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Problem The severity of motorway accidents that occurred on the hard shoulder (HS) is higher than for the main carriageway (MC). This paper compares and contrasts the most important factors affecting the severity of HS and MC accidents on motorways in England. Method Using police reported accident data, the accidents that occurred on motorways in England are grouped into two categories (i.e., HS and MC) according to the location. A generalized ordered logistic regression model is then applied to identify the factors affecting the severity of HS and MC accidents on motorways. The factors examined include accident and vehicle characteristics, traffic and environment conditions, as well as other behavioral factors. Results Results suggest that the factors positively affecting the severity include: number of vehicles involved in the accident, peak-hour traffic time, and low visibility. Differences between HS and MC accidents are identified, with the most important being the involvement of heavy goods vehicles (HGVs) and driver fatigue, which are found to be more crucial in increasing the severity of HS accidents. Practical applications Measures to increase awareness of HGV drivers regarding the risk of fatigue when driving on motorways, and especially the nearside lane, should be taken by the stakeholders. [ABSTRACT FROM AUTHOR]

Background & Aims: Relative adrenal insufficiency (AI) occurs in patients with cirrhosis with sepsis, but not with variceal bleeding. We evaluated adrenal function in cirrhotic patients with and without bleeding. Methods: Twenty cirrhotic patients with variceal bleeding were evaluated using the short synacthen test (SST) and 10 using the low-dose synacthen test (LDSST) followed by SST. The control group included 60 stable cirrhotic patients, assessed by LDSST (n = 50) or SST (n = 10), and 14 healthy volunteers. AI was diagnosed using SST, based on peak cortisol levels ≤18 μg/dL in nonstressed patients or Δmax <9 μg/dL or a total cortisol level <10 μg/dL in stressed patients with variceal bleeding—the current criteria for critical illness-related corticosteroid insufficiency. Using LDSST, diagnosis was based on peak concentrations of cortisol ≤18 μg/dL in nonstressed patients and <25 μg/dL (or Δmax <9 μg/dL) in patients with variceal bleeding. We evaluated patients with levels of serum albumin >2.5 g/dL, to indirectly assess cortisol binding. Results: All healthy volunteers had normal results from LDSSTs and SSTs. Patients with variceal bleeding had higher median baseline concentrations of cortisol (15.4 μg/dL) than stable cirrhotic patients (8.7 μg/dL, P = .001) or healthy volunteers (10.1 μg/dL, P = .01). Patients with variceal bleeding had higher median peak concentrations of cortisol than stable cirrhotic patients (SST results of 32.7 vs 21 μg/dL, P = .001; LDSST results of 9.3 vs 8.1 μg/dL; nonsignificant), with no differences in Δmax in either test. These differences were greater with variceal bleeding than in stable cirrhotic patients with AI. Subanalysis of patients with albumin levels >2.5 g/dL did not change these differences. Conclusions: Cirrhotic patients with variceal bleeding have AI. Despite higher baseline concentrations of serum cortisol and subnormal Δmax values, they did not have adequate responses to stress, and therefore had critical illness-related corticosteroid insufficiency. [Copyright &y& Elsevier]

Summary: Objectives: To investigate whether stress hyperglycemia affects the production of the main pro- and anti-inflammatory cytokines and the 28-day hospital mortality in patients with severe sepsis. Methods: The study included 62 patients with severe sepsis, divided in three groups according to their glycemic profile within 24h after admission: patients with stress hyperglycemia (group SH, n =16), diabetes mellitus type II (group DM, n =27), and normal glucose levels (group NG, n =19). The serum levels of the cytokines TNF-alpha, IL-6, IL-10 and TGFbeta-1 were measured within 24h after admission. Results: A higher percentage of septic patients with stress hyperglycemia died compared to diabetic patients (43.7 vs. 14.8%) and group NG (43.7 vs. 5.2%). Group SH had higher SOFA score and levels of IL-6 and IL-10 than group DM and group NG. It also had higher levels of TNF-alpha than group DM but not group NG. There was no difference in the levels of TGFbeta-1 among the three groups. Non-survivors had higher levels of IL-10, no difference was detected for IL-6, TNF-alpha, IL-10/TNF-alpha ratio and TGFbeta-1. Interleukin-10 values, mean fasting glucose values and age were found as prognostic factors associated with outcome. Conclusions: Stress hyperglycemia is associated with increased cytokine production and an adverse clinical outcome in patients with severe sepsis. [Copyright &y& Elsevier]

Abstract: Laboratory bioassays were conducted in order to evaluate the use of the entomopathogenic fungus, Metarhizium anisopliae (Metschinkoff) Sorokin (Deuteromycotina: Hyphomycetes), against adults of three stored-grain beetle species, Rhyzopertha dominica (F.) (Coleoptera: Bostrychidae), Sitophilus oryzae (L.) (Coleoptera: Curculionidae) and Tribolium confusum Jacquelin du Val (Coleoptera: Tenebrionidae). Two fungal preparations were compared, a conidial suspension and a conidial powder. These were applied to wheat, at three dosages, 8×106, 8×108 and 8×1010 conidia/kg of wheat, alone, or in combination with the diatomaceous earth (DE) formulation SilicoSec® (Biofa Gbmh, Germany), applied at 0.5g/kg of wheat. Adult insects were exposed to treated wheat for 24h, 48h, 7d and 14d. The mortality of R. dominica adults after 14d of exposure to the treated substrate was 100% and 96% at the dosages in combination, for the suspension and the powder, respectively. The respective figures without DE were 94.4% and 74.6%. In contrast, against S. oryzae adults, the application of conidial suspension combined with DE was not as effective as the application of DE alone. Adult mortality of S. oryzae increased notably on wheat treated with the conidial powder. Similarly, the conidial suspension, with or without DE, was not as effective against T. confusum as the conidial powder. The progeny production of R. dominica on wheat treated with the highest suspension dosage, with or without DE, was significantly lower than that for the other aqueous fungal dosages. Moreover, significantly less progeny were produced on wheat treated with the highest dosage of powder conidia combined with DE, in comparison with the other treatments. In contrast, S. oryzae progeny production was notably reduced only in wheat treated with the highest dosage of fungal spore powder mixed with DE. No T. confusum progeny were found on wheat treated with the highest dosage of both fungal preparations combined with DE. [Copyright &y& Elsevier]

Abstract: Laboratory experiments were carried out in order to assess the insecticidal effect of Metarhizium anisopliae (Metschinkoff) Sorokin (Deuteromycotina: Hyphomycetes) formulations against larvae of Tribolium confusum Du Val (Coleoptera: Tenebrionidae) on flour and wheat. M. anisopliae was applied at three dose rates, of 8×106, 8×108 and 8×1010 conidia/kg to either wheat or flour, respectively. Also the wheat/flour was treated with the diatomaceous earth (DE) formulation SilicoSec (Biofa, Germany), at two dose rates, 0.2 and 0.5g/kg of wheat or flour either alone or in combination with M. anisopliae with each fungal rate. Mortality of T. confusum larvae was assessed 7 days after exposure to the treated substrate. The bioassays were conducted at three temperatures, 20, 25 and 30°C, and two relative humidity (r.h.) levels, 55% and 75%. Larval mortality was notably varied among treatments, as well among temperature and humidity levels. For both fungus and DE, the increase of temperature increased their effectiveness. On the other hand, the increase of r.h. significantly reduced larval mortality for both M. anisopliae and SilicoSec. Both substances, either alone or in combination, were more effective on wheat than on flour. Also, the addition of 0.5g of SilicoSec in the fungal preparation, especially at the highest dose rate, increased larval mortality, in comparison with the fungus alone or in combination with 0.2g of SilicoSec. The results of the present work suggest that, under certain circumstances, the effectiveness of M. anisopliae against T. confusum larvae can be benefitted by the presence of DE. [Copyright &y& Elsevier]

The integrin α6β4 complex is a protein of the membrane of basal keratinocytes, localized at the surface of cells in contact with the basement membrane zone in normal skin. The expression of α6β4 was investigated in several autoimmune blistering skin diseases including bullous pemphigoid (BP), epidermolysis bullosa acquisita (EBA), bullous systemic lupus erythematosus (BSLE), and pemphigus vulgaris (PV) by an indirect immunofluorescence technique. In lesional bullous skin of BP, α6β4 expression was either absent, or in some cases represented an unusual irregular patchy staining. In contrast, in lesional bullous skin from EBA, BSLE, and PV, α6β4 expression was comparable to that observed in normal skin, i.e., a linear staining of the BMZ. Thus, analysis of the α6β4 integrin reactivity on lesional skin, in conjunction with the typical localization of collagen IV, allows a rapid and accurate distinction between BP and EBA. [ABSTRACT FROM AUTHOR]

Prenatal exposure to air pollution is robustly associated with fetal growth restriction but the extent to which it is associated with postnatal growth and the risk of childhood obesity remains unknown. We examined the association of prenatal exposure to air pollution with offspring obesity related measures and evaluated the possible protective effect of maternal fruits and vegetables intake (FV). We included 633 mother-child pairs from the Rhea pregnancy cohort in Crete, Greece. Fine particles (PM 2.5 and PM 10) exposure levels during pregnancy were estimated using land-use regression models. We measured weight, height and waist circumference at 4 and 6 years of age, and body composition analysis was performed at 6 years using bioimpedance. Maternal diet was evaluated by means of a semi-quantitative food frequency questionnaire in mid-pregnancy. Adjusted associations were obtained via multivariable regression analyses and multiplicative interaction was used to evaluate the potential modifying role of FV intake. Exposure to PMs in utero was not associated with measures of adiposity at 4 or 6 years of age. Associations at 4 years did not differ according to maternal consumption of FV. However, at 6 years, among children whose mothers reported consuming less than 5 servings of FV per day, one SD increase in PM 10 during pregnancy was associated with increased BMI (beta 0.41 kg/m2, 95% CI: −0.06, 0.88, p-interaction = 0.037) and increased waist circumference (beta 0.83 cm, 95% CI: −0.38, 2.05, p-interaction = 0.043) and one SD increase in PM 2.5 was associated with increased fat mass (beta 0.5 kg, 95% CI: 0.0, 0.99, p-interaction = 0.039) and increased percentage of body fat (beta 1.06%, 95% CI: −0.06, 2.17, p-interaction = 0.035). Similarly, higher prenatal PM 2.5 and PM 10 exposure was associated with increased risk for obesity and abdominal obesity at 6 years only in the low FV group. Exposure to fine particulate matter during pregnancy was not associated with obesity-related measures at 4 and 6 years. However, only among offspring of mothers who consumed inadequate FV, we observed higher obesity-related measures at 6 years. Our results indicate that mothers' diet during pregnancy may play a role in the relationship between air-pollution and childhood obesity. [ABSTRACT FROM AUTHOR]

This study quantifies the change in traffic flow on the M25 motorway in the UK due to the COVID-19 outbreak. Moreover, the impact of the change in traffic flow on non-exhaust PM 2.5 and PM 10 emissions for different categories of vehicle was explored. During the year of the COVID-19 outbreak (March 2020 to February 2021), the total traffic flows of passenger cars (PCs), light goods vehicles (LGVs), heavy goods vehicles (HGVs), and long HGVs on the M25 motorway decreased by 38.6%, 27.6%, 15.9% and 7.2%, respectively, in comparison to the previous year. Correspondingly, the total mass of non-exhaust emissions (PM 2.5 and PM 10) of PCs, LGVs, HGVs, and long HGVs reduced by 38.7%, 27.3%, 16.2% and 7%, respectively. The traffic flows per year before and during the COVID-19 outbreak of long HGVs were 87.2% and 80.7% less than those of PCs. Correspondingly, the long HGVs emitted 10.2% less but 36.3% more PM 2.5 emissions, as well as 10.9% and 66.7% more PM 10 emissions than the latter, indicating that long HGVs contribute much more to non-exhaust particles than PCs. In addition, it was found that resuspension of road dust on the M25 motorway was the largest contributor to air pollution among non-exhaust emissions, followed by road wear, tyre wear, and brake wear particles. [Display omitted] • Traffic flow was quantified on the M25 before and during the year of the outbreak. • Total non-exhaust PM 2.5 and PM 10 mass of four categories of vehicles were evaluated. • Long HGVs emitted the most non-exhaust particles, followed by HGVs, LGVs and PCs. • Resuspension of road dust was the largest contributor to non-exhaust particles. [ABSTRACT FROM AUTHOR]

[Display omitted] • Synthetic steroids suppress the hypothalamus-pituitary-thyroid (HPT) axis. • The effect of ACTH on thyroid function is not established. • Effect of single dose betamethasone or ACTH on thyroid function was compared. • Study population included hospitalized patients with acute gout / normal thyroid function. • ACTH had more prolonged and pronounced suppressive effect on the HPT axis. Although the suppressive action of synthetic steroids on the hypothalamus-pituitary-thyroid (HPT) axis is established, little is known regarding the effect of the administration of synthetic adrenocorticotropic hormone (ACTH). In the context of a randomized, open label, comparative study assessing the efficacy and safety of ACTH and betamethasone in the treatment of hospitalized patients with acute gout, we compared the effects of these agents on thyroid function tests. Serum TSH, total T4 and T3 and cortisol were measured before and at 24 and 48 h after a single intramuscular dose of synthetic ACTH (1 mg) or betamethasone (6 mg), in 38 hospitalized patients with acute gout and normal thyroid function. The final analysis included 32 patients, due to missing data. The ACTH and betamethasone groups did not differ regarding the mean age, gender, severity of gout attack, and baseline thyroid parameters. In the ACTH group TSH and T4 were significantly decreased at 24 and at 48 h compared to baseline, while T3 was decreased at 24 but not at 48 h. In the betamethasone group T3 remained stable; TSH and T4 decreased significantly from baseline levels at 24 h; at 48 h, TSH had returned to and T4 showed a partial rebound towards pre-treatment values. A single IM administration of 1 mg of synthetic ACTH has more profound and prolonged effects on the HPT axis, lasting for at least 48 h, compared to a single IM dose of 6 mg betamethasone. [ABSTRACT FROM AUTHOR]