EQ-5D-5L Population Norms and Quality-Adjusted Life Expectancy by Sociodemographic Characteristics and Modifiable Risk Factors for Adults in Queensland, Australia.

OBJECTIVES: Over half of Australia's disease burden is due to morbidity, predominantly chronic conditions. Health-related quality of life instruments provide measures of morbidity and health status across different dimensions with EQ-5D being one of the most widely used. This study reports EQ-5D-5L general population norms for Queensland, Australia using the recently published Australian value set. METHODS: Population survey results from cross-sectional computer-assisted telephone interviews for Queensland adults in 2022 and 2023 were analyzed. EQ-5D-5L, as well as modifiable risk factors and sociodemographic data were collected. Using the recently published final Australian EQ-5D-5L value set, mean utility scores were calculated for Queensland, as well as by sociodemographic characteristics, including remoteness and socioeconomic area-based measures, and modifiable risk factors, such as smoking and body mass index. Results were combined with life tables to estimate quality-adjusted life expectancy (QALE) for subgroups with different lifestyles. RESULTS: The EQ-5D utility score for the Queensland adult population was 0.916. Smoking daily, being obese or older in age, or living in the most disadvantaged socioeconomic area were associated with lower mean scores. QALE was 6.1 and 7.9 years shorter than the life expectancy for Queensland males and females, respectively, but generally, those who reported having healthier lifestyles had higher mean utility scores and thus longer QALE. CONCLUSIONS: In addition to reporting Queensland EQ-5D-5L general population norms, these results demonstrate potential QALE gains in people following healthier lifestyles. The results support investment in prevention and may motivate further studies in this important area.

Identification of patients with nonischemic dilated cardiomyopathy at risk of malignant ventricular arrhythmias: insights from cardiac magnetic resonance feature tracking.

BACKGROUND: Patients with nonischemic dilated cardiomyopathy (NIDCM) are prone to arrhythmias, and the cause of mortality in these patients is either end-organ dysfunction due to pump failure or malignant arrhythmia-related death. However, the identification of patients with NIDCM at risk of malignant ventricular arrhythmias (VAs) is challenging in clinical practice. The aim of this study was to evaluate whether cardiovascular magnetic resonance feature tracking (CMR-FT) could help in the identification of patients with NIDCM at risk of malignant VAs. METHODS: A total of 263 NIDCM patients who underwent CMR, 24-hour Holter electrocardiography (ECG) and inpatient ECG were retrospectively evaluated. The patients with NIDCM were allocated to two subgroups: NIDCM with VAs and NIDCM without VAs. From CMR-FT, the global peak radial strain (GPRS), global longitudinal strain (GPLS), and global peak circumferential strain (GPCS) were calculated from the left ventricle (LV) model. We investigated the possible predictors of NIDCM combined with VAs by univariate and multivariate logistic regression analyses. RESULTS: The percent LGE (15.51 ± 3.30 vs. 9.62 ± 2.18, P < 0.001) was higher in NIDCM patients with VAs than in NIDCM patients without VAs. Furthermore, the NIDCM patients complicated with VAs had significantly lower GPCS than the NIDCM patients without VAs (- 5.38 (- 7.50, - 4.22) vs.-9.22 (- 10.73, - 8.19), P < 0.01). Subgroup analysis based on LGE negativity showed that NIDCM patients complicated with VAs had significantly lower GPRS, GPCS, and GPLS than NIDCM patients without VAs (P < 0.05 for all). Multivariate analysis showed that both GPCS and %LGE were independent predictors of NIDCM combined with VAs. CONCLUSIONS: CMR global strain can be used to identify NIDCM patients complicated with VAs early, specifically when LGE is not present. GPCS < - 13.19% and %LGE > 10.37% are independent predictors of NIDCM combined with VAs.

Protocol for a process evaluation of a stepped wedge randomised controlled trial to reduce unnecessary hospitalisations of older people from residential aged care: the EDDIE+ study.

INTRODUCTION: The Early Detection of Deterioration in Elderly residents (EDDIE+) programme is a theory-informed, multi-component intervention aimed at upskilling and empowering nursing and personal care staff to identify and manage early signs of deterioration in residents of aged care facilities. The intervention aims to reduce unnecessary hospital admissions from residential aged care (RAC) homes. Alongside a stepped wedge randomised controlled trial, an embedded process evaluation will be conducted to assess the fidelity, acceptability, mechanisms of action and contextual barriers and enablers of the EDDIE+ intervention. METHODS AND ANALYSIS: Twelve RAC homes in Queensland, Australia are participating in the study. A comprehensive mixed-methods process evaluation, informed by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, will assess intervention fidelity, contextual barriers and enablers, mechanisms of action, and the acceptability of the programme from various stakeholder perspectives. Quantitative data will be collected prospectively from project documentation, including baseline context mapping of participating sites, activity tracking and regular check-in communication sheets. Qualitative data will be collected postintervention via semi-structured interviews with a range of stakeholder groups. The i-PARIHS constructs of innovation, recipients, context and facilitation will be applied to frame the analysis of quantitative and qualitative data. ETHICS AND DISSEMINATION: Ethical approval for this study has been granted by the Bolton Clarke Human Research Ethics Committee (approval number: 170031) with administrative ethical approval granted by the Queensland University of Technology University Human Research Ethics Committee (2000000618). Full ethical approval includes a waiver of consent for access to residents' demographic, clinical and health services de-identified data. A separate health services data linkage based on RAC home addresses will be sought through a Public Health Act application. Study findings will be disseminated through multiple channels, including journal publications, conference presentations and interactive webinars with a stakeholder network. TRIAL REGISTRATION NUMBER: Australia New Zealand Clinical Trial Registry (ACTRN12620000507987).

Negative Differential Friction Predicted in 2D Ferroelectric In2 Se3 Commensurate Contacts.

At the macroscopic scale, the friction force (f) is found to increase with the normal load (N), according to the classic law of Da Vinci-Amontons, namely, f = µN, with a positive definite friction coefficient (µ). Here, first-principles calculations are employed to predict that, the static force f, measured by the corrugation in the sliding potential energy barrier, is lowered upon increasing the normal load applied on one layer of the recently discovered ferroelectric In2 Se3 over another commensurate layer of In2 Se3 . That is, a negative differential friction coefficient µ can be realized, which thus simultaneously breaking the classic Da Vinci-Amontons law. Such a striking and counterintuitive observation can be rationalized by the delicate interplay of the interfacial van der Waals repulsive interactions and the electrostatic energy reduction due to the enhancement of the intralayer SeIn ionic bonding via charge redistribution under load. The present findings are expected to play an instrumental role in design of high-performance solid lubricants and mechanical-electronic nanodevices.

Treatment and prognostic factors of pituicytoma: a single-center experience and comprehensive literature review.

PURPOSE: Preoperative diagnosis of pituicytomas is difficult, and management and prognostic factors remain ambiguous. The purpose of this study was to elucidate the radiological characteristics of pituicytoma, to assess the risk factors affecting tumor progression, and to propose the optimal treatment regimen based on comprehensive analysis. METHODS: We reviewed the clinical data of 22 patients with pituicytoma confirmed pathologically in our institution. In addition, 93 cases of pituicytoma in the previous literature were recruited. The individual data of 115 patients were analyzed to evaluate the adverse factors affecting pituicytoma progression. RESULTS: In the combined cohort, 3 of 61 patients who underwent gross-total resection (GTR) developed recurrence (4.9%); of the 54 patients who received non-GTR, 19 progressed (35.2%). Univariate and multivariate Cox regression analysis verified male gender (HR 2.855, 95% CI 1.008-8.089; p = 0.048), TS (transsphenoidal surgery; HR 3.559, 95% CI 1.015-12.476; p = 0.047), and non-GTR (HR 4.388, 95%CI 1.240-15.521; p = 0.022) were independent unfavorable factors for pituicytoma progression. A multivariate logistic regression model verified that tumor diameter ≥ 1.85 cm (OR 4.859, 95% CI 1.335-17.691; p = 0.016) was independent adverse factors for GTR. Compared with TS, OT (open transcranial) is more likely to have postoperative complications (OR 3.185, 95% CI 1.020-9.944; p = 0.046), especially vision deterioration (OR 37.267, 95% CI 4.486-309.595; p = 0.001). CONCLUSION: Based on our findings, GTR was advocated as an optimal treatment for pituicytomas. However, in order to avoid damage to important structures, partial resection is acceptable. After that, adjuvant radiotherapy is recommended for male patients with high Ki-67 index, and the remaining patients can be followed up closely. When the tumor recurs or progresses, it is recommended to re-operate and remove the lesion completely as far as possible. If GTR is still not possible, postoperative radiotherapy for the residual tumor is recommended.

Comprehensive multiomics analysis of the effect of ginsenoside Rb1 on hyperlipidemia.

We analyzed the effects of ginsenoside Rb1 on hyperlipidemic in model mice. Using stool, plasma and hepatic tissue samples, we observed that the genera Blautia and Allobaculum were increased and Turicibacter was decrease in Rb1-treated mice as compared to untreated model mice. Ether lipid metabolism, glycerolipid metabolism, and glyoxylate and dicarboxylate metabolism were differentially enriched between the Rb1 and model groups. Lipidomics revealed 169 metabolites differentially expressed between the model and Rb1 groups in a positive ion model and 58 in a negative ion model. These metabolites mainly participate in glycerophospholipid, linoleic acid, and alpha-linolenic acid metabolism. The main metabolites enriched in these three pathways were phosphatidylcholine, diacylglycerol and ceramide, respectively. In a transcriptome analysis, 766 transcripts were differentially expressed between the Rb1 and model groups. KEGG analysis revealed lysine degradation, inositol phosphate metabolism, and glycerophospholipid metabolism to be the main enriched pathways. Multiomics analysis revealed glycerophospholipid metabolism to be a common pathway and phosphatidylcholine the main metabolite differentially enriched between the Rb1 and model groups. Results from fecal transplanted germ-free mice suggest that to suppress hyperlipidemia, Rb1 regulates gut microbiota by regulating the synthesis and decomposition of phosphatidylcholine in glycerophospholipid metabolism, which in turn decreases serum total cholesterol.

Strain induced spin-splitting and half-metallicity in antiferromagnetic bilayer silicene under bending.

Searching for half-metals in low dimensional materials is not only of scientific importance, but also has important implications for the realization of spintronic devices on a small scale. In this work, we show theoretically that simple bending can induce spin-splitting in bilayer silicene. For bilayer silicene with Bernal stacking, the monolayer has a long range ferromagnetic spin order and between the two monolayers, the spin orders are opposite, giving rise to an antiferromagnetic configuration for the ground state of the bilayer silicene. Under bending, the antiferromagnetic spin order is retained but the energetic degeneracy of opposite spin states is lifted. Due to the unusual deformation potentials of the conduction band minimum (CBM) and valence band maximum (VBM) as revealed by density-functional theory calculations and density-functional tight-binding calculations, this spin-splitting is nearly proportional to the degree of bending deformation. Consequently, the spin-splitting can be significant and the desired half-metallic state may emerge when the bending increases, which has been verified by direct simulation of the bent bilayer silicene using the generalized Bloch theorem. Our results hint that bilayer silicene may be an excellent candidate for half-metallicity.

Formation of Bloch Flat Bands in Polar Twisted Bilayers without Magic Angles.

The existence of Bloch flat bands of electrons provides a facile pathway to obtain exotic quantum phases owing to strong correlation. Despite the established magic angle mechanism for twisted bilayer graphene, understanding of the emergence of flat bands in twisted bilayers of two-dimensional polar crystals remains elusive. Here, we show that due to the polarity between constituent elements in the monolayer, the formation of complete flat bands in twisted bilayers is triggered as long as the twist angle is less than a certain critical value. Using the twisted bilayer of hexagonal boron nitride (hBN) as an example, our simulations using the density-functional tight-binding method reveal that the flat band originates from the stacking-induced decoupling of the highest occupied (lowest unoccupied) states, which predominantly reside in the regions of the moiré superlattice where the anion (cation) atoms in both layers are overlaid. Our findings have important implications for the future search for and study of flat bands in polar materials.

Unconventional deformation potential and half-metallicity in zigzag nanoribbons of 2D-Xenes.

Realization of half-metallicity (HM) in low dimensional materials is a fundamental challenge for nano spintronics and a critical component for developing alternative generations of information technology. Using first-principles calculations, we reveal an unconventional deformation potential for zigzag nanoribbons (NRs) of 2D-Xenes. Both the conduction band minimum (CBM) and valence band maximum (VBM) of the edge states have negative deformation potentials. This unique property, combined with the localization and spin-polarization of the edge states, enables us to induce spin-splitting and HM using an inhomogeneous strain pattern, such as simple in-plane bending. Indeed, our calculation using the generalized Bloch theorem reveals the predicted HM in bent zigzag silicene NRs. Furthermore, the magnetic stability of the long range magnetic order for the spin-polarized edge states is maintained well against the bending deformation. These aspects indicate that it is a promising approach to realize HM in low dimensions with the zigzag 2D-Xene NRs.

Factors associated with non-beneficial treatments in end of life hospital admissions: a multicentre retrospective cohort study in Australia.

OBJECTIVE: To quantitatively assess the factors associated with non-beneficial treatments (NBTs) in hospital admissions at the end of life. DESIGN: Retrospective multicentre cohort study. SETTING: Three large, metropolitan tertiary hospitals in Australia. PARTICIPANTS: 831 adult patients who died as inpatients following admission to the study hospitals over a 6-month period in 2012. MAIN OUTCOME MEASURES: Odds ratios (ORs) of NBT derived from logistic regression models. RESULTS: Overall, 103 (12.4%) admissions involved NBTs. Admissions that involved conflict within a patient's family (OR 8.9, 95% CI 4.1 to 18.9) or conflict within the medical team (OR 6.5, 95% CI 2.4 to 17.8) had the strongest associations with NBTs in the all subsets regression model. A positive association was observed in older patients, with each 10-year increment in age increasing the likelihood of NBT by approximately 50% (OR 1.5, 95% CI 1.2 to 1.9). There was also a statistically significant hospital effect. CONCLUSIONS: This paper presents the first statistical modelling results to assess the factors associated with NBT in hospital, beyond an intensive care setting. Our findings highlight potential areas for intervention to reduce the likelihood of NBTs.

Twist-driven separation of p-type and n-type dopants in single-crystalline nanowires.

The distribution of dopants significantly influences the properties of semiconductors, yet effective modulation and separation of p-type and n-type dopants in homogeneous materials remain challenging, especially for nanostructures. Employing a bond orbital model with supportive atomistic simulations, we show that axial twisting can substantially modulate the radial distribution of dopants in Si nanowires (NWs) such that dopants of smaller sizes than the host atom prefer atomic sites near the NW core, while dopants of larger sizes are prone to staying adjacent to the NW surface. We attribute such distinct behaviors to the twist-induced inhomogeneous shear strain in NW. With this, our investigation on codoping pairs further reveals that with proper choices of codoping pairs, e.g. B and Sb, n-type and p-type dopants can be well separated along the NW radial dimension. Our findings suggest that twisting may lead to realizations of p-n junction configuration and modulation doping in single-crystalline NWs.

Review of methods and study designs of evaluations related to clinical pathways.

Objective The HealthPathways program is an online information portal that helps clinicians provide consistent and integrated patient care within a local health system through localised pathways for diagnosis, treatment and management of various health conditions. These pathways are consistent with the definition of clinical pathways. Evaluations of HealthPathways programs have thus far focused primarily on website utilisation and clinical users' experience and satisfaction, with limited evidence on changes to patient outcomes. This lack motivated a literature review of the effects of clinical pathways on patient and economic outcomes to inform a subsequent HealthPathways evaluation. Methods A systematic review was performed to summarise the analytical methods, study designs and results of studies evaluating clinical pathways with an economic outcome component published between 1 January 2000 and 31 August 2017 in four academic literature databases. Results Fifty-five relevant articles were identified for inclusion in this review. The practical pre-post study design with retrospective baseline data extraction and prospective intervention data collection was most commonly used in the evaluations identified. Straightforward statistical methods for comparing outcomes, such as the t-test or χ2 test, were frequently used. Only four of the 55 articles performed a cost-effectiveness analysis. Clinical pathways were generally associated with improved patient outcomes and positive economic outcomes in hospital settings. Conclusions Clinical pathways evaluations commonly use pragmatic study designs, straightforward statistical tests and cost-consequence analyses. More HealthPathways program evaluations focused on patient and economic outcomes, clinical pathway evaluations in a primary care setting and cost-effectiveness analyses of clinical pathways are needed. What is known about the topic? HealthPathways is a web-based program that originated from Canterbury, New Zealand, and has seen uptake elsewhere in New Zealand, Australia and the UK. The HealthPathways program aims to assist the provision of consistent and integrated health services through dedicated, localised pathways for various health conditions specific to the health region. Evaluations of HealthPathways program focused on patient and economic outcomes have been limited. What does this paper add? This review synthesises the academic literature of clinical pathways evaluations in order to inform a subsequent HealthPathways evaluation. The focus of the synthesis was on the analytical methods and study designs used in the previous evaluations. The previous clinical pathway evaluations have been pragmatic in nature with relatively straightforward study designs and analysis. What are the implications for practitioners? There is a need for more economic and patient outcome evaluations for HealthPathways programs. More sophisticated statistical analyses and economic evaluations could add value to these evaluations, where appropriate and taking into consideration the data limitations.

Left ventricle primary cardiac fibroma in an adult: A case report.

There is a very low prevalence of cardiac fibroma in the adult population. Cardiac fibromas arise from heart fibroblasts, and these tumors are primarily located in the ventricles or in the interventricular septum. Symptomatic tumors are treated by resection. By contrast, asymptomatic tumors require a long-term follow-up or surgical resection as a preventive measure to avoid complications. The present study reports the case of a 43-year-old man, who presented with a cough and shortness of breath for 2 months. Echocardiogram and cardiac magnetic resonance imaging indicated a large mass located in the left ventricular lateral wall. The patient underwent surgical excision of the tumor, and histopathological examination confirmed the mass to be a fibroma. The patient had a good postoperative recovery and was discharged on day 9 post-surgery.

[Predicting Histological Grade of HCC in Rats using Intravoxel Incoherent Motion Imaging].

OBJECTIVE: To predict histological grade of hepatocellular carcinoma (HCC) in Wistar rats using intravoxel incoherent motion imaging (IVIM) with magnetic resonance imaging (MRI). METHODS: Liver lesions of HCC rat models induced by oral diethylnitrosamine (DEN) were scanned by IVIM to obtain apparent diffusion coefficient (ADC) and IVIM parameters,including true diffusion coefficient (D),pseudodiffusion coefficient (D*) and perfusion fraction (f). These HCC lesions were confirmed by Hematoxylin-Eosin (HE) stain and pathologically graded into low (grade Ⅰ+Ⅱ) and high (grade Ⅲ+Ⅳ) using the Edmondson-Steiner method. The ADC and IVIM parameters of the two grade groups were compared: their diagnostic performance were assessed using ROC curves. RESULTS: HCC models were successfully established in 48 rats,containing 50 HCC lesions (28 low-grade and 22 high-grade). The high-grade lesions had lower ADC (P=0.009) and D (P=0.005) values and higher D* (P=0.032) and f (P=0.044) values compared with the low-grade lesions. The largest jonden index appeared in the ROC curves at 0.907 8×10-3 mm2/s of ADC,0.817 6×10-3 mm2/s of D,24.31×10-3 mm2/s of D*,and 14.4% of f,respectively. The area under curves (AUCs) of these parameters ranged from 0.5 to 0.9,showing no significant differences (P>0.05). CONCLUSION: ADC and IVIM parameters have equal and moderate diagnostic values in predicting histologic grade of HCCs, which can be used for estimating pathological grading of HCCs before surgery.

Effects of water exchange rate on morphological and physiological characteristics of two submerged macrophytes from Erhai Lake.

Growth patterns of aquatic macrophytes have been shown to vary in response to hydrological properties; however, such properties are typically characterized by water level fluctuation, flow velocity, flooding season, and sedimentation, but not by water exchange rate (WER). Herein, we experimentally investigated how WER (three levels: exchange 0%, 20%, and 40% of total water per day) affects water and sediment properties, and the consequences that these variations have on the individual responses of two submerged macrophytes, Hydrilla verticillata and Myriophyllum aquaticum which were planted in two different sediment types (sand and clay). In the experiment without ramets, it was found that turbidity, pH value, and dissolved carbon dioxide concentration of the system water were statistically unaffected by WER, while water dissolved oxygen (DO) concentration and sediment oxidation-reduction potential (ORP, in both sediments) consistently increased with increasing WER, regardless of experimental time. In the experiment containing ramets, biomass accumulation and relative growth rate (RGR) of both species gradually increased with increasing WER regardless of sediment type. The mechanisms were related to (a) increased oxygen availability, as indicated by gradually increased water DO concentration and sediment ORP; and (b) enhanced phosphorus (P) and nitrogen (N) absorbing abilities associated with stimulated root growth, reflected in increased mean root length, specific root length, and the root/above-ground biomass ratio, with increasing WER. Additionally, in the experiments containing ramets, significant linear relationships were consistently detected between sediment ORP and root parameters, root parameters and plant nutrients (N and P), and plant nutrients and plant growth conditions (biomass accumulation and RGR). These results demonstrate that WER plays an important role in determining oxygen availability and thus impacts the growth of submerged macrophytes by altering the ability of roots to absorb nutrients, indicating that ecosystem functions are more sensitive to WER than previously recognized.

MicroRNA-146a promotes IgE class switch in B cells via upregulating 14-3-3σ expression.

B cells play a critical role in immune responses both in physiological and pathological conditions, and microRNAs have been shown to play important roles in regulating B cell proliferation and function. MiR-146a has been shown to modulate T cell immunity, but its function in regulating B cell response remains partially understood. Our previous studies indicated that germinal center (GC) B cells are significantly expanded in miR-146a-overexpressing (TG) mice. In this study, we further characterized the roles of miR-146a in regulating humoral immune responses to specific antigens. We found that the production of IgE antibody were significantly elevated in TG mice, while the antibody affinity maturation of IgM and IgG were similar between TG mice and the normal controls. We further found higher IgE antibody levels in TG B cell culture supernatant than that in normal controls. A global protein expression comparison of B cells from TG mice and the normal controls through TMT proteomic assay showed that 14-3-3σ, a key factor of immunoglobulin class switch DNA recombination (CSR) in B cells, was highly up-regulated in B cells with overexpression of miR-146a, while Smad4, the target of miR-146a, was decreased. Using an asthma model induced by OVA immunization, we further confirmed the increased level of OVA specific IgE antibodies in TG mice. These results demonstrate that miR-146a enhances class switch and secretion of IgE in B cells by upregulating 14-3-3σ expression, and suggest that miR-146a may be a potential target for asthma therapy.

Expression of HIF-1α and P-gp in non-small cell lung cancer and the relationship with HPV infection.

The aim of the study was to study the expression of hypoxia-inducible factor-1α (HIF-1α) and P-glycoprotein (P-gp) and analyze its correlation with human papillomavirus (HPV) infection. From January, 2012 to May, 2014, 72 cases of non-small cell lung cancer (NSCLC) pathologic tissue samples were selected from the study group. Fifty-four lung benign lesions were selected to serve as the control group. HIF-1α and P-gp expression levels were detected using immunohistochemistry. PCR was used to detect the expression of HPV genome employing specific primers for HPV 16 and 18 types. The results showed that there was 47.2 and 63.9% positive HIF-1α and P-gp expression in the study group. No P-gp or HIF-1α expression was detected in the control group. The results established a positive correlation between the expression of HIF-1α and P-gp. In the study group, the expression and differentiation degree of HIF-1α was related to lymphatic metastasis. The HIF-1α expression in the well-differentiated samples was lower than that in the moderate or poorly differentiated samples. HIF-1α expression in patients with lymphatic metastasis was higher than in patients without metastasis. The expression rate of P-gp in adenocarcinoma was higher than that in squamous carcinoma. The detection rate of HPV DNA was 45.83 and 3.70% in the study and control groups, respectively. The HPV infection and differentiation degree had relevance to lymphatic metastasis in the study group. The HPV DNA detection rate in the well-differentiated samples was lower than that in the moderate or poorly differentiated samples. The HPV DNA detection rate in patients with lymphatic metastasis was higher than that in patients with no lymphatic metastasis. There was a close link between HIF-1α, P-gp expression and NSCLC occurrence, and the development of multidrug resistance. In conclusion, the detection of HIF-1α and P-gp expression can effectively predict drug resistance during chemotherapy in NSCLC, and these proteins can be used in drug prognosis.

Tumour markers in rheumatoid arthritis-associated interstitial lung disease.

OBJECTIVES: Interstitial lung disease (ILD) is the most common pulmonary extra-articular manifestations of rheumatoid arthritis (RA), but the pathogenesis of RA-ILD is unknown. The purpose of this study was to investigate the tumour markers levels in patients of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) and to explore the diagnostic value of serum tumour markers for RA-ILD. METHODS: Twenty-eight patients with RA-ILD and 83 patients with RA only were included. Serum levels of tumour markers carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 15-3, CA125, and CA19-9 were measured. RESULTS: Tumour markers CA15-3, CA125 and CA19-9 were increased in RA-ILD patients compared with RA without ILD patients. Logistic regression analysis revealed that older age (OR=1.06, 95% CI=[1.02-1.11]) and higher CA125 (OR=1.03, 95% CI=[1.01-1.05]) related to the increased risk of RA-ILD. ROC curve analysis showed the relationship between CA125 and RA-ILD was moderate (area under ROC curve (AUC)=0.78, 95% CI=[0.68-0.88]). In addition, CA125 levels above the normal reference (<35 U/ml) raised the risk of RA-ILD (OR=6.00, 95% CI=[2.37-15.16]). CONCLUSIONS: RA patient with older age and elevated tumour markers especially CA125 levels should be evaluated to check whether there is a potential of ILD.

Impact of a new mandatory reporting law on reporting and identification of child sexual abuse: A seven year time trend analysis.

Child sexual abuse is widespread and difficult to detect. To enhance case identification, many societies have enacted mandatory reporting laws requiring designated professionals, most often police, teachers, doctors and nurses, to report suspected cases to government child welfare agencies. Little research has explored the effects of introducing a reporting law on the number of reports made, and the outcomes of those reports. This study explored the impact of a new legislative mandatory reporting duty for child sexual abuse in the State of Western Australia over seven years. We analyzed data about numbers and outcomes of reports by mandated reporters, for periods before the law (2006-2008) and after the law (2009-2012). Results indicate that the number of reports by mandated reporters of suspected child sexual abuse increased by a factor of 3.7, from an annual mean of 662 in the three year pre-law period to 2448 in the four year post-law period. The increase in the first two post-law years was contextually and statistically significant. Report numbers stabilized in 2010-2012, at one report per 210 children. The number of investigated reports increased threefold, from an annual mean of 451 in the pre-law period to 1363 in the post-law period. Significant decline in the proportion of mandated reports that were investigated in the first two post-law years suggested the new level of reporting and investigative need exceeded what was anticipated. However, a subsequent significant increase restored the pre-law proportion, suggesting systemic adaptive capacity. The number of substantiated investigations doubled, from an annual mean of 160 in the pre-law period to 327 in the post-law period, indicating twice as many sexually abused children were being identified.

Clinical features of rheumatoid arthritis-associated interstitial lung disease.

Interstitial lung disease (ILD) is the most common extra-articular manifestations of rheumatoid arthritis (RA) in the lung. This study aimed to identify clinical features of RA-associated ILD (RA-ILD). Patients with RA were retrospectively enrolled and sub-classified as RA-ILD or RA without ILD based on high-resolution computed tomography imaging. Pulmonary function testing parameters and levels of RA-related biomarkers, tumour markers, and acute-phase proteins were compared between the two groups. Logistic regression model was used to assess the strength of association between RA-ILD and clinical features of interest. Receiver operating characteristic analysis was performed to assess potential predictive value of clinical features for detecting RA-ILD. Comparison analysis indicated that the percentage of predicted value of total lung capacity, inspiratory capacity, and diffusion capacity of the lung for carbon monoxide (DLCO) were reduced in patients with RA-ILD. Tumour markers CA15-3 and CA125 were increased in patients with RA-ILD. Logistic regression analysis revealed that decreased DLCO was related to the increased likelihood of RA-ILD (OR = 0.94, 95%CI = [0.91, 0.98]). The cut-off point at 52.95 percent of predicted value could sensitively discriminate RA patients with or without ILD. Our study suggested that DLCO value could be a useful tool for detecting ILD in patients with RA.