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Item Hyperemesis gravidarum: Current concepts and management(BMJ Publishing Group, 2002) Kuşcu N.K.; Koyuncu F.Hyperemesis gravidarum is a common problem for an obstetrician. Though nausea and vomiting are quite common in pregnancy, hyperemesis is found in only 1-20 patients per 1000. In this practical review, a general outline of the syndrome, its relation to the gastrointestinal system and thyroid, mild and rare severe complications, and conventional treatment versus newer options are discussed.Item Ultra fast resolution of acute post-traumatic subdural haematoma(BMJ Publishing Group, 2005) Mirzai H.; Yaldiz C.; Eminoglu M.; Orguc S.[No abstract available]Item Validation of duruöz hand index for diabetic hand dysfunction(BMJ Publishing Group, 2009) Turan Y.; Duruöz M.T.; Aksakalli E.; Gürgan A.Objectives: Duruöz Hand Index (DHI) is a functional disability scale that can be used successfully to assess the functional disability with different hand arthropathies. The hands are frequently involved in diabetic patients. We aimed to examine the use of DHI for its accuracy and ease in assessing these patients. Methods: Forty patients with diabetes mellitus were recruited in this study. Hand pain was assessed with the visual analog scale. Duruöz Hand Index and Hand Functional Index were applied to assess the disability of hand. We evaluated the grip strength and 3 types of pinch strength (tip pinch, lateral or key pinch, and chuck or 3-finger pinch) for the dominant (D) and nondominant (ND) hands of each patient by 2 different kinds of Jamar dynamometers (JA Preston Corp, Jackson, MI). Results: The Jamar dynamometer scores were as follows (mean [SD]): grip strength-D (21.56 [5.86]), grip strength-ND (16.42 [4.26]), tip strength-D (5.14 [1.50]), tip strength-ND (5.13 [1.42]), lateral strength-D(5.15 [1.52]), lateral strength-ND (5.07 [1.19]), chuck strength-D (5.40 [1.40]), chuck strength-ND (5.33 [1.28]). There was a high correlation between DHI and Hand Functional Index (P < 0.001, Q = 0.586) showing that DHI has good convergent validity. The DHI had significant correlation with nonfunctional parameters such as visual analog scalepain (P < 0.001), restricted hand motion (P = 0.020), chuck strength-D (P = 0.006), pins test-D (P < 0.001), pins test-ND (P = 0.013), and assembly test (P = 0.025). Conclusions: The DHI is a practical scale that is efficient in accurate assessment of hand dysfunction in diabetic patients. Copyright © 2009 by The American Federation for Medical Research.Item Prevalence of depression and anxiety in patients with cystic fibrosis and parent caregivers: Results of the International Depression Epidemiological Study across nine countries(BMJ Publishing Group, 2014) Quittner A.L.; Goldbeck L.; Abbott J.; Duff A.; Lambrecht P.; Solé A.; Tibosch M.M.; Brucefors A.B.; Yüksel H.; Catastini P.; Blackwell L.; Barker D.Background: Individuals with chronic diseases and parent caregivers are at increased risk for symptoms of depression and anxiety. Prevalence of psychological symptoms was evaluated in adolescents and adults with cystic fibrosis (CF) and parent caregivers across nine countries. Methods: Patients with CF, ages 12 years and older, and caregivers of children with CF, birth to18 years of age, completed measures of depression and anxiety across 154 CF centres in Europe and the USA. Psychological symptoms were compared across countries using χ2. Logistic regression examined extent of comorbid symptoms, predictors of depression and anxiety, and concordance between parent and adolescent symptomatology. Results: Psychological symptoms were reported by 6088 patients with CF and 4102 parents. Elevated symptoms of depression were found in 10% of adolescents, 19% of adults, 37% of mothers and 31% of fathers. Elevations in anxiety were found in 22% of adolescents, 32% of adults, 48% of mothers and 36% of fathers. Overall, elevations were 2-3 times those of community samples. Participants reporting elevated anxiety were more likely to report depression (ORs: adolescents=14.97, adults=13.64, mothers=15.52, fathers=9.20). Significant differences in reports of depression and anxiety were found by patient age and parent respondent. Concordance between 1122 parent-teen dyads indicated that adolescents whose parents reported depression were more likely to be elevated on depression (OR=2.32). Similarly, adolescents whose parents reported anxiety were more likely to score in the elevated range on the anxiety measure (OR=2.22). Conclusions: Symptoms of depression and anxiety were elevated in both patients with CF and parents across several European countries and the USA. Annual screening of psychological symptoms is recommended for both patients and parents. © 2014, BMJ Publishing Group. All rights reserved.Item Are human adenovirus-5 and 36 associated with obesity in children?(BMJ Publishing Group, 2014) Cakmakliogullari E.K.; Sanlidag T.; Ersoy B.; Akcali S.; Var A.; Cicek C.Objectives: The aims of this study were to determine the association between adenovirus-5- and adenovirus-36-specific antibodies and obesity in children and to investigate their relationship with serum lipid and leptin levels. Methods: A cross-sectional study was performed on a total of 120 children who were divided into subgroups according to body mass index percentile as obese (Q95th percentile) or nonobese (G95th percentile). The presence of adenovirus-36 and adenovirus-5-neutralizing antibodies was investigated by using the serum neutralization assay. Serum leptin levels were determined by microenzyme immonoassay; highdensity lipoprotein, low-density lipoprotein, triglyceride, and cholesterol levels were measured by chemiluminescence method. Results: The presence of adenovirus-5-specific antibodies was 28.3% and 6.6% in the obese children and in non-obese children, respectively (P = 0.02). The frequency of adenovirus-36-specific antibodies was significantly greater (P = 0.018) in the obese children (26.6%) than in the non-obese children (10.0%). Serum leptin level of the obese group were significantly higher than that of the non-obese group (P = 0.000). Conclusions: Our data support the association between obesity and the presence of specific antibodies to adenovirus-36 and adenovirus-5 in children. Our research has the feature of being the first national study to indicate the relationship between adenovirus-36 and human obesity as well as the first international study to indicate the relationship between adenovirus-5 and human obesity. Copyright © 2014 by The American Federation for Medical Research.Item Young adult smokers' perceptions of plain packs, numbered packs and pack inserts in Turkey: A focus group study(BMJ Publishing Group, 2018) Mucan B.; Moodie C.Introduction The Turkish Government's National Tobacco Control Program 2015-2018' included plans to introduce plain packaging and also a ban on brand names on cigarette packs, allowing only assigned numbers on packs. We explored perceptions of these proposed measures, and also pack inserts with cessation messages, another novel way of using the packaging to communicate with consumers. Methods Eight focus groups were conducted with 47 young adult smokers in Manisa and Kutahya (Turkey) in December 2016. Participants were shown three straight-edged plain cigarette packs, as required in Australia, and then three bevelled-edged plain packs, as permitted in the UK. They were then shown plain packs with numbers rather than brand names, and finally three pack inserts with messages encouraging quitting or offering tips on how to do so. Participants were asked about their perceptions of each. Results Plain packs were considered unappealing and off-putting, although the bevelled-edged packs were viewed more favourably than the straight-edged packs. Numbered packs were thought by some to diminish the appeal created by the brand name and potentially decrease interest among never smokers and newer smokers. Pack inserts were thought to have less of an impact than the on-pack warnings, but could potentially help discourage initiation and encourage cessation. Conclusions That bevelled-edged plain packs were perceived more positively than straight-edged plain packs is relevant to countries planning to introduce plain packaging. The study provides a first insight into smokers' perceptions of a ban on brand names, which was perceived to reduce appeal among young people. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.Item Reliability and validity of the Turkish version of the Individual-Level Abortion Stigma Scale: A methodological study(BMJ Publishing Group, 2019) Cetinkaya A.; Özmen D.; Uyar F.; Tayhan A.Objectives The aim of this study was to assess the reliability and validity of the Turkish version of the Individual-Level Abortion Stigma Scale. Setting Three hospitals affiliated to Public Hospitals Union General Secretariat in Manisa, a city located in Western Turkey. Design This was a methodological study. Participants A total of 230 women aged 22-49 years who previously underwent abortion and volunteered to participate in the study. Primary and secondary outcome measures Data analysis was performed using the SPSS and LISREL software. The Content Validity Index was calculated based on the values obtained from expert opinions. In the reliability analysis, Cronbach's alpha values were calculated for the overall scale and its subscales. To test the stability of the scale over time, the scale was readministered to 30 women in the study 15 days later and the test-retest values (Pearson's correlation coefficients) were determined. In the validity analysis, the exploratory and confirmatory factor analyses were performed. In the exploratory factor analysis, the principal component analysis was performed using the varimax rotation and the factor loading of the scale was examined. Confirmatory factor analysis was performed to investigate the item-factor construct of the scale. Results The Content Validity Index was calculated as 0.86. The Cronbach's alpha values ranged between 0.83 and 0.94. The item-total correlation coefficients ranged between 0.36 and 0.72, and the test-retest reliability was 0.96 for the overall scale and its subscales (p<0.05). The total variance revealed by five factors was 75%. Confirmatory factor analysis of the scale revealed an acceptable compliance level (root mean square error of approximation=0.092, 2 /df=2.91, Goodness of Fit Index=0.831, Comparative Fit Index=0.928, p<0.001). Conclusions The results suggest that this scale has the potential for use in research and clinical settings to measure abortion stigma among women. © 2019 Author(s) (or their employer(s)).Item Possible complications of martial arts technique(BMJ Publishing Group, 2019) Gokalp G.; Berksoy E.; Bardak S.; Demir S.; Demir G.; Bicilioglu Y.; Zengin N.[No abstract available]Item Development of ASAS quality standards to improve the quality of health and care services for patients with axial spondyloarthritis(BMJ Publishing Group, 2019) Kiltz U.; Landewé R.B.M.; Van Der Heijde D.; Rudwaleit M.; Weisman M.H.; Akkoc N.; Boonen A.; Brandt J.; Carron P.; Dougados M.; Gossec L.; Jongkees M.; MacHado P.M.; Marzo-Ortega H.; Molto A.; Navarro-Compán V.; Niederman K.; Sampaio-Barros P.D.; Slobodin G.; Van Den Bosch F.E.; Van Tubergen A.; Van Weely S.; Wiek D.; Braun J.Objectives The Assessment of SpondyloArthritis International Society (ASAS) aimed to develop a set of quality standards (QS) to help improve the quality of healthcare provided to adult patients affected by axial spondyloarthritis (axSpA) worldwide. Methods An ASAS task force developed a set of QS using a stepwise approach. First, key areas for quality improvement were identified, discussed, rated and agreed on. Thereafter, areas were prioritised and statements for the most important key areas were phrased on consensus. Appropriate quality measures were defined to allow quantification of the QS at the community level. Results The ASAS task force, consisting of 20 rheumatologists, two physiotherapists and two patients, selected and proposed 34 potential key areas for quality improvement which were then commented by 140 ASAS members and patients. Within that process three new key areas came up, which led to a re-evaluation of all 37 key areas by 120 ASAS members and patients. Five key areas were identified as most important to determine quality of care: referral including rapid access, rheumatology assessment, treatment, education/self-management and comorbidities. Finally, nine QS were agreed on and endorsed by the whole ASAS membership. Conclusions ASAS successfully developed the first set of QS to help improving healthcare for adult patients with axSpA. Even though it may currently not be realistic to achieve the QS in all healthcare systems, they provide high-quality of care framework for patients with axSpA that should be aimed for. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.Item EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI): Study protocol for a multicentre, observational trial(BMJ Publishing Group, 2021) Weiss R.; Saadat-Gilani K.; Kerschke L.; Wempe C.; Meersch M.; Zarbock A.; Makhloufi H.; Cherak A.; Ghanem L.L.; Gouaglia Z.; Guadouri D.N.; Hama F.N.; Kara M.; Saadi O.; Sakhraoui R.; Bourou F.; Cherifi A.; Sadaoui R.G.; Ouyahia A.; Ouahab I.; Bouaoud S.; Abdoun M.; Tidjane A.; Tabeti B.; Boudjenan-Serradj N.; Rivera C.J.P.; Cabrer P.; Corso J.; García J.P.; Idarraga S.; Montoya C.; Figueroa R.; Aldana E.; Torrado M.A.; Peng K.; Ma Z.-M.; Yang Y.-F.; Zhu Y.-J.; Sklienka P.; Frelich M.; Jarkulis V.; Sevcik P.; Vodicka V.; Elbahnasawy M.G.; Elsalhawy S.; Motawea S.; Othman Z.; Sahma M.; Nafea A.M.; Ahmed N.; Attia D.A.; Emara M.M.; Bonna M.M.; Gabr M.A.; Tarbay A.I.; Abdehaleem I.A.; Mohamed E.E.; Eldeeb A.M.; Abbas A.M.; Magdy J.A.; Hamed Z.H.; Osman H.M.E.; Abbas M.S.; Joannes-Boyau O.; Barraud N.; Berthelot C.; Camus T.; Dahmi A.; Defaye M.; Derville S.; El-Boustani Y.; Deloge E.; Jacob H.; Monziols S.; Priem F.; Robin J.-J.; Legros V.; Floch T.; Muccio S.; Geneve C.; Legouge M.L.; Mauny S.T.; Mfam W.; Pascot L.; Aveline C.; Chartier M.; Duteurtre B.; Gautier J.F.; Cousin A.L.; Vautier P.; Nadaud J.; Begel N.; Chekirine C.-A.; Derlon V.; Grein E.; Lehair M.-A.; Magazzeni L.; Magazzeni P.; Potter C.; Roth C.; Voivret F.; Rimmelé T.; Cerro V.; Suria S.; Elmawieh J.; Stoclin A.; Cirenei C.; Andrieu G.; Couloumy S.; Falcone J.; Fajardy M.; Gagneuil A.; Girardet E.; Mazereeuw A.; Ponsonnard S.; Egreteau P.-Y.; Bertel M.; Bocher S.; Carn V.; Guen L.L.; Loup G.L.; Lefevre M.; Ichai C.; Diop A.; Jean-Michel V.; Devlieger S.; Duthoit J.; El Kadiri M.; Léger M.; Cassisa V.; Lasocki S.; Masson C.; Rineau E.; Verrier P.; Coquerel A.; Montravers P.; Atchade E.; Rochon C.-E.; Delerue C.; Quentin V.; Latry V.; Queixalos N.; Cottenceau V.; Braun T.; Bouzoubaa S.; Christ B.; Geiger A.; Gomille J.; Kieffer V.; Mangeant S.; Prochilo C.; Schmitt C.; Skwirba S.; Grand H.; Boury F.; Mayeur N.; Pasquie M.; Garçon P.; Bruckert V.; Arnould V.; Bonciu M.; Chapelle T.; Facchino L.; Fagot-Gandet F.; Iachim A.; Mannu E.; Perus O.; Plattier R.; Rozier R.; Pradel G.; Boudinaud M.; Hausermann M.-H.; Nguyen M.H.; Ramorasata A.; Barreau A.; Boivin A.-H.; Ravry C.; Mottard N.; Beuvelot J.; Bossion F.P.; Desebbe O.; Dörr C.; von Groote T.C.; Küllmar M.; Massoth C.; Ziemann S.; Grüßer L.; Kowark A.; Wittig P.; Brandenburger T.; Dimski T.; Döhmen N.; Huthmann L.; Kaierle D.; Pelletier C.; Schleß M.; Hohn A.; Cleophas S.; Haunhorst S.; Jansen M.; Schmitt A.; Soisch J.; Sturm K.; Rosenberger P.; Bendig A.; Flohr L.; Häberle H.; Hofmann P.; Kuhle J.; Leser N.M.; Pfister K.; Prohaska S.; Sennholz F.; Stetz L.; Weber K.; Stehr S.; Klaus S.; Sadlo M.; Boschin M.; Sengelhoff C.; Göbel U.M.; Haaker J.G.; Göttker C.-K.; Gründel M.; Heringlake M.; Baumgärtel R.; Berggren A.; Gülzow M.; Muras L.; Paarmann H.; Thal S.; Bentley A.; El-Masri D.; Sebastiani A.; Arnaoutoglou E.; Ntalouka M.; Stratigopoulou P.; Analytis A.; Mavrommatis E.; Tzimas P.; Karakosta A.; Pantazi D.; Dimakopoulou A.; Dimitropoulou K.; Ioannidis O.; Jalaawiy H.; Anwar A.; Hashim H.T.; Aldawoody H.I.R.; Cortegiani A.; Catalisano G.; Ingoglia G.; Ippolito M.; De Rosa S.; Cattin L.; Bianchin A.; Barone M.; Paternoster G.; Cutuli S.L.; Russo A.; Sollazzi L.; Cascarano L.; Antonelli M.; Aceto P.; Romanò B.; Spadaro S.; Tripodi V.F.; Rossi M.; Scappatura R.; Vadalà M.C.; Fiume D.; Strano M.T.; Oddo G.; Santorsola C.; Hussain B.A.; Alnaser A.R.; Ghassan A.H.; Hasanein K.; Theab M.; Shin S.; Jung S.; Lee K.; Jung S.M.; Baek J.; Elhadi M.K.; Aldressi W.W.O.; Abuzeid I.; Albaraesi M.; Aldressi S.; Khalel W.; Abdulwahed E.; Abujrad A.A.A.; Almaghrabi A.; Alteleeb M.; Alshareea E.A.A.; Biala M.I.; Deeknah A.; Gheddim D.A.; Ghmagh R.; Ikhrays N.S.A.A.; Sinan M.; Soula E.; Bahroun S.G.; Derwish K.; Mohamed A.M.; Younes E.S.; Al Islam Benjouira R.; Aliwa M.; Altashani N.A.; Alteb M.O.; Msherghi A.; Alagelli F.; Albarouni S.; Albishti A.; Aljamal S.; Alsori M.; Ekhuja T.; Elzwai S.; Ghula M.; Mustafa T.; Tuwaib A.; Zriba H.; Agilla H.M.; Rafanomezantsoa T.A.; Podesta A.M.C.; Bonnici D.M.; Pirotta T.; López G.A.G.; Mijovska M.M.; Davitkovska T.; Gavrilovska A.; Lukikj S.; Vesova M.; Zafirova D.; Amro S.; Hajjaj B.N.F.; Alkhazendar M.; Barakat Y.; Elejla S.A.; Elhissi A.; Khader A.; Salem A.; de Freitas Regufe R.; de Oliveira Eloy A.F.; Perdigão L.M.N.C.; Grigoriev E.; Ivkin A.; Kornelyuk R.; Yaroustovsky M.; Abramyan M.; Komardina E.; Lesteva N.; Aybazova M.; Kumykova E.; Lesina S.; Rybakov G.; Shestov A.; Barmou A.A.A.; Ahmed B.L.A.; Eliyas A.M.; Emadeldin Y.; Kaserer A.; Castellucci C.; Rössler J.; Akbas S.; Petrun A.M.; Gregorcic I.; Sok V.; Cicak R.; Bárcena E.; Guisado A.; Wi I.; Melchor J.R.; Becerra-Bolaños Á.; Cabrera-Doreste S.; Domínguez-Arbelo A.; Delgado-Alonso M.C.; Muiño-Palomar V.; Rodríguez-Pérez A.; Estévez J.M.; Munoz M.B.C.; Matas J.M.; Palao S.P.; Quirós M.D.M.; Teslev A.C.; Argilaga M.; Campos M.; Bainac A.; Batalla A.; Alvarez M.G.; Giné M.; Herránz G.; Hinojal I.; Ejea M.L.; de la Rosa Ruiz N.; Abasolo M.G.; Acuna C.R.H.; Zaranton I.I.; Mendigurenmurua A.; Sanz M.J.M.; de la Fuente E.O.; Vaquero M.P.P.; Iglesias A.S.; Mieres A.U.; Urrestizala A.U.; Ferreira L.; Lobato F.; Sevilla M.A.; Erazo A.; Miró P.; Sabaté S.; Vernetta D.; Perez A.A.; Pagola M.A.; Paulis B.C.; del Val Peciña E.; Odriozola A.G.; Aizpurua A.L.; Piquer O.P.; Garcia P.P.; Rezola P.O.; Lopez A.O.; de la Calle Gil I.; Casado R.N.; Adamove P.; Domenge R.B.; Blasco F.M.B.; Villamizar A.A.R.; Llaneras M.A.P.; García-Sánchez J.I.; Téllez L.F.; Zamorano S.G.; Herreros N.G.; Esteve A.R.; Rodríguez P.M.; Trigo I.G.; Alcaraz A.; Jiménez A.L.; Rubio I.; García N.; Callejas R.; Toha A.M.C.; Claros E.; Cobeta P.; Crespo P.; Dorado T.; Elías E.; Felices J.; Gil D.; Gómez M.; Mané N.; Martín M.; Martínez A.; Pereira L.; Samaranch A.B.N.; Serrano A.; Tiscar C.; VillaHoz J.; Menéndez P.G.; Cardona E.; Conesa A.; Estepa V.; Galán P.; Espí L.L.; Aldeán Y.L.; Manrique S.; Ariza V.M.; Villa L.V.; Suliman E.S.M.A.; Hamid H.; Ibrahim A.M.; Saeed M.M.; Mukadder O.S.; Altun D.; Canbolat N.; Dinçer M.B.; Seyhan T.Ö.; Yildirim S.A.; Iyigün M.; Yapici D.; Özdemir L.; Sagun A.; Boztug N.; Cetintas Y.; Dinc B.; Gündüz E.; Ünlügenç H.; Tunay D.L.; Karakaya D.; Dost B.; Komurcu O.; Akcil E.F.; Dilmen Ö.K.; Tunali Y.; Ok G.; Alsina E.T.; Hakli Ö.; Polat C.; Turgut N.; Kizilcik N.; Köner Ö.; Sen Ö.; Aydin N.; Basaran B.; Bingul E.S.; Gürkan Y.; Darcin K.; Ugur S.; Saracoglu K.T.; Demir A.; Aysegül Ö.; Balci E.; Girgin B.; Guler A.; Karadeniz Ü.; Özaslan N.; Hülya Y.Ö.; Ozcan N.; Postaci A.; Sahap M.; Salman N.; Sagir Ö.; Atik B.; Bicakcioglu M.; Demir H.F.; Fatih U.; Kocaoglu N.; Toprak H.I.; Aslan D.D.; Colak Y.Z.; Ozcan M.S.; Yilmaz M.; Karaca U.; Sahin S.H.; Karka Ö.E.; Senoglu G.D.; Karadag S.E.; Alkis N.; Baytas V.; Akdogan A.; Besir A.; Erturk E.; Kutanis D.; Saylan S.; Tugcugil E.; Ayvat P.; Günaydin B.; Büyükgebiz B.M.; Boran O.F.; Calisir F.; Orak Y.; Balkan B.K.; Büyükcoban S.; Gökel E.; Günenc S.F.; Özbilgin S.; Göre S.; Akesen S.; Cansabuncu S.; Momot N.; Panchenko A.; Pittet J.-F.; Rutledge K.Introduction More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. Methods and analysis EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. Ethics and dissemination EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369. ©Item Polygenic Risk Scores have high diagnostic capacity in ankylosing spondylitis(BMJ Publishing Group, 2021) Li Z.; Wu X.; Leo P.J.; De Guzman E.; Akkoc N.; Breban M.; MacFarlane G.J.; Mahmoudi M.; Marzo-Ortega H.; Anderson L.K.; Wheeler L.; Chou C.-T.; Harrison A.A.; Stebbings S.; Jones G.T.; Bang S.-Y.; Wang G.; Jamshidi A.; Farhadi E.; Song J.; Lin L.; Li M.; Wei J.C.-C.; Martin N.G.; Wright M.J.; Lee M.; Wang Y.; Zhan J.; Zhang J.-S.; Wang X.; Jin Z.-B.; Weisman M.H.; Gensler L.S.; Ward M.M.; Rahbar M.H.; Diekman L.; Kim T.-H.; Reveille J.D.; Wordsworth B.P.; Xu H.; Brown M.A.Objective We sought to test the hypothesis that Polygenic Risk Scores (PRSs) have strong capacity to discriminate cases of ankylosing spondylitis (AS) from healthy controls and individuals in the community with chronic back pain. Methods PRSs were developed and validated in individuals of European and East Asian ethnicity, using data from genome-wide association studies in 15 585 AS cases and 20 452 controls. The discriminatory values of PRSs in these populations were compared with other widely used diagnostic tests, including C-reactive protein (CRP), HLA-B27 and sacroiliac MRI. Results In people of European descent, PRS had high discriminatory capacity with area under the curve (AUC) in receiver operator characteristic analysis of 0.924. This was significantly better than for HLA-B27 testing alone (AUC=0.869), MRI (AUC=0.885) or C-reactive protein (AUC=0.700). PRS developed and validated in individuals of East Asian descent performed similarly (AUC=0.948). Assuming a prior probability of AS of 10% such as in patients with chronic back pain under 45 years of age, compared with HLA-B27 testing alone, PRS provides higher positive values for 35% of patients and negative predictive values for 67.5% of patients. For PRS, in people of European descent, the maximum positive predictive value was 78.2% and negative predictive value was 100%, whereas for HLA-B27, these values were 51.9% and 97.9%, respectively. Conclusions PRS have higher discriminatory capacity for AS than CRP, sacroiliac MRI or HLA-B27 status alone. For optimal performance, PRS should be developed for use in the specific ethnic groups to which they are to be applied. © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Item Plain tobacco packaging: Progress, challenges, learning and opportunities(BMJ Publishing Group, 2022) Moodie C.; Hoek J.; Hammond D.; Gallopel-Morvan K.; Sendoya D.; Rosen L.; Mucan Özcan B.; Van Der Eijk Y.The aim of this paper is to overview progress made with respect to the adoption of plain (or standardised) packaging, key challenges faced, evaluative evidence and opportunities for extending this policy. It has been a decade since Australia became the first country to require tobacco products to be sold in plain packaging; after slow initial uptake, 16 countries have now fully implemented this policy. Since 2020, plain packaging laws have become more comprehensive in some countries, expanding coverage beyond traditional tobacco products to include heated tobacco, tobacco accessories (rolling papers) and other nicotine-containing products (e-cigarettes). Laws have also become more innovative: some now ban non-biodegradable filters, include provision for a periodic change of the pack colour or require both plain packaging and health-promoting pack inserts. The tobacco industry has and will continue to use multi-jurisdictional strategies to oppose this policy. Evaluations suggest that plain packaging has improved health outcomes and has not burdened retailers, although research is limited to early policy adopters and important gaps in the literature remain. While the power of packaging as a sales tool has diminished in markets with plain packaging, tobacco companies have exploited loopholes to continue to promote their products and have increasingly focused on filter innovations. Opportunities exist for governments to strengthen plain packaging laws. © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.