Faecal haemoglobin and faecal calprotectin as indicators of bowel disease in patients presenting to primary care with bowel symptoms

OBJECTIVE: In primary care, assessing which patients with bowel symptoms harbour significant disease (cancer, higher-risk adenoma or IBD) is difficult. We studied the diagnostic accuracies of faecal haemoglobin (FHb) and faecal calprotectin (FC) in a cohort of symptomatic patients. DESIGN: From October 2013 to March 2014, general practitioners were prompted to request FHb and FC when referring patients with bowel symptoms to secondary care. Faecal samples were analysed for haemoglobin (EIKEN OC-Sensor io) and calprotectin (BÜHLMANN Calprotectin ELISA). Patients triaged to endoscopy were investigated within 6 weeks. All clinicians and endoscopists were blind to the faecal test results. The diagnostic accuracies of FHb and FC for identification of significant bowel disease were assessed. RESULTS: 1043 patients returned samples. FHb was detectable in 57.6% (median 0.4 µg/g, 95% CI 0.4 to 0.8; range 0–200). FC at 50 µg/g or above was present in 60.0%. 755 patients (54.6% women, median age 64 years (range 16–90, IQR 52–73)) returned samples and completed colonic investigations. 103 patients had significant bowel disease; the negative predictive values of FHb for colorectal cancer, higher-risk adenoma and IBD were 100%, 97.8% and 98.4%, respectively. Using cut-offs of detectable FHb and/or 200 µg/g FC detected two further cases of IBD, one higher-risk adenoma and no additional cancers. CONCLUSIONS: In primary care, undetectable FHb is a good ‘rule-out’ test for significant bowel disease and could guide who requires investigation

Ozanimod for treating moderately to severely active ulcerative colitis [ID3841] A Single Technology Appraisal

This report was commissioned by the NIHR Systematic Reviews Programme as project number 13/54/43Executive Summary: This summary provides a brief overview of the key issues identified by the evidence review group (ERG) as being potentially important for decision-making. It also includes the ERG’s preferred assumptions and the resulting incremental cost-effectiveness ratios (ICERs). • Section 1.1 provides an overview of the key issues and the differences in the assumptions of the company and the ERG in economic analysis. • Section 1.2 provides an overview of key model outcomes and the modelling assumptions that have the greatest effect on the ICER. • Sections 1.3 to 1.5 explain the key issues in more detail. Background information on the condition, technology and evidence and information on non-key issues are in the main ERG report. • Sections 1.6 and 1.7 provide an overview of the ERG’s preferred base case and sensitivity analyses undertaken by the ERG. All issues identified represent the ERG’s view, not the opinion of the National Institute for Health and Care Excellence (NICE)

Endophytic bacterial community composition in wheat (Triticum aestivum) is determined by plant tissue type, developmental stage and soil nutrient availability

Aims: To understand effects of tissue type, growth stage and soil fertilisers on bacterial endophyte communities of winter wheat (Triticum aestivum cv. Hereward). Methods: Endophytes were isolated from wheat grown under six fertiliser conditions in the long term Broadbalk Experiment at Rothamsted Research, UK. Samples were taken in May and July from root and leaf tissues. Results: Root and leaf communities differed in abundance and composition of endophytes. Endophytes were most abundant in roots and the Proteobacteria were most prevalent. In contrast, Firmicutes and Actinobacteria, the Gram positive phyla, were most prevalent in the leaves. Both fertiliser treatment and sample time influenced abundance and relative proportions of each phylum and genus in the endosphere. A higher density of endophytes was found in the Nil input treatment plants. Conclusions: Robust isolation techniques and stringent controls are critical for accurate recovery of endophytes. The plant tissue type, plant growth stage, and soil fertiliser treatment all contribute to the composition of the endophytic bacterial community in wheat. These results should help facilitate targeted development of endophytes for beneficial applications in agriculture

The material soul: Strategies for naturalising the soul in an early modern epicurean context

We usually portray the early modern period as one characterised by the ‘birth of subjectivity’ with Luther and Descartes as two alternate representatives of this radical break with the past, each ushering in the new era in which ‘I’ am the locus of judgements about the world. A sub-narrative called ‘the mind-body problem’ recounts how Cartesian dualism, responding to the new promise of a mechanistic science of nature, “split off” the world of the soul/mind/self from the world of extended, physical substance—a split which has preoccupied the philosophy of mind up until the present day. We would like to call attention to a different constellation of texts—neither a robust ‘tradition’ nor an isolated ‘episode’, somewhere in between—which have in common their indebtedness to, and promotion of an embodied, Epicurean approach to the soul. These texts follow the evocative hint given in Lucretius’ De rerum natura that ‘the soul is to the body as scent is to incense’ (in an anonymous early modern French version). They neither assert the autonomy of the soul, nor the dualism of body and soul, nor again a sheer physicalism in which ‘intentional’ properties are reduced to the basic properties of matter. Rather, to borrow the title of one of these treatises (L’Âme Matérielle), they seek to articulate the concept of a material soul. We reconstruct the intellectual development of a corporeal, mortal and ultimately material soul, in between medicine, natural philosophy and metaphysics, including discussions of Malebranche and Willis, but focusing primarily on texts including the 1675 Discours anatomiques by the Epicurean physician Guillaume Lamy; the anonymous manuscript from circa 1725 entitled L’Âme Matérielle, which is essentially a compendium of texts from the later seventeenth century (Malebranche, Bayle) along with excerpts from Lucretius; and materialist writings such Julien Offray de La Mettrie’s L’Homme-Machine (1748), in order to articulate this concept of a ‘material soul’ with its implications for notions of embodiment, materialism and selfhood

Social Competitiveness and Plasticity of Neuroendocrine Function in Old Age: Influence of Neonatal Novelty Exposure and Maternal Care Reliability

Early experience is known to have a profound impact on brain and behavioral function later in life. Relatively few studies, however, have examined whether the effects of early experience remain detectable in the aging animal. Here, we examined the effects of neonatal novelty exposure, an early stimulation procedure, on late senescent rats' ability to win in social competition. During the first 3 weeks of life, half of each litter received daily 3-min exposures to a novel environment while the other half stayed in the home cage. At 24 months of age, pairs of rats competed against each other for exclusive access to chocolate rewards. We found that novelty-exposed rats won more rewards than home-staying rats, indicating that early experience exerts a life-long effect on this aspect of social dominance. Furthermore, novelty-exposed but not home-staying rats exhibited habituation of corticosterone release across repeated days of social competition testing, suggesting that early experience permanently enhances plasticity of the stress response system. Finally, we report a surprising finding that across individual rat families, greater effects of neonatal novelty exposure on stress response plasticity were found among families whose dams provided more reliable, instead of a greater total quantity of, maternal care

Changing portrayals of medicine and patients in eighteenth-century medical writing : Lexical bundles in Public Health, Methods, and case studies

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Sociohistorical and cultural context of Late Modern English Medical Texts

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Scientific Periodicals : The Philosophical Transactions and the Edinburgh Medical Journal

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Towards new knowledge : The corpus of Late Modern English Medical Texts

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Manual to the LMEMT corpus

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