Efficacy and Findings of a Blinded Randomized Reintroduction Phase for the Low FODMAP Diet in Irritable Bowel Syndrome.

BACKGROUND AND AIMS: The efficacy of a low fermentable oligo-, di-, monosaccharides and polyols (FODMAP) diet in irritable bowel syndrome (IBS) is well established. After the elimination period, a reintroduction phase aims to identify triggers. We studied the impact of a blinded reintroduction using FODMAP powders to objectively identify triggers and evaluated the effect on symptoms, quality of life, and psychosocial comorbidities. METHODS: Responders to a 6-week low FODMAP diet, defined by a drop in IBS symptom severity score (IBS-SSS) compared with baseline, entered a 9-week blinded randomized reintroduction phase with 6 FODMAP powders (fructans, fructose, galacto-oligosaccharides, lactose, mannitol, sorbitol) or control (glucose). A rise in IBS-SSS (≥50 points) defined a FODMAP trigger. Patients completed daily symptom diaries and questionnaires for quality of life and psychosocial comorbidities. RESULTS: In 117 recruited patients with IBS, IBS-SSS improved significantly after the elimination period compared with baseline (150 ± 116 vs 301 ± 97, P < .0001, 80% responders). Symptom recurrence was triggered in 85% of the FODMAP powders, by an average of 2.5 ± 2 FODMAPs/patient. The most prevalent triggers were fructans (56%) and mannitol (54%), followed by galacto-oligosaccharides, lactose, fructose, sorbitol, and glucose (respectively 35%, 28%, 27%, 23%, and 26%) with a significant increase in abdominal pain at day 1 for sorbitol/mannitol, day 2 for fructans/galacto-oligosaccharides, and day 3 for lactose. CONCLUSION: We confirmed the significant benefit of the low FODMAP diet in tertiary-care IBS. A blinded reintroduction revealed a personalized pattern of symptom recurrence, with fructans and mannitol as the most prevalent, and allows the most objective identification of individual FODMAP triggers. Ethical commission University hospital of Leuven reference number: s63629; Clinicaltrials.gov number: NCT04373304.

The role of neuromodulation in chronic functional constipation: a systematic review.

BACKGROUND: Chronic functional constipation is a highly prevalent disorder in which, when conservative measures fail to relieve symptoms, surgical interventions are sometimes indicated. In recent years, neuromodulation for the treatment of functional constipation has gained interest but its role and effectiveness are still unclear. The purpose of this review is to provide a systematic overview on the current literature on the different modalities of neurostimulation and their effect on chronic functional constipation in adults as reported in the literature. METHODS: A search in the literature for articles concerning the effect of different types of neuromodulation on constipation was performed in PubMed using extensive search terms for the different modalities of neuromodulation. Studies and trials were checked for eligibility. For all types of neuromodulation together, 27 articles were included. RESULTS: 17 studies were included on SNM (sacral nerve modulation). Although multiple studies show positive results on the effect of SNM in constipation, double-blind crossover RCT's (randomised controlled trials) showed no significant effect. 3 studies were included for tSNS (transcutaneous sacral nerve stimulation), 2 for PTNS (percutaneous tibial nerve stimulation) and 2 for TTNS (transcutaneous tibial nerve stimulation). Studies and trials on these modalities of neuromodulation reported ambiguous results on statistical significance of the effect. For transcutaneous IFC (interferential current therapy) 2 studies were included, which both reported a statistically significant effect on all outcomes. CONCLUSION: The beneficial effect of neuromodulation in chronic functional constipation remains questionable. However, neuro-modulation might be worth considering in patients refractory to treatment before turning to more invasive measures. Future research should shed more light on the effects of neuromodulation in constipation.

Outcomes of different radioprotective precautions in children undergoing dental radiography: a systematic review.

PURPOSE: To evaluate the effectiveness of all radioprotective measures in underage patients who undergo a dental radiodiagnostic examination. METHODS: A systematic review was performed including randomised controlled trials (RCTs), or cluster trials, cohort studies, cross-sectional studies, case-control studies and comparative in vitro research. These studies examined the healthy underage human population (below 18 years) undergoing a dental radiodiagnostic examination. All radioprotective measures were included except for justification as an intervention. The primary outcomes were in vivo mortality and morbidity. Some surrogate or indirect outcomes such as in vitro effective dose and organ absorbed doses were also accepted. Secondary outcomes with regards to image quality and therapeutic value were also analysed. RESULTS: Eighteen papers were eligible for implementation. Fifteen studies underwent narrative synthesis. Regression analysis was performed on three studies. CONCLUSION: The following radioprotective measures can reduce the exposure dose. For lateral cephalometry: collimation, filtration, the fastest receptor type and circumstantial thyroid shielding. For oblique lateral radiographs: the shortest exposure time, a smaller horizontal angulation, a longer focus to skin distance. For intraoral radiography: rectangular collimation, the fastest image receptor speed and thyroid shielding when the thyroid gland is in line of or very close to the primary beam. For panoramic radiographs: collimation, the fastest receptor type and the use of automatic exposure control (AEC) or manual adjustment of intensity. For cone-beam computed tomography: collimation, the largest voxels size in relation to the treatment need, change in image settings such as ultra-low dose settings, shorter exposure time, a lower amount of projections, lower beam intensity, reduction of the potential, use of a thyroid shield except in two situations and the use of AEC. All of the changes in exposure parameters should be performed while maintaining a sufficient therapeutic value on an individual and indication-based level.

[Can we consider the journalist an actor in suicide prevention?] / Peut-on faire du journaliste un acteur de la prévention du suicide ?

INTRODUCTION: After more than 50 years of dedicated research, media coverage of suicide is now well known to have a significant influence on the suicide epidemiology. This influence is supposed to result from two opposite effects. The Werther effect (WE) refers to the robust increase of suicide rates following the publication of a suicide story. This specific kind of mass cluster implies a suggestion process, i.e. imitation of the depicted death by vulnerable persons. In contract, the preventive potential of medias has been labeled the "Papageno effect" (PE). Although more recently discovered and far less known, PE predicts that journalists can help prevent suicidal behaviors beyond a simple WE reduction. Because PE and WE directly bridge journalistic productions to suicidal events, several national and international health organisms (including the World Health Organization) started to see the media as new prevention opportunities. In this paper, we intend to assess the extent to which journalists can be considered as public health actors in the specific field of suicide prevention. METHODS: Based on a critical review of the so-called Media effect studies, we explore the opportunities, limits and constraints of collaborating with media professionals for public health actions. For that purpose, we focus on the main strategy employed so far, namely providing recommendations for more cautious coverage of suicide. An overview of the efficacy of these recommendations serves not only as a starting point for understanding how public health and journalistic perspectives can confront, but also how they can be combined in a fertile way. RESULTS: Numerous suicide prevention organisms developed strategies in order to assist journalists in reporting suicide stories in a safer way. As a formal support to these strategies, around 30 national or international guides have been produced around the word, with the shared aim of reducing WE and, eventually, promoting PE. The recommendations about articles' style and content that compose these guides were shown to be similar across the countries. They mostly meet public health concerns, rest on the available knowledge about the two effects' determinants and thus advocate for a less quantitatively and qualitatively prominent coverage. However, the way the guides were produced and implemented shows considerable variations. While most countries solely edited and/or distributed the recommendations with no complementary measures, several organisms associated their publication with promotion actions towards the journalists and general public. Evidence for the impact of the guides' publication on suicide rates, although encouraging, are seriously limited by methodological considerations. As a consequence, their efficacy is more often assessed in terms of media compliance to the recommendations. The extent to which media items respect the guidelines depends considerably on the way journalists are invited - or not - to resort to them. While the strategy seems inefficient when limited to a simple publication, the quality of suicide portrayal significantly improves when the guides are part of a whole prevention campaign dealing with suicide coverage. Moreover the journalist's implication at each step of the process seems a crucial point for its success. DISCUSSION: Media professionals are submitted to their own codes, constraints and missions which do not necessarily fit with public health concerns. If considered as prescriptions to reduce the suicide rates, journalists might see recommendations for a more cautious coverage to be a threat to their independence, thus accounting for their non-compliance. On the other hand, a real collaborative approach based on shared skills and knowledge could help sensitize journalists to a responsibility that PE and WE inevitably give them. Under these conditions, recommendations can become a precious resource to help media professional when facing a sensitive issue and finally contribute to fight against suicide.

A numerical analysis of the influence of tram characteristics and rail profile on railway traffic ground-borne noise and vibration in the Brussels Region.

Nowadays, damage potentially caused by passing train in dense cities is of increasing concern and restricts improvement to the interconnection of various public transport offers. Although experimental studies are common to quantify the effects of noise and vibration on buildings and on people, their reach is limited since the causes of vibrations can rarely be deduced from data records. This paper presents the numerical calculations that allow evaluating the main contributions of railway-induced ground vibrations in the vicinity of buildings. The reference case is the Brussels Region and, more particularly, the T2000 tram circulating in Brussels city. Based on a pertinent selection of the vibration assessment indicators and a numerical prediction approach, various results are presented and show that the free-field analysis is often improperly used in this kind of analysis as the interaction of soil and structure is required. Calculated high ground vibrations stem from singular rail surface defects. The use of resilient wheels is recommended in order to reduce the ground-borne noise and vibration to permissible values.

Worldwide policies on haemochromatosis and blood donation: a survey among blood services.

BACKGROUND AND OBJECTIVES: Haemochromatosis (HC) is a disorder of iron metabolism, requiring frequent phlebotomy to normalize high serum iron levels. There is currently no consensus relating to the eligibility of these patients to donate blood for transfusion. To gain a better understanding of the policies worldwide, a survey amongst blood services was performed. MATERIALS AND METHODS: A web-based questionnaire was developed and distributed among 44 blood services in 41 countries to identify the different policies relating to patients with HC and blood donation. RESULTS: Respondents from 35 blood services (80%) of 33 countries completed the questionnaire. In 24 blood services among them (69%), individuals with genetic susceptibility for HC and/or patients with HC are accepted as blood donors. In approximately one-third of these blood centres (33%), genetic carriers/patients are allowed to donate blood more frequently than regular donors. Prescription from/approval by the patient's treating physician and/or a donor physician is required in the majority of the blood services (87%). Similar policies were identified in a few countries; however, in general, the policies regarding blood donation from patients with HC remain widely variable. CONCLUSION: The results of our survey demonstrate large differences in the blood donation policies regarding carriers/patients with HC illustrating the need for uniform evidence-based and cost-effective policies which could benefit both HC patients and the blood supply around the world.

COPD is associated with reduced pulmonary interstitial expression of pentraxin-3.

Pentraxin (PTX)3 is involved in antimicrobial defence, apoptotic cell clearance and extracellular matrix stability. As these processes are altered in chronic obstructive pulmonary disease (COPD), we aimed to investigate PTX3 expression in patients with this disease. PTX3 expression was quantified by immunohistochemical staining of lung tissue from never-smokers, smokers without COPD, and in patients with COPD of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage I, II and III-IV. mRNA expression was examined in total lung tissue by quantitative RT-PCR. PTX3 concentration was measured in induced sputum and plasma by ELISA. PTX3 is mainly localised in the interstitium of the small airways and alveolar walls. There were no significant differences in pulmonary, sputum and plasma PTX3 expression between study groups. However, PTX3 expression in small airways correlated significantly with forced expiratory volume in 1 s (r = 0.35, p = 0.004). In the alveolar walls, PTX3 expression correlated significantly with carbon monoxide transfer coefficient (r = 0.28, p = 0.04). In sputum, PTX3 levels were highly correlated with the number of neutrophils. Finally, systemic levels of PTX3 tended to be lower in severe COPD compared with mild COPD. In COPD, airflow limitation and reduced transfer coefficient for carbon monoxide are associated with lower pulmonary interstitial expression of PTX3.

Role of IL-1α and the Nlrp3/caspase-1/IL-1ß axis in cigarette smoke-induced pulmonary inflammation and COPD.

Cigarette smoke (CS), the primary risk factor of chronic obstructive pulmonary disease (COPD), leads to pulmonary inflammation through interleukin-1 receptor (IL-1R)I signalling, as determined using COPD mouse models. It is unclear whether interleukin (IL)-1α or IL-1ß, activated by the Nlrp3/caspase-1 axis, is the predominant ligand for IL-1RI in CS-induced responses. We exposed wild-type mice (treated with anti-IL-1α or anti-IL-1ß antibodies), and IL-1RI knockout (KO), Nlrp3 KO and caspase-1 KO mice to CS for 3 days or 4 weeks and evaluated pulmonary inflammation. Additionally, we measured the levels of IL-1α and IL-1ß mRNA (in total lung tissue by RT-PCR) and protein (in induced sputum by ELISA) of never-smokers, smokers without COPD and patients with COPD. In CS-exposed mice, pulmonary inflammation was dependent on IL-1RI and could be significantly attenuated by neutralising IL-1α or IL-1ß. Interestingly, CS-induced inflammation occurred independently of IL-1ß activation by the Nlrp3/caspase-1 axis. In human subjects, IL-1α and IL-1ß were significantly increased in total lung tissue and induced sputum of patients with COPD, respectively, compared with never-smokers. These results suggest that not only IL-1ß but also IL-1α should be considered as an important mediator in CS-induced inflammation and COPD.

Empirical validation of a real options theory based method for optimizing evacuation decisions within chemical plants.

This article empirically assesses and validates a methodology to make evacuation decisions in case of major fire accidents in chemical clusters. In this paper, a number of empirical results are presented, processed and discussed with respect to the implications and management of evacuation decisions in chemical companies. It has been shown in this article that in realistic industrial settings, suboptimal interventions may result in case the prospect to obtain additional information at later stages of the decision process is ignored. Empirical results also show that implications of interventions, as well as the required time and workforce to complete particular shutdown activities, may be very different from one company to another. Therefore, to be optimal from an economic viewpoint, it is essential that precautionary evacuation decisions are tailor-made per company.

Making evacuation decisions by using a discrete-time approximation methodology.

This article further elaborates the findings by Reniers et al. in 2007 and 2008. A discrete-time approximation is presented to determine the severity of a major accident threat triggering immediate evacuation and its expected resulting costs. By implementing the proposed mathematical model, precautionary evacuation decision problems can be tackled in a realistic way, i.e., allowing for major accident threats with limited duration. Furthermore, the model is moulded into a working procedure which was used to develop software to solve the suggested algorithms. A case-study is provided and the results obtained by application of the methodology are discussed. Using a (realistic) discrete-time approximation computer simulation, we found that ignoring option characteristics may produce suboptimal intervention decisions in shutdown settings.

A multiple shutdown method for managing evacuation in case of major fire accidents in chemical clusters.

This paper may be regarded as the second part of a larger article. The basic decision model developed in the first part of the article by Reniers et al. [G.L.L. Reniers, N. Pauwels, A. Audenaert, B.J.M. Ale, K. Soudan, Management of evacuation in case of fire accidents in chemical industrial areas, J. Hazard. Mater., 147 (2007) 478-487] is extended to determine both the optimal time and the optimal mode to stop the ongoing activities in case of a major fire possibly giving rise to an escalating event. Chemical plants have multiple modes to stop their production processes, differing with respect to the resulting costs, and with respect to the required time and personnel to complete the shutdown operations. The existence of an additional and more economic (but slower) shutdown mode might encourage the decision maker to stop the production processes earlier, in a less intervening manner, whereas the availability of an additional faster (but less economic) shutdown procedure might stimulate the decision maker to stop the production processes later, in a more intervening manner.

Management of evacuation in case of fire accidents in chemical industrial areas.

Trade-offs between economic and safety arguments exist in the operation of chemical installations, should knock-on calamities induced by fire accidents occur: a sudden installation shutdown might result in substantial economic losses, but may be needed to ensure safety. Due to the very rare nature of domino effect risks induced decision problems an adequate evacuation decision aid model to be used by plant safety management does, to the best of the authors' knowledge, not exist. This paper develops a tentative approach to calculate the economic gains and/or losses linked to the decision problem whether or not, and when, to evacuate chemical installation(s) threatened by possible domino effect risks. The proposed model is illustrated by a case-study based on empirical data.

Radiological protective measures in highly industrialized areas: do the existing intervention levels apply?

Several international organizations have provided numerical guidance on the intervention levels for protective measures in case of a nuclear accident. The resulting intervention levels, however, are generic in nature and allow for (and even require) adjustment to site-specific conditions. As interventions in highly industrialized areas may result in important economic losses and potential secondary risks for the workers and the environment, we argue that the appropriate intervention levels for evacuating or relocating people from these areas might be higher than those generically derived. Furthermore, the optimal duration of these interventions will in general be shorter when imposed on industrial areas. The same results apply for sheltering, in case it requires a shut-down of the industrial production processes.

The monetary value of the person-Sievert: a practical approach in case of occupational exposures.

This paper gives some practical advice on the determination of the value of the person-Sievert, this figure being of primary importance when cost-benefit analysis is used to optimize (ALARA-principle) routine occupational exposures of professionals to external radiation. After a brief introduction on the use of cost-benefit analysis in a radioprotection context, more attention will be paid to the theoretical guidelines that exist on the monetary value of the person-Sievert. By combining these insights with the practical problems that occur in daily task preparations and evaluations, a more workable proposal for the determination of the value of the person-Sievert will be presented.

Activation of thick targets by energetic heavy ions and the resultant radiation levels.

This study completes data collected for thick targets exposed to carbon and oxygen ions accelerated at 86 MeV/u. The radioactivity induced in carbon and tungsten targets bombarded by argon projectiles at 95 MeV/u has been studied in order to assess the relative contributions of the incoming heavy ion and the mass number of the bombarded nuclei to the consequent radiation hazards related to the production of radioactive ion beams. Induced radioactivity measurements are only rarely made under controlled irradiation conditions, in order to derive from the measured activities the dose rates after beam bombardment and a prediction of radiation protection constraints.