Bariatric surgery tourism in the COVID-19 era

Background: Since the start of the Covid-19 pandemic primary and secondary health care services in Northern Ireland have observed an increase in the number of patients who have had bariatric surgery outside of the UK. This study sought to estimate the frequency of bariatric surgery tourism and to audit indications, blood monitoring and medical complications.Methods: All primary care centres within the Western Health Social Care Trust (WHSCT) were invited to document the number of patients undergoing bariatric surgery between January 1, 2017 and December 31, 2022. For one primary care centre, patients who underwent bariatric surgery were assessed against the National Institute of Health and Clinical Excellence (NICE) guideline indications for bariatric surgery. In addition, the blood monitoring of these patients was audited against the British Obesity and Metabolic Surgery Society (BOMSS) guidelines for up to two years following surgery. Medical contacts for surgical complications of bariatric surgery were recorded.Results: Thirty-five of 47 (74.5%) GP surgeries replied to the survey, representing 239,961 patients among 325,126 registrations (73.8%). In the six year study period 463 patients had reported having bariatric surgery to their GP. Women were more likely to have had bariatric surgery than men (85.1% versus 14.9%). There was a marked increase in the number of patients undergoing bariatric surgery with each year of the study (p&lt;0.0001 chi square for trend). Twenty-one of 47 patients (44.7%) evaluated in one primary care centre fulfilled NICE criteria for bariatric surgery. The level of three-month monitoring ranged from 23% (for vitamin D) to 89% (electrolytes), but decreased at two years to 9% (vitamin D) and 64% (electrolytes and liver function tests). Surgical complication prevalence from wound infections was 19% (9 of 44). Antidepressant medications were prescribed for 23 of 47 patients (48.9%).Conclusions: The WHSCT has experienced a growing population of patients availing of bariatric surgery outside of the National Health Service. In view of this and the projected increase in obesity prevalence, a specialist obesity management service is urgently required in Northern Ireland.</p

A systematic review of population based epidemiological studies in Myasthenia Gravis

<p>Abstract</p> <p>Background</p> <p>The aim was to collate all myasthenia gravis (MG) epidemiological studies including AChR MG and MuSK MG specific studies. To synthesize data on incidence rate (IR), prevalence rate (PR) and mortality rate (MR) of the condition and investigate the influence of environmental and technical factors on any trends or variation observed.</p> <p>Methods</p> <p>Studies were identified using multiple sources and meta-analysis performed to calculate pooled estimates for IR, PR and MR.</p> <p>Results</p> <p>55 studies performed between 1950 and 2007 were included, representing 1.7 billion population-years. For All MG estimated pooled IR (eIR): 5.3 per million person-years (C.I.:4.4, 6.1), range: 1.7 to 21.3; estimated pooled PR: 77.7 per million persons (C.I.:64.0, 94.3), range 15 to 179; MR range 0.1 to 0.9 per millions person-years. AChR MG eIR: 7.3 (C.I.:5.5, 7.8), range: 4.3 to 18.0; MuSK MG IR range: 0.1 to 0.32. However marked variation persisted between populations studied with similar methodology and in similar areas.</p> <p>Conclusions</p> <p>We report marked variation in observed frequencies of MG. We show evidence of increasing frequency of MG with year of study and improved study quality. This probably reflects improved case ascertainment. But other factors must also influence disease onset resulting in the observed variation in IR across geographically and genetically similar populations.</p

Cosmogenic 10Be chronology of the last deglaciation of western Ireland, and implications for sensitivity of the Irish Ice Sheet to climate change

Accelerator mass spectrometry (AMS) 14C dates of fossiliferous marine mud identify a readvance of the Irish Ice Sheet from the north and central lowlands of Ireland into the northern Irish Sea Basin during the Killard Point Stadial at ca. 16.5 cal k.y. B.P., with subsequent deglaciation occurring by ca. 15.0–15.5 cal k.y. B.P. Killard Point Stadial moraines have been mapped elsewhere in Ireland but have previously remained undated. Here, we report sixteen 10Be surface exposure dates that constrain the age of retreat of the Killard Point Stadial ice margin from western Ireland. Eight 10Be dates from the Ox Mountains (13.9–18.1 ka) indicate that fi nal deposition of the moraine occurred at 15.6 ± 0.5 ka (mean age, standard error). Eight 10Be dates from Furnace Lough (14.1–17.3 ka, mean age of 15.6 ± 0.4 ka) are statistically indistinguishable from the Ox Mountain samples, suggesting that the moraines were deposited during the same glacial event. Given the agreement between the two age groups, and their common association with a regionally signifi cant moraine system, we combine them to derive a mean age of 15.6 ± 0.3 ka (15.6 ± 1.0 ka with external uncertainty). This age is in excellent agreement with the timing of deglaciation from the Irish Sea Basin (at or older than 15.3 ± 0.2 cal k.y. B.P.) and suggests the onset of near-contemporaneous retreat of the Irish Ice Sheet from its maximum Killard Point Stadial limit. A reconstruction of the ice surface indicates that the Irish Ice Sheet reached a maximum surface elevation of ~500 m over the central Irish Lowlands during the Killard Point Stadial, suggesting a high sensitivity of the ice sheet to small changes in climate

A Neurodisparity Index of Nationwide Access to Neurological Health Care in Northern Ireland.

Nationwide disparities in managing neurological patients have rarely been reported. We compared neurological health care between the population who reside in a Health and Social Care Trust with a tertiary neuroscience center and those living in the four non-tertiary center Trusts in Northern Ireland. Using the tertiary center Trust population as reference, neurodisparity indices (NDIs) defined as the number of treated patients resident in each Trust per 100,000 residents compared to the same ratio in the tertiary center Trust for a fixed time period. NDIs were calculated for four neurological pathways-intravenous thrombolysis (iv-tPA) and mechanical thrombectomy (MT) for acute ischemic stroke (AIS), disease modifying treatment (DMT) in multiple sclerosis (MS) and admissions to a tertiary neurology ward. Neurological management was recorded in 3,026 patients. Patients resident in the tertiary center Trust were more likely to receive AIS treatments (iv-tPA and MT) and access to the neurology ward (p < 0.001) than patients residing in other Trusts. DMT use for patients with MS was higher in two non-tertiary center Trusts than in the tertiary center Trust. There was a geographical gradient for MT for AIS patients and ward admissions. Averaged NDIs for non-tertiary center Trusts were: 0.48 (95%CI 0.32-0.71) for patient admissions to the tertiary neurology ward, 0.50 (95%CI 0.38-0.66) for MT in AIS patients, 0.78 (95%CI 0.67-0.92) for iv-tPA in AIS patients, and 1.11 (95%CI 0.99-1.26) for DMT use in MS patients. There are important neurodisparities in Northern Ireland, particularly for MT and tertiary ward admissions. Neurologists and health service planners should be aware that geography and time-dependent management of neurological patients worsen neurodisparities

Evaluation: Programme to Support Palliative and Hospice Care in the Republic of Ireland, Final Report

Investment in end-of-life care has made Ireland a world leader in advancing palliative and hospice care but regional inequities persist, according to an evaluation by Professor Mary McCarron and colleagues at Trinity College Dublin.This evaluation examined The Atlantic Philanthropies' End of Life programme -- which aimed to improve the care and quality of life for patients dying from an incurable illness and to ensure they and their families received excellent end-of-life care and services. From its first grant in 2004 through its final grant in 2010, Atlantic invested 25 million in the programme

Cosmogenic 10Be chronology of the last deglaciation of western Ireland, and implications for sensitivity of the Irish Ice Sheet to climate change

Accelerator mass spectrometry (AMS) 14C dates of fossiliferous marine mud identify a readvance of the Irish Ice Sheet from the north and central lowlands of Ireland into the northern Irish Sea Basin during the Killard Point Stadial at ca. 16.5 cal k.y. B.P., with subsequent deglaciation occurring by ca. 15.0–15.5 cal k.y. B.P. Killard Point Stadial moraines have been mapped elsewhere in Ireland but have previously remained undated. Here, we report sixteen 10Be surface exposure dates that constrain the age of retreat of the Killard Point Stadial ice margin from western Ireland. Eight 10Be dates from the Ox Mountains (13.9–18.1 ka) indicate that fi nal deposition of the moraine occurred at 15.6 ± 0.5 ka (mean age, standard error). Eight 10Be dates from Furnace Lough (14.1–17.3 ka, mean age of 15.6 ± 0.4 ka) are statistically indistinguishable from the Ox Mountain samples, suggesting that the moraines were deposited during the same glacial event. Given the agreement between the two age groups, and their common association with a regionally signifi cant moraine system, we combine them to derive a mean age of 15.6 ± 0.3 ka (15.6 ± 1.0 ka with external uncertainty). This age is in excellent agreement with the timing of deglaciation from the Irish Sea Basin (at or older than 15.3 ± 0.2 cal k.y. B.P.) and suggests the onset of near-contemporaneous retreat of the Irish Ice Sheet from its maximum Killard Point Stadial limit. A reconstruction of the ice surface indicates that the Irish Ice Sheet reached a maximum surface elevation of ~500 m over the central Irish Lowlands during the Killard Point Stadial, suggesting a high sensitivity of the ice sheet to small changes in climate

A Neurodisparity Index of Nationwide Access to Neurological Health Care in Northern Ireland

Nationwide disparities in managing neurological patients have rarely been reported. We compared neurological health care between the population who reside in a Health and Social Care Trust with a tertiary neuroscience center and those living in the four non-tertiary center Trusts in Northern Ireland. Using the tertiary center Trust population as reference, neurodisparity indices (NDIs) defined as the number of treated patients resident in each Trust per 100,000 residents compared to the same ratio in the tertiary center Trust for a fixed time period. NDIs were calculated for four neurological pathways—intravenous thrombolysis (iv-tPA) and mechanical thrombectomy (MT) for acute ischemic stroke (AIS), disease modifying treatment (DMT) in multiple sclerosis (MS) and admissions to a tertiary neurology ward. Neurological management was recorded in 3,026 patients. Patients resident in the tertiary center Trust were more likely to receive AIS treatments (iv-tPA and MT) and access to the neurology ward (p < 0.001) than patients residing in other Trusts. DMT use for patients with MS was higher in two non-tertiary center Trusts than in the tertiary center Trust. There was a geographical gradient for MT for AIS patients and ward admissions. Averaged NDIs for non-tertiary center Trusts were: 0.48 (95%CI 0.32–0.71) for patient admissions to the tertiary neurology ward, 0.50 (95%CI 0.38–0.66) for MT in AIS patients, 0.78 (95%CI 0.67–0.92) for iv-tPA in AIS patients, and 1.11 (95%CI 0.99–1.26) for DMT use in MS patients. There are important neurodisparities in Northern Ireland, particularly for MT and tertiary ward admissions. Neurologists and health service planners should be aware that geography and time-dependent management of neurological patients worsen neurodisparities

Asynchronous Telepsychiatry Interviewer Training Recommendations: A Model for Interdisciplinary, Integrated Behavioral Health Care

Objective: Asynchronous telepsychiatry (ATP) is an integrative model of behavioral health service delivery that is applicable in a variety of settings and populations, particularly consultation in primary care. This article outlines the development of a training model for ATP clinician skills. Methods: Clinical and procedural training for ATP clinicians (n = 5) was provided by master's-level, clinical mental health providers developed by three experienced telepsychiatrists (P.Y. D.H., and J.S) and supervised by a tele-psychiatrist (PY, GX, DL) through seminar, case supervision, and case discussions. A training manual and one-on-one sessions were employed for initial training. Unstructured expert discussion and feedback sessions were conducted in the training phase of the study in year 1 and annually thereafter over the remaining 4 years of the study. The notes gathered during those sessions were synthesized into themes to gain a summary of the study telepsychiatrist training recommendations for ATP interviewers. Results: Expert feedback and discussion revealed three overarching themes of recommended skill sets for ATP interviewers: (1) comprehensive skills in brief psychiatric interviewing, (2) adequate knowledge base of behavioral health conditions and therapeutic techniques, and (3) clinical documentation, integrated care/consultation practices, and e-competency skill sets. The model of training and skill requirements from expert feedback sessions included these three skill sets. Technology training recommendations were also identified and included: (1) awareness of privacy/confidentiality for electronic data gathering, storage, management, and sharing; (2) technology troubleshooting; and (3) video filming/retrieval. Conclusions: We describe and provide a suggested training model for the use of ATP integrated behavioral health. The training needs for ATP clinicians were assessed on a limited convenience sample of experts and clinicians, and more rigorous studies of training for ATP and other technology-focused, behavioral health services are needed. Clinical Trials number: NCT03538860

Agreement between the Chinese Academy of Agricultural Sciences and the International Maize and Wheat Improvement Center

Agreement between CAAS and CIMMYT signed in Beijing, China on September 25, 1997. Agreement establishes cooperation for the promotion and acceleration in research and training for the scientific improvement of wheat and maize for China and other countries set forth in nine articles

MYC regulates fatty acid metabolism through a multigenic program in claudin-low triple negative breast cancer

Background: Recent studies have suggested that fatty acid oxidation (FAO) is a key metabolic pathway for the growth of triple negative breast cancers (TNBCs), particularly those that have high expression of MYC. However, the underlying mechanism by which MYC promotes FAO remains poorly understood. Methods: We used a combination of metabolomics, transcriptomics, bioinformatics, and microscopy to elucidate a potential mechanism by which MYC regulates FAO in TNBC. Results: We propose that MYC induces a multigenic program that involves changes in intracellular calcium signalling and fatty acid metabolism. We determined key roles for fatty acid transporters (CD36), lipases (LPL), and kinases (PDGFRB, CAMKK2, and AMPK) that each contribute to promoting FAO in human mammary epithelial cells that express oncogenic levels of MYC. Bioinformatic analysis further showed that this multigenic program is highly expressed and predicts poor survival in the claudin-low molecular subtype of TNBC, but not other subtypes of TNBCs, suggesting that efforts to target FAO in the clinic may best serve claudin-low TNBC patients. Conclusion: We identified critical pieces of the FAO machinery that have the potential to be targeted for improved treatment of patients with TNBC, especially the claudin-low molecular subtype