Development and validation of a patient‐assessed gastroparesis symptom severity measure: the Gastroparesis Cardinal Symptom Index

SummaryBackground : Patient‐based symptom assessments are necessary to evaluate the effectiveness of medical treatments for gastroparesis.Aim : To summarize the development and measurement qualities of the Gastroparesis Cardinal Symptom Index (GCSI), a new measure of gastroparesis‐related symptoms.Methods : The GCSI was based on reviews of the medical literature, clinician interviews and patient focus groups. The measurement qualities (i.e. reliability, validity) of the GCSI were examined in 169 gastroparesis patients. Patients were recruited from seven clinical centres in the USA to participate in this observational study. Patients completed the GCSI, SF‐36 Health Survey and disability day questions at a baseline visit and again after 8 weeks. Clinicians independently rated the severity of the patients' symptoms, and both clinicians and patients rated the change in gastroparesis‐related symptoms over the 8‐week study.Results: The GCSI consists of three sub‐scales: post‐prandial fullness/early satiety, nausea/vomiting and bloating. The internal consistency reliability was 0.84 and the test–re‐test reliability was 0.76 for the GCSI total score. Significant relationships were observed between the clinician‐assessed symptom severity and the GCSI total score, and significant associations were found between the GCSI scores and SF‐36 physical and mental component summary scores and restricted activity and bed disability days. Patients with greater symptom severity, as rated by clinicians, reported greater symptom severity on the GCSI. The GCSI total scores were responsive to changes in overall gastroparesis symptoms as assessed by clinicians (P = 0.0002) and patients (P = 0.002).Conclusion: The findings of this study indicate that the GCSI is a reliable and valid instrument for measuring the symptom severity in patients with gastroparesis

Horn Fly Control and Growth Implants are Effective Strategies for Heifers Grazing Flint Hills Pasture

Horn flies (Haematobia irritans (L.)) are considered the most important external parasite that negatively affects pasture-based beef systems with losses estimated to exceed $1 billion annually to the U.S. beef industry. Control strategies have relied heavily on insecticide applications to control horn flies and are implemented when the economic threshold of 200 flies/animal have been exceeded. When horn fly populations are maintained below 200 flies/animal by treating them with insecticides then the level of stress annoyance behaviors such as leg stomping, head throwing, and skin twitching decreases while grazing increases. While most stocker operators utilize some type of fly control these are rarely used as a single pharmaceutical technology to aid in performance of the animals. Additional pharmaceutical technologies are utilized in combination of others, with the use of de-wormers and implants showing the largest impact with performance of stockers. The objective of this study was to compare a commercial injectable insecticide, LongRange, to an insecticidal ear tag for horn fly control and determine the impact of weight performance on stockers when fly control technologies were used in combination with implants versus no implants

Atmosphere-ocean coupled processes in the Madden-Julian oscillation

The Madden-Julian oscillation (MJO) is a convectively coupled 30-70 day (intraseasonal) tropical atmospheric mode that drives variations in global weather, but which is poorly simulated in most atmospheric general circulation models. Over the past two decades, field campaigns and modeling experiments have suggested that tropical atmosphere-ocean interactions may sustain or amplify the pattern of enhanced and suppressed atmospheric convection that defines the MJO, and encourage its eastward propagation through the Indian and Pacific Oceans. New observations collected during the past decade have advanced our understand of the ocean response to atmospheric MJO forcing and the resulting intraseasonal sea surface temperature (SST) fluctuations. Numerous modeling studies have revealed a considerable impact of the mean state on MJO ocean-atmosphere coupled processes, as well as the importance of resolving the diurnal cycle of atmosphere--upper-ocean interactions. New diagnostic methods provide insight to atmospheric variability and physical processes associated with the MJO, but offer limited insight on the role of ocean feedbacks. Consequently, uncertainty remains concerning the role of the ocean in MJO theory. Our understanding of how atmosphere-ocean coupled processes affect the MJO can be improved by collecting observations in poorly sampled regions of MJO activity, assessing oceanic and atmospheric drivers of surface fluxes, improving the representation of upper-ocean mixing in coupled-model simulations, designing model experiments that minimize mean-state differences, and developing diagnostic tools to evaluate the nature and role of coupled ocean-atmosphere processes over the MJO cycle

Surveillance of RNase P, PMMoV, and CrAssphage in wastewater as indicators of human fecal concentration across urban sewer neighborhoods, Louisville, Kentucky

Wastewater surveillance has been widely used as a supplemental method to track the community infection levels of severe acute respiratory syndrome coronavirus 2. A gap exists in standardized reporting for fecal indicator concentrations, which can be used to calibrate the primary outcome concentrations from wastewater monitoring for use in epidemiological models. To address this, measurements of fecal indicator concentration among wastewater samples collected from sewers and treatment centers in four counties of Kentucky (N = 650) were examined. Results from the untransformed wastewater data over 4 months of sampling indicated that the fecal indicator concentration of human ribonuclease P (RNase P) ranged from 5.1 × 101 to 1.15 × 106 copies/ml, pepper mild mottle virus (PMMoV) ranged from 7.23 × 103 to 3.53 × 107 copies/ml, and cross-assembly phage (CrAssphage) ranged from 9.69×103 to 1.85×108 copies/ml. The results showed both regional and temporal variability. If fecal indicators are used as normalization factors, knowing the daily sewer system flow of the sample location may matter more than rainfall. RNase P, while it may be suitable as an internal amplification and sample adequacy control, has less utility than PMMoV and CrAssphage as a fecal indicator in wastewater samples when working at different sizes of catchment area. The choice of fecal indicator will impact the results of surveillance studies using this indicator to represent fecal load. Our results contribute broadly to an applicable standard normalization factor and assist in interpreting wastewater data in epidemiological modeling and monitoring

Abuse in Women and Men with and without Functional Gastrointestinal Disorders

We aimed to investigate the history of abuse in childhood and adulthood and health-related quality of life (HRQL) in women and men with FGID in the general adult population. A cross-sectional study in a random population sample (n = 1,537, 20–87 years) living in Östhammar municipality, Sweden, in 1995 was performed. Persons with FGID (n = 141) and a group of abdominal symptom-free controls (SSF, n = 97) were selected by means of a validated questionnaire assessing gastrointestinal symptoms (the ASQ). Abuse, anxiety and depression (the HADS) and HRQL (the PGWB) were measured. Women with FGID had a higher risk of having a history of some kind of abuse, as compared with the SSF controls (45% vs.16%, OR = 2.0, 95% CI: 1.01–3.9; SSF = 1), in contrast to men (29% vs. 24% n.s.). Women with a history of abuse and FGID had reduced HRQL 91 (95% CI 85–97) as compared with women without abuse history 100 (95% CI 96–104, P = 0.01, “healthy” = 102–105 on PGWB). Childhood emotional abuse was a predictor for consulting with OR = 4.20 (95% CI: 1.12–15.7.7). Thus, previous abuse is common in women with FGID and must be considered by the physician for diagnosis and treatment of the disorder

Ocean circulation and Tropical Variability in the Coupled Model ECHAM5/MPI-OM

This paper describes the mean ocean circulation and the tropical variability simulated by the Max Planck Institute for Meteorology (MPI-M) coupled atmosphere–ocean general circulation model (AOGCM). Results are presented from a version of the coupled model that served as a prototype for the Intergovernmental Panel on Climate Change (IPCC) Fourth Assessment Report (AR4) simulations. The model does not require flux adjustment to maintain a stable climate. A control simulation with present-day greenhouse gases is analyzed, and the simulation of key oceanic features, such as sea surface temperatures (SSTs), large-scale circulation, meridional heat and freshwater transports, and sea ice are compared with observations. A parameterization that accounts for the effect of ocean currents on surface wind stress is implemented in the model. The largest impact of this parameterization is in the tropical Pacific, where the mean state is significantly improved: the strength of the trade winds and the associated equatorial upwelling weaken, and there is a reduction of the model’s equatorial cold SST bias by more than 1 K. Equatorial SST variability also becomes more realistic. The strength of the variability is reduced by about 30% in the eastern equatorial Pacific and the extension of SST variability into the warm pool is significantly reduced. The dominant El Niño–Southern Oscillation (ENSO) period shifts from 3 to 4 yr. Without the parameterization an unrealistically strong westward propagation of SST anomalies is simulated. The reasons for the changes in variability are linked to changes in both the mean state and to a reduction in atmospheric sensitivity to SST changes and oceanic sensitivity to wind anomalies

Psychological illness is commonly associated with functional gastrointestinal disorders and is important to consider during patient consultation: a population-based study

BACKGROUND: Some individuals with functional gastrointestinal disorders (FGID) suffer long-lasting symptoms without ever consulting their doctors. Our aim was to study co-morbidity and lifestyle differences among consulters and non-consulters with persistent FGID and controls in a defined adult population. METHODS: A random sample of the general adult Swedish population was obtained by a postal questionnaire. The Abdominal Symptom Questionnaire (ASQ) was used to measure GI symptomatology and grade of GI symptom severity and the Complaint Score Questionnaire (CSQ) was used to measure general symptoms. Subjects were then grouped for study by their symptomatic profiles. Subjects with long-standing FGID (n = 141) and subjects strictly free from gastrointestinal (GI) symptoms (n = 97) were invited to attend their local health centers for further assessment. RESULTS: Subjects with FGID have a higher risk of psychological illness [OR 8.4, CI(95)(4.0–17.5)] than somatic illness [OR 2.8, CI(95)(1.3–5.7)] or ache and fatigue symptoms [OR 4.3, CI(95)(2.1–8.7)]. Subjects with psychological illness have a higher risk of severe GI symptoms than controls; moreover they have a greater chance of being consulters. Patients with FGID have more severe GI symptoms than non-patients. CONCLUSION: There is a strong relation between extra-intestinal, mental and somatic complaints and FGID in both patients and non-patients. Psychological illness increases the chance of concomitantly having more severe GI symptoms, which also enhance consultation behaviour