The impact of measurement error in modelled ambient particles exposures on health effect estimates in multi-level analysis: a simulation study.

Background: Various spatiotemporal models have been proposed for predicting ambient particulate exposure for inclusion in epidemiological analyses. We investigated the effect of measurement error in the prediction of particulate matter with diameter <10 µm (PM10) and <2.5 µm (PM2.5) concentrations on the estimation of health effects. Methods: We sampled 1,000 small administrative areas in London, United Kingdom, and simulated the “true” underlying daily exposure surfaces for PM10 and PM2.5 for 2009–2013 incorporating temporal variation and spatial covariance informed by the extensive London monitoring network. We added measurement error assessed by comparing measurements at fixed sites and predictions from spatiotemporal land-use regression (LUR) models; dispersion models; models using satellite data and applying machine learning algorithms; and combinations of these methods through generalized additive models. Two health outcomes were simulated to assess whether the bias varies with the effect size. We applied multilevel Poisson regression to simultaneously model the effect of long- and short-term pollutant exposure. For each scenario, we ran 1,000 simulations to assess measurement error impact on health effect estimation. Results: For long-term exposure to particles, we observed bias toward the null, except for traffic PM2.5 for which only LUR underestimated the effect. For short-term exposure, results were variable between exposure models and bias ranged from −11% (underestimate) to 20% (overestimate) for PM10 and of −20% to 17% for PM2.5. Integration of models performed best in almost all cases. Conclusions: No single exposure model performed optimally across scenarios. In most cases, measurement error resulted in attenuation of the effect estimate

Natural Orifice Surgery (NOS) Using StomaphyX™ for Repair of Gastric Leaks after Bariatric Revisions

Gastric leaks represent serious complications of bariatric surgery. With the increasing popularity and performance of bariatric procedures, the incidence of leaks and associated complications are expected to increase. Minimally invasive natural orifice surgery represents a novel and promising approach to gastric leak management, especially for morbidly obese patients who are at much higher risk from open or laparoscopic surgical procedures. The present article reports two cases of the safe and successful use of the EndoGastric Solutions StomaphyX™ device to alter the flow of gastric contents and repair gastric leaks resulting from bariatric revision surgery. Both patients were at a high risk and could not undergo another open or laparoscopic surgery to correct the leaks that were not healing. The StomaphyX procedures lasted approximately 30 min, were performed without any complications, and resulted in the resolution of the gastric leaks in both patients

Association between air pollution and asthma admission among children in Hong Kong

OBJECTIVE: To examine the association of air pollutants with hospital admission for childhood asthma in Hong Kong. METHODS: Data on hospital admissions for asthma, influenza and total hospital admissions in children aged ≤18 years at all Hospital Authority hospitals during 1997–2002 were obtained. Data on daily mean concentrations of particles with aerodynamic diameter <10 μm (i. e. PM(10)) and <2.5 μm (i. e. PM(2.5)), nitrogen dioxide (NO(2)), sulphur dioxide (SO(2)), and ozone (O(3)) and data on meteorological variables were associated with asthma hospital admissions using Poisson's regression with generalized additive models for correction of yearly trend, temperature, humidity, day-of-week effect, holiday, influenza admissions and total hospital admission. The possibility of a lag effect of each pollutant and the interaction of different pollutants were also examined. RESULTS: The association between asthma admission with change of NO(2), PM(10), PM(2.5) and O(3) levels remained significant after adjustment for multi-pollutants effect and confounding variables, with increase in asthma admission rate of 5.64% (3.21–8.14) at lag 3 for NO(2), 3.67% (1.52–5.86) at lag 4 for PM(10), 3.24% (0.93–5.60) at lag 4 for PM(2.5) and 2.63% (0.64–4.67) at lag 2 for O(3). Effect of SO(2) was lost after adjustment. CONCLUSION: Ambient levels of PM(10), PM(2.5), NO(2) and O(3) are associated with childhood asthma hospital admission in Hong Kong

Professionalism and Evolving Concepts of Quality

For much of the twentieth century, quality of care was defined specifically in terms of physician characteristics and behaviors. High-quality physicians were well trained, knowledgeable, skillful, and compassionate. More recently, quality of care has been defined in terms of systems of care. High-quality organizations develop and adopt practices to reduce adverse events and optimize outcomes. This essay discusses this transformation from physician-based to organization-based concepts of quality and the consequences for patient care and medical professionalism

Evolutionary stasis and lability in thermal physiology in a group of tropical lizards

Understanding how quickly physiological traits evolve is a topic of great interest, particularly in the context of how organisms can adapt in response to climate warming. Adjustment to novel thermal habitats may occur either through behavioural adjustments, physiological adaptation, or both. Here we test whether rates of evolution differ among physiological traits in the cybotoids, a clade of tropical Anolis lizards distributed in markedly different thermal environments on the Caribbean island of Hispaniola. We find that cold tolerance evolves considerably faster than heat tolerance, a difference that results because behavioural thermoregulation more effectively shields these organisms from selection on upper than lower temperature tolerances. Specifically, because lizards in very different environments behaviourally thermoregulate during the day to similar body temperatures, divergent selection on body temperature and heat tolerance is precluded, whereas night-time temperatures can only be partially buffered by behaviour, thereby exposing organisms to selection on cold tolerance. We discuss how exposure to selection on physiology influences divergence among tropical organisms and its implications for adaptive evolutionary response to climate warming

Hemangiopericytoma of the Greater Omentum

A 41-year-old Chinese woman was admitted to our hospital with epigastric pain. Computed tomography detected a heterogeneous enhancement tumor fed by the left gastroepiploic artery in the left lower quadrant and cholelithiasis. Excision of the tumor in the greater omentum and cholecystectomy were performed laparoscopically. Histological findings confirmed a diagnosis of hemangiopericytoma with low-grade malignancy. To our knowledge, hemangiopericytoma of the greater omentum is very rare, and only 12 cases were reported in English literature. We report a case of hemangiopericytoma arising in the greater omentum and review the literature

“I Kiss Them Because I Love Them”: The Emergence of Heterosexual Men Kissing in British Institutes of Education.

In this article, we combined data from 145 interviews and three ethnographic investigations of heterosexual male students in the U.K. from multiple educational settings. Our results indicate that 89% have, at some point, kissed another male on the lips which they reported as being non-sexual: a means of expressing platonic affection among heterosexual friends. Moreover, 37% also reported engaging in sustained same-sex kissing, something they construed as non-sexual and non-homosexual. Although the students in our study understood that this type of kissing remains somewhat culturally symbolized as a taboo sexual behavior, they nonetheless reconstructed it, making it compatible with heteromasculinity by recoding it as homosocial. We hypothesize that both these types of kissing behaviors are increasingly permissible due to rapidly decreasing levels of cultural homophobia. Furthermore, we argue that there has been a loosening of the restricted physical and emotional boundaries of traditional heteromasculinity in these educational settings, something which may also gradually assist in the erosion of prevailing heterosexual hegemony