'Pre-endoscopy point of care test (Simtomax- IgA/IgG-Deamidated Gliadin Peptide) for coeliac disease in iron deficiency anaemia: diagnostic accuracy and a cost saving economic model'.

BACKGROUND: International guidelines recommend coeliac serology in iron deficiency anaemia, and duodenal biopsy for those tested positive to detect coeliac disease. However, pre-endoscopy serology is often unavailable, thus committing endoscopists to take routine duodenal biopsies. Some endoscopists consider duodenal biopsy mandatory in anaemia to exclude other pathologies. We hypothesise that using a point of care test at endoscopy could fill this gap, by providing rapid results to target anaemic patients who require biopsies, and save costs by biopsy avoidance. We therefore assessed three key aspects to this hypothesis: 1) the availability of pre-endoscopy serology in anaemia; 2) the sensitivities and cost effectiveness of pre-endoscopy coeliac screening with Simtomax in anaemia; 3) whether other anaemia-related pathologies could be missed by this targeted-biopsy approach. METHODS: Group 1: pre-endoscopy serology availability was retrospectively analysed in a multicentre cohort of 934 anaemic patients at 4 UK hospitals. Group 2: the sensitivities of Simtomax, endomysial and tissue-transglutaminase antibodies were compared in 133 prospectively recruited patients with iron deficiency anaemia attending for a gastroscopy. The sensitivities were measured against duodenal histology as the reference standard in all patients. The cost effectiveness of Simtomax was calculated based on the number of biopsies that could have been avoided compared to an all-biopsy approach. Group 3: the duodenal histology of 153 patients presenting to a separate iron deficiency anaemia clinic were retrospectively reviewed. RESULTS: In group 1, serology was available in 361 (33.8 %) patients. In group 2, the sensitivity and negative predictive value (NPV) were 100 % and 100 % for Simtomax, 96.2 % and 98.9 % for IgA-TTG, and 84.6 % and 96.4 % for EMA respectively. In group 3, the duodenal histology found no causes for anaemia other than coeliac disease. CONCLUSION: Simtomax had excellent diagnostic accuracy in iron deficiency anaemia and was comparable to conventional serology. Duodenal biopsy did not identify any causes other than coeliac disease for iron deficiency anaemia, suggesting that biopsy avoidance in Simtomax negative anaemic patients is unlikely to miss other anaemia-related pathologies. Due to its 100 % NPV, Simtomax could reduce unnecessary biopsies by 66 % if only those with a positive Simtomax were biopsied, potentially saving £3690/100 gastroscopies. TRIAL REGISTRATION: The group 2 study was retrospectively registered with clinicaltrials.gov. Trial registration date: 13(th) July 2016; TRIAL REGISTRATION NUMBER: NCT02834429

Performance assessment of time-domain optical brain imagers, part 1: basic instrumental performance protocol

open21siAbstract.  Performance assessment of instruments devised for clinical applications is of key importance for validation and quality assurance. Two new protocols were developed and applied to facilitate the design and optimization of instruments for time-domain optical brain imaging within the European project nEUROPt. Here, we present the “Basic Instrumental Performance” protocol for direct measurement of relevant characteristics. Two tests are discussed in detail. First, the responsivity of the detection system is a measure of the overall efficiency to detect light emerging from tissue. For the related test, dedicated solid slab phantoms were developed and quantitatively spectrally characterized to provide sources of known radiance with nearly Lambertian angular characteristics. The responsivity of four time-domain optical brain imagers was found to be of the order of 0.1  m2 sr. The relevance of the responsivity measure is demonstrated by simulations of diffuse reflectance as a function of source-detector separation and optical properties. Second, the temporal instrument response function (IRF) is a critically important factor in determining the performance of time-domain systems. Measurements of the IRF for various instruments were combined with simulations to illustrate the impact of the width and shape of the IRF on contrast for a deep absorption change mimicking brain activation.H. Wabnitz; D. R. Taubert; M. Mazurenka; O. Steinkellner; A. Jelzow;R. Macdonald;D. Milej;P. Sawosz;M. Kacprzak;A. Liebert;R. Cooper;J. Hebden;A. Pifferi;A. Farina;I. Bargigia;D. Contini;M. Caffini;L. Zucchelli;L. Spinelli;R. Cubeddu;A. TorricelliH., Wabnitz; D. R., Taubert; M., Mazurenka; O., Steinkellner; A., Jelzow; R., Macdonald; D., Milej; P., Sawosz; M., Kacprzak; A., Liebert; R., Cooper; J., Hebden; Pifferi, ANTONIO GIOVANNI; Farina, Andrea; Bargigia, Ilaria; Contini, Davide; Caffini, Matteo; Zucchelli, LUCIA MARIA GRAZIA; Spinelli, Lorenzo; Cubeddu, Rinaldo; Torricelli, Alessandr

The Herschel Planetary Nebula Survey (HerPlaNS) I. Data Overview and Analysis Demonstration with NGC 6781

This is the first of a series of investigations into far-IR characteristics of 11 planetary nebulae (PNs) under the Herschel Space Observatory Open Time 1 program, Herschel Planetary Nebula Survey (HerPlaNS). Using the HerPlaNS data set, we look into the PN energetics and variations of the physical conditions within the target nebulae. In the present work, we provide an overview of the survey, data acquisition and processing, and resulting data products. We perform (1) PACS/SPIRE broadband imaging to determine the spatial distribution of the cold dust component in the target PNs and (2) PACS/SPIRE spectral-energy-distribution (SED) and line spectroscopy to determine the spatial distribution of the gas component in the target PNs. For the case of NGC 6781, the broadband maps confirm the nearly pole-on barrel structure of the amorphous carbon-richdust shell and the surrounding halo having temperatures of 26-40 K. The PACS/SPIRE multi-position spectra show spatial variations of far-IR lines that reflect the physical stratification of the nebula. We demonstrate that spatially-resolved far-IR line diagnostics yield the (T_e, n_e) profiles, from which distributions of ionized, atomic, and molecular gases can be determined. Direct comparison of the dust and gas column mass maps constrained by the HerPlaNS data allows to construct an empirical gas-to-dust mass ratio map, which shows a range of ratios with the median of 195+-110. The present analysis yields estimates of the total mass of the shell to be 0.86 M_sun, consisting of 0.54 M_sun of ionized gas, 0.12 M_sun of atomic gas, 0.2 M_sun of molecular gas, and 4 x 10^-3 M_sun of dust grains. These estimates also suggest that the central star of about 1.5 M_sun initial mass is terminating its PN evolution onto the white dwarf cooling track.Comment: 27 pages, 16 figures, accepted for publication in A&

Job strain and risk of obesity: systematic review and meta-analysis of cohort studies

Job strain, the most widely used indicator of work stress, is a risk factor for obesity-related disorders such as cardiovascular disease and type 2 diabetes. However, the extent to which job strain is related to the development of obesity itself has not been systematically evaluated. We carried out a systematic review (PubMed and Embase until May 2014) and meta-analysis of cohort studies to address this issue. Eight studies that fulfilled inclusion criteria showed no overall association between job strain and the risk of weight gain (pooled odds ratio for job strain compared with no job strain 1.04, 95% confidence interval (CI) 0.99-1.09, NTotal=18 240) or becoming obese (1.00, 95% CI 0.89-1.13, NTotal=42 222). In addition, a reduction in job strain over time was not associated with lower obesity risk (1.13, 95% CI 0.90-1.41, NTotal=6507). These longitudinal findings do not support the hypothesis that job strain is an important risk factor for obesity or a promising target for obesity prevention.International Journal of Obesity advance online publication, 30 June 2015; doi:10.1038/ijo.2015.103

A model of management academics' intentions to influence values

Business schools face increased criticism for failing in the teaching of management studies to nurture their students’ values. Assuming that individual academics play an important role in shaping the value-related influence of business schools, I model management academics’ intentions to influence values. The suggested model encompasses academics’ economic and social values as internal variables, as well as perceived support for attempting to influence values and academic tenure as social and structural variables. A test with empirical data from 1,254 management academics worldwide reveals that perceived external support is most relevant for explaining intentions. Moreover, academics’ social values, but not their economic ones, contribute to an explanation of their intentions to influence values. The results reveal how important it is for academics to believe that their colleagues, higher education institutions, and other stakeholders support their value-related behavioral intentions

An analysis of potential barriers and enablers to regulating the television marketing of unhealthy foods to children at the state government level in Australia

Background In Australia there have been many calls for government action to halt the effects of unhealthy food marketing on children\u27s health, yet implementation has not occurred. The attitudes of those involved in the policy-making process towards regulatory intervention governing unhealthy food marketing are not well understood. The objective of this research was to understand the perceptions of senior representatives from Australian state and territory governments, statutory authorities and non-government organisations regarding the feasibility of state-level government regulation of television marketing of unhealthy food to children in Australia.Method Data from in-depth semi-structured interviews with senior representatives from state and territory government departments, statutory authorities and non-government organisations (n=22) were analysed to determine participants\u27 views about regulation of television marketing of unhealthy food to children at the state government level. Data were analysed using content and thematic analyses.Results Regulation of television marketing of unhealthy food to children was supported as a strategy for obesity prevention. Barriers to implementing regulation at the state level were: the perception that regulation of television advertising is a Commonwealth, not state/territory, responsibility; the power of the food industry and; the need for clear evidence that demonstrates the effectiveness of regulation. Evidence of community support for regulation was also cited as an important factor in determining feasibility.Conclusions The regulation of unhealthy food marketing to children is perceived to be a feasible strategy for obesity prevention however barriers to implementation at the state level exist. Those involved in state-level policy making generally indicated a preference for Commonwealth-led regulation. This research suggests that implementation of regulation of the television marketing of unhealthy food to children should ideally occur under the direction of the Commonwealth government. However, given that regulation is technically feasible at the state level, in the absence of Commonwealth action, states/territories could act independently. The relevance of our findings is likely to extend beyond Australia as unhealthy food marketing to children is a global issue.<br /

Hypoxia Sensitive Metal β-Ketoiminate Complexes Showing Induced Single Strand DNA Breaks and Cancer Cell Death by Apoptosis

A series of ruthenium and iridium complexes have been synthesised and characterised with 20 novel crystal structures discussed. The library of β-ketoiminate complexes has been shown to be active against MCF-7 (human breast carcino-ma), HT-29 (human colon carcinoma), A2780 (human ovarian carcinoma) and A2780cis (cisplatin resistant human ovarian carcinoma) cell lines, with selected complexes being more than three times as active as cisplatin against the A2780cis cell line. Complexes have also been shown to be highly active under hypoxic conditions, with the activities of some complexes increasing with a decrease in O2 concentration. The enzyme thioredoxin reductase is over-expressed in cancer cells and complexes reported herein have the advantage of inhibiting this enzyme, with IC50 values measured in the nanomolar range. The anti-cancer activity of these complexes was further investigated to determine whether activity is due to effects on cellular growth or cell survival. The complexes were found to induce significant cancer cell death by apoptosis with levels induced correlating closely with activity in chemosensitivity studies. As a possible cause of cell death, the ability of the complexes to induce damage to cellular DNA was also assessed. The complexes failed to induce double strand DNA break or DNA crosslinking but induced significant levels of single DNA strand breaks indi-cating a different mechanism of action to cisplatin

Automatic detection of Ionospheric Alfvén Resonances in magnetic spectrograms using U-net

Ionospheric Alfven Resonances (IARs) are weak discrete non-stationary Alfven waves along magnetic field lines, at periods of ~0.5-20 Hz, that occur during local night-time, particularly during low geomagnetic activity. They are detectable through time-frequency analysis (spectrograms) of measurements made by sensitive search coil magnetometers. The IARs are generated by the interaction of electromagnetic energy partially trapped in the Earth-ionosphere cavity with the main geomagnetic field and their behavior provides proxy information about atmospheric ion density between 100-1000 km altitude. Limited methods exist to automatically detect and analyse their properties and behavior as they are difficult to extract using standard image and signal processing techniques. We present a new method for the detection of IARs based on the fully convolutional neural network U-net. U-net was chosen as it is able to perform accurate image segmentation and it can be trained in a supervised fashion on a relatively small labeled dataset utilizing data augmentation. We show that the resulting predictive model generated by training the U-net is able to detect IAR signals while mislabelling considerably less noise than other data analysis methods. We achieved our best results by using a training set of 178 hand-digitized examples from high-quality spectrograms measured at the Eskdalemuir Geophysical Observatory (UK). We find that the network converges in ten iterations with a final intersection over union (IoU) metric of 0.9 and a training loss of below 0.2. We use the trained network to extract IARs from over 2300 images, covering six years of search coil magnetometer data measured at the Eskdalemuir Observatory. U-net can also automatically handle missing data or days without IARs, giving a null result as expected. This constitutes the first use of a neural network for pattern recognition of unstructured image data such as spectrograms containing IAR signals, though the method is applicable to other types of resonances or geophysical features in the time-frequency domain