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SummaryBackgroundPsychotic experiences predict adverse health outcomes, particularly if they are persistent. However, it is unclear what distinguishes persistent from transient psychotic experiences.AimsIn a large population-based cohort, we aimed to (a) describe the course of hallucinatory experiences from childhood to adolescence, (b) compare characteristics of youth with persistent and remittent hallucinatory experiences, and (c) examine prediction models for persistence.MethodYouth were assessed longitudinally for hallucinatory experiences at mean ages of 10 and 14 years (n = 3473). Multi-informant-rated mental health problems, stressful life events, self-esteem, non-verbal IQ and parental psychopathology were examined in relation to absent, persistent, remittent and incident hallucinatory experiences. We evaluated two prediction models for persistence with logistic regression and assessed discrimination using the area under the curve (AUC).ResultsThe persistence rate of hallucinatory experiences was 20.5%. Adolescents with persistent hallucinatory experiences had higher baseline levels of hallucinatory experiences, emotional and behavioural problems, as well as lower self-esteem and non-verbal IQ scores than youth with remittent hallucinatory experiences. Although the prediction model for persistence versus absence of hallucinatory experiences demonstrated excellent discriminatory power (AUC-corrected = 0.80), the prediction model for persistence versus remittance demonstrated poor accuracy (AUC-corrected = 0.61).ConclusionsThis study provides support for the dynamic expression of childhood hallucinatory experiences and suggests increased neurodevelopmental vulnerability in youth with persistent hallucinatory experiences. Despite the inclusion of a wide array of psychosocial parameters, a prediction model discriminated poorly between youth with persistent versus remittent hallucinatory experiences, confirming that persistent hallucinatory experiences are a complex multifactorial trait.

Improvements have been made in identifying the prevalence of risk factors/indicators for violent extremism. A consistent problem is the lack of base rates. How to develop base rates is of equal concern. This study has two aims: (i) compare two methods for developing base rates; the Unmatched Count Technique (UCT) and direct questioning, (ii) generate base rates in a general population sample and compare these to a sample of lone‐actor terrorists (n = 125). We surveyed 2108 subjects from the general population. Participants were recruited from an online access panel and randomly assigned to one of three conditions; direct survey, control, or UCT. Survey items were based on a lone‐actor terrorist codebook developed from the wider literature. Direct questioning was more suitable under our study conditions where UCT resulted in deflation effects. Comparing the base rates identified a number of significant differences: (i) lone‐actor terrorists demonstrated propensity indicators related to a cognitive susceptibility, and a crime‐ and/or violence‐supportive morality more often; the general sample demonstrated protective factors more often, (ii) lone‐actor terrorists demonstrated situational indicators related to a crime‐ and/or violence‐supportive morality more often, whereas the general sample experienced situational stressors more often, (iii) lone‐actor terrorists demonstrated indicators related to exposure to extremism more often. Results suggest there are measurable differences in the prevalence of risk factors between lone‐actor terrorists and the general population. However, no single factor “predicts” violent extremism. This bears implications for our understanding of the interrelation of risk and protective factors, and for the risk assessment of violent extremism.

One of the most common usages of radiation in current medical diagnosis is computed tomography (CT) using X-rays. The potential health risk of CT scans has been discussed in various studies to determine whether low-dose radiation from CT could enhance the chromosome aberration yields in pediatric patients and increase their risk of carcinogenesis. For this reason, it is of great interest to study the effects of low-dose radiation. The induction of DNA damage by a CT scan examination has been demonstrated in several reports by the γ-H2AX assay, the micronuclei assay and dicentrics measurements. However, the results of most studies showed limitations. On the other hand, epidemiological studies give contradictory results for post-natal radiation exposure in the low-dose range, so it is still difficult to draw conclusions about the effects of CT examinations and risk of carcinogenesis. This article provides an overview of previously published data and summarizes the current state of knowledge.

Purpose:\ud \ud The pattern of dense tissue on a mammogram appears to provide additional information than overall density for risk assessment, but there has been little consistency in measures of texture identified. The purpose of this study is thus to validate a mammographic texture feature developed from a previous study in a new setting.\ud \ud Approach:\ud \ud A case–control study (316 invasive cases and 1339 controls) of women in Virginia, USA was used to validate a mammographic texture feature (MMTEXT) derived in a independent previous study. Analysis of predictive ability was adjusted for age, demographic factors, questionnaire risk factors (combined through the Tyrer-Cuzick model), and optionally BI-RADS breast density. Odds ratios per interquartile range (IQ-OR) in controls were estimated. Subgroup analysis assessed heterogeneity by mode of cancer detection (94 not detected by mammography).\ud \ud Results:\ud \ud MMTEXT was not a significant risk factor at 0.05 level after adjusting for classical risk factors (IQ-OR = 1.16, 95%CI 0.92 to 1.46), nor after further adjustment for BI-RADS density (IQ-OR = 0.92, 95%CI 0.76 to 1.10). There was weak evidence that MMTEXT was more predictive for cancers that were not detected by mammography (unadjusted for density: IQ-OR = 1.46, 95%CI 0.99 to 2.15 versus 1.03, 95%CI 0.79 to 1.35, Phet 0.10; adjusted for density: IQ-OR = 1.11, 95%CI 0.70 to 1.77 versus 0.76, 95%CI 0.55 to 1.05, Phet 0.21).\ud \ud Conclusions:\ud \ud MMTEXT is unlikely to be a useful imaging marker for invasive breast cancer risk assessment in women attending mammography screening. Future studies may benefit from a larger sample size to confirm this as well as developing and validating other measures of risk. This negative finding demonstrates the importance of external validation.

Reference intervals are a vital part of the information supplied by clinical laboratories to support interpretation of numerical pathology results such as are produced in clinical chemistry and hematology laboratories. The traditional method for establishing reference intervals, known as the direct approach, is based on collecting samples from members of a preselected reference population, making the measurements and then determining the intervals. An alternative approach is to perform analysis of results generated as part of routine pathology testing and using appropriate statistical techniques to determine reference intervals. This is known as the indirect approach. This paper from a working group of the International Federation of Clinical Chemistry (IFCC) Committee on Reference Intervals and Decision Limits (C-RIDL) aims to summarize current thinking on indirect approaches to reference intervals. The indirect approach has some major potential advantages compared with direct methods. The processes are faster, cheaper and do not involve patient inconvenience, discomfort or the risks associated with generating new patient health information. Indirect methods also use the same preanalytical and analytical techniques used for patient management and can provide very large numbers for assessment. Limitations to the indirect methods include possible effects of diseased subpopulations on the derived interval. The IFCC C-RIDL aims to encourage the use of indirect methods to establish and verify reference intervals, to promote publication of such intervals with clear explanation of the process used and also to support the development of improved statistical techniques for these studies.

Background: Previous studies of prognosis after a transient ischaemic attack (TIA) have recruited patients soon after the event, when the risk of stroke is very high. However, the majority of patients survive for many years after a TIA, and the need for continued preventive treatment to lower vascular risk will need to be reassessed at a later date. Obective: To determine the long term risks of stroke and other vascular events in patients with TIA who survive the initial high risk period. Methods: 290 patients were studied who had initially been followed up after a TIA in the Oxford community stroke project and in a contemporaneous hospital based cohort study, and who were alive and stroke-free at the end of planned follow up in 1988. All patients were followed for a further 10 years, and the risks of major vascular events (stroke, myocardial infarction, vascular death) were determined. Standardised mortality ratios (SMR) were calculated from the observed numbers of fatal events and the number expected on the basis of age and sex in the general population. Results: Median time since last TIA was 3.8 years (interquartile range, 2.2 to 5.8 years). The risk of major vascular events was constant through time. The 10 year risk of first stroke was 18.8% (95% confidence interval (CI), 13.6 to 23.7; 45 events). The 10 year risk of myocardial infarction or death from coronary heart disease was 27.8% (95% CI, 21.8 to 33.3; 67 events) and there was a significant excess of fatal coronary events compared with that expected in the general population (SMR = 1.47; 95% CI, 1.10 to 1.93; p = 0.009). A total of 114 patients had at least one major vascular event, with a 10 year risk of any first stroke, myocardial infarction, or vascular death of 42.8% (95% CI, 36.4 to 48.5). Conclusions: The overall risk of major vascular events remains high for 10 to 15 years after a TIA. It is important therefore that preventive treatments are continued in the long term, even in apparently "low risk" patients who have already survived free of stroke for several years.

International audience; The authors explored the risks and benefits of repeated irrigation of Populus alba saplings with aqueous paper sludge (APS). Saplings were cultivated in pots of forest soil (3 L) in a greenhouse for 7 weeks and watered twice a week with differing concentrations of APS (0, 10, 20, 30, 50, 75,and 100 % v/v with deionized water). Plant growth and ecophysiological variables along with zinc and aluminum transfer were monitored. A stimulation of plant growth was observed with sludge treatments of 30 or 50 %, significantly correlated to APS input (r = 0.81). This may be explained by the easily available nitrogen as is shown with the positive correlation of CO2 assimilation and leaf nitrogen (r = 0.70). However, a significant reduction in plant growth was observed when treatments of 75 and 100 % of APS were administered, despite a high nutritional level (nitrogen and phosphorus). The study suggests that APS concentrations from 30 to 50 % may positively affect the growth of poplar saplings; however, the higher concentrations indicated a risk for plant growth and the environment.

The aim of this work was to identify the key mechanisms governing transport of organic chemical substances from consumer articles to cotton wipes. The results were used to establish a mechanistic model to improve assessment of dermal contact exposure. Four types of PVC flooring, 10 types of textiles and one type of inkjet printed paper were used to establish the mechanisms and model. Kinetic extraction studies in methanol demonstrated existence of matrix diffusion and indicated the presence of a substance surface layer on some articles. Consequently, the proposed substance transfer model considers mechanical transport from a surface film and matrix diffusion in an article with a known initial total substance concentration. The estimated chemical substance transfer values to cotton wipes were comparable to the literature data (relative transfer ∼2%), whereas relative transfer efficiencies from spiked substrates were high (∼50%). For consumer articles, high correlation (r 2 =0.92) was observed between predicted and measured transfer efficiencies, but concentrations were overpredicted by a factor of 10. Adjusting the relative transfer from about 50% used in the model to about 2.5% removed overprediction. Further studies are required to confirm the model for generic use. © 2016 Nature America, Inc. All rights reserved.

Background The aims of this study were to review and update previous projections of the number of proximal femoral fractures in the Northern Ireland population and to ascertain if the trend of increasing age-specific fracture incidence was continuing. Methods Data from 1985 to 1997 was obtained from hospital theatre records to ascertain the number of surgical procedures for proximal femoral fracture. Data for the years 2005 and 2010 was obtained from Northern Ireland's Fracture Outcomes Research Database (FORD) and locally held records in one region not then using FORD. Demographic details were obtained from data published by the Northern Ireland Statistics and Research Agency. Age-specific fracture rates were calculated for males and females in 5 year age brackets and for populations aged 50+ and 65+. Updated projections for the number of proximal femoral fractures by 2020 were made assuming the continuation of the same age-specific fracture rates observed in 2010. Results From 1997 to 2010 the age-specific fracture incidence has fallen or plateaued across most observed age and sex subgroups. Over the period 2010 to 2020, male and female fracture numbers are projected to increase by 23% and 21% respectively which equates to approximately 400 extra proximal femoral fractures. Conclusion Over the next decade there will be an increasing burden on Northern Irish healthcare resources attributed to a rise in the number of proximal femoral fractures. The age-specific fracture rates in this population are no longer rising and hence the expected increase in healthcare costs is primarily a consequence of the anticipated changing demographic trends.

The minimum prevalence of lethal Osteogenesis imperfecta type II, thanatophoric dysplasia and achondroplasia were derived following detailed case note review of all perinatal lethal skeletal dysplasias (SD) in Northern Ireland over a 12 year period. Multiple sources of ascertainment, including genetic notes, radiological reports and post mortem findings, were used. 39 cases were identified. Thanatophoric dysplasia was the commonest diagnosis made (22), followed by osteogenesis imperfecta type II (four children) and achondroplasia (two children). Eleven other diagnoses each occurred once in the 12 year period. The minimum prevalence range, per live births, of each of the common skeletal dysplasias in Northern Ireland has been calculated; thanatophoric dysplasia 0.80/10,000, osteogenesis imperfecta type II 0.15/10,000 and achondroplasia 0.07/10,000. The prevalence range for thanatophoric dysplasia is much higher than reported in previous studies. We discuss reasons for the prevalence figures obtained.

The felling of a telecommunications mast highlighted a community's concern regarding an alleged cancer cluster of eleven cases in a small rural area of Northern Ireland. At the request of the Local District Council, the Northern Ireland Cancer Registry (NICR) undertook an investigation. After extensive searching and contact with the community, only 6 of the alleged cases could be identified. Of these six, two did not have cancer and one had a non-malignant tumour. In addition to the three confirmed cancer cases, a search of the NICR database identified a further 17 cancers of mixed types in keeping with the population pattern of cancers. Standardised incidence and mortality rates were within, or lower than, the expected level. The results were presented to the local community at an open meeting. Despite extensive media interest when the issue of the alleged cluster was first raised, the negative findings received only local media attention. This study illustrates the value of an accurate population cancer registry in addressing cancer cluster concerns.

Objective Advances in surgical, anaesthetic and percutaneous interventional techniques may have led to higher risk patients being referred for coronary artery bypass graft surgery (CABG). The purpose of this study was to compare the predicted mortality risk (EuroSCORE) of a contemporary cohort of patients referred for isolated elective CABG (2002) with that of a cohort referred five years previously (1997) and to examine temporal trends in patient demographics. Methods Records (n = 2873) of weekly cardiac surgical referral meetings were examined and the age, sex, type of operation and surgical decision for every patient referred from 1997 to 2002 inclusive were recorded. Furthermore samples of patients referred in 1997 (n = 111) and in 2002 (n = 110) were chosen, and a complete EuroSCORE was calculated for each patient and compared between groups. Results In both 1997 and 2002 the median EuroSCORE among patients not accepted for surgery was significantly higher than those accepted (1997; 3 vs 2, p

One of the main challenges in food contact materials research is to prove that the presence of non-intentionally added substances (NIAS) is not a safety issue. Migration extracts may contain many unknown substances present at low concentrations. It is difficult and time-consuming to identify all these potential NIAS and concurrently to assess their health risk upon exposure, whereas the health relevance at low exposure levels might not even be an issue. This paper describes a scientifically based, but pragmatic safety assessment approach for unknown substances present at low exposure levels in food contact matrices. This complex mixture safety assessment strategy (CoMSAS) enables one to distinguish toxicologically relevant from toxicologically less relevant substances, when related to their respective levels of exposure, and allows one to focus on the substances of potential health concern. In particular, substances for which exposure will be below certain thresholds may be considered not of health relevance in case specific classes of substances are excluded. This can reduce the amount of work needed for identification, characterisation and evaluation of unknown substances at low concentration. The CoMSAS approach is presented in this paper using a safety assessment of unknown NIAS that may migrate from three carton samples. © 2014 Taylor & Francis. Chemicals/CAS: aflatoxin, 1402-68-2; aflatoxin B1, 1162-65-8; aflatoxin B2, 7220-81-7; aflatoxin G1, 1165-39-5; aflatoxin G2, 7241-98-7; aflatoxin M1, 6795-23-9; ergocornine, 564-36-3; ergocristine, 511-08-0; ergocryptine, 511-09-1; ergometrine, 60-79-7; ergotamine, 113-15-5, 52949-35-6; ether, 60-29-7; fumonisin B1, 116355-83-0; HT 2 toxin, 26934-87-2; nivalenol, 23282-20-4; ochratoxin, 303-47-9, 37203-43-3; T 2 toxin, 21259-20-1; vomitoxin, 51481-10-8; zearalenone, 17924-92-4

BACKGROUND: Most studies on bariatric surgery outcomes are performed as clinical trials or reflect the clinical experience in single centers. The status of bariatric surgery in Germany has been examined with the cooperation of clinics and hospitals at the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University of Magdeburg (Germany) since January 1, 2005. METHODS: In this prospective multicenter observational study, the data obtained for all primary bariatric procedures, including all repeated operations, performed on consecutive patients with morbid obesity at participating hospitals from 2005 to 2007 were prospectively collected using an internet online data registry. Perioperative characteristics such as the spectrum of diagnostic measurements, type of surgical procedures, and short-and long-term out comes were investigated. RESULTS: During the study period 3,123 surgical procedures were performed. In 2005 and 2006, gastric banding (GB) was the operation performed most frequently, followed by the Roux-en-Y gastric bypass (RYGBP). In 2007, a RYGBP was carried out in 42.1% of all bariatric procedures. Among all patients, 74.4% were female. The mean BMI ranged from 48.5 kg/m(2) in 2005 to 48.0 kg/m(2) in 2007. Follow-up data after 12 months were available for 63.8% of the patients operated in 2005 and 2006. The mortality was 0.1% (30 days) and 0.16% (overall). CONCLUSION: As indicated by the worldwide trend, there is an ongoing change from GB to sleeve gastrectomy (SG) and malabsorptive procedures. The BMI of German bariatric surgical patients is substantially higher than that of patients from most other countries. There were no differences in overall outcomes during follow-up as compared to published studies.

Obwohl Über die laparoskopische Sleeve-Gastrektomie (LSG) noch keine ausreichenden Langzeitergebnisse vorliegen, wird diese Operation mitzunehmender Euphorie durchgefÜhrt. Multicenter-Studien sind in der Rekrutierungsphase, Langzeitergebnisse werden erst in 2–3 Jahren erwartet. Die LSG wird allgemein als eine zÜgig durchfÜhrbare und wenig traumatisierende Operation angesehen. Es gelten aber die gleichen GrundsÄtze der laparoskopischen Chirurgie: sorgfÄltige PrÄparationen, Vermeidung von kreuzenden Klammernahtreihen und das frÜhe Erkennen und Beherrschen von Leckagen. Nur so kann ein hoher operativer Standard gewÄhrleistet werden. Wir verwenden einen 32-CharriÈre-Magenbougie; daraus sollte ein circa 80–100 ml großer Schlauchmagen und ein Magenresektat mit mindestens 1000 ml FÜllungsvolumen resultieren. Werden diese Benchmarks angestrebt, kÖnnen Übergewichtsverluste (EWL) von circa 60% nach 1 Jahr erzielt werden. Sleeve Gastrectomy — Technique, Safety, Success, Trends Despite the lack of sufficient data concerning the long-time results, the morbidity, and the mortality of laparoscopic sleeve resection, this operation is performed with growing enthusiasm. However, general principles of laparoscopic surgery need to be observed to ensure good results. This article describes an operative technique and indication for the operation. Attention must be turned on the complete liberation of the dorsal aspect of the stomach, the absence of crossing staple lines, and the competent handling of intraoperative leakages. The use of a 32 Fr bougie results in a residual stomach volume of about 80—100 ml. Due to a good operative technique and a competent follow-up, excess weight loss (EWL) of about 60% can be achieved within the first postoperative year.

Die Kriterien zur Indikation fÜr ein Gastric Banding (GB) oder einen Bypass sind in den bekannten Leitlinien nur unscharf definiert und orientieren sich meist am BMI der Patienten. In der vorliegenden Arbeitwerden neben dem BMI auch die Rolle von hormonalen Mediatoren, die mit der morbiden Adipositasverbunden sind, die KomplikationstrÄchtigkeit und die Langzeitresultatedes GB dem laparoskopischen Gastric Bypass gegenÜbergestellt, um gegebenenfalls Grenzen des GB aufzuzeigen. Laparoscopic Gastric Banding - Where Are the Limits? The criteria for the indication of gastric banding (GB) or bypass in morbidly obese patients are poorly defined in the available guidelines and usually rely on the BMI of the patients. In this study, the role of the BMI and of hormonal mediators associated with morbid obesity are outlined. Furthermore, the complications and long-termresults of GB are analyzed and compared with laparoscopic gastric bypass in order to define the limits of GB.

International audience; Nineteen food contact papers and boards and one non-food contact board were extracted following test protocols developed within European Union funded project BIOSAFEPAPER. The extraction media were either hot or cold water, 95% ethanol or Tenax, according to the end use of the sample. The extractable dry matter content of the samples varied from 1200 to 11,800 mg/kg (0.8-35.5 mg/dm2). According to GC-MS the main substances extracted into water were pulp-derived natural products such as fatty acids, resin acids, natural wood sterols and alkanols. Substances extracted into ethanol particularly, were diisopropylnaphthalenes, alkanes and phthalic acid esters. The non-food contact board showed the greatest number and highest concentrations of GC-MS detectable compounds. The extracts were subjected to a battery of in vitro toxicity tests measuring both acute and sublethal cytotoxicity and genotoxic effects. None of the water or Tenax extracts was positive in cytotoxicity or genotoxicity assays. The ethanol extract of the non-food contact board gave a positive response in the genotoxicity assays, and all four ethanol extracts gave positive response(s) in the cytotoxicity assays to some extent. These responses could not be pinpointed to any specific compound, although there appeared a correlation between the total amount of extractables and toxicity.

Background: To assess whether the premorbid dietary intake of fatty acids, cholesterol, glutamate or antioxidants was associated with the risk of developing amyotrophic lateral sclerosis (ALS). Methods: Patients referred to our clinic during 2001–2002, who had definite, probable or possible ALS according to El Escorial criteria, without a familial history of ALS, were asked to participate in a case–control study (132 patients and 220 healthy controls). A food-frequency questionnaire was used to assess dietary intake for the nutrients of interest. Multivariate logistic regression analysis was performed with adjustment for confounding factors (sex, age, level of education, energy intake, body mass index and smoking). Results: A high intake of polyunsaturated fatty acid (PUFA) and vitamin E was significantly associated with a reduced risk of developing ALS (PUFA: odds ratio (OR) = 0.4, 95% confidence interval (CI) = 0.2 to 0.7, p = 0.001; vitamin E: OR = 0.4, 95% CI = 0.2 to 0.7, p = 0.001). PUFA and vitamin E appeared to act synergistically, because in a combined analysis the trend OR for vitamin E was further reduced from 0.67 to 0.37 (p = 0.02), and that for PUFA from 0.60 to 0.26 (p = 0.005), with a significant interaction term (p = 0.03). The intake of flavonols, lycopene, vitamin C, vitamin B 2 , glutamate, calcium or phytoestrogens was not associated with the risk of developing ALS. Conclusion: A high intake of PUFAs and vitamin E is associated with a 50–60% decreased risk of developing ALS, and these nutrients appear to act synergistically.

Total order ranking methods are multicriteria decision making techniques used for the ranking of various alternatives on the basis of more than one criterion. The criteria, which are the standards by which the elements of the system are judged are not always in agreement, they can be conflicting, motivating the need to find an overall optimum that can deviate from the optima of one or more of the single criteria. Total order ranking methods are based on an aggregation of the criteria in a scalar function, i.e. an order or ranking index, which allow to sort elements according to its numerical value. Several evaluation methods which define a ranking parameter generating a total order ranking have been proposed in the literature. Four total order ranking methods are here described: Desirability functions, Utility functions, Dominance functions and Absolute Reference method. These methods have been compared to each other by applying them to a decision making problem in the paper industry. Various bleaching processes have been analysed and compared on the basis of multiple criteria, the aim being to find out best bleaching process among the ones proposed in the last years as alternative to chlorine bleaching process which is of high environmental impact due to the potential for chlorinated dioxin production.

The reuse and recycling of waste paper sludge is increasing rapidly as far as the economical and positive environmental benefits are realised. In this study, primary sludge coming from a large production plant, located in the centre of Italy, was collected and the environmental quality of the sludge was assessed through geotechnical, physical and chemical analysis and leaching tests, as required by the Italian regulation on solid waste recovery. The results suggest that primary sludge from paper industry do not represent a major threat for the environment in regard to the heavy metal content. The use of this sludge for in situ applications appears an interesting avenue for an integrated management of waste from the paper industry.