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Mellody K, Bradley E, Bell M, Halai P, Cotterell L, Griffiths C, Watson R. 238 Retinol at a concentration of 0.3% restores fibrillin-rich microfibrils and modifies the epidermis in photoaged human skin in vivo in a manner similar to 1% retinol. J Invest Dermatol 2020. [DOI: 10.1016/j.jid.2020.03.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Heratizadeh A, Haufe E, Stölzl D, Abraham S, Heinrich L, Kleinheinz A, Wollenberg A, Weisshaar E, Augustin M, Wiemers F, Zink A, von Kiedrowski R, Hilgers M, Worm M, Pawlak M, Sticherling M, Fell I, Handrick C, Schäkel K, Staubach-Renz P, Asmussen A, Schwarz B, Bell M, Effendy I, Bieber T, Homey B, Gerlach B, Tchitcherina E, Stahl M, Schwichtenberg U, Rossbacher J, Buck P, Mempel M, Beissert S, Biedermann T, Weidinger S, Schmitt J, Werfel T. Baseline characteristics, disease severity and treatment history of patients with atopic dermatitis included in the German AD Registry TREATgermany. J Eur Acad Dermatol Venereol 2020; 34:1263-1272. [PMID: 31721316 DOI: 10.1111/jdv.16078] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/17/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND The Atopic Dermatitis (AD) TREATgermany registry was initiated by the German Society for Dermatology (DDG) in 2011 to evaluate the 'real-life' situation of health care for patients with AD. OBJECTIVES Interim data analysis on baseline characteristics as well as current and prescribed systemic treatments of the TREATgermany registry patients. METHODS Patients (≥18 years) with moderate-to-severe AD [objective (o)SCORAD > 20], or with current or previous anti-inflammatory systemic treatment for AD within 24 months, were included and are followed up over at least 24 months. To assess clinical signs, the eczema area severity index (EASI, 0-72), the oSCORAD (0-83) and the Investigator Global Assessment (IGA; 6-point scale) were used. The disease severity was globally scored by the patients [Patient Global Assessment (PGA); six-step Likert scale]. Disease symptoms were assessed by the patient-oriented eczema measure (POEM, 0-28) and numeric rating scales (NRS, 0-10). Health-related quality of life was measured using the dermatological life quality index (DLQI, 0-30). RESULTS A total of 612 patients were recruited across 32 sites between 06/2016 and 01/2019 (mean age: 42.6 ± 14.2 years; mean oSCORAD: 40.8 ± 16.3). The mean POEM score was 16.3 ± 7.5. Pruritus was rated highest among subjective symptoms (NRS: 5.4 ± 2.7). The mean DLQI value was 11.3 ± 7.5. The frequency of arterial hypertension was lower (20.8%) compared with the general population, whilst this was higher for depression (10%). More than 60% of the patients had received systemic glucocorticosteroids, and 36.8% had received cyclosporine A prior to inclusion. Dupilumab was the leading substance documented as either 'current' (12.1%) or 'prescribed' (31.4%) at baseline. CONCLUSIONS These 'real-life' data clearly demonstrate the substantial disease burden. Most of TREATgermany patients were already treated with or prescribed dupilumab at baseline. Moreover, current findings indicate the urgent need for further alternative agents in order to achieve a perceptible improvement of quality of life of patients with moderate-to-severe AD.
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Abraham S, Haufe E, Harder I, Heratizadeh A, Kleinheinz A, Wollenberg A, Weisshaar E, Augustin M, Wiemers F, Zink A, Biedermann T, von Kiedrowski R, Hilgers M, Worm M, Pawlak M, Sticherling M, Fell I, Handrick C, Schäkel K, Staubach P, Asmussen A, Schwarz B, Bell M, Neubert K, Effendy I, Bieber T, Homey B, Gerlach B, Tchitcherina E, Stahl M, Schwichtenberg U, Rossbacher J, Buck P, Mempel M, Beissert S, Werfel T, Weidinger S, Schmitt J. Implementation of dupilumab in routine care of atopic eczema: results from the German national registry TREATgermany. Br J Dermatol 2020; 183:382-384. [PMID: 32068242 DOI: 10.1111/bjd.18958] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Bogdanet D, Griffin TP, Bell M. A Rare Case of Infertility: SRY Positive 46, XX Testicular Disorder of Sexual Differentiation. IRISH MEDICAL JOURNAL 2020:60. [PMID: 32268053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Aim To highlight the complexity of infertility causes by describing the rare case of a man with a testicular disorder of sexual differentiation. Diagnosis A 33 years old Caucasian male presented with a 3-year-old history of primary infertility. His investigations revealed a low testosterone and a raised LH and FSH levels. A sample sent for sperm analysis revealed azoospermia. Chromosomal analysis and karyotyping revealed a 46 XX SRY positive karyotype. Treatment The patient was initiated on testosterone replacement and on calcium/vitamin D supplements. Conclusion Fertility evaluation requires complex assessments and a broad knowledge of possible causes.
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Sheridan A, Kemple M, Hyde A, Fox P, Furlong E, Coughlan B, Bell M, Naughton C, Carberry S, Drennan J. Non-use of cancer information services among people experiencing cancer in Ireland. Eur J Oncol Nurs 2020; 44:101700. [PMID: 32007695 DOI: 10.1016/j.ejon.2019.101700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/20/2019] [Accepted: 11/24/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this study was to explore the reasons for non-use of a national cancer society's cancer information services among people experiencing cancer. METHOD This study used a qualitative design. Semi-structured interviews were conducted with a total of 17 participants who had not previously utilised the Cancer Society's information services. Data were analysed using Thematic Analysis. RESULTS The key themes to emerge from the date were 'living in the here and now' and 'awareness of the Cancer Society'. For most participants, not utilising cancer information services was a means of coping with the initial diagnosis and the impact of treatment. Those who progressed to being ready to seek information identified the multi-disciplinary team as the primary source of trusted information, with particular mention of cancer nurse specialists. For participants with children, their role as a parent was central in how they managed their diagnosis. The majority of participants lacked awareness of the range of services provided by the Cancer Society. CONCLUSIONS Reasons for non-use of cancer information services were identified as: readiness to seek information and a lack of knowledge of the Cancer Societies' services. Cancer information services need to continue make a concerted effort to enhance visibility and awareness of its services to optimise patient engagement.
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Young A, Narbutt J, Harrison G, Lawrence K, Bell M, O'Connor C, Olson P, Grys K, Baczynska K, Rogowski‐Tylman M, Wulf H, Lesiak A, Philipsen P. 使用最佳防晒霜可促进维生素 D 合成. Br J Dermatol 2019. [DOI: 10.1111/bjd.18504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Young A, Narbutt J, Harrison G, Lawrence K, Bell M, O'Connor C, Olson P, Grys K, Baczynska K, Rogowski‐Tylman M, Wulf H, Lesiak A, Philipsen P. Optimal sunscreen use allows vitamin D synthesis. Br J Dermatol 2019. [DOI: 10.1111/bjd.18492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Castellano Pellicena I, O’Connor C, Bell M, Tobin D. 524 Melanin localisation and transport in the human epidermis. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mellody K, Bradley E, Halai P, Cotterell L, Horn J, Griffiths C, Bell M, Watson R. 610 Hibiscus abelmoschus seed extract induces remodelling of the papillary dermal fibrillin-rich microfibrils. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Costello M, Brennan M, Newman C, O'Shea P, Bell M. Pyroglutamic acidosis. QJM 2019; 112:613-614. [PMID: 31086977 DOI: 10.1093/qjmed/hcz107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 04/23/2019] [Indexed: 11/15/2022] Open
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Ramalingam G, Choi S, Agarwal S, Kunst G, Gill R, Fletcher SN, Klein AA, Shashidaran P, Waghmare K, Kadayam R, Flynn F, Gavin N, Mairead‐Machugh U, Bell M, Hawthorn A, Sajgalik P, Burri N, Meraglia A. Complications related to peri‐operative transoesophageal echocardiography – a one‐year prospective national audit by the Association of Cardiothoracic Anaesthesia and Critical Care. Anaesthesia 2019; 75:21-26. [DOI: 10.1111/anae.14734] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2019] [Indexed: 12/26/2022]
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Young AR, Narbutt J, Harrison GI, Lawrence KP, Bell M, O'Connor C, Olsen P, Grys K, Baczynska KA, Rogowski-Tylman M, Wulf HC, Lesiak A, Philipsen PA. Optimal sunscreen use, during a sun holiday with a very high ultraviolet index, allows vitamin D synthesis without sunburn. Br J Dermatol 2019; 181:1052-1062. [PMID: 31069787 PMCID: PMC6899952 DOI: 10.1111/bjd.17888] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2019] [Indexed: 12/17/2022]
Abstract
Background Sunlight contains ultraviolet (UV)A and UVB radiation. UVB is essential for vitamin D synthesis but is the main cause of sunburn and skin cancer. Sunscreen use is advocated to reduce the sun's adverse effects but may compromise vitamin D status. Objectives To assess the ability of two intervention sunscreens to inhibit vitamin D synthesis during a week‐long sun holiday. Methods The impact of sunscreens on vitamin D status was studied during a 1‐week sun holiday in Tenerife (28° N). Comparisons were made between two formulations, each with a sun protection factor (SPF) of 15. The UVA‐protection factor (PF) was low in one case and high in the other. Healthy Polish volunteers (n = 20 per group) were given the sunscreens and advised on the correct application. Comparisons were also made with discretionary sunscreen use (n = 22) and nonholiday groups (51·8° N, n = 17). Sunscreen use in the intervention groups was measured. Behaviour, UV radiation exposure, clothing cover and sunburn were monitored. Serum 25‐hydroxyvitamin D3 [25(OH)D3] was assessed by high‐performance liquid chromatography–tandem mass spectrometry. Results Use of intervention sunscreens was the same (P = 0·60), and both equally inhibited sunburn, which was present in the discretionary use group. There was an increase (P < 0·001) in mean ± SD 25(OH)D3 (28·0 ± 16·5 nmol L−1) in the discretionary use group. The high and low UVA‐PF sunscreen groups showed statistically significant increases (P < 0·001) of 19·0 ± 14·2 and 13·0 ± 11·4 nmol L−1 25(OH)D3, respectively with P = 0·022 for difference between the intervention sunscreens. The nonholiday group showed a fall (P = 0·08) of 2·5 ± 5·6 nmol L−1 25(OH)D3. Conclusions Sunscreens may be used to prevent sunburn yet allow vitamin D synthesis. A high UVA‐PF sunscreen enables significantly higher vitamin D synthesis than a low UVA‐PF sunscreen because the former, by default, transmits more UVB than the latter. What's already known about this topic? Action spectra (wavelength dependence) for erythema and the cutaneous formation of vitamin D overlap considerably in the ultraviolet (UV)B region. Theoretically, sunscreens that inhibit erythema should also inhibit vitamin D synthesis. To date, studies on the inhibitory effects of sunscreens on vitamin D synthesis have given conflicting results, possibly, in part, because people typically apply sunscreen suboptimally. Many studies have design flaws.
What does this study add? Sunscreens (sun protection factor, SPF 15) applied at sufficient thickness to inhibit sunburn during a week‐long holiday with a very high UV index still allow a highly significant improvement of serum 25‐hydroxyvitamin D3 concentration. An SPF 15 formulation with high UVA protection enables better vitamin D synthesis than a low UVA protection product. The former allows more UVB transmission.
Linked Editorial: https://doi.org/10.1111/bjd.18273. https://doi.org/10.1111/bjd.18492 available online https://www.bjdonline.com/article/optimal-sunscreen-use-during-a-sun-holiday-with-a-very-high-ultraviolet-index-allows-vitamin-d-synthesis-without-sunburn/
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Narbutt J, Philipsen P, Harrison G, Morgan K, Lawrence K, Baczynska K, Grys K, Rogowski‐Tylman M, Olejniczak‐Staruch I, Tewari A, Bell M, O'Connor C, Wulf H, Lesiak A, Young A. Optimal sunscreen use prevents holiday erythema. Br J Dermatol 2019. [DOI: 10.1111/bjd.17556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Narbutt J, Philipsen P, Harrison G, Morgan K, Lawrence K, Baczynska K, Grys K, Rogowski‐Tylman M, Olejniczak‐Staruch I, Tewari A, Bell M, O'Connor C, Wulf H, Lesiak A, Young A. 优化防晒霜使用以防止假日红斑. Br J Dermatol 2019. [DOI: 10.1111/bjd.17572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Klotzbach P, Abhik S, Hendon HH, Bell M, Lucas C, G Marshall A, Oliver ECJ. On the emerging relationship between the stratospheric Quasi-Biennial oscillation and the Madden-Julian oscillation. Sci Rep 2019; 9:2981. [PMID: 30814656 PMCID: PMC6393487 DOI: 10.1038/s41598-019-40034-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 02/07/2019] [Indexed: 11/16/2022] Open
Abstract
A strong relationship between the quasi-biennial oscillation (QBO) of equatorial stratospheric winds and the amplitude of the Madden-Julian oscillation (MJO) during the boreal winter has recently been uncovered using observational data from the mid-1970s to the present. When the QBO is in its easterly phase in the lower stratosphere, it favors stronger MJO activity during boreal winter, while the MJO tends to be weaker during the westerly phase of the QBO. Here we show using reconstructed indices of the MJO and QBO back to 1905 that the relationship between enhanced boreal winter MJO activity and the easterly phase of the QBO has only emerged since the early 1980s. The emergence of this relationship coincides with the recent cooling trend in the equatorial lower stratosphere and the warming trend in the equatorial upper troposphere, which appears to have sensitized MJO convective activity to QBO-induced changes in static stability near the tropopause. Climate change is thus suggested to have played a role in promoting coupling between the MJO and the QBO.
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Narbutt J, Philipsen PA, Harrison GI, Morgan KA, Lawrence KP, Baczynska KA, Grys K, Rogowski-Tylman M, Olejniczak-Staruch I, Tewari A, Bell M, O'Connor C, Wulf HC, Lesiak A, Young AR. Sunscreen applied at ≥ 2 mg cm -2 during a sunny holiday prevents erythema, a biomarker of ultraviolet radiation-induced DNA damage and suppression of acquired immunity. Br J Dermatol 2018; 180:604-614. [PMID: 30307614 DOI: 10.1111/bjd.17277] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Sun protection factor (SPF) is assessed with sunscreen applied at 2 mg cm-2 . People typically apply around 0·8 mg cm-2 and use sunscreen daily for holidays. Such use results in erythema, which is a risk factor for skin cancer. OBJECTIVES To determine (i) whether typical sunscreen use resulted in erythema, epidermal DNA damage and photoimmunosuppression during a sunny holiday, (ii) whether optimal sunscreen use inhibited erythema and (iii) whether erythema is a biomarker for photoimmunosuppression in a laboratory study. METHODS Holidaymakers (n = 22) spent a week in Tenerife (very high ultraviolet index) using their own sunscreens without instruction (typical sunscreen use). Others (n = 40) were given SPF 15 sunscreens with instructions on how to achieve the labelled SPF (sunscreen intervention). Personal ultraviolet radiation (UVR) exposure was monitored electronically as the standard erythemal dose (SED) and erythema was quantified. Epidermal cyclobutane pyrimidine dimers (CPDs) were determined by immunostaining, and immunosuppression was assessed by contact hypersensitivity (CHS) response. RESULTS There was no difference between personal UVR exposure in the typical sunscreen use and sunscreen intervention groups (P = 0·08). The former had daily erythema on five UVR-exposed body sites, increased CPDs (P < 0·001) and complete CHS suppression (20 of 22). In comparison, erythema was virtually absent (P < 0·001) when sunscreens were used at ≥ 2 mg cm-2 . A laboratory study showed that 3 SED from three very different spectra suppressed CHS by around ~50%. CONCLUSIONS Optimal sunscreen use prevents erythema during a sunny holiday. Erythema predicts suppression of CHS (implying a shared action spectrum). Given that erythema and CPDs share action spectra, the data strongly suggest that optimal sunscreen use will also reduce CPD formation and UVR-induced immunosuppression.
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Joly-Tonetti N, Wibawa J, Bell M, Tobin D. 人皮肤表皮中黑色素分布依据. Br J Dermatol 2018. [DOI: 10.1111/bjd.17234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Joly-Tonetti N, Wibawa J, Bell M, Tobin D. Basis of melanin distribution in the human skin epidermis. Br J Dermatol 2018. [DOI: 10.1111/bjd.17220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Joly-Tonetti N, Wibawa JID, Bell M, Tobin DJ. An explanation for the mysterious distribution of melanin in human skin: a rare example of asymmetric (melanin) organelle distribution during mitosis of basal layer progenitor keratinocytes. Br J Dermatol 2018; 179:1115-1126. [PMID: 29956303 DOI: 10.1111/bjd.16926] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Melanin is synthesized by melanocytes in the basal layer of the epidermis. When transferred to surrounding keratinocytes melanin is the key ultraviolet radiation-protective biopolymer responsible for skin pigmentation. Most melanin is observable in the proliferative basal layer of the epidermis and only sparsely distributed in the stratifying/differentiating epidermis. The latter has been explained as 'melanin degradation' in suprabasal layers. OBJECTIVES To re-evaluate the currently accepted basis for melanin distribution in human epidermis and to discover whether this pattern is altered after a regenerative stimulus. METHODS Normal epidermis of adult human skin, at rest and after tape-stripping, was analysed by a range of (immuno)histochemical and high-resolution microscopy techniques. In vitro models of melanin granule uptake by human keratinocytes were attempted. RESULTS We propose a different fate for melanin in the human epidermis. Our evidence indicates that the bulk of melanin is inherited only by the nondifferentiating daughter cell postmitosis in progenitor keratinocytes via asymmetric organelle inheritance. Moreover, this preferred pattern of melanin distribution can switch to a symmetric or equal daughter cell inheritance mode under conditions of stress, including regeneration. CONCLUSIONS In this preliminary report, we provide a plausible and histologically supported explanation for how human skin pigmentation is efficiently organized in the epidermis. Steady-state epidermis pigmentation may involve much less redox-sensitive melanogenesis than previously thought, and at least some premade melanin may be available for reuse. The epidermal melanin unit may be an excellent example with which to study organelle distribution via asymmetric or symmetric inheritance in response to microenvironment and tissue demands.
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Haufe E, Abraham S, Heratizadeh A, Harder I, Zink A, Weisshaar E, Kleinheinz A, von Kiedrowski R, Worm M, Bell M, Wollenberg A, Neubert K, Staubach-Renz P, Hilgers M, Bieber T, Fell I, Homey B, Effendy I, Mempel M, Schäkel K, Beissert S, Weidinger S, Werfel T, Schmitt J. Verminderte berufliche Leistungsfähigkeit und Lebensqualität bei Patienten mit moderater bis schwerer Neurodermitis. Hautarzt 2018; 69:815-824. [DOI: 10.1007/s00105-018-4261-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Chadwick DR, Cardenas LM, Dhanoa MS, Donovan N, Misselbrook T, Williams JR, Thorman RE, McGeough KL, Watson CJ, Bell M, Anthony SG, Rees RM. The contribution of cattle urine and dung to nitrous oxide emissions: Quantification of country specific emission factors and implications for national inventories. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 635:607-617. [PMID: 29679833 PMCID: PMC6024564 DOI: 10.1016/j.scitotenv.2018.04.152] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/10/2018] [Accepted: 04/10/2018] [Indexed: 05/27/2023]
Abstract
Urine patches and dung pats from grazing livestock create hotspots for production and emission of the greenhouse gas, nitrous oxide (N2O), and represent a large proportion of total N2O emissions in many national agricultural greenhouse gas inventories. As such, there is much interest in developing country specific N2O emission factors (EFs) for excretal nitrogen (EF3, pasture, range and paddock) deposited during gazing. The aims of this study were to generate separate N2O emissions data for cattle derived urine and dung, to provide an evidence base for the generation of a country specific EF for the UK from this nitrogen source. The experiments were also designed to determine the effects of site and timing of application on emissions, and the efficacy of the nitrification inhibitor, dicyandiamide (DCD) on N2O losses. This co-ordinated set of 15 plot-scale, year-long field experiments using static chambers was conducted at five grassland sites, typical of the soil and climatic zones of grazed grassland in the UK. We show that the average urine and dung N2O EFs were 0.69% and 0.19%, respectively, resulting in a combined excretal N2O EF (EF3), of 0.49%, which is <25% of the IPCC default EF3 for excretal returns from grazing cattle. Regression analysis suggests that urine N2O EFs were controlled more by composition than was the case for dung, whilst dung N2O EFs were more related to soil and environmental factors. The urine N2O EF was significantly greater from the site in SW England, and significantly greater from the early grazing season urine application than later applications. Dycandiamide reduced the N2O EF from urine patches by an average of 46%. The significantly lower excretal EF3 than the IPCC default has implications for the UK's national inventory and for subsequent carbon footprinting of UK ruminant livestock products.
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Zhou H, Slominski R, Dave P, Wright W, Seymour L, Bell M, Spandau D, Turner M. LB1566 Investigation of inflammatory response mediators in ex vivo skin culture. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.06.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Diffey BL, O'Connor C, Marlow I, Bell M, O'Mahony MM. A theoretical and experimental study of the temporal reduction in UV protection provided by a facial day cream. Int J Cosmet Sci 2018; 40:401-407. [DOI: 10.1111/ics.12480] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/04/2018] [Indexed: 11/29/2022]
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Walker EMK, Bell M, Cook TM, Grocott MPW, Moonesinghe SR. Patient reported outcome of adult perioperative anaesthesia in the United Kingdom: a cross-sectional observational study. Br J Anaesth 2018; 117:758-766. [PMID: 27956674 DOI: 10.1093/bja/aew381] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Understanding the patient perspective on healthcare is central to the evaluation of quality. This study measured selected patient-reported outcomes after anaesthesia in order to identify targets for research and quality improvement. METHODS This cross-sectional observational study in UK National Health Service hospitals, recruited adults undergoing non-obstetric surgery requiring anaesthesia care over a 48 h period. Within 24 h of surgery, patients completed the Bauer questionnaire (measuring postoperative discomfort and satisfaction with anaesthesia care), and a modified Brice questionnaire to elicit symptoms suggestive of accidental awareness during general anaesthesia (AAGA). Patient, procedural and pharmacological data were recorded to enable exploration of risk factors for these poor outcomes. RESULTS 257 hospitals in 171 NHS Trusts participated (97% of eligible organisations). Baseline characteristics were collected on 16,222 patients; 15,040 (93%) completed postoperative questionnaires. Anxiety was most frequently cited as the worst aspect of the perioperative experience. Thirty-five per cent of patients reported severe discomfort in at least one domain: thirst (18.5%; 95% CI 17.8-19.1), surgical pain (11.0%; 10.5-11.5) and drowsiness (10.1%; 9.6-10.5) were most common. Despite this, only 5% reported dissatisfaction with any aspect of anaesthesia-related care. Regional anaesthesia was associated with a reduced burden of side-effects. The incidence of reported AAGA was one in 800 general anaesthetics (0.12%) CONCLUSIONS Anxiety and discomfort after surgery are common; despite this, satisfaction with anaesthesia care in the UK is high. The inconsistent relationship between patient-reported outcome, patient experience and patient satisfaction supports using all three of these domains to provide a comprehensive assessment of the quality of anaesthesia care.
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McDonnell TC, Belyazid S, Sullivan TJ, Bell M, Clark C, Blett T, Evans T, Cass W, Hyduke A, Sverdrup H. Vegetation dynamics associated with changes in atmospheric nitrogen deposition and climate in hardwood forests of Shenandoah and Great Smoky Mountains National Parks, USA. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2018; 237:662-674. [PMID: 29549857 DOI: 10.1016/j.envpol.2018.01.112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 06/08/2023]
Abstract
Ecological effects of atmospheric nitrogen (N) and sulfur (S) deposition on two hardwood forest sites in the eastern United States were simulated in the context of a changing climate using the dynamic coupled biogeochemical/ecological model chain ForSAFE-Veg. The sites are a mixed oak forest in Shenandoah National Park, Virginia (Piney River) and a mixed oak-sugar maple forest in Great Smoky Mountains National Park, Tennessee (Cosby Creek). The sites have received relatively high levels of both S and N deposition and the climate has warmed over the past half century or longer. The model was used to evaluate the composition of the understory plant communities, the alignment between plant species niche preferences and ambient conditions, and estimate changes in relative species abundances as reflected by plant cover under various scenarios of future atmospheric N and S deposition and climate change. The main driver of ecological effects was soil solution N concentration. Results of this research suggested that future climate change might compromise the capacity for the forests to sustain habitat suitability. However, vegetation results should be considered preliminary until further model validation can be performed. With expected future climate change, preliminary estimates suggest that sustained future N deposition above 7.4 and 5.0 kg N/ha/yr is expected to decrease contemporary habitat suitability for indicator plant species located at Piney River and Cosby Creek, respectively.
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