A survey of current practices by the British Oculoplastic Surgery Society (BOPSS) and recommendations for delivering a sustainable multidisciplinary approach to thyroid eye disease in the United Kingdom

The Royal College of Physicians (RCP) and Thyroid Eye Disease Amsterdam Declaration Implementation Group (TEAMeD-5) have the common goal of improving access to high quality care for thyroid eye disease (TED). The TEAMeD-5 programme recommends all patients with moderate-to-severe TED should have access to multidisciplinary clinics (MDT) with combined Ophthalmology and Endocrinology expertise

Pay-as-you-go LPG: A mixed-methods pilot study in urban Rwanda

2.8 billion people still cook with biomass fuels, resulting in devastating impacts on health, gender equity and the environment. Pay-as-you-go (PAYG) liquid petroleum gas (LPG) is a new technology designed to make LPG affordable for urban biomass users by allowing customers to pay for fuel in small amounts. This mixed-methods study (N = 64) combined stove usage data, cooking diaries, household interviews and telephone surveys to examine a commercial PAYG LPG pilot in Kigali. It aimed to understand how households used PAYG LPG and its potential in accelerating access to clean cooking in urban Rwanda. PAYG LPG rapidly displaced charcoal as the primary cooking fuel for the majority of participants, resulting in a mean monthly reduction in household fuel expenditure of 3240 RWF (3.50 USD) and a mean consumption of 1.2 kg/capita/month. Participants spanning all income brackets in Kigali made use of PAYG LPG. The ability to pay in smaller amounts seemed to be critical to initial adoption and sustained use during the pilot. Follow-up activities with a small subsample of participants (N = 10) found that 70% continued to use full cylinder LPG (typically 12 kg) as their primary cooking fuel in the two months after the PAYG service was withdrawn. Throughout the pilot almost all participants continued to use charcoal, which accounted for 21% of cooking events. We identified a range of drivers of fuel stacking that encompassed both cultural and practical factors such as cylinder delivery delays and taste preferences for certain foods. We conclude that PAYG LPG could contribute to the clean cooking transition in urban Rwanda, but that larger scale pilots are needed to better understand both the supply- and demand-side viability

Cleaning up the stack: Evaluating a clean cooking fuel stacking intervention in urban Kenya

There are a growing number of market-based providers of clean cooking solutions in sub-Saharan Africa that rely on use customer fuel sales to subsidise upfront cost of equipment. These business models can widen access to clean cooking but are undermined by the continued use of polluting fuels, known as “fuel stacking”, which limits provider revenues whilst perpetuating the negative impacts of cooking with traditional fuels. This study aimed to design and test a fuel stacking intervention with commercial pay-as-you-go LPG customers in Kisumu, Kenya. It consisted of three main phases: developing and testing a survey tool for diagnosing drivers of stacking (n = 99); using an intervention design framework (the Behaviour Change Wheel) to design an intervention consisting of the bundled provision of a pressure cooker, chapati pan and training; and testing the intervention in a small (n = 19) pre-post study. There was high uptake of the intervention, with the pans being used by all participants on roughly two-fifths of days. Target foods were cooked more frequently on LPG in the intervention phase, resulting in a significant increase in PAYG LPG use and an insignificant decrease in charcoal use. A third of participants stopped cooking with charcoal altogether, but some residual charcoal usage continued amongst the remainder. The results show that targeted stacking interventions can simultaneously promote sustained use of clean fuels and dis-adoption of polluting ones, resulting in commercial gains for clean cooking fuel providers. This could address the wicked problem of fuel stacking and accelerate progress towards Sustainable Development Goal 7

Dexamethasone induces apoptosis in pulmonary arterial smooth muscle cells

BACKGROUND: Dexamethasone suppressed inflammation and haemodynamic changes in an animal model of pulmonary arterial hypertension (PAH). A major target for dexamethasone actions is NF-κB, which is activated in pulmonary vascular cells and perivascular inflammatory cells in PAH. Reverse remodelling is an important concept in PAH disease therapy, and further to its anti-proliferative effects, we sought to explore whether dexamethasone augments pulmonary arterial smooth muscle cell (PASMC) apoptosis. METHODS: Analysis of apoptosis markers (caspase 3, in-situ DNA fragmentation) and NF-κB (p65 and phospho-IKK-α/β) activation was performed on lung tissue from rats with monocrotaline (MCT)-induced pulmonary hypertension (PH), before and after day 14–28 treatment with dexamethasone (5 mg/kg/day). PASMC were cultured from this rat PH model and from normal human lung following lung cancer surgery. Following stimulation with TNF-α (10 ng/ml), the effects of dexamethasone (10(−8)–10(−6) M) and IKK2 (NF-κB) inhibition (AS602868, 0–3 μM (0-3×10(−6) M) on IL-6 and CXCL8 release and apoptosis was determined by ELISA and by Hoechst staining. NF-κB activation was measured by TransAm assay. RESULTS: Dexamethasone treatment of rats with MCT-induced PH in vivo led to PASMC apoptosis as displayed by increased caspase 3 expression and DNA fragmentation. A similar effect was seen in vitro using TNF-α-simulated human and rat PASMC following both dexamethasone and IKK2 inhibition. Increased apoptosis was associated with a reduction in NF-κB activation and in IL-6 and CXCL8 release from PASMC. CONCLUSIONS: Dexamethasone exerted reverse-remodelling effects by augmenting apoptosis and reversing inflammation in PASMC possibly via inhibition of NF-κB. Future PAH therapies may involve targeting these important inflammatory pathways

Effects of regional-scale and convective transports on tropospheric ozone chemistry revealed by aircraft observations during the wet season of the AMMA campaign

The African Monsoon Multidisciplinary Analyses (AMMA) fourth airborne campaign was conducted in July–August 2006 to study the chemical composition of the middle and upper troposphere in West Africa with the major objective to better understand the processing of chemical emissions by the West African Monsoon (WAM) and its associated regional-scale and vertical transports. In particular, the french airborne experiment was organized around two goals. The first was to characterize the impact of Mesoscale Convective Systems (MCSs) on the ozone budget in the upper troposphere and the evolution of the chemical composition of these convective plumes as they move westward toward the Atlantic Ocean. The second objective was to discriminate the impact of remote sources of pollution over West Africa, including transport from the middle east, Europe, Asia and from southern hemispheric fires. Observations of O<sub>3</sub>, CO, NO<sub>x</sub>, H<sub>2</sub>O and hydroperoxide above West Africa along repeated meridional transects were coupled with transport analysis based on the FLEXPART lagrangian model. The cross analysis of trace gas concentrations and transport pathways revealed 5 types of air masses: convective uplift of industrial and urban emissions, convective uplift of biogenic emissions, slow advection from Cotonou polluted plumes near the coast, meridional transport of upper tropospheric air from the subtropical barrier region, and meridional transport of Southern Hemisphere (SH) biomass burning emissions. O<sub>3</sub>/CO correlation plots and the correlation plots of H<sub>2</sub>O<sub>2</sub> with a OH proxy revealed not only a control of the trace gas variability by transport processes but also significant photochemical reactivity in the mid- and upper troposphere. The study of four MCSs outflow showed contrasted chemical composition and air mass origins depending on the MCSs lifetime and latitudinal position. Favorables conditions for ozone production were found for MCSs with increased MCS lifetime (>1.5 days), which allowed for more H<sub>2</sub>O<sub>2</sub> formation, and with trajectories crossing the 10° N latitude, which increased CO transport to the upper troposphere. The upper tropospheric concentrations sampled in the MCS outflow regions showed mixed origins including local vertical convective transport, and uplifting of air from the low troposphere over the middle-east related to the summer Asian low pressure system or from the southern hemispheric fires

A survey of current practices by the British Oculoplastic Surgery Society (BOPSS) and recommendations for delivering a sustainable multidisciplinary approach to thyroid eye disease in the United Kingdom

BACKGROUND: The Royal College of Physicians (RCP) and Thyroid Eye Disease Amsterdam Declaration Implementation Group (TEAMeD-5) have the common goal of improving access to high quality care for thyroid eye disease (TED). The TEAMeD-5 programme recommends all patients with moderate-to-severe TED should have access to multidisciplinary clinics (MDT)  with combined Ophthalmology and Endocrinology expertise. METHODS: The British Oculoplastic Surgery Society represents oculoplastic surgeons who usually lead TED care in the UK. A two-stage survey of the membership was conducted to ascertain current practice of existing resources. RESULTS: Seventy percent (45/65) of respondents in Survey 1 were aware of current RCP guidance, but only 49% (22/45) rated it as a good means of improving access to comprehensive TED service. Sixty percent (39/65) of respondents are working in a multidisciplinary TED clinic with co-location of ophthalmologists and endocrinologists. Care for TED appears not to be provided in a multidisciplinary context in up to 31% (20/65). Thirty five (54%) of the respondents rated their relationship with endocrinology colleagues as good. Best practice guidelines recommend routine quality of life assessments but only 6/28 (21%) of respondents use this modality in current practice. Six percent (4/65) of areas appear not to be using intravenous steroids. In many areas (25%, 16/65), second-line immunosuppression is provided in a different trust and in 8% (5/65), it appears not to be used at all. CONCLUSION: This survey is a 'snapshot' of current TED management in the UK and findings suggest scope for improvement. We recommend a framework for more robust collaboration across specialties and propose standards endorsed by multidisciplinary stakeholder societies

Hypothyroidism and type d personality:Results from E-MPATHY, a cross-sectional international online patient survey

ContextBetween 10% and 15% of people with hypothyroidism experience persistent symptoms, despite achieving biochemical euthyroidism.The underlying causes are unclear. Type D personality (a vulnerability factor for general psychological distress) is associated with poor healthstatus and symptom burden but has not been studied in people with hypothyroidism.ObjectiveTo investigate type D personality in hypothyroidism and explore associations with other characteristics and patient-reported outcomes.DesignMultinational, cross-sectional survey.SettingOnline.ParticipantsIndividuals with self-reported, treated hypothyroidism.InterventionQuestionnaire.Main Outcome MeasuresType D personality and associations with baseline characteristics, control of the symptoms of hypothyroidism bymedication, satisfaction with care and treatment of hypothyroidism, impact of hypothyroidism on everyday living.ResultsA total of 3915 responses were received, 3523 of which were valid. The prevalence of type D personality was 54.2%. Statisticallysignificant associations were found between type D personality and several respondent characteristics (age, marital status, ethnicity,household income, comorbidities, type of treatment for hypothyroidism, most recent TSH level), anxiety, depression, somatization, poorcontrol of the symptoms of hypothyroidism by medication, dissatisfaction with care and treatment of hypothyroidism, and a negative impactof hypothyroidism on everyday living).DiscussionOur study found a high prevalence of type D personality among people with hypothyroidism who responded to the survey. Type Dpersonality may be an important determinant of dissatisfaction with treatment and care among people with hypothyroidism. Our findings requireindependent confirmation. Close collaboration between the disciplines of thyroidology and psychology is likely to be key in progressing ourunderstanding in this area

Use of thyroid hormones in hypothyroid and euthyroid patients: A survey of members of the Endocrine Society of Australia

\ua9 2024 The Authors. Clinical Endocrinology published by John Wiley & Sons Ltd.Objective: Hypothyroidism is a common endocrine condition usually managed with levothyroxine (LT4). However, controversy remains around the use of liothyronine (LT3). We aimed to investigate the practices of Australian endocrinologists when managing patients with hypothyroidism, their use of LT3 + LT4 combination therapy and use of thyroid hormones in euthyroid patients. Design and Participants: Members of the Endocrine Society of Australia (ESA) were invited to participate in an online questionnaire. Measurements: We analysed questionnaires that had complete demographic data. Results: Eighty-seven questionnaires fulfilled the criteria. LT4 was used as first line treatment for hypothyroidism by all respondents. Only 45% reported that their patients were dispensed the brand of LT4 that they recommend. LT3 (alone or in combination) was prescribed by 44% in their clinical practice. Although 49% of respondents would consider LT3 + LT4 in patients with normal TSH who had ongoing symptoms of hypothyroidism, the inability of LT4 to restore normal physiology was ranked the least likely explanation for persistent symptoms and only 32% would consider it for themselves if they were diagnosed with hypothyroidism. The majority (55%), in accordance with evidence, would not prescribe thyroid hormone to euthyroid individuals but 39% would consider use in euthyroid female infertility with high levels of thyroid antibodies and 11% in euthyroid patients with a simple goitre growing over time. LT4 use in pregnancy was variable among members. Conclusions: Australian endocrinologists mostly follow international guidelines when prescribing thyroid hormone therapy and many prescribe combination LT3 and LT4 therapy, particularly for patients who remain symptomatic on LT4 monotherapy. Prescribing practices are largely similar to other countries who have completed similar questionnaires