Management of Cardiopulmonary Complications of Cirrhosis

Advanced portal hypertension accompanying end-stage liver disease results in an altered milieu due to inadequate detoxification of blood from splanchnic circulation by the failing liver. The portosystemic shunts with hepatic dysfunction result in an increased absorption and impaired neutralisation of the gastrointestinal bacteria and endotoxins leads to altered homeostasis with multiorgan dysfunction. The important cardiopulmonary complications are cirrhotic cardiomyopathy, hepatopulmonary syndrome, portopulmonary hypertension, and right-sided hydrothorax

Cassia occidentalis poisoning as the probable cause of hepatomyoencephalopathy in children in western Uttar Pradesh

Background & objectives: Recurrent annual outbreaks of acute encephalopathy illness affecting young children have been reported for several years in many districts of western Uttar Pradesh (UP). Our earlier investigations over three consecutive years (2002-2005) proved that these outbreaks were due to a fatal multi-system disease (hepatomyoencephalopathy syndrome) probably caused by some phytotoxin and not due to viral encephalitis as believed so far. We conducted a case-control study to investigate the risk, if any, from various environmental factors and also to identify the putative toxic plant responsible for development of this syndrome. Methods: Eighteen cases with acute hepatomyoencephalopathy syndrome admitted in 2005 in a secondary care paediatric hospital of Bijnor district of western UP were included in the study. Three age-matched controls were selected for each case. A semi-structured questionnaire was developed and applied to all 18 cases and 54 controls. All interviews were conducted within one week of discharge or death of each case. Quantitative data were analyzed using the relevant established statistical tests. Results: Parents of 8 (44.4%) cases gave a definite history of their children eating beans of Cassia occidentalis weed before falling ill, compared with 3 (5.6% controls), the odds ratio being 12.9 (95% CI 2.6-88.8, P<0.001). History of pica was the other associated factor with the disease, odds ratio 5.20 (95% CI 1.4-19.5, P<0.01). No other factor was found significantly associated with the disease. Interpretation & conclusions: Consumption of C. occidentalis beans probably caused these outbreaks, described earlier as hepatomyoencephalopathy syndrome. Public education has the potential to prevent future outbreaks

Amplification of Fluctuations in Unstable Systems with Disorder

We study the early-stage kinetics of thermodynamically unstable systems with quenched disorder. We show analytically that the growth of initial fluctuations is amplified by the presence of disorder. This is confirmed by numerical simulations of morphological phase separation (MPS) in thin liquid films and spinodal decomposition (SD) in binary mixtures. We also discuss the experimental implications of our results.Comment: 15 pages, 4 figure

Frequent Financial Reporting and Managerial Myopia

Using the transition of US firms from annual reporting to semi-annual reporting and then to quarterly reporting over the period 1950-1970, we provide evidence on the effects of increased reporting frequency on firms’ investment decisions. Estimates from difference-in-differences specifications indicate that increased reporting frequency is associated with an economically large decline in investments. Additional analyses reveal that the decline in investments is most consistent with frequent financial reporting inducing myopic management behavior. Our evidence informs the recent controversial debate about eliminating quarterly reporting for US corporations

Examining trends in the representation of young people and alcohol in Australian newspapers over twenty years (2000-2019)

Background: The news media can reflect and influence public opinion, as well as affect individual practice. In the context of significant changes in alcohol consumption among young people over the past twenty years, we examined Australian newspaper reporting of young people (under 18 years) and alcohol to assess whether there have been changes over time in the content and slant of articles that reflect or elucidate these trends. Methods: Factiva was used to search newspaper articles from major Australian newspapers over a twenty year period (2000-2019). After screening, two researchers coded 2,415 newspaper articles across four key domains: article type, article theme, sources cited and topic slant (e.g. approving, disapproving tone). Change over time across the study period was assessed using joinpoint Poisson regression analyses. Results: There was a significant increase in articles on young people and alcohol between 2000 and 2008, before a corresponding decrease to 2019. Policy or prevention strategies were the most common theme of articles (35.8%), followed by articles reporting on risks or harms associated with alcohol use for young people (18.1%). Researchers were the most common source reported (25.1%), followed by politicians (19.0%). Three quarters of articles (75.9%) had a socially disapproving topic slant, which increased significantly up until 2011, with a corresponding decrease thereafter. Conclusion: Attention to, and problematisation of, young people and alcohol increased in the first decade of this millennium which may have acted to sustain or accelerate declining drinking trends. However, this dissipated back to baseline levels in the second decade, which may indicate a lag time in recognition of young people’s drinking becoming less of a public health ‘problem’

Declining drinking among adolescents: are we seeing a denormalisation of drinking and a normalisation of non-drinking?

Background In the early 2000s, alcohol use among young people began to decline in many western countries, especially among adolescents (aged between 12-17 years old). These declines have continued steadily over the past two decades, against the backdrop of much smaller declines among the general population. Argument Hypotheses examining individual factors fail adequately to provide the necessary ‘big picture’ thinking needed to understand declines in adolescent drinking. We use the normalisation thesis to argue that there is strong international evidence for both processes of denormalisation of drinking and normalisation of non-drinking occurring for adolescents in many western countries. Conclusions Research on declining adolescent drinking provides evidence of both denormalisation of alcohol consumption and normalisation of non-drinking. This has implications for enabling policy environments more amenable to regulation and increasing the acceptability of non-drinking in social contexts. Normalisation theory (and its various interpretations) provides a useful multi-dimensional tool for understanding declines in adolescent drinking

Response to commentaries: (de)normalization of drinking and its implications for young people, sociality, culture and epidemiology

Commentar

Why is adolescent drinking declining? A systematic review and narrative synthesis

Background: Adolescent drinking has declined across many developed countries from the turn of the century. The aim of this review is to explore existing evidence examining possible reasons for this decline. Methods: We conducted systematic searches across five databases: Medline, PsycINFO, CINAHL, Informit Health and Scopus. Studies were included if association between declining alcohol consumption and potential explanatory factors were measured over time. Narrative synthesis was undertaken due to substantial methodological heterogeneity in these studies. Results: 17 studies met the inclusion criteria. Five studies found moderate evidence for changes in parental practices as a potential cause for the decline. Five studies that examined whether alcohol policy changes influenced the decline found weak evidence of association. Three studies explored whether alcohol use has been substituted by illicit substances but no evidence was found. Two studies examined the effect of a weaker economy; both identified increase in adolescent alcohol use during times of economic crisis. One study indicated that changes in exposure to alcohol advertising were positively associated with the decline and another examined the role of immigration of non-drinking populations but found no evidence of association. One study tested participation in organised sports and party lifestyle as a potential cause but did not use robust analytical methods and therefore did not provide strong evidence of association for the decline. Conclusions: The most robust and consistent evidence was identified for shifts in parental practices. Further research is required using robust analytical methods such as ARIMA modelling techniques and utilising cross-national data

Trends in the sequence of first alcohol, cannabis and cigarette use in Australia, 2001–2016

Background Recent analyses of data from the US found that young people were increasingly engaging in cannabis use before alcohol and cigarettes. These shifts are important for public health, but it is not clear whether such trends extend beyond the US. The aim of this study is to examine whether and how the age and sequencing of initiation into alcohol, cannabis and cigarette use has changed in Australia since the early 2000s. Methods Data came from six waves of the Australian National Drug Strategy Household Survey, spanning 2001–2016. We used data from 18 to 21 year-olds (n = 6849) and examined trends in the age at first use for each of the three substances plus any changes in the order of initiation. Results The mean age of initiation increased steadily for all three substances (e.g. from 14.9 in 2001 to 16.4 in 2016 for alcohol), while the prevalence of any use declined. There were some changes in ordering of use. For example, in 2001, 62 % of respondents who used both cigarettes and cannabis had first used cigarettes at an earlier age than cannabis, compared with 41 % in 2016. Young people who used both alcohol and cannabis remained more likely to try alcohol before cannabis across the study period. Conclusions Our results partly replicated US findings, with differences potentially reflecting the substantially different environment around these substances in the US compared to Australia. The age of initiation for alcohol, cigarette and cannabis use in Australia has increased sharply over the past 15 years

Registration between DCT and EBSD datasets for multiphase microstructures

The ability to characterise the three-dimensional microstructure of multiphase materials is essential for understanding the interaction between phases and associated materials properties. Here, laboratory-based diffraction-contrast tomography (DCT), a recently-established materials characterization technique that can determine grain phases, morphologies, positions and orientations in a voxel-based reconstruction method, was used to map part of a dual-phase steel alloy sample. To assess the resulting microstructures that were produced by the DCT technique, an EBSD map was collected within the same sample volume. To identify the 2D slice of the 3D DCT reconstruction that best corresponded to the EBSD map, a novel registration technique based solely on grain-averaged orientations was developed -- this registration technique requires very little a priori knowledge of dataset alignment and can be extended to other techniques that only recover grain-averaged orientation data such as far-field 3D X-ray diffraction microscopy. Once the corresponding 2D slice was identified in the DCT dataset, comparisons of phase balance, grain size, shape and texture were performed between DCT and EBSD techniques. More complicated aspects of the microstructural morphology such as grain boundary shape and grains less than a critical size were poorly reproduced by the DCT reconstruction, primarily due to the difference in resolutions of the technique compared with EBSD. However, lab-based DCT is shown to accurately determine the centre-of-mass position, orientation, and size of the large grains for each phase present, austenite and martensitic ferrite. The results reveals a complex ferrite grain network of similar crystal orientations that are absent from the EBSD dataset. Such detail demonstrates that lab-based DCT, as a technique, shows great promise in the field of multi-phase material characterization.Comment: 15 pages, 11 figures. Preprint submitted to Materials Characterizatio