Journal articles on the topic 'Adjusted mean numbers'
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SHAH, AMI A., FREDRICK M. WIGLEY, and LAURA K. HUMMERS. "Telangiectases in Scleroderma: A Potential Clinical Marker of Pulmonary Arterial Hypertension." Journal of Rheumatology 37, no. 1 (December 1, 2009): 98–104. http://dx.doi.org/10.3899/jrheum.090697.
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Objective.Clinical markers are needed to identify scleroderma patients at risk for pulmonary arterial hypertension (PAH) since early therapy may improve survival. We investigated whether increased numbers of telangiectases in scleroderma associate with measures of pulmonary vascular disease.Methods.One hundred forty-seven consecutive adult patients with scleroderma were enrolled in this cross-sectional study and scored for the presence of matted telangiectases on 11 body areas. Per body area, telangiectases were scored as 0 if none were present, 1 if there were fewer than 10 telangiectases, and 2 if 10 or more telangiectases were counted. Linear regression analysis was performed to assess the association between right ventricular systolic pressure (RVSP) and telangiectasia score, adjusted for age, race, smoking status, scleroderma subtype, disease duration, and autoantibody status. Logistic regression analysis was performed with PAH by right-heart catheterization (RHC) as the dependent variable.Results.The mean telangiectasia score was 6.0 (SD 4.5, range 0–20). RVSP and telangiectasia score were positively correlated (r = 0.271, p = 0.001). The mean RVSP increased by 10.9 mm Hg for every 10-point increase in telangiectasia score (95% CI 3.6–18.3 mm Hg, p = 0.004), adjusted for potential confounders. The adjusted relative odds of PAH by RHC were 12.4 for patients with a 10-point increase in telangiectasia score (95% CI 1.78–85.9, p = 0.01).Conclusion.Increased numbers of telangiectases strongly associate with the presence of pulmonary vascular disease. Telangiectases may be a clinical marker of more widespread aberrant microvascular disease in scleroderma.
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Peque, Dennis. "On Using Adaptive Cluster Sampling Design in Forest Inventory: It's Implication to Forest Biodiversity Status Reporting." Science and Humanities Journal 9, no. 1 (December 1, 2009): 56–66. http://dx.doi.org/10.47773/shj.1998.091.5.
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This paper presents adaptive cluster sampling (ACS) as a method of assessing forest biodiversity. In this study, ACS was used to estimate the abundance of ecologically sparse population of Diospyros philippinensis (Desrousseaux) within the Visayas State University Forest Reserve. Its statistical efficiency were analyzed by comparing them to the conventional systematic sampling (Syst) estimator. Results indicated that adaptive cluster sampling (ACS) plots captured more trees into the sample compared to systematic sampling (Syst) plots. In addition, ACS estimates for mean and total numbers of individuals per ha was higher than systematic sampling estimates and in terms of variance ACS gave substantially lower variance than systematic sampling. However, the ratio of the adjusted SE of ACS to the adjusted SE of systematic sampling for each species and the combined data of the two species was generally lesser than 1 which means that ACS was not a better design than systematic sampling.
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Dommershuijsen, Lisanne J., Rikje Ruiter, Nicole S. Erler, Dimitris Rizopoulos, M. Arfan Ikram, and M. Kamran Ikram. "Peripheral Immune Cell Numbers and C-Reactive Protein in Parkinson’s Disease: Results from a Population-Based Study." Journal of Parkinson's Disease 12, no. 2 (February 15, 2022): 667–78. http://dx.doi.org/10.3233/jpd-212914.
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Background: The immune system is known to be involved in Parkinson’s disease (PD) pathogenesis, but the temporal relationship between peripheral immune responses and PD remains unknown. Objective: We determined the association between peripheral immune cell numbers, C-reactive protein (CRP), and prevalent as well as incident PD. Methods: This study was embedded in the population-based setting of the Rotterdam Study. We repeatedly measured peripheral immune cell numbers (differential leukocyte count and platelet count, granulocyte-to-lymphocyte ratio [GLR], platelet-to-lymphocyte ratio [PLR], and adapted systemic immune-inflammation index [adapted SII]) and CRP between 1990 and 2016. Participants were continuously followed-up for PD until 2018. We estimated the association of the markers with prevalent and incident PD using logistic regression models and joint models, respectively. Models were adjusted for age, sex, smoking, body mass index, and medication use. Odds ratios (OR) and hazard ratios (HR) are shown per doubling of the marker. Results: A total of 12,642 participants were included in this study. The mean age (standard deviation) was 65.1 (9.8) years and 57.5%were women. Participants with a higher lymphocyte count were less likely to have prevalent PD (adjusted OR: 0.34, 95%CI 0.17–0.68). Participants with a higher GLR, PLR, and adapted SII were more likely to have prevalent PD, but these effects were explained by the lymphocyte count. The peripheral immune cell numbers and CRP were not significantly associated with the risk of incident PD. Conclusion: We found participants with a higher lymphocyte count to be less likely to have prevalent PD, but we did not find an association between peripheral immune cell numbers nor CRP and the risk of incident PD.
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Cunha, Daniel de Noronha Figueiredo Vieira da, José Carlos Pereira, Fabyano Fonseca e. Silva, Oriel Fajardo de Campos, José Luis Braga, and Janaina Azevedo Martuscello. "Selection of models of lactation curves to use in milk production simulation systems." Revista Brasileira de Zootecnia 39, no. 4 (April 2010): 891–902. http://dx.doi.org/10.1590/s1516-35982010000400026.
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The objective of this study was to select models of lactation curves with a better adjustment to the observed data in models of milk production simulation systems. A data base on 6,459 recordings of daily milk production was used. These data were obtained from monthly and fortnightly controls of milk between 2004 and 2007, from 472 lactations of animals from ten different milking cow herd farms. Based on rolling averages of milk production (MP-L/day) per cow, the ten herd farms were divided into low (L < 15), medium (15 <M < 20) and high (H > 20). Data were also divided according to the lactation numbers in first, second, third or greater. Eight lactation curve models commonly used in literature were compared. The models were individually adjusted for each lactation. The goodness of fit used for comparison of those models was the coefficient of determination, mean square error, mean square prediction error and the Bayesian information criterion. The values for the goodness of fit obtained in each model were compared by using 95% probability confidence interval. Wilmink (1987) model showed a better adjustment for cows of the first lactation numbers, whereas the Wood (1967) model showed a better adjustment for cows of the third or greater lactations numbers for the low milk production groups. Wood model showed a better adjustment for all the lactation numbers for the medium milk production group. Dijkstra (1997) model showed a better adjustment for all lactation numbers for the high milk production group. Despite of being more recent, the model by Pollott (2000), mechanist based and with a higher number of parameters, showed a good convergence for the used data.
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Dilliwar, Leena, Med Ram Verma, Yash Pal Singh, Vijay Bahadur Sharma, Sanjay Kumar, and Ajay Shukla. "Nonlinear modelling of sheep and goat populations in India." Journal of Applied and Natural Science 8, no. 4 (December 1, 2016): 1766–69. http://dx.doi.org/10.31018/jans.v8i4.1037.
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The objective of this paper was to study the trend in population of sheep and goat populations during 1951 to 2012 in India. The data were compiled from various issues of BAHS (Basic Animal Husbandry Statistics) for the period 1951 to 2012. Different nonlinear growth models such as Parabolic/Sikka, Brody, Brody modified, Wood, Logistic and Gompertz models were fitted to the census data of sheep and goat population. The goodness of fit of the models was tested by Coefficient of determination (R2), Adjusted coefficient of determination (R2), Mean Square Error (MSE), Mean Absolute Error (MAE) and Akaike Information Criteria (AIC). The populations of sheep and goat in India during the year 1951 were 39.10 million and 47.20 million numbers respectively and reached 135.17 million and 65.06 million respectively in the year 2012. Based on the various measures of goodness of fit we observed that the Parabolic/Sikka model was the best fitted model for studying the pattern in the populations of sheep and goat in India. This model has been used to project the sheep and goat population in India during 2020, 2025 and 2030. If the present pattern of growth continued in near future then the projected sheep population will be 102.37 million numbers whereas goat population will be 151.57 million numbers in the year 2030. The present study will provide the pattern in which the changes have been observed in sheep and goat populations in India during 1951 to 2012.
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Mistry, Hema. "EXPLORING TWO COST-ADJUSTMENT METHODS FOR SELECTION BIAS IN A SMALL SAMPLE: USING A FETAL CARDIOLOGY DATASET." International Journal of Technology Assessment in Health Care 30, no. 3 (July 2014): 325–32. http://dx.doi.org/10.1017/s026646231400021x.
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Objectives: In economic evaluations of healthcare technologies, situations arise where data are not randomized and numbers are small. For this reason, obtaining reliable cost estimates of such interventions may be difficult. This study explores two approaches in obtaining cost estimates for pregnant women screened for a fetal cardiac anomaly.Methods: Two methods to reduce selection bias in health care: regression analyses and propensity scoring methods were applied to the total mean costs of pregnancy for women who received specialist cardiac advice by means of two referral modes: telemedicine and direct referral.Results: The observed total mean costs of pregnancy were higher for the telemedicine group than the direct referral group (4,918 versus 4,311 GBP). The regression model found that referral mode was not a significant predictor of costs and the cost difference between the two groups was reduced from 607 to 94 GBP. After applying the various propensity score methods, the groups were balanced in terms of sizes and compositions; and again the cost differences between the two groups were smaller ranging from -62 (matching “by hand”) to 333 GBP (kernel matching).Conclusions: Regression analyses and propensity scoring methods applied to the dataset may have increased the homogeneity and reduced the variance in the adjusted costs; that is, these methods have allowed the observed selection bias to be reduced. I believe that propensity scoring methods worked better for this dataset, because after matching the two groups were similar in terms of background characteristics and the adjusted cost differences were smaller.
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Mears, Alex, Tim Kendall, Cornelius Katona, Carole Pashley, and Sarah Pajak. "Retirement intentions of older consultant psychiatrists." Psychiatric Bulletin 28, no. 4 (April 2004): 130–32. http://dx.doi.org/10.1192/pb.28.4.130.
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Aims and MethodThis survey gathered data on the retirement intentions of consultant psychiatrists over the age of 50 years, in order to address retention issues. A questionnaire was sent to all 1438 consultants over this age in the UK.ResultsA total of 848 questionnaires were returned, an adjusted response rate of 59%. The mean age at which consultants intended to retire in this sample was 60 years (s.d. 4.16), suggesting a potential loss of 5725 consultant years. Reasons for early retirement are complex: factors encouraging retirement include too much bureaucracy, lack of free time and heavy case-loads; those discouraging retirement include enjoyment of work, having a good team and money. Mental Health Officer status is an important determinant in the decision to retire early.Clinical ImplicationsWith numerous vacancies in consultant psychiatrist posts throughout the UK, premature retirement is a cause for concern, possibly contributing to an overall reduction in consultant numbers of 5%. Addressing factors that influence consultants' decisions to leave the health service early should form an important part of an overall strategy to increase consultant numbers.
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Vecchi, Gabriel A., and Thomas R. Knutson. "Estimating Annual Numbers of Atlantic Hurricanes Missing from the HURDAT Database (1878–1965) Using Ship Track Density." Journal of Climate 24, no. 6 (March 15, 2011): 1736–46. http://dx.doi.org/10.1175/2010jcli3810.1.
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Abstract This study assesses the impact of imperfect sampling in the presatellite era (between 1878 and 1965) on North Atlantic hurricane activity measures and on the long-term trends in those measures. The results indicate that a substantial upward adjustment of hurricane counts may be needed prior to 1965 to account for likely “missed” hurricanes due to sparse density of reporting ship traffic. After adjusting for the estimate of missed hurricanes in the basin, the long-term (1878–2008) trend in hurricane counts changes from significantly positive to no significant change (with a nominally negative trend). The adjusted hurricane count record is more strongly connected to the difference between main development region (MDR) sea surface temperature (SST) and tropical-mean SST than with MDR SST. These results do not support the hypothesis that the warming of the tropical North Atlantic due to anthropogenic greenhouse gas emissions has caused Atlantic hurricane frequency to increase.
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Bloomfield, Katherine, Zhenqiang Wu, Annie Tatton, Cheryl Calvert, Nancye Peel, Ruth Hubbard, Hamish Jamieson, et al. "An interRAI derived frailty index predicts acute hospitalizations in older adults residing in retirement villages: A prospective cohort study." PLOS ONE 17, no. 3 (March 2, 2022): e0264715. http://dx.doi.org/10.1371/journal.pone.0264715.
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Objectives The development of frailty tools from electronically recorded healthcare data allows frailty assessments to be routinely generated, potentially beneficial for individuals and healthcare providers. We wished to assess the predictive validity of a frailty index (FI) derived from interRAI Community Health Assessment (CHA) for outcomes in older adults residing in retirement villages (RVs), elsewhere called continuing care retirement communities. Design Prospective cohort study. Setting and participants 34 RVs across two district health boards in Auckland, Aotearoa New Zealand (NZ). 577 participants, mean age 81 years; 419 (73%) female; 410 (71%) NZ European, 147 (25%) other European, 8 Asian (1%), 7 Māori (1%), 1 Pasifika (<1%), 4 other (<1%). Methods interRAI-CHA FI tool was used to stratify participants into fit (0–0.12), mild (>0.12–0.24), moderate (>0.24–0.36) and severe (>0.36) frail groups at baseline (the latter two grouped due to low numbers of severely frail). Primary outcome was acute hospitalization; secondary outcomes included long-term care (LTC) entry and mortality. The relationship between frailty and outcomes were explored with multivariable Cox regression, estimating hazard ratios (HRs) and 95% confidence intervals (95%CIs). Results Over mean follow-up of 2.5 years, 33% (69/209) of fit, 58% (152/260) mildly frail and 79% (85/108) moderate-severely frail participants at baseline had at least one acute hospitalization. Compared to the fit group, significantly increased risk of acute hospitalization were identified in mildly frail (adjusted HR = 1.88, 95%CI = 1.41–2.51, p<0.001) and moderate-severely frail (adjusted HR = 3.52, 95%CI = 2.53–4.90, p<0.001) groups. Similar increased risk in moderate-severely frail participants was seen in LTC entry (adjusted HR = 5.60 95%CI = 2.47–12.72, p<0.001) and mortality (adjusted HR = 5.06, 95%CI = 1.71–15.02, p = 0.003). Conclusions and implications The FI derived from interRAI-CHA has robust predictive validity for acute hospitalization, LTC entry and mortality. This adds to the growing literature of use of interRAI tools in this way and may assist healthcare providers with rapid identification of frailty.
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Taira, Kazuya, and Sumio Fujita. "Prediction of Age-Adjusted Mortality From Stroke in Japanese Prefectures: Ecological Study Using Search Engine Queries." JMIR Formative Research 6, no. 1 (January 20, 2022): e27805. http://dx.doi.org/10.2196/27805.
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Background Stroke is a major cause of death and the need for nursing care in Japan, with large regional disparities. Objective The purpose of this study was to clarify the association between stroke-related information retrieval behavior and age-adjusted mortality in each prefecture in Japan. Methods Age-adjusted mortality from stroke and aging rates were obtained from publicly available Japanese government statistics. A total of 9476 abstracts of Japanese articles related to symptoms and signs of stroke were identified in Ichushi-Web, a Japanese web-based database of biomedical articles, and 100 highly frequent words (hereafter referred to as the Stroke 100) were extracted. Using data from 2014 to 2019, a random forest analysis was carried out using the age-adjusted mortality from stroke in 47 prefectures as the outcome variable and the standardized retrieval numbers of the Stroke 100 words in the log data of Yahoo! JAPAN Search as predictive variables. Regression analysis was performed using a generalized linear mixed model (GLMM) with the number of standardized searches for Stroke 100 words with high importance scores in the random forest model as the predictive variable. In the GLMM, the aging rate and data year were used as control variables, and the random slope of data year and random intercept were calculated by prefecture. Results The mean age-adjusted mortality from stroke was 28.07 (SD 4.55) deaths per 100,000 for all prefectures in all data years. The accuracy score of the random forest analysis was 89.94%, the average error was 2.79 degrees, and the mean squared error was 13.57 degrees. The following 9 variables with high importance scores in the random forest analysis were selected as predictive variables for the regression analysis: male, age, hospitalization, enforcement, progress, stroke, abnormal, use, and change. As a result of the regression analysis with GLMM, the standardized partial regression coefficients (β) and 95% confidence intervals showed that the following internet search terms were significantly associated with age-adjusted mortality from stroke: male (β=−5.83, 95% CI −8.67 to −3.29), age (β=−5.83, 95% CI −8.67 to −3.29), hospitalization (β=−5.83, 95% CI −8.67 to −3.29), and abnormal (β=3.83, 95% CI 1.14 to 6.56). Conclusions Stroke-related search behavior was associated with age-adjusted mortality from stroke in each prefecture in Japan. Query terms that were strongly associated with age-adjusted mortality rates of stroke suggested the possibility that individual characteristics, such as sex and age, have an impact on stroke-associated mortality and that it is important to receive medical care early after stroke onset. Further studies on the criteria and timing of alerting are needed by monitoring information-seeking behavior to identify queries that are strongly associated with stroke mortality.
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Cepeda-Vega, Andrés, Rafael Amaya-Gómez, Miguel Asuaje, Carlos Torres, Carlos Valencia, and Nicolás Ratkovich. "Pipeline Two-Phase Flow Pressure Drop Algorithm for Multiple Inclinations." Processes 10, no. 5 (May 19, 2022): 1009. http://dx.doi.org/10.3390/pr10051009.
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A Generalized Additive Model (GAM) is proposed to predict the pressure drop in a gas–liquid two-phase flow at horizontal, vertical, and inclined pipes based on 21 different dimensionless numbers. It is fitted from 4605 points, considering a fluid pattern classification as Annular, Bubbly, Intermittent, and Segregated. The GAM non-parametric method reached high prediction capacity and allowed a great degree of interpretability (i.e., it helped to visualize and test statistical inference), considering that each predictor’s marginal effects could be described, unlike in other Machine Learning (ML) methods. The prediction capacity of the GAM model for the pressure gradient obtained an adjusted R2 and a mean relative error of 99.1% and 12.93%, respectively. This capacity is maintained even when ignoring Bubbly flow in the training sample. A regularization technique to filter some variables was used, but most of the predictors must maintain the model’s high predictive ability. For example, dimensionless numbers such as the Reynolds, Froude, and Weber numbers show p-values of less than 0.01% to explain the pressure gradient in the different flow patterns. The model performs adequately on 500 randomly sampled data points not used to fit the model with an error lower than 15%. The variable importance for the model and the relationship with the pressure gradient is evaluated based on the obtained splines and p-values.
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Chung, Daniel, and Georgios Matheou. "Large-Eddy Simulation of Stratified Turbulence. Part I: A Vortex-Based Subgrid-Scale Model." Journal of the Atmospheric Sciences 71, no. 5 (April 28, 2014): 1863–79. http://dx.doi.org/10.1175/jas-d-13-0126.1.
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Abstract The stretched-vortex subgrid-scale (SGS) model is extended to enable large-eddy simulation of buoyancy-stratified turbulence. Both stable and unstable stratifications are considered. The extended model retains the anisotropic form of the original stretched-vortex model, but the SGS kinetic energy and the characteristic SGS eddy size are modified by buoyancy subject to two constraints: first, the SGS kinetic energy dynamics is determined by stationary and homogeneous conditions, and second, the SGS eddy size obeys a scaling analogous to the Monin–Obukhov similarity theory. The SGS model construction, comprising an ensemble of subgrid stretched-vortical structures, naturally limits vertical mixing but allows horizontal mixing provided the alignment of the SGS vortex ensemble is favorable, even at high nominal gradient Richardson numbers. In very stable stratification, the model recovers the z-less limit, in which a vortex-based Obukhov length controls the SGS dynamics, while in very unstable stratification, the model recovers the free-convection limit, in which a vortex-based Deardorff velocity controls the SGS dynamics. The efficacy of the present SGS model is demonstrated by simulating the canonical stationary and homogeneous, stratified sheared turbulence at high Reynolds numbers and moderately high Richardson numbers. In the postprocessing, the SGS dynamics of the stretched-vortex model is further interrogated to yield predictions of buoyancy-adjusted one-dimensional SGS spectra and SGS root-mean-square velocity-derivative fluctuations.
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Dajsakdipon, Thanate, Jitprapa Konmun, Umaporn Udomsubpayakul, and Thitiya Dejthevaporn. "Real World Experience of Long Term Treatment Outcome in Hormone Receptor-positive Metastatic Breast Cancer with or without Everolimus and Exemestane after Prior Aromatase Inhibitor." Asian Pacific Journal of Cancer Care 6, no. 2 (May 6, 2021): 149–58. http://dx.doi.org/10.31557/apjcc.2021.6.2.149-158.
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Background: Everolimus/exemestane has been shown to improve progression-free survival in patients with endocrine-resistant metastatic breast cancer. The regimen has been well-accepted despite lack of survival benefit. In real-life setting, patients were not well-selected and hence benefit of such treatment may not be as robust. Method: This is a retrospective review of 143 hormone receptor (HR) positive, HER-2 negative MBC patients who progressed on nonsteroidal aromatase inhibitors. Patients who received everolimus/exemestane in any treatment lines (EE group) were compared to patients who never received everolimus (NE group). Primary end point was survival adjusted to prognostic factors. Results: There were 52 patients in EE group and 91 in NE group with mean age of 58.6 years. Median follow-up time was 51 months. Unadjusted median OS was significantly longer in EE [33 vs 25 months, HR 0.66 (95%CI 0.44-0.998); p = 0.049]. In univariate analysis, factors affecting survival included numbers of metastatic sites, bone metastasis, EE treatment and numbers of treatment lines. Independent factors that remained significant in multivariate analysis were treatment lines [HR 0.71 (95%CI 0.63-0.79); p < 0.05] and numbers of metastatic sites. Median numbers of treatment line after NSAI failure was 5.2 vs 3.6 lines in EE and NE, respectively.Conclusion: In this real-life practice data, pts with HR positive, HER-2 negative MBC who had progressed on NSAI, sequential use of multiple treatment regimens of endocrine and chemotherapy is essential to longer survival. Everolimus/exemestane may have contributed, to a lesser extent, to this improvement in survival.
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Merry, A. F., D. A. Sidebotham, N. G. Middleton, M. V. Calder, and C. S. Webster. "Tenoxicam 20 mg or 40 mg after Thoracotomy: A Prospective, Randomized, Double-blind, Placebo-controlled Study." Anaesthesia and Intensive Care 30, no. 2 (April 2002): 160–66. http://dx.doi.org/10.1177/0310057x0203000206.
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Forty-five adults undergoing thoracotomy were randomized to receive placebo, tenoxicam 20 mg or tenoxicam 40 mg IV during chest wall closure. All patients received intraoperative fentanyl and intercostal blocks followed by morphine by patient-controlled analgesia. Patient numbers 13 to 45 also received thoracic epidural analgesia by continuous infusion of bupivacaine 0.125%, patient numbers 25 to 45 having fentanyl 2 μg/ml added to the epidural infusion. Efficacy parameters and adverse reactions were assessed over the first 24 hours postoperatively. On a 100 mm visual analogue scale, mean (SD) pain at rest (adjusted area under curve for hours 1 to 24) was 25.8 (12.5), 17.4 (14.8) and 16.5 (13.3) mm for groups receiving placebo, 20 mg and 40 mg tenoxicam, respectively (ANOVA: P< 0.05). There were no significant differences between study groups postoperatively in pain on coughing, opioid consumption, blood gas measurements, nausea, vomiting, sedation, blood loss, haemoglobin or serum creatinine. One patient in each tenoxicam group reported epigastric pain, rated moderate. These data support the inclusion of tenoxicam 20 mg IV in the management of pain at rest for patients undergoing thoracotomy, but do not show additional benefit for a higher dose.
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Neale, Christopher D., Pernille E. Christensen, Christian Dall, Charlotte Suppli Ulrik, Nina Godtfredsen, and Henrik Hansen. "Sleep Quality and Self-Reported Symptoms of Anxiety and Depression Are Associated with Physical Activity in Patients with Severe COPD." International Journal of Environmental Research and Public Health 19, no. 24 (December 14, 2022): 16804. http://dx.doi.org/10.3390/ijerph192416804.
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Sleep quantity, quality and symptoms of depression or anxiety potentially affect the level of daily physical activity (PAL) and plausibly counteracts benefits from pulmonary rehabilitation programs. Their collective impact on PAL is sparsely investigated, particularly in patients with severely progressed chronic obstructive pulmonary disease (COPD). Aim: To investigate if sleep quantity, quality and symptoms from self-reported hospital anxiety and depression scores (HADS) are associated with PAL. Methods: In this exploratory cross-sectional study data were analysed from 148 participants with COPD; GOLD grade II-IV; GOLD group B to D (52% female, mean 69.7 ± SD of 8.4 years, FEV1% predicted 33.6 ± 10.9, 6MWD 327 ± 122 m, CAT 20 ± 7 points), eligible for conventional outpatient hospital-based pulmonary rehabilitation. Participants had sleep and PAL measured 24 h per day for five consecutive days with an activPAL monitor. Adjusted negative binomial regression was applied to investigate the associations with PAL. Results: Participants walked median (25th, 75th percentile) of 2358 (1325.75; 3822.25) steps per day and 14% walked >5000 steps per day on average. Time in bed (TIB) were a median (25th, 75th percentile) of 8.3 (7.1; 9.7) hours and numbers of nocturnal sleeping bouts (NSB) were 1.5 (0.8; 3), Anxiety (HADS-A) and depression (HADS-D) scores were median (25th, 75th percentile) of 5 (3; 8) points and 3 (2; 6) points, respectively, whereof 29% (HADS-A) and 15% (HADS-D) reported scores ≥8 points indicating significant symptoms. The fully adjusted rate ratio (RR) for steps per day for TIB (hours) [RR 0.97 (95% CI: 0.92; 1.02)], NSB (numbers) [RR 1.02 (95% CI: 0.97; 1.07)] were not significantly associated with number of steps per day, while there was a significantly association with number of steps per day for HADS-A [RR 1.04 (95% CI: 1.01; 1.07)] and HADS-D [RR 0.95 (95% CI: 0.91; 0.99)]. Conclusion: This exploratory cross-sectional study found a statistically significant association between HADS-A and HADS-D with numbers of steps per day in patients with severe COPD.
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Greenwood, Emma, Cassandra Dickson, and William van Wettere. "Feeding Strategies Before and at Mixing: The Effect on Sow Aggression and Behavior." Animals 9, no. 1 (January 11, 2019): 23. http://dx.doi.org/10.3390/ani9010023.
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Hierarchy formation in domestic sows results in aggression and stress, which might be ameliorated through nutritional satiety. The effect on aggression in group housed, gestating sows provided a standard or high volume of a “standard” diet, or diet enhanced with lignocellulose before, at, and after mixing was studied. Ninety-six Large White cross Landrace weaned sows were allocated to: control diet (CON), high volume diet (HI), and lignocellulose-enhanced diet before and at mixing (LC), and after mixing (LCM) (24 sows per treatment). Sows were housed in stalls for 10 days before mixing, when the CON, HI, and LCM groups were fed a standard diet, and in the LC group, a diet enhanced with lignocellulose at 2.5% was given. At mixing, the CON group continued on a standard diet at 2.5 kg/sow per day, HI were fed the standard diet at 4 kg/sow per day for the first four days and 2.5 kg/sow per day thereafter, and LC and LCM were fed the lignocellulose-enhanced diet at 2.5 kg/sow per day. Behavior, salivary cortisol concentrations, lesion number, and condition were recorded on M0, M1, M6, and M14. Reproduction was assessed using pregnancy rate and progesterone measurements. There were several treatment effects on aggression in the sows following mixing. There were significantly lower fight numbers (CON = 0.34 ± 0.03 Log (1 + x) transformed mean and SEM (1.49 untransformed adjusted mean), LC = 0.31 ± 0.04 (1.14), LCM = 0.42 ± 0.04 (0.28), HI = 0.35 ± 0.04 (1.64); p = 0.001) and longer individual fight durations in the LCM group compared to the CON and LC group (CON = 0.88 s ± 0.07 Log transformed mean and SEM (10.31 s, untransformed adjusted mean), LC = 0.89 ± 0.09 (13.51), LCM = 1.16 ± 0.07 (21.43), HI = 01.03 ± 0.07 (16.42); p = 0.04), and overall higher injury numbers in the LC and LCM groups than the HI. Time spent eating was significantly lower in the CON group than both HI and LC (CON = 7.79 ± 0.37, LC = 8.91 ± 0.38, LCM = 8.49 ± 0.42, HI = 9.55 ± 0.39; p = 0.007). The time spent drinking was also affected by treatment, with more time spent drinking in CON than LC (p = 0.024). The condition score of the sows was affected by diet, with higher condition scores in the HI group than LCM and LC (CON = 2.98 ± 0.11, LC = 2.75 ± 0.10, LCM = 2.74 ± 0.10, HI = 3.12 ± 0.10; p = 0.017). These results suggest that feeding a diet containing 2.5% lignocellulose and a standard diet at a high feeding level for four days post-mixing may affect overall aggression and possibly satiety levels. Our data found decreased fight numbers and increased fight duration in the LCM compared to the LC treatment, and therefore, feeding the fiber source before mixing affects aggression levels differently than when fed just after mixing. A further understanding of different fiber sources and how their physiochemical properties affect digestion and sow satiety would enable critical evaluation and use of fiber sources for benefits in reducing aggression at mixing.
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Cheung, Johnny T. K., Ruby Yu, and Jean Woo. "Is polypharmacy beneficial or detrimental for older adults with cardiometabolic multimorbidity? Pooled analysis of studies from Hong Kong and Europe." Family Practice 37, no. 6 (June 29, 2020): 793–800. http://dx.doi.org/10.1093/fampra/cmaa062.
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Abstract Background Physicians often prescribe high numbers of medications for managing multiple cardiometabolic diseases. It is questionable whether polypharmacy (concurrent use of five or more medications) is beneficial or detrimental for older adults with cardiometabolic multimorbidity (co-occurrence of two or more diseases). Objective To examine combined effects of multimorbidity and polypharmacy on hospitalization and frailty and to determine whether effect sizes of polypharmacy vary with numbers of cardiometabolic diseases Methods We pooled longitudinal data of community-dwelling older adults in Hong Kong, Israel, and 17 European countries. They completed questionnaires for baseline assessment from 2015 to 2018 and reassessment at 1–2-year follow-up. We performed regression analyses to address the objective. Results Among 44 818 participants (mean age: 69.6 years), 28.3% had polypharmacy and 34.8% suffered from cardiometabolic multimorbidity. Increased risks of hospitalization and worsening frailty were found in participants with ‘multimorbidity alone’ [adjusted odds ratio (AOR) 1.10 and 1.26] and ‘polypharmacy alone’ (AOR 1.57 and 1.68). With ‘multimorbidity and ‘polypharmacy’ combined, participants were not at additive risks (AOR 1.53 and 1.47). In stratified analysis, with increasing numbers of cardiometabolic diseases, associations of polypharmacy with hospitalization and frailty were attenuated but remained statistically significant. Conclusion Polypharmacy is less detrimental, yet still detrimental, for older adults living with cardiometabolic multimorbidity. Physicians should optimize prescription regardless of the number of diseases. Health policymakers and researchers need to consider their interrelationship in hospitalization risk predictions and in developing frailty scales.
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Fang, Jiajie, Xuanli Xu, Qiqi Mao, Yufan Ying, Xu Zhang, and Liping Xie. "Lower circulating adiponectin is associated with higher risk of renal cell carcinoma: A meta-analysis." International Journal of Biological Markers 35, no. 1 (January 24, 2020): 57–64. http://dx.doi.org/10.1177/1724600819898696.
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Background: Changes in circulating adiponectin have been related to the risks of various cancers. However, the association between circulating adiponectin and the risk of renal cell carcinoma has not been fully determined. A meta-analysis was performed to evaluate the relationship between circulating adiponectin and renal cell carcinoma risk. Methods: Observational studies that evaluated the association between circulating adiponectin and renal cell carcinoma risk were identified via a systematic search of PubMed and Embase databases. The difference between circulating adiponectin in renal cell carcinoma cases and healthy controls, and the multivariable adjusted association between circulating adiponectin and renal cell carcinoma risk were evaluated. A random effects model was used if significant heterogeneity existed; otherwise a fixed effects model was applied. Results: Eight case-control studies with 2624 renal cell carcinoma cases and 2904 healthy controls were included. Pooled results showed that circulating adiponectin was significantly lower in renal cell carcinoma cases than in healthy controls (mean difference = −1.08 ug/mL; 95% confidence interval (CI) −1.62, −0.54; P < 0.001). Higher circulating adiponectin was independently associated with a significantly lowered risk of renal cell carcinoma (adjusted odds ratio for 1 SD increment of adiponectin = 0.78; 95% CI: 0.63, 0.96; P = 0.02). Subgroup analyses according to characteristics including study design, ethnics of participants, blood samples, numbers of participants, mean ages of participants, and study quality showed consistent results. Conclusions: Lower circulating adiponectin is associated with increased risk of renal cell carcinoma. The potential pathophysiological mechanisms underlying the role of circulating adiponectin in the pathogenesis of renal cell carcinoma deserve further investigation.
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Boasson, Rosalinda, and Michael Shaw. "The effects of heat shock and inoculum density on growth and sporulation in axenic cultures of the flax rust fungus." Canadian Journal of Botany 66, no. 1 (January 1, 1988): 189–93. http://dx.doi.org/10.1139/b88-030.
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The number of mycelial colonies of Melampsora lini (Ehrenb.) Lév. was increased by a 2-h heat shock at 31 °C delivered 3 h after uredospores were seeded on a liquid medium at 17 ± 0.5 °C under axenic conditions. At 35–38 days from seeding, the ratio of the respective number of colonies in shock and nonshock treatments in 125-mL culture flasks was highest (7.5 to 22) at inoculum levels (1 to 4 × 103 uredospores cm−2) that yielded about 10 colonies per flask without heat shock; the ratio declined sharply at inoculum levels adjusted to yield either smaller or larger numbers of colonies per flask without heat shock. Sporulation (extinction at 458 nm) and protein per colony were positively correlated; were not directly affected by heat shock; were determined by colony number; increased to maxima as mean colony number per flask increased from 1 or less to from 10 to 100 in different experiments; and decreased at higher colony numbers per flask. The results indicate that heat shock promotes the initiation of colonies; that colony number determines the duration of logarithmic growth; and that increasing competition among individual colonies is the primary factor limiting growth and sporulation, whether or not the uredospore germlings are subjected to heat shock.
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Noergard, P., L. Raff, U. Poulsgaard, L. Eriksen, and T. M. Soeland. "Mean chewing time in horses fed different forages supplemented with concentrates." BSAP Occasional Publication 34 (2006): 131–34. http://dx.doi.org/10.1017/s1463981500042370.
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SummaryA 3 x 3 Latin square design was conducted with 3 trotters (mean weight 510 kg) fed concentrates supplemented with 5.0 kg wrap bale grass silage (WS), 7.0 kg mixed hay (H) or 6.0 kg barley straw (BS) daily. Amounts of concentrates were adjusted to cover maintenance energy requirements together with forage. Concentrates, WS, H and BS had 86, 80, 86, and 87% DM with 350, 560, 610 and 740 g NDF/kg DM, and 190, 350, 390 and 490 g ADF/kg DM, respectively. Forages and concentrates were fed twice daily, but during the 4 experimental days, the horses had access to one quarter of the daily forage ration for 60 minutes at 9 am, 11 am, 1 pm and 3 pm. Forages not eaten within each of the four meals were recorded and fed again at 4 pm. Eating behaviour was observed and jaw moments (JM) recorded from 7 am to 4 pm by measuring pressure oscillations (PO) in a tube filled with water positioned around the mouth. Effective time spent chewing (ECT) and the numbers of jaw movements (JM) were identified from the manual observations and JM with exclusion of small pauses without mastication. The number of JM, the effective chewing rate and the ECT values per kg forage DM, forage NDF and forage ADF differed significantly (P<0.01) between forages and between forages and concentrates (P<0.01). The mean ECT values ranged from 50±4.7 minutes per kg WS dry matter to 100±4.7 minutes per kg BS dry matter, and from 90± 6 minutes per kg WS NDF to 135±6 minutes per kg BS NDF. The highest chewing rate (1.45±0.06 Hz) was found during concentrate meals and the lowest during BS meals (1.20±0.05 Hz). The horses spent more time eating (min/kg NDF) forages compared with values reported from cattle eating forages, whereas the total ECT values of 90 to 135 minutes chewing time per kg NDF in horses range from 60 to 90% of the time dairy cows to spent masticating during eating plus ruminating.
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McCarthy, Robert J., Katarina G. Ivankovich, Emily A. Ramirez, Ashley M. Adams, Arjun K. Ramesh, Philip A. Omotosho, and Asokumar Buvanendran. "Association of the addition of a transversus abdominis plane block to an enhanced recovery program with opioid consumption, postoperative antiemetic use, and discharge time in patients undergoing laparoscopic bariatric surgery: a retrospective study." Regional Anesthesia & Pain Medicine 45, no. 3 (January 12, 2020): 180–86. http://dx.doi.org/10.1136/rapm-2019-101009.
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BackgroundIncreasing numbers of laparoscopic bariatric surgeries are being performed and enhanced recovery from anesthesia and surgery (ERAS) protocols have been implemented to optimize care for these patients. We evaluated the effects of an anesthesiologist placed preoperative transversus abdominis plane block (TAP) as part of a bariatric surgery ERAS protocol. We hypothesized that an anesthesiologist placed preoperative TAP added to an ERAS protocol following laparoscopic bariatric surgery would reduce total opioid consumption.MethodsA retrospective cohort of consecutive patients between January 1, 2017 and December 31, 2018 at a single large tertiary care center studied. TAP blocks were added to the ERAS protocol beginning in the second quarter of 2017. The primary outcome was total opioid analgesia use in mg oral morphine equivalents. Secondary outcomes were antiemetics administered and length of hospitalization. Data were analyzed using a generalized linear mixed model adjusted for sociodemographic, surgical, and preoperative risk factors that have been associated with opioid and antiemetic use and length of hospitalization.ResultsFive hundred and nine cases were analyzed; TAP blocks were performed in 94/144 (65%) laparoscopic Roux-en-Y gastric bypass (LRYGB) and in 172/365 (47%) laparoscopic sleeve gastrectomy (LSG) patients. Mean (95% CI) adjusted total opioid administered was lower by 11% (1% to 19%, p=0.02), antiemetic drug administration was lower by 15% (-2% to 25%, p=0.06) and discharge time lower by 39% (26% to 48%, p<0.01) following LRYGB in the TAP group. Mean (95% CI) adjusted total opioid administered was lower by 9% (2% to 16%, p<0.01), antiemetic drug administration was lower by 11% (3% to 18%, p<0.01) and discharge time lower by 11% (2% to 18%, p=0.02) following LSG in the TAP group.ConclusionsTAP blocks added to a laparoscopic bariatric surgery ERAS protocol were associated with decreased total opioid use, number of antiemetic treatments, and length of stay; however, these changes were not likely clinically important. Our findings do not support widespread clinical benefit of TAP use in ERAS protocols for laparoscopic bariatric surgery.
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Mansor, Elliza, Norliza Ahmad, Diana Raj, Nor Afiah Mohd Zulkefli, and Zalilah Mohd Shariff. "Predictors of Parental Barriers to Reduce Excessive Child Screen Time Among Parents of Under-Five Children in Selangor, Malaysia: Cross-sectional Study." Journal of Medical Internet Research 23, no. 4 (April 13, 2021): e25219. http://dx.doi.org/10.2196/25219.
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Background Globally, there is an increasing prevalence of excessive screen time exposure among young children, including in Malaysia. Parents are advised to limit this exposure, but there are barriers for many of them to follow this recommendation. To date, there is a lack of research on the factors that cause these parental barriers. Objective This study aimed to determine the parental barrier toward the reduction of excessive child screen time and its predictors among parents of children aged younger than 5 years in the Petaling District, Selangor, Malaysia. Methods A cross-sectional study was conducted from April 2019 to June 2020 among 789 parent-child dyads attending child health clinics in the Petaling District. Validated self-administered questionnaires were used to capture information on sociodemographic, parental, child-related, and environmental factors and parental barriers. Stratified sampling with probability proportionate to size was employed. Data were analyzed using SPSS Statistics version 25 (IBM Corp). Descriptive analysis and bivariable analysis were performed before multiple linear regression was used to identify predictors of parental barriers. Results The overall mean score of parental barriers was 3.51 (SD 0.83), indicating that the average numbers of barriers experienced by parents were more than 3. The multivariable analysis showed that the predictors of parental barriers included monthly household income (adjusted β=–.03, 95% CI –0.05 to –0.02), parents who worked in public sectors (adjusted β=.18, 95% CI 0.06 to 0.29), positive parental attitude on screens (adjusted β=.68, 95% CI 0.58 to 0.79), low parent self-efficacy to influence child’s physical activity (adjusted β=–.32, 95% CI –0.43 to –0.20), and child screen time (adjusted β=.04, 95% CI 0.02 to 0.06). Conclusions The strongest predictor of parental barriers to reduce excessive child screen time was the positive parental attitude on screen time which could contribute to their abilities to limit child screen time. Thus, future intervention strategies should aim to foster correct parental attitudes toward screen time activities among young children.
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Kearsley-Fleet, L., E. Baildam, M. Beresford, H. Foster, T. Southwood, W. Thomson, and K. Hyrich. "POS1292 REAL-WORLD EFFECTIVENESS OF ETANERCEPT AND ADALIMUMAB IN CHILDREN AND YOUNG PEOPLE WITH JUVENILE IDIOPATHIC ARTHRITIS (JIA) WITHOUT UVEITIS." Annals of the Rheumatic Diseases 80, Suppl 1 (May 19, 2021): 927.1–927. http://dx.doi.org/10.1136/annrheumdis-2021-eular.186.
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Background:Biologic therapies have revolutionised treatment pathways and outcomes for patients with juvenile idiopathic arthritis (JIA). Although there is a choice of approved TNF inhibitors available as a first biologic, there lacks data to inform treatment choices in clinical practice.Objectives:To compare short-term outcomes on etanercept and adalimumab in children and young people with JIA without uveitis, including drug survival, arthritis disease activity and function ability at 1 year.Methods:All patients starting a first biologic (etanercept/adalimumab including biosimilars) from 2010 in the UK JIA biologic registers (BCRD and BSPAR ETN) were included. Those with systemic JIA or with any history of uveitis were excluded. Data were collected at start of therapy, 6 months, 1 year, and then annually, including patient demographic, disease activity and drug therapy. In this analysis, drug survival and arthritis disease activity / function ability at 1 year (range 3-15 months) were investigated; comparing between therapies using logistic / linear regression, adjusted for propensity deciles.Results:There were 550 patients with outcome data available (to 30 Sept 2020); 384 etanercept, 166 adalimumab. At registration, 68% female, median age 12 years old (IQR 8-14), median disease duration 1 year (IQR 1-4), 72% on concomitant methotrexate. Disease activity was similar between both therapies at baseline and one year. At one year, 70% were still on biologic therapy; most stopping therapy for ineffectiveness (45%), adverse events (31%), or patient / family choice (15%). Inactive disease and minimal disease activity was achieved in 26% and 46% respectively, 48% achieved a minimally clinical important improvement in their functional ability (CHAQ improvement >0.13).All PatientsAdalimumabEtanerceptN550166384Females68%59%71%Age (years), median (IQR)12 (8-14)12 (10-14)11 (8-14)Disease duration (years), median (IQR)1 (1-4)1 (0-3)1 (1-4)ILARPersistent oligo9%6%11%Extended oligo20%14%23%RF negative37%32%39%RF positive11%11%12%Psoriatic5%8%4%Enthesitis-related16%27%11%Undifferentiated1%2%1%Concomitant oral steroids16%20%15%Concomitant methotrexate72%84%66%Follow-up time, yearsMedian (IQR)2.5 (1.4-3.8)2.1 (1.2-3.1)3.0 (1.6-4.0)Min-Max0.4 - 8.20.4 - 7.30.4 - 8.2Drug SurvivalStill on drug at one year70%67%71%Still on drug at two years47%50%46%CHAQBaseline, mean (SE)0.9 (0.04)0.8 (0.06)1.0 (0.04)One Year, mean (SE)0.7 (0.03)0.5 (0.06)0.7 (0.04)Change, mean (SE)-0.2 (0.04)-0.2 (0.06)-0.2 (0.04)Regression coef (95% CI)--0.09 (-0.2, 0.04)RefPD Adjusted coef (95% CI)--0.08 (-0.2, 0.07)RefMCID (CHAQ)Proportion achieved48%48%48%OR (95% CI)-1.0 (0.6, 1.5)RefPD Adjusted OR (95% CI)-1.2 (0.8, 1.9)RefJADASBaseline, mean (SE)14 (0.4)14 (0.7)14 (0.4)One Year, mean (SE)5 (0.3)4 (0.5)6 (0.3)Change, mean (SE)-9 (0.4)-9 (0.7)-8 (0.5)Regression coef (95% CI)--1.1 (-2.3, -0.01)*RefPD Adjusted coef (95% CI)--1.0 (-2.8, 0.8)RefInactive Disease (JADAS<1)Proportion achieved26%32%24%OR (95% CI)-1.5 (1.0, 2.4)RefPD Adjusted OR (95% CI)-1.5 (0.9, 2.4)RefMinimal Disease Activity (MDA) [excludes enthesitis-related JIA]N=473N=121N=352Proportion achieved46%49%45%OR (95% CI)-1.2 (0.8, 1.9)RefPD Adjusted OR (95% CI)-1.2 (0.8, 2.0)RefChildhood Health Assessment Questionnaire (CHAQ), confidence interval (CI), International League Against Rheumatism (ILAR), interquartile range (IQR), odds ratio (OR), propensity decile (PD), rheumatoid factor (RF), standard error (SE). *p<0.05Conclusion:This is the first comparative effectiveness analysis of adalimumab and etanercept within UK children receiving TNFi therapies for JIA. Despite large patient numbers, there was no evidence of difference between adalimumab and etanercept regarding arthritis disease control or treatment persistence. For children without uveitis, both adalimumab and etanercept can be considered as effective treatment options for children and young people with JIA.Disclosure of Interests:None declared
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Leung, Luke K. P., and Luke K. P. Leung. "Ecology of Australian tropical rainforest mammals. III. The Cape York rat, Rattus leucopus (Muridae : Rodentia)." Wildlife Research 26, no. 3 (1999): 317. http://dx.doi.org/10.1071/wr96044.
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This is the first detailed ecological study of the Cape York rat, Rattus leucopus, a small rodent found on the Cape York Peninsula, North Queensland, Australia. A total of 296 animals was captured 1135 times in rainforest at Iron Range during a capture–mark–recapture study from 1989 to 1991. Compared with other native species of Rattus in more variable habitats, populations of R. leucopus were relatively stable: adjusted mean numbers on the traplines exhibited a 2.3–2.6-fold change. This stability may be related to the apparently more stable food supply in tropical rainforest. Evidence from this study indicates that populations are limited by food availability: male reproductive condition peaked in December when fruit availability was high; and mean population abundance significantly increased in moist areas where food supply was apparently higher. R. leucopus was nocturnal, terrestrial, omnivorous, and nested communally in burrows. Breeding occurred throughout the study. Young became trappable at the age of 22 days. Reproductive maturity was reached at the age of three months. Females gave birth to their first litters when they were at least four months old, and continued to breed into their second or third year.
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Inobhas, Abhibol, Sunee Chansangpetch, Anita Manassakorn, Visanee Tantisevi, and Prin Rojanapongpun. "Effect of oral statin use on mitomycin-C augmented trabeculectomy outcomes." PLOS ONE 16, no. 1 (January 15, 2021): e0245429. http://dx.doi.org/10.1371/journal.pone.0245429.
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Purpose The effect of statins on wound healing is controversial, and their effect on trabeculectomy outcomes remains unclear. This study aimed to examine the relationship between oral statin use and trabeculectomy outcomes. Methods Medical records of patients who underwent primary mitomycin-C augmented trabeculectomy with 2 years of follow-up were reviewed. Pre- and postoperative intraocular pressures (IOP) and numbers of medications, subconjunctival 5-fluorouracil (5-FU) injections, and bleb-needling procedures were compared between statin users and nonusers. Failure was defined as an eye that failed to achieve a 20% lowering of IOP from baseline or had an IOP > 21 mm Hg, as well as an eye that required further surgical intervention, developed hypotony, or had no light perception visual acuity. Results In total, 158 subjects were enrolled, with 47 eyes from statin users and 111 eyes from statin nonusers. The 24-month cumulative probability of failure was 78.7% for statin users and 60.4% for nonusers (P = .013). Cox proportional-hazards modeling showed a significantly higher hazard risk in statin users (adjusted hazard ratio 1.61, P = .026). There were no significant between-group differences in mean IOPs or number of medications (both P > .05) at 24 months. Multivariable Poisson regression analysis that statin use was associated with increased numbers of 5-FU injections (P = .014) and bleb-needling procedures (P = .031). Conclusions This study demonstrated that oral statin use was associated with higher rates of trabeculectomy failure and increased numbers of 5-FU injections and bleb-needling procedures.
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Stirland, Lucy E., Sarah Gregory, Tom C. Russ, Craig W. Ritchie, and Graciela Muniz-Terrera. "Associations between midlife chronic conditions and medication use with anxiety and depression: A cross-sectional analysis of the PREVENT Dementia study." Journal of Comorbidity 10 (January 1, 2020): 2235042X2092044. http://dx.doi.org/10.1177/2235042x20920443.
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Background: Multimorbidity including physical and mental illness is increasing in prevalence. We aimed to investigate the associations between physical conditions and medication use with anxiety and depression in midlife. Methods: We conducted an observational cross-sectional study of volunteers in the PREVENT Dementia study. Using logistic and linear regression, we investigated the association between increasing numbers of self-reported chronic physical conditions and medications with self-reported depression and anxiety disorder, and scores on the Center for Epidemiologic Studies Depression (CES-D) scale and Spielberger State-Trait Anxiety Inventory (STAI) state subtest. Results: Of the 210 participants, 148 (71%) were women and 188 (90%) Caucasian. The mean age was 52 (standard deviation (SD) = 5.5) years. The mean number of physical conditions was 2.2 (SD = 1.9) and medications 1.7 (SD = 2.2). Each additional physical condition was associated with increased odds of self-reported depression (odds ratio (OR) 1.41, 95% confidence interval (CI) 1.11–1.80; p = 0.004, adjusted for age and gender) and anxiety disorder (OR 1.70, 95% CI 1.30–2.37; p < 0.001). Increasing medication use was associated with self-reported depression (adjusted OR per additional medication 1.35, 95% CI 1.08–1.71; p = 0.008) but not anxiety disorder. For each additional condition, CES-D scores increased by 0.72 (95% CI 0.11–1.33; p = 0.020) and for each extra medication, by 0.88 (95% CI 0.32–1.44; p = 0.002). There was no significant association between increasing conditions and medications with STAI scores. In models accounting for antidepressant use, all associations were attenuated. Conclusions: Having more physical conditions is associated with anxiety and depression in midlife, and taking more medications is associated with depression but not anxiety.
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Ferree, David C., and Garth A. Cahoon. "Influence of Leaf to Fruit Ratios and Nutrient Sprays on Fruiting, Mineral Elements, and Carbohydrates of Apple Trees." Journal of the American Society for Horticultural Science 112, no. 3 (May 1987): 445–49. http://dx.doi.org/10.21273/jashs.112.3.445.
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Abstract For 5 years, the leaf to fruit ratios of mature ‘Golden Delicious’ (Malus domestica Borkh.) apple trees on M.9 rootstock with declining leaf N levels and fruit size were adjusted to low, medium, or high levels of leaves per fruit, 2 weeks after bloom, coupled with 8 weekly foliar sprays of urea, phosphorus-potassium-sulfur (PKS), or urea plus PKS beginning at pink. No interaction occurred between the leaf : fruit ratios and foliar sprays. Mean leaf N over 5 years was slightly reduced when the crop was adjusted to high numbers of leaves: fruit and increased by urea or PKS foliar sprays. The only effect of adjustment in leaf: fruit ratio or foliar nutrients on nonstructural carbohydrate (NSC) levels was an increase in leaf NSC in 1978-1980. As the number of leaves per fruit increased, the percentage of the total harvest in the larger size classes increased with corresponding decrease in the smaller size classes. Total yield per tree, fruit firmness, and russeting were not influenced by adjusting the leaf : fruit ratio, while soluble solids were increased and fruit color decreased at the high level of leaves per fruit. Foliar urea sprays increased the percentage of fruit in the largest size class, yield per tree, fruit firmness, soluble solids, color, and the amount of russet.
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Gordon, Louisa, Catherine Olsen, David C. Whiteman, Thomas M. Elliott, Monika Janda, and Adele Green. "Prevention versus early detection for long-term control of melanoma and keratinocyte carcinomas: a cost-effectiveness modelling study." BMJ Open 10, no. 2 (February 2020): e034388. http://dx.doi.org/10.1136/bmjopen-2019-034388.
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ObjectiveTo compare the long-term economic impact of melanoma prevention by sun protection, with the corresponding impact of early detection of melanoma to decrease melanoma deaths.DesignCost-effectiveness analysis using Markov cohort model. Data were primarily from two population-based randomised controlled trials, epidemiological and costing reports, and included flow-on effects for keratinocyte cancers (previously non-melanoma skin cancers) and actinic keratoses.SettingQueensland, Australia.ParticipantsMen and women with a mean age 50 years modelled for 30 years.InterventionsDaily sunscreen use (prevention) compared with annual clinical skin examinations (early detection) and comparing these in turn with the status quo.Primary and secondary outcomesCosts, counts of melanoma, melanoma deaths, keratinocyte cancers, life years and quality-adjusted life years.ResultsPer 100 000 individuals, for early detection, primary prevention and without intervention, there were 2446, 1364 and 2419 new melanomas, 556, 341 and 567 melanoma deaths, 64 452, 47 682 and 64 659 keratinocyte cancers and £493.5, £386.4 and £406.1 million in economic costs, respectively. There were small differences between prevention and early detection in life years saved (0.09%) and quality-adjusted life years gained (0.10%).ConclusionsCompared with early detection of melanoma, systematic sunscreen use at a population level will prevent substantial numbers of new skin tumours, melanoma deaths and save healthcare costs. Primary prevention through daily use of sunscreen is a priority for investment in the control of melanoma.
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Haines, S. N. M., and S. A. Shields. "The Determination of Diesel Engine Friction Characteristics by Electronic Cylinder Disablement." Proceedings of the Institution of Mechanical Engineers, Part A: Journal of Power Engineering 203, no. 2 (May 1989): 129–38. http://dx.doi.org/10.1243/pime_proc_1989_203_017_02.
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The use of electronically controlled unit injectors on a high-speed direct injection diesel engine has allowed the development of a new technique for measuring motoring losses. The digital engine controller is programmed to skip successive numbers of injections in a specific circulating sequence, while dynamometer load is adjusted to maintain the desired speed. The linearity between required brake torque and the proportion of disabled to normal injection cycles permits extrapolation of results to find the negative load that would be required to motor the engine at that speed. The method appears to yield more reliable results than traditional approaches, and gives hot motoring values of mean effective torque without the need for external heating or a motoring facility. The equipment and method involved are described, and readings obtained for the whole speed range are presented. These are correlated with losses estimated from pressure measurements, and compared with friction characteristics produced by alternative techniques.
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CUTTLE, S. P., R. V. SCURLOCK, and B. M. S. DAVIES. "A 6-year comparison of nitrate leaching from grass/clover and N-fertilized grass pastures grazed by sheep." Journal of Agricultural Science 131, no. 1 (August 1998): 39–50. http://dx.doi.org/10.1017/s0021859698005565.
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Nitrate leaching was measured over a 3-year period from rotationally grazed perennial ryegrass (Lolium perenne L.) pasture receiving 200 kg fertilizer-N/ha and from similarly grazed ryegrass/white clover (Trifolium repens L.) pasture that received no N fertilizer. The results are discussed together with those from the same plots in the preceding 3 years when they were stocked continuously. Under both managements, the numbers of grazing sheep were adjusted on the basis of the quantity of herbage available on the plots. During the whole 6 years, mean nitrate concentrations in soil water collected by porous cup samplers remained below the European Union limit of 11·3 mg N/l except for the fertilized grass plots in year 5 of the study. Quantities of nitrate leached ranged from 6 to 34 kg/ha per year from the grass/clover plots and 2·46 kg/ha from the fertilized plots. Leaching losses from both types of pasture were positively correlated with the numbers of lamb grazing days in the later part of the grazing season. This relationship and the high spatial variability associated with the measurements indicated that N derived from excreta was the main source of leached nitrate. It was concluded that, where pastures of equal productivity are compared, similar quantities of N are likely to be leached from grass/clover swards as from grass swards receiving N fertilizer.
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Lee, Wonik, Charles Spiekerman, Masahiro Heima, Hafsteinn Eggertsson, Gerald Ferretti, Peter Milgrom, and Suchitra Nelson. "The Effectiveness of Xylitol in a School-Based Cluster-Randomized Clinical Trial." Caries Research 49, no. 1 (November 21, 2014): 41–49. http://dx.doi.org/10.1159/000360869.
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Objective: The purpose of this double-blind, cluster-randomized clinical trial was to examine the effects of xylitol gummy bear snacks on dental caries progression in primary and permanent teeth of inner-city school children. Methods: A total of 562 children aged 5-6 years were recruited from five elementary schools in East Cleveland, Ohio. Children were randomized by classroom to receive xylitol (7.8 g/day) or placebo (inulin fiber 20 g/day) gummy bears. Gummy bears were given three times per day for the 9-month kindergarten year within a supervised school environment. Children in both groups also received oral health education, toothbrush and fluoridated toothpaste, topical fluoride varnish treatment and dental sealants. The numbers of new decayed, missing, and filled surfaces for primary teeth (dmfs) and permanent teeth (DMFS) from baseline to the middle of 2nd grade (exit exam) were compared between the treatment (xylitol/placebo) groups using an optimally-weighted permutation test for cluster-randomized data. Results: The mean new d3-6mfs at the exit exam was 5.0 ± 7.6 and 4.0 ± 6.5 for the xylitol and placebo group, respectively. Similarly, the mean new D3-6MFS was 0.38 ± 0.88 and 0.48 ± 1.39 for the xylitol and placebo group, respectively. The adjusted mean difference between the two groups was not statistically significant: new d3-6mfs: mean 0.4, 95% CI -0.25, 0.8), and new D3-6MFS: mean 0.16, 95% CI -0.16, 0.43. Conclusion: Xylitol consumption did not have additional benefit beyond other preventive measures. Caries progression in the permanent teeth of both groups was minimal, suggesting that other simultaneous prevention modalities may have masked the possible beneficial effects of xylitol in this trial. © 2014 S. Karger AG, Basel
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Rukuni, Ruramayi, Celia Gregson, Cynthia Kahari, Farirayi Kowo, Grace McHugh, Shungu Munyati, Hilda Mujuru, et al. "The IMpact of Vertical HIV infection on child and Adolescent SKeletal development in Harare, Zimbabwe (IMVASK Study): a protocol for a prospective cohort study." BMJ Open 10, no. 2 (February 2020): e031792. http://dx.doi.org/10.1136/bmjopen-2019-031792.
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IntroductionThe scale-up of antiretroviral therapy (ART) across sub-Saharan Africa (SSA) has reduced mortality so that increasing numbers of children with HIV (CWH) are surviving to adolescence. However, they experience a range of morbidities due to chronic HIV infection and its treatment. Impaired linear growth (stunting) is a common manifestation, affecting up to 50% of children. However, the effect of HIV on bone and muscle development during adolescent growth is not well characterised. Given the close link between pubertal timing and musculoskeletal development, any impairments in adolescence are likely to impact on future adult musculoskeletal health. We hypothesise that bone and muscle mass accrual in CWH is reduced, putting them at risk of reduced bone mineral density (BMD) and muscle function and increasing fracture risk. This study aims to determine the impact of HIV on BMD and muscle function in peripubertal children on ART in Zimbabwe.Methods and analysisChildren with (n=300) and without HIV (n=300), aged 8–16 years, established on ART, will be recruited into a frequency-matched prospective cohort study and compared. Musculoskeletal assessments including dual-energy X-ray absorptiometry, peripheral quantitative computed tomography, grip strength and standing long jump will be conducted at baseline and after 1 year. Linear regression will be used to estimate mean size-adjusted bone density and Z-scores by HIV status (ie, total-body less-head bone mineral content for lean mass adjusted for height and lumbar spine bone mineral apparent density. The prevalence of low size-adjusted BMD (ie, Z-scores <−2) will also be determined.Ethics and disseminationEthical approval for this study has been granted by the Medical Research Council of Zimbabwe and the London School of Hygiene and Tropical Medicine Ethics Committee. Baseline and longitudinal analyses will be published in peer-reviewed journals and disseminated to research communities.
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Yoon, Minjae, Pil-Sung Yang, Eunsun Jang, Hee Tae Yu, Tae-Hoon Kim, Jae-Sun Uhm, Jong-Youn Kim, et al. "Improved Population-Based Clinical Outcomes of Patients with Atrial Fibrillation by Compliance with the Simple ABC (Atrial Fibrillation Better Care) Pathway for Integrated Care Management: A Nationwide Cohort Study." Thrombosis and Haemostasis 119, no. 10 (July 2, 2019): 1695–703. http://dx.doi.org/10.1055/s-0039-1693516.
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Background An integrated care approach might be of benefit for clinical outcomes of patients with atrial fibrillation (AF). This study evaluated whether compliance with the Atrial fibrillation Better Care (ABC) pathway for integrated care management (“A” Avoid stroke; “B” Better symptom management; “C” Cardiovascular risk and Comorbidity optimization) would improve population-based clinical outcomes in a nationwide AF cohort. Methods and Results From the Korea National Health Insurance Service database, a total of 204,842 nonvalvular AF patients were enrolled between January 1, 2005 and December 31, 2015. Patients that fulfilled all criteria of the ABC pathway were defined as the “ABC” group, and those who did not were the “Non-ABC” group.Over a mean follow-up of 6.2 ± 3.5 years, the ABC pathway compliant group had lower rates of all-cause death (0.80 vs. 2.72 per 100 person-years, p < 0.001) and the composite outcome of “death, ischemic stroke, major bleeding, and myocardial infarction” (2.34 vs. 5.92 per 100 person-years, p < 0.001) compared with the Non-ABC compliant group. Adjusted Cox multivariable regression showed that the ABC group had a significantly lower risk of all-cause death (adjusted hazard ratio [HR] 0.82; 95% confidence interval [CI], 0.78–0.86) and the composite outcome (adjusted HR 0.86; 95% CI, 0.83–0.89). With the increasing numbers of ABC pathway criteria fulfilled, the risk of all-cause death and composite outcome were progressively lowered. Conclusion In the first study of a nationwide population cohort, we show that compliance with the simple ABC pathway is associated with improved clinically relevant outcomes of patients with AF. Given the high health care burden associated with AF, such a streamlined holistic approach to AF management should be implemented, to improve the care of such patients.
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Soares, Mario, Yun Zhao, Emily Calton, Kaveri Pathak, Wendy Chan She Ping-Delfos, Nicola Cummings, and Patience Nsatimba. "The Impact of the Metabolic Syndrome and Its Components on Resting Energy Expenditure." Metabolites 12, no. 8 (August 5, 2022): 722. http://dx.doi.org/10.3390/metabo12080722.
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We determined whether metabolic syndrome (MetS) and the increasing number of its components influenced the resting energy expenditure (REE). Data on adult men (n = 72, 40%) and women (n = 108, 60%) from European (n = 154, 86%) and Sub-Saharan African (n = 26, 14%) ancestry were used. Ninety-five (53%) participants had MetS (MetS+), while 85 (47%) were without MetS (MetS−). REE was determined through indirect calorimetry, body composition by DEXA, and clinical biochemistry by standard laboratory techniques. MetS+ had a significantly higher REE (mean ± se: MetS+: 5995 ± 87.3 vs. MetS−: 5760 ± 86.3 kJ/d, p = 0.025) when adjusted for age, gender, fat mass (FM), fat-free mass (FFM), ethnicity, season, 25OHD, insulin sensitivity, and time of data collection. Within each MetS status group, an increase in the number of components (C) resulted in a stepwise increase in REE. Relative to zero components, those with 1C had adjusted REE higher by +526 ± 248.1 kJ/d (p = 0.037), while 2C were higher than 1C by +298 ± 140.8 kJ/d (p = 0.037). Similarly, relative to 3C, those with 4C had REE higher by +242 ± 120.7 kJ/d (p = 0.049). The higher REE of 5C over 4C by 132 ± 174.5 kJ/d did not achieve statistical significance. MetS was associated with a significantly higher REE. This greater energetic cost varied directly with the numbers of its components but was most evident in those not diagnosed with the syndrome.
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Sugiharto, Sugiharto, and Deny Setiawan. "Pemanfaatan Bonus Demografi melalui Peningkatan Indeks Pembangunan Manusia di Sumatera Utara." JUPIIS: JURNAL PENDIDIKAN ILMU-ILMU SOSIAL 7, no. 1 (July 1, 2015): 1. http://dx.doi.org/10.24114/jupiis.v7i1.2268.
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This writing aims to gain the picture of profile in using of demographic bonus through increasing Human Development Index in the North Sumatra Province. It focus on local policy in utilizing the demographic bonus through elevating Human Development Index on several sectors such as education, health, and economy. Education sector coverage two indicators following Adult Literacy Rate Index (Lit) and Mean Years of Schooling Index (MYS). The population in this research is the citizen’s age group of 15 and more due to in fact that there many student dropout from the age group. The limitation is required for gain the representative number which is represents the fact, considering that citizen age group lower than 15 is still in schooling or preparing to school so it not apropriate to relying the years of schooling. Health sector indicate the numbers of years of life which is hopefully can be enjoyed by the citizens in an area by entering information regarding annual birth rate and death rate (variable e₀), that assumed represents average of age of life and citizen healthy in their life. Economic sector (Proper Life Standard), the profile uses the average of the real per capita expenditure which is adjusted (adjusted real per capita expenditure) or purchasing power parity. Based on study of the three of human development index, can be obtained the data concerning the factual picture of local government profile in utilizing demographic bonus.
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Jun, Se-Ran, L. Joseph Su, Eryn Matich, and Ping-Ching Hsu. "Abstract 3680: Distinctive metabolomics profiles associated with African American current smokers who have high aggressive prostate cancer." Cancer Research 82, no. 12_Supplement (June 15, 2022): 3680. http://dx.doi.org/10.1158/1538-7445.am2022-3680.
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Abstract Background: Smoking has not been an established risk factor for prostate cancer (PCa), and has not been emphasized in PCa prevention. However, recent studies have shown increasing evidence that there is a higher risk of biochemical recurrence, PCa mortality, and metastasis among current smokers, presenting an urgent need in re-evaluating the association between smoking and aggressive PCa. This study aimed to determine whether smoking increase the likelihood of developing a more aggressive prostate cancer. Methods: Equal numbers of African Americans (AAs) and European Americans (EAs) by smoking status (never/former/current) matched with PCa aggressiveness, BMI, 5-year age group, and year of baseline recruitment, totaling 480 participants, were included in the metabolomics study. For metabolomics analysis, fold change and BH-adjusted p-value from t-test adjusted for age for univariate analysis, and PCA adjusted for age and PLS-DA supervised statistical analysis for multivariate analysis were employed to decipher the underlying metabolomic patterns, and identify significantly dysregulated metabolites for the variables of interest. Results: AA participants were significantly younger (mean=61.4, SD=7.7) compared with EAs (mean=63.5, SD=7.5). Current smokers had a 2.4 times higher risk of high aggressive PCa. When stratified by race, the risk diminished for EAs but increased for AAs. Global metabolic profiles detected a total of 1,487 compounds of known identity. After excluding metabolites with missing values in more than 20% of the samples and with small standard variation, we observed a distinct cluster of participants from AA aggressive PCa patients and current smokers that were separated from EAs and never smokers. With BH-adjusted p-value < 0.05 and fold change > 2, we identified 10 significantly dysregulated metabolites between AA and EA among high aggressive PCa and current smokers. Further, 36 metabolites between current and never smokers among AA high aggressive PCa were significantly dysregulated, but none of them are annotated as tobacco metabolites. Conclusion: Our study presented distinctive metabolomics profiles specific to AA current smokers who had high aggressive PCa. Furthermore, the distinctive patterns were not driven by the tobacco metabolites, with the potential to identify metabolites that might help to understand the relationships between smoking and aggressive PCa in AA. Citation Format: Se-Ran Jun, L. Joseph Su, Eryn Matich, Ping-Ching Hsu. Distinctive metabolomics profiles associated with African American current smokers who have high aggressive prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3680.
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Omori, Ryosuke, Nico Nagelkerke, and Laith J. Abu-Raddad. "HIV and herpes simplex virus type 2 epidemiological synergy: misguided observational evidence? A modelling study." Sexually Transmitted Infections 94, no. 5 (December 4, 2017): 372–76. http://dx.doi.org/10.1136/sextrans-2017-053336.
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ObjectivesTo investigate whether observational studies of HIV and herpes simplex virus type 2 (HSV-2) infections have the capacity to assess the HIV/HSV-2 epidemiological synergy.MethodsAn individual-based Monte Carlo model was used to simulate HIV/HSV-2 epidemics in two scenarios: no HIV/HSV-2 biological interaction and HSV-2 seropositivity enhancing HIV acquisition. Cross-sectional observational studies were simulated by sampling individuals from the population to assess resulting crude and adjusted ORs of the HIV/HSV-2 association. Meta-analyses were conducted to estimate the pooled mean ORs. Impact of under-reporting of sexual behaviour and miscapture of high-risk individuals was assessed through sensitivity analyses.ResultsAssuming no HIV/HSV-2 biological interaction, the crude HIV/HSV-2 OR ranged between 1.38 and 9.93, with a pooled mean of 6.45 (95% CI 5.81 to 7.17). Adjustment for the number of sexual partners over last year, over lifetime and for both partner numbers simultaneously reduced the mean OR to 5.45 (95% CI 4.90 to 6.06), 3.70 (95% CI 3.32 to 4.12) and 3.54 (95% CI 3.17 to 3.94), respectively. Assuming HIV/HSV-2 biological interaction, the crude OR ranged between 3.44 and 9.95, with a pooled mean of 8.05 (95% CI 7.14 to 9.07). The adjustments reduced the mean OR to 7.00 (95% CI 6.21 to 7.90), 3.76 (95% CI 3.32 to 4.25) and 3.68 (95% CI 3.25 to 4.17), respectively. Under-reporting of partners reduced the confounder-adjustment effects. Miscapture of high-risk individuals considerably lowered the estimated ORs.ConclusionsIt is difficult to control for sexual-behaviour confounding in observational studies. The observed HIV/HSV-2 association appears more consistent with two infections sharing the same mode of transmission, rather than with HSV-2 enhancing HIV acquisition.
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Meacock, Rachel, Laura Anselmi, Søren Rud Kristensen, Tim Doran, and Matt Sutton. "Higher mortality rates amongst emergency patients admitted to hospital at weekends reflect a lower probability of admission." Journal of Health Services Research & Policy 22, no. 1 (July 8, 2016): 12–19. http://dx.doi.org/10.1177/1355819616649630.
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Objective Patients admitted as emergencies to hospitals at the weekend have higher death rates than patients admitted on weekdays. This may be because the restricted service availability at weekends leads to selection of patients with greater average severity of illness. We examined volumes and rates of hospital admissions and deaths across the week for patients presenting to emergency services through two routes: (a) hospital Accident and Emergency departments, which are open throughout the week; and (b) services in the community, for which availability is more restricted at weekends. Method Retrospective observational study of all 140 non-specialist acute hospital Trusts in England analyzing 12,670,788 Accident and Emergency attendances and 4,656,586 emergency admissions (940,859 direct admissions from primary care and 3,715,727 admissions through Accident and Emergency) between April 2013 and February 2014.Emergency attendances and admissions to hospital and deaths in any hospital within 30 days of attendance or admission were compared for weekdays and weekends. Results Similar numbers of patients attended Accident and Emergency on weekends and weekdays. There were similar numbers of deaths amongst patients attending Accident and Emergency on weekend days compared with weekdays (378.0 vs. 388.3). Attending Accident and Emergency at the weekend was not associated with a significantly higher probability of death (risk-adjusted OR: 1.010). Proportionately fewer patients who attended Accident and Emergency at weekend were admitted to hospital (27.5% vs. 30.0%) and it is only amongst the subset of patients attending Accident and Emergency who were selected for admission to hospital that the probability of dying was significantly higher at the weekend (risk-adjusted OR: 1.054). The average volume of direct admissions from services in the community was 61% lower on weekend days compared to weekdays (1317 vs. 3404). There were fewer deaths following direct admission on weekend days than weekdays (35.9 vs. 80.8). The mortality rate was significantly higher at weekends amongst direct admissions (risk-adjusted OR: 1.212) due to the proportionately greater reduction in admissions relative to deaths. Conclusions There are fewer deaths following hospital admission at weekends. Higher mortality rates at weekends are found only amongst the subset of patients who are admitted. The reduced availability of primary care services and the higher Accident and Emergency admission threshold at weekends mean fewer and sicker patients are admitted at weekends than during the week. Extending services in hospitals and in the community at weekends may increase the number of emergency admissions and therefore lower mortality, but may not reduce the absolute number of deaths.
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Wouters, Loes, Dorien Zwart, Carmen Erkelens, Esther de Groot, Roger Damoiseaux, Arno Hoes, and Frans Rutten. "Chest discomfort at night and risk of acute coronary syndrome: cross-sectional study of telephone conversations." British Journal of General Practice 70, suppl 1 (June 2020): bjgp20X711317. http://dx.doi.org/10.3399/bjgp20x711317.
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BackgroundDuring telephone triage it is difficult to assign the adequate urgency to patients with chest discomfort. Considering the time of calling could be helpful.AimTo assess the risk of acute coronary syndrome (ACS) in certain time periods and whether sex influences this risk.MethodCross-sectional study of 1,655 recordings of telephone conversations of patients who called the out-of-hours services primary care (OHS-PC) for chest discomfort. Call time, patient characteristics, symptoms, medical history and urgency allocation of the triage conversations were collected. The final diagnosis of each call was retrieved at the patient’s general practice. Absolute numbers of patients with and without ACS were plotted and risks per hour were calculated. The risk ratio of ACS at night (0 am to 9 am) was calculated by comparing to the risk at other hours, and was adjusted for gender and age.ResultsThe mean age of callers was 58.9 (SD ± 19.5) years, 55.5% were women and in total, 199 (12.0%) had an ACS. The crude risk ratio for an ACS at night was 1.80 (CI = 1.39 to 2.34, P<0.001); 2.33 (1.68 to 3.22, P<0.001) for men, and 1.29 (0.83 to 1.99, P = 0.256) for women. The adjusted risk ratio for ACS of all people at night was 1.82 (1.07 to 3.10, P = 0.039).ConclusionPatients calling the OHS-PC for chest discomfort between 0–9 am have almost twice a higher risk of ACS than those calling other hours, a phenomenon more evident in men than in women. At night, dispatching ambulances more ‘straightaway’ could be considered for these patients with chest discomfort.
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Van De Weg, F. B., D. A. W. M. Van Der Windt, and A. C. Vahl. "Wound healing: Total contact cast vs. custom-made temporary footwear for patients with diabetic foot ulceration." Prosthetics and Orthotics International 32, no. 1 (January 1, 2008): 3–11. http://dx.doi.org/10.1080/03093640701318672.
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The objective of this study was to compare the effectiveness of irremovable total-contact casts (TCC) and custom-made temporary footwear (CTF) to heal neuropathic foot ulcerations in individuals with diabetes. In this prospective clinical trial, 43 patients with plantar ulcer Grade 1 or 2 (Wagner scale) were randomized to one of two off-loading modalities: TCC or CTF. Outcomes assessed were wound surface area reduction (cm2) and time to wound healing (days) at 2, 4, 8 and 16 weeks. To evaluate safety, possible side effects were recorded at each follow-up visit. The results showed no significant difference in wound surface area reduction (adjusted for baseline wound surface) at 2, 4, 8 or 16 weeks (adjusted mean difference 0.10 cm2; 95% CI −0.92−0.72 at 16 weeks). At 16 weeks, 12 patients had a completely healed ulcer, 6 per group. The median time to healing was shorter for the patients using a cast (52 vs. 90 days, p = 0.26). Five patients with TCC and two with CTF developed device-related complications. It was concluded that: (i) the rate of wound healing is not significantly different for patients treated with CTF or TCC. The difference in wound surface area was small and not significant at any time during follow-up; and (ii) the difference in healing time (38 days) may have attained statistical significance if the numbers in these sub-groups (2×6) had been higher. Since there appears to be little difference in effectiveness between both off-loading modalities, further investigation into the benefits of CTF is warranted.
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Bonell, Chris, Elizabeth Allen, Emily Warren, Jennifer McGowan, Leonardo Bevilacqua, Farah Jamal, Zia Sadique, et al. "Modifying the secondary school environment to reduce bullying and aggression: the INCLUSIVE cluster RCT." Public Health Research 7, no. 18 (October 2019): 1–164. http://dx.doi.org/10.3310/phr07180.
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Background Bullying, aggression and violence among children and young people are some of the most consequential public mental health problems. Objectives The INCLUSIVE (initiating change locally in bullying and aggression through the school environment) trial evaluated the Learning Together intervention, which involved students in efforts to modify their school environment using restorative approaches and to develop social and emotional skills. We hypothesised that in schools receiving Learning Together there would be lower rates of self-reported bullying and perpetration of aggression and improved student biopsychosocial health at follow-up than in control schools. Design INCLUSIVE was a cluster randomised trial with integral economic and process evaluations. Setting Forty secondary schools in south-east England took part. Schools were randomly assigned to implement the Learning Together intervention over 3 years or to continue standard practice (controls). Participants A total of 6667 (93.6%) students participated at baseline and 5960 (83.3%) students participated at final follow-up. No schools withdrew from the study. Intervention Schools were provided with (1) a social and emotional curriculum, (2) all-staff training in restorative approaches, (3) an external facilitator to help convene an action group to revise rules and policies and to oversee intervention delivery and (4) information on local needs to inform decisions. Main outcome measures Self-reported experience of bullying victimisation (Gatehouse Bullying Scale) and perpetration of aggression (Edinburgh Study of Youth Transitions and Crime school misbehaviour subscale) measured at 36 months. Intention-to-treat analysis using longitudinal mixed-effects models. Results Primary outcomes – Gatehouse Bullying Scale scores were significantly lower among intervention schools than among control schools at 36 months (adjusted mean difference –0.03, 95% confidence interval –0.06 to 0.00). There was no evidence of a difference in Edinburgh Study of Youth Transitions and Crime scores. Secondary outcomes – students in intervention schools had higher quality of life (adjusted mean difference 1.44, 95% confidence interval 0.07 to 2.17) and psychological well-being scores (adjusted mean difference 0.33, 95% confidence interval 0.00 to 0.66), lower psychological total difficulties (Strengths and Difficulties Questionnaire) score (adjusted mean difference –0.54, 95% confidence interval –0.83 to –0.25), and lower odds of having smoked (odds ratio 0.58, 95% confidence interval 0.43 to 0.80), drunk alcohol (odds ratio 0.72, 95% confidence interval 0.56 to 0.92), been offered or tried illicit drugs (odds ratio 0.51, 95% confidence interval 0.36 to 0.73) and been in contact with police in the previous 12 months (odds ratio 0.74, 95% confidence interval 0.56 to 0.97). The total numbers of reported serious adverse events were similar in each arm. There were no changes for staff outcomes. Process evaluation – fidelity was variable, with a reduction in year 3. Over half of the staff were aware that the school was taking steps to reduce bullying and aggression. Economic evaluation – mean (standard deviation) total education sector-related costs were £116 (£47) per pupil in the control arm compared with £163 (£69) in the intervention arm over the first two facilitated years, and £63 (£33) and £74 (£37) per pupil, respectively, in the final, unfacilitated, year. Overall, the intervention was associated with higher costs, but the mean gain in students’ health-related quality of life was slightly higher in the intervention arm. The incremental cost per quality-adjusted life year was £13,284 (95% confidence interval –£32,175 to £58,743) and £1875 (95% confidence interval –£12,945 to £16,695) at 2 and 3 years, respectively. Limitations Our trial was carried out in urban and periurban settings in the counties around London. The large number of secondary outcomes investigated necessitated multiple statistical testing. Fidelity of implementation of Learning Together was variable. Conclusions Learning Together is effective across a very broad range of key public health targets for adolescents. Future work Further studies are required to assess refined versions of this intervention in other settings. Trial registration Current Controlled Trials ISRCTN10751359. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 7, No. 18. See the NIHR Journals Library website for further project information. Additional funding was provided by the Educational Endowment Foundation.
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Panjabi, Sumeet, May Hagiwara, and Thomas E. Delea. "Healthcare Utilization (HRU) and Costs Among Multiple Myeloma (MM) Patients (Pts) Receiving Second or Subsequent Line Treatment (Tx) with Carfilzomib (CAR) or Pomalidomide (POM)." Blood 128, no. 22 (December 2, 2016): 2419. http://dx.doi.org/10.1182/blood.v128.22.2419.2419.
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Abstract Background A recent retrospective study compared healthcare outcomes and costs in pts with MM receiving CAR or POM using health insurance claims data and reported that CAR pts had higher healthcare costs than POM pts (Parikh ASCO 2016). The results of this analysis have not been confirmed by other investigators. Objective To compare HRU and costs among pts receiving monotherapy with CARor POM +/-dexamethasone (dex) as 2nd or subsequent Tx for MM in the US using a health insurance claims database. Methods This was a retrospective observational study using the MarketScan® database. Pts were adults with MM (ICD-9-CM code 203.0) who initiated MM Tx, including CAR, POM, bortezomib, lenalidomide, thalidomide, and other chemotherapies (CT) for MM, between Jan 1, '06 and Dec 31, '14. Pts were excluded for (1) Receipt of a MM Tx before the first MM diagnosis date (Dx date) (2) enrollment gap during the 180-days before Dx date, or between Dx date and the first day on Tx, or the 30 days after Tx initiation, or (3) age <18 y at Tx initiation. Medical/pharmacy claims for MM Tx including CT were tracked for each pt since Tx initiation. After initiation of a first treatment, subsequent lines of therapy (LOT) were identified based on evidence of a new Tx after 90 days since LOT initiation, or >90-day gap in Tx. For each pt with ≥1 CAR or POM LOT, the first LOT with CAR or POM was defined as the index LOT. The date of initiation of this LOT was defined as index date. Pts with CAR or POM as 1st line Tx or in combination with other CT (excluding dex) or with stem cell transplant (SCT) during the index LOT were excluded. Monthly HRU and costs during the index LOT (total, on Tx, off Tx) were compared for pts receiving monotherapy (+/- dex) with CAR vs. POM using inverse probability of treatment weights (IPTW) to obtain average treatment effect (ATE) estimates controlling for measured baseline covariates. IPTWs were based on propensity scores for receipt of CAR estimated by logistic regression with LOT, age, sex, region, plan type, Charlson index, comorbidities, pre-index healthcare cost, and receipt of prior SCT as covariates. Results We identified 114 CAR and 144 POM pts. CAR pts were more likely to receive index Tx in 2nd vs. subsequent LOT, initiate LOT after 2013, be male, and have chronic renal disease, anemia, and diabetes. POM pts were more likely to have prior SCT, chronic pain, and coronary heart disease. Based on examination of standardized differences, IPTW samples were well balanced in baseline characteristics. IPTW adjusted mean monthly total healthcare costs were $19,776 with POM vs. $17,321 with CAR (difference=-$2,455, p=0.52) (Table). Consistent with its mode of administration, the adjusted mean monthly numbers of visits and costs of Tx administration were greater for CAR. The adjusted mean monthly number prescriptions (Rx) were greater for POM vs. CAR. Otherwise, there were no statistically significant differences between groups in adjusted mean monthly total HRU and costs. Conclusions IPTW-adjustedmonthlyHRU and costs do not vary significantly for pts receiving monotherapy with CAR or POM +/- dex for 2nd or subsequent line Tx for MM. To avoid potential bias, treatment comparisons using real world evidence require consideration of patient characteristics that may influence treatment choices and outcomes. Disclosures Panjabi: Amgen, Inc.: Employment, Equity Ownership. Hagiwara:Amgen, Inc.: Research Funding. Delea:Amgen, Inc.: Research Funding.
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DeJoubner, Nutan J., Qunna Li, Wayne A. C. Harris, Zhibo Wang, Yuan Liu, and Edmund K. Waller. "Advanced Non Small Cell Lung Cancer Patients with Fewer Numbers of Blood Myeloid Dendritic Cells and CD4 Cells Prior to Treatment Have Inferior Progression-Free Survival: Implications for Cancer Immunotherapy." Blood 120, no. 21 (November 16, 2012): 4837. http://dx.doi.org/10.1182/blood.v120.21.4837.4837.
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Abstract Abstract 4837 Background: The tumor microenvironment includes tumor cells, and host-derived endothelial cells, fibroblasts, innate and adaptive immune cells. Tumors may induce neo-vascularization that supports local tumor growth or immune suppression and tolerance that facilitates tumor metastasis. We hypothesized that the patients with higher numbers of circulating CD34+ endothelial progenitor cells (CD34+/CD146+/CD45-, CEC), a cellular bio-marker for vasculogenesis, would have worse post-treatment outcomes and patients with more hematopoietic progenitor cells (CD34+/CD45+/CD45dim/CD133+, HPC) and Immune cells including T-cells would have better outcomes. Methods: We analyzed blood samples from sixty-two patients with advanced NSCLC at 3 time points: before chemotherapy, after cycle one, and at completion of treatment or progression of disease, in an IRB-approved protocol. CEC, HPC, and immune subsets were measured by high throughput multi-parameter flow cytometry, 2.5,000,000 events were acquired using a lyse, no-wash method optimized for rare event detection. Primary outcomes were progression free survival(PFS) and Overall Survival(OS) from the time of study entry. The patient population was stratified into groups based on optimum cut-off point for each cell subset of interest. Statistical analysis was done with log-rank test and Cox regression. Results: Mean age at diagnosis was 64 (37–87 years), 30 events (death) occurred with median follow-up of 9.3 months. Forty-six patients (74%) had disease progression with a median follow-up of 4.7 months. At baseline lower numbers of WBC, Neutrophil lymphocyte ratio(NLR), CEC, HPC were associated with better PFS, while only WBC and Neutrophil lymphocyte ratio (NLR) were associated with a favorable OS. While lower numbers of Immune cells were associated with worse PFS and OS (increased HR death or relapse) in univariate analysis as noted in the Table. Only covariates that were significant and non collinear were entered in the Multivariable model adjusted for age, gender, smoking, race, TNM stage, pathology, and performance status at diagnosis. This showed that baseline numbers of CD4+ T-cell (HR 0.46; 95% CI 0.33–0.98; p= 0.045), Myeloid DC (HR 0.38; 95% CI 0.39–0.81; p=0.012), HPC (continuous variable) (HR 0.78; 95% CI 0.64–0.93; p= 0.008) were significant for disease progression, while NLR was significant for death after study entry (Figure; HR 3; 95% CI 1.45–6.25; p=0 0.003). Conclusions: In patients with advanced NSCLC, lower numbers of HPC and NLR were associated with improved PFS and OS respectively. Lower numbers of immune subsets at diagnosis were associated with inferior outcomes to treatment, supporting the role for immune-mediated disease control. Disclosures: No relevant conflicts of interest to declare.
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Tang, Minhua, Qi Zhao, Kangqi Yi, Yiling Wu, Yu Xiang, Maryam Zaid, Shuheng Cui, et al. "Association between Metabolic Phenotypes of Body Fatness and Incident Stroke: A Prospective Cohort Study of Chinese Community Residents." Nutrients 14, no. 24 (December 9, 2022): 5258. http://dx.doi.org/10.3390/nu14245258.
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This study aimed to assess the association of body mass index (BMI)-based and waist circumference (WC)-based metabolic phenotypes with the risk of stroke among Chinese community residents. A total of 34,294 participants (mean ± standard deviation age: 56.05 ± 11.26 years) with no previous stroke diagnosis history were included in this cohort study. BMI-based metabolic phenotypes were classified into eight groups: metabolically healthy and normal weight (MHNW), metabolically healthy and underweight (MHUW), metabolically healthy and overweight (MHOW), metabolically healthy and obese (MHO), metabolically unhealthy and normal weight (MUNW), metabolically unhealthy and underweight (MUUW), metabolically unhealthy and overweight (MUOW), and metabolically unhealthy and obese (MUO). WC-based metabolic phenotypes were classified into four groups: metabolically healthy and normal WC (MHNWC), metabolically healthy and oversized WC (MHOWC), metabolically unhealthy and normal WC (MUNWC), and metabolically unhealthy and oversized WC (MUOWC). The association of these phenotypes with developing stroke events was examined using proportional hazards models. A total of 546 cases of first-stroke onset were recorded over a median follow-up time of 4.97 years. Compared with the reference group, the obesity phenotypes showed higher risks for stroke. The adjusted HRs (95% CIs) of MHUW, MHOW, MHO, MUNW, MUUW, MUOW, and MUO phenotypes were 1.01 (0.41, 2.49), 1.47 (1.09, 2.00), 1.33 (0.80, 2.22), 2.49 (1.87, 3.30), 3.92 (1.44, 10.72), 2.14 (1.64, 2.79), and 2.60 (1.91, 3.55), respectively. The adjusted HRs (95% CIs) of MHOWC, MUNWC, and MUOWC were 1.41 (1.02, 1.94), 2.25 (1.76, 2.87), and 2.16 (1.63, 2.87), respectively. The metabolic phenotypes defined by an alternative definition all showed significant positive associations (except for MHUW), with the adjusted HR ranging from 1.51 to 3.08 based on BMI and from 1.68 to 2.24 based on WC. The risk of stroke increased with the increase in metabolic abnormality numbers in different BMI and WC groups (all p trend < 0.001). The present study suggests that maintaining normal body weight or WC and improving metabolic health are of great significance in preventing cerebrovascular diseases.
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Ma, Wanxing, Zhimin Chen, and Qing Zhu. "Ultra-Short-Term Forecasting of Photo-Voltaic Power via RBF Neural Network." Electronics 9, no. 10 (October 18, 2020): 1717. http://dx.doi.org/10.3390/electronics9101717.
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With the fast expansion of renewable energy systems during recent years, the stability and quality of smart grids using solar energy have been challenged because of the intermittency and fluctuations. Hence, forecasting photo-voltaic (PV) power generation is essential in facilitating planning and managing electricity generation and distribution. In this paper, the ultra-short-term forecasting method for solar PV power generation is investigated. Subsequently, we proposed a radial basis function (RBF)-based neural network. Additionally, to improve the network generalization ability and reduce the training time, the numbers of hidden layer neurons are limited. The input of neural network is selected as the one with higher Spearman correlation among the predicted power features. The data are normalized and the expansion parameter of RBF neurons are adjusted continuously in order to reduce the calculation errors and improve the forecasting accuracy. Numerous simulations are carried out to evaluate the performance of the proposed forecasting method. The mean absolute percentage error (MAPE) of the testing set is within 10%, which show that the power values of the following 15 min. can be predicted accurately. The simulation results verify that our method shows better performance than other existing works.
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Wiener, R. Constance, D. Leann Long, and Richard J. Jurevic. "Blood Levels of the Heavy Metal, Lead, and Caries in Children Aged 24-72 Months: NHANES III." Caries Research 49, no. 1 (October 24, 2014): 26–33. http://dx.doi.org/10.1159/000365297.
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Lead remains a significant pollutant. It has acute toxic and chronic effects on many tissues and accumulates in teeth and bones. The researchers for this study investigated the association of blood lead levels with the extent/severity of caries as measured by the number of decayed/filled teeth of children aged 24-72 months using data from NHANES III (the Third National Health and Nutrition Examination Survey), accounting for the excess zero caries in the analysis and using less than 2 µg/dl as the reference blood lead level (n = 3,127). Zero-inflated negative binomial regression models indicated unadjusted extent/severity mean ratios of 1.79, 1.88 and 1.94 for the number of decayed/filled teeth in children whose blood lead levels were 2-5, 5-10 and >10 µg/dl, respectively, compared with children having <2 µg/dl blood lead levels. The results did not attenuate when other variables were added to the model for the 5-10 and >10 µg/dl levels of exposure. The adjusted extent/severity mean ratios were 1.84, 2.14 and 1.91, respectively, for the categories. This study indicated a strong association of blood lead levels with increasing numbers of carious teeth in children aged 24-72 months. These findings support other studies in an innovative analysis handling cases of children with no caries. The findings may inform caries risk assessment. © 2014 S. Karger AG, Basel
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Hyder, Joseph A., R. Sterling Haring, Daniel Sturgeon, Priscilla K. Gazarian, Wei Jiang, Zara Cooper, Stuart R. Lipsitz, Holly G. Prigerson, and Joel S. Weissman. "Occupational Variation in End-of-Life Care Intensity." American Journal of Hospice and Palliative Medicine® 35, no. 3 (June 2, 2017): 377–83. http://dx.doi.org/10.1177/1049909117710633.
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Background: End-of-life (EOL) care intensity is known to vary by secular and geographic patterns. US physicians receive less aggressive EOL care than the general population, presumably the result of preferences shaped by work-place experience with EOL care. Objective: We investigated occupation as a source of variation in EOL care intensity. Methods: Across 4 states, we identified 660 599, nonhealth maintenance organization Medicare beneficiaries aged ≥66 years who died between 2004 and 2011. Linking death certificates, we identified beneficiaries with prespecified occupations: nurses, farmers, clergy, mortuary workers, homemakers, first-responders, veterinary workers, teachers, accountants, and the general population. End-of-life care intensity over the last 6 months of life was assessed using 5 validated measures: (1) Medicare expenditures, rates of (2) hospice, (3) surgery, (4) intensive care, and (5) in-hospital death. Results: Occupation was a source of large variation in EOL care intensity across all measures, before and after adjustment for sex, education, age-adjusted Charlson Comorbidity Index, race/ethnicity, and hospital referral region. For example, absolute and relative adjusted differences in expenditures were US$9991 and 42% of population mean expenditure ( P < .001 for both). Compared to the general population on the 5 EOL care intensity measures, teachers (5 of 5), homemakers (4 of 5), farmers (4 of 5), and clergy (3 of 5) demonstrated significantly less aggressive care. Mortuary workers had lower EOL care intensity (4 of 5) but small numbers limited statistical significance. Conclusion: Occupations with likely exposure to child development, death/bereavement, and naturalistic influences demonstrated lower EOL care intensity. These findings may inform patients and clinicians navigating choices around individual EOL care preferences.
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Fraser, Gary E., Karen Jaceldo-Siegl, Michael Orlich, Andrew Mashchak, Rawiwan Sirirat, and Synnove Knutsen. "Dairy, soy, and risk of breast cancer: those confounded milks." International Journal of Epidemiology 49, no. 5 (February 25, 2020): 1526–37. http://dx.doi.org/10.1093/ije/dyaa007.
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Abstract Background Associations between soy, dairy intakes and breast cancer risk are inconsistent. No studies exist with large numbers of dairy consumers and soy consumers to assess mutual confounding. Methods The study cohort contains 52 795 North American women, initially free of cancer, followed for 7.9 years (29.7% were Black). Dietary intakes were estimated from food frequency questionnaires and, for 1011 calibration study subjects, from six structured 24-h dietary recalls. Incident invasive breast cancers were detected mainly by matching with cancer registries. Analyses used multivariable proportional hazards regression. Results The participants (mean age of 57.1 years) experienced 1057 new breast cancer cases during follow-up. No clear associations were found between soy products and breast cancer, independently of dairy. However, higher intakes of dairy calories and dairy milk were associated with hazard ratios (HRs) of 1.22 [95% confidence interval (CI): 1.05–1.40] and 1.50 (95% CI 1.22–1.84), respectively, comparing 90th to 10th percentiles of intakes. Full fat and reduced fat milks produced similar results. No important associations were noted with cheese and yogurt. Substituting median intakes of dairy milk users by those of soy milk consumers was associated with HR of 0.68 (95% CI: 0.55–0.85). Similar-sized associations were found among pre- and post-menopausal cases, with CIs also excluding the null in estrogen receptor (ER+, ER-), and progesterone receptor (PR+) cancers. Less biased calibrated measurement-error adjusted regressions demonstrated yet stronger, but less precise, HRs and CIs that still excluded the null. Conclusions Higher intakes of dairy milk were associated with greater risk of breast cancer, when adjusted for soy intake. Current guidelines for dairy milk consumption could be viewed with some caution.
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Wouters, Loes T., Dorien L. Zwart, Daphne C. Erkelens, Noël S. Cheung, Esther de Groot, Roger A. Damoiseaux, Arno W. Hoes, and Frans H. Rutten. "Chest discomfort at night and risk of acute coronary syndrome: cross-sectional study of telephone conversations." Family Practice 37, no. 4 (January 30, 2020): 473–78. http://dx.doi.org/10.1093/fampra/cmaa005.
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Abstract Background During telephone triage, it is difficult to assign adequate urgency to patients with chest discomfort. Considering the time of calling could be helpful. Objective To assess the risk of acute coronary syndrome (ACS) in certain time periods and whether sex influences this risk. Methods Cross-sectional study of 1655 recordings of telephone conversations of patients who called the out-of-hours services primary care (OHS-PC) for chest discomfort. Call time, patient characteristics, symptoms, medical history and urgency allocation of the triage conversations were collected. The final diagnosis of each call was retrieved at the patient’s general practice. Absolute numbers of patients with and without ACS were plotted and risks per hour were calculated. The risk ratio of ACS at night (0 to 9 am) was calculated by comparing to the risk at other hours and was adjusted for gender and age. Results The mean age of callers was 58.9 (standard deviation ±19.5) years, 55.5% were women and, in total, 199 (12.0%) had an ACS. The crude risk ratio for an ACS at night was 1.80 (confidence interval 1.39–2.34, P < 0.001): 2.33 (1.68–3.22, P < 0.001) for men and 1.29 (0.83–1.99, P = 0.256) for women. The adjusted risk ratio for ACS of all people at night was 1.82 (1.07–3.10, P = 0.039). Conclusions Patients calling the OHS-PC for chest discomfort between 0 and 9 am have almost twice a higher risk of ACS than those calling other hours, a phenomenon more evident in men than in women. At night, dispatching ambulances more ‘straightaway’ could be considered for these patients with chest discomfort. Trial number NTR7331.
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Clarkson, Jan E., Nigel B. Pitts, Beatriz Goulao, Dwayne Boyers, Craig R. Ramsay, Ruth Floate, Hazel J. Braid, et al. "Risk-based, 6-monthly and 24-monthly dental check-ups for adults: the INTERVAL three-arm RCT." Health Technology Assessment 24, no. 60 (November 2020): 1–138. http://dx.doi.org/10.3310/hta24600.
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Background Traditionally, patients are encouraged to attend dental recall appointments at regular 6-month intervals, irrespective of their risk of developing dental disease. Stakeholders lack evidence of the relative effectiveness and cost-effectiveness of different recall strategies and the optimal recall interval for maintenance of oral health. Objectives To test effectiveness and assess the cost–benefit of different dental recall intervals over a 4-year period. Design Multicentre, parallel-group, randomised controlled trial with blinded clinical outcome assessment at 4 years and a within-trial cost–benefit analysis. NHS and participant perspective costs were combined with benefits estimated from a general population discrete choice experiment. A two-stratum trial design was used, with participants randomised to the 24-month interval if the recruiting dentist considered them clinically suitable. Participants ineligible for 24-month recall were randomised to a risk-based or 6-month recall interval. Setting UK primary care dental practices. Participants Adult, dentate, NHS patients who had visited their dentist in the previous 2 years. Interventions Participants were randomised to attend for a dental check-up at one of three dental recall intervals: 6-month, risk-based or 24-month recall. Main outcomes Clinical – gingival bleeding on probing; patient – oral health-related quality of life; economic – three analysis frameworks: (1) incremental cost per quality-adjusted life-year gained, (2) incremental net (societal) benefit and (3) incremental net (dental health) benefit. Results A total of 2372 participants were recruited from 51 dental practices; 648 participants were eligible for the 24-month recall stratum and 1724 participants were ineligible. There was no evidence of a significant difference in the mean percentage of sites with gingival bleeding between intervention arms in any comparison. For the eligible for 24-month recall stratum: the 24-month (n = 138) versus 6-month group (n = 135) had an adjusted mean difference of –0.91 (95% confidence interval –5.02 to 3.20); the risk-based (n = 143) versus 6-month group had an adjusted mean difference of –0.98 (95% confidence interval –5.05 to 3.09); the 24-month versus risk-based group had an adjusted mean difference of 0.07 (95% confidence interval –3.99 to 4.12). For the overall sample, the risk-based (n = 749) versus 6-month (n = 737) adjusted mean difference was 0.78 (95% confidence interval –1.17 to 2.72). There was no evidence of a difference in oral health-related quality of life between intervention arms in any comparison. For the economic evaluation, under framework 1 (cost per quality-adjusted life-year) the results were highly uncertain, and it was not possible to identify the optimal recall strategy. Under framework 2 (net societal benefit), 6-month recalls were the most efficient strategy with a probability of positive net benefit ranging from 78% to 100% across the eligible and combined strata, with findings driven by the high value placed on more frequent recall services in the discrete choice experiment. Under framework 3 (net dental health benefit), 24-month recalls were the most likely strategy to deliver positive net (dental health) benefit among those eligible for 24-month recall, with a probability of positive net benefit ranging from 65% to 99%. For the combined group, the optimal strategy was less clear. Risk-based recalls were more likely to be the most efficient recall strategy in scenarios where the costing perspective was widened to include participant-incurred costs, and in the Scottish subgroup. Limitations Information regarding factors considered by dentists to inform the risk-based interval and the interaction with patients to determine risk and agree the interval were not collected. Conclusions Over a 4-year period, we found no evidence of a difference in oral health for participants allocated to a 6-month or a risk-based recall interval, nor between a 24-month, 6-month or risk-based recall interval for participants eligible for a 24-month recall. However, people greatly value and are willing to pay for frequent dental check-ups; therefore, the most efficient recall strategy depends on the scope of the cost and benefit valuation that decision-makers wish to consider. Future work Assessment of the impact of risk assessment tools in informing risk-based interval decision-making and techniques for communicating a variable recall interval to patients. Trial registration Current Controlled Trials ISRCTN95933794. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme [project numbers 06/35/05 (Phase I) and 06/35/99 (Phase II)] and will be published in full in Health Technology Assessment; Vol. 24, No. 60. See the NIHR Journals Library website for further project information.