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There is significant research on the motivations and migration experiences of South Asian international students in Australia and the United Kingdom (UK); however, the employability journeys of this group are not well understood. This article addresses this gap, illuminating the specific employability challenges experienced and perceived by South Asian postgraduate international students enrolled in Australia and the UK. Drawing on qualitative research comprising semi-structured interviews with 30 South Asian postgraduate international students studying at a university in Australia and in the UK, the findings highlight significant barriers to employability along four key axes: time pressures from study and adjustment issues (micro); lack of internship opportunities offered at the universities (meso); lack of culturally tailored university career services (meso) and perceptions of employers' as well as Government policy implications (macro). Acknowledging and understanding these findings are important for universities to support South Asian international student employability experiences and graduate outcomes to remain competitive in the global job market. The findings suggest recommendations to enhance the employability of South Asian students in the UK and Australia.

This study extends our knowledge of internal branding in the context of employees in the higher education sector. Employing a quantitative methodology in UK universities, a conceptual model is presented and tested on 235 employees. Internal market orientation (IMO) is examined as a management tool to drive employees' university brand commitment "en route" to brand supportive behavior. The results show that the effect of IMO on employees' university brand commitment varies among employees of different demographic groups. A two-step cluster analysis is carried out to highlight the impact of demographic heterogeneity. The results show that universities with higher level of IMO perform better relating to their internal branding outcomes in terms of employee university brand commitment as well as brand supportive behavior. However significant differences are found for the effect of IMO on employees' university brand commitment especially in the cluster of the "Mature Male Academics," suggesting specific managerial attention.

Congenital hypothyroidism is one of the most common causes of preventable intellectual disability in the UK and worldwide. Early diagnosis is critical to allow for early intervention. At present, 1 in 2000 to 1 in 3000 babies born in the UK have congenital hypothyroidism. Of these, most will not display any clinical manifestations or symptoms in the first few weeks of life. In short, babies will develop intellectual disability if they go undiagnosed. It is therefore no surprise that the day 5 blood spot is essential for good outcomes and harm reduction. Diagnosis of thyroid disorder is based on measuring the thyroid hormones and thyroid stimulating hormone levels. The most common cause of congenital hypothyroidism is an abnormality in thyroid gland development (dysgenesis) but it may also be the result of a defect in thyroid hormonogenesis or may be temporary as a result of maternal medications passing through the placenta, maternal blocking antibodies or iodine excess or deficiency. Rarely, it is the result of pituitary or hypothalamic abnormality when it is called central or secondary/tertiary hypothyroidism. This short article offers practical advice on how to diagnose and treat congenital hypothyroidism and how to interpret the results of available biochemical tests. [ABSTRACT FROM AUTHOR]

This paper utilises a Vygotskian framework to examine the ways in which teachers shape the creation of children's artwork in educational contexts. Reflexive ethnography and a bottom up approach to discourse analysis are used to analyse a range of qualitative data including photographs, observational notes and audio recordings collected from a Year 1 and a Year 4 art lesson held in English Primary schools. It is argued that the co-creation of art in the classroom is a dynamic and collaborative process which is negotiated between teachers and children in different ways. This argument is discussed in relation to the ways in which different teaching approaches shape and limit the creation of children's artwork. (Contains 2 figures.)

Introduces a web-based formative assessment system that consists of knowledge tests based on multiple true-false questions which is capable of monitoring students' educational progress on an individual basis or as small groups and providing feedback. (Author/YDS)

Background: Cerebrospinal fluid (CSF) leaks can be associated with significant morbidity such as meningitis. Surgical management has proven effective, with endoscopic approaches having become the gold standard due to success rates >90%. Inability to localise the leak site prior to surgery is associated with surgical failure. The use of intrathecal fluorescein (IF) to localise CSF fistulae sites was first demonstrated in 1960. Despite this, its use in this context is unlicensed. Objective: Evaluate the safety and efficacy of IF use in the management of CSF leak repairs in our centre. Methods: All patients who underwent endoscopic repair of CSF fistula by a single surgeon where IF was used between January 2010 – September 2019 at a single-centre (tertiary skull base referral unit in the United Kingdom) were retrospectively analysed. Primary outcome measures were localisation of CSF fistula with IF (efficacy) and peri-operative complications likely to be attributable to IF (safety). Results: There were 55 patients included (60 procedures) with a positive localisation rate of 90.0% with IF. The overall peri-operative complication rate was 8.3% (n = 5). It is likely that none were related to IF use. However, three complications may be linked giving a complication rate potentially related to IF of 5.0%. There were no peri-operative mortalities. Conclusion: Many studies have demonstrated IF to be safe at low doses (<50mg) with a high sensitivity, specificity and positive predicative value. Our results demonstrate that the use of IF in our centre is safe and effective at identifying CSF fistulae. While we have reported some complications in our cohort, these were unlikely to be directly attributable IF use. We have described no serious complications such as seizures, limb weakness or death. We believe this study adds to the growing body of evidence that IF use in the management CSF fistula repairs is safe and effective. [ABSTRACT FROM AUTHOR]

Includes three articles that discuss: (1) the creation of a persistent digital archive email collection, including technical issues; (2) a project at Cornell University that provides library users with personalized electronic library services; and (3) the digitization of a photographic collection in the United Kingdom for preservation purposes. (LRW)

Most studies linking indoor environments and productivity have been conducted in controlled, static conditions often unrepresentative of the real world. This paper uses a case-study-based, real-world approach to empirically investigate the link between indoor environment and workplace productivity in a mechanically-ventilated office environment in southern England. Environmental parameters were monitored continuously. Transverse and longitudinal surveys recorded perceptions of the working environment and self-reported productivity. Performance tasks provided proxy measures of performance. Productivity was perceived to decrease when occupants perceived thermal discomfort and stuffy air. Correlations with perceived changes in productivity were stronger for perceived rather than measured environmental conditions, implying occupants' subjective feelings impacted perceived productivity more than objective environmental conditions. Task scores were 15% lower when conducted at CO2 levels above 800 ppm compared to below 800 ppm. Insights from the study can help to optimize indoor office environments and improve workplace productivity. [ABSTRACT FROM AUTHOR]

In this paper, we conduct a comprehensive investigation of the Halloween effect evolution in the US stock market over its entire history as well as in the other developed markets (UK, French, Canadian, German and Japanese). We employ various statistical techniques (average analysis, Student's t-test, ANOVA, and the Mann-Whitney test) and the trading simulation approach to analyse the evolution of the Halloween effect. The results suggest that in the US stock market and other developed markets, the Halloween effect only became detectable in the middle of the 20th century. Recently it is still present in the US stock market and most of the other developed markets, which provides opportunities to build a trading strategy which can beat the market. Therefore, it can be concluded that, in the main, the Halloween effect in the US market and other developed markets is consistent with the Adaptive Market Hypothesis. [ABSTRACT FROM AUTHOR]

In the trials, a substantial proportion of newborns who underwent therapeutic hypothermia (TH) had an adverse outcome after hypoxic-ischaemic encephalopathy (HIE). Cooled babies were noted to have fewer cerebral lesions on MRI but when present lesions were predictive of adverse outcome. We investigate the predictive value of cerebral MRI in babies who undergo cooling in the clinical setting outside of the clinical trials in a prospective UK cohort. Of 75 babies recruited from four centres, neurodevelopment was available for 69 (92%) with 29% (20/69) being abnormal. The unfavourable MRI group (n = 22) had significantly lower motor (p < 0.001), language (p < 0.001) and cognition (p < 0.001) scores on Bayley-III assessment, compared to the favourable MRI group (n = 47). On multiple regression there was a significant relationship between basal ganglia and thalami abnormality and motor (p = 0.002), cognition (p = 0.011) and language (p = 0.013) outcomes. Half of the babies who had an MRI predictive of adverse outcome (11/22) had highest grade cerebral palsy. Cerebral MRI had 95% sensitivity, 94% specificity, 91% PPV and 98% NPV in predicting neurodevelopment. In this clinical cohort, fewer children had adverse neurodevelopment after TH compared to the TH trials. However, half the children who had an MRI predictive of adverse ND outcome had the most severe form of cerebral palsy. In this cohort, cerebral MRI was found to be highly predictive of neurodevelopmental outcome. • In this cohort, conventional cerebral MRI is highly predictive of neurodevelopmental outcome. • 73% of babies with cerebral MRI predictive of adverse outcome developed cerebral palsy. • Conventional cerebral MRI provides useful prognostic information for counselling families. [ABSTRACT FROM AUTHOR]

Reports on the results of a survey designed to explore the views of educational psychologists about their use of behavior modification with clients. Summarizes the responses of a random sample of educational psychologists practicing in the United Kingdom. Finds that most respondents do not implement behavior modification in the traditional manner. Includes questionnaire. (KO)

In this paper, we analyze the potential role of growth in inequality for forecasting real housing returns of the United Kingdom. In our forecasting exercise, we use linear and nonlinear models, as well as measures of absolute and relative consumption and income inequalities at quarterly frequency over the period 1975–2016. Our results indicate that, while nonlinearity in the data generating process of real housing returns is important, growth in inequality does not necessarily carry important information in forecasting the future path of housing prices in the United Kingdom. [ABSTRACT FROM AUTHOR]

This paper investigates international students' acculturation, an important aspect for universities to consider when they try to develop a positive loyal customer relationship with international students. The paper presents the influences of social media usage on international students' acculturation process in both psychological and behavioural aspects, and whether international students' acculturation predicts students' academic achievement, perceived value and university loyalty. Self-identification is examined for its moderating effect between social media usage and Chinese international students' acculturation. This study collected samples from Chinese international students studying in UK universities. The results find that Chinese international students' psychological acculturation to the host culture has no significant relationship with their academic achievement, but their strong self-identification can help with their host culture acculturation. This study makes contributions in current acculturation research and managerial practice for universities which target international markets. • Social media impacts on Chinese international students' acculturation in the UK. • Self-identification and social media usage interact and has its significant impact on students' acculturation. • Academic achievement has little to do with their psychological host culture acculturation. • Chinese international students' academic achievements lead to their perceived university value and university loyalty. • Managerial implications are recommended towards Chinese international students as target market. [ABSTRACT FROM AUTHOR]

Heavy metal pollution and the potential for co-selection of resistance to antibiotics in the environment is growing concern. However, clear associations between heavy metals and antibiotic resistance in river systems have not been developed. Here we investigated relationships between total and bioavailable heavy metals concentrations; metal resistance gene (MRG) and antibiotic resistance gene (ARG) abundances; mobile genetic elements; and the composition of local bacterial communities in low and high metal polluted rivers in UK and India. The results indicated that MRGs conferring resistance to cobalt (Co) and nickel (Ni) (rcnA), and Co, zinc (Zn), and cadmium (Cd) (czcA), and ARGs conferring resistance to carbapenem and erythromycin were the dominating resistant genes across the samples. The relative MRGs, ARGs, and integrons abundances tended to increase at high metal polluted environments, suggesting high metals concentrations have a strong potential to promote metal and antibiotic resistance by horizontal gene transmission and affecting bacterial communities, leading to the development of multi-metal and multi-antibiotic resistance. Network analysis demonstrated the positive and significant relationships between MRGs and ARGs as well as the potential for integrons playing a role in the co-transmission of MRGs and ARGs (r > 0.80, p < 0.05). Additionally, the major host bacteria of various MRGs and ARGs that could be accountable for greater MRGs and ARGs levels at high metal polluted environments were also identified by network analysis. Spearman's rank-order correlations and RDA analysis further confirm relationships between total and bioavailable heavy metals concentrations and the relative MRG, ARG, and integron abundances, as well as the composition of related bacterial communities (r > 0.80 (or < −0.80), p < 0.05). These findings are critical for assessing the possible human health concerns associated with metal-driven antibiotic resistance and highlight the need of considering metal pollution for developing appropriate measures to control ARG transmission. [Display omitted] • Metals exposure trigger co-selection of metal and antibiotic resistance in bacteria. • Metals could promote ARGs transmission by affecting MGEs and bacterial communities. • Significant relationships were found between MRGs and ARGs. • Int1 could facilitate the co-transmission of metal and antibiotic resistance. [ABSTRACT FROM AUTHOR]

The article focuses on the U.S. Supreme Court cases Octane Fitness LLC v. Icon Health & Fitness Inc. and Highmark Inc. v. Allcare Health Management System Inc., which dealt with the payment of attorneys' fees in patent litigation. Topics include attorney fee recovery in the U.S. and Great Britain and judicial discretion in attorneys' fee awards.

Introduction: There is concern that glucagon-like peptide-1 (GLP1) receptor agonists may be associated with acute pancreatitis. The data from the ABCD nationwide liraglutide audit (November 2009–June 2013; 6010 patients) provide an opportunity to assess the extent of the problem in routine clinical practice in the UK. Methods: At every patient visit, audit-contributors were invited to submit, via an electronic form, clinical data collected as part of routine clinical practice, including data on possible side effects of treatment. Cases of 'possible pancreatitis' were identified and we contacted the centres concerned to obtain full details. Results: To date, the audit has monitored 3720 years of exposure to liraglutide. There were four cases of possible pancreatitis documented from the 6010 patients on liraglutide: three patients had likely causes of pancreatitis identified and one patient had no aetiological cause. This sole case represents an incidence of 0.027/100 patient-years of exposure to liraglutide. Conclusion: In cases of acute pancreatitis of a patient on liraglutide, if another cause can be found (usually gall stones associated with obesity), the drug is not be necessarily culpable. People with Type 2 diabetes are at greater risk of acute pancreatitis (hazard ratio between 1.5 and 2.8). Thus, the possibility of liraglutide-associated pancreatitis in 'real-world' clinical practice (0.027/100 patient years) represents a very small risk. [ABSTRACT FROM AUTHOR]

Abstract: This paper uses probabilistic climate change data from the UK Climate Change Projections 2009 to define extreme climate change in order to model the effect of future temperature change, particularly summer overheating on the energy consumption of, and comfort in, existing English homes (located in Oxford). Climate change risk is then analysed as a factor of climate hazard, exposure and vulnerability. With the risk of overheating theoretically identified, the risk of overheating and the future change impact on space heating energy use is then virtually detailed for four English home types modelled using future weather years in a dynamic simulation modelling software (IES). A range of passive adaptation measures are then critically reviewed with regard to their effectiveness in minimising the negative impacts of climate change and to identify the most effective measures in reducing or eliminating the negative impacts of climate change on comfort and energy consumption. In addition the adaptation options are grouped and tested as packages in order to identify the optimal solution for adaptive retrofitting of English homes. For all homes modelled, user-controlled shading proved to be the most effective adaptation. Increasing the surface albedo of the building fabric and exposure of thermal mass were also revealed to be effective although proving to be complicated and requiring detailed consideration of the optimal locations. Ultimately among the passive options tested, the research found that none could completely eliminate the risk of overheating in the homes, particularly by the 2080s. [Copyright &y& Elsevier]

Abstract: In both the UK and USA, hysterectomy remains the commonest major gynaecological operation. It is the only definitive cure for dysfunctional uterine bleeding, and rates highest in satisfaction scores compared to other treatments, and improves quality of life. Conservative alternatives to hysterectomy, including endometrial ablative techniques, the Mirena Intrauterine System (IUS) and uterine artery embolization (UAE) for fibroids, have not greatly reduced hysterectomy rates. The majority of hysterectomies are performed by the abdominal route, fibroids being the most common indication. The overall mortality rate is 0.5–2/1000 and the rate of visceral damage is 0.5–2%. In both countries the majority are total, the subtotal procedure accounting for less than 5%. Recent research showed no major advantage for subtotal over total hysterectomy (or vice versa) in terms of pelvic organ function, although longer-term data are required to resolve issues on vault/cervical stump prolapse, and to establish whether the beneficial effects of both operations on bladder and sexual function persist long term. Research is required on abdominal versus vaginal hysterectomy in the absence of prolapse, and on why hysterectomy rates vary so widely between countries, and even between regions within the same country. Since fibroids remain the commonest indication for hysterectomy, research is also required to optimize conservative treatments such as UAE, focussed ultrasound surgery and myomectomy. [Copyright &y& Elsevier]

The article discusses loan agreements, prepayment fees, and the Great Britain High Court's ruling in the 2012 case Aston Hill Financial Inc. v. African Minerals Finance Ltd. which deals with the prepayment of a loan prior to the contractual due date. The legal rights of borrowers and lenders are examined in this case, along with an interpretation of the terms of a contract.

Background. Statin-associated muscle symptoms (SAMS) are the major side effects reported for statins. Data from previous studies suggest that 7–29% of patients on statin had associated muscle symptoms. In the UK, there is a lack of corresponding data on SAMS and factors associated with the development of SAMS. Objective. This analysis is aimed at establishing the prevalence of SAMS and identifying major contributory risk factors in patients attending a lipid clinic. Methods. Clinical records of 535 consecutive patients, who visited the lipid clinic in the University Hospitals of Leicester, were studied retrospectively between 2009 and 2012. SAMS were defined by the presence of muscle symptoms with two or more different statins. Patients who reported muscle symptoms to statin with one or no rechallenge were excluded. The association of SAMS with clinical characteristics such as age and BMI, sex, smoking, excess alcohol, comorbidities, and medications was tested for statistical significance. A binomial logistic regression model was applied to adjust for risk factors significantly associated with SAMS. Results. The prevalence of SAMS was found to be 11%. On unadjusted analysis, the mean age of patients who had SAMS was significantly higher than those without SAMS (59.4 ± 10.5 years vs. 50.3 ± 13.4 years, respectively, P < 0.001). Nonsmokers were more likely to develop SAMS in comparison to active smokers (P = 0.037). Patients taking antihypertensive medications were more likely to develop SAMS (P = 0.010). In binomial logistic regression analysis, only age was positively and significantly associated with SAMS after adjusting for other risk factors (β = 0.054 , P = 0.001). Conclusion. To the best of our knowledge, this study is the largest cohort of patients with SAMS in the United Kingdom. Our data suggest that the prevalence of SAMS is 11% and increased age is a risk factor associated with the development of SAMS in our cohort of patients. [ABSTRACT FROM AUTHOR]

UK guidelines recommend liraglutide 3.0 mg in adults treated within specialist weight management services with BMI ≥35 kg/m 2 , prediabetes and high cardiovascular disease risk. We aimed to clinically evaluate liraglutide 3.0 mg in specialist weight management services. We evaluated liraglutide 3.0 mg in weight management services at Guys and St Thomas' NHS Foundation Trust. Objective body weight (BW) was measured at baseline and 4 months, allowing classification as 'responders' (≥5% BW reduction) and 'non-responders' (<5% BW reduction). One hundred and twenty-one patients were evaluated. At 4 months, 76.0% attended follow-up (82.6% responders, 17.4% non-responders); BW (-8.6 kg, 95%CI:-9.8, -7.4 kg), BMI (-3.2 kg/m 2 , 95%CI: -3.6, -2.8) and %-BW (-6.6%, IQR: -8.8%, -5.2%) significantly reduced. In responders, HbA1c reduced by -5.0 mmol/mol (IQR: -7.0. -4.0 mmol/mol). In responders BW continued to reduce up to 12 months (4 m: -10.2 kg, p < .0001; 6 m: -15.6 kg, p < .0001; 9 m: -16.5 kg, p < .0001; 12 m: -16.7 kg, p < .01). Those of Black African and Caribbean ethnicity experienced less BW loss than those of white ethnicity (4.12 kg, p = .017) and had a greater attrition rate. In adults with obesity and prediabetes who are treated within specialist weight management services, liraglutide 3.0 mg reduces BW and HbA1c. Those of Black African and Caribbean ethnicity experienced less BW reduction and greater attrition at 4 months. Further evaluation of the ethnic differences in response to obesity pharmacotherapy is required., (© 2024 The Authors. Clinical Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

The PAM intervention is a behavioural intervention to support adherence to anti-hypertensive medications and therefore to lower blood pressure. This feasibility trial recruited 101 nonadherent patients (54% male, mean age 65.8 years) with hypertension and high blood pressure from nine general practices in the UK. The trial had 15.5% uptake and 7.9% attrition rate. Patients were randomly allocated to two groups: the intervention group (n = 61) received the PAM intervention as an adjunct to usual care; the control group (n = 40) received usual care only. At 3 months, biochemically validated medication adherence was improved by 20% (95% CI 3-36%) in the intervention than control, and systolic blood pressure was reduced by 9.16 mmHg (95% CI 5.69-12.64) in intervention than control. Improvements in medication adherence and reductions in blood pressure suggested potential intervention effectiveness. For a subsample of patients, improvements in medication adherence and reductions in full lipid profile (cholesterol 1.39 mmol/mol 95% CI 0.64-1.40) and in glycated haemoglobin (3.08 mmol/mol, 95% CI 0.42-5.73) favoured the intervention. A larger trial will obtain rigorous evidence about the potential clinical effectiveness and cost-effectiveness of the intervention.Trial registration Trial date of first registration 28/01/2019. ISRCTN74504989. https://doi.org/10.1186/ISRCTN74504989 .

Background: COVID-19 has caused a global pandemic of unprecedented proportions. Elective cardiac surgery has been universally postponed with only urgent and emergency cardiac operations being performed. The National Health Service in the United Kingdom introduced national measures to conserve intensive care beds and significantly limit elective activity shortly after lockdown., Case Presentation: We report two cases of early post-operative mortality secondary to COVID-19 infection immediately prior to the implementation of these widespread measures., Conclusion: The role of cardiac surgery in the presence of COVID-19 is still very unpredictable and further studies on both short term and long term outcomes are warranted.

Introduction: The ORBITA trial of percutaneous coronary intervention (PCI) versus a placebo procedure for patients with stable angina was conducted across six sites in the United Kingdom via home monitoring and telephone consultations. Patients underwent detailed assessment of medication adherence which allowed us to measure the efficacy of the implementation of the optimization protocol and interpretation of the main trial endpoints., Methods: Prescribing data were collected throughout the trial. Self-reported adherence was assessed, and urine samples collected at pre-randomization and at follow-up for direct assessment of adherence using high-performance liquid chromatography with tandem mass spectrometry (HPLC MS/MS)., Results: Self-reported adherence was >96% for all drugs in both treatment groups at both stages. The percentage of samples in which drug was detected at pre-randomization and at follow-up in the PCI versus placebo groups respectively was: clopidogrel, 96% versus 90% and 98% versus 94%; atorvastatin, 95% versus 92% and 92% versus 91%; perindopril, 95% versus 97% and 85% versus 100%; bisoprolol, 98% versus 99% and 96% versus 97%; amlodipine, 99% versus 99% and 94% versus 96%; nicorandil, 98% versus 96% and 94% versus 92%; ivabradine, 100% versus 100% and 100% versus 100%; and ranolazine, 100% versus 100% and 100% versus 100%., Conclusions: Adherence levels were high throughout the study when quantified by self-reporting methods and similarly high proportions of drug were detected by urinary assay. The results indicate successful implementation of the optimization protocol delivered by telephone, an approach that could serve as a model for treatment of chronic conditions, particularly as consultations are increasingly conducted online., (© 2021 The Authors. Pharmacology Research & Perspectives published by John Wiley & Sons Ltd, British Pharmacological Society and American Society for Pharmacology and Experimental Therapeutics.)

Objective: To describe the prevalence of and factors associated with different thyroid dysfunction phenotypes in women who are asymptomatic preconception., Design: Observational cohort study., Setting: A total of 49 hospitals across the United Kingdom between 2011 and 2016., Participants: Women aged 16 to 41years with history of miscarriage or subfertility trying for a pregnancy., Methods: Prevalences and 95% confidence intervals (CIs) were estimated using the binomial exact method. Multivariate logistic regression analyses were conducted to identify risk factors for thyroid disease., Intervention: None., Main Outcome Measure: Rates of thyroid dysfunction., Results: Thyroid function and thyroid peroxidase antibody (TPOAb) data were available for 19213 and 19237 women, respectively. The prevalence of abnormal thyroid function was 4.8% (95% CI, 4.5-5.1); euthyroidism was defined as levels of thyroid-stimulating hormone (TSH) of 0.44 to 4.50 mIU/L and free thyroxine (fT4) of 10 to 21 pmol/L. Overt hypothyroidism (TSH > 4.50 mIU/L, fT4 < 10 pmol/L) was present in 0.2% of women (95% CI, 0.1-0.3) and overt hyperthyroidism (TSH < 0.44 mIU/L, fT4 > 21 pmol/L) was present in 0.3% (95% CI, 0.2-0.3). The prevalence of subclinical hypothyroidism (SCH) using an upper TSH concentration of 4.50 mIU/L was 2.4% (95% CI, 2.1-2.6). Lowering the upper TSH to 2.50 mIU/L resulted in higher rates of SCH, 19.9% (95% CI, 19.3-20.5). Multiple regression analyses showed increased odds of SCH (TSH > 4.50 mIU/L) with body mass index (BMI) ≥ 35.0 kg/m2 (adjusted odds ratio [aOR] 1.71; 95% CI, 1.13-2.57; P = 0.01) and Asian ethnicity (aOR 1.76; 95% CI, 1.31-2.37; P < 0.001), and increased odds of SCH (TSH ≥ 2.50 mIU/L) with subfertility (aOR 1.16; 95% CI, 1.04-1.29; P = 0.008). TPOAb positivity was prevalent in 9.5% of women (95% CI, 9.1-9.9)., Conclusions: The prevalence of undiagnosed overt thyroid disease is low. SCH and TPOAb are common, particularly in women with higher BMI or of Asian ethnicity. A TSH cutoff of 2.50 mIU/L to define SCH results in a significant proportion of women potentially requiring levothyroxine treatment., (© Endocrine Society 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: Liquid chromatography-tandem mass spectrometry (LC-MS/MS) is a new method to objectively and robustly detect nonadherence. We applied this technique to study nonadherence to cardiovascular medications in people with type 2 diabetes (T2DM)., Research Design and Methods: Routine urine samples, received at the time of the annual diabetes review from 228 people with T2DM in primary care, were assessed for adherence by LC-MS/MS., Results: A total of 28.1% patients ( N = 64) were nonadherent to antidiabetic, antihypertensive, and/or lipid-lowering medications. Nonadherence to statins was the highest at 23.7%, and nonadherence to oral hypoglycemic agents was 9.3%. HbA 1c , albumin-to-creatinine ratio, and lipid profiles were significantly higher in the patients who were nonadherent compared with those who were adherent to treatment., Conclusions: This unique study shows that routine urine samples can be used for adherence testing screening by LC-MS/MS and has demonstrated high nonadherence rates especially to statins in people with T2DM. Future intervention studies using LC-MS/MS as a diagnostic/therapeutic tool may help to improve clinical outcomes., (© 2019 by the American Diabetes Association.)

Nonadherence to antihypertensive medications is known to be a major health problem. Novel biochemical analyses using liquid chromatography-tandem mass spectrometry are becoming accepted as a clinically useful objective measure to manage (non)adherence in Hypertension Clinics. Discussion of results from such analyses with patients can significantly improve adherence and blood pressure control. Our objective was to model the cost-effectiveness of performing liquid chromatography-tandem mass spectrometry-based analyses in improving adherence in patients with hypertension. Lifetime cost-utility was assessed from a UK healthcare payer perspective, using a Markov model. Efficacy was based on study findings of lowering blood pressure because of improved adherence to drug treatment. Cost and utilities were derived from literature. The base case cohort consisted of males aged 65 years. Subgroup analyses included varying population sex and age and a subgroup of patients with apparent resistant hypertension. Additionally, univariate and probabilistic sensitivity analyses were performed. Our findings are reported after the Consolidated Health Economic Evaluation Reporting Standards checklist. Per patient, screening resulted in 0.020 incremental quality-adjusted life-years and a negative incremental cost of £495, suggesting the intervention to be dominant compared with care as usual. Targeting younger patients or patients with apparent resistant hypertension would further improve these outcomes. Modeling suggested that screening prevented 518 myocardial infarctions and 305 stroke events in a cohort of 10 000 male hypertensive patients. Using liquid chromatography-tandem mass spectrometry-based biochemical analyses to improve adherence in hypertensive patients is likely to be an effective and cost-saving strategy, especially in patients with apparent resistant hypertension.

Background: Gaps in our understanding of genetic susceptibility to malignant hyperthermia (MH) limit the application and interpretation of genetic diagnosis of the condition. Our aim was to define the prevalence and role of variants in the three genes implicated in MH susceptibility in the largest comprehensively phenotyped MH cohort worldwide., Methods: We initially included one individual from each positive family tested in the UK MH Unit since 1971 to detect variants in RYR1, CACNA1S, or STAC3. Screening for genetic variants has been ongoing since 1991 and has involved a range of techniques, most recently next generation sequencing. We assessed the pathogenicity of variants using standard guidelines, including family segregation studies. The prevalence of recurrent variants of unknown significance was compared with the prevalence reported in a large database of sequence variants in low-risk populations., Results: We have confirmed MH susceptibility in 795 independent families, for 722 of which we have a DNA sample. Potentially pathogenic variants were found in 555 families, with 25 RYR1 and one CACNA1S variants previously unclassified recurrent variants significantly over-represented (P<1×10 -7 ) in our cohort compared with the Exome Aggregation Consortium database. There was genotype-phenotype discordance in 86 of 328 families suitable for segregation analysis. We estimate non-RYR1/CACNA1S/STAC3 susceptibility occurs in 14-23% of MH families., Conclusions: Our data provide current estimates of the role of variants in RYR1, CACNA1S, and STAC3 in susceptibility to MH in a predominantly white European population., (Copyright © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

We hypothesized that screening for nonadherence to antihypertensive treatment using liquid chromatography-tandem mass spectrometry-based biochemical analysis of urine/serum has therapeutic applications in nonadherent hypertensive patients. A retrospective analysis of hypertensive patients attending specialist tertiary care centers was conducted in 2 European countries (United Kingdom and Czech Republic). Nonadherence to antihypertensive treatment was diagnosed using biochemical analysis of urine (United Kingdom) or serum (Czech Republic). These results were subsequently discussed with each patient, and data on follow-up clinic blood pressure (BP) measurements were collected from clinical files. Of 238 UK patients who underwent biochemical urine analysis, 73 were nonadherent to antihypertensive treatment. Their initial urinary adherence ratio (the ratio of detected to prescribed antihypertensive medications) increased from 0.33 (0-0.67) to 1 (0.67-1) between the first and the last clinic appointments. The observed increase in the urinary adherence ratio in initially nonadherent UK patients was associated with the improved BP control; by the last clinic appointment, systolic and diastolic BPs were ≈19.5 and 7.5 mm Hg lower than at baseline ( P =0.001 and 0.009, respectively). These findings were further corroborated in 93 nonadherent hypertensive patients from Czech Republic-their average systolic and diastolic BPs dropped by ≈32.6 and 17.4 mm Hg, respectively ( P <0.001), on appointments after the biochemical analysis. Our data show that nonadherent hypertensive patients respond to liquid chromatography-tandem mass spectrometry-based biochemical analysis with improved adherence and significant BP drop. Such repeated biochemical analyses should be considered as a therapeutic approach in nonadherent hypertensive patients., (© 2017 The Authors.)