Visibility of age restriction warnings, harm reduction messages and terms and conditions: a content analysis of paid-for gambling advertising in the United Kingdom.

OBJECTIVE: The inclusion and design of age restriction warnings, harm reduction messages and terms and conditions (T&Cs) in gambling advertising is self-regulated in the United Kingdom. Our study examines the visibility and nature of this information in a sample of paid-for gambling adverts. STUDY DESIGN: A content analysis of a stratified random sample of gambling adverts (n = 300) in the United Kingdom from eight paid-for advertising channels (March 2018). METHODS: For each advert, we assessed whether any age restriction warnings, harm reduction messages and T&Cs were present. If so, visibility was scored on a five-point scale ranging from very poor (≤10% of advert space) to very good (≥26% of advert), which had high inter-rater reliability. Descriptive information on position, design and tone of language was recorded. RESULTS: One in seven adverts (14%) did not feature an age restriction warning or harm reduction message. In adverts that did, 84% of age restriction warnings and 54% of harm reduction messages had very poor visibility. At least one in ten adverts did not contain T&Cs. In adverts that did, 73% had very poor visibility. For age restriction warnings, harm reduction messages and T&Cs, most appeared in small fonts and outside the main advert frame. Most harm reduction messages did not actually reference gambling-related harms. CONCLUSION: Age restriction warnings, harm reduction messages and T&Cs do not always appear in paid-for gambling advertising. When they do, visibility is often very poor and the messaging not clear. The findings do not support a self-regulatory approach to managing this information in gambling adverts.

Credentialing for robotic lobectomy: what is the learning curve? A retrospective analysis of 272 consecutive cases by a single surgeon.

Credentialing processes for surgeons seeking robotic thoracic surgical privileges are not evidence-based, and the learning curve has not been reported. The goal of this study is to review our experience with robotic lobectomies and provide evidence for the development of a more uniform credentialing process. We performed a retrospective review of the first 272 consecutive robotic lobectomies performed between 2011 and 2017 by a single surgeon with prior video-assisted thoracoscopic (VATS) experience. Primary outcomes were operative duration, blood loss, chest tube duration, length of hospital stay, intraoperative complication, and conversion to thoracotomy. The patients were subdivided by surgical date into two cohorts of 120 consecutive patients to compare differences in outcomes, thereby illustrating the learning curve. Between 2011 and 2017, 272 patients (median age 67.5 years) underwent a robotic lobectomy by a single surgeon. The majority of patients (157/272) had early stage (T1N0) adenocarcinoma. For the entire cohort, median operative time was 160 min (83-317 min). The median blood loss was 75 mL (10-4000 mL). Median chest tube duration was 2 days (1-23 days) and median hospital stay was 3 days (1-25 days). Intraoperative complications occurred in seven patients. Only six patients required conversion to thoracotomy. Using multivariable logistic regression, it was found that the age, gender, and stage do not factor into conversion to thoracotomy, but BMI was found to be a significant covariate (p 0.043). As the surgeon performs more surgeries, there is a significantly shorter operative time (p < 0.001), decreased blood loss (p < 0.001), and shorter hospital stay (p < 0.014). When the first 120 and last 120 surgeries were compared, there was significantly less blood loss (234.6 vs 78.69 cc, p < 0.001), shorter operative time (181.9 vs 147.4 min, p < 0.001), shorter tube duration (3.49 vs 3.11 days, p 0.007), and shorter length of stay (4.03 vs 3.48 days, p < 0.001), respectively. More intraoperative complications were observed during the first 120 surgeries (6/120) compared to the last 120 surgeries (0/120; Fischer exact p = 0.029). Regression model plots did not show any apparent and significant change points, but rather a steady improvement. The more cases the surgeon does, the better is the outcome in terms of operative duration, blood loss, post-operative length of stay and intraoperative complications. The learning curve for robotic surgery for a surgeon with prior VATS experience is that of a continuous improvement with experience instead of a particular change point. Since most thoracic surgeons who perform robotic-assisted surgery have already gotten past their VATS learning curves, they no longer have a definable learning curve for robotic surgery. Hence, if a surgeon is already proficient and credentialed to perform VATS lung resections, he or she is no longer faced with a significant learning curve for robotic lung resections, and should be credentialed to do so once he or she has undergone the appropriate training with the equipment and technology.

Tsunami-related injury in Aceh Province, Indonesia.

The Asian tsunami, of December 2004, caused widespread loss of life. A series of surveys were conducted to assess tsunami-related mortality and injury, risk factors, care seeking and injury outcomes. Three surveys of tsunami-affected populations, in seven districts of Aceh province, were conducted between March and August 2005. Surveys employed a two-stage cluster design and probability proportional to size sampling methods. Overall, 17.7% (95% confidence interval (CI)=16.8-18.6) of the population was reported as dead/missing1 and 8.5% (95% CI=7.9-9.2) had been injured. Odds of mortality were 1.41% (95% CI=1.27-1.58) times greater in females than in males; risk of injury was opposite, with an odds of injury of 0.81 (95% CI=0.61-0.96) for females in comparison to males. Mortality was greatest among the oldest and young population sub-groups, and injuries were most prevalent among middle-aged populations (20-49). An estimated 25,572 people were injured and 3682 (1.2%) suffered lasting disabilities. While mortality was particularly elevated among females and among the youngest and oldest age groups, injury rates were the greatest among males and the working-age population, suggesting that those are more likely to survive the tsunami were also more likely to be injured.

P3b versus P3a: an event-related potential investigation of the glucose facilitation effect.

The ingestion of a glucose containing drink has been shown to improve performance on a variety of cognitive tasks. There is debate, however, as to whether glucose especially benefits hippocampal memory functioning or whether it has a more global effect on attentional systems. The present study used event related potential methodology (ERPs) to investigate further glucose-mediated cognitive processes. Each participant acted as his/her own control in a repeated measures design, receiving one of two possible treatments (25 g glucose vs. placebo) in a counterbalanced order. After a two hour fasting period participants completed a visual three-stimulus oddball task. This paradigm involves an individual detecting an infrequent target stimulus randomly embedded in a train of repetitive background or standard stimuli. Detection of the target results in a large P3b ERP component (memory updating effect). The infrequent presentation of a novel and irrelevant stimulus, randomly interspersed with the target and standard stimuli, generates a P3a response (orientation of attention effect). These components were used as markers to establish whether the glucose enhancement effect was restricted to the neuro-cognitive processes related to memory. Consistent with behavioural work, glucose moderated the magnitude and latency of the P3b ERP component. However, glucose also interacted with attentional systems (P3a and an earlier P2), although this effect was non-significant. This work converges with recent fMRI findings indicating the sensitivity of the medial-temporal lobes and the pre-frontal cortex to glucose administration.

Weight loss has an independent beneficial effect on symptoms of gastro-oesophageal reflux in patients who are overweight.

BACKGROUND: Weight loss is commonly recommended as part of first-line management of gastrooesophageal reflux disease (GORD) despite the paucity of published clinical trials. The aim of this study was to prospectively assess the independent effect of weight loss on reflux symptoms in overweight individuals with either normal endoscopic findings or grade-I oesophagitis. METHODS: Thirty-four patients were recruited on the basis of a body mass index (BMI) of greater than 23 and symptoms of GORD for at least 6 months. All patients were advised to lose weight. Symptoms of gastro-oesophageal reflux (GOR) were scored, using a modified DeMeester questionnaire at 0, 6, and 26 weeks. Patients who were unable to stop taking all medication for control of symptoms were excluded from the study. Changes in weight and symptom score were analysed by using a paired t test. Correlation between change in weight and symptom score was assessed with the Pearson correlation test. RESULTS: Thirty-four patients were studied (18 men and 16 women) with a mean age of 65 years (range, 24-70 years). The mean weight at recruitment was 83.4 kg (standard deviation (s), 4.5 kg; BMI, 23.5 kg/m2 (s, 2.3 kg/m2). Twenty-seven patients (80% of the total) lost weight with a mean of 4.0 kg (P < 0.01) and improved by a mean reduction of 75% from the initial symptom score (P < 0.001). In nine patients the symptoms disappeared completely. Three patients gained weight and had a deterioration of their symptoms, whereas four patients gained weight but still improved their symptom score. There was a significant direct correlation between weight loss and symptom score (R = 0.548, P < 0.001). CONCLUSIONS: This study has shown a significant association between weight loss and improvement in symptoms of GOR. Patients who are overweight should be encouraged to lose weight as part of the first-line management.

Hepatitis G infection: role in cryptogenic chronic liver disease and primary liver cell cancer in the UK. Trent Hepatitis C virus Study Group.

Hepatitis G virus (HGV) is a flavivirus that can cause acute hepatitis and persistent infection but its role in chronic liver disease or primary liver cancer is unproven. In this study we have examined the prevalence of HGV RNA in the serum of patients with hepatitis C virus (HCV) infection and in patients with cryptogenic chronic liver disease, including non-alcoholic steatohepatitis (NASH), and in patients with HCV-related hepatocellular carcinoma (HCC) and HCC arising in patients with cryptogenic liver disease. One-hundred and thirty patients who were positive for antibody to HCV (anti-HCV), 54 patients with cryptogenic chronic liver disease (including 17 patients with NASH) and 46 patients with hepatitis C-related (n = 27) or cryptogenic liver disease-related HCC (n = 19) were studied. HGV RNA was detected using nested reverse transcriptase-polymerase chain reaction (RT-PCR) and was found in 16.1% of patients with HCV infection. HGV RNA was not detected in any patient with cryptogenic liver disease. In patients with HCC, 7/34 samples were positive for HGV RNA and six out of seven HGV-positive subjects also had HCV infection. Only one patient with HCC in cryptogenic liver disease was positive for HGV RNA. Hence, cryptogenic liver disease in the UK is not caused by HGV/GBVc infection. It seems unlikely that HGV plays a significant role in hepatocarcinogenesis.

Two-generation chronic toxicity study with hexachlorobenzene in the rat.

The toxicological effects of analytical grade hexachlorobenzene (HCB) were examined in a two-generation feeding study in which 40 male and 40 female weanling Sprague-Dawley rats, except where noted, were fed diets containing 0.0 (64 males, 64 females), 0.32, 1.6, 8.0 or 40.0 (66 males, 66 females) ppm HCB. After 3 months on test, the F0 rats were bred and 50 pups (F1) of each sex were randomly selected from every group. At weaning the F0 animals were killed, and the F1 animals were fed their parents' diet for the remainder of their lifetimes (130 weeks). There were no treatment-related effects on growth, feed consumption, haematological parameters or survival in either generation. Increased heart and liver weights were found in the F0 generation males fed 8.0 and 40 ppm HCB. HCB had no effect on fertility, but did significantly reduce pup viability in the 40.0-ppm group. Histopathological changes in the F1 generation included significant linear trends for the incidence of parathyroid adenomas and phaeochromocytomas in both sexes, neoplastic liver nodules in females, centrolobular basophilic chromogenesis of the liver in both sexes, peliosis of the liver in females, peribiliary lymphocytosis of the liver in males and chronic nephrosis of the kidney in males.

Long-term toxicity of hexachlorobenzene in the rat and the effect of dietary vitamin A.

The toxicological effects of analytical-grade hexachlorobenzene (HCB) were examined in two chronic studies. Study I was an in utero exposure carcinogenicity feeding experiment in which Sprague-Dawley rats, in groups of 40 males and 40 females except where noted, were fed from weaning on diets containing 0.0 (64 M/64 F), 0.32, 1.6, 8.0 or 40.0 (66 M/66 F) ppm HCB. After 3 months on test, the F0 rats were bred and 50 pups (F1) of each sex were randomly selected from every group. From weaning, when the F0 animals were killed, the F1 animals were fed their parents' diet for the rest of their life (130 wk). There were no treatment-related effects on growth, feed consumption, haematological parameters or survival in either generation. Increased heart and liver weights were found in the 8.0 and 40 ppm F0 males. HCB had no effect on fertility but pup viability was significantly reduced in the 40 ppm group. Histopathological changes in the F1 generation included significant linear trends in the incidence of parathyroid adenomas and phaeochromocytomas in both sexes, neoplastic liver nodules in females, centrilobular basophilic chromogenesis of the liver in both sexes, peliosis of the liver in females, peribiliary lymphocytosis of the liver in males and chronic nephrosis of the kidney in males. In Study II, the toxicological effects of HCB were examined as a consequence of varying the dietary levels of vitamin A. In this single generation lifetime (119 wk) feeding study, groups of 50 weanling Sprague-Dawley male rats were randomly assigned to each of the following dietary groups: control, control + 40 ppm HCB, 1/10 the vitamin A content of the control diet, 1/10 vitamin A + 40 ppm HCB, 10 times the vitamin A content of the control diet and 10 times vitamin A + 40 ppm HCB. After 25 and 49 wk on test, five animals from each group were killed and subjected to haematological and histological examinations. All other aspects of evaluation were similar to those for the F1 generation in Study I. No consistent differences were observed in the haematological parameters and there were no significant differences in the incidence of pathological lesions between the test groups. The animals in the 1/10 vitamin A groups, with or without HCB, had significantly lower body weights and poorer survival than did their corresponding control (normal vitamin A) groups.

Reversibility of ethylenethiourea-induced thyroid lesions.

Groups of 50 male and 50 female Sprague-Dawley rats were fed diets containing 0, 75, 100, or 150 ppm ethylenethiourea (ETU) for 7 weeks, at which time subgroups of 10 animals from each group were killed. Subsequent subgroups of 10, 10, and 20 animals were killed after an additional 2, 3, and 4 weeks, respectively, on the control diet in order to examine whether the toxicological effects induced by ETU were reversible. In both sexes, the mean body weight and feed consumption were significantly decreased in all treated groups, while the mean thyroid weight (absolute as well as relative to both body and brain weight) appeared to increase linearly with dose. Mean T4 blood levels in animals fed 150 ppm ETU were significantly below those in controls. The magnitude of the changes in body weight, thyroid weight, and T4 blood levels observed during the first 7 weeks of the study decreased after ETU was removed from the diet. The statistical procedures developed and applied here may be useful in other experiments designed to assess the reversibility of other toxicological endpoints.

Effect of a low-carbohydrate diet and alcohol on perceptual motor skill.

Eleven adults of both sexes ate a low-carbohydrate diet consisting mainly of meat, fish, and eggs for two days. After a low-carbohydrate breakfast on the third day, they operated a Stressalyzer to test their basic perceptual motor skill. Each subject drank 1.5 oz. rye whiskey at hourly intervals from 9:30 A.M. to 12:30 P.M. Blood glucose decreased to below 50 mg. per 100 ml. in three of the eleven subjects; two of the three had decreased perceptual motor skill.