Malignancy and mortality in a population-based cohort of patients with coeliac disease or 'gluten sensitivity'

Aim: To determine the risk of malignancy and mortality in patients with a positive endomysial or anti-gliadin antibody test in Northern Ireland.

Methods: A population-based retrospective cohort study design was used. Laboratory test results used in the diagnosis of coeliac disease were obtained from the Regional Immunology Laboratory, cancer statistics from the Northern Ireland Cancer Registry and mortality statistics from the General Registrar Office, Northern Ireland. Age standardized incidence ratios of malignant neoplasms and standardized mortality ratios of all-cause and cause-specific mortality were calculated.

Results: A total of 13 338 people had an endomysial antibody and/or an anti-gliadin antibody test in Northern Ireland between 1993 and 1996. There were 490 patients who tested positive for endomysial antibodies and they were assumed to have coeliac disease. There were 1133 patients who tested positive for anti-gliadin anti-bodies and they were defined as gluten sensitive. Malignant neoplasms were not significantly associated with coeliac disease; however, all-cause mortality was significantly increased following diagnosis. The standardized incidence and mortality ratios for non-Hodgkin's lymphoma were increased in coeliac disease patients but did not reach statistical significance. Lung and breast cancer incidence were significantly lower and all-cause mortality, mortality from malignant neoplasms, non-Hodgkin's lymphoma and digestive system disorders were significantly higher in gluten sensitive patients compared to the Northern Ireland population.

Conclusion: Patients with coeliac disease or gluten sensitivity had higher mortality rates than the Northern Ireland population. This association persists more than one year after diagnosis in patients testing positive for anti-gliadin antibodies. Breast cancer is significantly reduced in the cohort of patients with gluten sensitivity. © 2007 The WJG Press. All rights reserved.

Reinforced Stone Columns in Weak Deposits – A Laboratory Model Study

This paper investigates the performance of stone columns in a weak deposit such as peat. It evaluates the effects of reinforcing stone columns by jacketing with a tubular wire mesh and bridging reinforcement with a metal rod and a concrete plug. A series of plate loading tests was conducted on isolated stone columns installed in a soil bed consisting of a peat layer sandwiched between two layers of sand. The load–displacement characteristics of footings supported by stone columns were investigated by applying load to a circular plate supported on: (a) untreated soil; (b) soil treated with stone columns; and (c) soil treated with stone columns reinforced with the above reinforcing techniques. The work has shown that the settlement characteristics of the soil can be improved by installing stone columns and that a significant enhancement in the load–settlement response is achieved when the columns are reinforced by the various methods.

Purification capacity of a highly loaded laboratory scale tidal flow reed bed system with effluent recirculation

The purification capacity of a laboratory scale tidal flow reed bed system with final effluent recirculation at a ratio of 1:1 was investigated in this study. In particular, this four-stage reed bed system was highly loaded with strong agricultural wastewater. Under the hydraulic and organic loading rates as high as 0.43 m3/m2d and 1055 gCOD/m2d, respectively, the average removal efficiencies of COD, BOD5, SS, NH4-N and P were 77%, 78%, 66%, 62% and 38%. Even with the high loading rates, approximately 30% of NH4-N was converted into NO2-N and NO3-N from the mid-stage of the system where nitrification took place. The results suggest that the multi-stage reed bed system could be employed to treat strong wastewater under high loading, especially for the substantive mass removal of solids, organic matter and ammoniacal-nitrogen. Tidal flow combined with effluent recirculation is a favourable operation strategy to achieve this objective.

Nonlinear PCA with Local Approach for Diesel Engine Fault Detection and Diagnosis

This brief examines the application of nonlinear statistical process control to the detection and diagnosis of faults in automotive engines. In this statistical framework, the computed score variables may have a complicated nonparametric distri- bution function, which hampers statistical inference, notably for fault detection and diagnosis. This brief shows that introducing the statistical local approach into nonlinear statistical process control produces statistics that follow a normal distribution, thereby enabling a simple statistical inference for fault detection. Further, for fault diagnosis, this brief introduces a compensation scheme that approximates the fault condition signature. Experimental results from a Volkswagen 1.9-L turbo-charged diesel engine are included.

A prospective clinical trial of a real-time polymerase chain reaction assay for the diagnosis of candidemia in nonneutropenic, critically ill adults

Background. Invasive Candida infection among nonneutropenic, critically ill adults is a clinical problem that has received increasing attention in recent years. Poor performance of extant diagnostic modalities has promoted risk-based, preemptive prescribing in view of the poor outcomes associated with inadequate or delayed antifungal therapy; this risks unnecessary overtreatment. A rapid, reliable diagnostic test could have a substantial impact on therapeutic practice in this patient population.

Methods. Three TaqMan-based real-time polymerase chain reaction assays were developed that are capable of detecting the main medically important Candida species, categorized according to the likelihood of fluconazole susceptibility. Assay 1 detected Candida albicans, Candida parapsilosis, Candida tropicalis, and Candida dubliniensis. Assays 2 and 3 detected Candida glabrata and Candida krusei, respectively. The clinical performance of these assays, applied to serum, was evaluated in a prospective trial of nonneutropenic adults in a single intensive care unit.

Results. In all, 527 specimens were obtained from 157 participants. All 3 assays were run in parallel for each specimen; they could be completed within 1 working day. Of these, 23 specimens were obtained from 23 participants categorized as having proven Candida infection at the time of sampling. If a single episode of Candida famata candidemia was excluded, the estimated clinical sensitivity, specificity, and positive and negative predictive values of the assays in this trial were 90.9%, 100%, 100% and 99.8%, respectively.

Conclusions. These data suggest that the described assays perform well in this population for enhancing the diagnosis of candidemia. The extent to which they may affect clinical outcomes, prescribing practice, and cost-effectiveness of care remains to be ascertained.

Proposed wavelet-neurofuzzy combined system for power qualityviolations detection and diagnosis

A system for the identification of power quality violations is proposed. It is a two-stage system that employs the potentials of the wavelet transform and the adaptive neurofuzzy networks. For the first stage, the wavelet multiresolution signal analysis is exploited to denoise and then decompose the monitored signals of the power quality events to extract its detailed information. A new optimal feature-vector is suggested and adopted in learning the neurofuzzy classifier. Thus, the amount of needed training data is extensively reduced. A modified organisation map of the neurofuzzy classifier has significantly improved the diagnosis efficiency. Simulation results confirm the aptness and the capability of the proposed system in power quality violations detection and automatic diagnosis