BOB CAT: a Large-Scale Review and Delphi Consensus for Management of Barrett’s Esophagus With No Dysplasia, Indefinite for, or Low-Grade Dysplasia

OBJECTIVES: Barrett’s esophagus (BE) is a common premalignant lesion for which surveillance is recommended. This strategy is limited by considerable variations in clinical practice. We conducted an international, multidisciplinary, systematic search and evidence-based review of BE and provided consensus recommendations for clinical use in patients with nondysplastic, indefinite, and low-grade dysplasia (LGD). METHODS: We defined the scope, proposed statements, and searched electronic databases, yielding 20,558 publications that were screened, selected online, and formed the evidence base. We used a Delphi consensus process, with an 80% agreement threshold, using GRADE (Grading of Recommendations Assessment, Development and Evaluation) to categorize the quality of evidence and strength of recommendations. RESULTS: In total, 80% of respondents agreed with 55 of 127 statements in the final voting rounds. Population endoscopic screening is not recommended and screening should target only very high-risk cases of males aged over 60 years with chronic uncontrolled reflux. A new international definition of BE was agreed upon. For any degree of dysplasia, at least two specialist gastrointestinal (GI) pathologists are required. Risk factors for cancer include male gender, length of BE, and central obesity. Endoscopic resection should be used for visible, nodular areas. Surveillance is not recommended for <5 years of life expectancy. Management strategies for indefinite dysplasia (IND) and LGD were identified, including a de-escalation strategy for lower-risk patients and escalation to intervention with follow-up for higher-risk patients. CONCLUSIONS: In this uniquely large consensus process in gastroenterology, we made key clinical recommendations for the escalation/de-escalation of BE in clinical practice. We made strong recommendations for the prioritization of future research.

Summary of the Snowmastodon Project Special Volume: A high-elevation, multi-proxy biotic and environmental record of MIS 6-4 from the Ziegler Reservoir fossil site, Snowmass Village, Colorado, USA

In North America, terrestrial records of biodiversity and climate change that span Marine Oxygen Isotope Stage (MIS) 5 are rare. Where found, they provide insight into how the coupling of the ocean-atmosphere system is manifested in biotic and environmental records and how the biosphere responds to climate change. In 2010-2011, construction at Ziegler Reservoir near Snowmass Village, Colorado (USA) revealed a nearly continuous, lacustrine/wetland sedimentary sequence that preserved evidence of past plant communities between similar to 140 and 55 lea, including all of MIS 5. At an elevation of 2705 m, the Ziegler Reservoir fossil site also contained thousands of well-preserved bones of late Pleistocene megafauna, including mastodons, mammoths, ground sloths, horses, camels, deer, bison, black bear, coyotes, and bighorn sheep. In addition, the site contained more than 26,000 bones from at least 30 species of small animals including salamanders, otters, muskrats, minks, rabbits, beavers, frogs, lizards, snakes, fish, and birds. The combination of macro- and micro-vertebrates, invertebrates, terrestrial and aquatic plant macrofossils, a detailed pollen record, and a robust, directly dated stratigraphic framework shows that high-elevation ecosystems in the Rocky Mountains of Colorado are climatically sensitive and varied dramatically throughout MIS 5 

Ataluren for the treatment of nonsense-mutation cystic fibrosis: a randomised, double-blind, placebo-controlled phase 3 trial

Background: Ataluren was developed to restore functional protein production in genetic disorders caused by nonsense mutations, which are the cause of cystic fibrosis in 10% of patients. This trial was designed to assess the efficacy and safety of ataluren in patients with nonsense-mutation cystic fibrosis. 

Methods: This randomised, double-blind, placebo-controlled, phase 3 study enrolled patients from 36 sites in 11 countries in North America and Europe. Eligible patients with nonsense-mutation cystic fibrosis (aged ≥6 years; abnormal nasal potential difference; sweat chloride >40 mmol/L; forced expiratory volume in 1 s [FEV₁] ≥40% and ≤90%) were randomly assigned by interactive response technology to receive oral ataluren (10 mg/kg in morning, 10 mg/kg midday, and 20 mg/kg in evening) or matching placebo for 48 weeks. Randomisation used a block size of four, stratified by age, chronic inhaled antibiotic use, and percent-predicted FEV₁. The primary endpoint was relative change in percent-predicted FEV₁ from baseline to week 48, analysed in all patients with a post-baseline spirometry measurement. This study is registered with ClinicalTrials.gov, number NCT00803205. 

Findings: Between Sept 8, 2009, and Nov 30, 2010, 238 patients were randomly assigned, of whom 116 in each treatment group had a valid post-baseline spirometry measurement. Relative change from baseline in percent-predicted FEV₁ did not differ significantly between ataluren and placebo at week 48 (-2·5% vs -5·5%; difference 3·0% [95% CI -0·8 to 6·3]; p=0·12). The number of pulmonary exacerbations did not differ significantly between treatment groups (rate ratio 0·77 [95% CI 0·57-1·05]; p=0·0992). However, post-hoc analysis of the subgroup of patients not using chronic inhaled tobramycin showed a 5·7% difference (95% CI 1·5-10·1) in relative change from baseline in percent-predicted FEV₁ between the ataluren and placebo groups at week 48 (-0·7% [-4·0 to 2·1] vs -6·4% [-9·8 to -3·7]; nominal p=0·0082), and fewer pulmonary exacerbations in the ataluern group (1·42 events [0·9-1·9] vs 2·18 events [1·6-2·7]; rate ratio 0·60 [0·42-0·86]; nominal p=0·0061). Safety profiles were generally similar for ataluren and placebo, except for the occurrence of increased creatinine concentrations (ie, acute kidney injury), which occurred in 18 (15%) of 118 patients in the ataluren group compared with one (<1%) of 120 patients in the placebo group. No life-threatening adverse events or deaths were reported in either group. I

nterpretation: Although ataluren did not improve lung function in the overall population of nonsense-mutation cystic fibrosis patients who received this treatment, it might be beneficial for patients not taking chronic inhaled tobramycin. 

Funding: PTC Therapeutics, Cystic Fibrosis Foundation, US Food and Drug Administration's Office of Orphan Products Development, and the National Institutes of Health. 

The Relationship Between Laughter Intensity and Perceived Humour

There is a long history of recognizing a continuum in social signals of positive affect, with the continuum ranging from mild amusement signals to strong laughter. However there has been little systematic effort to assess what this continuum might mean. We present data that shows that incorporating intensity measures of laughter into laughter research is an important component and that there is a strong relationship between laughter intensity and humour. This may be intuitively obvious but the strength of the relationship suggests that intensity measures should be included in all laughter research.

MHD wave modes resolved in fine-scale chromospheric magnetic structures

Within the last decade, due to significant improvements in the spatial and temporal resolution of chromospheric data, magneto hydrodynamic (MHD)wave studies in this fascinating region of the Sun's atmosphere have risen to the forefront of solar physics research. In this review we begin by reviewing the challenges and debates that have manifested in relation to MHD wave mode identification in fine-scale chromosphericmagnetic structures, including spicules, fibrils and mottles. Next we goon to discuss how the process of accurately identifying MHD wave modes also has a crucial role to play in estimating their wave energy flux.This is of cardinal importance for estimating what the possible contribution of MHD waves is to solar atmospheric heating. Finally, we detail how such advances in chromospheric MHD wave studies have also allowed us, for the first time, to implement cutting-edge magneto seismological techniques that provide new insight into the sub-resolution plasma structuring of the lower solar atmosphere.

Ultrasound entropy may be a new non-invasive measure of pre-clinical vascular damage in young hypertensive patients

Background: The identification of pre-clinical microvascular damage in hypertension by non-invasive techniques has proved frustrating for clinicians. This proof of concept study investigated whether entropy, a novel summary measure for characterizing blood velocity waveforms, is altered in participants with hypertension and may therefore be useful in risk stratification.

Methods: Doppler ultrasound waveforms were obtained from the carotid and retrobulbar circulation in 42 participants with uncomplicated grade 1 hypertension (mean systolic/diastolic blood pressure (BP) 142/92 mmHg), and 26 healthy controls (mean systolic/diastolic BP 116/69 mmHg). Mean wavelet entropy was derived from flow-velocity data and compared with traditional haemodynamic measures of microvascular function, namely the resistive and pulsatility indices.

Results: Entropy, was significantly higher in control participants in the central retinal artery (CRA) (differential mean 0.11 (standard error 0.05 cms(-1)), CI 0.009 to 0.219, p 0.017) and ophthalmic artery (0.12 (0.05), CI 0.004 to 0.215, p 0.04). In comparison, the resistive index (0.12 (0.05), CI 0.005 to 0.226, p 0.029) and pulsatility index (0.96 (0.38), CI 0.19 to 1.72, p 0.015) showed significant differences between groups in the CRA alone. Regression analysis indicated that entropy was significantly influenced by age and systolic blood pressure (r values 0.4-0.6). None of the measures were significantly altered in the larger conduit vessel.

Conclusion: This is the first application of entropy to human blood velocity waveform analysis and shows that this new technique has the ability to discriminate health from early hypertensive disease, thereby promoting the early identification of cardiovascular disease in a young hypertensive population.

Human Perception of Laughter from Context-free Whole Body Motion Dynamic Stimuli

Laughter is a ubiquitous social signal in human interactions yet it remains understudied from a scientific point of view. The need to understand laughter and its role in human interactions has become more pressing as the ability to create conversational agents capable of interacting with humans has come closer to a reality. This paper reports on three aspects of the human perception of laughter when context has been removed and only the body information from the laughter episode remains. We report on ability to categorise the laugh type and the sex of the laugher; the relationship between personality factors with laughter categorisation and perception; and finally the importance of intensity in the perception and categorisation of laughter.

The SEMAINE corpus of emotionally coloured character interactions

We have recorded a new corpus of emotionally coloured conversations. Users were recorded while holding conversations with an operator who adopts in sequence four roles designed to evoke emotional reactions. The operator and the user are seated in separate rooms; they see each other through teleprompter screens, and hear each other through speakers. To allow high quality recording, they are recorded by five high-resolution, high framerate cameras, and by four microphones. All sensor information is recorded synchronously, with an accuracy of 25 μs. In total, we have recorded 20 participants, for a total of 100 character conversational and 50 non-conversational recordings of approximately 5 minutes each. All recorded conversations have been fully transcribed and annotated for five affective dimensions and partially annotated for 27 other dimensions. The corpus has been made available to the scientific community through a web-accessible database.

Additionality of Incubator Support on Networks of University Spin-Out Firms

The formation rate of university spin-out firms has increased markedly over the past decade. While this is seen as an important channel for the commercialisation of academic research, concerns have centred around high failure rates and no-to-low growth among those which survive compared to other new technology based firms. Universities have responded to this by investing in incubators to assist spin-outs to overcome their liability of newness. Yet how effective are incubators in supporting these firms? Here we examine this in terms of the structural networks that spin-out firms form, the role of the incubator in this and the effect of this on the spin-out process.

The Belfast Storytelling Database: A spontaneous social interaction database with laughter focused annotation

To support the endeavor of creating intelligent interfaces between computers and humans the use of training materials based on realistic human-human interactions has been recognized as a crucial task. One of the effects of the creation of these databases is an increased realization of the importance of often overlooked social signals and behaviours in organizing and orchestrating our interactions. Laughter is one of these key social signals; its importance in maintaining the smooth flow of human interaction has only recently become apparent in the embodied conversational agent domain. In turn, these realizations require training data that focus on these key social signals. This paper presents a database that is well annotated and theoretically constructed with respect to understanding laughter as it is used within human social interaction. Its construction, motivation, annotation and availability are presented in detail in this paper.

Turing’s Menagerie: Talking Lions, Virtual Bats, Electric Sheep and Analogical Peacocks: Common Ground and Common Interest are Necessary Components of Engagement

This theoretical paper attempts to define some of the key components and challenges required to create embodied conversational agents that can be genuinely interesting conversational partners. Wittgenstein’s argument concerning talking lions emphasizes the importance of having a shared common ground as a basis for conversational interactions. Virtual bats suggests that–for some people at least–it is important that there be a feeling of authenticity concerning a subjectively experiencing entity that can convey what it is like to be that entity. Electric sheep reminds us of the importance of empathy in human conversational interaction and that we should provide a full communicative repertoire of both verbal and non-verbal components if we are to create genuinely engaging interactions. Also we may be making the task more difficult rather than easy if we leave out non-verbal aspects of communication. Finally, analogical peacocks highlights the importance of between minds alignment and establishes a longer term goal of being interesting, creative, and humorous if an embodied conversational is to be truly an engaging conversational partner. Some potential directions and solutions to addressing these issues are suggested.