Comparison of reproducibility precision on mass fraction in some interlaboratory studies of methods of food analysis.

The relationship between reproducibility standard deviation and mass fraction in food analysis has been studied in compilations of statistics from collaborative trials and from proficiency tests. There was a broad tendency for both categories of statistics to follow the Horwitz function although systematic deviations from it were easily detected at both extremes of the mass fraction range (below 10-7 and above 10-2). The two compilations were found to have very similar properties over the whole range of mass fractions, that is from about 10-10 (0.1 ppb) upwards. This similarity has implications for the determination of detection limit.

Implementation of a teaching programme to improve doctors' awareness of DVLA guidelines: a multicentre study.

INTRODUCTION: Over half of the UK population holds a driver's licence. Driver and Vehicle Licensing Authority (DVLA) guidelines are available for conditions from most specialties. Despite this, no focused training occurs in the undergraduate or postgraduate setting. We evaluate the impact of a teaching programme to improve guideline awareness. METHODS: A 25-point questionnaire was designed using the current DVLA guidelines. Five questions were included for the following fields: neurology, cardiology, drug and alcohol abuse, visual disorders and respiratory. This was distributed to doctors in training at five hospitals. Four weeks later, a single-session teaching programme was implemented. The questionnaire was redistributed. Preintervention and postintervention scores were compared using the Wilcoxon rank sum test. RESULTS: 139 preteaching and 144 post-teaching questionnaires were completed. Implementation of a single-session teaching programme significantly improved the knowledge of DVLA guidelines in all five areas explored. Median scores: neurology, preteaching 40%, post-teaching 100%, p<0.001; cardiology, 0%, 100%, p<0.001; drug and alcohol misuse, 0%, 100%, p<0.001; visual disorders, 40%, 100%, p<0.001; respiratory disorders, 20%, 100%, p<0.001; and overall, 28%, 92%, p<0.001. CONCLUSIONS: Knowledge of DVLA guidelines among our cohort was poor. Implementation of a single-session teaching programme can significantly improve guideline knowledge and awareness, serving as a cost-effective intervention.

The 2015 advanced life support guidelines: a summary and evidence for the updates.

The International Liaison Committee on Resuscitation recently released updated 2015 recommendations for resuscitation. The guidelines form the basis for all levels of resuscitation training, now from first aid to advanced life support (ALS), and for trainees of varying medical skills, from schoolchildren to medical students and consultants. We highlight major updates relating to intra-arrest and postarrest care, and the evidence for their recommendation. We also summarise areas of uncertainty in the evidence for ALS, and highlight current discussions that will likely inform the next round of recommendations.

Comorbidity in Emetophobia (Specific Phobia of Vomiting).

BACKGROUND: Emetophobia (fear of vomiting) is an anxiety disorder in which individuals report clinical levels of fear that they may vomit or be exposed to the vomit of others. The prevalence of comorbidity of emetophobia with other conditions has previously only been investigated using self-report instruments. METHOD: Sixty-four adults with emetophobia participated in an online structured clinical diagnostic interview assessing the presence of emetophobia and other conditions. RESULTS: Higher comorbidity for depression, generalized anxiety disorder, panic disorder, social anxiety disorder and obsessive-compulsive disorder were found in participants compared with general population norms. CONCLUSIONS: Emetophobia is commonly comorbid with other anxiety and depressive disorders. Comorbidity rates, when assessed using a structured clinical interview, were lower than previously reported using self-report alone. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Emetophobia (specific phobia of vomiting) is a clinical fear of vomiting. Individuals with emetophobia show high comorbidity with other anxiety and mood disorders. The most common comorbid conditions were generalized anxiety disorder, panic disorder, hypochondriasis and obsessive-compulsive disorder. Clinicians should ensure that they assess for the presence of comorbid conditions when treating emetophobia.

Development and pilot testing of a patient-participatory pressure ulcer prevention care bundle.

This study developed and piloted a patient-centered pressure ulcer prevention care bundle for adult hospitalized patients to promote patient participation in prevention. The care bundle had 3 core messages: (1) keep moving, (2) care for your skin, and (3) ensure a good diet. A brief video, combined brochure/checklist, and poster were developed as training resources. Patient evaluation identified benefits of the care bundle; however, the combined checklist/brochure was rarely used.

Acute musculoskeletal infection in children: assessment and management.

Musculoskeletal infection in children is challenging to treat, and includes septic arthritis, deep tissue infection, osteomyelitis, discitis and pyomyositis. Delays to diagnosis and management, and under-treatment can be life-threatening and result in chronic disability. The British Orthopaedic Association Standards for Trauma include critical steps in the timely diagnosis and management of acute musculoskeletal infection in children, the principles of acute clinical care and the service delivery requirements to appropriately manage this cohort of patients. Orthopaedic and paediatric services are likely to encounter cases of acute musculoskeletal infection in children and thus an awareness and thorough understanding of the British Orthopaedic Association Standards for Trauma guidelines is essential. This article reviews these guidelines and associated published evidence for the management of children with acute musculoskeletal infection.

Normalisation of data from allergens proficiency tests.

The problem of allergen analysis using ELISA kits from different commercial products giving significantly different results is widely acknowledged. The effect on proficiency testing results is that different assigned values have to be generated for the different kits used. Some experimental Food Analysis Performance Assessment Scheme (FAPAS) proficiency tests aimed to establish whether the use of a standardised calibrant could be used to normalise the complete data set without recourse to differentiation. Three recent FAPAS proficiency tests (2776 peanut, 2778 soya and 2781 gluten) sent out a second spiked sample, in addition to the usual spiked and unspiked samples. Further analysis of the data was undertaken after the completion of the tests. The ratio of the submitted results for the two spiked samples yielded complete data sets which could be tested for normality of the distribution. Where the raw data for each individual test sample was clearly non-normal and multi-modal, the ratio data yielded a much more normal and symmetrical distribution. The use of one of the test samples as a single-point calibrant has some limitations but the principle of applying a standardisation clearly works. The development of internationally recognised sets of certified reference calibration standards for use by allergens testing laboratories would greatly benefit the analysis.

Proficiency testing has improved the quality of data of total vitamin B2 analysis in liquid dietary supplement.

A previously reported proficiency test for the analysis of vitamin B(2) in liquid dietary supplement demonstrated bimodality. The same trend has now been observed in four subsequent tests of this type. The trend would not so easily have been observed without applying a fit-for-purpose standard deviation that is more generous than that predicted by the Horwitz equation. Since originally reporting the bimodal problem and hypothesising its cause by incomplete enzymic digestion of riboflavin-5-phosphate, there has been a general improvement in the reporting of the higher mode. This is thought to correspond to free riboflavin following complete digestion of the sample. Several individual participants appear to have learned from the experience and have changed their reporting of the lower mode to the higher mode.

Assessment and improvement of junior doctor handover in the emergency department.

INTRODUCTION: Effective handover between junior doctors is widely accepted as essential for patient safety. The British Medical Association in association with the National Health Service (NHS) National Patient Safety Agency and NHS Modernisation Agency have produced clear guidance regarding the contents and setting for a safe and efficient handover. We aimed to understand current junior doctor's opinions on the handover process in a London emergency department (ED), with subsequent assessment, and any necessary improvement, of handover practices within the department. METHODS: In a London ED, a baseline survey was completed by the senior house officer (SHO) cohort to gauge current opinions of the existing handover process. Concurrently, a blinded prospective audit of handover practises was conducted. Multiple improvement strategies were subsequently implemented and assessed via Plan-Do-Study-Act (PDSA) cycles. A standard operating procedure was initially introduced and 'rolled out' throughout the department. This intervention was followed by development of an electronic handover note to ease completion of a satisfactory handover. Additional surveys were conducted to continually assess SHO opinion on how the handover process was developing. The final improvement strategy was formal handover teaching at the SHO induction. RESULTS: Baseline audit and SHO survey highlighted several opportunities for improvement. 5 handover components were deemed essential: (1) documented handover note; (2) doctor's names; (3) history of presenting complaint; (4) ED actions; and (5) ongoing plan. The frequency of these components saw significant improvement by completion of the final PDSA. Following SHO rotation, all of the essential components fell, only to recover after the next improvement strategy. CONCLUSIONS: Junior doctors in a London ED were not satisfied with the current SHO handover process, and handover practices were not adequate. While the rotational nature of the SHO cohort makes sustained change challenging, implementation of thoughtful and realistic improvement strategies can significantly improve handover quality.

The Chaotic Terrains of Mercury Reveal a History of Planetary Volatile Retention and Loss in the Innermost Solar System.

Mercury's images obtained by the 1974 Mariner 10 flybys show extensive cratered landscapes degraded into vast knob fields, known as chaotic terrain (AKA hilly and lineated terrain). For nearly half a century, it was considered that these terrains formed due to catastrophic quakes and ejecta fallout produced by the antipodal Caloris basin impact. Here, we present the terrains' first geologic examination based on higher spatial resolution MESSENGER (MErcury Surface Space ENvironment GEochemistry and Ranging) imagery and laser altimeter topography. Our surface age determinations indicate that their development persisted until ~1.8 Ga, or ~2 Gyrs after the Caloris basin formed. Furthermore, we identified multiple chaotic terrains with no antipodal impact basins; hence a new geological explanation is needed. Our examination of the Caloris basin's antipodal chaotic terrain reveals multi-kilometer surface elevation losses and widespread landform retention, indicating an origin due to major, gradual collapse of a volatile-rich layer. Crater interior plains, possibly lavas, share the chaotic terrains' age, suggesting a development associated with a geothermal disturbance above intrusive magma bodies, which best explains their regionality and the enormity of the apparent volume losses involved in their development. Furthermore, evidence of localized, surficial collapse, might reflect a complementary, and perhaps longer lasting, devolatilization history by solar heating.

Kisspeptin enhances brain responses to olfactory and visual cues of attraction in men.

Successful reproduction is a fundamental physiological process that relies on the integration of sensory cues of attraction with appropriate emotions and behaviors and the reproductive axis. However, the factors responsible for this integration remain largely unexplored. Using functional neuroimaging, hormonal, and psychometric analyses, we demonstrate that the reproductive hormone kisspeptin enhances brain activity in response to olfactory and visual cues of attraction in men. Furthermore, the brain regions enhanced by kisspeptin correspond to areas within the olfactory and limbic systems that govern sexual behavior and perception of beauty as well as overlap with its endogenous expression pattern. Of key functional and behavioral significance, we observed that kisspeptin was most effective in men with lower sexual quality-of-life scores. As such, our results reveal a previously undescribed attraction pathway in humans activated by kisspeptin and identify kisspeptin signaling as a new therapeutic target for related reproductive and psychosexual disorders.

Effects of Glucagon-like Peptide-1 on the Reproductive Axis in Healthy Men.

CONTEXT: Glucagon-like peptide-1 (GLP-1) potently reduces food intake and augments glucose-stimulated insulin secretion. Recent animal data suggest that GLP-1 may also influence reproduction. As GLP-1 receptor agonists are currently widely used in clinical practice to treat obesity/type 2 diabetes, it is necessary to determine the effects of GLP-1 on the reproductive system in humans. OBJECTIVE: To investigate the effects of GLP-1 administration on the reproductive axis in humans. DESIGN: Single-blind, randomized, placebo-controlled crossover study. SETTING: Clinical Research Facility, Imperial College Healthcare NHS Trust. PARTICIPANTS: Eighteen healthy men (mean age 24.7 ± 0.1years, mean BMI 22.1 ± 0.4kg/m2). INTERVENTION: Eight-hour intravenous infusion of 0.8 pmol/kg/min GLP-1 or rate-matched vehicle infusion. MAIN OUTCOME MEASURES: Number of luteinizing hormone (LH) pulses, LH, follicle-stimulating hormone (FSH), and testosterone levels. RESULTS: The number of LH pulses (number of LH pulses/500 min: vehicle 4.2 ± 0.4, GLP-1 4.5 ± 0.3, P = 0.46), LH area under the curve (AUC) (vehicle 1518 ± 88min.IU/L, GLP-1 1524 ± 101min.IU/L, P = 0.95), follicle-stimulating hormone AUC (vehicle 1210 ± 112 min IU/L, GLP-1 1216 ± 112 min IU/L, P = 0.86), and testosterone AUC (vehicle 10893 ± 615 min nmol/L, GLP-1 11088 ± 792 min nmol/L, P = 0.77) did not significantly differ during vehicle and GLP-1 administration. Glucagon-like peptide-1 significantly reduced food intake (vehicle 15.7 ± 1.3 kcal/kg, GLP-1 13.4 ± 1.3 kcal/kg, P = 0.01). CONCLUSIONS: In contrast to the animal literature, our data demonstrate that acute GLP-1 administration does not affect reproductive hormone secretion in healthy men.

Effects of Peptide YY on the Hypothalamic-Pituitary-Gonadal Axis in Healthy Men.

CONTEXT: Central and peripheral administration of peptide YY (PYY) has potent anorectic effects, and PYY analogs are under development as antiobesity treatments. Recent animal data suggest PYY may also influence the reproductive axis; however the effects of PYY on the human reproductive system are unknown. OBJECTIVE: To investigate the effects of PYY administration on the reproductive axis in healthy young men. DESIGN: Single-blind, randomized, placebo-controlled crossover study. SETTING: Clinical Research Facility, Imperial College Healthcare NHS Trust. PARTICIPANTS: Eighteen healthy eugonadal men (mean age 24.1 ± 0.9 years, mean body mass index 22.2 ± 0.4 kg/m2). INTERVENTION: Eight-hour intravenous infusion of 0.4 pmol/kg/min PYY3-36 or rate-matched vehicle infusion. MAIN OUTCOME MEASURES: Number of luteinizing hormone (LH) pulses, LH, follicle stimulating hormone (FSH), and testosterone levels. RESULTS: The number of LH pulses (mean number of LH pulses/8 hours: PYY 4.4 ± 0.3 vs vehicle 4.4 ± 0.4, P > .99), LH area under the curve (AUC) (PYY 1503 ± 79 IU.min/L vs vehicle 1574 ± 86 IU.min/L, P = .36), FSH AUC (PYY 1158 ± 513 IU.min/L vs vehicle 1199 ± 476 IU.min/L, P = .49) and testosterone AUC (PYY 10 485 ± 684 IU.min/L vs vehicle 11 133 ± 803 IU.min/L, P = .24) were similar during PYY and vehicle infusions. CONCLUSIONS: Acute intravenous infusion of 0.4 pmol/kg/min PYY does not affect the reproductive axis in healthy men.

Determination of the phenoxyacid herbicides MCPA, mecoprop and 2,4-D in kidney tissue using liquid chromatography with electrospray tandem mass spectrometry.

An analytical method was developed to determine the phenoxyacid herbicides 2,4-D, MCPA and mecoprop in kidney tissue from animals where poisoning is suspected. Samples were Soxhlet extracted using diethyl ether and the extracts cleaned-up using anion exchange solid phase extraction cartridges. Analysis was performed using liquid chromatography with negative-ion electrospray tandem mass spectrometry (LC-MS/MS). The method was evaluated by analysing control kidney samples fortified at 1 and 5 mg/kg. Mean recoveries ranged from 82 to 93% with relative standard deviations from 3.2 to 19%. The limit of detection was estimated to be 0.02 mg/kg.

A critical review of the specifications and performance of antibody and DNA-based methods for detection and quantification of allergens in foods.

Despite the availability of a large number of antibody and DNA based methods for detection and quantification of allergens in food there remain significant difficulties in selecting the optimum technique to employ. Published methods from research groups mostly contain sufficient detail concerning target antigen, calibration procedures and method performance to allow replication by others. However, routine allergen testing by the food industry relies upon commercialised test kits and frequently the suppliers provide disappointingly little specification detail on the grounds that this is proprietary information. In this review we have made a critical assessment of the published literature describing the performance of both commercial and non-commercial test kits for food allergens over the period 2008-2018. Mass spectrometric methods, which have the potential to become reference methods for allergens, are not covered in this review. Available information on the specifications of commercial ELISA and LFD test kits are tabulated for milk, egg and peanut allergens, where possible linking to publications concerning collaborative studies and proficiency testing. For a number of commercial PCR test kits, specifications provided by manufacturers for detection of a small selection of allergen are tabulated. In conclusion we support the views of others of the critical need for allergen reference materials as the way forward to improve the comparability of different testing strategies in foods.