CMV in the gut: a critical review of CMV detection in the immunocompetent host with colitis.

As scientific techniques for the detection of cytomegalovirus (CMV) improve, we are able to detect small amounts of CMV in the mucosal wall. As clinicians, we are unsure how to interpret the results of this novel test. There is controversy in the literature as to the significance of the detection of CMV in the gut. Whilst the importance of CMV and reactivation of the virus is clear in those patients such as allograft recipients with established immune compromise, the role is less clear in patients with less damaged immune systems. We explore whether the detection of CMV in such cases influences outcome and how it should be optimally managed. We discuss the optimal management of such cases, according to current guidelines, with a review of the literature

SATURN'S INNER SATELLITES: ORBITS, MASSES, AND THE CHAOTIC MOTION OF ATLAS FROM NEW CASSINI IMAGING OBSERVATIONS

We present numerically-derived orbits and mass estimates for the inner Saturnian satellites, Atlas, Prometheus, Pandora, Janus and Epimetheus from a fit to 2580 new Cassini ISS astrometric observations spanning February 2004 to August 2013. The observations are provided in a supplementary table. We estimate GM_ Atlas=0.384+/-0.001 x 10^(-3)km^3s^(-2), a value 13% smaller than the previously published estimate but with an order of magnitude reduction in the uncertainty. We also find GM_ Prometheus=10.677+/-0.006x10(-3)km^3s^(-2), GM_Pandora=9.133+/-0.009x10^(-3)km^3s^(-2), GM_Janus=126.51+/-0.03x10^(-3)km^3s^(-2) and GM_Epimetheus=35.110+/-0.009x10^(-3)km^3s^(-2), consistent with previously published values, but also with significant reductions in uncertainties. We show that Atlas is currently librating in both the 54:53 co-rotation-eccentricity resonance (CER) and the 54:53 inner Lindblad (ILR) resonance with Prometheus, making it the latest example of a coupled CER-ILR system, in common with the Saturnian satellites Anthe, Aegaeon and Methone, and possibly Neptune's ring arcs. We further demonstrate that Atlas's orbit is chaotic, with a Lyapunov time of ~10 years, and show that its chaotic behaviour is a direct consequence of the coupled resonant interaction with Prometheus, rather than being an indirect effect of the known chaotic interaction between Prometheus and Pandora. We provide an updated analysis of the second-order resonant perturbations involving Prometheus, Pandora and Epimetheus based on the new observations, showing that these resonant arguments are librating only when Epimetheus is the innermost of the co-orbital pair, Janus and Epimetheus. We also find evidence that the known chaotic changes in the orbits of Prometheus and Pandora are not confined to times of apse anti-alignement.Comment: 23 pages, 16 figures. Accepted for publication in The Astronomical Journal 23 September 2014 (corrected Fig. 11

Sustained benefit from intravenous immunoglobulin therapy for gastrointestinal involvement in systemic sclerosis

Objective. IVIG is known to confer significant benefit in rheumatologic conditions, including inflammatory myopathy. This study aimed to assess the efficacy of IVIG across different aspects of internal organ involvement in refractory active SSc, particularly the gastrointestinal (GI) system. / Methods. SSc patients with overlap polymyositis who remained active and unresponsive to conventional disease-modifying agents and who subsequently received IVIG were identified. GI symptoms were assessed using validated questionnaires. The Medical Research Council Sum Score for muscle strength and modified Rodnan skin score (mRSS) were assessed. Serial measurements were undertaken at baseline prior to the first IVIG treatment and post-treatment in the most recent assessment. / Results. Fifteen SSc patients were consecutively recruited into this observational study. The mean duration of IVIG treatment was 2.3 years, with treatment frequency ranging from every 6 weeks to 4 months. Compared with baseline, there was a significant reduction in gastro-oesophageal reflux frequency and intensity mean scores (P = 0.006 and P = 0.013, respectively). Significant improvement in the Gastrointestinal Tract (GIT) 2.0 score from a baseline mean score of 1.07 (s.d. 0.67) to 0.60 (0.46) (P = 0.002) was observed. There was regression in the markers of muscle disease with a reduction in the mean (s.d.) Medical Research Council sum score and the median creatine kinase level (P = 0.001 and P = 0.025, respectively). Significant amelioration of the mean basal modified Rodnan skin score from 21.5 (s.d. 13.8) to 10 (10.6) (P = 0.005) was observed. / Conclusion. IVIG may be a helpful adjunctive therapy in the amelioration of some key clinical aspects in refractory SSc. Sustained benefit from IVIG suggests a specific immunomodulatory effect on those with established SSc GI complications

Transiting Disintegrating Planetary Debris around WD 1145+017

More than a decade after astronomers realized that disrupted planetary material likely pollutes the surfaces of many white dwarf stars, the discovery of transiting debris orbiting the white dwarf WD 1145+017 has opened the door to new explorations of this process. We describe the observational evidence for transiting planetary material and the current theoretical understanding (and in some cases lack thereof) of the phenomenon.Comment: Invited review chapter. Accepted March 23, 2017 and published October 7, 2017 in the Handbook of Exoplanets. 15 pages, 10 figure

Development and formative evaluation of the e-Health implementation toolkit

<b>Background</b> The use of Information and Communication Technology (ICT) or e-Health is seen as essential for a modern, cost-effective health service. However, there are well documented problems with implementation of e-Health initiatives, despite the existence of a great deal of research into how best to implement e-Health (an example of the gap between research and practice). This paper reports on the development and formative evaluation of an e-Health Implementation Toolkit (e-HIT) which aims to summarise and synthesise new and existing research on implementation of e-Health initiatives, and present it to senior managers in a user-friendly format.<p></p> <b>Results</b> The content of the e-HIT was derived by combining data from a systematic review of reviews of barriers and facilitators to implementation of e-Health initiatives with qualitative data derived from interviews of "implementers", that is people who had been charged with implementing an e-Health initiative. These data were summarised, synthesised and combined with the constructs from the Normalisation Process Model. The software for the toolkit was developed by a commercial company (RocketScience). Formative evaluation was undertaken by obtaining user feedback. There are three components to the toolkit - a section on background and instructions for use aimed at novice users; the toolkit itself; and the report generated by completing the toolkit. It is available to download from http://www.ucl.ac.uk/pcph/research/ehealth/documents/e-HIT.xls<p></p> <b>Conclusions</b> The e-HIT shows potential as a tool for enhancing future e-Health implementations. Further work is needed to make it fully web-enabled, and to determine its predictive potential for future implementations

Patient-Specific Prosthetic Fingers by Remote Collaboration - A Case Study

The concealment of amputation through prosthesis usage can shield an amputee from social stigma and help improve the emotional healing process especially at the early stages of hand or finger loss. However, the traditional techniques in prosthesis fabrication defy this as the patients need numerous visits to the clinics for measurements, fitting and follow-ups. This paper presents a method for constructing a prosthetic finger through online collaboration with the designer. The main input from the amputee comes from the Computer Tomography (CT) data in the region of the affected and the non-affected fingers. These data are sent over the internet and the prosthesis is constructed using visualization, computer-aided design and manufacturing tools. The finished product is then shipped to the patient. A case study with a single patient having an amputated ring finger at the proximal interphalangeal joint shows that the proposed method has a potential to address the patient's psychosocial concerns and minimize the exposure of the finger loss to the public.Comment: Open Access articl