Occupational Rhinitis : Diagnosis and Health-related Quality of Life

Occupational rhinitis is mainly caused by work environment and not by stimuli encountered outside the workplace. It differs from rhinitis that is worsened by, but not mainly caused by, workplace exposures. Occupational rhinitis can develop in response to allergens, inhaled irritants, or corrosive gases. The thesis evaluated the use of challenge tests in occupational rhinitis diagnostics, studied the long-term health-related quality of life among allergic occupational rhinitis patients, and the allergens of wheat grain among occupational respiratory allergy patients. The diagnosed occupational rhinitis was mainly allergic rhinitis, which was caused by occupational agents, most commonly flours and animal allergens. The non-IgE-mediated rhinitis reactions were less frequent and caused more often asthma than rhinitis. Both nasal challenges and inhalation challenges were found to be safe tests. The inhalation challenge tests had considerably resource-intensive methodology. However, the evaluation of nasal symptoms and signs together with bronchial reactions saved time and expense compared with the organization of multiple individual challenges. The scoring criteria used matched well with the weighted amount of discharge ≥ 0.2 g and in most cases gave comparable results. The challenge tests are valuable tools when there is uncertainty whether the patient's exposure should be reduced or discontinued. It was found that continuing exposure decreases health-related quality of life among patients with allergic occupational rhinitis despite of rhinitis medications, still approximately ten years after the diagnosis. Health-related quality of life among occupational rhinitis patients without any longer occupational exposure was mainly similar than that of the healthy controls. This highlights the importance of the reduction and cessation of occupational exposure. To achieve this, 17% of occupational rhinitis patients had been re-educated. Alpha-amylase inhibitors, lipid transfer protein 2G, thaumatin -like protein, and peroxidase I were found to be relevant allergens in Finnish patients with occupational respiratory wheat allergy. Of these allergens, thaumatin-like protein and lipid transfer protein 2G were found as new allergens associated with baker's rhinitis and asthma. The knowledge of the new clinically relevant proteins can be used in the future in the development of better standardized diagnostic preparations.

Women’s Wellness after Cancer Program Study (WWACP)– A multi centre randomised controlled trial examining the benefits and cost effectiveness of an Evidenced Based, e-health intervention

Background Advances in cancer diagnosis and treatment have significantly improved survival rates, through their subsequent health needs are often not adequately addressed by current health services. National Health and Medical Research Council (NHMRC) Partnerships Project awarded a national collaborative project to develop, trial and evaluate clinical benefits and cost effectiveness of an e-health enabled structured health promotion intervention - The Women’s Wellness after Cancer Program (WWACP). The aim of this e-health enabled multimodal intervention is to improve health related quality of life in women previously treated for target cancers. Aim The WWACP is a 12-week web based, interactive, holistic program. Primary outcomes for this project are to promote a positive change in health-related quality of life (HRQoL) and reduction in Body Mass Index (BMI) in the women undertaking WWACP compared to women who receive usual care. Secondary outcomes include managing other side effects of cancer treatment through evidence-based nutrition and exercise practices, dealing with stress, sleep, menopause and sexuality issues. Methods The single-blinded multi-center randomized controlled trial recruited a toatl of 330 women within 24 months of completion of chemotherapy and /or radiotherapy. Women were randomly assigned to either a usual care or intervention group. Women provided with the intervention were provided with an interactive iBook and journal, web interface, and three virtual consultations by experienced cancer nurses. A variety of methods were utilized, to enable positive self- efficacy and lifestyle changes. These include online coaching with a registered nurse trained in the intervention, plus written educational and health promotional information. The program has been delivered through the e-health enabled interfaces, which enables virtual delivery via desktop and mobile computing devices. Importantly this enables accessibility for rural and regional women in Australia who are frequently geographically disadvantaged in terms of health care provision. Results Research focusing on alternative methods of delivering post treatment / or survivorship care in cancer utilizing web based interfaces is limited, but emerging evidence suggests that Internet interventions can increase psychological and physical wellbeing in cancer patients. The WWACP trial aims to establish the effectiveness of delivery of the program in terms of positive patient outcomes and cost effective, flexibility. The trial will be completed in September and results will be presented at the conference. Conclusions Women after acute hematological, breast and gynecological cancer treatments demonstrate good cancer survival rates and face residual health problems which are amenable to behavioral interventions. The conclusion of active treatment is a key 'teachable moment' in which sustainable positive lifestyle change can be achieved if patients receive education and psychological support which targets key treatment related health problems and known chronic disease risk factors.

Digital Photography in the Diagnosis and Follow-up of Ocular Diseases

Purpose: The aim of the present study was to develop and test new digital imaging equipment and methods for diagnosis and follow-up of ocular diseases. Methods: The whole material comprised 398 subjects (469 examined eyes), including 241 patients with melanocytic choroidal tumours, 56 patients with melanocytic iris tumours, 42 patients with diabetes, a 52-year old patient with chronic phase of VKH disease, a 30-year old patient with an old blunt eye injury, and 57 normal healthy subjects. Digital 50° (Topcon TRC 50 IA) and 45° (Canon CR6-45NM) fundus cameras, a new handheld digital colour videocamera for eye examinations (MediTell), a new subtraction method using the Topcon Image Net Program (Topcon corporation, Tokyo, Japan), a new method for digital IRT imaging of the iris we developed, and Zeiss photoslitlamp with a digital camera body were used for digital imaging. Results: Digital 50° red-free imaging had a sensitivity of 97.7% and two-field 45° and 50° colour imaging a sensitivity of 88.9-94%. The specificity of the digital 45°-50° imaging modalities was 98.9-100% versus the reference standard and ungradeable images that were 1.2-1.6%. By using the handheld digital colour video camera only, the optic disc and central fundus located inside 20° from the fovea could be recorded with a sensitivity of 6.9% for detection of at least mild NPDR when compared with the reference standard. Comparative use of digital colour, red-free, and red light imaging showed 85.7% sensitivity, 99% specificity, and 98.2 % exact agreement versus the reference standard in differentiation of small choroidal melanoma from pseudomelanoma. The new subtraction method showed growth in four of 94 melanocytic tumours (4.3%) during a mean ±SD follow-up of 23 ± 11 months. The new digital IRT imaging of the iris showed the sphincter muscle and radial contraction folds of Schwalbe in the pupillary zone and radial structural folds of Schwalbe and circular contraction furrows in the ciliary zone of the iris. The 52-year-old patient with a chronic phase of VKH disease showed extensive atrophy and occasional pigment clumps in the iris stroma, detachment of the ciliary body with severe ocular hypotony, and shallow retinal detachment of the posterior pole in both eyes. Infrared transillumination imaging and fluorescein angiographic findings of the iris showed that IR translucence (p=0.53), complete masking of fluorescence (p=0.69), presence of disorganized vessels (p=0.32), and fluorescein leakage (p=1.0) at the site of the lesion did not differentiate an iris nevus from a melanoma. Conclusions: Digital 50° red-free and two-field 50° or 45° colour imaging were suitable for DR screening, whereas the handheld digital video camera did not fulfill the needs of DR screening. Comparative use of digital colour, red-free and red light imaging was a suitable method in the differentiation of small choroidal melanoma from different pseudomelanomas. The subtraction method may reveal early growth of the melanocytic choroidal tumours. Digital IRT imaging may be used to study changes of the stroma and posterior surface of the iris in various diseases of the uvea. It contributed to the revealment of iris atrophy and serous detachment of the ciliary body with ocular hypotony together with the shallow retinal detachment of the posterior pole as new findings of the chronic phase of VKH disease. Infrared translucence and angiographic findings are useful in differential diagnosis of melanocytic iris tumours, but they cannot be used to determine if the lesion is benign or malignant.

The AOL Huffington Post merger

This article examines the merger between AOL and the Huffington Post. The broader issues around the merger will be investigated, especially the implication for rights, in particular free expression, and their conditions for exercise and actual exercise online. One major issue is that of the status of user-generated content and how the existing legal regime reflects the ethical concerns of users over how their content, data and information is used and commodified by the for-profit Internet intermediaries and platforms, especially when they start to merge and form concentrations. The extent to which the current legal regimes, especially human rights, deal with these problems in an adequate fashion will be assessed, along with the presentation of some suggestions of alternative approaches which may be more effective in practice.

The third post-Newtonian gravitational wave polarizations and associated spherical harmonic modes for inspiralling compact binaries in quasi-circular orbits

The gravitational waveform (GWF) generated by inspiralling compact binaries moving in quasi-circular orbits is computed at the third post-Newtonian (3PN) approximation to general relativity. Our motivation is two-fold: (i) to provide accurate templates for the data analysis of gravitational wave inspiral signals in laser interferometric detectors; (ii) to provide the associated spin-weighted spherical harmonic decomposition to facilitate comparison and match of the high post-Newtonian prediction for the inspiral waveform to the numerically-generated waveforms for the merger and ringdown. This extension of the GWF by half a PN order (with respect to previous work at 2.5PN order) is based on the algorithm of the multipolar post-Minkowskian formalism, and mandates the computation of the relations between the radiative, canonical and source multipole moments for general sources at 3PN order. We also obtain the 3PN extension of the source multipole moments in the case of compact binaries, and compute the contributions of hereditary terms (tails, tails-of-tails and memory integrals) up to 3PN order. The end results are given for both the complete plus and cross polarizations and the separate spin-weighted spherical harmonic modes.

Editorial: Are adolescent and young adult cancer patients affected by ‘chemobrain’?: A call for evidence

An adolescent and young adult (AYA) cancer patient is defined as an individual of 15 to 39 years of age at the time of initial cancer diagnosis.1,2 The number of AYA cancer survivors has dramatically increased over the past decades due to availability of novel therapeutics, with the 5-year overall survival rate among adolescents aged 15 to 19 years old exceeds 80% for most cancers.3 AYA cancer survivors, however, often experience a myriad of treatment-related chronic and late toxicities that can lead to functional impairment at great economic, emotional and social cost.4 As the cure rates of AYA cancers continue to improve and survivors live longer, post-treatment health issues in these survivors are becoming increasingly relevant, and more in-depth research is needed in this group of patients...

The grumpy stump - ultrasound and stump appendicitis

BACKGROUND: Stump appendicitis, the inflammation of an incompletely removed appendix, is a rare clinical presentation. Sonography can be useful in the diagnosis of the condition; by either directly visualising the inflamed stump, or by identifying signs of peri-caecal inflammation that can raise suspicion of the condition. SUMMARY OF WORK: A potential case of stump appendicitis was identified. This prompted a review of literature focused on the incidence of stump appendicitis, utility of ultrasound to identify an inflamed appendiceal stump, and surgical techniques used in appendectomy. SUMMARY OF RESULTS: Stump appendicitis is rare, with as few as 61 cases identified in literature during the last 60 years1. Of the two common techniques of appendectomy, which are ligation and invagination, the former can sometimes leave a residual stump that acts as a potential lumen for the pathophysiological process of appendicitis to recur. Established sonographic criteria for appendicitis also apply to the residual stump. Sonographic secondary signs that suggest the presence of acute appendicitis2 have also been demonstrated in cases of stump appendicitis3, even in the absence of an identifiable stump. DISCUSSION AND CONCLUSIONS: Appendicitis is usually dismissed in patients with a history of appendectomy. Though uncommon, sonographers should be aware of stump appendicitis in post-appendectomy patients that present with right iliac fossa pain from months to decades later. REFERENCE(S) 1. Subramanian A, Liang MK. A 60-year literature review of stump appendicitis: The need for a critical view. Am J Surg; 2012;203(4):503–7. 2. Reddan T, Corness J, Mengersen K, Harden F. Ultrasound of paediatric appendicitis and its secondary sonographic signs: providing a more meaningful finding. J Med Radiat Sci. 2015;DOI: 10.1002/jmrs.154 3. Martínez Chamorro E, Merina Castilla A, Muñoz Fraile B, Koren Fernández L, Borruel Nacenta S. Stump appendicitis: Preoperative imaging findings in four cases. Abdom Imaging. 2013;38(6):1214–9.

Automatic post-adoptive information technology use: The role of innovativeness goal

The business value of information technology (IT) is realized through the continuous use of IT subsequent to users’ adoption. Understanding post-adoptive IT usage is useful in realizing potential IT business value. Most previous research on post-adoptive IT usage, however, dismisses the unintentional and unconscious aspects of usage behavior. This paper advances understanding of the unintentional, unconscious, and thereby automatic usage of IT features during the post-adoptive stage. Drawing from Social Psychology literature, we argue human behaviors can be triggered by environmental cues and directed by the person’s mental goals, thereby operating without a person’s consciousness and intentional will. On this basis, we theorize the role of a user’s innovativeness goal, as the desired state of an act to innovate, in directing the user’s unintentional, unconscious, and automatic post-adoptive IT feature usage behavior. To test the hypothesized mechanisms, a human experiment employing a priming technique, is described.

Data mining approaches to software fault diagnosis

Automatic identification of software faults has enormous practical significance. This requires characterizing program execution behavior and the use of appropriate data mining techniques on the chosen representation. In this paper, we use the sequence of system calls to characterize program execution. The data mining tasks addressed are learning to map system call streams to fault labels and automatic identification of fault causes. Spectrum kernels and SVM are used for the former while latent semantic analysis is used for the latter The techniques are demonstrated for the intrusion dataset containing system call traces. The results show that kernel techniques are as accurate as the best available results but are faster by orders of magnitude. We also show that latent semantic indexing is capable of revealing fault-specific features.

Reconciling Opposites in Organisation Studies: An Aristotelian Approach to Modernism and Post-modernism

In view of the current fragmentation in management and organisation studies, we argue that there is a need to elaborate techniques that help reconcile contradictory and superficially incommensurable standpoints. For this purpose, we draw on ‘pre-modern’ Aristotelian epistemological and methodological sources, particularly the idea of ‘saving the appearances’ (SA), not previously introduced into organisation studies. Using SA as our starting point, we outline a methodology that helps to develop reasonable and acceptable intermediary positions in contemporary debates between ‘modernism’ and ‘post-modernism’. We illustrate the functioning of SA in the case of three issues in the philosophy of science where ‘modernist’ and ‘post-modernist’ scholars seem to have incommensurable standpoints: the nature of scientific knowledge; the conception of causality; and the epistemology of practice. We show in particular how to use the logics of ‘qualification’, ‘new conception’, and ‘complementary combination’ to form the basis for mediating positions which could then be accepted by less extreme proponents of both ‘modernism’ and ‘postmodernism’.

On the discursive construction of success/failure in narratives of post-merger integration

This article concentrates on the discursive constmction of success and failure in narratives of post-merger integration. Drawing on extensive interview material from eight Finnish-Swedish mergers and acquisitions, the empirical analysis leads to distinguishing four types of discourse — 'rationalistic', 'cultural', 'role-bound' and 'individualistic' — that narrators employ in recounting their experiences. In particular, the empirical material illustrates how the discursive frameworks enable specific (di.scursive) strategies and moves for (re)framing the success/failure, justification/legitimization of one's own actions, and (re)constniction of responsibility when dealing with socio-psychological pressures associated with success/failtire. The analysis also suggests that, as a result of making use of these discursive strategies and moves, success stories are likely to lead to overly optimistic or, in the case of failure stories, overly pessimistic views on the management's ability to control these change processes. Tliese findings imply that we should take the discursive elements that both constrain our descriptions and explanations seriously, and provide opportunities for more or less intentional (re)interpretations of postmerger integration or other organizational change processes.

Resolving Ambiguities in Confused Online Tamil Characters with Post Processing Algorithms

This paper addresses the problem of resolving ambiguities in frequently confused online Tamil character pairs by employing script specific algorithms as a post classification step. Robust structural cues and temporal information of the preprocessed character are extensively utilized in the design of these algorithms. The methods are quite robust in automatically extracting the discriminative sub-strokes of confused characters for further analysis. Experimental validation on the IWFHR Database indicates error rates of less than 3 % for the confused characters. Thus, these post processing steps have a good potential to improve the performance of online Tamil handwritten character recognition.