Diagnostic findings in sinonasal aspergillosis in dogs in the United Kingdom: 475 cases (2011-2021).

OBJECTIVES: To describe the diagnostic tests used and their comparative performance in dogs diagnosed with sinonasal aspergillosis in the United Kingdom. A secondary objective was to describe the signalment, clinical findings and common clinicopathologic abnormalities in sinonasal aspergillosis. MATERIALS AND METHODS: A multi-centre retrospective survey was performed involving 23 referral centres in the United Kingdom to identify dogs diagnosed with sinonasal aspergillosis from January 2011 to December 2021. Dogs were included if fungal plaques were seen during rhinoscopy or if ancillary testing (via histopathology, culture, cytology, serology or PCR) was positive and other differential diagnoses were excluded. RESULTS: A total of 662 cases were entered into the database across the 23 referral centres. Four hundred and seventy-five cases met the study inclusion criteria. Of these, 419 dogs had fungal plaques and compatible clinical signs. Fungal plaques were not seen in 56 dogs with turbinate destruction that had compatible clinical signs and a positive ancillary test result. Ancillary diagnostics were performed in 312 of 419 (74%) dogs with observed fungal plaques permitting calculation of sensitivity of cytology as 67%, fungal culture 59%, histopathology 47% and PCR 71%. CLINICAL SIGNIFICANCE: The sensitivities of ancillary diagnostics in this study were lower than previously reported challenging the clinical utility of such tests in sinonasal aspergillosis. Treatment and management decisions should be based on a combination of diagnostics including imaging findings, visual inspection, and ancillary testing, rather than ancillary tests alone.

Association between leptin levels and severity of suicidal behaviour in schizophrenia spectrum disorders.

OBJECTIVE: Associations between suicidality and lipid dysregulation are documented in mental illness, but the potential role of leptin remains unclear. We examined the association between leptin and suicidal behaviour in schizophrenia, together with the influence of other clinical and biological indices. METHOD: We recruited a sample of 270 participants with schizophrenia spectrum diagnoses. Blood samples were analysed for leptin, while symptom severity was assessed by Positive and Negative Syndrome Scale (PANSS) and Inventory of Depressive Symptomatology (IDS-C). Patients' history of suicidal behaviour was categorized into three subgroups based on IDS-C suicide subscale: No suicidal behaviour, mild/moderate suicidal behaviour and severe suicidal behaviour with/without attempts. RESULTS: Mild/moderate suicidal behaviour was present in 17.4% and severe suicidal behaviour in 34.8%. Both groups were significantly associated with female gender (OR = 6.0, P = 0.004; OR = 5.9, P = 0.001), lower leptin levels (OR = 0.4, P = 0.008; OR = 0.5, P = 0.008) and more severe depression (OR = 1.2, P < 0.001; OR = 1.1, P < 0.001) respectively. Smoking (OR = 2.6, P = 0.004), younger age of onset (OR = 0.9, P = 0.003) and less use of leptin-increasing medications (OR = 0.5, P = 0.031) were associated with severe/attempts group, while higher C-reactive protein CRP (OR = 1.3, P = 0.008) was associated with mild/moderate group. CONCLUSION: Lower leptin levels were associated with higher severity of suicidal behaviour in schizophrenia.

Cardiovascular risk remains high in schizophrenia with modest improvements in bipolar disorder during past decade.

OBJECTIVE: While CVD risk has decreased in the general population during the last decade, the situation in patients with schizophrenia (SCZ) and bipolar disorder (BD) is unknown. METHODS: We compared CVD risk factors in patients with SCZ and BD recruited from 2002-2005 (2005 sample, N = 270) with patients recruited from 2006-2017 (2017 sample, N = 1011) from the same catchment area in Norway. The 2017 sample was also compared with healthy controls (N = 922) and the general population (N range = 1285-4587, Statistics Norway) from the same area and period. RESULTS: Patients with SCZ and BD in the 2017 sample had significantly higher level of most CVD risk factors compared to healthy controls and the general population. There was no significant difference in the prevalence of CVD risk factors in SCZ between the 2005 and 2017 samples except a small increase in glucose in the 2017 sample. There were small-to-moderate reductions in hypertension, obesity, total cholesterol, low-density lipoprotein, systolic and diastolic blood pressure in the BD 2017 sample compared to the 2005 sample. CONCLUSION: Despite major advances in health promotion during the past decade, there has been no reduction in the level of CVD risk factors in patients with SCZ and modest improvement in BD.

Canine sterile steroid-responsive lymphadenitis in 49 dogs.

OBJECTIVES: To report clinical and laboratory features, treatment responses and outcome in dogs diagnosed with sterile steroid-responsive lymphadenitis in the United Kingdom. MATERIALS AND METHODS: Medical records of dogs diagnosed with sterile steroid-responsive lymphadenitis from 2009 to 2016 at six specialist referral centres were evaluated retrospectively. RESULTS: The study included 49 dogs. Springer spaniels appeared to be over-represented (16 of 49 dogs). Young dogs (median age: 3 years and 9 months) and females (31 of 49) were frequently affected. Clinical presentation was variable, with pyrexia (39 of 49), lethargy (35 of 49) and anorexia (21 of 49) the most commonly reported clinical signs. Lymph node cytology or histopathology demonstrated neutrophilic, pyogranulomatous, granulomatous or necrotising lymphadenitis without a detectable underlying cause in all cases. Because a sterile immune-mediated aetiology was suspected, all dogs received prednisolone, which was followed by rapid resolution of clinical signs and lymphadenopathy in most cases. CLINICAL SIGNIFICANCE: Sterile steroid-responsive lymphadenitis should be considered in dogs with pyrexia of unknown origin with inflammatory lymphadenopathy if no underlying cause can be found and often responds well to immunosuppressive corticosteroid therapy.

Metabolic risk factors in schizophrenia and bipolar disorder: The effect of comedication with selective serotonin reuptake inhibitors and antipsychotics.

BACKGROUND: The aim of this observational study was to investigate the relationship between metabolic factors and use of selective serotonin reuptake inhibitors (SSRIs) combined with olanzapine, quetiapine or risperidone. METHODS: Data from the Norwegian Thematically Organized Psychosis study, a cross-sectional study on 1301 patients with schizophrenia (n=868) or bipolar disorder (n=433), were analyzed. As exposure variables in the linear regression model were included the dose or serum concentration of SSRIs (n=280) and of olanzapine (n=398), quetiapine (n=234) or risperidone (n=128). The main outcome variables were levels of total cholesterol, low and high density lipoprotein (LDL and HDL) cholesterol, triglycerides and glucose. RESULTS: One defined daily dose (DDD) per day of an SSRI in addition to olanzapine was associated with an increase in total cholesterol of 0.16 (CI 0.01 to 0.32) mmol/L (P=0.042) and an increase in LDL-cholesterol of 0.17 (CI 0.02 to 0.31) mmol/L (P=0.022). An SSRI serum concentration in the middle of the reference interval in addition to quetiapine was associated with an increase in total cholesterol of 0.39 (CI 0.10 to 0.68) mmol/L (P=0.011) and an increase in LDL-cholesterol of 0.29 (0.02 to 0.56) mmol/L (P=0.037). There were no such effects when combined with risperidone. CONCLUSIONS: The findings indicate only minor deteriorations of metabolic variables associated with treatment with an SSRI in addition to olanzapine and quetiapine, and none when combined with risperidone. These results suggest that SSRIs can be used in combination with antipsychotics, and that the possible increase in cardiovascular risk is negligible.

Nitrification by microalgal-bacterial consortia for ammonium removal in flat panel sequencing batch photo-bioreactors.

Ammonium removal from artificial wastewater by microalgal-bacterial consortia in a flat-panel reactor (FPR1) was compared with a microalgae-only flat-panel reactor (FPR2). The microalgal-bacterial consortia removed ammonium at higher rates (100±18mgNH4+-NL-1d-1) than the microalgae (44±16mgNH4+-NL-1d-1), after the system achieved a stable performance at a 2days hydraulic retention time. Nitrifiers present in the microalgae-bacteria consortia increased the ammonium removal: the ammonium removal rate by nitrifiers and by algae in FPR1 was, respectively, 50(±18) and 49(±22)mgNH4+-NL-1d-1. Apparently ammonium removal by algae was not significantly different between FPR1 and FPR2. The activity of the nitrifiers did not negatively affect the nitrogen uptake by algae, but improved the total ammonium removal rate of FPR1.

The PEARL score predicts 90-day readmission or death after hospitalisation for acute exacerbation of COPD.

BACKGROUND: One in three patients hospitalised due to acute exacerbation of COPD (AECOPD) is readmitted within 90 days. No tool has been developed specifically in this population to predict readmission or death. Clinicians are unable to identify patients at particular risk, yet resources to prevent readmission are allocated based on clinical judgement. METHODS: In participating hospitals, consecutive admissions of patients with AECOPD were identified by screening wards and reviewing coding records. A tool to predict 90-day readmission or death without readmission was developed in two hospitals (the derivation cohort) and validated in: (a) the same hospitals at a later timeframe (internal validation cohort) and (b) four further UK hospitals (external validation cohort). Performance was compared with ADO, BODEX, CODEX, DOSE and LACE scores. RESULTS: Of 2417 patients, 936 were readmitted or died within 90 days of discharge. The five independent variables in the final model were: Previous admissions, eMRCD score, Age, Right-sided heart failure and Left-sided heart failure (PEARL). The PEARL score was consistently discriminative and accurate with a c-statistic of 0.73, 0.68 and 0.70 in the derivation, internal validation and external validation cohorts. Higher PEARL scores were associated with a shorter time to readmission. CONCLUSIONS: The PEARL score is a simple tool that can effectively stratify patients' risk of 90-day readmission or death, which could help guide readmission avoidance strategies within the clinical and research setting. It is superior to other scores that have been used in this population. TRIAL REGISTRATION NUMBER: UKCRN ID 14214.

Childhood trauma is associated with increased brain responses to emotionally negative as compared with positive faces in patients with psychotic disorders.

BACKGROUND: Childhood trauma increases risk of a range of mental disorders including psychosis. Whereas the mechanisms are unclear, previous evidence has implicated atypical processing of emotions among the core cognitive models, in particular suggesting altered attentional allocation towards negative stimuli and increased negativity bias. Here, we tested the association between childhood trauma and brain activation during emotional face processing in patients diagnosed with psychosis continuum disorders. In particular, we tested if childhood trauma was associated with the differentiation in brain responses between negative and positive face stimuli. We also tested if trauma was associated with emotional ratings of negative and positive faces. METHOD: We included 101 patients with a Diagnostic and Statistical Manual of Mental Disorders (DSM) schizophrenia spectrum or bipolar spectrum diagnosis. History of childhood trauma was obtained using the Childhood Trauma Questionnaire. Brain activation was measured with functional magnetic resonance imaging during presentation of faces with negative or positive emotional expressions. After the scanner session, patients performed emotional ratings of the same faces. RESULTS: Higher levels of total childhood trauma were associated with stronger differentiation in brain responses to negative compared with positive faces in clusters comprising the right angular gyrus, supramarginal gyrus, middle temporal gyrus and the lateral occipital cortex (Cohen's d = 0.72-0.77). In patients with schizophrenia, childhood trauma was associated with reporting negative faces as more negative, and positive faces as less positive (Cohen's d > 0.8). CONCLUSIONS: Along with the observed negativity bias in the assessment of emotional valence of faces, our data suggest stronger differentiation in brain responses between negative and positive faces with higher levels of trauma.

Validation of the DECAF score to predict hospital mortality in acute exacerbations of COPD.

BACKGROUND: Hospitalisation due to acute exacerbations of COPD (AECOPD) is common, and subsequent mortality high. The DECAF score was derived for accurate prediction of mortality and risk stratification to inform patient care. We aimed to validate the DECAF score, internally and externally, and to compare its performance to other predictive tools. METHODS: The study took place in the two hospitals within the derivation study (internal validation) and in four additional hospitals (external validation) between January 2012 and May 2014. Consecutive admissions were identified by screening admissions and searching coding records. Admission clinical data, including DECAF indices, and mortality were recorded. The prognostic value of DECAF and other scores were assessed by the area under the receiver operator characteristic (AUROC) curve. RESULTS: In the internal and external validation cohorts, 880 and 845 patients were recruited. Mean age was 73.1 (SD 10.3) years, 54.3% were female, and mean (SD) FEV1 45.5 (18.3) per cent predicted. Overall mortality was 7.7%. The DECAF AUROC curve for inhospital mortality was 0.83 (95% CI 0.78 to 0.87) in the internal cohort and 0.82 (95% CI 0.77 to 0.87) in the external cohort, and was superior to other prognostic scores for inhospital or 30-day mortality. CONCLUSIONS: DECAF is a robust predictor of mortality, using indices routinely available on admission. Its generalisability is supported by consistent strong performance; it can identify low-risk patients (DECAF 0-1) potentially suitable for Hospital at Home or early supported discharge services, and high-risk patients (DECAF 3-6) for escalation planning or appropriate early palliation. TRIAL REGISTRATION NUMBER: UKCRN ID 14214.

Reduced heart rate variability in schizophrenia and bipolar disorder compared to healthy controls.

OBJECTIVE: Despite current diagnostic systems distinguishing schizophrenia (SZ) and bipolar disorder (BD) as separate diseases, emerging evidence suggests they share a number of clinical and epidemiological features, such as increased cardiovascular disease (CVD) risk. It is not well understood if poor cardiac autonomic nervous system regulation, which can be indexed non-invasively by the calculation of heart rate variability (HRV), contributes to these common CVD risk factors in both diseases. METHOD: We calculated HRV in 47 patients with SZ, 33 patients with BD and 212 healthy controls. Measures of symptom severity were also collected from the patient groups. RESULTS: Heart rate variability was significantly reduced in both these disorders in comparison with the healthy participants; however, there were no HRV differences between disorders. Importantly, these reductions were independent of the medication, age or body mass index effects. There was also preliminary evidence that patients with reduced HRV had increased overall and negative psychosis symptom severity regardless of SZ or BD diagnosis. CONCLUSION: We suggest that HRV may provide a possible biomarker of CVD risk and symptom severity in severe mental illness. Thus, our results highlight the importance of cardiometabolic screening across SZ and bipolar spectrum disorders.

Twin parenthood: the midwife's role--a randomised controlled trial.

OBJECTIVE: To determine whether a midwife-led intervention improved preparation for twin parenting and maternal psychosocial outcome. DESIGN: Randomised controlled trial. SETTING: Two maternity units in North East England. POPULATION: A cohort of 162 women with uncomplicated twin pregnancy. METHODS: Self-completion questionnaire at multiple time points. MAIN OUTCOME MEASURES: The primary outcome was probable postnatal depression (measured with the Edinburgh Postnatal Depression Scale, EPDS) 26 weeks after delivery. Secondary outcomes included preparation for parenting, maternal anxiety, parenting stress, and maternal wellbeing. RESULTS: The mean maternal EPDS scores at 26 weeks after delivery were 5.4 (SD 4.5) in the twin intervention (TI) group and 6.9 (SD 5.5) in the twin control (TC) group, and the mean difference between the groups was 1.5 (95% confidence interval, 95% CI, -0.2 to 3.3). The relative risk (RR) of having probable depression in the TI group compared with the TC group at 26 weeks was 0.48 (95% CI 0.19-1.20) for mothers and 0.84 (95% CI 0.42-1.70) for fathers. There were no statistically significant differences in maternal anxiety or parenting stress. TI mothers reported increased maternal wellbeing, reaction to motherhood, family support, mood, and greater self-confidence 26 weeks after delivery, and felt more prepared for parenting. CONCLUSION: As a result of the limited sample size, the study was unable to detect a difference in maternal depression using the maternal EPDS mean score. The antenatal preparation for parenting programme did not improve postnatal maternal anxiety or parenting stress; however, it did improve postnatal maternal wellbeing, mood, self-confidence, reaction to motherhood, and better prepared mothers to parent twin infants. Midwives have a key role in preparing mothers to parent twins.

Photo-oxygenation to support nitrification in an algal-bacterial consortium treating artificial wastewater.

Oxygenation by photosynthesis in a mixed culture of algae and nitrifiers was investigated for its potential to support nitrification. An open photo-bioreactor (1L fermentor; 30°C) was inoculated with an enriched culture of nitrifiers obtained from activated sludge and a pure culture of Scenedesmus sp. The reactor was illuminated (60 µmol/m2 s) and operated as a sequencing batch reactor with 50% discharge per cycle and sludge retention time of 15 or 30 days. Full nitrification of synthetic wastewater (50 mgNH4+-N/L) without mechanical aeration was achieved after less than 14 cycles (18.5 h React per 24h cycle) and the biomass steadily increased until a concentration of 1.9 g VSS/L with 29 mg chl-a/L. The maximum observed nitrification rate was 7.7 mgNH4+-N/Lh. A mass balance showed that ammonium removal was primarily by nitrification (81-85%) rather than by ammonium uptake by algae.

Urinary fluoride excretion in 6- to 7-year-olds ingesting milk containing 0.5 or 0.9 mg fluoride.

Effectiveness of 0.5 mg fluoride (F) milk ingestion in preventing caries has been termed only 'moderate'. In this 3-arm partial cross-over intervention, 32 children aged 6-7 years in a non-F area were recruited and urinary F excretion (UFE) measured before and after ingestion of 0.5 or 0.9 mg F milk. Maintaining customary dietary and oral hygiene habits, children underwent a 2-week 'wash-in' with non-F milk, providing a 24-hour urine sample on day 4 of non-F (baseline) and F milk ingestion containing either (i) 0.5 mg or (ii) 0.9 mg F (intervention). A comparative group of thirteen 6- to 7-year-olds living in fluoridated areas provided a 24-hour urine sample on day 4 of daily non-F milk ingestion, following a 2-week non-F milk wash-in. Valid urine samples were analysed for F and UFE estimated from corrected 24-hour urine volume and F concentration. For the 24 test children providing 2 valid urine samples, mean (95% CI) change in corrected 24-hour UFE was 0.130 (0.049, 0.211) and 0.153 (0.062, 0.245) mg/day for 0.5 mg (p < 0.007) and 0.9 mg F (p < 0.001) groups, respectively. Post-intervention, mean (SD) corrected 24-hour UFE was 0.437 (0.153) mg/day and 0.420 (0.188) mg/day for the 0.5 and 0.9 mg F groups, respectively, which were lower than the WHO provisional standards (0.48-0.60 mg F/day). F milk consumption significantly increased UFE; however, the F content of 0.5 and 0.9 mg F milk may be too low to achieve WHO provisional UFE standards concomitant with optimal F exposure in children aged ≥6 years.

Application of Quantitative Microbial Risk Assessment to analyze the public health risk from poor drinking water quality in a low income area in Accra, Ghana.

In Accra, Ghana, a majority of inhabitants lives in over-crowded areas with limited access to piped water supply, which is often also intermittent. This study assessed in a densely populated area the risk from microbial contamination of various sources of drinking water, by conducting a Quantitative Microbiological Risk Assessment (QMRA) to estimate the risk to human health from microorganism exposure and dose-response relationships. Furthermore the cost-effectiveness in reducing the disease burden through targeted interventions was evaluated. Five risk pathways for drinking water were identified through a survey (110 families), namely household storage, private yard taps, communal taps, communal wells and water sachets. Samples from each source were analyzed for Escherichia coli and Ascaris contamination. Published ratios between E. coli and other pathogens were used for the QMRA and disease burden calculations. The major part of the burden of disease originated from E. coli O157:H7 (78%) and the least important contributor was Cryptosporidium (0.01%). Other pathogens contributed 16% (Campylobacter), 5% (Rotavirus) and 0.3% (Ascaris). The sum of the disease burden of these pathogens was 0.5 DALYs per person per year, which is much higher than the WHO reference level. The major contamination pathway was found to be household storage. Disinfection of water at household level was the most cost-effective intervention (<5 USD/DALY-averted) together with hygiene education. Water supply network improvements were significantly less cost-effective.

Rectal lymphoma in 11 dogs: a retrospective study.

OBJECTIVES: To retrospectively evaluate the clinical behaviour and immunophenotype of lymphoma of the rectum in dogs. METHODS: Eleven dogs diagnosed with lymphoma of the rectum on histopathology were retrospectively reviewed. Immunohistochemistry with CD3 and CD79a antibodies was performed at diagnosis or retrospectively. RESULTS: Treatment protocol varied with six dogs undergoing surgery and adjuvant chemotherapy, two received chemotherapy after only incisional biopsy, one had surgical resection only, one was treated symptomatically and one dog was not treated. Chemotherapy treatment consisted of either a -low-dose COP (cyclophosphamide - prednisolone - vincristine) protocol (four dogs) or a six-week CHOP-based (cyclophosphamide - vincristine - -prednisolone - anthracycline) protocol (four dogs). Dogs that received chemotherapy lived significantly longer than dogs that did not receive chemotherapy (2352 versus 70 days). Median survival time was not reached, and there was an overall mean survival time of 1697 days. Immunohistochemistry was performed in 10 of 11 samples, and was consistent with B-cell -lymphoma in all cases. CLINICAL SIGNIFICANCE: Canine lymphoma of the rectum is associated with a favourable prognosis. Immunohistochemical evaluation of these lesions was consistent with B-cell lymphoma in all cases in which it was examined.

Radiotherapy in the management of localized mucocutaneous oral lymphoma in dogs: 14 cases.

Oral mucocutaneous lymphoma is rare in dogs. Surgery and chemotherapy do not usually provide effective long-term control. The objective of this study was to retrospectively evaluate survival of dogs with localized oral lymphoma treated with radiation therapy. The medical database of three institutions was searched for dogs with diagnosis of oral lymphoma treated with radiotherapy. Dogs with evidence of systemic disease were excluded. Survival was calculated with the Kaplan-Meier method and prognostic variables analysed with log-rank test. Fourteen dogs were included in the study. Mean survival was 1129 days [95% confidence interval (CI) 711-1546] with median survival of 770 days. The overall response of radiotherapy was 67% (five complete and three partial responses). A survival advantage was seen in dogs with no evidence of lymph node metastasis (P = 0.002) and that achieved a complete response to radiation therapy (P = 0.013). Radiation therapy was a well-tolerated and effective treatment for localized oral lymphoma.

Prevalence of asthma and bronchial hyperreactivity in Danish schoolchildren: no change over 10 years.

AIM: To describe the point prevalence of current physician-diagnosed asthma and bronchial hyperreactivity (BHR) in 2001 among unselected Danish schoolchildren aged 6-17 years, compared with the prevalence from a similar study from 1990 to 1991. METHODS: Cross-sectional study using parental questionnaire on asthma and respiratory symptoms combined with a 6-min free running test with peak expiratory flow rate (PEFR) measurement (n = 1051, response rate 89.3%). Results were compared with those of a similar study in the same area from 1990 to 1991. Main outcome measures were current physician-diagnosed asthma or BHR in children without physician-diagnosed asthma measured by either a decrease in lung function after standardized running test and/or variability in PEFR on home monitoring. RESULTS: The prevalence of current physician-diagnosed asthma was 4.0% [95% confidence interval (CI) 2.7-5.3%] in 1990-1991 and 3.6% (95% CI 2.4-4.8%) in 2001. The prevalence of BHR was 3.2% (95% CI 2.0-4.4%) in 1990-1991 and 2.0% (95% CI 1.1-2.9%) in 2001. The combined prevalence was 7.2% (95% CI 5.4-8.9%) in 1990-1991 and 5.6% (95% CI 4.2-7.1%) in 2001. CONCLUSION: The point prevalence of current physician-diagnosed asthma and BHR among unselected Danish schoolchildren aged 6-17 years was unchanged over 10 years between 1990-1991 and 2001.

Non-voice-related throat symptoms: comparative analysis of laryngopharyngeal reflux and globus pharyngeus scales.

BACKGROUND: This study calculated the comparability of two throat symptom assessment scales devised to evaluate either laryngopharyngeal reflux or globus. SETTING: United Kingdom hospital out-patient departments. METHOD: A total of 334 subjects, with and without throat symptoms, completed the Reflux Symptom Index and/or the Glasgow and Edinburgh Throat Scale. The following were calculated for the resultant data: Cronbach's α coefficient, principal component analysis, Kaiser normalisation, varimax and oblimin rotation, and eigenvalues. RESULTS: Analysis of data from the Reflux Symptom Index and the Glasgow and Edinburgh Throat Scale revealed clearly similar symptom domains regarding (1) coughing and blockage, and (2) globus or postnasal drip or throat-clearing, as did combined analysis of their amalgamated items. Both instruments had good overall internal consistency (α = 0.75 and 0.81, respectively). The 'heartburn or reflux' item in the Reflux Symptom Index mapped poorly to each underlying factor. DISCUSSION: The most commonly used laryngopharyngeal reflux and globus assessment questionnaires appear to detect very similar symptom clusters. The management of throat disorders may previously have been over-reliant on the presenting pattern of throat symptoms. Our findings indicate a need to revisit the traditional clinical classification of throat symptoms.

Nitrogen mass balances for pilot-scale biofilm stabilization ponds under tropical conditions.

Nitrogen removal in biofilm waste stabilization ponds were modeled using nitrogen mass balance equations. Four pilot-scale biofilm maturation ponds were constructed in Uganda. Pond 1 was control; the others had 15 baffles in each of them. Two loading conditions were investigated (period 1, 18.2g and period 2, 26.8 g NH(4)-Nd(-1)). Total nitrogen and TKN mass balances were made. Bulk water and biofilm nitrification rates were determined and used in the TKN mass balance. Results for total nitrogen mass balance showed that for both periods, denitrification was the major removal mechanism. Nitrogen uptake by algae was more important during period 1 than in period 2. The TKN mass balance predicted well effluent TKN for period 2 than period 1. This could be due to fluctuations in algae density and ammonia uptake during period 1, no conclusions on reliability of mass balance model in period 1 was made.

Randomised cross-over study of oral appliances for snoring.

OBJECTIVES: To compare a mandibular advancement splint to a control bite raising appliance in the treatment of snoring with or without mild obstructive sleep apnoea syndrome. DESIGN: A prospective two-treatment randomised cross-over clinical trial. SETTING: Single centre secondary care Dental Hospital. PARTICIPANTS: Fifty-two subjects (36 men, 16 women) diagnosed with non-apnoeic snoring or mild obstructive sleep apnoea syndrome (apnoea/hypopnoea index < or =15 events/h), were recruited from Departments of Respiratory Medicine and ENT surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust. MAIN OUTCOME MEASURES: The Snoring Symptoms Inventory questionnaire (SSI) and the Epworth Sleepiness Score (ESS) were used to evaluate changes in symptoms. Patient reported outcomes (compliance, adverse events, splint preference) were recorded by questionnaire. Subjects attended for five study visits and used a mandibular advancement splint and a bite raising appliance at home each for 4 weeks, with a 3-week washout period between devices. RESULTS AND CONCLUSIONS: Thirty-eight subjects completed the study. Both the mandibular advancement splint and bite raising appliance significantly reduced the SSI compared to the baseline scores: mandibular advancement splint 5.5, P = 0.013; bite raising appliance 3.1, P = 0.005. No statistically significant difference between the two treatment periods was detected (P > 0.05). The reduction in the Epworth Sleepiness Score was: mandibular advancement splint 1.0, P = 0.02; bite raising appliance 0.3, P = 0.4. The change in the Epworth Sleepiness Score was not statistically significantly different between the mandibular advancement splint and bite raising appliance treatment periods (P > 0.05). CONCLUSIONS: In this cohort of patients diagnosed with snoring +/- mild OSA: 1 both the mandibular advancement splint and bite raising appliance designs of splint appeared to reduce the symptoms of snoring; 2 no difference in the magnitude of this effect was detected in favour of one design of splint.