Cardiovascular Disease and Sleep-Disordered Breathing in Acromegaly

Treatment goals in acromegaly include symptom relief, tumour control and reversal of the excess morbidity and mortality associated with the disorder. Cardiovascular complications include concentric biventricular hypertrophy and cardiomyopathy, hypertension, valvular heart disease and arrhythmias, while metabolic disturbance (insulin resistance/diabetes mellitus, dyslipidaemia) further increases the risk of cardiovascular and cerebrovascular events. Sleep-disordered breathing (in the form of sleep apnoea) is also common in patients with acromegaly and may exacerbate cardiovascular dysfunction, in addition to contributing to impaired quality of life. Accordingly, and in keeping with evidence that cardiorespiratory complications in acromegaly are not automatically reversed/ameliorated simply through the attainment of 'safe' growth hormone and insulin-like growth factor 1 levels, recent guidelines have emphasised the need not only to achieve stringent biochemical control, but also to identify and independently treat these comorbidities. It is important, therefore, that patients with acromegaly are systematically screened at diagnosis, and periodically thereafter, for the common cardiovascular and respiratory manifestations and that biochemical targets do not become the only treatment goal

The PlaceMarker Survey: A Place-Based Tool for Supporting the Monitoring and Appraisal of River-Related Projects and Natural Capital Assessments

The PlaceMarker Survey is an operational tool to support the delivery of the core aims of England’s Environment Agency (EA) in helping to increase resilience to climate change, manage flood risk, and create a better place for people and wildlife. It was developed in response to a recognised need by the EA’s National Environmental Assessment and Sustainability (NEAS) team for a broad-based survey undertaken in the field to get to know the site and prior to more specialist surveys. The key aim of the survey is to capture in a systematic and consistent way the character and condition of a place where river-related projects such as flood risk management and river restoration schemes are proposed to inform discussions around the design and planning of a project and provide the baseline for future place-based monitoring. The tool comprises: a Study Area Survey and one or more River Surveys, which provide measurements to generate metrics and information to support assessments of Habitat and Biodiversity, Landscape, Amenity, and Heritage. Data are stored, analysed, retrieved, shared, and displayed through a web-based information system. It is intended that a PlaceMarker Survey will be conducted on at least three occasions in the lifetime of a project or asset: pre-inception of a project to understand the broad environmental baseline and assist in the design of a scheme; immediately post-project to confirm the “as-built condition”; and post-recovery from the works to monitor the environmental response to interventions at the site. Tracking the assessments over time informs evaluations of environmental enhancements and supports decision-making around adaptive management

Hydromorphological frameworks: emerging trajectories

This paper forms a postscript to a Special Issue that reports on research funded through the European Union’s FP7 programme under Grant Agreement No. 282656 (REFORM)

11C-metomidate PET-CT scanning can identify aldosterone-producing adenomas after unsuccessful lateralisation with CT/MRI and adrenal venous sampling.

Primary hyperaldosteronism, characterised by hypertension and hypokalaemia, is a syndrome caused by aldosterone excess most commonly from either a unilateral aldosterone-producing adenoma or bilateral adrenal hyperplasia. Subtype classification can be challenging with cross-sectional imaging and even with interventional radiological techniques such as adrenal venous sampling. Imaging with 11C-metomidate positron emission tomography-computed tomography (PET-CT) is an emerging tool that facilitates functional characterisation and potentially successful surgical intervention of aldosterone-producing adenomas. This technique has highlighted that, although unilateral adenomas and bilateral hyperplasia represent opposite ends of the disease spectrum, a relatively common intermediate phenotype exists of unilateral/bilateral multinodular disease

Physical modelling of the combined effect of vegetation and wood on river morphology

The work described in this publication was supported by the European Union Seventh Framework Programme through the grant to the budget of the Integrating Activity HYDRALAB IV, Contract no. 261520 (HyIV-HULL-01). The experiments have been performed thanks to the invaluable support of the Geography, Environment and Earth Sciences Department — University of Hull, in particular Stuart McLelland, Brendan Murphy, Rob Thomas, and Lucy Clarke. Diego Ravazzolo produced the wood dowels and helped in the executions of the experiments, along with Nana Osei and Sandra Zanella. The paper has benefitted from comments and suggestions by three anonymous referees

Order effects in high stakes undergraduate examinations: An analysis of 5 years of administrative data in one UK medical school

This is the final version. Available from the publisher via the DOI in this record.Statistical code and data set are available from the authors on request: contact JBu ( [email protected]).Objective: To investigate the association between student performance in undergraduate objective structured clinical examinations (OSCEs) and the examination schedule to which they were assigned to undertake these examinations. Design: Analysis of routinely collected data. Setting: One UK medical school. Participants: 2331 OSCEs of 3 different types (obstetrics OSCE, paediatrics OSCE and simulated clinical encounter examination OSCE) between 2009 and 2013. Students were not quarantined between examinations. Outcomes: (1) Pass rates by day examination started, (2) pass rates by day station undertaken and (3) mean scores by day examination started. Results: We found no evidence that pass rates differed according to the day on which the examination was started by a candidate in any of the examinations considered (p>0.1 for all). There was evidence (p=0.013) that students were more likely to pass individual stations on the second day of the paediatrics OSCE (OR 1.27, 95% CI 1.05 to 1.54). In the cases of the simulated clinical encounter examination and the obstetrics and gynaecology OSCEs, there was no (p=0.42) or very weak evidence (p=0.099), respectively, of any such variation in the probability of passing individual stations according to the day they were attempted. There was no evidence that mean scores varied by day apart from the paediatric OSCE, where slightly higher scores were achieved on the second day of the examination. Conclusions: There is little evidence that different examination schedules have a consistent effect on pass rates or mean scores: students starting the examinations later were not consistently more or less likely to pass or score more highly than those starting earlier. The practice of quarantining students to prevent communication with (and subsequent unfair advantage for) subsequent examination cohorts is unlikely to be required.University of Cambridge School of Clinical Medicin

Acromegaly and Cushing's syndrome caused by a neuroendocrine tumor arising within a sacrococcygeal teratoma.

A 60-year-old man with a pre-existing stable sacrococcygeal teratoma developed acromegaly, ectopic Cushing's syndrome, and 5HIAA secretion. To our knowledge, this represents the first reported case of ACTH and serotonin secretion, and likely GHRH or GH cosecretion, from a sacrococcygeal teratoma in an adult