The effects of wind on the loading and vibration of stone pinnacles

© 2016 International Masonry Society. All rights reserved. Following the collapse of a tympanum pinnacle at Beverley Minster in Yorkshire, a research project was undertaken to investigate the wind forces which act on stone pinnacles. A survey was conducted and the most common failure modes were identified, which highlighted the importance of dynamic forces in addition to the static drag force. Further, the potential impact of decorative crockets on these forces was of interest. Both static and dynamic forces on pinnacles were investigated through a series of wind tunnel tests. The results demonstrate the relative magnitude of these forces, and that the decorative crockets do appreciably affect both the drag force and wind-induced vibration. The experimental data was used to derive general relationships for wind forces acting on stone pinnacles for potential use in engineering practice

Neurodevelopmental outcomes in individuals with fetal alcohol spectrum disorder (FASD) with and without exposure to neglect : clinical cohort data from a national FASD diagnostic clinic

Disentangling the relative developmental impact of prenatal alcohol exposure from postnatal neglect is clinically valuable for informing future service provision. In this study developmental outcomes across groups are compared in a ‘natural experiment’. Methods: Clinical data from 99 persons with fetal alcohol spectrum disorder (FASD) diagnoses were audited. Developmental outcomes (diagnosis of attention deficit hyperactivity disorder, ADHD; social and communication disorder, SCD; or autism spectrum disorder, ASD; Short Sensory Profile, SSP; Vineland II Adaptive Behaviour Scales) were compared across two exposure groups: prenatal alcohol only; and mixed prenatal alcohol and neglect. Results: ADHD (74%) and ASD/SCD (68%) were common, with no significant difference between groups (ADHD, P=0.924; ASD, P=0.742). Vineland age equivalence scores were lower than chronological age (11.1y—prenatal alcohol only—and 12.7y—neglect) across all domains, especially receptive language (3.7y for both groups). Age equivalence did not differ between groups, with the exception of domestic daily living (neglect: 7.7y vs prenatal alcohol only: 5.8y, P=0.027). A probable/definite difference on SSP was more common in the prenatal alcohol only (96% vs 67%, P=0.006). For the individual subscales of SSP, there were no significant differences by neglect category. Discussion: Postnatal neglect in this group did not make the developmental outcome any worse, suggesting that prenatal alcohol influences these outcomes independently. Professionals who support families looking after a child with both FASD and a history of neglect should be aware that the behavioural difficulties are likely to be related to prenatal alcohol exposure and not necessarily reflective of parenting quality

Bone gain following loading is site-specifically enhanced by prior and concurrent disuse in aged male mice

The primary aim of osteoanabolic therapies is to strategically increase bone mass in skeletal regions likely to experience high strains. In the young healthy skeleton, this is primarily achieved by bone's adaptation to loading. This adaptation appears to fail with age, resulting in osteoporosis and fractures. We previously demonstrated that prior and concurrent disuse enhances bone gain following loading in old female mice. Here, we applied site specificity micro-computed tomography analysis to map regional differences in bone anabolic responses to axial loading of the tibia between young (19-week-old) and aged (19-month-old), male and female mice. Loading increased bone mass specifically in the proximal tibia in both sexes and ages. Young female mice gained more cortical bone than young males in specific regions of the tibia. However, these site-specific sex differences were lost with age such that bone gain following loading was not significantly different between old males and females. To test whether disuse enhances functional adaption in old male mice as it does in females, old males were subjected to sciatic neurectomy or sham surgery, and loading was initiated four days after surgery. Disuse augmented tibial cortical bone gain in response to loading in old males, but only in regions which were load-responsive in the young. Prior and concurrent disuse also increased loading-induced trabecular thickening in the proximal tibia of old males. Understanding how diminished background loading rejuvenates the osteogenic loading response in the old may improve osteogenic exercise regimes and lead to novel osteoanabolic therapies

Evidence uptake is only part of the process: stakeholders’ insights on WHO treatment guideline recommendation processes for radical cure of P. vivax malaria

Health policy processes should be evidence-informed, transparent and timely, but these processes are often unclear to stakeholders outside the immediate policymaking environment. We spoke to 36 international malaria stakeholders to gain insights on the processes involved in the World Health Organization’s Global Malaria Programme’s recommendations for their treatment guidelines of P. vivax malaria. Four key themes which drew on the 3i policy framework and Shiffman’s four factors that influence global and national policymaking were identified to understand these processes. Triggers for policy change and change prioritisation, evidence types that inform policy, effects of funding on decision-making processes, and transparency and communication of these processes to external stakeholders. Results indicate that more clarity is needed on what triggers global malaria policy change processes, a clearer justification of evidence types used to inform policymaking, better understanding of the impact of the WHO’s funding model on policymaking and further transparency and improved communication of these processes to external stakeholders is also needed. We suggest that global malaria policymaking could be improved by using the following strategies: ensuring that identified triggers actually initiate the policy change process, expediting decision-making timelines by developing a priority framework for assessing new evidence, adopting suitable frameworks to assess contextual evidence, and increasing the transparency of the role of non-state funders in policy decision-making processes and when publishing new recommendations

Accurate Liability Estimation Improves Power in Ascertained Case Control Studies

Linear mixed models (LMMs) have emerged as the method of choice for confounded genome-wide association studies. However, the performance of LMMs in non-randomly ascertained case-control studies deteriorates with increasing sample size. We propose a framework called LEAP (Liability Estimator As a Phenotype, https://github.com/omerwe/LEAP) that tests for association with estimated latent values corresponding to severity of phenotype, and demonstrate that this can lead to a substantial power increase

The Allergy Questionnaire for Athletes: A simple screening tool for the assessment of exercise-induced bronchoconstriction

Aim: Evaluating respiratory symptoms in athletic individuals can be difficult and therefore robust clinical assessment tools are required (1). The Allergy Questionnaire for Athletes (AQUA) is validated to assess allergic +/- respiratory symptoms (2). The purpose of this study was therefore to determine the value of AQUA as a screening tool to confirm or refute exercise-induced bronchoconstriction (EIB) in athletes. Methods: One-hundred and forty-seven athletes (male: n = 100: female: n = 47) (age: 32 ± 9 years) completed AQUA and performed spirometry pre-and-post a eucapnic voluntary hyperpnoea challenge (EVH). A positive AQUA was determined as a score ≥5 (2). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated and evaluated against objective evidence of EIB: (EVH threshold [-10% ΔFEV1 at two consecutive time-points] and [-15% ΔFEV1 at one time-point]) (3). Diagnostic accuracy was calculated using receiver operating characteristics area under the curve (ROC-AUC). Results: All participants demonstrated normal baseline lung function (FEV1 % predicted >80%). The prevalence of EIB was 16% (-10% ΔFEV1) and 11% (-15% ΔFEV1) (mean ΔFEV1 = -7.4% ± 7.9). Eighty-seven (59%) provided a positive AQUA score (range: 0-25). ROC-AUC for AQUA was 65% (-10% ΔFEV1) and 69% (-15% ΔFEV1). A negative AQUA score was highly predictive of negative EVH test outcome. Sensitivity, specificity, PPV and NPV are presented in Table 1. Conclusion: AQUA is a simple screening tool that provides value in ruling out EIB, and should be considered during clinical assessment (i.e. inform referral for objective testing) or as a ‘first-step’ as part of screening interventions. It is important to acknowledge that a positive AQUA score should not be used to confirm EIB, in the absence of indirect bronchoprovocation. The development and validation of an athlete specific questionnaire to confirm EIB remains an avenue for future research

Anti‐doping Policy, Therapeutic Use Exemption and Medication Use in Athletes with Asthma: A Narrative Review and Critical Appraisal of Current Regulations

Asthma is prevalent in athletes and when untreated can impact both respiratory health and sports performance. Pharmacological inhaler therapy currently forms the mainstay of treatment; however, for elite athletes competing under the constraints of the World Anti-Doping Code (Code), a number of established therapies are prohibited both in and/or out of competition and/or have a maximum permitted dose. The recent release of medical information detailing inhaler therapy in high-profile athletes has brought the legitimacy and utilisation of asthma medication in this setting into sharp focus. This narrative review critically appraises recent changes to anti-doping policy and the Code in the context of asthma management, evaluates the impact of asthma medication use on sports performance and employs a theory of behaviour to examine perceived determinants and barriers to athletes adhering to the anti-doping rules of sport when applied to asthma

Does the measurement of fractional exhaled nitric oxide have a role in the detection of exercise-induced bronchoconstriction in athletes?

Aim: Fractional exhaled nitric oxide (FeNO) is an indirect marker of airway inflammation, recommended for the assessment and management of asthma (1). The role of FeNO in detecting exercise-induced bronchoconstriction (EIB) and monitoring respiratory health in athletes has however yet to be established. The aim of this pilot study was therefore to evaluate the value of FeNO in detecting EIB in a screened cohort of athletes. Method: Fifty-three endurance trained athletes (male: n = 36) (age: 34 ± 10 years) performed baseline FeNO and spirometry pre-and-post a eucapnic voluntary hyperpnoea challenge (EVH) (2). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for established FeNO thresholds: (intermediate [>25ppb] and high [>50ppb]) (1) and evaluated against objective evidence of EIB: (EVH diagnostic cut-off [-10% ΔFEV1 at two consecutive time-points] (3) and [-15% ΔFEV1 at one time-point]) (2). The diagnostic accuracy of FeNO was calculated using receiver operating characteristics area under the curve (ROC-AUC). Results: All athletes had normal resting lung function (>80% FEV1 pred). The prevalence of EIB was 19% (-10% ΔFEV1) and 15% (-15% ΔFEV1) (mean ΔFEV1 = -8.2% ± 9.2). FeNO values >25ppb and >50ppb were observed in 45% and 17% of the cohort, respectively. ROC-AUC for FeNO was 75% (-10% ΔFEV1) and 83% (-15% ΔFEV1). Sensitivity, specificity, PPV and NPV are presented in Table 1. Conclusion: FeNO is a simple tool that has an established role in the assessment of airway inflammation in athletes. FeNO >50 had good specificity (93%) for a positive EVH test; however given the poor predictive values, our findings indicate that FeNO should not be employed as a substitute for indirect bronchoprovocation for diagnostic purposes. Future research is required to establish normative values and determine the role of FeNO in modifying the treatment of EIB in athletes

Impact of diagnostic misclassification on estimation of genetic correlations using genome-wide genotypes

Disorders that share genetic risk factors often are placed in closely related diagnostic categories and treated similarly. Until recently, evidence for shared genetic etiology derived from classical research strategies – coaggregation in family and twin studies. Accumulating sufficient numbers of families was often problematic. However, in the era of genome-wide genotyping, we can now directly estimate the degree of sharing of genetic risk factors between disorders. This strategy is practical even for very rare disorders, where it is infeasible to ascertain informative families. Importantly, the estimates of genetic correlations from genome-wide genotypes are derived using such distant relatives that contamination by shared environmental factors seems unlikely. However, any method that seeks to quantify the shared etiology of disorders assumes they can be distinguished diagnostically from one another without error. Here we investigate the impact of misdiagnosis on estimates of genetic correlation both from traditional family data and from genome-wide genotypes of case–control samples from unrelated individuals. Our analyses show similar results for levels of misdiagnosis in both types of data. In both scenarios, genetic variances and heritabilities tend to be slightly underestimated but genetic correlations are overestimated, sometimes substantially so. For example, two genetically distinct but equally heritable disorders each with prevalence 1%, can generate false-positive estimates of genetic correlations of >0.2 in the presence of 10% reciprocal misdiagnosis. Strategies for minimizing the effects of misdiagnosis in cross-disorder genetic studies are discussed