouping, phylotyping, multilocus-sequence typing with phylogenetic-tree analysis and pulsed-field-gel electrophoresis (PFGE). From the 209 unique positive urinary samples 166 UPEC were isolated, of which 129 were fully susceptible to the tested antibiotics. Of the 53 sequence types (STs), the four most prevalent STs (ST95, ST131, ST73 and ST357) accounted for 60% of all UPEC strains. Antimicrobial resistance was less frequently observed for ST95 and ST73 than for the others. A majority of rare STs and a few common STs constituted the diversity pattern within the population structure, which was composed of the two phylogenetically distinct clades. Eleven genetically closely related groups were determined by PFGE, which accounted for 42 of the 166 UPEC isolates, without overt geo-temporal clustering. Our results indicate that a few major lineages of UPEC, selected by unidentified factors, are disseminated in this community and contribute to a large fraction of acute UTIs.
The Working Party has produced this report in order to prompt readers to engage at an early stage in InsurTech projects, through considering (i) the full range of risks associated with InsurTech developments, (ii) the lifecycle of an InsurTech venture and how any risk considerations may vary over this lifecycle and (iii) the extent to which InsurTech ventures align with risk strategy and risk appetite.
The report contains practical guidance for actuaries, risk professionals, insurance companies and their Boards on these considerations, and can be used to facilitate appropriate questioning, to help ensure that InsurTech-related business decisions are fully cognisant of the risk management issues and to help ensure the success of projects.
The Working Party developed this guidance having carried out an industry survey on a number of risk management topics relating to InsurTech, as well as having carried out interviews with a number of relevant senior stakeholders across the insurance industry, in order to better understand current sentiment and how risk management plays a part when considering opportunities in InsurTech. The Working Party views on the findings from these activities are summarised in the report.
To examine the diagnostic value of hyoid cephalometrics in predicting retroglossal obstruction severity in patients with obstructive sleep apnoea hypopnea syndrome.
Ninety-six obstructive sleep apnoea hypopnea syndrome patients diagnosed by polysomnography were recruited. Polysomnography was repeated with a nasopharyngeal tube after eliminating rhinal and palatopharyngeal obstruction. Cervical vertebra lateral films and hyoid cephalometric measurements were obtained, including the distances of the hyoid to the: mental tubercle, prevertebral plane, mental tubercle coronal plane and mental tubercle horizontal plane.
The apnoea-hypopnoea index for nasopharyngeal tube polysomnography was significantly correlated with distances from the hyoid to: prevertebral plane (r = 0.350), coronal plane (r = 0.477), horizontal plane (r = 0.529) and mental tubercle (r = 0.560). It was strongly correlated with the hyoid to mental tubercle distance/hyoid to prevertebral plane distance value (r = 0.683), and (hyoid to coronal plane distance plus hyoid to horizontal plane distance)/hyoid to prevertebral plane distance value (r = 0.675).
Obstructive sleep apnoea hypopnea syndrome patients with longer hyoid to mental tubercle distances, and/or more inferior and posterior hyoid bone position, are more prone to retroglossal stenosis and obstruction. Hyoid cephalometrics are valuable for predicting retroglossal obstruction severity.
Knowledge, attitudes and practices (KAP) of the population regarding severe fever with thrombocytopenia syndrome (SFTS) in endemic areas of Lu'an in China were assessed before and after an intervention programme. The pre-intervention phase was conducted using a sample of 425 participants from the 12 selected villages with the highest rates of endemic SFTS infection. A predesigned interview questionnaire was used to assess KAP. Subsequently, an intervention programme was designed and applied in the selected villages. KAP was re-assessed for each population in the selected villages using the same interview questionnaire. Following 2 months of the programme, 339 participants had completed the re-assessed survey. The impact of the intervention programme was evaluated using suitable statistical methods. A significant increase in the KAP and total KAP scores was noted following the intervention programme, whereas the proportion of correct knowledge, the positive attitudes and the effective practices toward SFTS of respondents increased significantly. The intervention programme was effective in improving KAP level of SFTS in populations that were resident in endemic areas.
Piglets are characteristically cold intolerant and thus susceptible to high mortality. However, browning of white adipose tissue (WAT) can induce non-shivering thermogenesis as a potential strategy to facilitate the animal’s response to cold. Whether cold exposure can induce browning of subcutaneous WAT (sWAT) in piglets in a similar manner as it can in humans remains largely unknown. In this study, piglets were exposed to acute cold (4°C, 10 h) or chronic cold exposure (8°C, 15 days), and the genes and proteins of uncoupling protein 1 (UCP1)-dependent and independent thermogenesis, mitochondrial biogenesis, lipogenic and lipolytic processes were analysed. Interestingly, acute cold exposure induced browning of porcine sWAT, smaller adipocytes and the upregulated expression of UCP1, PGC1α, PGC1β, C/EBPβ, Cidea, UCP3, CKMT1 and PM20D1. Conversely, chronic cold exposure impaired the browning process, reduced mitochondrial numbers and the expression of browning markers, including UCP1, PGC1α and PRDM16. The present study demonstrated that acute cold exposure (but not chronic cold exposure) induces porcine sWAT browning. Thus, browning of porcine sWAT could be a novel strategy to balance the body temperature of piglets, and thus could be protective against cold exposure.
A 36C1 peak has been found at about 37 ka BP in the Guliya ice core, drilled from the Qinghai-Tibetan Plateau. This peak is indicative of enhanced cosmogenic isotope production in the atmosphere, rather than a change in accumulation rate. Comparison with the records of 10Be and 36C1 in ice cores from Antarctica and Greenland indicates that peaks of the cosmogenic isotopes are global, and that they can be used as time markers for dating ice cores. Interestingly, the 37 ka BP global event coincided with a cold period.
An updated compilation of published and new data of major-ion (Ca, Cl, K, Mg, Na, NO3, SO4) and methylsulfonate (MS) concentrations in snow from 520 Antarctic sites is provided by the national ITASE (International Trans-Antarctic Scientific Expedition) programmes of Australia, Brazil, China, Germany, Italy, Japan, Korea, New Zealand, Norway, the United Kingdom, the United States and the national Antarctic programme of Finland. The comparison shows that snow chemistry concentrations vary by up to four orders of magnitude across Antarctica and exhibit distinct geographical patterns. The Antarctic-wide comparison of glaciochemical records provides a unique opportunity to improve our understanding of the fundamental factors that ultimately control the chemistry of snow or ice samples. This paper aims to initiate data compilation and administration in order to provide a framework for facilitation of Antarctic-wide snow chemistry discussions across all ITASE nations and other contributing groups. The data are made available through the ITASE web page (http://www2.umaine.edu/itase/content/syngroups/snowchem.html) and will be updated with new data as they are provided. In addition, recommendations for future research efforts are summarized.
Stable-water-isotope data (δD and δ18O) from three groups of samples (fresh-snow and snow-pit samples collected on Qomolangma (Mount Everest) and Xixa-bangma during field seasons 1997, 1998 and 2001, and precipitation samples collected at Tingri station during summer 2000) are presented and used to survey the isotopic composition of precipitation over the northern slope of the central Himalaya. Multi-year snow-pit samples on Qomolangma have a local meteoric water-line (slope = 8) close to the global value. Deuterium excess (d = δD – 8δ18O) values at Tingri are much lower than those in fresh snow from Qomolangma, probably due to differences in moisture source and air-mass trajectories as well as local weather conditions. There is no obvious seasonal trend for d values in the Qomolangma region. A negative relationship exists between δ18O and d values in both fresh snow on Qomolangma and precipitation at Tingri. Fresh-snow samples collected from different altitudes on Xixabangma allow us to investigate the altitude effect on δ18O values in snow. Of four storm events, only one has an obvious altitude effect on δ18O variation and a very low gradient of −0.1 % per 100 m elevation.
Failure of metallic materials due to plastic and/or creep deformation occur by the emergence of necking, microvoids, and cracks at heterogeneities in the material microstructure. While many traditional deformation modeling approaches have difficulty capturing these emergent phenomena, the discrete element method (DEM) has proven effective for the simulation of materials whose properties and response vary over multiple spatial scales, e.g., bulk granular materials. The DEM framework inherently provides a mesoscale simulation approach that can be used to model macroscopic response of a microscopically diverse system. DEM naturally captures the heterogeneity and geometric frustration inherent to deformation processes. While DEM has recently been adapted successfully for modeling the fracture of brittle solids, to date it has not been used for simulating metal deformation. In this paper, we present our progress in reformulating DEM to model the key elastic and plastic deformation characteristics of FCC polycrystals to create an entirely new crystal plasticity modeling methodology well-suited for the incorporation of heterogeneities and simulation of emergent phenomena.
We investigated the first presence of qnrA among Shigella sonnei clinical isolates in Jiangsu Province, China. The qnrA-positive isolates coexisted with the mutation in gyrA at codon 83, these isolates were resistant to nalidixic acid and 22·2% (2 of 9) of them were resistant to norfloxacin.
Tigers are among the most at-risk large carnivores and the South China tiger is the most threatened tiger subspecies. Reintroduction programmes are one strategy to re-establishing extirpated populations. China is committed to restoring wild South China tigers, but uncertainty remains about factors constraining these efforts. The aim of this study was to query conservation and reintroduction professionals about their attitudes and concerns and to provide guidance regarding a possible tiger reintroduction effort in South Central China. We carried out a global survey of 287 scholars and practitioners involved with wildlife reintroduction and conservation. We received responses from 68 (23.7%) respondents. More than 70% supported a potential South China tiger reintroduction effort, but many expressed concerns over planning and implementation, adherence to International Union for Conservation of Nature reintroduction guidelines and elimination of underlying threats. Respondents generally believed that China has the capacity to carry out such a programme, but may not have the experience or socio-political environment to address the issues facing human populations; 62% of respondents suggested a plausible release site should be greater than 2000 km2. To our knowledge, this is the first survey related to a potential large carnivore reintroduction programme in Asia; it has implications for future reintroduction and recovery programmes in Asia and globally.
This study aimed to develop a simple and accurate method to diagnose paediatric obstructive sleep apnoea hypopnea syndrome.
A total of 311 children with suspected paediatric obstructive sleep apnoea hypopnea syndrome were included in the study. Multiple clinical parameters, including sex, age, body mass index, history of snoring or gasping, history of nasal obstruction, history of running nose, palatine tonsil size, adenoid to nasopharynx ratio, and tympanogram type, were compared with polysomnography results using relevant correlation and regression analyses. A diagnostic scale was established using the regression equation and the correlation between the polysomnography result and scale result was determined.
The apnoea–hypopnea index correlated significantly with a history of snoring or gasping, palatine tonsil size, and tympanogram type. Stepwise logistic regression analysis revealed that the polysomnography result correlated significantly with a history of snoring or gasping, palatine tonsil size, and the adenoid to nasopharynx ratio. The percentage correlation between the scale and polysomnography results was 77.8 per cent.
The diagnostic scale can be used to diagnose paediatric obstructive sleep apnoea hypopnea syndrome for clinical application when polysomnography cannot be performed. However, it is not suitable for assessing the severity of paediatric obstructive sleep apnoea hypopnea syndrome.
As a disconnection syndrome, schizophrenia has shown impaired resting-state functional connectivity (rsFC) in the orbitofrontal cortex (OFC); however, the OFC is a rather heterogeneous region and the rsFC changes in the OFC subregions remain unknown.
A total of 98 schizophrenia patients and 102 healthy controls underwent resting-state functional MRI using a sensitivity-encoded spiral-in imaging sequence (SENSE-SPIRAL) to reduce susceptibility-induced signal loss and distortion. The OFC subregions were defined according to a previous parcellation study that divided the OFC into the anterior (OFCa), medial (OFCm), posterior (OFCp), intermediate (OFCi), and lateral (OFCl) subregions. The rsFC was compared using two-way repeated-measures ANOVA.
Whether or not global signal regression, compared with healthy controls, schizophrenia patients consistently exhibited decreased rsFC between the left OFCi and the left middle temporal gyrus and the right middle frontal gyrus (MFG), between the right OFCi and the right MFG and the left inferior frontal gyrus, between the right OFCm and the middle cingulate cortex and the left Rolandic operculum. These rsFC changes still remained significant even after cortical atrophy correction.
These findings suggest a selective functional disconnection of the OFC subregions in schizophrenia, and provide more precise information about the functional disconnections of the OFC in this disorder.
Measurements of crystal size have been made on seven firn cores drilled at sites covering a range of mean annual temperature from –12.6° to –52.5°C and a range of accumulation rate from 52 to 315 kg m−2 a−1. The sorting coefficient, which gives a measure of the dispersion of crystal sizes within a sample, shows an overall pattern when data from all cores are grouped together as a function of depth. The values are generally small near the surface, increasing to a maximum around 8 m depth, then decreasing but becoming more diffuse at greater depths. Below about 5 m depth, the crystal size increases at an essentially constant rate, which depends on temperature, but in the upper 5 or 7 m the size increases at 1.5 to 2 times this rate. The seasonal variation in temperature enhances the effective mean growth rate of crystals in the near-surface layers compared to conditions with a constant mean temperature and accounts for a part of that increase. But it is likely that vapour diffusion along strong vertical temperature gradients causes the greater part of the observed increase in growth rate. The dependence of crystal-growth rate on temperature is consistent with the Arrhenius-type relation found by other studies.
This paper presents the distribution of average δD andδ18O values for the top 1 m of surface snow for a large area of Antarctica. The samples were collected on the 1990 International Trans-Antarctica Expedition which crossed the continent from the northern tip of the Antarctic Peninsula to Mirny Station. The empirical relationships between the isotopes, temperature and elevation are computed. The slopes of δD with respect to the surface temperature for the segments west (Patriot Hills-Vostok) and east of Vostok (Komsomolskaya-Mirny) are not significantly different to that observed between Dumont d’Urville and Dome C (Lorius and Merlivat, 1977) which are often used to interpret deep ice-core isotopic profiles. There is, however, a noticeable shift between the two regression lines with, for a given temperature, higher isotopic values west of Vostok. The deuterium excess values increase sharply at 3000 m.a.s.l. on the plateau, confirming the results of Petit and others (1991).
The ice cap on Nelson Island in the South Shetland Islands, West Antarctica, was studied between 1985 and 1989. The ice cap has an average thickness of 120 m. it is temperate, exists under the sub-Antarctic maritime climate and almost completely covers the island. Owing to intense percolation of meltwater (and, to some extent, liquid precipitation), the snow-firn layer is in the soaked facies, with a firn-ice transition at a depth of 25-26 m at the summit. A force-balance model suggests that the ice is almost linearly viscous but has a high viscosity. The model further suggests that basal sliding makes a larger contribution to the ice movement than does ice deformation. From 1970 to 1988. the average accumulation rate was 120 kg m−2a−1 at the centre, and between 1985 and 1989 the equilibrium-line elevation averaged 110m a.s.l. Analysis of chemical impurities in the surface snow suggests that the precipitation source is mainly local marine air masses and that human activity has already exerted a detectable influence on the local environment.
Psychosocial therapy after deliberate self-harm might be associated with reduced risk of specific causes of death.
In this matched cohort study, we included patients, who after an episode of deliberate self-harm received psychosocial therapy at a Suicide Prevention Clinic in Denmark between 1992 and 2010. We used propensity score matching in a 1:3 ratio to select a comparison group from 59 046 individuals who received standard care. National Danish registers supplied data on specific causes of death over a 20-year follow-up period.
At the end of follow-up, 391 (6.9%) of 5678 patients in the psychosocial therapy group had died, compared with 1736 (10.2%) of 17 034 patients in the matched comparison group. Lower odds ratios of dying by mental or behavioural disorders [0.54, 95% confidence interval (CI) 0.37–0.79], alcohol-related causes (0.63, 95% CI 0.50–0.80) and other diseases and medical conditions (0.61, 95% CI 0.49–0.77) were noted in the psychosocial therapy group. Also, we found a reduced risk of dying by suicide as well as other external causes, however, not by neoplasms and circulatory system diseases. Numbers needed to treat were 212.9 (95% CI 139.5–448.4) for mental or behavioural disorders as a cause of death, 111.1 (95% CI 79.2–210.5) for alcohol-related causes and 96.8 (95% CI 69.1–161.8) for other diseases and medical conditions.
Our findings indicate that psychosocial therapy after deliberate self-harm might reduce long-term risk of death from select medical conditions and external causes. These promising results should be tested in a randomized design.