bluuebunny/crossref_metadata_2025 huggingface dataset:
Double-sided reel-to-reel metal-organic chemical vapor deposition system of YBa2Cu3O7-δ thin films
Authors: Zhang Fei , Xiong Jie , Liu Xin , Zhao Ruipeng , Zhao Xiaohui , Tao Bowan , Li Yanrong
Published: June 2014

Two-micrometer thick YBa2Cu3O7-δ (YBCO) films have been successfully deposited on both sides of LaAlO3 single crystalline substrates by using a home-made reel-to-reel metal-organic chemical vapor deposition (MOCVD) system, which has two opposite symmetrical shower heads and a special-designed heater. This technique can simultaneously fabricate double-sided films with high deposition rate up to 500 nm/min, and lead to doubling current carrying capability of YBCO, especially for coated conductors (CCs). X-ray diffraction analysis showed that YBCO films were well crystallized and highly epitaxial with the full width at half maximum values of 0.2° ∼ 0.3° for the rocking curves of (005) YBCO and 1.0° for Φ-scans of (103) YBCO. Scanning electron microscope revealed dense, crack-free, slightly rough surface with Ba-Cu-O precipitates. The films showed critical current density (Jc, 77 K, 0 T) of about 1 MA/cm2, and overall critical current of 400 A/cm, ascribed to the double-sided structure. Our results also demonstrated that the temperature and composition in the deposition zone were uniform, which made MOCVD preparation of low cost and high performance double-sided YBCO CCs more promising for industrialization.
In-situ spectroscopic ellipsometry study of copper selective-area atomic layer deposition on palladium
Authors: Jiang Xiaoqiang , Wang Han , Qi Jie , Willis Brian G.
Published: June 2014

Selective area copper atomic layer deposition on palladium seed layers has been investigated with in-situ real-time spectroscopic ellipsometry to probe the adsorption/desorption and reaction characteristics of individual deposition cycles. The reactants are copper bis(2,2,6,6-tetramethyl-3,5-heptanedionate) vapor and hydrogen gas. Self-limiting atomic layer deposition was observed in the temperature range of 135–230 °C in a low pressure reactor. Under optimal conditions, growth occurs selectively on palladium and not on silicon dioxide or silicon nitride layers. Based on in-situ ellipsometry data and supporting experiments, a new mechanism for growth is proposed. In the proposed mechanism, precursor adsorption is reversible, and dissociatively adsorbed hydrogen are the stable surface intermediates between growth cycles. The mechanism is enabled by continuous diffusion of palladium from the seed layer into the deposited copper film and strong H* binding to palladium sites. Less intermixing can be obtained at low growth temperatures and short cycle times by minimizing Cu/Pd inter-diffusion.
Positive Long-Term Effects of Pilates Exercise on the Age-Related Decline in Balance and Strength in Older, Community-Dwelling Men and Women
Authors: Bird Marie-Louise , Fell James
Published: June 2014

This study investigated the effect of Pilates exercise on physical fall risk factors 12 months after an initial 5-week Pilates intervention. The authors hypothesized that ongoing Pilates participation would have a positive effect on physical fall risk factors in those who continued with Pilates exercise compared with those who ceased. Thirty older ambulatory adults (M = 69 years, SD = 7) participated in Pilates classes for 5 weeks with testing preintevention (Time 1 [T1]) and postintervention (Time 2 [T2]) and 12 months later (Time 3 [T3]). Balance and leg strength were compared using a 2-way analysis of variance with repeated measures. Postural sway, dynamic balance, and function improvements evident after the initial Pilates training (T1–T2) were maintained at T3 (p < .01). Significant differences existed at T3 for dynamic balance and strength between participants who continued performing Pilates (n = 14) and those who had ceased. Balance improvements after a short Pilates intervention were maintained 1 year later in all participants, with increased benefits from ongoing participation.
Body Composition, Muscle Capacity, and Physical Function in Older Adults: An Integrated Conceptual Model
Authors: Brady Anne O. , Straight Chad R. , Evans Ellen M.
Published: June 2014

The aging process leads to adverse changes in body composition (increases in fat mass and decreases in skeletal muscle mass), declines in physical function (PF), and ultimately increased risk for disability and loss of independence. Specific components of body composition or muscle capacity (strength and power) may be useful in predicting PF; however, findings have been mixed regarding the most salient predictor of PF. The development of a conceptual model potentially aids in understanding the interrelated factors contributing to PF with the factors of interest being physical activity, body composition, and muscle capacity. This article also highlights sex differences in these domains. Finally, factors known to affect PF, such as sleep, depression, fatigue, and self-efficacy, are discussed. Development of a comprehensive conceptual model is needed to better characterize the most salient factors contributing to PF and to subsequently inform the development of interventions to reduce physical disability in older adults.
Transfer Effects of Fall Training on Balance Performance and Spatiotemporal Gait Parameters in Healthy Community-Dwelling Older Adults: A Pilot Study
Authors: Donath Lars , Faude Oliver , Bridenbaugh Stephanie A. , Roth Ralf , Soltermann Martin , Kressig Reto W. , Zahner Lukas
Published: June 2014

This study examined transfer effects of fall training on fear of falling (Falls Efficacy Scale—International [FES–I]), balance performance, and spatiotemporal gait characteristics in older adults. Eighteen community-dwelling older adults (ages 65–85) were randomly assigned to an intervention or control group. The intervention group completed 12 training sessions (60 min, 6 weeks). During pre- and posttesting, we measured FES–I, balance performance (double limb, closed eyes; single limb, open eyes; double limb, open eyes with motor-interfered task), and gait parameters (e.g., velocity; cadence; stride time, stride width, and stride length; variability of stride time and stride length) under single- and motor-interfered tasks. Dual tasks were applied to appraise improvements of cognitive processing during balance and gait. FES–I (p = .33) and postural sway did not significantly change (0.36 < p < .79). Trends toward significant interaction effects were found for step width during normal walking and stride length variability during the motor dual task (p = .05, ηp2 = .22). Fall training did not sufficiently improve fear of falling, balance, or gait performance under single- or dual-task conditions in healthy older adults.
Agreement Between Virtual and In-the-Field Environment Audits of Assisted Living Sites
Authors: Chudyk Anna M. , Winters Meghan , Gorman Erin , McKay Heather A. , Ashe Maureen C.
Published: June 2014

The authors investigated the use of Google Earth’s Street View option to audit the presence of built environment features that support older adults’ walking. Two raters conducted virtual (Street View) and in-the-field audits of 48 street segments surrounding urban and suburban assisted living sites in metropolitan Vancouver, BC, Canada. The authors determined agreement using absolute agreement. Their findings indicate that Street View may identify the presence of features that promote older adults’ walking, including sidewalks, benches, public washrooms, and destinations. However, Street View may not be as reliable as in-the-field audits to identify details associated with certain items, such as counts of trees or street lights; presence, features, and height of curb cuts; and sidewalk continuity, condition, and slope. Thus, the appropriateness of virtual audits to identify microscale built environment features associated with older adults’ walking largely depends on the purpose of the audits—specifically, whether the measurer seeks to capture highly detailed features of the built environment.
Enabling the genomic revolution in Africa
Authors:   The H3Africa Consortium, Matovu Enock , Bucheton Bruno , Chisi John , Enyaru John , Hertz-Fowler Christiane , Koffi Mathurin , Macleod Annette , Mumba Dieuodonne , Sidibe Issa , Simo Gustave , Simuunza Martin , Mayosi Bongani , Ramesar Rajkumar , Mulder Nicola , Ogendo Stephen , Mocumbi Ana Olga , Hugo-Hamman Christopher , Ogah Okechukwu , El Sayed Ahmed , Mondo Charles , Musuku John , Engel Mark , De Vries Jantina , Lesosky Maia , Shaboodien Gasnat , Cordell Heather , Paré Guillaume , Keavney Bernard , Motala Ayesha , Sobngwi Eugene , Mbanya Jean Claude , Hennig Branwen , Balde Naby , Nyirenda Moffat , Oli John , Adebamowo Clement , Levitt Naomi , Mayige Mary , Kapiga Saidi , Kaleebu Pontiano , Sandhu Manjinder , Smeeth Liam , McCarthy Mark , Rotimi Charles
Published: June 2014

H3Africa is developing capacity for health-related genomics research in Africa
Comparative Analysis of the Capacity of Elite Suppressor CD4
+
and CD8
+
T Cells To Inhibit HIV-1 Replication in Monocyte-Derived Macrophages
Authors: Walker-Sperling Victoria E. K. , Buckheit Robert W. , Blankson Joel N.
Published: June 2014

Elite controllers or suppressors (ESs) are HIV-1-infected individuals who are able to maintain viral loads below the limit of detection of clinical assays without antiretroviral therapy. The mechanisms of virologic control are not fully understood, but ESs have been shown to have a more effective CD8
+
T cell response to infected CD4
+
T cells than chronic progressors (CPs). While macrophages are another cell type productively infected by HIV-1, few studies have examined the ability of primary effector T cells to suppress HIV-1 replication in these target cells. Here, we compared the ability of unstimulated primary CD4
+
and CD8
+
effector T cells to suppress viral replication in monocyte-derived macrophages (MDMs) in ESs and CPs. While CD4
+
effector T cells were capable of inhibiting viral replication in MDMs, the magnitude of this response was not significantly different between ESs and CPs. In contrast, the CD8
+
T cells from ESs were significantly more effective than those from CPs at inhibiting viral replication in MDMs. The CD4
+
T cell response was partially mediated by soluble factors, while the CD8
+
T cell response required cell-to-cell interaction. Our results suggest that the individual contributions of various effector cells should be considered in rational vaccine design and in ongoing eradication efforts.

IMPORTANCE
Elite suppressors are individuals capable of maintaining low-level viremia in HIV-1 infection without antiretroviral drugs. Their T cell responses have been implicated in eliminating infected CD4
+
T cells, and as such, elite suppressors may represent a model of a functional cure of HIV-1 infection. Here, we sought to determine whether the suppressive T cell responses against infected CD4
+
T cells also apply to infected macrophages by comparing the responses of elite suppressors and HIV-1-positive individuals on highly active antiretroviral therapy (HAART). Our results show that the CD8
+
cells but not CD4
+
T cells from elite suppressors have a response against infected macrophages superior to the response of CD8
+
cells from patients on HAART. Our results suggest that the induction of a CD8
+
T cell response effective against infected macrophages is an outcome to consider in rational vaccine design.
Interaction Patterns betweenPotato Virus Yand eIF4E-Mediated Recessive Resistance in the Solanaceae
Authors: Moury Benoît , Janzac Bérenger , Ruellan Youna , Simon Vincent , Ben Khalifa Mekki , Fakhfakh Hatem , Fabre Frédéric , Palloix Alain
Published: June 2014

The structural pattern of infectivity matrices, which contains infection data resulting from inoculations of a set of hosts by a set of parasites, is a key parameter for our understanding of biological interactions and their evolution. This pattern determines the evolution of parasite pathogenicity and host resistance, the spatiotemporal distribution of host and parasite genotypes, and the efficiency of disease control strategies. Two major patterns have been proposed for plant-virus genotype infectivity matrices. In the gene-for-gene model, infectivity matrices show a nested pattern, where the host ranges of specialist virus genotypes are subsets of the host ranges of less specialized viruses. In contrast, in the matching-allele (MA) model, each virus genotype is specialized to infect one (or a small set of) host genotype(s). The corresponding infectivity matrix shows a modular pattern where infection is frequent for plants and viruses belonging to the same module but rare for those belonging to different modules. We analyzed the structure of infectivity matrices betweenPotato virus Y(PVY) and plant genotypes in the familySolanaceaecarrying different eukaryotic initiation factor 4E (eIF4E)-coding alleles conferring recessive resistance. Whereas this system corresponds mechanistically to an MA model, the expected modular pattern was rejected based on our experimental data. This was mostly because PVY mutations involved in adaptation to a particular plant genotype displayed frequent pleiotropic effects, conferring simultaneously an adaptation to additional plant genotypes with different eIF4E alleles. Such effects should be taken into account for the design of strategies of sustainable control of PVY through plant varietal mixtures or rotations.

IMPORTANCEThe interaction pattern between host and virus genotypes has important consequences on their respective evolution and on issues regarding the application of disease control strategies. We found that the structure of the interaction betweenPotato virus Y(PVY) variants and host plants in the familySolanaceaedeparts significantly from the current model of interaction considered for these organisms because of frequent pleiotropic effects of virus mutations. These mutational effects allow the virus to expand rapidly its range of host plant genotypes, make it very difficult to predict the effects of mutations in PVY infectivity factors, and raise concerns about strategies of sustainable management of plant genetic resistance to viruses.
Isolation and Characterization of a Novel Alphaherpesvirus in Fruit Bats
Authors: Sasaki Michihito , Setiyono Agus , Handharyani Ekowati , Kobayashi Shintaro , Rahmadani Ibenu , Taha Siswatiana , Adiani Sri , Subangkit Mawar , Nakamura Ichiro , Sawa Hirofumi , Kimura Takashi
Published: June 2014

Bats are known to harbor emerging RNA viruses. Recent studies have used high-throughput sequencing technology to identify various virus species, including DNA viruses that are harbored by bats; however, little is known about the nature of these potentially novel viruses. Here, we report the characterization of a novel herpesvirus isolated from an Indonesian pteropodid bat. The virus, tentatively named fruit bat alphaherpesvirus 1 (FBAHV1), has a double-stranded DNA genome of 149,459 bp. The phylogenetic analyses suggested that FBAHV1 is phylogenetically grouped with simplexviruses within the subfamily
Alphaherpesvirinae
. Inoculation of FBAHV1 into laboratory mice caused a lethal infection. Virus infection was observed in lung, liver, and brain tissue. Serological and PCR screening revealed that fruit bats infected with FBAHV1 or its related virus are widely distributed in Indonesia. The identification of FBAHV1 makes a considerable contribution to our understanding of simplexviruses associated with bats.

IMPORTANCE
Bats are known to harbor emerging viruses, such as lyssaviruses, henipaviruses, severe acute respiratory syndrome-like coronaviruses, and filoviruses. Although alphaherpesviruses are disseminated in humans and other animals, there is little information about their distribution in bats. Here, we isolated a previously unknown alphaherpesvirus from an Indonesian fruit bat. Genome sequence analysis suggested that the virus is a member of the genus
Simplexvirus
within the subfamily
Alphaherpesvirinae
, which also includes common human viruses, such as herpes simplex virus 1 and herpes simplex virus 2. FBAHV1 is the first bat-derived alphaherpesvirus whose complete genome has been sequenced.
The West Nile Virus-Like Flavivirus Koutango Is Highly Virulent in Mice due to Delayed Viral Clearance and the Induction of a Poor Neutralizing Antibody Response
Authors: Prow Natalie A. , Setoh Yin X. , Biron Rebecca M. , Sester David P. , Kim Kwang Sik , Hobson-Peters Jody , Hall Roy A. , Bielefeldt-Ohmann Helle
Published: June 2014

The mosquito-borne West Nile virus (WNV) is responsible for outbreaks of viral encephalitis in humans, horses, and birds, with particularly virulent strains causing recent outbreaks of disease in eastern Europe, the Middle East, North America, and Australia. Previous studies have phylogenetically separated WNV strains into two main genetic lineages (I and II) containing virulent strains associated with neurological disease. Several WNV-like strains clustering outside these lineages have been identified and form an additional five proposed lineages. However, little is known about whether these strains have the potential to induce disease. In a comparative analysis with the highly virulent lineage I American strain (WNV
NY99
), the low-pathogenicity lineage II strain (B956), a benign Australian strain, Kunjin (WNV
KUN
), the African WNV-like Koutango virus (WNV
KOU
), and a WNV-like isolate from Sarawak, Malaysia (WNV
Sarawak
), were assessed for neuroinvasive properties in a murine model and for their replication kinetics
in vitro
. While WNV
NY99
replicated to the highest levels
in vitro
,
in vivo
mouse challenge revealed that WNV
KOU
was more virulent, with a shorter time to onset of neurological disease and higher morbidity. Histological analysis of WNV
KOU
- and WNV
NY99
-infected brain and spinal cords demonstrated more prominent meningoencephalitis and the presence of viral antigen in WNV
KOU
-infected mice. Enhanced virulence of WNV
KOU
also was associated with poor viral clearance in the periphery (sera and spleen), a skewed innate immune response, and poor neutralizing antibody development. These data demonstrate, for the first time, potent neuroinvasive and neurovirulent properties of a WNV-like virus outside lineages I and II.

IMPORTANCE
In this study, we characterized the
in vitro
and
in vivo
properties of previously uncharacterized West Nile virus strains and West Nile-like viruses. We identified a West Nile-like virus, Koutango virus (WNV
KOU
), that was more virulent than a known virulent lineage I virus, WNV
NY99
. The enhanced virulence of WNV
KOU
was associated with poor viral clearance and the induction of a poor neutralizing antibody response. These findings provide new insights into the pathogenesis of West Nile virus.
Interactions between the Influenza A Virus RNA Polymerase Components and Retinoic Acid-Inducible Gene I
Authors: Li Weizhong , Chen Hongjun , Sutton Troy , Obadan Adebimpe , Perez Daniel R.
Published: June 2014

The influenza A virus genome possesses eight negative-strand RNA segments in the form of viral ribonucleoprotein particles (vRNPs) in association with the three viral RNA polymerase subunits (PB2, PB1, and PA) and the nucleoprotein (NP). Through interactions with multiple host factors, the RNP subunits play vital roles in replication, host adaptation, interspecies transmission, and pathogenicity. In order to gain insight into the potential roles of RNP subunits in the modulation of the host's innate immune response, the interactions of each RNP subunit with retinoic acid-inducible gene I protein (RIG-I) from mammalian and avian species were investigated. Studies using coimmunoprecipitation (co-IP), bimolecular fluorescence complementation (BiFc), and colocalization using confocal microscopy provided direct evidence for the RNA-independent binding of PB2, PB1, and PA with RIG-I from various hosts (human, swine, mouse, and duck). In contrast, the binding of NP with RIG-I was found to be RNA dependent. Expression of the viral NS1 protein, which interacts with RIG-I, did not interfere with the association of RNA polymerase subunits with RIG-I. The association of each individual virus polymerase component with RIG-I failed to significantly affect the interferon (IFN) induction elicited by RIG-I and 5′ triphosphate (5′ppp) RNA in reporter assays, quantitative reverse transcription-PCR (RT-PCR), and IRF3 phosphorylation tests. Taken together, these findings indicate that viral RNA polymerase components PB2, PB1, and PA directly target RIG-I, but the exact biological significance of these interactions in the replication and pathogenicity of influenza A virus needs to be further clarified.

IMPORTANCE
RIG-I is an important RNA sensor to elicit the innate immune response in mammals and some bird species (such as duck) upon influenza A virus infection. Although the 5′-triphosphate double-stranded RNA (dsRNA) panhandle structure at the end of viral genome RNA is responsible for the binding and subsequent activation of RIG-I, this structure is supposedly wrapped by RNA polymerase complex (PB2, PB1, and PA), which may interfere with the induction of RIG-I signaling pathway. In the present study, PB2, PB1, and PA were found to individually interact with RIG-Is from multiple mammalian and avian species in an RNA-independent manner, without significantly affecting the generation of IFN. The data suggest that although RIG-I binding by RNA polymerase complex is conserved in different species, it does not appear to play crucial role in the modulation of IFN
in vitro
.
Parents’ perspectives on the value of assistance dogs for children with autism spectrum disorder: a cross-sectional study
Authors: Burgoyne Louise , Dowling Lisa , Fitzgerald Anthony , Connolly Micaela , P Browne John , Perry Ivan J
Published: June 2014

Objective

While there is an emerging literature on the usefulness of assistance dogs for children with autism spectrum disorder (ASD), there is a dearth of quantitative data on the value of assistance dog interventions for the family unit and family functioning. Using previously validated scales and scales developed specifically for this study, we measured parents’/guardians’ perceptions of how having an assistance dog affects: (1) child safety from environmental dangers, (2) public reception of ASD and (3) levels of caregiver strain and sense of competence. We also obtained open-ended response data from parents/guardians on benefits and constraints of having an assistance dog.

Setting

This study was based in the primary care setting, within the context of a specific accredited assistance dog centre in Ireland.

Participants

A total of 134 parents/guardians with an assistance dog, and 87 parents of children on the waiting list were surveyed.

Primary and secondary outcome measures

The primary outcome measures were scores on environmental hazards and public reception scales. The secondary outcome measures were scores on caregiver strain and competence scales.

Results

Parents/guardians of children who have ASD and an assistance dog rate their child as significantly safer from environmental dangers (p<0.001), perceive that the public act more respectfully and responsibly towards their child (p<0.001) and feel more competent about managing their child (p=0.023) compared with parents on the waiting list. There was a concentration of positive feeling towards assistance dog interventions with particular focus on safety and comfort for children, and a sense of freedom from family restrictions associated with ASD. The amount of dedication and commitment required to care for a dog were viewed as the primary constraints.

Conclusions

Our findings indicate that parents perceive that assistance dog interventions can be a valuable intervention for families with children who have ASD.
How does morphology impact on diastolic function in hypertrophic cardiomyopathy? A single centre experience
Authors: Finocchiaro Gherardo , Haddad Francois , Pavlovic Aleksandra , Magavern Emma , Sinagra Gianfranco , Knowles Joshua W , Myers Jonathan , Ashley Euan A
Published: June 2014

Objectives

It is unclear if morphology impacts on diastole in hypertrophic cardiomyopathy (HCM). We sought to determine the relationship between various parameters of diastolic function and morphology in a large HCM cohort.

Setting

Tertiary referral centre from Stanford, California, USA.

Partecipants

383 patients with HCM and normal systolic function between 1999 and 2011. A group of 100 prospectively recruited age-matched and sex-matched healthy participants were used as controls.

Primary and secondary outcome measures

Echocardiograms were assessed by two blinded board-certified cardiologists. HCM morphology was classified as described in the literature (reverse, sigmoid, symmetric, apical and undefined).

Results

Reverse curvature morphology was most commonly observed (218 (57%). Lateral mitral annular E′<12 cm/s was present in 86% of reverse, 88% of sigmoid, 79% of symmetric, 86% of apical and 81% of undefined morphology, p=0.65. E/E′ was similarly elevated (E/E′: 12.3±7.9 in reverse curvature, 12.1±6.1 in sigmoid, 12.7±9.5 in symmetric, 9.4±4.0 in apical, 12.7±7.9 in undefined morphology, p=0.71) and indexed left atrial volume (LAVi)>40 mL/m2was present in 47% in reverse curvature, 33% in sigmoid, 32% in symmetric, 37% in apical and 32% in undefined, p=0.09. Each morphology showed altered parameters of diastolic function when compared with the control population. Left ventricular (LV) obstruction was independently associated with all three diastolic parameters considered, in particular with LAVi>40 mL/m2(OR 2.04 (95% CI 1.23 to 3.39), p=0.005), E/E′>15 (OR 4.66 (95% CI 2.51 to 8.64), p<0.001) and E′<8 (OR 2.55 (95% CI 1.42 to 4.53), p=0.001). Other correlates of diastolic dysfunction were age, LV wall thickness and moderate-to-severe mitral regurgitation.

Conclusions

In HCM, diastolic dysfunction is present to similar degrees independently from the morphological pattern. The main correlates of diastolic dysfunction are LV obstruction, age, degree of hypertrophy and degree of mitral regurgitation.
Managing risk in cancer presentation, detection and referral: a qualitative study of primary care staff views
Authors: Cook Neil , Thomson Gillian , Dey Paola
Published: June 2014

Objectives

In the UK, there have been a number of national initiatives to promote earlier detection and prompt referral of patients presenting to primary care with signs and symptoms of cancer. The aim of the study was to explore the experiences of a range of primary care staff in promoting earlier presentation, detection and referral of patients with symptoms suggestive of cancer.

Setting

Six primary care practices in northwest England. Participants: 39 primary care staff from a variety of disciplines took part in five group and four individual interviews.

Results

The global theme to emerge from the interviews was ‘managing risk’, which had three underpinning organising themes: ‘complexity’, relating to uncertainty of cancer diagnoses, service fragmentation and plethora of guidelines; ‘continuity’, relating to relationships between practice staff and their patients and between primary and secondary care; ‘conflict’ relating to policy drivers and staff role boundaries. A key concern of staff was that policymakers and those implementing cancer initiatives did not fully understand how risk was managed within primary care.

Conclusions

Primary care staff expressed a range of views and opinions on the benefits of cancer initiatives. National initiatives did not appear to wholly resolve issues in managing risk for all practitioners. Staff were concerned about the number of guidelines and priorities they were expected to implement. These issues need to be considered by policymakers when developing and implementing new initiatives.
Dietary changes and associations with metabolic improvements in adults with type 2 diabetes during a patient-centred dietary intervention: an exploratory analysis
Authors: England C Y , Thompson J L , Jago R , Cooper A R , Andrews R C
Published: June 2014

Objectives

Describe dietary intake of participants enrolled in a non-prescriptive dietary intervention and dietary changes at 6 months and explore whether these changes had a role in observed improvements in glycated haemoglobin (HbA1c), weight, lipids and blood pressure.

Design

Secondary analysis of data from the Early ACTivity in Diabetes randomised controlled trial.

Participants

262 patients with newly diagnosed type 2 diabetes randomised to the dietary intervention.

Outcomes and analysis

Changes in energy intake, macronutrients, fibre and alcohol and in weight, waist circumference, lipids, HbA1c and blood pressure at baseline and 6 months. Multivariate models were used to examine associations between dietary changes and metabolic variables.

Results

Men reported reducing mean energy intake from 1903±462 kcal to 1685 kcal±439 kcal (p<0.001), increasing carbohydrate intake from 42.4±6.6% to 43.8±6.6% (p=0.002) and reducing median alcohol intake from 13 (0–27) g to 5 (0–18) g (p<0.001). Women reported reducing mean energy intake from 1582±379 kcal to 1459±326 kcal (p<0.001) with no change to macronutrient distribution and alcohol. Fibre intake was maintained. In men (n=148), weak and clinically insignificant associations were found between increased carbohydrates and reduction in HbA1c (β=−0.003 (−0.006, −0.001); p=0.009), increased fibre and reduction in total cholesterol (β=−0.023 (−0.044, −0.002); p=0.033), decreased total fat and reduction in low-density lipoprotein (LDL)-cholesterol (β=0.024 (0.006, 0.001); p=0.011), and decreased alcohol and reduction in diastolic blood pressure (β=0.276 (0.055, 0.497); p=0.015). In women (n=75), associations were found between a decrease in transfats and reductions in waist circumference (β=−0.029 (0.006, 0.052); p=0.015), total cholesterol (β=0.399 (0.028, 0.770); p=0.036) and LDL cholesterol (β=0.365 (0.042, 0.668); p=0.028).

Conclusions

Clinically important metabolic improvements observed in a patient-centred dietary intervention were not explained by changes in macronutrients. However, a non-prescriptive approach may promote a reduction in total energy intake while maintaining fibre consumption.

Trial registration number

The Early ACTID trial numberISRCTN92162869.
Acupuncture as analgesia for non-emergent acute non-specific neck pain, ankle sprain and primary headache in an emergency department setting: a protocol for a parallel group, randomised, controlled pilot trial
Authors: Kim Kun Hyung , Ryu Ji Ho , Park Maeng Real , Kim Yong In , Min Mun Ki , Park Yong Myeon , Kim Yu Ri , Noh Seung Hee , Kang Min Joo , Kim Young Jun , Kim Jae Kyu , Lee Byung Ryul , Choi Jun Yong , Yang Gi Young
Published: June 2014

Introduction

This study aims to assess the feasibility of acupuncture as an add-on intervention for patients with non-emergent acute musculoskeletal pain and primary headache in an emergency department (ED) setting.

Methods and analysis

A total of 40 patients who present to the ED and are diagnosed to have acute non-specific neck pain, ankle sprain or primary headache will be recruited by ED physicians. An intravenous or intramuscular injection of analgesics will be provided as the initial standard pain control intervention for all patients. Patients who still have moderate to severe pain after the 30 min of initial standard ED management will be considered eligible. These patients will be allocated in equal proportions to acupuncture plus standard ED management or to standard ED management alone based on computer-generated random numbers concealed in opaque, sealed, sequentially numbered envelopes. A 30 min session of acupuncture treatment with manual and/or electrical stimulation will be provided by qualified Korean medicine doctors. All patients will receive additional ED management at the ED physician's discretion and based on each patient's response to the allocated intervention. The primary outcome will be pain reduction measured at discharge from the ED by an unblinded assessor. Adverse events in both groups will be documented. Other outcomes will include the patient-reported overall improvement, disability due to neck pain (only for neck-pain patients), the treatment response rate, the use of other healthcare resources and the patients’ perceived effectiveness of the acupuncture treatment. A follow-up telephone interview will be conducted by a blinded assessor 72±12 h after ED discharge.

Ethics and dissemination

Written informed consent will be obtained from all participants. The study has been approved by the Institutional Review Boards (IRBs). The results of this study will guide a full-scale randomised trial of acupuncture in an ED context.

Trial registration number

ClinicalTrials.gov:NCT02013908.
Insurance claims data: a possible solution for a national sports injury surveillance system? An evaluation of data information against ASIDD and consensus statements on sports injury surveillance
Authors: Åman Malin , Forssblad Magnus , Henriksson-Larsén Karin
Published: June 2014

Background

Before preventive actions can be suggested for sports injuries at the national level, a solid surveillance system is required in order to study their epidemiology, risk factors and mechanisms. There are guidelines for sports injury data collection and classifications in the literature for that purpose. In Sweden, 90% of all athletes (57/70 sports federations) are insured with the same insurance company and data from their database could be a foundation for studies on acute sports injuries at the national level.

Objective

To evaluate the usefulness of sports injury insurance claims data in sports injury surveillance at the national level.

Method

A database with 27 947 injuries was exported to an Excel file. Access to the corresponding text files was also obtained. Data were reviewed on available information, missing information and dropouts. Comparison with ASIDD (Australian Sports Injury Data Dictionary) and existing consensus statements in the literature (football (soccer), rugby union, tennis, cricket and thoroughbred horse racing) was performed in a structured manner.

Result

Comparison with ASIDD showed that 93% of the suggested data items were present in the database to at least some extent. Compliance with the consensus statements was generally high (13/18). Almost all claims (83%) contained text information concerning the injury.

Conclusions

Relatively high-quality sports injury data can be obtained from a specific insurance company at the national level in Sweden. The database has the potential to be a solid base for research on acute sports injuries in different sports at the national level.
Clinical characteristics and short-term outcomes in patients with elevated admission systolic blood pressure after acute ST-elevation myocardial infarction: a population-based study
Authors: Huang Bi , Yang Yanmin , Zhu Jun , Liang Yan , Tan Huiqiong
Published: June 2014

Objective

Prognostic value of lower admission systolic blood pressure (SBP) in patients with acute myocardial infarction has been confirmed, but the impact of elevated admission SBP on short-term outcomes has been evaluated only by a limited number of studies and they have reported conflicting results. The aim of our study was to investigate the characteristics and short-term outcomes in patients with elevated admission SBP after ST-elevation myocardial infarction (STEMI).

Design

A population-based, observational study.

Setting

The multicentre registry in China.

Participants

A total of 7510 consecutive patients with STEMI were registered. Patients were divided into three groups according to admission SBP: normal admission SBP (100–139 mm Hg), modestly elevated admission SBP (140–179 mm Hg) and excessively elevated admission SBP (≥180 mm Hg). The primary outcomes were 7-day and 30-day all-cause mortality, major adverse cardiac events (MACE) and bleeding rate.

Results

Of 6591 patients, 4182 (63.5%) had normal admission SBP, 2187 (33.2%) modestly elevated admission SBP and 222 (3.4%) excessively elevated admission SBP. Patients with elevated admission SBP had a high-risk profile, such as were more likely to be older, with more concomitant cardiovascular morbidities, presenting with more events of anterior myocardial infarction and less reperfusion treatment. However, 7-day and 30-day all-cause mortality, MACE and bleeding rate were comparable among groups (all p>0.05). Survival curves and MACE curves were similar among groups (p=0.377 and 0.375, respectively). After multivariate adjustment, elevated admission SBP was not associated with increased risk of short-term death and bleeding, and MACE was comparable with normal admission SBP.

Conclusions

Although those with elevated admission SBP after STEMI were at a higher risk for cardiovascular events, they did not have poorer short-term outcomes compared with patients with normal admission SBP.
A population-based cross-sectional study of barriers to uptake of eye care services in South India: the Rapid Assessment of Visual Impairment (RAVI) project
Authors: Marmamula Srinivas , Khanna Rohit C , Shekhar Konegari , Rao Gullapalli N
Published: June 2014

Objective

To assess the barriers to uptake of eye care services among those with avoidable impairment in the population aged ≥40 years in the South Indian state of Andhra Pradesh.

Design

Cross-sectional study.

Setting

Community setting.

Participants

Of 7800 participants recruited from one urban and two rural locations using a two-stage cluster random sampling methodology, 7378 (95%) were examined. Eye examinations were conducted using a rapid assessment protocol. Visual impairment (VI) was defined as presenting visual acuity <6/18 in the better eye. For the purpose of this study, VI caused due to cataract or uncorrected refractive error was considered avoidable VI. A validated questionnaire was used to collect information on barriers for uptake of services among those who had avoidable VI.

Primary outcome

Barriers to uptake of services among those with avoidable VI.

Results

The prevalence of avoidable VI was 11.8% (95% CI 11.0% to 12.5%; n=868). Among these, 71.1% (n=617) individuals reported ‘person-related’ barriers whereas 28.9% (n=251) individuals reported ‘service-related’ barriers to uptake of services. Among the ‘person-related’ barriers, the leading barrier was ‘lack of perceived need’ (61.1%; n=377) for reasons such as old age, good vision in the other eye. This was followed by ‘no one to accompany’ (20.3%; n=125). Of the 251 individuals who had ‘service-related’ barriers, lack of affordability was the major barrier (76.1%; n=191) followed by lack of accessibility (12.7%; n=32). Over 11% (n=28) of the individuals were advised to wait for cataract surgery.

Conclusions

Person-related barriers are more common than service-related barriers in Andhra Pradesh. As the barriers trend more towards ‘person-related’ phenomenon such as person's attitude and ‘felt need’ to improve vision, newer and much intensive awareness campaigns are needed to bring about an attitudinal/behavioural change among individuals to improve the uptake of services.
Long-term clinical outcomes after deployment of femoral vascular closure devices in coronary angiography and percutaneous coronary intervention: an observational single-centre registry follow-up
Authors: Lee Stephen Wai-Luen , Tam Chor-Cheung , Wong Ka-Lam , Kong Shun-Ling , Yung See-Yue , Wong Yiu-Tung , Chiu Suk-Yee , Lam Cheung-Chi , Chan Ki-Wan , Chan Hon-Wah
Published: June 2014

Objectives

There are few data evaluating the long-term effect of femoral vascular closure devices (FCDs) on patients’ clinical outcome. We aim to evaluate the incidence of peripheral vascular disease (PVD) in patients who received FCD following its deployment in coronary angiography and percutaneous coronary intervention (PCI) procedures.

Design and setting

Observational study of a single-centre registry.

Participants

From June 2000 to September 2004, 265 patients who received FCD after coronary angiography and PCIs were enrolled on the study.

Outcome measures

Clinical follow-up (using Rutherford's categories of claudication), ankle brachial index (ABI) and duplex ultrasound of femoral arteries (using the non-accessed side as control) were performed to evaluate the presence of PVD.

Results

The mean follow-up interval was 3320±628 days. 1 patient (0.4%) suffered from grade 2 claudication and another (0.4%) suffered from grade 1 claudication. The mean ABIs of the accessed side and non-accessed side were 1.06±0.13 and 1.08±0.11, respectively (p=0.17). For duplex ultrasound, the mean common femoral artery peak systolic velocities of the accessed side and non-accessed side were 87.4±22.3 and 87.7±22.1 cm/s, respectively (p=0.73); the mean superficial femoral artery peak systolic velocities of the accessed side and non-accessed side were 81.4±20.1 and 81.31±17.8 cm/s, respectively (p=0.19).

Conclusions

The use of FCD after a coronary angiogram and PCI is safe and does not increase the long-term risk of PVD.
Passive smoking at home is a risk factor for community-acquired pneumonia in older adults: a population-based case–control study
Authors: Almirall Jordi , Serra-Prat Mateu , Bolíbar Ignasi , Palomera Elisabet , Roig Jordi , Hospital Imma , Carandell Eugenia , Agustí Mercè , Ayuso Pilar , Estela Andreu , Torres Antoni ,   the Study Group of Community-Acquired Pneumonia in Catalan Countries (PACAP)
Published: June 2014

Objective

To assess whether passive smoking exposure at home is a risk factor for community-acquired pneumonia (CAP) in adults.

Setting

A population-based case-control study was designed in a Mediterranean area with 860 000 inhabitants >14 years of age.

Participants

1003 participants who had never smoked were recruited.

Primary and secondary outcome measures

Risk factors for CAP, including home exposure to passive smoking, were registered. All new cases of CAP in a well-defined population were consecutively recruited during a 12-month period.

Methods

A population-based case-control study was designed to assess risk factors for CAP, including home exposure to passive smoking. All new cases of CAP in a well-defined population were consecutively recruited during a 12-month period. The subgroup of never smokers was selected for the present analysis.

Results

The study sample included 471 patients with CAP and 532 controls who had never smoked. The annual incidence of CAP was estimated to be 1.14 cases×10–3inhabitants in passive smokers and 0.90×10−3in non-passive smokers (risk ratio (RR) 1.26; 95% CI 1.02 to 1.55) in the whole sample. In participants ≥65 years of age, this incidence was 2.50×10−3in passive smokers and 1.69×10−3in non-passive smokers (RR 1.48, 95% CI 1.08 to 2.03). In this last age group, the percentage of passive smokers in cases and controls was 26% and 18.1%, respectively (p=0.039), with a crude OR of 1.59 (95% CI 1.02 to 2.38) and an adjusted (by age and sex) OR of 1.56 (95% CI 1.00 to 2.45).

Conclusions

Passive smoking at home is a risk factor for CAP in older adults (65 years or more).
Effect of a redesigned fracture management pathway and ‘virtual’ fracture clinic on ED performance
Authors: Vardy J , Jenkins P J , Clark K , Chekroud M , Begbie K , Anthony I , Rymaszewski L A , Ireland A J
Published: June 2014

Objectives

Collaboration between the orthopaedic and emergency medicine (ED) services has resulted in standardised treatment pathways, leaflet supported discharge and a virtual fracture clinic review. Patients with minor, stable fractures are discharged with no further follow-up arranged. We aimed to examine the time taken to assess and treat these patients in the ED along with the rate of unplanned reattendance.

Design

A retrospective study was undertaken that covered 1 year before the change and 1 year after. Prospectively collected administrative data from the electronic patient record system were analysed and compared before and after the change.

Setting

An ED and orthopaedic unit, serving a population of 300 000, in a publicly funded health system.

Participants

2840 patients treated with referral to a traditional fracture clinic and 3374 patients managed according to the newly redesigned protocol.

Outcome measures

Time for assessment and treatment of patients with orthopaedic injuries not requiring immediate operative management, and 7-day unplanned reattendance.

Results

Where plaster backslabs were replaced with removable splints, the consultation time was reduced. There was no change in treatment time for other injuries treated by the new discharge protocol. There was no increase in unplanned ED attendance, related to the injury, within 7 days (p=0.149). There was a decrease in patients reattending the ED due to a missed fracture clinic appointment.

Conclusions

This process did not require any new time resources from the ED staff. This process brought significant benefits to the ED as treatment pathways were agreed. The pathway reduced unnecessary reattendance of patients at face-to-face fracture clinics for a review of stable, self-limiting injuries.
Effect of exercise on anthropometric measures and serum lipids in older individuals: a systematic review and meta-analysis
Authors: Kuhle Carol L , Steffen Mark W , Anderson Paul J , Murad Mohammad Hassan
Published: June 2014

Objectives

Overweight and obesity are increasing in individuals over age 60 years. This systematic review quantifies the effect of exercise on body mass index (BMI), waist circumference (WC) and lipids in overweight and obese individuals over the age of 60 years.

Settings

Nine randomised controlled trials conducted in Brazil, Great Britain, Iceland, Japan and the USA compared aerobic and/or resistance exercise with a control group.

Participants

Final analysis reviewed 1166 participants over the age of 60 years for 3–9 months.

Primary outcome measures

This study reviewed the effects of exercise on BMI, WC and low-density lipoprotein (LDL).

Results

Exercise produced a significant reduction in BMI (−1.01 kg/m2, 95% CI −2.00 to −0.01) and WC (−3.09 cm, 95% CI −4.14 to −2.04) but not LDL cholesterol (−0.31 mg/dL, 95% CI −0.81 to 0.19). Analyses revealed substantial heterogeneity likely due to the type and intensity of exercise. Data on adverse effects were minimal. The overall level of evidence is moderate due to imprecision and heterogeneity.

Conclusions

Exercise in overweight and obese older individuals improves anthropometric measures such as BMI and WC. The effect of exercise on serum lipids is unclear.