Summary
This guidance for the management of patients with allergic and non‐allergic rhinitis has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and ...Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is for use by both adult physicians and paediatricians practicing in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a web‐based system. Their comments and suggestions were carefully considered by the SOCC. Where evidence was lacking, consensus was reached by the experts on the committee. Included in this guideline are clinical classification of rhinitis, aetiology, diagnosis, investigations and management including subcutaneous and sublingual immunotherapy. There are also special sections for children, co‐morbid associations and pregnancy. Finally, we have made recommendations for potential areas of future research.
Diarrhoeal diseases are major contributors to the global burden of disease, particularly in children. However, comprehensive estimates of the incidence and mortality due to specific aetiologies of ...diarrhoeal diseases are not available. The objective of this study is to provide estimates of the global and regional incidence and mortality of diarrhoeal diseases caused by nine pathogens that are commonly transmitted through foods.
We abstracted data from systematic reviews and, depending on the overall mortality rates of the country, applied either a national incidence estimate approach or a modified Child Health Epidemiology Reference Group (CHERG) approach to estimate the aetiology-specific incidence and mortality of diarrhoeal diseases, by age and region. The nine diarrhoeal diseases assessed caused an estimated 1.8 billion (95% uncertainty interval UI 1.1-3.3 billion) cases and 599,000 (95% UI 472,000-802,000) deaths worldwide in 2010. The largest number of cases were caused by norovirus (677 million; 95% UI 468-1,153 million), enterotoxigenic Escherichia coli (ETEC) (233 million; 95% UI 154-380 million), Shigella spp. (188 million; 95% UI 94-379 million) and Giardia lamblia (179 million; 95% UI 125-263); the largest number of deaths were caused by norovirus (213,515; 95% UI 171,783-266,561), enteropathogenic E. coli (121,455; 95% UI 103,657-143,348), ETEC (73,041; 95% UI 55,474-96,984) and Shigella (64,993; 95% UI 48,966-92,357). There were marked regional differences in incidence and mortality for these nine diseases. Nearly 40% of cases and 43% of deaths caused by these nine diarrhoeal diseases occurred in children under five years of age.
Diarrhoeal diseases caused by these nine pathogens are responsible for a large disease burden, particularly in children. These aetiology-specific burden estimates can inform efforts to reduce diarrhoeal diseases caused by these nine pathogens commonly transmitted through foods.
Measuring quality of recovery-15 after day case surgery Chazapis, M.; Walker, E.M.K.; Rooms, M.A. ...
British journal of anaesthesia,
February 2016, 20160201, 2016-Feb, 2016-02-00, Letnik:
116, Številka:
2
Journal Article
Recenzirano
Odprti dostop
‘Quality of recovery’ scores are patient-reported outcome measures evaluating recovery after surgery and anaesthesia. However, they are not widely used in the clinical or research setting. The ...Quality of Recovery-15 (QoR-15) is a recently developed, psychometrically tested and validated questionnaire.
We conducted a prospective study of all adult patients undergoing orthopaedic day case surgery over a period of six months (June 2013–November 2013). Patients completed the QoR-15 score preoperatively, and then were asked to repeat the score by telephone at 24 h, 48 h and seven days after surgery.
633 patients from a possible 714 (89%) completed the preoperative questionnaire and data from 437 patients who completed scores at all four time points were analysed. Most patients returned to their preoperative score by 48 h, and had exceeded it by seven days. Construct validity was supported by a negative correlation with duration of surgery and total inpatient opioid use. There was also excellent internal consistency (Cronbach’s alpha 0.80–0.83).
The QoR-15 is a clinically acceptable and feasible patient-centred outcome measure after day case surgery. The score demonstrated good validity, reliability and responsiveness. However, measurement of the QoR-15 score on the day of surgery may not provide a true baseline value. We suggest one follow-up call at 48 h would enable an adequate patient-centred assessment of postoperative recovery after day case orthopaedic surgery.
We present spectroscopic observations of the host galaxies of 82 low-redshift Type Ia supernovae (SNe Ia) discovered by the Palomar Transient Factory. We determine star formation rates, ...gas-phase/stellar metallicities, and stellar masses and ages of these objects. As expected, strong correlations between the SN Ia light-curve width (stretch) and the host age/mass/metallicity are found: fainter, faster declining events tend to be hosted by older/massive/metal-rich galaxies. There is some evidence that redder SNe Ia explode in higher metallicity galaxies, but we found no relation between the SN colour and host galaxy extinction based on the Balmer decrement, suggesting that the colour variation of these SNe does not primarily arise from this source. SNe Ia in higher mass/metallicity galaxies also appear brighter after stretch/colour corrections than their counterparts in lower mass hosts, and the stronger correlation is with gas-phase metallicity suggesting this may be the more important variable. We also compared the host stellar mass distribution to that in galaxy-targeted SN surveys and the high-redshift untargeted Supernova Legacy Survey (SNLS). SNLS has many more low-mass galaxies, while the targeted searches have fewer. This can be explained by an evolution in the galaxy stellar mass function, coupled with an SN delay-time distribution proportional to t
−1. Finally, we found no significant difference in the mass–metallicity relation of our SN Ia hosts compared to field galaxies, suggesting any metallicity effect on the SN Ia rate is small.
Abstract
Pressure plays a key role in the study of quantum materials. Its application in angle resolved photoemission (ARPES) studies, however, has so far been limited. Here, we report the evolution ...of the
k
-space electronic structure of bulk Ca
2
RuO
4
, lightly doped with Pr, under uniaxial strain. Using ultrathin plate-like crystals, we achieve uniaxial strain levels up to −4.1%, sufficient to suppress the insulating Mott phase and access the previously unexplored electronic structure of the metallic state at low temperature. ARPES experiments performed while tuning the uniaxial strain reveal that metallicity emerges from a marked redistribution of charge within the Ru
t
2
g
shell, accompanied by a sudden collapse of the spectral weight in the lower Hubbard band and the emergence of a well-defined Fermi surface which is devoid of pseudogaps. Our results highlight the profound roles of lattice energetics and of the multiorbital nature of Ca
2
RuO
4
in this archetypal Mott transition and open new perspectives for spectroscopic measurements.
We describe the design and performance of the near-infrared (1.51-1.70 m), fiber-fed, multi-object (300 fibers), high resolution (R = λ/Δλ ∼ 22,500) spectrograph built for the Apache Point ...Observatory Galactic Evolution Experiment (APOGEE). APOGEE is a survey of ∼105 red giant stars that systematically sampled all Milky Way populations (bulge, disk, and halo) to study the Galaxy's chemical and kinematical history. It was part of the Sloan Digital Sky Survey III (SDSS-III) from 2011 to 2014 using the 2.5 m Sloan Foundation Telescope at Apache Point Observatory, New Mexico. The APOGEE-2 survey is now using the spectrograph as part of SDSS-IV, as well as a second spectrograph, a close copy of the first, operating at the 2.5 m du Pont Telescope at Las Campanas Observatory in Chile. Although several fiber-fed, multi-object, high resolution spectrographs have been built for visual wavelength spectroscopy, the APOGEE spectrograph is one of the first such instruments built for observations in the near-infrared. The instrument's successful development was enabled by several key innovations, including a "gang connector" to allow simultaneous connections of 300 fibers; hermetically sealed feedthroughs to allow fibers to pass through the cryostat wall continuously; the first cryogenically deployed mosaic volume phase holographic grating; and a large refractive camera that includes mono-crystalline silicon and fused silica elements with diameters as large as ∼400 mm. This paper contains a comprehensive description of all aspects of the instrument including the fiber system, optics and opto-mechanics, detector arrays, mechanics and cryogenics, instrument control, calibration system, optical performance and stability, lessons learned, and design changes for the second instrument.
Robust establishment of survival in multiple myeloma (MM) and its relationship to recurrent genetic aberrations is required as outcomes are variable despite apparent similar staging. We assayed copy ...number alterations (CNA) and translocations in 1036 patients from the NCRI Myeloma XI trial and linked these to overall survival (OS) and progression-free survival. Through a meta-anlysis of these data with data from MRC Myeloma IX trial, totalling 1905 newly diagnosed MM patients (NDMM), we confirm the association of t(4;14), t(14;16), t(14;20), del(17p) and gain(1q21) with poor prognosis with hazard ratios (HRs) for OS of 1.60 (P=4.77 × 10
), 1.74 (P=0.0005), 1.90 (P=0.0089), 2.10 (P=8.86 × 10
) and 1.68 (P=2.18 × 10
), respectively. Patients with 'double-hit' defined by co-occurrence of at least two adverse lesions have an especially poor prognosis with HRs for OS of 2.67 (P=8.13 × 10
) for all patients and 3.19 (P=1.23 × 10
) for intensively treated patients. Using comprehensive CNA and translocation profiling in Myeloma XI we also demonstrate a strong association between t(4;14) and BIRC2/BIRC3 deletion (P=8.7 × 10
), including homozygous deletion. Finally, we define distinct sub-groups of hyperdiploid MM, with either gain(1q21) and CCND2 overexpression (P<0.0001) or gain(11q25) and CCND1 overexpression (P<0.0001). Profiling multiple genetic lesions can identify MM patients likely to relapse early allowing stratification of treatment.
Hubble Space Telescope spectroscopic observations of the nearby Type Ia supernova (SN Ia) SN 2011fe, taken on 10 epochs from −13.1 to +40.8 d relative to B-band maximum light, and spanning the ...far-ultraviolet (UV) to the near-infrared (IR) are presented. This spectroscopic coverage makes SN 2011fe the best-studied local SN Ia to date. SN 2011fe is a typical moderately luminous SN Ia with no evidence for dust extinction. Its near-UV spectral properties are representative of a larger sample of local events (Maguire et al.). The near-UV to optical spectra of SN 2011fe are modelled with a Monte Carlo radiative transfer code using the technique of 'abundance tomography', constraining the density structure and the abundance stratification in the SN ejecta. SN 2011fe was a relatively weak explosion, with moderate Fe-group yields. The density structures of the classical model W7 and of a delayed detonation model were tested. Both have shortcomings. An ad hoc density distribution was developed which yields improved fits and is characterized by a high-velocity tail, which is absent in W7. However, this tail contains less mass than delayed detonation models. This improved model has a lower energy than one-dimensional explosion models matching typical SNe Ia (e.g. W7, WDD1; Iwamoto et al.). The derived Fe abundance in the outermost layer is consistent with the metallicity at the SN explosion site in M101 (∼0.5 Z). The spectroscopic rise-time (∼19 d) is significantly longer than that measured from the early optical light curve, implying a 'dark phase' of ∼1 d. A longer rise-time has significant implications when deducing the properties of the white dwarf and binary system from the early photometric behaviour.
SMAP (Soil Moisture Active and Passive) radiometer observations at ~40 km resolution are routinely assimilated into the NASA Catchment Land Surface Model to generate the 9-km SMAP Level-4 Soil ...Moisture product. This study demonstrates that adding high-resolution radar observations from Sentinel-1 to the SMAP assimilation can increase the spatio-temporal accuracy of soil moisture estimates. Radar observations were assimilated either separately from or simultaneously with radiometer observations. Assimilation impact was assessed by comparing 3-hourly, 9-km surface and root-zone soil moisture simulations with
measurements from 9-km SMAP core validation sites and sparse networks, from May 2015 to December 2016. The Sentinel-1 assimilation consistently improved surface soil moisture, whereas root-zone impacts were mostly neutral. Relatively larger improvements were obtained from SMAP assimilation. The joint assimilation of SMAP and Sentinel-1 observations performed best, demonstrating the complementary value of radar and radiometer observations.
Understanding the patient perspective on healthcare is central to the evaluation of quality. This study measured selected patient-reported outcomes after anaesthesia in order to identify targets for ...research and quality improvement.
This cross-sectional observational study in UK National Health Service hospitals, recruited adults undergoing non-obstetric surgery requiring anaesthesia care over a 48 h period. Within 24 h of surgery, patients completed the Bauer questionnaire (measuring postoperative discomfort and satisfaction with anaesthesia care), and a modified Brice questionnaire to elicit symptoms suggestive of accidental awareness during general anaesthesia (AAGA). Patient, procedural and pharmacological data were recorded to enable exploration of risk factors for these poor outcomes.
257 hospitals in 171 NHS Trusts participated (97% of eligible organisations). Baseline characteristics were collected on 16,222 patients; 15,040 (93%) completed postoperative questionnaires. Anxiety was most frequently cited as the worst aspect of the perioperative experience. Thirty-five per cent of patients reported severe discomfort in at least one domain: thirst (18.5%; 95% CI 17.8-19.1), surgical pain (11.0%; 10.5-11.5) and drowsiness (10.1%; 9.6-10.5) were most common. Despite this, only 5% reported dissatisfaction with any aspect of anaesthesia-related care. Regional anaesthesia was associated with a reduced burden of side-effects. The incidence of reported AAGA was one in 800 general anaesthetics (0.12%)
Anxiety and discomfort after surgery are common; despite this, satisfaction with anaesthesia care in the UK is high. The inconsistent relationship between patient-reported outcome, patient experience and patient satisfaction supports using all three of these domains to provide a comprehensive assessment of the quality of anaesthesia care.
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