Health, psychosocial factors and retirement intentions among Finnish physicians

Background Early retirement among physicians is a worldwide problem and all efforts to try to minimize it are of importance.

Faint supernovae and supernova impostors: case studies of SN 2002kg/NGC 2403-V37 and SN 2003gm

Photometric and spectroscopic observations of the faint Supernovae (SNe) 2002kg and 2003gm, and their precursors, in NGC 2403 and NGC 5334, respectively, are presented. The properties of these SNe are discussed in the context of previously proposed scenarios for faint SNe: low-mass progenitors producing underenergetic SNe; SNe with ejecta constrained by a circumstellar medium; and outbursts of massive Luminous Blue Variables (LBVs). The last scenario has been referred to as 'Type V SNe', 'SN impostors' or 'fake SNe'.

The UNCRC and social workers' relationships with young children

In the UK, The Munro Review of Child Protection (2010, 2011a, 2011b) has recently highlighted that among the failings in safeguarding children known to social services is the lack of meaningful relationships between social workers and children. In her final report, Munro (2011b) has made recommendations for a more child-centred system anchored on two themes – the child's journey and the United Nations Convention on the Rights of the Child (UNCRC). This article illustrates by way of practical examples how the UNCRC, together with the detailed advice and guidance contained in the UNCRC general comments numbers 5, 7 and 12, provides the best framework for developing effective social work relationships with, and safeguarding, young children.

A silicone elastomer vaginal ring for HIV prevention containing two microbicides with different mechanisms of action

Vaginal rings are currently being developed for the long-term (at least 30 days) continuous delivery of microbicides against human immunodeficiency virus (HIV). Research to date has mostly focused on devices containing a single antiretroviral compound, exemplified by the 25 mg dapivirine ring currently being evaluated in a Phase III clinical study. However, there is a strong clinical rationale for combining antiretrovirals with different mechanisms of action in a bid to increase breadth of protection and limit the emergence of resistant strains. Here we report the development of a combination antiretroviral silicone elastomer matrix-type vaginal ring for simultaneous controlled release of dapivirine, a non-nucleoside reverse transcriptase inhibitor, and maraviroc, a CCR5-targeted HIV-1 entry inhibitor. Vaginal rings loaded with 25 mg dapivirine and various quantities of maraviroc (50– 400 mg) were manufactured and in vitro release assessed. The 25 mg dapivirine and 100 mg maraviroc formulation was selected for further study. A 24-month pharmaceutical stability evaluation was conducted, indicating good product stability in terms of in vitro release, content assay, mechanical properties and related substances. This combination ring product has now progressed to Phase I clinical testing.

Obesity associated severe asthma represents a distinct clinical phenotype - Analysis of the British Thoracic Society Difficult Asthma Registry patient cohort according to body mass index

BACKGROUND: Obesity has emerged as a risk factor for the development of asthma and it may also influence asthma control and airways inflammation. However, the role of obesity in severe asthma remains unclear. OBJECTIVE: To explore the association between obesity (defined by BMI) and severe asthma. METHODS: Data from the National Registry for dedicated UK Difficult Asthma Services were used to compare patient demographics, disease characteristics and healthcare utilisation between three body mass index (BMI) categories (normal weight: 18.5 -24.99, overweight: 25 -29.99, obese: =30) in a well characterised group of severe asthmatic adults. RESULTS: The study population consisted of 666 severe asthmatics with a median BMI of 29.8 (interquartile range 22.5 -34.0). The obese group exhibited greater asthma medication requirements in terms of maintenance corticosteroid therapy (48.9% versus 40.4% and 34.5% in the overweight and normal weight groups, respectively), steroid burst therapy and short-acting ß2-agonist (SABA) use per day. Significant differences were seen with gastro-oesophageal reflux disease (GORD) (53.9% versus 48.1% and 39.7% in the overweight and normal weight groups, respectively) and proton pump inhibitor (PPI) use. Bone density scores were higher in the obese group, whilst pulmonary function testing revealed a reduced FVC and raised Kco. Serum IgE levels decreased with increasing BMI and the obese group were more likely to report eczema, but less likely to have a history of nasal polyps. CONCLUSIONS: Severe asthmatics display particular characteristics according to BMI that support the view that obesity associated severe asthma may represent a distinct clinical phenotype.1Royal Brompton Hospital, London, UK;2Department of Computing, Imperial College, UK3Airways Disease, National Heart & Lung Institute, Imperial College, UK;4Centre for infection and immunity, Queen's University of Belfast, UK;5University of Leicester, UK;6The University of Manchester and University Hospital of South Manchester, UK;7Birmingham Heartlands Hospital, University of Birmingham, UK;8Gartnavel General Hospital, University of Glasgow, UK;9Glasgow Royal Infirmary, Glasgow, UKCorrespondence: Dr Andrew N. Menzies-Gow, Royal Brompton Hospital, Fulham Road, London SW3 6HP.

Depletion of four nitrofuran antibiotics and their tissue-bound metabolites in porcine tissues and determination using LC-MS/MS and HPLC-UV

Depletion of the nitrofuran antibiotics furazolidone, furaltadone, nitrofurantoin and nitrofurazone and their tissue-bound metabolites AOZ, AMOZ, AHD and SEM from pig muscle, liver and kidney tissues is described. Groups of pigs were given feed medicated with one of the nitrofuran drugs at a therapeutic concentration (400 mg kg(-1)) for ten days. Animals were slaughtered at intervals and tissue samples collected for analysis for six weeks following withdrawal of medicated feed. These samples were analysed both for parent nitrofurans (using LC-MS/MS and HPLC-UV), and for tissue-bound metabolites (using LC-MS/MS). The parent drugs were detectable only sporadically and only in pigs subjected to no withdrawal period whatsoever. This confirms the instability of the four major nitrofuran antibiotics in edible tissues. In contrast, the metabolites accumulated to high concentrations in tissues (ppm levels) and had depletion half lives of between 5.5 and 15.5 days. The metabolites of all four drugs were still readily detectable in tissues six weeks after cessation of treatment. This emphasizes the benefits of monitoring for the stable metabolites of the nitrofurans.

Exploring the use of physical activity loyalty cards for behaviour change in public health: randomised controlled trial

Abstract
Background Physical inactivity is a major public health concern, and more innovative approaches are urgently needed to address it. The UK Government supports the use of incentives and so-called nudges to encourage healthy behaviour changes, and has encouraged business sector involvement in public health through the Public Health Responsibility Deal. To test the effectiveness of provision of incentives to encourage adults to increase their physical activity, we
recruited 406 adults from a workplace setting (office-based) to take part in an assessor-blind randomised controlled trial.
Methods
We developed the physical activity loyalty card scheme, which integrates a novel physical activity tracking system with web-based monitoring (palcard). Participants were recruited from two buildings at Northern Ireland’s main
government offices and were randomly allocated (grouped by building [n=2] to reduce contamination) to either incentive group (n=199) or no incentive group (n=207). We included participants aged 16–65 years, based at the worksite 4 days or more per week and for 6 h or more per day, and able to complete 15 min of moderate-paced walking (self-report). Exclusion criteria included having received specific advice by a general practitioner not to exercise. A statistician not involved in administration of the trial prepared a computer-generated random allocation sequence. Random assignments were placed in individually numbered, sealed envelopes by the statistician to ensure concealment of allocation. Only the assessor was masked to assignment. Sensors were placed along footpaths and the gym in the workplace. Participants scanned their loyalty card at the sensor when undertaking physical activity (eg, walking), which logged activity. Participants in the incentive group monitored their physical activity, collected points, and received rewards (retail vouchers) for minutes of physical activity completed over the 12-week intervention. Rewards were vouchers sponsored by local retailers. Participants in the no incentive group used their loyalty card to self-monitor their physical activity but were not able to earn points or receive rewards. The primary outcome was change in minutes of moderate to vigorous physical activity with the Global Physical Activity Questionnaire, measured at baseline, week 12, and 6 months. Activity was objectively measured with the tracking system over the 12-week intervention. Mann Whitney U tests were done to assess change between groups.
Findings
The mean age of participants was 43·32 years (SD 9·37), and 272 (67%) were women. We obtained follow-up data from 353 (87%) participants at week 12 and 341 (84%) at 6 months. At week 12, participants in the incentive group increased moderate to vigorous physical activity by a median of 60 min per week (IQR –10 to 120) compared with 30 min per week (–60 to 90) in the no incentive group (p=0·05). At 6 months, participants in the incentive group had
increased their moderate to vigorous physical activity by 30 min per week (–60 to 100) from baseline compared with 0 min per week (–115 to 1110) in the no incentive group (p=0·099). We noted no significant differences between groups
for use of loyalty card (p=0·18). Participants in the incentive group recorded a mean of 60·22 min (95% CI 50·90–69·55) of physical activity per week with their loyalty card on week 1 and 23·56 min (17·06–30·06) at week 12, which was similar to that for those in the no incentive group (59·74 min, 51·24–68·23, at week 1; 20·25 min, 14·45–26·06, at week 12; p=0·94 for differences between groups at week 1; p=0·45 for differences between groups at week 12).
Interpretation:
Financial incentives showed a short-term behaviour change in physical activity. This innovative study contributes to the necessary evidence base, and has important implications for physical activity promotion and business engagement in health. The optimum incentive-based approach needs to be established. Results should be interpreted with some caution as the analyses of secondary outcomes were not adjusted for multiple comparisons.

Clofarabine doubles the response rate in older patients with acute myeloid leukemia but does not improve survival

Better treatment is required for older patients with acute myeloid leukemia (AML) not considered fit for intensive chemotherapy. We report a randomized comparison of lowdose Ara-C (LDAC) vs the novel nucleoside, clofarabine, in untreated older patients with AML and high-risk myelodysplastic syndrome (MDS). A total of 406 patients with de novo (62%), secondary disease (24%), or high-risk MDS (>10% marrow blasts) (15%), median age 74 years, were randomized to LDAC 20 mg twice daily for 10 days every 6 weeks or clofarabine 20 mg/m2 on days 1 to 5, both for up to 4 courses. These patients had more adverse demographics than contemporaneous intensively treated patients. The overall remission rate was 28%, and 2-year survival was 13%. Clofarabine significantly improved complete remission (22% vs 12%; hazard ratio [HR] 5 0.47 [0.28-0.79]; P 5 .005) and overall response (38% vs 19%; HR 5 0.41 [0.26-0.62]; P < .0001), but there was no difference in overall survival, explained by poorer survival in the clofarabine patients who did not gain complete remission and also following relapse. Clofarabine was more myelosuppressive and required more supportive care. Although clofarabine doubled remission rates, overall survival was not improved overall or in any subgroup. The treatment of patients of the type treated here remains a major unmet need. This trial was registered at www.clinicaltrials.gov as #ISRCTN 11036523.

A sparse representation based fast detection method for surface defect detection of bottle caps

A practical machine-vision-based system is developed for fast detection of defects occurring on the surface of bottle caps. This system can be used to extract the circular region as the region of interests (ROI) from the surface of a bottle cap, and then use the circular region projection histogram (CRPH) as the matching features. We establish two dictionaries for the template and possible defect, respectively. Due to the requirements of high-speed production as well as detecting quality, a fast algorithm based on a sparse representation is proposed to speed up the searching. In the sparse representation, non-zero elements in the sparse factors indicate the defect's size and position. Experimental results in industrial trials show that the proposed method outperforms the orientation code method (OCM) and is able to produce promising results for detecting defects on the surface of bottle caps.

Development and validation of a rapid multiplex ELISA for pyrrolizidine alkaloids and their N-oxides in honey and feed Rapid Detection in Food and Feed

Pyrrolizidine alkaloids (PAs) are a group of plant secondary metabolites with carcinogenic and hepatotoxic properties. When PA-producing plants contaminate crops, toxins can be transferred through the food chain and cause illness in humans and animals, most notably hepatic veno-occlusive disease. Honey has been identified as a direct risk of human exposure. The European Food Safety Authority has recently identified four groups of PAs that are of particular importance for food and feed: senecionine-type, lycopsamine-type, heliotrine-type and monocrotaline-type. Liquid or gas chromatography methods are currently used to detect PAs but there are no rapid screening assays available commercially. Therefore, the aim of this study was to develop a rapid multiplex ELISA test for the representatives of three groups of alkaloids (senecionine, lycopsamine and heliotrine types) that would be used as a risk-management tool for the screening of these toxic compounds in food and feed. The method was validated for honey and feed matrices and was demonstrated to have a detection capability less than 25 µg/kg for jacobine, lycopsamine, heliotrine and senecionine. The zinc reduction step introduced to the extraction procedure allows for the additional detection of the presence of N-oxides of PAs. This first multiplex immunoassay for PA detection with N-oxide reduction can be used for the simultaneous screening of 21 samples for >12 PA analytes. Honey samples (n?=?146) from various origins were analysed for PA determination. Six samples were determined to contain measurable PAs >25 µg/kg by ELISA which correlated to >10 µg/kg by LC-MS/MS.

Protracted Peace processes: Policy (Un)learning and the Cyprus Debacle

The article examines why a comprehensive settlement to resolve the Cyprus problem has yet to be reached despite the existence of a positive incentive structure and the proactive involvement of regional and international organizations, including the European Union and the United Nations. To address this question, evidence from critical turning points in foreign policy decision-making in Turkey, Greece and the two communities in Cyprus is drawn on. The role of hegemonic political discourses is emphasized, and it is argued that the latter have prevented an accurate evaluation of incentives that could have set the stage for a constructive settlement. However, despite the political debacle in the Cypriot negotiations, success stories have emerged, such as the reactivation of the Committee for Missing Persons (CMP), a defunct body for almost 25 years, to become the most successful bi-communal project following Cyprus’s EU accession. Contradictory evidence in the Cypriot peace process is evaluated and policy lessons to be learned from the CMP ‘success story’ are identified.

Political Extremism in the 1920s and 1930s: Do German Lessons Generalize?

We examine the impact of the Great Depression on the share of votes for right-wing extremists in elections in the 1920s and 1930s. We confirm the existence of a link between political extremism and economic hard times as captured by growth or contraction of the economy. What mattered was not simply growth at the time of the election, but cumulative growth performance. The impact was greatest in countries with relatively short histories of democracy, with electoral systems that created low hurdles to parliamentary representation, and which had been on the losing side in World War I.

Evolving to the optoelectronic mouse for phycotoxin analysis in shellfish

Despite ethical and technical concerns, the in vivo method, or more commonly referred to mouse bioassay (MBA), is employed globally as a reference method for phycotoxin analysis in shellfish. This is particularly the case for paralytic shellfish poisoning (PSP) and emerging toxin monitoring. A high-performance liquid chromatography method (HPLC-FLD) has been developed for PSP toxin analysis, but due to difficulties and limitations in the method, this procedure has not been fully implemented as a replacement. Detection of the diarrhetic shellfish poisoning (DSP) toxins has moved towards LC-mass spectrometry (MS) analysis, whereas the analysis of the amnesic shellfish poisoning (ASP) toxin domoic acid is performed by HPLC. Although alternative methods of detection to the MBA have been described, each procedure is specific for a particular toxin and its analogues, with each group of toxins requiring separate analysis utilising different extraction procedures and analytical equipment. In addition, consideration towards the detection of unregulated and emerging toxins on the replacement of the MBA must be given. The ideal scenario for the monitoring of phycotoxins in shellfish and seafood would be to evolve to multiple toxin detection on a single bioanalytical sensing platform, i.e. 'an artificial mouse'. Immunologically based techniques and in particular surface plasmon resonance technology have been shown as a highly promising bioanalytical tool offering rapid, real-time detection requiring minimal quantities of toxin standards. A Biacore Q and a prototype multiplex SPR biosensor have been evaluated for their ability to be fit for purpose for the simultaneous detection of key regulated phycotoxin groups and the emerging toxin palytoxin. Deemed more applicable due to the separate flow channels, the prototype performance for domoic acid, okadaic acid, saxitoxin, and palytoxin calibration curves in shellfish achieved detection limits (IC20) of 4,000, 36, 144 and 46 μg/kg of mussel, respectively. A one-step extraction procedure demonstrated recoveries greater than 80 % for all toxins. For validation of the method at the 95 % confidence limit, the decision limits (CCα) determined from an extracted matrix curve were calculated to be 450, 36 and 24 μg/kg, and the detection capability (CCβ) as a screening method is ≤10 mg/kg, ≤160 μg/kg and ≤400 μg/kg for domoic acid, okadaic acid and saxitoxin, respectively.