Self-Reported Hearing Handicap and Mental Health in Australia: Some Preliminary Findings

"Article Copyright 2012 The Authors." "Published edition Copyright 2012 Australian Academic Press. Published version of the paper reproduced here with permission from the publisher."It has long been suggested that the consequences of adult hearing impairment (HI) include stress, anxiety and depression, yet relatively little formal assessment of mental health status amongst adult Australians who have acquired HI has been reported. This questionnaire- based study investigated the self-reported hearing handicap and mental health characteristics of a sample of 375 Australian adults with HI who were members of Better Hearing Australia (BHA) in six Australian states/territories. Participants completed two mental health questionnaires; the Kessler Psychological Distress Scale-10 (K-10; Kessler, Andrews, Colpe, & Hiripi, 2002) and the Depression- Anxiety-Stress Scale (DASS; Lovibond & Lovibond, 1995) as well as the short version of the Hearing Handicap Inventory for Adults — Screening Version (HHIA-S; Newman, Weinstein, Jacobson, & Hug, 1990). No difference was found in the prevalence of psychological distress amongst participants compared to that of the Australian adult population. It was noted, however, that increased severity of self-reported hearing handicap was associated with higher levels of self-perceived psychological distress. In turn, high or very high levels of psychological distress measured on the K-10 were correlated with depressive states more than with stress or anxiety ratings on the DASS. The results highlighted the need to incorporate a combination of questionnaire-based measures in evaluating self-reported mental health and hearing handicap

Use of 100 kV versus 120 kV in computed tomography pulmonary angiography in the detection of pulmonary embolism: effect on radiation dose and image quality.

Objective: To determine the effective radiation dose and image quality resulting from 100 versus 120 kilovoltage (kV) protocols among patients referred for computed tomography pulmonary angiography (CTPA). Methods: Sixty-six patients with clinical suspicion of pulmonary embolism (PE) were prospectively enrolled. Two CTPA protocols (group A: n=33, 100 kV/115 mAs; group B: n=33, 120 kV/90 mAs) were compared. Two experienced radiologists assessed image quality in terms of diagnostic performance and effect of artefacts. Image quality parameters [CT attenuation, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR)] and effective radiation dose between the two protocols were compared. Results: The contrast enhancement in central and peripheral pulmonary arteries was significantly higher in group A than in group B (P<0.001) with the identical SNR (P=0.26), whereas the CNR was significantly higher in group A than in group B (P<0.001). The effective radiation dose for the 100 and 120 kV scans was 3.2 and 6.8 mSv, respectively. Conclusions: Reducing the tube voltage from 120 to 100 kV in CTPA allows a significant reduction of radiation dose without significant loss of diagnostic image quality

De la compétence à l’empathie : évaluation de l’évolution de la perception qu’ont les étudiants en médecine des chirurgiens dans le cadre d’un programme associant le patient comme enseignant et la réflexion basée sur les arts

Introduction: The purpose of this study was to identify whether the incorporation of a combined Patient as teacher (PAT) and arts-based reflection (ABR) program during a surgical clerkship rotation could influence more humanistic perceptions of surgeons, using an innovative evaluation approach. Methods: A novel, single question evaluation tool was created. Third year medical-students were asked to “list the top 5 attributes of a surgeon, in order of perceived importance” both before and after their surgical clerkship rotations and participation in the PAT/ABR program. Attributes identified by students were coded as either “humanistic” or “non-humanistic,” which were then analyzed using generalized linear regression models under a Bayesian framework. Results: After participation in the PAT/ABR program, the predicted probability of students ranking a humanistic characteristic as the most important attribute of a surgeon had increased by 17%, and the predicted probability of students ranking a humanistic characteristic amongst their top three attributes for a surgeon had increased by 21%. Conclusion: This innovative evaluative method suggested the success of a combined PAT/ABR program in encouraging a humanistic perspective of surgery and this approach could potentially be explored to evaluate other humanistic education initiatives.Résumé Introduction : L’objectif de cette étude était de déterminer si l’introduction d’une nouvelle approche d’évaluation associant la participation de Patients comme enseignants (PCE) à une Réflexion basée sur les arts (RBA) dans un stage d’externat en chirurgie permettait de mieux percevoir les qualités humanistes chez les chirurgiens. Méthodes : Un nouvel outil d’évaluation à question unique a été créé. Des étudiants en troisième année de médecine ont été invités à ‘’énumérer les cinq principaux attributs d’un chirurgien, par ordre d’importance perçue’’, avant et après leur stage d’externat en chirurgie et le programme PCE/RBA. Les attributs identifiés par les étudiants ont été codés comme « humanistes » ou « non humanistes », puis analysés à l’aide de modèles de régression linéaire généralisée dans un cadre bayésien. Résultats : Après leur participation au programme PCE/RBA, la probabilité prédite moyenne que les étudiants classent un trait humaniste comme l’attribut le plus important d’un chirurgien a augmenté de 17 %, et la probabilité prédite que les étudiants classent un trait humaniste parmi les trois premiers attributs d’un chirurgien a augmenté de 21 %. Conclusion : Cette méthode d’évaluation innovante porte à croire que le programme PCE/RBA réussit en effet à favoriser une vision humaniste de la chirurgie. Cette approche peut être explorée pour évaluer d’autres activités de formation axées sur l’humanisme

Lower cardiorespiratory fitness contributes to increased insulin resistance and fasting glycaemia in middle-aged South Asian compared with European men living in the UK

AIMS/HYPOTHESIS: This study aimed to determine the extent to which increased insulin resistance and fasting glycaemia in South Asian men, compared with white European men, living in the UK, was due to lower cardiorespiratory fitness (maximal oxygen uptake [[Formula: see text]]) and physical activity. METHODS: One hundred South Asian and 100 age- and BMI-matched European men without diagnosed diabetes, aged 40–70 years, had fasted blood taken for measurement of glucose concentration, HOMA-estimated insulin resistance (HOMA(IR)), plus other risk factors, and underwent assessment of physical activity (using accelerometry), [Formula: see text], body size and composition, and demographic and other lifestyle factors. For 13 South Asian and one European man, HbA(1c) levels were >6.5% (>48 mmol/mol), indicating potential undiagnosed diabetes; these men were excluded from the analyses. Linear regression models were used to determine the extent to which body size and composition, fitness and physical activity variables explained differences in HOMA(IR) and fasting glucose between South Asian and European men. RESULTS: HOMA(IR) and fasting glucose were 67% (p < 0.001) and 3% (p < 0.018) higher, respectively, in South Asians than Europeans. Lower [Formula: see text], lower physical activity and greater total adiposity in South Asians individually explained 68% (95% CI 45%, 91%), 29% (11%, 46%) and 52% (30%, 80%), respectively, and together explained 83% (50%, 119%) (all p < 0.001) of the ethnic difference in HOMA(IR). Lower [Formula: see text] and greater total adiposity, respectively, explained 61% (9%, 111%) and 39% (9%, 76%) (combined effect 63% [8%, 115%]; all p < 0.05) of the ethnic difference in fasting glucose. CONCLUSIONS/INTERPRETATION: Lower cardiorespiratory fitness is a key factor associated with the excess insulin resistance and fasting glycaemia in middle-aged South Asian, compared with European, men living in the UK. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00125-013-2969-y) contains peer-reviewed but unedited supplementary material, which is available to authorised users

Dichloridobis(2-chloro­benzyl-κC)[5,6-diphenyl-3-(2-pyrid­yl)-1,2,4-triazine-κ2 N 2,N 3]tin(IV)

The asymmetric unit of the crystal structure of the title compound, [Sn(C7H6Cl)2Cl2(C20H14N4)], contains two independent mol­ecules. Each SnIV atom is chelated by the bipyridine-like N-heterocycle and exists in a distorted trans-C2SnCl2N2 octa­hedral coordination environment. One chloro­benzyl substituent is disordered in each mol­ecule in 0.5:0.5 and 0.778 (2):0.222 (2) ratios

Dichloridobis(4-chloro­benzyl-κC)(1,10-phenanthroline-κ2 N,N′)tin(IV)

In the crystal structure of the title compound, [Sn(C7H6Cl)2Cl2(C12H8N2)], the SnIV atom is chelated by the N-heterocycle and the metal atom exists in a trans-C2SnCl2N2 distorted octa­hedral coordination environment

The Gastrointestinal Exertional Heat Stroke Paradigm: Pathophysiology, Assessment, Severity, Aetiology and Nutritional Countermeasures

Exertional heat stroke (EHS) is a life-threatening medical condition involving thermoregulatory failure and is the most severe condition along a continuum of heat related illnesses. Current EHS policy guidance principally advocates a thermoregulatory management approach, despite growing recognition that gastrointestinal (GI) microbial translocation contributes to the pathophysiology. Contemporary research has focussed on understanding the relevance of GI barrier integrity and strategies to maintain it during periods of exertional-heat stress. GI barrier integrity can be assessed non-invasively using a variety of in vivo techniques, including active inert mixed-weight molecular probe recovery tests and passive biomarkers indicative of GI structural integrity loss or microbial translocation. Strenuous exercise is well-characterised to disrupt GI barrier integrity, and aspects of this response correlate with the corresponding magnitude of thermal strain. The aetiology of GI barrier integrity loss following exertional-heat stress is poorly understood, though may directly relate to localised hyperthermia, splanchnic hypoperfusion mediated ischemic injury, and alternations in several neuroendocrine-immune responses. Nutritional countermeasures to maintain GI barrier integrity following exertional-heat stress provide a promising approach to mitigate EHS. The focus of this review is to evaluate: (1) the GI paradigm of exertional heat stroke; (2) techniques to assess GI barrier integrity; (3) typical GI barrier integrity responses to exertional-heat stress; (4) the aetiology of GI barrier integrity loss following exertional-heat stress; and (5) nutritional countermeasures to maintain GI barrier integrity in response to exertional-heat stress

Morphological variations of explosive residue particles and implications for understanding detonation mechanisms

The possibility of recovering undetonated explosive residues following detonation events is well-known; however, the morphology and chemical identity of these condensed phase postblast particles remains undetermined. An understanding of the postblast explosive particle morphology would provide vital information during forensic examinations, allowing rapid initial indication of the explosive material to be microscopically determined prior to any chemical analyses and thereby saving time and resources at the crucial stage of an investigation. In this study, condensed phase particles collected from around the detonations of aluminized ammonium nitrate and RDX-based explosive charges were collected in a novel manner utilizing SEM stubs. By incorporating the use of a focused ion beam during analysis, for the first time it is possible to determine that such particles have characteristic shapes, sizes, and internal structures depending on the explosive and the distance from the detonation at which the particles are recovered. Spheroidal particles (10–210 μm) with microsurface features recovered following inorganic charge detonations were dissimilar to the irregularly shaped particles (5–100 μm) recovered following organic charge firings. Confirmatory analysis to conclude that the particles were indeed explosive included HPLC-MS, Raman spectroscopy, and mega-electron volt–secondary ionization mass spectrometry. These results may impact not only forensic investigations but also the theoretical constructs that govern detonation theory by indicating the potential mechanisms by which these particles survive and how they vary between the different explosive types.EPSRC Grant EP/G037264/

Sleep Disordered Breathing, Obesity and Atrial Fibrillation: A Mendelian Randomisation Study.

Funder: National Institute for Health Research (NIHR)It remains unclear whether the association between obstructive sleep apnoea (OSA), a form of sleep-disordered breathing (SDB), and atrial fibrillation (AF) is causal or mediated by shared co-morbidities such as obesity. Existing observational studies are conflicting and limited by confounding and reverse causality. We performed Mendelian randomisation (MR) to investigate the causal relationships between SDB, body mass index (BMI) and AF. Single-nucleotide polymorphisms associated with SDB (n = 29) and BMI (n = 453) were selected as instrumental variables to investigate the effects of SDB and BMI on AF, using genetic association data on 55,114 AF cases and 482,295 controls. Primary analysis was conducted using inverse-variance weighted MR. Higher genetically predicted SDB and BMI were associated with increased risk of AF (OR per log OR increase in snoring liability 2.09 (95% CI 1.10-3.98), p = 0.03; OR per 1-SD increase in BMI 1.33 (95% CI 1.24-1.42), p < 0.001). The association between SDB and AF was not observed in sensitivity analyses, whilst associations between BMI and AF remained consistent. Similarly, in multivariable MR, SDB was not associated with AF after adjusting for BMI (OR 0.68 (95% CI 0.42-1.10), p = 0.12). Higher BMI remained associated with increased risk of AF after adjusting for OSA (OR 1.40 (95% CI 1.30-1.51), p < 0.001). Elevated BMI appears causal for AF, independent of SDB. Our data suggest that the association between SDB, in general, and AF is attributable to mediation or confounding from obesity, though we cannot exclude that more severe SDB phenotypes (i.e., OSA) are causal for AF

Whole blood transcriptional responses of very preterm infants during late-onset sepsis

Background Host immune responses during late-onset sepsis (LOS) in very preterm infants are poorly characterised due to a complex and dynamic pathophysiology and challenges in working with small available blood volumes. We present here an unbiased transcriptomic analysis of whole peripheral blood from very preterm infants at the time of LOS. Methods RNA-Seq was performed on peripheral blood samples (6–29 days postnatal age) taken at the time of suspected LOS from very preterm infants <30 weeks gestational age. Infants were classified based on blood culture positivity and elevated C-reactive protein concentrations as having confirmed LOS (n = 5), possible LOS (n = 4) or no LOS (n = 9). Bioinformatics and statistical analyses performed included pathway over-representation and protein-protein interaction network analyses. Plasma cytokine immunoassays were performed to validate differentially expressed cytokine pathways. Results The blood leukocyte transcriptional responses of infants with confirmed LOS differed significantly from infants without LOS (1,317 differentially expressed genes). However, infants with possible LOS could not be distinguished from infants with no LOS or confirmed LOS. Transcriptional alterations associated with LOS included genes involved in pathogen recognition (mainly TLR pathways), cytokine signalling (both pro-inflammatory and inhibitory responses), immune and haematological regulation (including cell death pathways), and metabolism (altered cholesterol biosynthesis). At the transcriptional-level cytokine responses during LOS were characterised by over-representation of IFN-α/β, IFN-γ, IL-1 and IL-6 signalling pathways and up-regulation of genes for inflammatory responses. Infants with confirmed LOS had significantly higher levels of IL-1α and IL-6 in their plasma. Conclusions Blood responses in very preterm infants with LOS are characterised by altered host immune responses that appear to reflect unbalanced immuno-metabolic homeostasis