Obesity in adults: a 2022 adapted clinical practice guideline for Ireland

This Clinical Practice Guideline (CPG) for the management of obesity in adults in Ireland, adapted from the Canadian CPG, defines obesity as a complex chronic disease characterised by excess or dysfunctional adiposity that impairs health. The guideline reflects substantial advances in the understanding of the determinants, pathophysiology, assessment, and treatment of obesity. It shifts the focus of obesity management toward improving patient-centred health outcomes, functional outcomes, and social and economic participation, rather than weight loss alone. It gives recommendations for care that are underpinned by evidence-based principles of chronic disease management; validate patients' lived experiences; move beyond simplistic approaches of "eat less, move more" and address the root drivers of obesity. People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of body weight. Education is needed for all healthcare professionals in Ireland to address the gap in skills, increase knowledge of evidence-based practice, and eliminate bias and stigma in healthcare settings. We call for people living with obesity in Ireland to have access to evidence-informed care, including medical, medical nutrition therapy, physical activity and physical rehabilitation interventions, psychological interventions, pharmacotherapy, and bariatric surgery. This can be best achieved by resourcing and fully implementing the Model of Care for the Management of Adult Overweight and Obesity. To address health inequalities, we also call for the inclusion of obesity in the Structured Chronic Disease Management Programme and for pharmacotherapy reimbursement, to ensure equal access to treatment based on health-need rather than ability to pay

Time And temperature affect glycolysis in blood samples regardless of fluoride-based preservatives: a potential underestimation of diabetes

Background: The inhibition of glycolysis prior to glucose measurement is an important consideration when interpreting glucose tolerance tests. This is particularly important in gestational diabetes mellitus where prompt diagnosis and treatment is essential. A study was planned to investigate the effect of preservatives and temperature on glycolysis. Methods: Blood samples for glucose were obtained from consented women. Lithium heparin and fluoride-EDTA samples transported rapidly in ice slurry to the laboratory were analysed for glucose concentration and then held either in ice slurry or at room temperature for varying time intervals. Paired fluoride-citrate samples were received at room temperature and held at room temperature, with analysis at similar time intervals. Results: No significant difference was noted between mean glucose concentrations when comparing different sample types received in ice slurry. The mean glucose concentrations decreased significantly for both sets of samples when held at room temperature (0.4mmol/L) and in ice slurry (0.2mmol/L).2018-05-08 JG: cover page removed from PD

Comparison of citrate-fluoride-EDTA with fluoride-EDTA additives to stabilize plasma glucose measurements in women being screened during pregnancy with an oral glucose tolerance test: a prospective observational study

We recently highlighted the importance of implementing recommended preanalytical standards to avoid missing the diagnosis of gestational diabetes mellitus (GDM)1(1 ).The placement of samples on an ice slurry with separation within 30 min, however, is not always practical

Revision of the genus<em> Ulvella</em> (Ulvellaceae, Ulvophyceae) based on morphology and <em>tufA</em> gene sequences of species in culture, with <em>Acrochaete</em> and <em>Pringsheimiella</em> placed in synonymy

Microfilamentous green algae in the Ulvellaceae are notoriously difficult to identify and classify. We revised Ulvella based on the morphology of 46 unialgal culture isolates, including several from type localities, and we were guided by a phylogenetic reconstruction based on chloroplast-encoded tufA gene sequences. Species previously referred to Acrochaete, including the type species A. repens, formed a clade that included Pringsheimiella scutata and Ulvella lens, the type species of their respective genera. These species were placed in a single genus, and Ulvella had priority. The circumscription of the genus was emended to include microscopic species with branched filaments that may or may not form mono- and polystromatic disc-shaped thalli. Ten new species were described (viz. U. aequicrassa, U. dasycala, U. gigas, U. glabra, U. globocaespitosa, U. inopinata, U. pachypes, U. pseudorepens, U. vacuospora, and U. waernii), and two were resurrected (U. parasitica, previously considered a synonym of A. repens, and U. porphyrae, previously synonymised with A. viridis). Ectochaete polymorpha was placed in synonymy with U. leptochaete and Acrochaete parasitica f. zosterae with Ochlochaete hystrix. Ten new combinations were proposed for species previously referred to Acrochaete (viz. U. cingens, U. codicola, U. geniculata, U. inflata, and U. taylori) or Pringsheimiella (viz. U. gratulans, U. mauritiana, U. sanctae-luciae, U. striata, and U. udoteae)

Music Therapy Advances in Neuro-disability - Innovations in Research and Practice:Summary Report and Reflections on a Two-Day International Conference

This article provides a summary of the oral papers presented during a two day international conference, which took place on 7th & 8th June 2013, at the Royal Hospital for Neuro-disability (RHN) in London. The summary texts detail innovative research projects and clinical developments across music therapy, music neuroscience and music psychology addressing the needs of those with acquired and degenerative neurological conditions. The diverse and evolving work in this field is reflected in the topics covered, including disorders of consciousness, dementia, stroke, and the use of modern neuro-imaging methods to measure the effects of music therapy at a cortical level. A discussion of the implications of these converging foci highlights the benefits of the cross-disciplinary dialogue that characterised the conference

Exposure to tobacco smoke measured by urinary nicotine metabolites increases risk of p16/Ki-67 co-expression and high-grade cervical neoplasia in HPV positive women: A two year prospective study.

BACKGROUND Human papillomavirus (HPV) is considered the strongest epidemiologic risk factor for cervical cancer. However, it is not a sufficient cause given the high prevalence of transient infections. We examined the relationship between exposure to tobacco smoke, measured using urinary nicotine metabolite concentrations, and p16/Ki-67 co-expression in cervical smears and subsequent risk of developing CIN2+/CIN3+ lesions in HPV positive women. METHODS This prospective longitudinal study enrolled women presenting to colposcopy with cytological abnormalities LSIL/ASCUS at the National Maternity Hospital, Dublin. Women gave a urine sample which was used to perform the Nicotine Metabolite Assay (Siemens). HPV positive (HC2) cervical smears were stained by immunocytochemistry for p16/Ki-67 (CINtec PLUS, Roche). Two year follow-up data, including histological diagnosis, was collected for each woman. Crude and adjusted odds ratios were calculated using logistic regression to investigate associations between tobacco smoke, p16/Ki-67 positivity and CIN2+/CIN3 + . RESULTS In total, 275 HPV positive women were included. Women with nicotine metabolite concentrations above 500 ng/mL, indicative of smoking, were classified as smokers. Smokers were at an increased risk of testing positive for p16/Ki-67 (OR 1.678; 1.027-2.740) and CIN2+ and CIN3+ (OR 1.816; 1.107-2.977 and OR 2.453; 1.200-5.013) in compared to non-smokers. In p16/Ki-67 positive women, smoking further increased their risk of CIN2+/CIN3+ (OR 2.290; 1.017-5.159 and OR 3.506 (1.534-8.017). CONCLUSION HPV positive women exposed to tobacco smoke are at a higher risk of testing positive for p16/Ki-67 co-expression. Risk of high-grade disease is almost doubled in women who are exposed to tobacco smoke

An approach for determining allowable between reagent lot variation

Clinicians trust medical laboratories to provide reliable results on which they rely for clinical decisions. Lab- oratories fulfil their responsibility for accurate and consistent results by utilizing an arsenal of approaches, ranging from validation and verification experiments to daily quality control procedures. All these procedures verify, on different moments, that the results of a certain examination procedure have analytical performance characteristics (APC) that meet analytical performance specifications (APS) set for a particular intended use. The APC can in part be determined by esti- mating the measurement uncertainty component under con- ditions of within-laboratory precision (uRw), which comprises all components influencing the measurement uncertainty of random sources. To maintain the adequacy of their mea- surement procedures, laboratories need to distinguish aspects that are manageable vs. those that are not. One of the aspects that may influence uRw is the momentary significant bias caused by shifts in reagent and/or calibrator lots, which, when accepted or unnoticed, become a factor of the APC. In this paper, we postulate a model for allocating a part of allowable uRw to between-reagent lot variation, based on the need for long-term consistency of the measurement variability for that specific measurand. The allocation manages the ratio between short-term and long-term variation and indicates laboratories when to reject or correct certain variations due to reagent lots

Improving the laboratory result release process in the light of ISO 15189:2012 standard

The ISO 15189:2012 standard section 5.9.1 requires laboratories to review results before release, considering quality control, previous results, and clinical information, if any, and to issue documented procedures about it. While laboratory result reporting is generally regarded as part of the post-analytical phase, the result release process requires a general view of the total examination process. Reviewing test results may follow with troubleshooting and test repetition, including reanalyzing an individual sample or resampling. A systematic understanding of the result release may help laboratory professionals carry out appropriate test repetition and ensure the plausibility of laboratory results. In this paper, we addressed the crucial steps in the result release process, including evaluation of sample quality, critical result notification, result reporting, and recommendations for the management of the result release, considering quality control alerts, instrument flags, warning messages, and interference indexes. Error detection tools and plausibility checks mentioned in the present paper can support the daily practice of results release