Publications by authors named "Robert Smith"

1,506 Publications

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Lung Cancer Screening Eligibility and Screening Patterns Among Black and White Adults in the United States.

JAMA Netw Open 2021 Oct 1;4(10):e2130350. Epub 2021 Oct 1.

Division of Pulmonary Medicine, Thoracic Oncology Research Group, Hollings Cancer Center, Medical University of South Carolina, Charleston.

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http://dx.doi.org/10.1001/jamanetworkopen.2021.30350DOI Listing
October 2021

Motivations and Barriers for Veterinarians When Facilitating Fertility Management on UK Dairy Farms.

Front Vet Sci 2021 29;8:709336. Epub 2021 Sep 29.

Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom.

It is economically essential, but challenging, for dairy farmers to manage bovine fertility. Vets can help farmers to improve fertility, and this is cost-effective bringing benefits for production, animal health and welfare, and the environment. However, the extent to which vets are involved in fertility varies considerably between farms, for reasons that are unclear. This study investigated the motivators and barriers that vets perceive when trying to increase their involvement with fertility management on UK dairy farms. Interviews were conducted with 20 vets and four themes identified. The first, "clinical baggage," highlighted vets' disillusionment due to past experiences of low uptake of their advice by farmers. Consequently, some vets made assumptions about farmer needs and behaviours, and exhibited ageist stereotyping. These issues, along with concerns and fatigue associated with repeatedly offering the same advice which was not acted upon, negatively influenced vets' engagement with farmers. The second theme "stuck in the comfort zone" revealed a loss of enthusiasm by some senior vets, whilst others lacked confidence to engage due to perceived gaps in their knowledge. Vets also reported farmers not perceiving their problems and lack of farm data or facilities, as barriers. The "vet-farmer relationship" theme highlighted building trust and developing strong relationships which were key drivers for vets to proactively engage and to "go the extra mile" for their clients. The final theme "money matters" explored vets' motivations to improve their clients' profitability and included the future sustainability of their own businesses. Our themes provide useful insight into the challenges vets face and provide key areas that can be targeted in future interventions to improve veterinary involvement in fertility management. For example, post-graduate training and support for vets needs to consider factors such as reflection, mentorship, stereotyping, relationships, communication, and leadership skills. This type of postgraduate support is currently limited for vets and requires investment from stakeholders if improvements in production, animal health and welfare, and the environment are to be achieved. Our findings are informative for facilitating veterinary involvement in any disease context, and are relevant for stakeholders including governments, educators, charities, farmer representatives, environmentalists, and veterinary leaders.
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http://dx.doi.org/10.3389/fvets.2021.709336DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8511516PMC
September 2021

Effects of Dipeptidyl Peptidase-4 Inhibitors and Sulfonylureas on Cognitive and Physical Function in Nursing Home Residents.

Diabetes Obes Metab 2021 Oct 13. Epub 2021 Oct 13.

Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI.

Aims: Dipeptidyl peptidase-4 inhibitors (DPP4Is) may mitigate hypoglycemia-mediated declines in cognitive and physical functioning compared to sulfonylureas (SUs), yet comparative studies are unavailable among older adults, especially nursing home (NH) residents. We evaluated the effects of DPP4Is versus SUs on cognitive and physical functioning among NH residents.

Materials And Methods: This new-user cohort study included long-stay NH residents aged ≥65 years from the 2007-2010 national US Minimum Data Set (MDS) clinical assessments and linked Medicare claims. We measured cognitive decline from the validated 6-point MDS Cognitive Performance Scale, functional decline from the validated 28-point MDS Activities of Daily Living scale, and hospitalizations or emergency department visits for altered mental status from Medicare claims. We compared 180-day outcomes in residents who initiated a DPP4I versus SU after 1:1 propensity score matching using Cox regression models.

Results: The matched cohort (N=1,784) had a mean (SD) age of 80 (8) years and was 73% female. Approximately 46% had no or mild cognitive impairment and 35% had no or mild functional impairment before treatment initiation. Compared to SU users, DPP4I users had lower 180-day rates of cognitive decline (hazard ratio [HR]=0.61, 95%CI 0.31-1.19), altered mental status events (HR=0.71, 95%CI 0.39-1.27), and functional decline (HR=0.89, 95%CI 0.51-1.56), but estimates were imprecise.

Conclusions: Rates of cognitive and functional decline may be reduced among older NH residents using DPP4Is compared to SUs, but larger studies with greater statistical power should resolve the remaining uncertainty by providing more precise effect estimates. This article is protected by copyright. All rights reserved.
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http://dx.doi.org/10.1111/dom.14573DOI Listing
October 2021

Protocol of a systematic review and network meta-analysis for the prevention and treatment of perinatal depression.

BMJ Open 2021 Oct 11;11(10):e048764. Epub 2021 Oct 11.

School of Nursing, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong

Introduction: Perinatal depression is common and can often lead to adverse health outcomes for mother and child. Multiple pharmacological and non-pharmacological treatments have been evaluated against usual care or placebo controls in meta-analyses for preventing and treating perinatal depression compared. It is not yet established which of these candidate treatments might be the optimal approach for prevention or treatment.

Methods And Analysis: A systematic review and Bayesian network meta-analyses will be conducted. Eight electronic databases shall be searched for randomised controlled trials that have evaluated the effectiveness of treatments for prevention and/or treatment of perinatal depression. Screening of articles shall be conducted by two reviewers independently. One network meta-analysis shall evaluate the effectiveness of interventions in preventing depression during the perinatal period. A second network meta-analysis shall compare the effectiveness of treatments for depression symptoms in women with perinatal depression. Bayesian 95% credible intervals shall be used to estimate the pooled mean effect size of each treatment, and surface under cumulative ranking area will be used to rank the treatments' effectiveness.

Ethics And Dissemination: We shall report our findings so that healthcare providers can make informed decisions on what might be the optimal approach for addressing perinatal depression to prevent cases and improve outcomes in those suffering from depression through knowledge exchange workshops, international conference presentations and journal article publications.

Prospero Registration Number: CRD42020200081.
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http://dx.doi.org/10.1136/bmjopen-2021-048764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8506850PMC
October 2021

Surgical implantation of balloon-expandable heart valves for the treatment of mitral annular calcification.

J Thorac Cardiovasc Surg 2021 Aug 25. Epub 2021 Aug 25.

Department of Cardiothoracic Surgery, Baylor Scott & White-The Heart Hospital, Plano, Tex; Department of Cardiovascular Research, Baylor Scott & White-The Heart Hospital, Plano, Tex.

Objectives: The treatment of mitral valve disease in the presence of mitral annular calcification (MAC) is associated with an increased risk of cardiovascular and all-cause mortality. Various surgical and transcatheter techniques for the treatment of mitral disease with severe MAC have been described. However, these procedures are associated with high risk of operative morbidity and mortality. We describe our experience with open surgical implantation of a balloon-expandable valve (BEV) in patients with severe MAC as an alternative approach.

Methods: BEV implantation was performed with direct vision through the left atrium via a median sternotomy or minimally invasive approach. The midportion of the anterior leaflet is excised, and a ventricular septal myectomy performed if there is high risk for left ventricular outflow tract obstruction. The primary outcome was technical success according to the Mitral Valve Academic Research Consortium criteria; secondary outcomes were 30-day and 1-year mortality.

Results: From October 2015 through October 2020, 51 patients at 2 institutions underwent BEV-in-MAC (mean age, 73.9 ± 8.8 years; 60.8% [31/51] were female; mean Society of Thoracic Surgeons predicted risk of mortality: 6.8% ± 4.8%). Technical success was 94.1% (48/51). Thirty-day and 1-year mortality were 13.7% (7/51) and 33.3% (15/45), and for stroke 3.9% (2/51) and 4.4% (2/45), respectively.

Conclusions: Surgical implantation of a BEV in the mitral position offers a treatment option for patients with mitral valve disease complicated by severe MAC who are at increased risk for conventional surgical approaches and at risk for left ventricular outflow tract obstruction with transcatheter approaches.
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http://dx.doi.org/10.1016/j.jtcvs.2021.08.047DOI Listing
August 2021

Endothelial cell-derived pro-fibrotic factors increase TGF-β1 expression by smooth muscle cells in response to cycles of hypoxia-hyperoxia.

Biochim Biophys Acta Mol Basis Dis 2021 Oct 1;1868(1):166278. Epub 2021 Oct 1.

Department of Biology, Baylor University, B.207 Baylor Science Building, One Bear Place #97388, Waco, TX 76798-7388, USA. Electronic address:

Background: The vascular pathology of peripheral artery disease (PAD) encompasses abnormal microvascular architecture and fibrosis in response to ischemia-reperfusion (I/R) cycles. We aimed to investigate the mechanisms by which pathological changes in the microvasculature direct fibrosis in the context of I/R.

Methods: Primary human aortic endothelial cells (ECs) were cultured under cycles of normoxia-hypoxia (NH) or normoxia-hypoxia-hyperoxia (NHH) to mimic I/R. Primary human aortic smooth muscle cells (SMCs) were cultured and treated with media from the ECs.

Findings: The mRNA and protein expression of the pro-fibrotic factors platelet derived growth factor (PDGF)-BB and connective tissue growth factor (CTGF) were significantly upregulated in ECs undergoing NH or NHH cycles. Treatment of SMCs with media from ECs undergoing NH or NHH cycles led to significant increases in TGF-β1, TGF-β pathway signaling intermediates, and collagen expression. Addition of neutralizing antibodies against PDGF-BB and CTGF to the media blunted the increases in TGF-β1 and collagen expression. Treatment of SMCs with PAD patient-derived serum also led to increased TGF-β1 levels.

Interpretation: In an in-vitro model of I/R, which recapitulates the pathophysiology of PAD, increased secretion of PDGF-BB and CTGF by ECs was shown to be predominantly driving TGF-β1-mediated expression by SMCs. These cell culture experiments help elucidate the mechanism and interaction between ECs and SMCs in microvascular fibrosis associated with I/R. Thus, targeting these pro-fibrotic factors may be an effective strategy to combat fibrosis in response to cycles of I/R.

Funding: National Institute on Aging at the National Institutes of Health grant number R01AG064420.

Research In Context: Evidence before this study: Previous studies in gastrocnemius biopsies from peripheral artery disease (PAD) patients showed that transforming growth factor beta 1 (TGF-β1), the most potent inducer of pathological fibrosis, is increased in the vasculature of PAD patients and correlated with collagen deposition. However, the exact cellular source of TGF-β1 remained unclear. Added value of this study: Exposing cells to cycles of normoxia-hypoxia-hyperoxia (NHH) resulted in pathological changes that are consistent with human PAD. This supports the idea that the use of NHH may be a reliable, novel in vitro model of PAD useful for studying associated pathophysiological mechanisms. Furthermore, pro-fibrotic factors (PDGF-BB and CTGF) released from endothelial cells were shown to induce a fibrotic phenotype in smooth muscle cells. This suggests a potential interaction between these cell types in the microvasculature that drives increased TGF-β1 expression and collagen deposition. Thus, targeting these pro-fibrotic factors may be an effective strategy to combat fibrosis in response to cycles of ischemia-reperfusion.
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http://dx.doi.org/10.1016/j.bbadis.2021.166278DOI Listing
October 2021

The relationship between multisite peripheral joint pain and physical activity levels in older adults: A cross-sectional survey.

Musculoskeletal Care 2021 Sep 28. Epub 2021 Sep 28.

School of Medicine, Primary Care Centre Versus Arthritis, Keele University, Keele, Staffordshire, UK.

Introduction: Research on levels of physical activity (PA) in those with peripheral joint pain have only focused on single sites, in the knee or hips. This study investigated the levels of PA in adults with single-site and multisite peripheral joint pain compared to adults with no joint pain.

Methods: Analysis of a cross-sectional population survey mailed to adults aged ≥45 years (n = 28,443) was conducted. Respondents reported any peripheral joint pain in the last 12 months in either the hands, hips, knees or feet; PA levels were self-reported using the short telephone activity rating scale. The association between PA levels, peripheral joint pain and outcomes of health status (physical and mental component scores, using SF-12) pain intensity (10-point scale) and health-related quality of life (HRQoL) (EQ-5D) were investigated using analysis of variance and ordinal regressions.

Results: Compared to those with no joint pain, all pain groups reported lower levels of PA: joint pain in one site (odds ratio = 0.91, 95% CI: 0.83-0.99); two sites (0.74, 0.67-0.81), three sites (0.65, 0.59-0.72) and four sites (0.47, 0.42-0.53). Across all joint pain groups, levels of PA were associated with pain intensity, physical health status, mental health status and HRQoL.

Discussion: Adults with more sites of peripheral joint pain were more likely to report lower levels of PA. Those with more sites of pain and lower levels of PA reported poorer outcomes. Health care providers should be aware that those with multisite joint pain are most likely to have low levels of PA.
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http://dx.doi.org/10.1002/msc.1593DOI Listing
September 2021

Periodically Disturbing the Spatial Structure of Biofilms Can Affect the Production of an Essential Virulence Factor in .

mSystems 2021 Oct 28;6(5):e0096121. Epub 2021 Sep 28.

Department of Biological Sciences, Halmos College of Arts and Science, Nova Southeastern Universitygrid.261241.2, Fort Lauderdale, Florida, USA.

Understanding the environmental factors that affect the production of virulence factors has major implications in evolution and medicine. While spatial structure is important in virulence factor production, observations of this relationship have occurred in undisturbed or continuously disturbed environments. However, natural environments are subject to periodic fluctuations, including changes in physical forces, which could alter the spatial structure of bacterial populations and impact virulence factor production. Using Pseudomonas aeruginosa PA14, we periodically applied a physical force to biofilms and examined production of pyoverdine. Intermediate frequencies of disturbance reduced the amount of pyoverdine produced compared to undisturbed or frequently disturbed conditions. To explore the generality of this finding, we examined how an intermediate disturbance frequency affected pyoverdine production in 21 different strains of P. aeruginosa. Periodic disturbance increased, decreased, or did not change the amount of pyoverdine produced relative to undisturbed populations. Mathematical modeling predicts that interactions between pyoverdine synthesis rate and biofilm density determine the amount of pyoverdine synthesized. When the pyoverdine synthesis rates are high, depletion of the biofilm due to disturbance reduces the accumulation of pyoverdine. At intermediate synthesis rates, production of pyoverdine increases during disturbance as bacteria dispersed into the planktonic state enjoy increased growth and pyoverdine production rates. At low synthesis rates, disturbance does not alter the amount of pyoverdine produced since disturbance-driven access to nutrients does not augment pyoverdine synthesis. Our results suggest that environmental conditions shape robustness in the production of virulence factors and may lead to novel approaches to treat infections. Virulence factors are required to cause infections. Previous work has shown that the spatial organization of a population, such as a biofilm, can increase the production of some virulence factors, including pyoverdine, which is produced by Pseudomonas aeruginosa. Pyoverdine is essential for the infection process, and reducing its production can limit infections. We have discovered that periodically changing the spatial structure of a biofilm of P. aeruginosa strain PA14 using a physical force can reduce the production of pyoverdine. A mathematical model suggests that this is due to the disruption of spatial organization. Using additional strains of P. aeruginosa isolated from patients and the environment, we use experiments and modeling to show that this reduction in pyoverdine is due to interactions between biofilm density and the synthesis rate of pyoverdine. Our results identify conditions where pyoverdine production is reduced and may lead to novel ways to treat infections.
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http://dx.doi.org/10.1128/mSystems.00961-21DOI Listing
October 2021

Vertical Migration of Adult Plecoptera and Trichoptera above Forested Headwater Streams.

Insects 2021 Aug 27;12(9). Epub 2021 Aug 27.

Department of Biology, Lycoming College, Williamsport, PA 17814, USA.

Stream insects are essential components of aquatic and terrestrial ecosystem structure and function. Terrestrial stages are important components of terrestrial food webs, and flight-capable individuals are responsible for long-distance dispersal. Horizontal migrations by flying or crawling adults away from stream channels that link insects to riparian food webs and movements across catchment boundaries are well established through empirical research, but studies examining vertical migration of adult stream insects into forest canopies are generally lacking. This study focused on differences in adult Plecoptera and Trichoptera abundance at ground level versus the riparian canopy and differences in abundances among summer and autumn sampling periods to empirically demonstrate use of canopy ecosystems by stream insects. Malaise traps at ground level and canopy traps placed 8 to 10 m above the stream at four sites in the Mosquito Creek watershed (Pennsylvania) were used to examine vertical migration. Larval assemblages were collected and compared to adult assemblage to investigate patterns of local migration in the catchment. We found significantly more stream insects at ground level than in the forest canopy for Trichoptera, Plecoptera, and all individual plecopteran families, but a meaningful number of individuals were found in the riparian canopy. Canopy abundances were similar to abundances captured in adjacent ground-level habitats in other studies. Comparisons of adult and larval abundances among sites, taxa, and stages indicated site- and taxon-specific patterns for vertical movement into riparian canopies. Demonstrating that adult stream insects utilize riparian forest canopies indicates that riparian forest conservation should be prioritized over reforestation and that several potential research questions exist to inform riparian management.
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http://dx.doi.org/10.3390/insects12090770DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8468684PMC
August 2021

Lichen-based critical loads for deposition of nitrogen and sulfur in US forests.

Environ Pollut 2021 Sep 21;291:118187. Epub 2021 Sep 21.

USDA Forest Service, Biological and Physical Resources, Washington, DC, USA.

Critical loads are thresholds of atmospheric deposition below which harmful ecological effects do not occur. Because lichens are sensitive to atmospheric deposition, lichen-based critical loads can foreshadow changes of other forest processes. Here, we derive critical loads of nitrogen (N) and sulfur (S) deposition for continental US and coastal Alaskan forests, based on nationally consistent lichen community surveys at 8855 sites. Across the eastern and western US ranges of 459 lichen species, each species' realized optimum was the N or S atmospheric deposition value at which it most frequently occurred. The mean of optima for all species at a site, weighted by their abundances, was defined as a community "airscore" indicative of species' collective responses to atmospheric deposition. To determine critical loads for adverse community compositional shifts, we then modeled changes in airscores as a function of deposition, climate and forest habitat predictors in nonparametric multiplicative regression. Critical loads, indicative of initial shifts from pollution-sensitive toward pollution-tolerant species, occurred at 1.5 kg N ha y and 2.7 kg S ha y. Importantly, these critical loads remain constant under any climate regime nationwide, suggesting both simplicity and nationwide applicability. Our models predict that preventing excess N deposition of just 0.2-2.0 kg ha y in the next century could offset the detrimental effects of predicted climate warming on lichen communities. Because excess deposition and climate warming both harm the most ecologically influential species, keeping conditions below critical loads would sustain both forest ecosystem functioning and climate resilience.
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http://dx.doi.org/10.1016/j.envpol.2021.118187DOI Listing
September 2021

Mitral Valve Surgery After Transcatheter Edge-to-Edge Repair: Mid-Term Outcomes From the CUTTING-EDGE International Registry.

JACC Cardiovasc Interv 2021 Sep;14(18):2010-2021

San Raffaele University Hospital, Milan, Italy.

Objectives: The aim of this study was to determine clinical and echocardiographic characteristics, mechanisms of failure, and outcomes of mitral valve (MV) surgery after transcatheter edge-to-edge repair (TEER).

Background: Although >100,000 mitral TEER procedures have been performed worldwide, longitudinal data on MV surgery after TEER are lacking.

Methods: Data from the multicenter, international CUTTING-EDGE registry were retrospectively analyzed. Clinical and echocardiographic outcomes were evaluated. Median follow-up duration was 9.0 months (interquartile range [IQR]: 1.2-25.7 months) after MV surgery, and follow-up was 96.1% complete at 30 days and 81.1% complete at 1 year.

Results: From July 2009 to July 2020, 332 patients across 34 centers underwent MV surgery after TEER. The mean age was 73.8 ± 10.1 years, median Society of Thoracic Surgeons risk for MV repair at initial TEER was 4.0 (IQR: 2.3-7.3), and primary/mixed and secondary mitral regurgitation were present in 59.0% and 38.5%, respectively. The median interval from TEER to surgery was 3.5 months (IQR: 0.5-11.9 months), with overall median Society of Thoracic Surgeons risk of 4.8% for MV replacement (IQR: 2.8%-8.4%). The primary indication for surgery was recurrent mitral regurgitation (33.5%), and MV replacement and concomitant tricuspid surgery were performed in 92.5% and 42.2% of patients, respectively. The 30-day and 1-year mortality rates were 16.6% and 31.3%, respectively. On Kaplan-Meier analysis, the actuarial estimates of mortality were 24.1% at 1 year and 31.7% at 3 years after MV surgery.

Conclusions: In this first report of the CUTTING-EDGE registry, the mortality and morbidity risks of MV surgery after TEER were not negligible, and only <10% of patients underwent MV repair. These registry data provide valuable insights for further research to improve these outcomes.
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http://dx.doi.org/10.1016/j.jcin.2021.07.029DOI Listing
September 2021

Feasibility of Aerobic Exercise and Tai-Chi Interventions in Advanced Lung Cancer Patients: A Randomized Controlled Trial.

Integr Cancer Ther 2021 Jan-Dec;20:15347354211033352

The University of Hong Kong, Hong Kong, China.

Background: A majority of lung cancer patients are diagnosed at advanced stages. Although there is considerable evidence of the benefits of aerobic exercise and tai-chi for lung cancer patients, little is known about the comparative effectiveness of the 2 exercise modes in advanced lung cancer patients.

Objectives: To explore the feasibility and preliminary effects of aerobic exercise and tai-chi interventions on survival and well-being among advanced lung cancer patients.

Methods: In an assessor-blinded, exploratory randomized controlled trial, 30 advanced lung cancer patients were randomized to an aerobic exercise group, a tai-chi group (both attending 12-week, twice-weekly supervised sessions), or a self-management control group (receiving written exercise guidelines). The primary outcomes focused on feasibility including intervention completion, exercise adherence, and adverse events, while the secondary outcomes addressed preliminary effects and included 1-year survival, cancer symptoms (Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Score, Brief Fatigue Inventory), quality of life (EORTC QLQ-C30, QLQ-LC13), physical performance (6-minute walk test, up-and-go, sit-to-stand, 1-leg standing), activity levels (actigraph), and circadian rhythms (salivary cortisol).

Results: Intervention feasibility was established with a satisfactory completion rate at post-intervention for the aerobic exercise group (80%) and the tai-chi group (78%). The tai-chi group attained higher adherence than the exercise group in terms of attendance in supervised sessions (89% vs 75% of scheduled classes) and self-practice (225% vs 87% of the prescribed amount). Higher adherence to self-practice in the tai-chi group remained at the 6-month follow-up (81% vs 38% of the prescribed amount). No adverse event as a result of the intervention was reported. Effect-related outcomes did not show statistically significant changes in any group, except an improvement post-intervention in the up-and-go (-2.26, 95% CI: -4.04, -0.48) and sit-to-stand tests (4.52, 95% CI: 2.19, 6.85) in the aerobic exercise group.

Conclusions: The findings support the feasibility of aerobic exercise and tai-chi interventions in advanced lung cancer patients. A future study with a larger sample from multiple sites is recommended to confirm the comparative effects of the 2 exercise interventions relative to the self-management group and to enhance the generalizability of the findings.
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http://dx.doi.org/10.1177/15347354211033352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8461121PMC
October 2021

Cross-sectional and longitudinal associations between subcutaneous adipose tissue thickness and dual-energy X-ray absorptiometry fat mass.

Clin Physiol Funct Imaging 2021 Nov 22;41(6):514-522. Epub 2021 Sep 22.

Energy Balance and Body Composition Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas, USA.

The present study examined cross-sectional and longitudinal relationships between total and segmental subcutaneous tissue thicknesses from ultrasonography (US) and total and segmental fat mass (FM) estimates from dual-energy X-ray absorptiometry (DXA). Traditional US FM estimates were also examined. Twenty resistance-trained males (mean ± SD; age: 22.0 ± 2.6 years; body mass: 74.8 ± 11.5 kg; DXA fat: 17.5 ± 4.5%) completed a 6-week supervised resistance training programme while consuming a hypercaloric diet. Pre- and post-intervention body composition was assessed by DXA and B-mode US. Data were analysed using Pearson's correlation (r), Lin's correlation coefficient (CCC), paired t-tests, Wilcoxon signed-rank tests and Bland-Altman analysis, as appropriate. Cross-sectionally, correlations were observed between total DXA FM and total subcutaneous tissue thickness (r = 0.88). Longitudinally, a correlation was observed between total DXA FM changes and total subcutaneous tissue changes (r = 0.49, CCC = 0.38). Correlations of similar magnitudes were observed for the upper body and trunk estimates, but DXA FM changes were unrelated to subcutaneous tissue changes for the lower body and arms. Cross-sectionally, US 2-compartment FM and DXA FM were correlated (r = 0.91, CCC = 0.83). Longitudinally, a weaker correlation was observed (r = 0.47, CCC = 0.33). In summary, longitudinal associations between US and DXA are weaker than cross-sectional relationships; additionally, correlations between US subcutaneous tissue and whole-body DXA FM appear to be driven by the trunk region rather than appendages. Reporting raw skinfold thicknesses rather than FM estimates alone may improve the utility of techniques based on subcutaneous tissue thickness, such as US and skinfolds.
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http://dx.doi.org/10.1111/cpf.12727DOI Listing
November 2021

Epistasis shapes the fitness landscape of an allosteric specificity switch.

Nat Commun 2021 09 21;12(1):5562. Epub 2021 Sep 21.

Department of Biochemistry, University of Wisconsin-Madison, Madison, WI, USA.

Epistasis is a major determinant in the emergence of novel protein function. In allosteric proteins, direct interactions between inducer-binding mutations propagate through the allosteric network, manifesting as epistasis at the level of biological function. Elucidating this relationship between local interactions and their global effects is essential to understanding evolution of allosteric proteins. We integrate computational design, structural and biophysical analysis to characterize the emergence of novel inducer specificity in an allosteric transcription factor. Adaptive landscapes of different inducers of the designed mutant show that a few strong epistatic interactions constrain the number of viable sequence pathways, revealing ridges in the fitness landscape leading to new specificity. The structure of the designed mutant shows that a striking change in inducer orientation still retains allosteric function. Comparing biophysical and functional properties suggests a nonlinear relationship between inducer binding affinity and allostery. Our results highlight the functional and evolutionary complexity of allosteric proteins.
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http://dx.doi.org/10.1038/s41467-021-25826-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8455584PMC
September 2021

The effects of phosphocreatine disodium salts plus blueberry extract supplementation on muscular strength, power, and endurance.

J Int Soc Sports Nutr 2021 Sep 9;18(1):60. Epub 2021 Sep 9.

Department of Nutrition and Human Sciences, University of Nebraska-Lincoln, Lincoln, NE, 68510, USA.

Background: Numerous studies have demonstrated the efficacy of creatine supplementation for improvements in exercise performance. Few studies, however, have examined the effects of phosphocreatine supplementation on exercise performance. Furthermore, while polyphenols have antioxidant and anti-inflammatory properties, little is known regarding the influence of polyphenol supplementation on muscular strength, power, and endurance. Thus, the purpose of the present study was to compare the effects of 28 days of supplementation with phosphocreatine disodium salts plus blueberry extract (PCDSB), creatine monohydrate (CM), and placebo on measures of muscular strength, power, and endurance.

Methods: Thirty-three men were randomly assigned to consume either PCDSB, CM, or placebo for 28 days. Peak torque (PT), average power (AP), and percent decline for peak torque (PT%) and average power (AP%) were assessed from a fatigue test consisting of 50 maximal, unilateral, isokinetic leg extensions at 180°·s before and after the 28 days of supplementation. Individual responses were assessed to examine the proportion of subjects that exceeded a minimal important difference (MID).

Results: The results demonstrated significant (p < 0.05) improvements in PT for the PCDSB and CM groups from pre- (99.90 ± 22.47 N·m and 99.95 ± 22.50 N·m, respectively) to post-supplementation (119.22 ± 29.87 N·m and 111.97 ± 24.50 N·m, respectively), but no significant (p = 0.112) change for the placebo group. The PCDSB and CM groups also exhibited significant improvements in AP from pre- (140.18 ± 32.08 W and 143.42 ± 33.84 W, respectively) to post-supplementation (170.12 ± 42.68 W and 159.78 ± 31.20 W, respectively), but no significant (p = 0.279) change for the placebo group. A significantly (p < 0.05) greater proportion of subjects in the PCDSB group exceeded the MID for PT compared to the placebo group, but there were no significant (p > 0.05) differences in the proportion of subjects exceeding the MID between the CM and placebo groups or between the CM and PCDSB groups.

Conclusions: These findings indicated that for the group mean responses, 28 days of supplementation with both PCDSB and CM resulted in increases in PT and AP. The PCDSB, however, may have an advantage over CM when compared to the placebo group for the proportion of individuals that respond favorably to supplementation with meaningful increases in muscular strength.
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http://dx.doi.org/10.1186/s12970-021-00456-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8427883PMC
September 2021

Editorial: Recent Advances in Pheochromocytoma and Paraganglioma: Molecular Pathogenesis, Clinical Impacts, and Therapeutic Perspective.

Front Endocrinol (Lausanne) 2021 23;12:720983. Epub 2021 Aug 23.

School of Biomedical Sciences, Faculty of Medicine, University of Queensland, Herston, QLD, Australia.

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http://dx.doi.org/10.3389/fendo.2021.720983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8419464PMC
August 2021

The effectiveness of pre- and post-operative rehabilitation for lung cancer: A systematic review and meta-analysis on postoperative pulmonary complications and length of hospital stay.

Clin Rehabil 2021 Sep 8:2692155211043267. Epub 2021 Sep 8.

School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong.

Objective: To investigate the effects of rehabilitation either before or after operation for lung cancer on postoperative pulmonary complications and the length of hospital stay.

Data Sources: MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL Plus, SPORTDiscus, PsycInfo and Embase were searched from inception until June 2021.

Review Methods: Inclusion criteria were patients scheduled to undergo or had undergone operation for lung cancer, randomised controlled trials comparing rehabilitative interventions initiated before hospital discharge to usual care control. Two reviewers independently assessed eligibility, extracted data and risks of bias. Pooled odds ratios (ORs) or standardised mean differences (SMDs) with 95% Confidence Intervals (CI) were estimated using random-effects meta-analyses.

Results: Twenty-three studies were included (12 preoperative, 10 postoperative and 1 perioperative), with 2068 participants. The pooled postoperative pulmonary complication risk and length of hospital stay were reduced after preoperative interventions (OR = 0.32; 95% CI = 0.22, 0.47; = 0.0% and SMD = -1.68 days, 95% CI = -2.23, -1.13; = 77.8%, respectively). Interventions delivered during the immediate postoperative period did not have any significant effects on either postoperative pulmonary complication or length of hospital stay (OR = 0.85; 95% CI = 0.56, 1.29; = 0.0% and SMD = -0.23 days, 95% CI = -1.08, 0.63; = 64.6%, respectively). Meta-regression showed an association between a higher number of supervised sessions and shorter hospital length of stay in preoperative studies (β = -0.17, 95% CI = -0.29, -0.05).

Conclusion: Preoperative rehabilitation is effective in reducing postoperative pulmonary complications and length of hospital stay associated with lung cancer surgery. Short-term postoperative rehabilitation in inpatient settings is probably ineffective.
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http://dx.doi.org/10.1177/02692155211043267DOI Listing
September 2021

Contributions of village animal health workers to foot-and-mouth disease control in Cambodia.

Transbound Emerg Dis 2021 Sep 7. Epub 2021 Sep 7.

Independent Livestock Consultant, Pursat, Cambodia.

Local animal health services in rural communities in Cambodia are mainly provided by village animal health workers (VAHWs), although the participation and contribution of VAHWs to livestock disease prevention are uncertain. The participation of the VAHWs as identified by their 'dropout rate' was examined in a desktop review in December 2020 of the national data on VAHWs recorded between 2011 and 2020. The contribution and involvement of VAHWs in disease prevention programmes were examined in a survey conducted between February and March 2014, then analyzed in the context of other surveys of VAHW knowledge, attitudes and practices. The survey involved guided group discussion with VAHWs (n = 198) from the two Cambodian provinces of Kampong Cham and Pursat. This study identified that VAHWs generated less than 22% of their annual household incomes from animal health services. Less than one-third had vaccinated livestock against foot-and-mouth disease (FMD), with none having vaccinated cattle every 6 months during the study period, and nearly half of the VAHWs having never vaccinated their own cattle against FMD. As no privately provided FMD vaccination services occurred in these communities, with all vaccines delivered through the government-subsidized programme, the findings confirmed that VAHWs only vaccinated animals against FMD when vaccines were made available by the Government. The desktop review found that the number of VAHWs in 2020 declined by more than 24% since 2017, and the proportion of female VAHWs was consistently low, with a mean of 8.26 (±1.019). These findings confirm findings from previous studies that identified considerable weaknesses in the VAHW system in Cambodia, particularly in contributing to FMD control. Cambodian animal health authorities require more effective policies to strengthen the current VAHW system, improving their services delivery; their retention as 'active'; their development of more sustainable roles with lower 'dropout' rates and the prolonged gender inequity. With the limited availability of government-subsidized FMD vaccination currently, extension programmes that engage VAHWs and farmers in seeking privately funded and delivered FMD vaccination that incorporates appropriate multivalent FMD serotype vaccines of high quality, delivered in small dose vials from a robust cold chain, is suggested. This strategy would assist VAHWs to contribute to the provision of private livestock vaccination services that are likely essential for sustainable FMD prevention and control in Cambodia.
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http://dx.doi.org/10.1111/tbed.14317DOI Listing
September 2021

When leaders are marketers: a duality perspective on the effect of openness to experience on marketing behaviors and the moderating role of bottom-line mentality.

Curr Psychol 2021 Sep 1:1-15. Epub 2021 Sep 1.

Sawyer Business School, Suffolk University, 73 Tremont St, Boston, MA 02108 USA.

While research has considered the effects of CEO and top-management team members' characteristics on strategic initiatives (e.g. marketing), less research has examined when non-executive leaders directly contribute to these initiatives. In this research, drawing from the duality framework on leader characteristics, we examine how leader openness to experience is associated with their increased engagement in marketing behaviors (e.g. recruiting new customers). Across two field studies, including an exploratory sample of small business owners and a sample of non-executive leaders in the outpatient physical therapy industry, we find that openness to experience was related to leaders' likelihood of executing marketing functions. Additionally, this relationship was weakened when leaders had a primary focus on short-term financial outcomes (i.e., high bottom-line mentality). We further link marketing to unit-level performance in a subsample of Study 2, suggesting that non-executive leaders' marketing behaviors can impact objective organizational performance.
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http://dx.doi.org/10.1007/s12144-021-02216-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8409699PMC
September 2021

Gaze Behavior During Navigation and Visual Search of an Open-World Virtual Environment.

Front Psychol 2021 9;12:681042. Epub 2021 Aug 9.

DEVCOM Army Research Laboratory, Aberdeen Proving Ground, MD, United States.

Eye tracking has been an essential tool within the vision science community for many years. However, the majority of studies involving eye-tracking technology employ a relatively passive approach through the use of static imagery, prescribed motion, or video stimuli. This is in contrast to our everyday interaction with the natural world where we navigate our environment while actively seeking and using task-relevant visual information. For this reason, an increasing number of vision researchers are employing virtual environment platforms, which offer interactive, realistic visual environments while maintaining a substantial level of experimental control. Here, we recorded eye movement behavior while subjects freely navigated through a rich, open-world virtual environment. Within this environment, subjects completed a visual search task where they were asked to find and count occurrence of specific targets among numerous distractor items. We assigned each participant into one of four target conditions: Humvees, motorcycles, aircraft, or furniture. Our results show a statistically significant relationship between gaze behavior and target objects across Target Conditions with increased visual attention toward assigned targets. Specifically, we see an increase in the number of fixations and an increase in dwell time on target relative to distractor objects. In addition, we included a divided attention task to investigate how search changed with the addition of a secondary task. With increased cognitive load, subjects slowed their speed, decreased gaze on objects, and increased the number of objects scanned in the environment. Overall, our results confirm previous findings and support that complex virtual environments can be used for active visual search experimentation, maintaining a high level of precision in the quantification of gaze information and visual attention. This study contributes to our understanding of how individuals search for information in a naturalistic (open-world) virtual environment. Likewise, our paradigm provides an intriguing look into the heterogeneity of individual behaviors when completing an un-timed visual search task while actively navigating.
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http://dx.doi.org/10.3389/fpsyg.2021.681042DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8380848PMC
August 2021

Absolute and Dose-Adjusted Serum Concentrations of Clozapine in Patients Switching vs. Maintaining Treatment: An Observational Study of 1979 Patients.

CNS Drugs 2021 Sep 20;35(9):999-1008. Epub 2021 Aug 20.

Center for Psychopharmacology, Diakonhjemmet Hospital, PO Box 85, 0319, Vinderen, Oslo, Norway.

Background: Clozapine is an effective drug for the management of schizophrenia that has not responded to other agents, but some patients experience insufficient or adverse effects and discontinue treatment.

Objective: We investigated a potential association between clozapine serum concentrations and switching to other antipsychotics in a large real-world patient population from a therapeutic drug monitoring service.

Methods: Absolute and dose-adjusted serum concentrations (concentration-to-dose ratios [C/D ratios]) of clozapine during dosing between 100 and 1000 mg/day were measured in 1979 Norwegian patients during the period 2005-2019. These variables were compared in patients switching to other antipsychotic drugs versus maintaining clozapine treatment using linear mixed models. Smoking habits were known for 49% of the patients. To prevent potential nonadherence affecting clozapine switching, only patients with serum concentrations above 50% of the lower reference range were included.

Results: In total, 190 patients (9.6%) switched from clozapine to another antipsychotic drug during the study period, whereas the remaining patients were not detected as switchers and were interpreted as maintaining treatment. Patients switching treatment had 23.5% lower absolute concentrations (954 vs. 1245 nmol/L; p < 0.001) and 15.7% lower daily doses (305 vs. 362 mg/day; p < 0.001) of clozapine than did nonswitchers, making the clozapine C/D ratio 9.7% lower in switchers than in nonswitchers after correcting for smoking habits (2.80 vs. 3.10 nmol/L/mg/day; p = 0.032).

Conclusions: The present study suggests that decreased absolute and dose-adjusted serum concentrations of clozapine were associated with clozapine discontinuation. The significantly reduced clozapine concentrations regardless of prescribed dose in switchers versus nonswitchers may indicate a pharmacokinetic mechanism underlying the risk of clozapine discontinuation.
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http://dx.doi.org/10.1007/s40263-021-00847-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8408068PMC
September 2021

Painful scrotal dermatitis secondary to topical 5-fluorouracil.

Dermatol Online J 2021 Jun 15;27(6). Epub 2021 Jun 15.

Department of Dermatology, Eastern Virginia Medical School, Norfolk, VA.

5-Fluorouracil (5-FU) is an antineoplastic agent that is used topically to treat actinic keratoses. Although topical 5-FU frequently causes irritant contact dermatitis at the site of application, distant skin reactions are rare and could relate to accidental transfer or systemic absorption of the drug. We present a patient who developed a painful scrotal dermatitis after applying the topical cream to actinic keratoses on his chest. Upon discontinuation of topical 5-FU, the reaction resolved over a four-week period with oral prednisone and topical betamethasone ointment. The patient was re-challenged with topical 5-FU one year later and again developed scrotal pain and erythema similar to the initial reaction. Scrotal dermatitis is a rare adverse effect of topical 5-FU therapy that can be associated with significant distress and disruption of daily activities.
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http://dx.doi.org/10.5070/D327654060DOI Listing
June 2021

Gene Expression Of Methylation Cycle And Related Genes In Lymphocytes And Brain Of Patients With Schizophrenia And Non-Psychotic Controls.

Biomark Neuropsychiatry 2021 Dec 24;5. Epub 2021 Jun 24.

Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA.

Some of the biochemical abnormalities underlying schizophrenia, involve differences in methylation and methylating enzymes, as well as other related target genes. We present results of a study of differences in mRNA expression in peripheral blood lymphocytes (PBLs) and post-mortem brains of chronic schizophrenics (CSZ) and non-psychotic controls (NPC), emphasizing the differential effects of sex and antipsychotic drug treatment on mRNA findings. We studied mRNA expression in lymphocytes of 61 CSZ and 49 NPC subjects using qPCR assays with TaqMan probes to assess levels of DNMT, TET, GABAergic, NR3C1, BDNF mRNAs, and several additional targets identified in a recent RNA sequence analysis. In parallel we studied DNMT1 and GAD67 in samples of brain tissues from 19 CSZ, 26 NPC. In PBLs DNMT1 and DNMT3A mRNA levels were significantly higher in male CSZ vs NPC. No significant differences were detected in females. The GAD1, NR3C1 and CNTNAP2 mRNA levels were significantly higher in CSZ than NPC. In CSZ patients treated with clozapine, GAD-1 related, CNTNAP2, and IMPA2 mRNAs were significantly higher than in CSZ subjects not treated with clozapine. Differences between CSZ vs NPC in these mRNAs was primarily attributable to the clozapine treatment. In the brain samples, DNMT1 was significantly higher and GAD67 was significantly lower in CSZ than in NPC, but there were no significant sex differences in diagnostic effects. These findings highlight the importance of considering sex and drug treatment effects in assessing the substantive significance of differences in mRNAs between CSZ and NPC.
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http://dx.doi.org/10.1016/j.bionps.2021.100038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8341034PMC
December 2021

Early Functional Outcomes After Evolutionary Total Knee Arthroplasty: A Randomized Controlled Trial. Is New Always Better?

JB JS Open Access 2021 Jul-Sep;6(3). Epub 2021 Jul 28.

Wrightington Hospital, Wigan, United Kingdom.

Total knee replacement (TKR) designs continue to evolve with the aim of improving patient outcomes; however, there remains a significant patient dissatisfaction rate. We report the early functional outcomes of an evolutionary knee design in the context of a single-blinded, noninferiority, randomized controlled trial.

Methods: Patients were randomized to receive either the P.F.C. SIGMA or ATTUNE knee implant systems (DePuy Synthes). All implants were fixed-bearing, cruciate-retaining, and cemented constructs. Patients were assessed at baseline and 6 weeks, 3 months, and 1 year postoperatively using clinical and functional outcome measures, including range of motion, Oxford Knee Score (OKS), Oxford Knee Score-Activity and Participation Questionnaire (OKS-APQ), Patient Knee Implant Performance (PKIP) score, 5-Level EuroQol 5 Dimensions (EQ-5D-5L), and Short Form-36 outcome measures.

Results: There were 150 patients who underwent a surgical procedure (76 with the ATTUNE implant and 74 with the P.F.C. SIGMA implant), with 147 patients remaining at the final review. No differences were observed in any of the outcome measures between the groups at any time point. Tourniquet time was significantly shorter in the P.F.C. SIGMA arm (p = 0.001); however, this had no clinical impact on the OKS (analysis of covariance [ANCOVA] test) at the final review (p = 0.825). There was no difference in the numbers of patients achieving the minimal clinically important difference for the OKS between the groups (p = 0.817).

Conclusions: This trial did not show inferiority of the ATTUNE implant when compared with the P.F.C. SIGMA implant. The authors believe that implant innovation should continue and that modern implants should be introduced into the market following randomized controlled trials. Further work should assess the effect of non-implant-related factors on patient outcomes.

Level Of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.2106/JBJS.OA.21.00016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318648PMC
July 2021

Costs of a Train-the-Trainer Program to Teach Primary Care Faculty Mental Health Care.

Med Care 2021 Nov;59(11):970-974

Medicine.

Background: Mental health care must improve in this country. With the worsening shortage of psychiatrists and other mental health professionals, the next generation of physicians in primary care will need to be better trained in mental health care.

Objectives: We estimate the direct cost of implementing an evidence-based Train-the-Trainer (3T) program to disseminate mental health training to allopathic medical school faculty; once trained, faculty can teach a much-enhanced curriculum of mental health care to medical students and residents.

Methods: A combination of published standardized unit costs and an activity-based costing approach is used to estimate the direct costs (labor and nonlabor) for implementing the 3T program.

Results: The estimated direct cost of implementing the 3T program at one prototypical school, including the 12-month start-up period (1.1 million) and 18-month rollout period (8.6 million), is ∼9.7 million dollars.

Conclusions: Successfully adopted in all US allopathic medical schools, the 3T program will provide over 3800 attitudinally competent and mental health skills-qualified primary care faculty members. They would then be available to train nearly 100,000 medical students per year and 55,000 primary care residents to be as competent in basic mental health care as in medical care. This 3T program will begin to meet the needs each year for the millions of adults with major mental disorders that now are largely unrecognized and untreated.
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http://dx.doi.org/10.1097/MLR.0000000000001621DOI Listing
November 2021

Socioeconomic inequalities in distance to and participation in a community-based running and walking activity: A longitudinal ecological study of parkrun 2010 to 2019.

Health Place 2021 Sep 29;71:102626. Epub 2021 Jul 29.

School of Health and Related Research, 30 Regents Court, Sheffield, S1 4DA, UK.

Objectives: To conduct a longitudinal ecological analysis of the distance to and participation in free weekly outdoor physical activity events (parkrun) in England from 2010 to 2019, and related socioeconomic and ethnic inequalities, to inform policies to support participation in physically active community events.

Methods: We calculate distance to the nearest parkrun event for each English Lower Layer Super Output Area (LSOA) each month from January 2010 to December 2019. We then report the trends in distance to and participation in parkrun by Index of Multiple Deprivation quintile. We also report trends in the Relative Index of Inequality (RII) by deprivation for participation and distance to nearest event. We go on to investigate trends in LSOA level determinants (e.g. deprivation and ethnic density) of parkrun participation between 2010 and 2019, using multivariable Poisson regression models.

Results: Mean distance to the nearest parkrun event decreased from 34.1 km in 2010, to 4.6 km in 2019. Throughout the period, parkrun events tended to be situated closer to deprived areas compared to less deprived areas. Participation rates increased superlinearly (greater than linear increase) from 2010 to 2013 before slowing to linear growth. Participation over the period exhibits a clear socioeconomic gradient, with people from deprived areas having consistently lower participation rates over the period. parkrun participation rates became more equal between 2010 and 2013 (RII improved from 189 to 39), before stabilising at an RII between 32.9 and 39.6 from 2014 to 2019. The results of the Poisson regression model validate this finding; the coefficients on IMD score initially increased from -0.050 in 2010 to -0.038 in 2013, and then remained relatively stable to 2019 (-0.035).

Conclusions: Over the past 10 years, geodesic distance to the nearest parkrun decreased from a mean of 34 km to 5 km. In 2010, there was equality between the least and most deprived areas but by 2017 the distance of the most deprived areas was 29% that of the least deprived. Participation was shown to have increased over the past 10 years which can be split into two distinct phases: from 2010 to 2013 participation increased super-linearly and inequality in participation fell dramatically; from 2013 to 2019 participation increased linearly, and inequality in participation remained stable. Despite parkrun's ambitions of creating inclusive events and engaging with deprived communities, the socioeconomic gradient in participation rates remained high and stable since 2013. Gaining a better understanding of the reasons why parkrun grew so quickly may be useful for other physical activity movements, while further analysis of the relatively lower participation rates in areas with higher socioeconomic deprivation is important for developing initiatives to encourage physical activity in these communities.
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http://dx.doi.org/10.1016/j.healthplace.2021.102626DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8522482PMC
September 2021

Tracking changes in body composition: comparison of methods and influence of pre-assessment standardisation.

Br J Nutr 2021 Jul 30:1-19. Epub 2021 Jul 30.

Energy Balance & Body Composition Laboratory, Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, TX, USA.

The present study reports the validity of multiple assessment methods for tracking changes in body composition over time and quantifies the influence of unstandardised pre-assessment procedures. Resistance-trained males underwent 6 weeks of structured resistance training alongside a hyperenergetic diet, with four total body composition evaluations. Pre-intervention, body composition was estimated in standardised (i.e. overnight fasted and rested) and unstandardised (i.e. no control over pre-assessment activities) conditions within a single day. The same assessments were repeated post-intervention, and body composition changes were estimated from all possible combinations of pre-intervention and post-intervention data. Assessment methods included dual-energy X-ray absorptiometry (DXA), air displacement plethysmography, three-dimensional optical imaging, single- and multi-frequency bioelectrical impedance analysis, bioimpedance spectroscopy and multi-component models. Data were analysed using equivalence testing, Bland-Altman analysis, Friedman tests and validity metrics. Most methods demonstrated meaningful errors when unstandardised conditions were present pre- and/or post-intervention, resulting in blunted or exaggerated changes relative to true body composition changes. However, some methods - particularly DXA and select digital anthropometry techniques - were more robust to a lack of standardisation. In standardised conditions, methods exhibiting the highest overall agreement with the four-component model were other multi-component models, select bioimpedance technologies, DXA and select digital anthropometry techniques. Although specific methods varied, the present study broadly demonstrates the importance of controlling and documenting standardisation procedures prior to body composition assessments across distinct assessment technologies, particularly for longitudinal investigations. Additionally, there are meaningful differences in the ability of common methods to track longitudinal body composition changes.
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http://dx.doi.org/10.1017/S0007114521002579DOI Listing
July 2021

Effect of qigong for sleep disturbance-related symptom clusters in cancer: a systematic review and meta-analysis.

Sleep Med 2021 09 29;85:108-122. Epub 2021 Jun 29.

School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; School of Nursing, College of Nursing, Taipei Medical University, Taiwan; Alice Ho Miu Ling Nethersole Charity Foundation Professor in Nursing, Hong Kong. Electronic address:

Objectives: To examine the effects of qigong interventions on sleep disturbance-related symptom clusters for cancer patients and to explore the possible mediating role of fatigue and depression in affecting sleep.

Methods: In this systematic review and meta-analysis, a systematic search was conducted through October 2020 by searching multiple English and Chinese databases. Inclusion was limited to randomized controlled trials that measured the effect of qigong on sleep and fatigue/depressive symptoms in cancer patients. Eleven studies involving 907 cancer patients were included in the systematic review, whereas the meta-analysis included ten studies with 851 cancer patients.

Results: The most commonly investigated form of qigong was Taichi, and the intervention length ranged from 10 days to 6 months. All studies employed self-reported measurements. Overall, qigong significantly improved sleep (SMD = -1.28, 95% CI: -2.01, -0.55) and fatigue (SMD = -0.89, 95% CI: -1.59, -0.19) in cancer patients post-intervention, but not depressive symptoms (SMD = -0.69, 95% CI: -1.81, 0.42). Notably, the benefits on sleep and fatigue became non-significant after 3 months. Qigong's effect on sleep was significantly mediated by its effect on fatigue (β = 1.27, SE = 0.24, p = 0.002), but not depressive symptoms (β = 0.53, SE = 0.26, p = 0.106).

Conclusions: Qigong can be recommended for improving sleep disturbance-fatigue symptom clusters in the cancer population, while qigong's benefit on sleep is likely based on its effect on reducing fatigue. Future qigong studies should adopt more rigorous design and employ strategies to maintain longevity of intervention benefits.
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http://dx.doi.org/10.1016/j.sleep.2021.06.036DOI Listing
September 2021

Lung Cancer Screening Rates During the COVID-19 Pandemic.

Chest 2021 Jul 21. Epub 2021 Jul 21.

Surveillance and Health Equity Sciences, American Cancer Society, Atlanta, GA.

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http://dx.doi.org/10.1016/j.chest.2021.07.030DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8294072PMC
July 2021

Comparative safety of dipeptidyl peptidase-4 inhibitors and sulfonylureas among frail older adults.

J Am Geriatr Soc 2021 Oct 21;69(10):2923-2930. Epub 2021 Jul 21.

Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.

Background: Studies comparing dipeptidyl peptidase-4 inhibitors (DPP4Is) to sulfonylureas (SUs) are unavailable for frail older adults, especially nursing home (NH) residents. We examined the effects of DPP4Is versus SUs on severe adverse glycemic events, cardiovascular events, and death among NH residents.

Methods: We conducted a national retrospective cohort study of long-stay NH residents aged ≥65 years using 2008-2010 national US Minimum Data Set clinical assessment data and linked Medicare claims. Exposure was new DPP4I versus new SU use assessed via Medicare Part D drug claims. One-year outcomes were severe hypoglycemia, severe hyperglycemia, acute myocardial infarction (AMI), heart failure (HF), major adverse cardiovascular events plus HF (MACE+HF), and death. We compared outcomes after propensity score matching using Cox proportional hazards regression models.

Results: The cohort (N = 2016) had a mean (SD) age of 81 (8.1) years and was 72% female. Compared with SU users, DPP4I users had a lower 1-year rate of severe hypoglycemic events (HR = 0.57, 95% CI 0.34-0.94), but statistically similar rates of severe hyperglycemic events (HR = 0.94, 95% CI 0.52-1.72), AMI (HR = 0.76, 95% CI 0.44-1.30), HF (HR = 1.01, 95% CI 0.79-1.30), MACE+HF (HR = 0.90, 95% CI 0.72-1.12), and death (HR = 0.97, 95% CI 0.86-1.10).

Conclusions: DPP4Is should be a preferred treatment option over SUs for NH residents and other frail older adults given the importance of avoiding hypoglycemia.
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http://dx.doi.org/10.1111/jgs.17371DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497422PMC
October 2021
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