Validation of the olfactory disorders questionnaire for English‐speaking patients with olfactory disorders

Objectives 1. To adapt the existing German language olfactory disorders questionnaire for use with English-speaking patients 2. To validate the adapted version for routine clinical use Design The translated version of the original German questionnaire was revised with a patient and a clinician to reflect British language and culture. Patients attending an olfactory dysfunction clinic were recruited to perform the adapted questionnaire on two occasions at least one month apart. Additional online participants completed the questionnaire via the charity Fifth Sense. Main outcome measures • Re-test reliability of the English olfactory disorders questionnaire (eODQ) in affected patients including potential for redundancy in any of the included questions • Correlation of eODQ scores with Sniffin’ Sticks scores Results Eighty-seven patients reporting olfactory dysfunction were recruited and had a mean age of 48 with 35% of them being male; 50 datasets were available for analysis. A total of 957 members of the charity entered responses into the online questionnaire; 699 responses could be scored with participants’ mean age of 55 years and with 69% reporting as female. The eODQ score and Sniffin’ Sticks TDI score at timepoint 1 were correlated to assess for concurrent validity, (r=-0.15, p=0.17) and showed no significant correlation. Female participants had a significantly higher mean total eODQ score than men, 55.75 compared to 52.28 (p=0.001). The average score was 54.7 (SD 13.5) with a range from 26 to 87. The internal consistency of the questionnaire was good with a Cronbach’s alpha of 0.90 (Confidence intervals 0.89, 0.91). Conclusions The results of this study support the use of the eODQ in a native English-speaking population and highlight the different distinctions between “objective” testing of olfaction with the Sniffin’ Sticks test and the patient reported impact of olfactory dysfunction on daily life. These two types of assessment can be easily administered in an outpatient setting and used in the assessment and management of olfactory dysfunction

Chronic rhinosinusitis:a qualitative study of patient views and experiences of current management in primary and secondary care

OBJECTIVES: To explore patient views and perspectives of current management of chronic rhinosinusitis (CRS) in primary and secondary care. DESIGN: Semistructured qualitative telephone interviews as part of the MACRO programme (Defining best Management for Adults with Chronic RhinOsinusitis). SETTING: Primary care and secondary care ear, nose and throat outpatient clinics in the UK. PARTICIPANTS: Twenty-five patients consented to in-depth telephone interviews. Transcribed recordings were managed using NVivo software and analysed using inductive thematic analysis. RESULTS: CRS has a significant impact on patients' quality of life, affecting their ability to work effectively, their social interactions and daily living. Patients seek help when symptoms become unmanageable, but can become frustrated with the primary care system with difficulties obtaining an appointment, and lack of continuity of care. Patients perceive that general practitioners can be dismissive of CRS symptoms, and patients often prioritise other concerns when they consult. Health system barriers and poor communication can result in delays in accessing appropriate treatment and referral. Adherence to intranasal steroids is a problem and patients are uncertain about correct technique. Nasal irrigation can be time-consuming and difficult for patients to use. Secondary care consultations can appear rushed, and patients would like specialists to take a more 'holistic' approach to their management. Surgery is often considered a temporary solution, appropriate when medical options have been explored. CONCLUSIONS: Patients are frustrated with the management of their CRS, and poor communication can result in delays in receiving appropriate treatment and timely referral. Patients seek better understanding of their condition and guidance to support treatments decisions in light of uncertainties around the different medical and surgical options. Better coordinated care between general practice and specialist settings and consistency of advice has the potential to increase patient satisfaction and improve outcomes

GLI1 confers profound phenotypic changes upon LNCaP prostate cancer cells that include the acquisition of a hormone independent state

The GLI (GLI1/GLI2) transcription factors have been implicated in the development and progression of prostate cancer although our understanding of how they actually contribute to the biology of these common tumours is limited. We observed that GLI reporter activity was higher in normal (PNT-2) and tumourigenic (DU145 and PC-3) androgen-independent cells compared to androgen-dependent LNCaP prostate cancer cells and, accordingly, GLI mRNA levels were also elevated. Ectopic expression of GLI1 or the constitutively active NGLI2 mutant induced a distinct cobblestone-like morphology in LNCaP cells that, regarding the former, correlated with increased GLI2 as well as expression of the basal/stem-like markers CD44, beta1-integrin, Np63 and BMI1, and decreased expression of the luminal marker AR (androgen receptor). LNCaP-GLI1 cells were viable in the presence of the AR inhibitor bicalutamide and gene expression profiling revealed that the transcriptome of LNCaP-GLI1 cells was significantly closer to DU145 and PC-3 cells than to control LNCaP-pBP (empty vector) cells, as well as identifying LCN2/NGAL as a highly induced transcript which is associated with hormone independence in breast and prostate cancer. Functionally, LNCaP-GLI1 cells displayed greater clonal growth and were more invasive than control cells but they did not form colonies in soft agar or prostaspheres in suspension suggesting that they do not possess inherent stem cell properties. Moreover, targeted suppression of GLI1 or GLI2 with siRNA did not reverse the transformed phenotype of LNCaP-GLI1 cells nor did double GLI1/GLI2 knockdowns activate AR expression in DU145 or PC-3 cells. As such, early targeting of the GLI oncoproteins may hinder progression to a hormone independent state but a more detailed understanding of the mechanisms that maintain this phenotype is required to determine if their inhibition will enhance the efficacy of anti-hormonal therapy through the induction of a luminal phenotype and increased dependency upon AR function

Thomas rotation and Thomas precession

Exact and simple calculation of Thomas rotation and Thomas precessions along a circular world line is presented in an absolute (coordinate-free) formulation of special relativity. Besides the simplicity of calculations the absolute treatment of spacetime allows us to gain a deeper insight into the phenomena of Thomas rotation and Thomas precession.Comment: 20 pages, to appear in Int. J. Theo. Phy

On the relation of Thomas rotation and angular velocity of reference frames

In the extensive literature dealing with the relativistic phenomenon of Thomas rotation several methods have been developed for calculating the Thomas rotation angle of a gyroscope along a circular world line. One of the most appealing concepts, introduced in \cite{rindler}, is to consider a rotating reference frame co-moving with the gyroscope, and relate the precession of the gyroscope to the angular velocity of the reference frame. A recent paper \cite{herrera}, however, applies this principle to three different co-moving rotating reference frames and arrives at three different Thomas rotation angles. The reason for this apparent paradox is that the principle of \cite{rindler} is used for a situation to which it does not apply. In this paper we rigorously examine the theoretical background and limitations of applicability of the principle of \cite{rindler}. Along the way we also establish some general properties of {\it rotating reference frames}, which may be of independent interest.Comment: 14 pages, 2 figure

Does quantum mechanics tell an atomistic spacetime?

The canonical answer to the question posed is "Yes." -- tacitly assuming that quantum theory and the concept of spacetime are to be unified by `quantizing' a theory of gravitation. Yet, instead, one may ponder: Could quantum mechanics arise as a coarse-grained reflection of the atomistic nature of spacetime? -- We speculate that this may indeed be the case. We recall the similarity between evolution of classical and quantum mechanical ensembles, according to Liouville and von Neumann equation, respectively. The classical and quantum mechanical equations are indistinguishable for objects which are free or subject to spatially constant but possibly time dependent, or harmonic forces, if represented appropriately. This result suggests a way to incorporate anharmonic interactions, including fluctuations which are tentatively related to the underlying discreteness of spacetime. Being linear and local at the quantum mechanical level, the model offers a decoherence and natural localization mechanism. However, the relation to primordial deterministic degrees of freedom is nonlocal.Comment: Based on invited talks at Fourth International Workshop DICE2008, held at Castello Pasquini / Castiglioncello, Italy, 22-26 September 2008 and at DISCRETE'08 - Symposium on Prospects in the Physics of Discrete Symmetries, held at IFIC, Valencia, Spain, 11-16 December 2008 - to appear in respective volumes of Journal of Physics: Conference Serie

Antibiotic usage in chronic rhinosinusitis: analysis of national primary care electronic health records

Background : The aim of this study was to analyse rates of antibiotic usage in chronic rhinosinusitis (CRS) in primary care in England and Wales and to identify trends in the choice of antibiotics prescribed. Methods : We used linked data from primary care EHRs, with diagnoses coded using the Read terminology (Clinical Practice Research Datalink) from consenting general practices, with (2) hospital care administrative records (Hospital Episode Statistics, HES recorded using ICD-10). Results : From the total of 88,317 cases of CRS identified, 40,462 (46%) had an antibiotic prescription within 5 days of their first CRS diagnosis. Of patients receiving a first line antibiotic within 5 days of CRS diagnosis, over 80%, in each CRS group, received a subsequent prescription for an antibiotic. Within 5 years of diagnosis, 9% are estimated to have had 5 or more antibiotics within 5 days of a CRS-related consultation. With data spanning almost 20 years, it was possible to discern trends in antibiotics prescriptions, with a clear increasing trend towards macrolide and tetracycline prescribing evident. Conclusions : While antibiotics may have been prescribed for acute exacerbations, we have found high rates of repeated antibiotic prescription in some patients with CRS in primary care. There is a need for stronger evidence on the role of antibiotics in CRS management

Antibiotic usage in chronic rhinosinusitis: analysis of national primary care electronic health records

BACKGROUND: The aim of this study was to analyse rates of antibiotic usage in chronic rhinosinusitis (CRS) in primary care in England and Wales and to identify trends in the choice of antibiotics prescribed. METHODS: We used linked data from primary care EHRs, with diagnoses coded using the Read terminology (Clinical Practice Research Datalink) from consenting general practices, with (2) hospital care administrative records (Hospital Episode Statistics, HES recorded using ICD-10). RESULTS: From the total of 88,317 cases of CRS identified, 40,462 (46%) had an antibiotic prescription within 5 days of their first CRS diagnosis. Of patients receiving a first line antibiotic within 5 days of CRS diagnosis, over 80%, in each CRS group, received a subsequent prescription for an antibiotic. Within 5 years of diagnosis, 9% are estimated to have had 5 or more antibiotics within 5 days of a CRS-related consultation. With data spanning almost 20 years, it was possible to discern trends in antibiotics prescriptions, with a clear increasing trend towards macrolide and tetracycline prescribing evident. CONCLUSIONS: While antibiotics may have been prescribed for acute exacerbations, we have found high rates of repeated antibiotic prescription in some patients with CRS in primary care. There is a need for stronger evidence on the role of antibiotics in CRS management

Parosmia is associated with relevant olfactory recovery after olfactory training in postinfectious smell loss

Objective/Hypothesis: This study aims to determine the association between parosmia and clinically relevant recovery of olfactory function in patients with post-infectious olfactory dysfunction (PIOD) receiving olfactory training. Study Design: Retrospective cohort study. Methods: This was a retrospective cohort study of patients with PIOD that received olfactory training. Adult patients with the major complaint of quantitative smell loss were recruited and treated at several ENT clinics in German between 2008 and 2018. The outcome was based on the association between smell-loss related factors (including parosmia and phantosmia) and clinically relevant changes in overall and subdimension olfactory function of threshold, discrimination, and identification using binary logistic regression analysis. Results: A total of 153 participants with PIOD were included. Clinically relevant improvements in overall olfactory function were more likely in those that had lower baseline olfactory function. Relevant improvements in discrimination function were more likely in those that had lower baseline olfactory function and those that had parosmia at the initial visit. Similarly, relevant improvements in odor identification were more likely in those that had a lower baseline olfactory function and in those who had parosmia at the first visit. Clinically significant improvements in odor threshold were more likely in those who were older in age. Conclusions: This study demonstrated that the presence of parosmia is associated with clinically relevant recovery in olfactory discrimination and identification function in patients with PIOD receiving olfactory training. Level of Evidence: 4 Laryngoscope, 2020