Can the CalproQuest predict a positive Calprotectin test? A prospective diagnostic study

BACKGROUND: Diagnosis of inflammatory bowel disease (IBD) in primary care (PC) is challenging and associated with a considerable diagnostic delay. Using a calprotectin test for any PC patient with abdominal complaints would cause significant costs. The 8-item-questionnaire CalproQuest was developed to increase the pre-test probability for a positive Calprotectin. It is a feasible instrument to assess IBD in PC, but has not yet been evaluated in clinical routine. This study, therefore, aimed to validate whether the CalproQuest increases pretest-probability for a positive fecal Calprotectin. METHODS: Prospective diagnostic trial. The CalproQuest consists of 4 major and 4 minor questions suggestive for IBD. It is considered positive if ≥ 2 major or 1 major and 2 minor criteria are positive. Primary outcome: Sensitivity and specificity of the CalproQuest for Calprotectin levels ≥ 50 μg/g and for positive IBD diagnosis among patients referred to endoscopic evaluation at secondary care level. Secondary finding: Patient-reported diagnostic delay. RESULTS: 156 patients from 7 study centers had a complete CalproQuest and fecal Calprotectin test. The sensitivity and specificity of CalproQuest for Calprotectin ≥ 50 μg/g was 36% and 57%. The sensitivity and specificity of the CalproQuest for positive IBD diagnosis was 37% and 67%. The diagnostic delay was 61 months (SD 125.2). CONCLUSION: In this prospective diagnostic study, the sensitivity and specificity of CalproQuest for Calprotectin levels ≥ 50 μg/g and positive IBD diagnosis were poor. Additional prospective studies concerning the ideal cut-off values, validity and cost-effectiveness of a combined use with the Calprotectin test in the PC setting are necessary

What Do National Flags Stand for?: An Exploration of Associations Across 11 Countries

We examined the concepts and emotions people associate with their national flag, and how these associations are related to nationalism and patriotism across 11 countries. Factor analyses indicated that the structures of associations differed across countries in ways that reflect their idiosyncratic historical developments. Positive emotions and egalitarian concepts were associated with national flags across countries. However, notable differences between countries were found due to historical politics. In societies known for being peaceful and open-minded (e.g., Canada, Scotland), egalitarianism was separable from honor-related concepts and associated with the flag; in countries that were currently involved in struggles for independence (e.g., Scotland) and countries with an imperialist past (the United Kingdom), the flag was strongly associated with power-related concepts; in countries with a negative past (e.g., Germany), the primary association was sports; in countries with disruption due to separatist or extremist movements (e.g., Northern Ireland, Turkey), associations referring to aggression were not fully rejected; in collectivist societies (India, Singapore), obedience was linked to positive associations and strongly associated with the flag. In addition, the more strongly individuals endorsed nationalism and patriotism, the more they associated positive emotions and egalitarian concepts with their flag. Implications of these findings are discussed

What do national flags stand for? An exploration of associations across 11 countries

We examined the concepts and emotions people associate with their national flag, and how these associations are related to nationalism and patriotism across 11 countries. Factor analyses indicated that the structures of associations differed across countries in ways that reflect their idiosyncratic historical developments. Positive emotions and egalitarian concepts were associated with national flags across countries. However, notable differences between countries were found due to historical politics. In societies known for being peaceful and open-minded (e.g., Canada, Scotland), egalitarianism was separable from honor-related concepts and associated with the flag; in countries that were currently involved in struggles for independence (e.g., Scotland) and countries with an imperialist past (United Kingdom), the flag was strongly associated with power-related concepts; in countries with a negative past (e.g., Germany), the primary association was sports; in countries with disruption due to separatist or extremist movements (e.g., Northern Ireland, Turkey), aggression-related concepts were not disassociated; in collectivist societies (India, Singapore), obedience was linked to positive associations and strongly associated with the flag. In addition, the more strongly individuals endorsed nationalism and patriotism, the more they associated positive emotions and egalitarian concepts with their flag. Implications of these findings are discussed.PostprintPeer reviewe

Somatic mosaicism and common genetic variation contribute to the risk of very-early-onset inflammatory bowel disease

Very-early-onset inflammatory bowel disease (VEO-IBD) is a heterogeneous phenotype associated with a spectrum of rare Mendelian disorders. Here, we perform whole-exome-sequencing and genome-wide genotyping in 145 patients (median age-at-diagnosis of 3.5 years), in whom no Mendelian disorders were clinically suspected. In five patients we detect a primary immunodeficiency or enteropathy, with clinical consequences (XIAP, CYBA, SH2D1A, PCSK1). We also present a case study of a VEO-IBD patient with a mosaic de novo, pathogenic allele in CYBB. The mutation is present in ~70% of phagocytes and sufficient to result in defective bacterial handling but not life-threatening infections. Finally, we show that VEO-IBD patients have, on average, higher IBD polygenic risk scores than population controls (99 patients and 18,780 controls; P < 4 × 10-10), and replicate this finding in an independent cohort of VEO-IBD cases and controls (117 patients and 2,603 controls; P < 5 × 10-10). This discovery indicates that a polygenic component operates in VEO-IBD pathogenesis