GPs’ understanding and practice of safety netting for potential cancer presentations : a qualitative study in primary care

Background Safety netting is a diagnostic strategy used in UK primary care to ensure patients are monitored until their symptoms or signs are explained. Despite being recommended in cancer diagnosis guidelines, little evidence exists about which components are effective and feasible in modern-day primary care. Aim To understand the reality of safety netting for cancer in contemporary primary care. Design and setting A qualitative study of GPs in Oxfordshire primary care. Method In-depth interviews with a purposive sample of 25 qualified GPs were undertaken. Interviews were recorded and transcribed verbatim, and analysed thematically using constant comparison. Results GPs revealed uncertainty about which aspects of clinical practice are considered safety netting. They use bespoke personal strategies, often developed from past mistakes, without knowledge of their colleagues’ practice. Safety netting varied according to the perceived risk of cancer, the perceived reliability of each patient to follow advice, GP working patterns, and time pressures. Increasing workload, short appointments, and a reluctance to overburden hospital systems or create unnecessary patient anxiety have together led to a strategy of selective active follow-up of patients perceived to be at higher risk of cancer or less able to act autonomously. This left patients with low-risk-but-not-no-risk symptoms of cancer with less robust or absent safety netting. Conclusion GPs would benefit from clearer guidance on which aspects of clinical practice contribute to effective safety netting for cancer. Practice systems that enable active follow-up of patients with low-risk-but-not-no-risk symptoms, which could represent malignancy, could reduce delays in cancer diagnosis without increasing GP workload

Maternal serum lactate dehydrogenase level as a predictor of adverse pregnancy outcome in women with severe preeclampsia

Background: Preeclampsia is a multisystem disorder causing vascular endothelial damage and leads to leakage of lactate dehydrogenase (LDH) into maternal serum. This study evaluated the serum LDH levels in severe preeclamptic women to detect any correlation with adverse pregnancy outcomes. Methods: A prospective cohort study compared LDH levels of 68 severe preeclamptic women with 68 normotensives in the third trimester, matched for age, parity, and gestational age. The preeclamptic women were followed up until delivery to assess the maternal and neonatal outcomes. Data were analyzed with SPSS for Windows version 23. The level of significance was set at p<0.05. Results: Both groups were comparable in their characteristics. The mean LDH level for severe preeclamptic group (717.40 IU/L) was higher than for the normotensive group (162.90 IU/L) and this was significant (p=0.001). Cesarean delivery was less likely when LDH was >600 compared to ≤600 (OR 0.31; p=0.049) indicating a potential protective effect. The likelihood of IUGR (OR 3.14; p=0.045), IUFD (OR 6.48; p=0.028), stillbirth (OR 7.06 p=0.007), perinatal mortality (OR 4.84; p=0.004) and low birth weight <2500 gm (OR 3.77; p=0.025) were all significantly higher with LDH levels >600 IU/L. Conclusions: Maternal serum LDH levels were found to be significantly increased in pregnant women with severe preeclampsia compared to their normotensive counterparts, and elevated levels >600 IU/L in the third trimester was associated with adverse perinatal outcomes

An early MIS 3 pluvial phase in Southeast Arabia: climatic and archaeological implications

Climatic changes in Arabia are of critical importance to our understanding of both monsoon variability and the dispersal of anatomically modern humans (AMH) out of Africa. The timing of dispersal is associated with the occurrence of pluvial periods during Marine Isotope Stage (MIS) 5 (ca. 130–74 ka), after which arid conditions between ca. 74 and 10.5 ka are thought to have restricted further migration and range expansion within the Arabian interior. Whilst a number of records indicate that this phase of aridity was punctuated by an increase in monsoon strength during MIS 3, uncertainties regarding the precision of terrestrial records and suitability of marine archives as records of precipitation, mean that the occurrence of this pluvial remains debated. Here we present evidence from a series of relict lake deposits within southeastern Arabia, which formed at the onset of MIS 3 (ca. 61–58 ka). At this time, the incursion of monsoon rainfall into the Arabian interior activated a network of channels associated with an alluvial fan system along the western flanks of the Hajar Mountains, leading to lake formation. Multiproxy evidence indicates that precipitation increases intermittently recharged fluvial systems within the region, leading to lake expansion in distal fan zones. Conversely, decreased precipitation led to reduced channel flow, lake contraction and a shift to saline conditions. These findings are in contrast to the many other palaeoclimatic records from Arabia, which suggest that during MIS 3, the latitudinal position of the monsoon was substantially further south and did not penetrate the peninsula. Additionally, the occurrence of increased rainfall at this time challenges the notion that the climate of Arabia following MIS 5 was too harsh to permit the further range expansion of indigenous communities

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Polygenic risk for alcohol misuse is moderated by romantic partnerships

Background and Aims Previous twin research suggests relationship status can moderate underlying genetic liability towards alcohol misuse. This paper examined: (1) whether genome-wide polygenic scores (GPS) for alcohol consumption are associated with alcohol misuse; (2) whether these GPS are moderated by romantic relationships (gene-environment interaction; G x E) and (3) whether G x E results are consistent across sex. Design Linear mixed-effects models were used to test associations between genome-wide polygenic scores, relationship status and alcohol use/misuse. Setting Finnish twins born between 1983 and 1987 identified through Finland's central population registry. Participants An intensively studied subset of Finnish Twin Study (FinnTwin12) during the young adult phase (aged 20-26 years). The analytical sample includes those with complete interview and genetic data (n = 1201). Measurements Key measurements included involvement in a romantic partnership, drinking frequency, intoxication frequency and DSM-IV alcohol dependence (AD) symptoms. Genome-wide polygenic scores (GPS) were created from available summary statistics from a large genome-wide association study (GWAS) of drinks per week. Results GPS predicted drinking frequency [b = 0.109; 95% confidence interval (CI) = 0.050, 0.168], intoxication frequency (b = 0.111; 95% CI = 0.054, 0.168) and AD symptoms (b = 0.123; 95% CI = 0.064, 0.182). Having a romantic relationship negatively influenced the association between GPS and drinking frequency (b = -0.105; 95% CI = -0.211, -0.001), intoxication frequency (b = -0.118; 95% CI = -0.220, -0.016) and AD symptoms (b = -0.119; 95% CI = -0.229, -0.009). There was a three-way interaction between sex, relationship status and GPS for intoxication frequency (b = 0.223; 95% CI = 0.013, 0.433), such that the reduced association between GPS and intoxication frequency for those in a relationship was only apparent in males. We found no evidence of three-way interactions for drinking frequency or AD symptoms. Conclusions Being in a romantic relationship reduced the association between genetic predisposition and drinking, high-risk drinking and alcohol problems. However, for high-risk drinking the protective effect was limited to males, mapping onto earlier findings suggesting that males benefit more from romantic partnerships.Peer reviewe

Accelerated sludge solubilisation under sulphate reducing conditions: the effect of hydrolytic enzymes on sludge floc size distribution and EPS composition

Extracellular polymeric substances (EPS) are the construction materials for microbial aggregates such as biofilms, flocs and sludge, and greatly contribute to the structural integrity of sludge flocs in wastewater treatment processes. The loss of integrity of the sewage sludge floc is believed to be due to enhanced hydrolysis of important structural components such as lignin, protein and cellulose in the sludge floc matrix. The mechanism of enhanced sludge floc fracture, due to the action of enzymes hydrolysing these structural components, remains a key element in our understanding of how the floc integrity in systems utilising a sulphate reducing system is compromised. A range of relatively non-specific exogenous enzymes (ß-glucosidase, cellulase, proteases: trypsin, pronase E and chymotrypsin) were added to a sulphidogenic bioreactor- (containing both sulphate reducing bacteria (SRB) and a methanogenic bacterial system) and a (control) methanogenic bioreactor sample, and the effect of these enzymes on sludge floc size (diameter) distribution and EPS composition was investigated. Sludge samples from the bioreactors were examined under bright field and differential interference contrast light microscopy. Proteolytic and glucohydrolytic activity of the enzymes were monitored using standard enzyme assaying techniques, and Bradford, Somogyi-Nelson, and total carbohydrate assays were performed to establish the composition of the EPS (after extraction with 3% (v/v) glutaraldehyde and Sephacryl S-400 size exclusion chromatography). Sludge flocs present in the sulphidogenic environment of the sulphidogenic bioreactor were found to have smaller diameters than their counterparts present in the methanogenic bioreactor. The addition of hydrolytic (i.e. proteolytic and glycohydrolytic) enzymes resulted in an increased rate of matrix hydrolysis, leading to increased rates of floc fracture and deflocculation. The presence of ß-glucosidase, cellulase, and proteases naturally residing within the sludge floc was confirmed. We propose that the addition of commercially available enzymes may be prohibitively costly on a large scale, and that the activity of the enzymes naturally residing within the floc matrix be optimised or enhanced. As the bulk of the EPS was shown to be composed of mainly polysaccharides, we propose that by increasing the activity of the naturally occurring ß-glucosidases residing within the floc matrix, the process of deflocculation may be enhanced. As sulphide has been shown to increase the activity of this very important key enzyme, we propose that this is one of the contributing factors why sludge solubilisation is accelerated under sulphate reducing conditions

Scaling of axial muscle architecture in juvenile Alligator mississippiensis reveals an enhanced performance capacity of accessory breathing mechanisms

From Wiley via Jisc Publications RouterHistory: received 2020-11-16, rev-recd 2021-07-08, accepted 2021-07-12, pub-electronic 2021-07-23Article version: VoRPublication status: PublishedFunder: Biotechnology and Biological Sciences Research Council; Id: http://dx.doi.org/10.13039/501100000268; Grant(s): BB/I021116/1Funder: National Science Foundation; Id: http://dx.doi.org/10.13039/100000001; Grant(s): 17565187Abstract: Quantitative functional anatomy of amniote thoracic and abdominal regions is crucial to understanding constraints on and adaptations for facilitating simultaneous breathing and locomotion. Crocodilians have diverse locomotor modes and variable breathing mechanics facilitated by basal and derived (accessory) muscles. However, the inherent flexibility of these systems is not well studied, and the functional specialisation of the crocodilian trunk is yet to be investigated. Increases in body size and trunk stiffness would be expected to cause a disproportionate increase in muscle force demands and therefore constrain the basal costal aspiration mechanism, necessitating changes in respiratory mechanics. Here, we describe the anatomy of the trunk muscles, their properties that determine muscle performance (mass, length and physiological cross‐sectional area [PCSA]) and investigate their scaling in juvenile Alligator mississippiensis spanning an order of magnitude in body mass (359 g–5.5 kg). Comparatively, the expiratory muscles (transversus abdominis, rectus abdominis, iliocostalis), which compress the trunk, have greater relative PCSA being specialised for greater force‐generating capacity, while the inspiratory muscles (diaphragmaticus, truncocaudalis ischiotruncus, ischiopubis), which create negative internal pressure, have greater relative fascicle lengths, being adapted for greater working range and contraction velocity. Fascicle lengths of the accessory diaphragmaticus scaled with positive allometry in the alligators examined, enhancing contractile capacity, in line with this muscle's ability to modulate both tidal volume and breathing frequency in response to energetic demand during terrestrial locomotion. The iliocostalis, an accessory expiratory muscle, also demonstrated positive allometry in fascicle lengths and mass. All accessory muscles of the infrapubic abdominal wall demonstrated positive allometry in PCSA, which would enhance their force‐generating capacity. Conversely, the basal tetrapod expiratory pump (transversus abdominis) scaled isometrically, which may indicate a decreased reliance on this muscle with ontogeny. Collectively, these findings would support existing anecdotal evidence that crocodilians shift their breathing mechanics as they increase in size. Furthermore, the functional specialisation of the diaphragmaticus and compliance of the body wall in the lumbar region against which it works may contribute to low‐cost breathing in crocodilians

The microbiological quality of air improves when using air conditioning systems in cars

<p>Abstract</p> <p>Background</p> <p>Because of better comfort, air conditioning systems are a common feature in automobiles these days. However, its impact on the number of particles and microorganisms inside the vehicle - and by this its impact on the risk of an allergic reaction - is yet unknown.</p> <p>Methods</p> <p>Over a time period of 30 months, the quality of air was investigated in three different types of cars (VW Passat, VW Polo FSI, Seat Alhambra) that were all equipped with a automatic air conditioning system. Operation modes using fresh air from outside the car as well as circulating air from inside the car were examined. The total number of microorganisms and the number of mold spores were measured by impaction in a high flow air sampler. Particles of 0.5 to 5.0 μm diameter were counted by a laser particle counter device.</p> <p>Results</p> <p>Overall 32 occasions of sampling were performed. The concentration of microorganisms outside the cars was always higher than it was inside the cars. Few minutes after starting the air conditioning system the total number of microorganisms was reduced by 81.7%, the number of mold spores was reduced by 83.3%, and the number of particles was reduced by 87.8%. There were no significant differences neither between the types of cars nor between the types of operation mode of the air conditioning system (fresh air vs. circulating air). All parameters that were looked for in this study improved during utilization of the car's air conditioning system.</p> <p>Conclusions</p> <p>We believe that the risk of an allergic reaction will be reduced during use also. Nevertheless, we recommend regular maintenance of the system and replacement of older filters after defined changing intervals.</p

Biological, clinical and population relevance of 95 loci for blood lipids.

Plasma concentrations of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides are among the most important risk factors for coronary artery disease (CAD) and are targets for therapeutic intervention. We screened the genome for common variants associated with plasma lipids in &gt;100,000 individuals of European ancestry. Here we report 95 significantly associated loci (P &lt; 5 x 10(-8)), with 59 showing genome-wide significant association with lipid traits for the first time. The newly reported associations include single nucleotide polymorphisms (SNPs) near known lipid regulators (for example, CYP7A1, NPC1L1 and SCARB1) as well as in scores of loci not previously implicated in lipoprotein metabolism. The 95 loci contribute not only to normal variation in lipid traits but also to extreme lipid phenotypes and have an impact on lipid traits in three non-European populations (East Asians, South Asians and African Americans). Our results identify several novel loci associated with plasma lipids that are also associated with CAD. Finally, we validated three of the novel genes-GALNT2, PPP1R3B and TTC39B-with experiments in mouse models. Taken together, our findings provide the foundation to develop a broader biological understanding of lipoprotein metabolism and to identify new therapeutic opportunities for the prevention of CAD