The evidence for automated grading in diabetic retinopathy screening

Peer reviewedPostprin

Effectiveness of policy to provide breastfeeding groups (BIG) for pregnant and breastfeeding mothers in primary care: cluster randomised controlled trial

Objective To assess the clinical effectiveness and cost effectiveness of a policy to provide breastfeeding groups for pregnant and breastfeeding women

Relationship between sociodemographic factors and specialty destination of UK trainee doctors:a national cohort study

We are grateful to UKMED for releasing the data for this project. We also are grateful to the following for their support of the application to UKMED for this and other research projects: Dr Sally Curtis (University of Southampton, UK), Dr Sandra Nicholson (Barts and The London School of Medicine and Dentistry, UK). We thank Daniel Smith and Andy Knapton of the General Medical Council of the UK for their support for the application and throughout the project, particularly regarding data linkage and troubleshooting.Peer reviewedPublisher PD

Star-Forming or Starbursting? The Ultraviolet Conundrum

Compared to starburst galaxies, normal star forming galaxies have been shown to display a much larger dispersion of the dust attenuation at fixed reddening through studies of the IRX-beta diagram (the IR/UV ratio "IRX" versus the UV color "beta"). To investigate the causes of this larger dispersion and attempt to isolate second parameters, we have used GALEX UV, ground-based optical, and Spitzer infrared imaging of 8 nearby galaxies, and examined the properties of individual UV and 24 micron selected star forming regions. We concentrated on star-forming regions, in order to isolate simpler star formation histories than those that characterize whole galaxies. We find that 1) the dispersion is not correlated with the mean age of the stellar populations, 2) a range of dust geometries and dust extinction curves are the most likely causes for the observed dispersion in the IRX-beta diagram 3) together with some potential dilution of the most recent star-forming population by older unrelated bursts, at least in the case of star-forming regions within galaxies, 4) we also recover some general characteristics of the regions, including a tight positive correlation between the amount of dust attenuation and the metal content. Although generalizing our results to whole galaxies may not be immediate, the possibility of a range of dust extinction laws and geometries should be accounted for in the latter systems as well.Comment: 18 pages, 17 figures, accepted for publication in Ap

The Spectral Energy Distribution of Dust Emission in the Edge-on spiral galaxy NGC 4631 as seen with Spitzer and the James Clerk Maxwell telescope

We explore variations in dust emission within the edge-on Sd spiral galaxy NGC 4631 using 3.6-160 μm Spitzer Space Telescope data and 450-850 μm JCMT data with the goals of understanding the relation between PAHs and dust emission, studying the variations in the colors of the dust emission, and searching for possible excess submillimeter emission compared to what is expected from dust models extrapolated from far-infrared wavelengths. The 8 μm PAH emission correlates best with 24 μm hot dust emission on 1.7 kpc scales, but the relation breaks down on 650 pc scales, possibly because of differences in the mean free paths between photons that excite the PAHs and photons that heat the dust and possibly because the PAHs are destroyed by the hard radiation fields within some star formation regions. The ratio of 8 μm PAH emission to 160 μm cool dust emission appears to vary as a function of radius. The 70 μm/160 μm and 160 μm/450 μm flux density ratios are remarkably constant even though the surface brightnesses vary by factors of 25, which suggests that the emission is from dust heated by a nearly uniform radiation field. Globally, we find an excess of 850-1230 μm emission relative to what would be predicted by dust models. The 850 μm excess is highest in regions with low 160 μm surface brightnesses, although the magnitude depends on the model fit to the data. We rule out variable emissivity functions or ~4 K dust as the possible origins of this 850 μm emission, but we do discuss the other possible mechanisms that could produce the emission

Acute kidney injury as an independent risk factor for unplanned 90-day hospital readmissions

Background Reducing readmissions is an international priority in healthcare. Acute kidney injury (AKI) is common, serious and also a global concern. This analysis evaluates AKI as a candidate risk factor for unplanned readmissions and determines the reasons for readmissions. Methods GLOMMS-II is a large population cohort from one health authority in Scotland, combining hospital episode data and complete serial biochemistry results through data-linkage. 16453 people (2623 with AKI and 13830 without AKI) from GLOMMS-II who survived an index hospital admission in 2003 were used to identify the causes of and predict readmissions. The main outcome was “unplanned readmission or death” within 90 days of discharge. In a secondary analysis, the outcome was limited to readmissions with acute pulmonary oedema. 26 candidate predictors during the index admission included AKI (defined and staged 1–3 using an automated e-alert algorithm), prior AKI episodes, baseline kidney function, index admission circumstances and comorbidities. Prediction models were developed and assessed using multivariable logistic regression (stepwise variable selection), C statistics, bootstrap validation and decision curve analysis. Results Three thousand sixty-five (18.6%) patients had the main outcome (2702 readmitted, 363 died without readmission). The outcome was strongly predicted by AKI. Multivariable odds ratios for AKI stage 3; 2 and 1 (vs no AKI) were 2.80 (2.22–3.53); 2.23 (1.85–2.68) and 1.50 (1.33–1.70). Acute pulmonary oedema was the reason for readmission in 26.6% with AKI and eGFR < 60; and 4.0% with no AKI and eGFR ≥ 60. The best stepwise model from all candidate predictors had a C statistic of 0.698 for the main outcome. In a secondary analysis, a model for readmission with acute pulmonary oedema had a C statistic of 0.853. In decision curve analysis, AKI improved clinical utility when added to any model, although the incremental benefit was small when predicting the main outcome. Conclusions AKI is a strong, consistent and independent risk factor for unplanned readmissions – particularly readmissions with acute pulmonary oedema. Pre-emptive planning at discharge should be considered to minimise avoidable readmissions in this high risk group

Prognostic Role of CMR in Patients Presenting With Ventricular Arrhythmias

Objectives The goal of this study was to explore whether fibrosis detected by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) is an independent predictor of hard cardiovascular events in patients presenting with ventricular arrhythmia. Background In patients at risk of sudden cardiac death, risk stratification for device therapy remains challenging. Methods A total of 373 consecutive patients with sustained ventricular tachycardia (VT) (n = 204) or nonsustained ventricular tachycardia (NSVT) (n = 169) underwent LGE-CMR. The group was prospectively followed up for a median of 2.6 years (range 11 months to 11 years). The predetermined endpoint was a composite of cardiac death/arrest, new episode of sustained VT, or appropriate implantable cardioverter-defibrillator discharge. Results Mean left ventricular (LV) ejection fraction (EF) was 60 ± 13%. The presence of fibrosis was a strong and independent predictor of the primary outcome for the whole group (hazard ratio [HR]: 3.3, 95% confidence interval [CI]: 1.8 to 5.8, p < 0.001). In the sustained VT subset, both LV fibrosis and severely impaired systolic function (LVEF <35%) were significant independent predictors in the multivariate model (HR: 3.0, 95% CI: 1.4 to 6.2, p = 0.001; and HR: 2.5, 95% CI: 1.1 to 6.2, p = 0.038, respectively). In the NSVT subset, the presence of fibrosis was the only independent predictor of the endpoint (HR: 4.2, 95% CI: 1.7 to 10.1, p = 0.006). Conclusions LGE-CMR–detected fibrosis is an independent predictor of adverse outcomes in patients with ventricular arrhythmia and may have an important role in risk stratification

Ultraviolet through far-infrared spatially resolved analysis of the recent star formation in M81 (NGC 3031)

The recent star formation (SF) in the early-type spiral galaxy M81 is characterized using imaging observations from the far-ultraviolet to the far-infrared. We compare these data with models of the stellar, gas, and dust emission for subgalactic regions. Our results suggest the existence of a diffuse dust emission not directly linked to the recent star formation. We find a radial decrease of the dust temperature and dust mass density, and in the attenuation of the stellar light. The IR emission in M81 can be modeled with three components: (1) cold dust with a temperature = 18 ± 2 K, concentrated near the H II regions but also presenting a diffuse distribution; (2) warm dust with = 53 ± 7 K, directly linked with the H II regions; and (3) aromatic molecules, with diffuse morphology peaking around the H II regions. We derive several relationships to obtain total IR luminosities from IR monochromatic fluxes, and we compare five different star formation rate (SFR) estimators for H II regions in M81 and M51: the UV, H alpha, and three estimators based on Spitzer data. We find that the H alpha luminosity absorbed by dust correlates tightly with the 24 mu m emission. The correlation with the total IR luminosity is not as good. Important variations from galaxy to galaxy are found when estimating the total SFR with the 24 mu m or the total IR emission alone. The most reliable estimations of the total SFRs are obtained by combining the H alpha emission (or the UV) and an IR luminosity (especially the 24 mu m emission), which probe the unobscured and obscured SF, respectively. For the entire M81 galaxy, about 50% of the total SF is obscured by dust. The percentage of obscured SF ranges from 60% in the inner regions of the galaxy to 30% in the outer zones

Maintaining musculoskeletal health using a behavioural therapy approach : a population-based randomised controlled trial (the MAmMOTH Study)

Acknowledgements: The study was funded by Arthritis Research UK (now Versus Arthritis) grant number: 20748. Costs for delivery of the intervention were provided by NHS Grampian, NHS Greater Glasgow and Clyde, and NHS Highland. The funder of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report. We acknowledge the contribution of the trial steering committee to the successful conduct of the study. The members were Professor Ernest Choy (Cardiff University), Professor Tamar Pincus (Royal Holloway, University of London) and Gordon Taylor (Bath University). We thank Brian Taylor and Mark Forrest from the Centre for Healthcare Randomised Trials (CHaRT) at the University of Aberdeen for their technical assistance and Professor Graeme MacLennan, Director of CHaRT, for methodological input. Professor John Norrie (originally University of Aberdeen now University of Edinburgh) and Dr. Majid Artus (originally Keele University, now the Osmaston surgery, Derbyshire) were study investigators at the time of grant award but subsequently left the study. We thank Kathy Longley (a representative of Fibromyalgia Action UK) for her input to the grant application and the project as well as from members of the public on the University of Aberdeen College of Life Sciences and Medicine Research Interest Group. The prioritisation of “Prevention of chronic pain” arose from a 2012 meeting of the Arthritis Research UK Clinical Study Group in Pain to which patients contributed.Peer reviewedPostprintsupplementary_datasupplementary_dat

Three Year Evaluation of Xpert MTB/RIF in a Low Prevalence Tuberculosis Setting

Objectives Xpert MTB/RIF (Cepheid) is a rapid molecular assay shown to be sensitive and specific for pulmonary tuberculosis (TB) diagnosis in highly endemic countries. We evaluated its diagnostic performance in a low TB prevalence setting, examined rifampicin resistance detection and quantitative capabilities predicting graded auramine microscopy and time to positivity (TTP) of culture. Methods Xpert MTB/RIF was used to test respiratory samples over a 3 year period. Samples underwent graded auramine microscopy, solid/ liquid culture, in-house IS6110 real-time PCR, and GenoType MTBDRplus (HAIN Lifescience) to determine rifampicin and/or isoniazid resistance. Results A total of 2103 Xpert MTB/RIF tests were performed. Compared to culture sensitivity was 95.8%, specificity 99.5%, positive predictive value (PPV) 82.1%, and negative predictive value (NPV) 99.9%. A positive correlation was found between auramine microscopy grade and Xpert MTB/RIF assay load. We found a clear reduction in the median TTP as Xpert MTB/RIF assay load increased. Rifampicin resistance was detected. Conclusions Xpert MTB/RIF was rapid and accurate in diagnosing pulmonary TB in a low prevalence area. Rapid results will influence infection prevention and control and treatment measures. The excellent NPV obtained suggests further work should be carried out to assess its role in replacing microscopy