The goitrous conditions of the thyroid gland

In presenting this study of the Pathology of Goitre I would like to make it clear that the work arose as a corollary to a more general inquiry into the problems of *Protein* disturbances both dietetic and inflammatory. The first observations were made, post mortem, on children that had died from unexplained causes after a tentative clinical diagnosis of dietetic disturbance varying from anaphylaxis to diarrhoea and vomiting. It became apparent that children could be placed in one of three groups: — normal, lymphoid, or alymphoid, if attention were directed to the thymus, spleen, pyloric mucosa, appendix and tonsils (faucial and pharyngeal). Associated with this there appeared in certain sites in the peritoneum (pyloric and caeco-appendicular) changes in the fat tissue which seemed to vary in its lymphoid character with the thymus - perhaps like the thymus the range of its meta-trophy is between lymphocytes and fat - in an endothelial organ. From this attention was soon called to the thyroid gland, Graves' disease, and to the histopathology of appendicitis and gastric ulcer by reason of the constant lymphocytic reaction presented in these conditions

Vertical integration and firm boundaries : the evidence

Since Ronald H. Coase's (1937) seminal paper, a rich set of theories has been developed that deal with firm boundaries in vertical or input–output structures. In the last twenty-five years, empirical evidence that can shed light on those theories also has been accumulating. We review the findings of empirical studies that have addressed two main interrelated questions: First, what types of transactions are best brought within the firm and, second, what are the consequences of vertical integration decisions for economic outcomes such as prices, quantities, investment, and profits. Throughout, we highlight areas of potential cross-fertilization and promising areas for future work

Innovation in Diabetes - Ideas and Initiatives

A collection of multiple reports on MyDiabetesMyWay (MDMW). Included reports are: MyDiabetesMyWay Patient Portal; MyDiabetesMyWay e-learning hub (Moodle) ; SCI-diabetes/ MDMW Communication Portal- Tools for Remote Communication/ Consultation; Risk Modelling for Care Planning- integration into Informatics Dashboard for Clinical Use; Access to Chronic Medication Service (CMS) and Pharmaceutical Care Planning Medication and Lifestyle Coaching; Multi-media Diabetes Resources; Promoting Diabetes Education; Tele-Pharmacy; Understanding my diabetes medication; Pharmaceutical Industry and Medical Technology (PIMTs); An on-line and interactive education system for young people with type 1 diabetes to understand self-management for their lifestyle; Proof of Concept study to deliver personalised use of information to support diabetes management and behaviour change; right information; right time; right way; Virtual promotion of physical activity for people with type 2 diabetes; Remote foot ulcer management: RAPID (Reducing Amputation in People with Diabetes); Diabetic foot screening – development of technology; Portable capillary HbA1c testing for diagnosis and self-monitoring of diabetes; Possibility of mobile phone adaption for testing; Web app for decision support for patients with type 1 diabetes undertaking sport or exercise; Online level 3 structured education for type 1 diabetes; My Diabetes My Way electronic personal health record – uptake at scale; TeleClinics for diabetes; Develop a diabetes sim / game in which the main character has diabetes. Young people need to keep the sim / character alive as they face the various challenges of life or the game; Development of meaningful automated glucose data to in-patient clinical areas; In-patient Care: Integrated eHealth solutions to improve patient care, safety and outcomes; Innovative model of care to address the 'process of care' in managing people with long term conditions; Young Persons Remote Clinic Consultation; Maximise use of the data to support self-management of patients with co-morbidities; Virtual practice outreach and education in primary care

Baseline characteristics of people experiencing homelessness with a recent drug overdose in the PHOENIx pilot randomised controlled trial

Background: Drug-related deaths in Scotland are the highest in Europe. Half of all deaths in people experiencing homelessness are drug related, yet we know little about the unmet health needs of people experiencing homelessness with recent non-fatal overdose, limiting a tailored practice and policy response to a public health crisis. Methods: People experiencing homelessness with at least one non-fatal street drug overdose in the previous 6 months were recruited from 20 venues in Glasgow, Scotland, and randomised into PHOENIx plus usual care, or usual care. PHOENIx is a collaborative assertive outreach intervention by independent prescriber NHS Pharmacists and third sector homelessness workers, offering repeated integrated, holistic physical, mental and addictions health and social care support including prescribing. We describe comprehensive baseline characteristics of randomised participants. Results: One hundred and twenty-eight participants had a mean age of 42 years (SD 8.4); 71% male, homelessness for a median of 24 years (IQR 12–30). One hundred and eighteen (92%) lived in large, congregate city centre temporary accommodation. A quarter (25%) were not registered with a General Practitioner. Participants had overdosed a mean of 3.2 (SD 3.2) times in the preceding 6 months, using a median of 3 (IQR 2–4) non-prescription drugs concurrently: 112 (87.5%) street valium (benzodiazepine-type new psychoactive substances); 77 (60%) heroin; and 76 (59%) cocaine. Half (50%) were injecting, 50% into their groins. 90% were receiving care from Alcohol and Drug Recovery Services (ADRS), and in addition to using street drugs, 90% received opioid substitution therapy (OST), 10% diazepam for street valium use and one participant received heroin-assisted treatment. Participants had a mean of 2.2 (SD 1.3) mental health problems and 5.4 (SD 2.5) physical health problems; 50% received treatment for physical or mental health problems. Ninety-one per cent had at least one mental health problem; 66% had no specialist mental health support. Participants were frail (70%) or pre-frail (28%), with maximal levels of psychological distress, 44% received one or no daily meal, and 58% had previously attempted suicide. Conclusions: People at high risk of drug-related death continue to overdose repeatedly despite receiving OST. High levels of frailty, multimorbidity, unsuitable accommodation and unmet mental and physical health care needs require a reorientation of services informed by evidence of effectiveness and cost-effectiveness. Trial registration UK Clinical Trials Registry identifier: ISRCTN 10585019

Angular Power Spectra of the Millimeter Wavelength Background Light from Dusty Star-forming Galaxies with the South Pole Telescope

We use data from the first 100 square-degree field observed by the South Pole Telescope (SPT) in 2008 to measure the angular power spectrum of temperature anisotropies contributed by the background of dusty star-forming galaxies (DSFGs) at millimeter wavelengths. From the auto and cross-correlation of 150 and 220 GHz SPT maps, we significantly detect both Poisson distributed and, for the first time at millimeter wavelengths, clustered components of power from a background of DSFGs. The spectral indices between 150 and 220 GHz of the Poisson and clustered components are found to be 3.86 +- 0.23 and 3.8 +- 1.3 respectively, implying a steep scaling of the dust emissivity index beta ~ 2. The Poisson and clustered power detected in SPT, BLAST (at 600, 860, and 1200 GHz), and Spitzer (1900 GHz) data can be understood in the context of a simple model in which all galaxies have the same graybody spectrum with dust emissivity index of beta = 2 and dust temperature T_d = 34 K. In this model, half of the 150 GHz background light comes from redshifts greater than 3.2. We also use the SPT data to place an upper limit on the amplitude of the kinetic Sunyaev-Zel'dovich power spectrum at l = 3000 of 13 uK^2 at 95% confidence.Comment: 18 pages, 9 figure

A measurement of secondary cosmic microwave background anisotropies with two years of South Pole Telescope observations

We present the first three-frequency South Pole Telescope (SPT) cosmic microwave background (CMB) power spectra. The band powers presented here cover angular scales 2000 < ell < 9400 in frequency bands centered at 95, 150, and 220 GHz. At these frequencies and angular scales, a combination of the primary CMB anisotropy, thermal and kinetic Sunyaev-Zel'dovich (SZ) effects, radio galaxies, and cosmic infrared background (CIB) contributes to the signal. We combine Planck and SPT data at 220 GHz to constrain the amplitude and shape of the CIB power spectrum and find strong evidence for non-linear clustering. We explore the SZ results using a variety of cosmological models for the CMB and CIB anisotropies and find them to be robust with one exception: allowing for spatial correlations between the thermal SZ effect and CIB significantly degrades the SZ constraints. Neglecting this potential correlation, we find the thermal SZ power at 150 GHz and ell = 3000 to be 3.65 +/- 0.69 muK^2, and set an upper limit on the kinetic SZ power to be less than 2.8 muK^2 at 95% confidence. When a correlation between the thermal SZ and CIB is allowed, we constrain a linear combination of thermal and kinetic SZ power: D_{3000}^{tSZ} + 0.5 D_{3000}^{kSZ} = 4.60 +/- 0.63 muK^2, consistent with earlier measurements. We use the measured thermal SZ power and an analytic, thermal SZ model calibrated with simulations to determine sigma8 = 0.807 +/- 0.016. Modeling uncertainties involving the astrophysics of the intracluster medium rather than the statistical uncertainty in the measured band powers are the dominant source of uncertainty on sigma8 . We also place an upper limit on the kinetic SZ power produced by patchy reionization; a companion paper uses these limits to constrain the reionization history of the Universe.Comment: 25 pages; 14 figures; Submitted to ApJ (Updated to reflect referee comments

Risk of Injection-Site Abscess among Infants Receiving a Preservative-Free, Two-Dose Vial Formulation of Pneumococcal Conjugate Vaccine in Kenya.

There is a theoretical risk of adverse events following immunization with a preservative-free, 2-dose vial formulation of 10-valent-pneumococcal conjugate vaccine (PCV10). We set out to measure this risk. Four population-based surveillance sites in Kenya (total annual birth cohort of 11,500 infants) were used to conduct a 2-year post-introduction vaccine safety study of PCV10. Injection-site abscesses occurring within 7 days following vaccine administration were clinically diagnosed in all study sites (passive facility-based surveillance) and, also, detected by caregiver-reported symptoms of swelling plus discharge in two sites (active household-based surveillance). Abscess risk was expressed as the number of abscesses per 100,000 injections and was compared for the second vs first vial dose of PCV10 and for PCV10 vs pentavalent vaccine (comparator). A total of 58,288 PCV10 injections were recorded, including 24,054 and 19,702 identified as first and second vial doses, respectively (14,532 unknown vial dose). The risk ratio for abscess following injection with the second (41 per 100,000) vs first (33 per 100,000) vial dose of PCV10 was 1.22 (95% confidence interval [CI] 0.37-4.06). The comparator vaccine was changed from a 2-dose to 10-dose presentation midway through the study. The matched odds ratios for abscess following PCV10 were 1.00 (95% CI 0.12-8.56) and 0.27 (95% CI 0.14-0.54) when compared to the 2-dose and 10-dose pentavalent vaccine presentations, respectively. In Kenya immunization with PCV10 was not associated with an increased risk of injection site abscess, providing confidence that the vaccine may be safely used in Africa. The relatively higher risk of abscess following the 10-dose presentation of pentavalent vaccine merits further study

Detailed SZ study of 19 LoCuSS galaxy clusters: masses and temperatures out to the virial radius

We present 16-GHz AMI SZ observations of 19 clusters with L_X >7x10^37 W (h50=1) selected from the LoCuS survey (0.142<z<0.295) and of A1758b, in the FoV of A1758a. We detect 17 clusters with 5-23sigma peak surface brightnesses. Cluster parameters are obtained using a Bayesian cluster analysis. We fit isothermal beta-models to our data and assume the clusters are virialized (with all the kinetic energy in gas internal energy). Our gas temperature, T_AMI, is derived from AMI SZ data, not from X-ray spectroscopy. Cluster parameters internal to r500 are derived assuming HSE. We find: (i) Different gNFW parameterizations yield significantly different parameter degeneracies. (ii) For h70 = 1, we find the virial radius r200 to be typically 1.6+/-0.1 Mpc and the total mass M_T(r200) typically to be 2.0-2.5xM_T(r500).(iii) Where we have found M_T X-ray (X) and weak-lensing (WL) values in the literature, there is good agreement between WL and AMI estimates (with M_{T,AMI}/M_{T,WL} =1.2^{+0.2}_{-0.3} and =1.0+/-0.1 for r500 and r200, respectively). In comparison, most Suzaku/Chandra estimates are higher than for AMI (with M_{T,X}/M_{T,AMI}=1.7+/-0.2 within r500), particularly for the stronger mergers.(iv) Comparison of T_AMI to T_X sheds light on high X-ray masses: even at large r, T_X can substantially exceed T_AMI in mergers. The use of these higher T_X values will give higher X-ray masses. We stress that large-r T_SZ and T_X data are scarce and must be increased. (v) Despite the paucity of data, there is an indication of a relation between merger activity and SZ ellipticity. (vi) At small radius (but away from any cooling flow) the SZ signal (and T_AMI) is less sensitive to ICM disturbance than the X-ray signal (and T_X) and, even at high r, mergers affect n^2-weighted X-ray data more than n-weighted SZ, implying significant shocking or clumping or both occur even in the outer parts of mergers.Comment: 45 pages, 33 figures, 13 tables Accepted for publication in MNRA