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Inflammatory phenotypes in patients with severe asthma are associated with distinct airway microbiology
Get PDFThis is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Background
Asthma pathophysiology and treatment responsiveness are predicted by inflammatory phenotype. However, the relationship between airway microbiology and asthma phenotype is poorly understood.
Objective
We aimed to characterize the airway microbiota in patients with symptomatic stable asthma and relate composition to airway inflammatory phenotype and other phenotypic characteristics.
Methods
The microbial composition of induced sputum specimens collected from adult patients screened for a multicenter randomized controlled trial was determined by using 16S rRNA gene sequencing. Inflammatory phenotypes were defined by sputum neutrophil and eosinophil cell proportions. Microbiota were defined by using α- and β-diversity measures, and interphenotype differences were identified by using similarity of percentages, network analysis, and taxon fold change. Phenotypic predictors of airway microbiology were identified by using multivariate linear regression.
Results
Microbiota composition was determined in 167 participants and classified as eosinophilic (n = 84), neutrophilic (n = 14), paucigranulocytic (n = 60), or mixed neutrophilic-eosinophilic (n = 9) asthma phenotypes. Airway microbiology was significantly less diverse (P = .022) and more dissimilar (P = .005) in neutrophilic compared with eosinophilic participants. Sputum neutrophil proportions, but not eosinophil proportions, correlated significantly with these diversity measures (α-diversity: Spearman r = −0.374, P < .001; β-diversity: r = 0.238, P = .002). Interphenotype differences were characterized by a greater frequency of pathogenic taxa at high relative abundance and reduced Streptococcus, Gemella, and Porphyromonas taxa relative abundance in patients with neutrophilic asthma. Multivariate regression confirmed that sputum neutrophil proportion was the strongest predictor of microbiota composition.
Conclusions
Neutrophilic asthma is associated with airway microbiology that is significantly different from that seen in patients with other inflammatory phenotypes, particularly eosinophilic asthma. Differences in microbiota composition might influence the response to antimicrobial and steroid therapies and the risk of lung infection
Laparoscopic Adjustable Gastric Banding in Australian adolescents: Should it be done?
Get PDF“This is a post-peer-review, pre-copyedit version of an article published in Obesity Surgery. The final authenticated version is available online at: http://dx.doi.org/10.1007/s11695-017-2544-6”.Objective
There are very few studies on laparoscopic adjustable gastric banding (LAGB) in obese adolescents with follow up for more than 36 months, let alone good prospective data beyond 24 months in Australian adolescents. We aimed to evaluate medium term (>36 months) safety and efficacy of LAGB in adolescents with severe obesity.
Methods
This is a prospective cohort study (March 2009–December 2015) in one tertiary referral hospital including obese adolescents (14–18 years) with a body mass index (BMI) >40 (or ≥35 with comorbidities) who consented to have LAGB. Exclusion criteria were syndromal causes of obesity, depression and oesophageal motility disorders. Main outcome measures include change in weight and BMI at 6, 12, 24, 36 and 48 months post LAGB; postoperative complications; and admissions.
Results
Twenty-one adolescents (median [interquartile range (IQR)] 17.4 [16.5–17.7] years, 9 males, mean ± SD BMI 47.3 ± 8.4 kg/m2) had a median follow up of 45.5 [32–50] months post LAGB. Follow up data were available for 16 adolescents. Weight and BMI improved significantly at all follow up times (all p < 0.01). The median maximum BMI loss was 10 [7.1–14.7] kg/m2. There were four minor early complications. Seven bands were removed due to weight loss failure/regain (two had also obstructive symptoms).
Conclusions
We have shown in the longest prospective LAGB postoperative follow up study of Australian adolescents that LAGB improves BMI in the majority of adolescents without significant comorbidities. LAGB is still a reasonable option to be considered as a temporary procedure to manage severe obesity during adolescence
Objectively diagnosing rumination syndrome in children using esophageal pH-impedance and manometry
Get PDFThis article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving'.
© 2017 John Wiley & Sons, Inc. All rights reserved.Background
Rumination syndrome is characterized by recurrent regurgitation of recently ingested food into the mouth. Differentiation with other diagnoses and gastroesophageal reflux disease (GERD) in particular, is difficult. Recently, objective pH‐impedance (pH‐MII) and manometry criteria were proposed for adults. The aim of this study was to determine diagnostic ambulatory pH‐MII and manometry criteria for rumination syndrome in children.
Methods
Clinical data and 24‐hour pH‐MII and manometry recordings of children with a clinical suspicion of rumination syndrome were reviewed. Recordings were analyzed for retrograde bolus flow extending into the proximal esophagus. Peak gastric and intraesophageal pressures closely related to these events were recorded and checked for a pattern compatible with rumination. Events were classified into primary, secondary, and supragastric belch–associated rumination.
Key Results
Twenty‐five consecutive patients (11 males, median age 13.3 years [IQR 5.9‐15.8]) were included; recordings of 18 patients were suitable for analysis. Rumination events were identified in 16/18 patients, with 50% of events occurring 30 mmHg, while only 50% of all events was characterized by peaks >30 mmHg and an additional 20% by peaks >25 mmHg. Four patients had evidence of acid GERD, all showing secondary rumination.
Conclusions and Inferences
Combined 24‐hour pH‐MII and manometry can be used to diagnose rumination syndrome in children and to distinguish it from GERD. Rumination patterns in children are similar compared with adults, albeit with lower gastric pressure increase. We propose a diagnostic cutoff for gastric pressure increase >25 mmHg associated with retrograde bolus flow into the proximal esophagus
Tensile behaviour of individual fibre bundles in the human lumbar anulus fibrosus
Get PDF© 2017 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 12 month embargo from date of publication (Nov 2017) in accordance with the publisher’s archiving policyDisc degeneration is a common medical affliction whose origins are not fully understood. An improved understanding of its underlying mechanisms could lead to the development of more effective treatments.
The aim of this paper was to investigate the effect of (1) degeneration, (2) circumferential region and (3) strain rate on the microscale mechanical properties (toe region modulus, linear modulus, extensibility, phase angle) of individual fibre bundles in the anulus fibrosus lamellae of the human intervertebral disc. Healthy and degenerate fibre bundles excised from different circumferential regions in the outer anulus (posterolateral, lateral, anterolateral, anterior) were tensile tested at slow (0.1%/s), medium (1%/s) and fast (10%/s) strain rates using a micromechanical testing system.
Our preliminary results showed that neither degeneration nor circumferential region significantly affected the fibre bundles’ mechanical behaviour. However, when the fibre bundles were tested at higher strain rates, this resulted in significantly higher linear moduli and lower phase angles.
These findings, compared with data from other studies investigating single and multiple lamellae sections, suggest that degeneration has minimal effect on outer anulus mechanics irrespective of structural level, and the inter- and intra-lamellar arrangement and continuity of the fibre bundles may influence the lamellae’s regional behaviour and viscoelasticity
The equivalence of multi-axis spine systems: Recommended stiffness limits using a standardized testing protocol
Get PDF© 2017 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 12 month embargo from date of publication (Sept 2017) in accordance with the publisher’s archiving policyThe complexity of multi-axis spine testing often makes it challenging to compare results from different studies. The aim of this work was to develop and implement a standardized testing protocol across three six-axis spine systems, compare them, and provide stiffness and phase angle limits against which other test systems can be compared. Standardized synthetic lumbar specimens (n = 5), comprising three springs embedded in polymer at each end, were tested on each system using pure moments in flexion–extension, lateral bending, and axial rotation. Tests were performed using sine and triangle waves with an amplitude of 8 Nm, a frequency of 0.1 Hz, and with axial preloads of 0 and 500 N. The stiffness, phase angle, and R2 value of the moment against rotation in the principal axis were calculated at the center of each specimen. The tracking error was adopted as a measure of each test system to minimize non-principal loads, defined as the root mean squared difference between actual and target loads. All three test systems demonstrated similar stiffnesses, with small (<14%) but significant differences in 4 of 12 tests. More variability was observed in the phase angle between the principal axis moment and rotation, with significant differences in 10 of 12 tests. Stiffness and phase angle limits were calculated based on the 95% confidence intervals from all three systems. These recommendations can be used with the standard specimen and testing protocol by other research institutions to ensure equivalence of different spine systems, increasing the ability to compare in vitro spine studies
Ultrastructural organization of elastic fibres in the partition boundaries of the annulus fibrosus within the intervertebral disc
Get PDF© 2017 Acta Materialia Inc. Published by Elsevier Ltd. This manuscript version is made available under the CC-BY-NCND
4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 24 month embargo from date of publication (Dec 2017) in accordance with the publisher’s archiving policyThe relationship between elastic fibre disorders and disc degeneration, aging and progression of spine deformity have been discussed in a small number of studies. However, the clinical relevance of elastic fibres in the annulus fibrosus (AF) of the disc is poorly understood. Ultrastructural visualization of elastic fibres is an important step towards understanding their structure-function relationship. In our previous studies, a novel technique for visualization of elastic fibres across the AF was presented and their ultrastructural organization in intra- and inter-lamellar regions was compared. Using the same novel technique in the present study, the ultrastructural organization of elastic fibres in the partition boundaries (PBs), which are located between adjacent collagen bundles, is presented for the first time. Visualization of elastic fibres in the PBs in control and partially digested (digested) samples was compared, and their orientation in two different cutting planes (transverse and oblique) were discussed. The ultrastructural analysis revealed that elastic fibres in PBs were a well-organized dense and complex network having different size and shape. Adjacent collagen bundles in a cross section (CS) lamella appear to be connected to each other, where elastic fibres in the PBs were merged in parallel or penetrated into the collagen bundles. There was no significant difference in directional coherency coefficient of elastic fibres between the two different cutting planes (p = .35). The present study revealed that a continuous network of elastic fibres may provide disc integrity by connecting adjacent bundles of CS lamellae together. Compared to our previous studies, the density of the elastic fibre network in PBs was lower, and fibre orientation was similar to the intra-lamellar space and inter-lamellar matrix.
Statement of Significance
A detailed ultrastructural study in the partition boundaries of the annulus fibrosus within the disc revealed a well-organized elastic fibre network with a complex ultrastructure. The continuous network of elastic fibres may provide disc integrity by connecting adjacent bundles of cross section lamellae together. The density of the elastic fibre network in PBs was lower, and fibre orientation was similar to the intra-lamellar space and the inter-lamellar matrix
Results from 15 years of quality surveillance for a National Indigenous Point-of-Care Testing Program for diabetes
Get PDF© 2017 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 12 month embargo from date of publication (July 2017) in accordance with the publisher’s archiving policyIntroduction
Diabetes is a major health problem for Australia's Aboriginal and Torres Strait Islander peoples. Point-of-care testing for haemoglobin A1c (HbA1c) has been the cornerstone of a long-standing program (QAAMS) to manage glycaemic control in Indigenous people with diabetes and recently, to diagnose diabetes.
Methods
The QAAMS quality management framework includes monthly testing of quality control (QC) and external quality assurance (EQA) samples. Key performance indicators of quality include imprecision (coefficient of variation [CV%]) and percentage acceptable results. This paper reports on the past 15 years of quality testing in QAAMS and examines the performance of HbA1c POC testing at the 6.5% cut-off recommended for diagnosis.
Results
The total number of HbA1c EQA results submitted from 2002 to 2016 was 29,093. The median imprecision for EQA testing by QAAMS device operators averaged 2.81% (SD 0.50; range 2.2 to 3.9%) from 2002 to 2016 and 2.44% (SD 0.22; range 2.2 to 2.9%) from 2009 to 2016. No significant difference was observed between the median imprecision achieved in QAAMS and by Australasian laboratories from 2002 to 2016 (p = 0.05; two-tailed paired t-test) and from 2009 to 2016 (p = 0.17; two-tailed paired t-test). For QC testing from 2009 to 2016, imprecision averaged 2.5% and 3.0% for the two levels of QC tested. Percentage acceptable results averaged 90% for QA testing from 2002 to 2016 and 96% for QC testing from 2009 to 2016. The DCA Vantage was able to measure a patient and an EQA sample with an HbA1c value close to 6.5% both accurately and precisely.
Conclusion
HbA1c POC testing in QAAMS has remained analytically sound, matched the quality achieved by Australasian laboratories and met profession-derived analytical goals for 15 years
Evidence for the breakdown of an Angkorian hydraulic system, and its historical implications for understanding the Khmer Empire
Get PDF© 2017 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/BY-NC-ND/4.0/).This paper examines the construction and design of a 7-km long embankment, probably built for King
Jayavarman IV between 928 and 941 CE, as part of a new capital. We calculate that the capacities of the outlets
were too small, and conclude that the embankment failed, probably within a decade of construction, so that the
benefits of the reservoir stored by the embankment and the access road on top of it were lessened substantially.
We explain how the design was sub-optimal for construction, and that while the layout had a high aesthetic
impact, the processes for ensuring structural integrity were poor. Simple and inexpensive steps to secure the weir
were not undertaken. We speculate that this early failure may have contributed to the decision to return the
royal court and the capital of the Khmer Empire to the Angkor region, marking a critically important juncture in
regional history
What characteristics of nursing homes are most valued by consumers? A discrete choice experiment with residents and family members
Get PDFThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.Objectives
To generate a scoring algorithm weighted on the preferences of consumers for assessing the quality of care in nursing homes (i.e., aged care homes or institutions) in six key domains.
Methods
A discrete choice experiment was undertaken with residents of nursing homes (n = 126) or family member proxies (n = 416) in cases where severe cognitive impairment precluded resident participation. Analysis was undertaken using conditional and mixed logit regression models to determine preferences for potential attributes.
Results
The findings indicate that all six attributes investigated were statistically significant factors for participants. Feeling at home in the resident’s own room was the most important characteristic to both residents and family members. Care staff being able to spend enough time with residents, feeling at home in shared spaces, and staff being very flexible in care routines were also characteristics identified as important for both groups. The results of the Swait-Louviere test rejected the null hypothesis that the estimated parameters between residents and family members were the same, indicating that data from these two groups could not be pooled to generate a single weighted scoring algorithm for the Consumer Choice Index-Six Dimension instrument. Preferences were therefore encapsulated to generate scoring algorithms specific to residents and family members.
Conclusions
This study provides important insights into the characteristics of nursing home care that are most valued by consumers. The Consumer Choice Index-Six Dimension instrument may be usefully applied in the evaluation, planning, and design of future services.This study was supported by funding provided by the National Health and Medical Research Council Partnership Centre on Dealing with Cognitive and Related Functional Decline in Older People (grant no. GNT9100000). G. Chen was supported by a grant funded by the financial support of Cancer Council SA’s Beat Cancer Project on behalf of its donors and the state government of South Australia through the Department of Health together with the support of the Flinders Medical Centre Foundation, its donors, and partners
Domestic violence and companion animals in the context of LGBT people’s relationships
Get PDFThis is an Accepted Manuscript of an article published by
SAGE Publications in Sexualities, available online: http://
journals.sagepub.com/doi/
full/10.1177/1363460716681476
This manuscript version is made available under the CCBY-
NC-ND 4.0 license http://creativecommons.org/
licenses/by-nc-nd/4.0/ which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.The link between domestic violence and animal abuse has now been well established, indicating that where there is one form of abuse, there is often the other. Research on this link, however, has almost exclusively focused on heterosexual cisgender people’s relationships. Lacking, then, is an exploration of the possibly unique links between domestic violence and animal abuse in the context of lesbian, gay, bisexual and trans (LGBT) people’s relationships. In this article we adopt a feminist intersectional approach informed by Critical Animal Studies to advocate for a non-pathologising approach to understanding LGBT people’s relationships with regard to the link between domestic violence and animal abuse