The Burden of Revision Sinonasal Surgery in the UK – Data from the Chronic Rhinosinusitis Epidemiology Study (CRES); a cross sectional study

Objectives/Hypothesis The aim of this study was to investigate the surgical revision rate in patients with Chronic Rhinosinusitis (CRS) in the UK CRS Epidemiology Study (CRES). Previous evidence from national Sinonasal Audit showed that 1459 CRS patients demonstrated a surgical revision rate 19.1% at 5 years, with highest rates seen in those with polyps (20.6%). Setting Thirty secondary care centres around the UK. Participants A total of 221 controls and 1249 patients with CRS were recruited to the study including those with polyps (CRSwNPs), without polyps (CRSsNPs) and with allergic fungal rhinosinusitis (AFRS). Interventions Self-administered questionnaire. Primary outcome measure The need for previous sinonasal surgery. Results A total of 651 patients with CRSwNPs, 553 with CRSsNPs and 45 with AFRS were included. A total of 396 (57%) of patients with CRSwNPs/AFRS reported having undergone previous endoscopic nasal polypectomy (ENP), of which 182 of the 396 (46%) reported having received more than one operation. The mean number of previous surgeries per patient in the revision group was 3.3 (range 2 to 30) and a mean duration of time of 10 years since the last procedure. The average length of time since their first operation up to inclusion in the study was 15.5 years (range 0-74). Only 27.9% of all patients reporting a prior ENP had received concurrent endoscopic sinus surgery (ESS) (n=102). For comparison, surgical rates in patients with CRSsNPs were significantly lower; 13% of cases specifically reported ESS and of those only 30% reported multiple procedures (chi-squared p < 0.001). Conclusions This study demonstrated there is a high burden of both primary and revision surgery in patients with CRS, worst in those with AFRS and least in those with CRSsNPs. The burden of revision surgery appears unchanged in the decade since the Sinonasal Audit

How does pain lead to disability? A systematic review and meta-analysis of mediation studies in people with back and neck pain

Disability is an important outcome from a clinical and public health perspective. However, it is unclear how disability develops in people with low back pain or neck pain. More specifically, the mechanisms by which pain leads to disability are not well understood. Mediation analysis is a way of investigating these mechanisms by examining the extent to which an intermediate variable explains the effect of an exposure on an outcome. This systematic review and meta-analysis aimed to identify and examine the extent to which putative mediators explain the effect of pain on disability in people with low back pain or neck pain. Five electronic databases were searched. We found 12 studies (N = 2961) that examined how pain leads to disability with mediation analysis. Standardized regression coefficients (β) of the indirect and total paths were pooled. We found evidence to show that self-efficacy (β = 0.23, 95% confidence interval [CI] = 0.10 to 0.34), psychological distress (β = 0.10, 95% CI = 0.01 to 0.18), and fear (β = 0.08, 95% CI = 0.01 to 0.14) mediated the relationship between pain and disability, but catastrophizing did not (β = 0.07, 95% CI = −0.06 to 0.19). The methodological quality of these studies was low, and we highlight potential areas for development. Nonetheless, the results suggest that there are significant mediating effects of self-efficacy, psychological distress, and fear, which underpins the direct targeting of these constructs in treatment

A Dimer of the Toll-Like Receptor 4 Cytoplasmic Domain Provides a Specific Scaffold for the Recruitment of Signalling Adaptor Proteins

The Toll-like receptor 4 (TLR4) is a class I transmembrane receptor expressed on the surface of immune system cells. TLR4 is activated by exposure to lipopolysaccharides derived from the outer membrane of Gram negative bacteria and forms part of the innate immune response in mammals. Like other class 1 receptors, TLR4 is activated by ligand induced dimerization, and recent studies suggest that this causes concerted conformational changes in the receptor leading to self association of the cytoplasmic Toll/Interleukin 1 receptor (TIR) signalling domain. This homodimerization event is proposed to provide a new scaffold that is able to bind downstream signalling adaptor proteins. TLR4 uses two different sets of adaptors; TRAM and TRIF, and Mal and MyD88. These adaptor pairs couple two distinct signalling pathways leading to the activation of interferon response factor 3 (IRF-3) and nuclear factor κB (NFκB) respectively. In this paper we have generated a structural model of the TLR4 TIR dimer and used molecular docking to probe for potential sites of interaction between the receptor homodimer and the adaptor molecules. Remarkably, both the Mal and TRAM adaptors are strongly predicted to bind at two symmetry-related sites at the homodimer interface. This model of TLR4 activation is supported by extensive functional studies involving site directed mutagenesis, inhibition by cell permeable peptides and stable protein phosphorylation of receptor and adaptor TIR domains. Our results also suggest a molecular mechanism for two recent findings, the caspase 1 dependence of Mal signalling and the protective effects conferred by the Mal polymorphism Ser180Leu

Genome-Wide Analyses of Vocabulary Size in Infancy and Toddlerhood:Associations With Attention-Deficit/Hyperactivity Disorder, Literacy, and Cognition-Related Traits

Background: The number of words children produce (expressive vocabulary) and understand (receptive vocabulary) changes rapidly during early development, partially due to genetic factors. Here, we performed a meta–genome-wide association study of vocabulary acquisition and investigated polygenic overlap with literacy, cognition, developmental phenotypes, and neurodevelopmental conditions, including attention-deficit/hyperactivity disorder (ADHD). Methods: We studied 37,913 parent-reported vocabulary size measures (English, Dutch, Danish) for 17,298 children of European descent. Meta-analyses were performed for early-phase expressive (infancy, 15–18 months), late-phase expressive (toddlerhood, 24–38 months), and late-phase receptive (toddlerhood, 24–38 months) vocabulary. Subsequently, we estimated single nucleotide polymorphism–based heritability (SNP-h2) and genetic correlations (rg) and modeled underlying factor structures with multivariate models. Results: Early-life vocabulary size was modestly heritable (SNP-h2 = 0.08–0.24). Genetic overlap between infant expressive and toddler receptive vocabulary was negligible (rg = 0.07), although each measure was moderately related to toddler expressive vocabulary (rg = 0.69 and rg = 0.67, respectively), suggesting a multifactorial genetic architecture. Both infant and toddler expressive vocabulary were genetically linked to literacy (e.g., spelling: rg = 0.58 and rg = 0.79, respectively), underlining genetic similarity. However, a genetic association of early-life vocabulary with educational attainment and intelligence emerged only during toddlerhood (e.g., receptive vocabulary and intelligence: rg = 0.36). Increased ADHD risk was genetically associated with larger infant expressive vocabulary (rg = 0.23). Multivariate genetic models in the ALSPAC (Avon Longitudinal Study of Parents and Children) cohort confirmed this finding for ADHD symptoms (e.g., at age 13; rg = 0.54) but showed that the association effect reversed for toddler receptive vocabulary (rg = −0.74), highlighting developmental heterogeneity. Conclusions: The genetic architecture of early-life vocabulary changes during development, shaping polygenic association patterns with later-life ADHD, literacy, and cognition-related traits.</p

A comparison of Eulerian and Lagrangian transport and non-linear reaction algorithms

When laboratory-measured chemical reaction rates are used in simulations at the field-scale, the models typically overpredict the apparent reaction rates. The discrepancy is primarily due to poorer mixing of chemically distinct waters at the larger scale. As a result, realistic field-scale predictions require accurate simulation of the degree of mixing between fluids. The Lagrangian particle-tracking (PT) method is a now-standard way to simulate the transport of conservative or sorbing solutes. The method’s main advantage is the absence of numerical dispersion (and its artificial mixing) when simulating advection. New algorithms allow particles of different species to interact in nonlinear (e.g., bimolecular) reactions. Therefore, the PT methods hold a promise of more accurate field-scale simulation of reactive transport because they eliminate the masking effects of spurious mixing due to advection errors inherent in grid-based methods. A hypothetical field-scale reaction scenario is constructed and run in PT and Eulerian (finite-volume/finite-difference) simulators. Grid-based advection schemes considered here include 1st- to 3rd-order spatially accurate total-variation-diminishing flux-limiting schemes, both of which are widely used in current transport/reaction codes. A homogeneous velocity field in which the Courant number is everywhere unity, so that the chosen Eulerian methods incur no error when simulating advection, shows that both the Eulerian and PT methods can achieve convergence in the L1 (integrated concentration) norm, but neither shows stricter pointwise convergence. In this specific case with a constant dispersion coefficient and bimolecular reaction A+B¿P, the correct total amount of product is 0.221MA0, where MA0 is the original mass of reactant A. When the Courant number drops, the grid-based simulations can show remarkable errors due to spurious over- and under-mixing. In a heterogeneous velocity field (keeping the same constant and isotropic dispersion), the PT simulations show an increased reaction total from 0.221MA0 to 0.372MA0 due to fluid deformation, while the 1st-order Eulerian simulations using ˜ 106 cells (with a classical grid Peclet number ¿x/aL of 10) have total product of 0.53MA0, or approximately twice as much additional reaction due to advection error. The 3rd-order TVD algorithm fares better, with total product of 0.394MA0, or about 1.14 times the increased reaction total. A very strict requirement on grid Peclet numbers for Eulerian simulations will be required for realistic reactions because of their nonlinear nature. We analytically estimate the magnitude of the effect for the end-member cases of very fast and very slow reactions and show that in either case, the mass produced is proportional to View the MathML source where Pe is the Peclet number. Therefore, extra mass is produced according to View the MathML source where the dispersion includes any numerical dispersion error. We test two PT methods, one that kills particles upon reaction and another that decrements a particle’s mass. For the bimolecular reaction studied here, the computational demands of the particle-killing methods are much smaller than, and the particle-number-preserving algorithm are on par with, the fastest Eulerian methods.Peer ReviewedPostprint (author's final draft

A Cryogenic Silicon Interferometer for Gravitational-wave Detection

The detection of gravitational waves from compact binary mergers by LIGO has opened the era of gravitational wave astronomy, revealing a previously hidden side of the cosmos. To maximize the reach of the existing LIGO observatory facilities, we have designed a new instrument that will have 5 times the range of Advanced LIGO, or greater than 100 times the event rate. Observations with this new instrument will make possible dramatic steps toward understanding the physics of the nearby universe, as well as observing the universe out to cosmological distances by the detection of binary black hole coalescences. This article presents the instrument design and a quantitative analysis of the anticipated noise floor

All-sky search for continuous gravitational waves from isolated neutron stars using Advanced LIGO O2 data

© 2019 American Physical Society. We present results of an all-sky search for continuous gravitational waves (CWs), which can be produced by fast spinning neutron stars with an asymmetry around their rotation axis, using data from the second observing run of the Advanced LIGO detectors. Three different semicoherent methods are used to search in a gravitational-wave frequency band from 20 to 1922 Hz and a first frequency derivative from -1×10-8 to 2×10-9 Hz/s. None of these searches has found clear evidence for a CW signal, so upper limits on the gravitational-wave strain amplitude are calculated, which for this broad range in parameter space are the most sensitive ever achieved

Money, (Co)Production and Power in Digital

This article discusses the contribution of critical political economy approaches to digital journalism studies and argues that these offer important correctives to celebratory perspectives. The first part offers a review and critique of influential claims arising from self-styled new studies of convergence culture, media and creative industries. The second part discusses the contribution of critical political economy in examining digital journalism and responding to celebrant claims. The final part reflects on problems of restrictive normativity and other limitations within media political economy perspectives and considers ways in which challenges might be addressed by more synthesising approaches. The paper proposes developing radical pluralist, media systems and comparative analysis, and advocates drawing on strengths in both political economy and culturalist traditions to map and evaluate practices across all sectors of digital journalism