Baseline morning cortisol level as a predictor of pituitary-adrenal reserve: a comparison across three assays

The short ACTH stimulation test (250 μg) is the dynamic test most frequently used to assess adrenal function. It is possible that a single basal cortisol could be used to predict the dynamic response, but research has been hampered by the use of different assays and thresholds. OBJECTIVE: To propose a morning baseline cortisol criterion of three of the most commonly used modern cortisol immunoassays - Advia Centaur (Siemens), Architect (Abbott) and the Roche Modular System (Roche) - that could predict adrenal sufficiency. DESIGN: Observational, retrospective cross-sectional study at two centres. PATIENTS AND MEASUREMENTS: Retrospective analysis of the results of 1019 Short Synacthen tests (SSTs) with the Advia Centaur, 449 SSTs with the Architect and 2050 SSTs with the Roche Modular System assay. Serum cortisol levels were measured prior to injection of 250 μg Synacthen and after 30 min. Overall, we were able to collate data from a total of 3518 SSTs in 3571 patients. RESULTS: Using receiver-operator curve analysis, baseline cortisol levels for predicting passing the SST with 100% specificity were 358 nmol/l for Siemens, 336 nmol/l for Abbott and 506 nmol/l for Roche. Utilizing these criteria, 589, 158 and 578 SSTs, respectively, for Siemens, Abbott and Roche immunoassays could have been avoided. CONCLUSIONS: We have defined assay-specific morning cortisol levels that are able to predict the integrity of the hypothalamo-pituitary-adrenal axis. We propose that this represents a valid tool for the initial assessment of adrenal function and has the potential to obviate the need for dynamic testing in a significant number of patients

Bio-psychosocial determinants of cardiovascular disease in a rural population on Crete, Greece: formulating a hypothesis and designing the SPILI-III study

Background: In 1988, the SPILI project was established in order to evaluate the cardiovascular disease (CVD) risk profile of the inhabitants of Spili, in rural Crete, Greece. The first reports from this project revealed that against the unfavourable risk factors’ profile observed, only a few men with a previous myocardial infarction were encountered. A follow-up study (SPILI II) was performed twelve years after the initial examination, and the unfavourable cardiovascular risk profile was re-confirmed. Presentation of the Hypothesis: This paper presents a hypothesis formulated on the basis of previous research to investigate if dynamic psycho-social determinants, including social coherence of the local community, religiosity and spirituality, are protective against the development of coronary heart disease in a well-defined population. Testing the Hypothesis: A follow-up examination of this Cretan cohort is currently being performed to assess the link between psychosocial factors and CVD. Psychosocial factors including sense of control, religiosity and spirituality are assessed in together with conventional CVD risk factors. Smoking and alcohol consumption, as well as dietary habits and activity levels are recorded. Oxidative stress and inflammatory markers, as well as ultrasound measurement of carotid intima media thickness, a preclinical marker of atherosclerosis, will also be measured. Implications of the hypothesis tested: The issue of the cardio-protective effect of psycho-social factors would be revisited based on the results of this Cretan cohort; nevertheless, further research is needed across different subpopulations in order to establish a definite relationship. A comprehensive approach based on the aspects of biosocial life may result in more accurate CVD risk management

Mucosal injury following short term tracheal intubation: a novel animal model and composite injury score

Objectives: Postintubation laryngotracheal injury is common. Assessment of histopathological changes currently requires animal models. We set about developing a viable, resource effective animal model to study these effects and to develop a detailed tissue injury score. Methods: Six pigs were anaesthetised using a standard regimen. We intubated the tracheas using a standard endotracheal tube modified to include optical sensors. Animals were anaesthetised for a duration of two to four hours, and their lungs were ventilated using a normoxic gas mixture. Following euthanasia, the tracheas were removed and underwent histological assessment by two independent veterinary pathologists. The histological lesions, including controls, were described and quantified, and two pathologists classified tissues according to a novel injury score. Results: Mean duration of tracheal intubation was 191 minutes (SD±41.6). In all except one animal, cuff pressures were maintained in the range of 25 – 45 cmH20. Histopathological findings in all study animals showed more extensive changes than previously described with short-term intubation. Changes were seen in all mucosal layers consistent with acute, suppurative and ulcerative tracheitis. The range of scores of the developed composite scoring system among the animals was wider than in earlier descriptions. There was a high percentage of agreement between both pathologists. Conclusions: We have described a novel tissue injury score to assess pathological changes following short term intubation in a viable animal model. The scoring system distinguished between the test animals as well as controls and may be appropriate for continuing study of intubation injury

A novel reformulation of the Theory of Critical Distances to design notched metals against dynamic loading

In the present study the linear-elastic Theory of Critical Distances (TCD) is reformulated to make it suitable for predicting the strength of notched metallic materials subjected to dynamic loading. The accuracy and reliability of the proposed reformulation of the TCD was checked against a number of experimental results generated by testing, under different loading/strain rates, notched cylindrical samples of aluminium alloy 6063-T5, titanium alloy Ti–6Al–4V, aluminium alloy AlMg6, and an AlMn alloy. To further validate the proposed design method also different data sets taken from the literature were considered. Such an extensive validation exercise allowed us to prove that the proposed reformulation of the TCD is successful in predicting the dynamic strength of notched metallic materials, this approach proving to be capable of estimates falling within an error interval of ±20%. Such a high level of accuracy is certainly remarkable, especially in light of the fact that it was reached without the need for explicitly modelling the stress vs. strain dynamic behaviour of the investigated ductile metals

Reviewing, indicating, and counting books for modern research evaluation systems

In this chapter, we focus on the specialists who have helped to improve the conditions for book assessments in research evaluation exercises, with empirically based data and insights supporting their greater integration. Our review highlights the research carried out by four types of expert communities, referred to as the monitors, the subject classifiers, the indexers and the indicator constructionists. Many challenges lie ahead for scholars affiliated with these communities, particularly the latter three. By acknowledging their unique, yet interrelated roles, we show where the greatest potential is for both quantitative and qualitative indicator advancements in book-inclusive evaluation systems.Comment: Forthcoming in Glanzel, W., Moed, H.F., Schmoch U., Thelwall, M. (2018). Springer Handbook of Science and Technology Indicators. Springer Some corrections made in subsection 'Publisher prestige or quality

Time-dynamic effects on the global temperature when harvesting logging residues for bioenergy

The climate mitigation potential of using logging residues (tree tops and branches) for bioenergy has been debated. In this study, a time-dependent life cycle assessment (LCA) was performed using a single-stand perspective. Three forest stands located in different Swedish climate zones were studied in order to assess the global temperature change when using logging residues for producing district heating. These systems were compared with two fossil reference systems in which the logging residues were assumed to remain in the forest to decompose over time, while coal or natural gas was used for energy. The results showed that replacing coal with logging residues gave a direct climate benefit from a single-stand perspective, while replacing natural gas gave a delayed climate benefit of around 8-12 years depending on climate zone. A sensitivity analysis showed that the time was strongly dependent on the assumptions for extraction and combustion of natural gas. The LCA showed that from a single-stand perspective, harvesting logging residues for bioenergy in the south of Sweden would give the highest temperature change mitigation potential per energy unit. However, the differences between the three climate zones studied per energy unit were relatively small. On a hectare basis, the southern forest stand would generate more biomass compared to the central and northern locations, which thereby could replace more fossil fuel and give larger climate benefits

Effect of religiosity/spirituality and sense of coherence on depression within a rural population in Greece: the Spili III project

Background: Recent research has addressed the hypothesis that religiosity/spirituality and sense of coherence buffer the negative effects of stress on numerous health issues. The aim of the current study was to further this work by exploring potential links between psycho-social factors such as religiosity/ spirituality and sense of coherence with depression. Methods: A total of 220 subjects of the SPILI III cohort (1988-2012) attending a primary care setting in the town of Spili on rural Crete represented the target group. All participants underwent a standardized procedure. Validated questionnaires were used to evaluate sense of coherence, depression levels and religious and spiritual beliefs. A multiple linear regression analysis of the Beck Depression Inventory Scale (BDI) in relation to demographic characteristics, scores on the Royal Free Interview for Spiritual and Religious Beliefs scale (RFI-SRB) and Sense of Coherence scale (SOC) was used. Results: A significant inverse association was found between BDI and RFI-SRB scale (B-coef=-0.6999, p<0.001), as well as among BDI and SOC scale (B-coef=-0.556, p<0.001). Conclusions: The findings of the current observational study indicate that highly religious participants are less likely to score high in the depression scale. Furthermore, participants with high SOC scored significantly low in the BDI scale. Further research is required in order to explore the potential effect of SOC and religiosity/spirituality in mental health