Greater Absolute Increase Research Articles

Impact of COVID-19 on Young Adolescent Mental Health: Comparison of Depression, Anxiety and Behaviour Problems in 12 Year Olds Immediately Before and During the Pandemic in a UK Birth Cohort

Background: We examine whether there has been an increase in young adolescent and maternal mental health problems from pre to post-onset of the COVID-19 pandemic in the UK.Methods: Children aged 11 - 12 years and their mothers participating in a UK population-based birth cohort (Wirral Child Health and Development Study) provided mental health data between December 2019 and March 2020 and again 3 months after lockdown, 89% (N = 202) of 226 assessed pre-COVID-19. Emotional and behavioural problems were assessed by self- and maternal report, and long-term vulnerability by maternal report of prior child adjustment, and maternal prenatal depression. A range of COVID-19 associated risks were assessed as potential moderators.Findings: The young adolescents reported a 44% increase in symptoms of depression and 26% for PTSD. After adjustment for her own depression, the corresponding maternal reports of child symptoms gave increases of 71% and 43%. Both female gender and having had high internalising symptoms earlier in childhood were associated with elevated rates of depression pre-pandemic, and with greater absolute increases during COVID-19. Disruptive behaviour problems increased particularly in children without previous externalising symptoms. Mothers’ own depression increased by 42%, and this change was greater among those who had been depressed during pregnancy. No change in anxiety was observed among children or mothers. None of these increases was moderated by COVID-19 related experiences such as front-line worker status of a parent or financial impacts. Prior to the pandemic, rates of maternal and child depression were greater in families experiencing higher deprivation, but changed only in less deprived families, raising their rates to those of the high deprivation group. Interpretation: In the UK COVID-19 has led to a marked increase in mental health problems in young adolescents and their mothers.Funding: Medical Research Council and CWP NHS Foundation TrustDeclaration of Interests: The authors declare no conflicts of interest.Ethics Approval Statement: Ethical approval for the study was granted by the Cheshire North and West Research Ethics Committee on the 27 June 2006 (reference no. 05/Q1506/107), and 7th June 2010 (reference no. 10/H1010/4) and on 22nd December 2014 and 8th June 2020 (reference no. 14/NW/1484).

Prevalence of hypertension and controlled hypertension among United States adults: Evidence from NHANES 2017-18 survey

BackgroundThis study aims to compare the prevalence of hypertension (HTN) and controlled hypertension (CHTN) in US adults and determine the absolute difference in the prevalence of HTN and CHTN between the JNC7 and ACC/AHA 2017 guidelines. MethodsData for this study were derived from the most recent cycle of the National Health and Nutrition Examination Survey (NHANES) 2017–2018. After excluding participants with missing systolic blood pressure (BP) or diastolic BP and aged <18 years, 4730 participants were included in the final analyses. BP was defined as the average of the first three measurements. The prevalence of HTN and CHTN, including absolute differences of these prevalences, were estimated using both JNC7 and ACC/AHA 2017 guidelines. ResultsThe overall weighted prevalence of HTN was 31.7% (95% CI: 28.7–34.8) based on JNC7, while the corresponding prevalence was 45.6% (95% CI: 43.0–48.3) when new guideline of ACC/AHA was used. Of the people who had HTN according to the JNC7 and ACC/AHA 2017 guidelines, 48.2% (95% CI: 44.4–52.0) and 21.0% (95% CI: 18.1–24.2) had a controlled blood pressure level, respectively. When blood pressure was assessed using both guidelines, the greatest absolute increase in rates of HTN and CHTN was 17.4% and 30.0% in people aged 40–59 years, respectively. ConclusionGiven the high burden of disease due to complications arising from untreated HTN, as well as the higher costs of untreated disease, new guidelines have important public health implications to early detection of patients at risk and prevent complications across different populations.

Impact of Longitudinal Virtual Primary Care on Diabetes Quality of Care

Individuals living in rural areas experience a higher prevalence of diabetes and diabetes‐related morbidity than their urban counterparts due to socioeconomic challenges and limited access to care. In randomized controlled trials, use of telemedicine has been effective in increasing access to care and lowering hemoglobin A1C levels for diabetic patients, but whether these results can be generalized to real‐world primary care settings remains unknown. We compare diabetes quality of care among veterans who received longitudinal virtual primary care versus those who received traditional in‐person care.The Virtual Integrated Multisite Patient Aligned Care Team (V‐IMPACT) is a novel primary care delivery model implemented by the Department of Veterans Affairs that utilizes video visits to provide longitudinal primary care services in rural areas that have difficulty recruiting and retaining primary care providers. We conducted a retrospective quasi‐experimental study utilizing difference‐in‐differences analysis to evaluate diabetes quality of care before and after implementation of V‐IMPACT in participating primary care clinics from January 1, 2016, through December 31, 2019, with staggered V‐IMPACT implementation across clinics occurring in 2018. Our primary outcome of interest was change in hemoglobin A1C (HbA1C) before and after implementation of V‐IMPACT among patients with diabetes. Secondary outcomes included the proportion who received urine microalbuminuria screening and were prescribed statins, ACE or ARBs.We identified 64 639 veterans with type 2 diabetes receiving care in 44 VA primary care clinics where V‐IMPACT was implemented. Patients were eligible for analysis if they had at least one primary care encounter and at least one documented hemoglobin A1C level available during the observation period. We excluded patients younger than 18 years old and those with metastatic cancer. Propensity score matching was used to construct a matched‐pair cohort of patients with balanced demographics and comorbidities who did and did not receive V‐IMPACT services.Our propensity‐matched cohort included 9150 veterans split evenly between those who participated in V‐IMPACT and those who remained in usual in‐person care. Mean HbA1C decreased from 7.35% to 7.29% among diabetics who were exposed to V‐IMPACT and from 7.29% to 7.23% among those receiving traditional in‐person care before and after V‐IMPACT implementation. No significant difference was found in the change in HbA1C between groups (difference‐in‐differences estimate, 0.0035%; −0.034 to 0.041%). We observed a 4.1% (95% CI 1.4‐6.8%) greater absolute increase in the proportion of diabetic Veterans prescribed statins in the V‐IMPACT group compared to the control group and a 5.7% greater increase in the proportion prescribed ACE/ARBs. V‐IMPACT implementation was not associated with significant changes in the proportion of veterans receiving urine microalbuminuria screening (−0.06%, 95% CI −2.9 to 2.8).The quality of diabetes care delivered by a longitudinal virtual primary care model was similar if not better than traditional in‐person care.Primary care access remains a challenge for many clinics and health systems serving rural populations. Our study demonstrates that a longitudinal telemedicine‐based primary care model can be effective for the management of diabetes and supports consideration of longitudinal telemedicine as a strategy to increase primary care access in rural communities.Department of Veterans Affairs.

Production externalities of shrimp aquaculture on paddy farming in coastal Bangladesh

Shrimp aquaculture is a fast-growing industry in many parts of the world. The expansion of the industry has raised concerns about its external impacts on the local environment and ecosystems, including agriculture. This study examines changes over time in land use and soil salinity levels using satellite data and soil sample data from Satkhira district in Bangladesh. Moreover, the study measures the impact of shrimp aquaculture on soil salinity in neighboring paddy farms and evaluates how this, in turn, affects paddy farm profits, using farm-level data from 316 paddy plots. Results show that the land covered by shrimp ponds almost doubled in terms of percentage of land area, expanding from 22 % in 1990 to 38 % in 2016. Soil salinity also increased significantly over the same period. Farm-level analysis shows that salinity levels are relatively higher in paddy plots that are closer to shrimp ponds. Each additional 1-meter decrease in the distance between paddy plots and shrimp ponds induces a 0.14 % increase in soil salinity in both Aman (rainfed) and Boro (irrigated) seasons. As salinity is higher in paddy plots closer to shrimp ponds, the same percentage change results in a greater absolute increase in salinity levels in nearby paddy plots relative to plots located farther away. Furthermore, due to the higher salinity levels, paddy profits per hectare are relatively lower in paddy plots closer to shrimp ponds. On average, a 1-meter decrease in the distance between paddy plots and shrimp ponds results in a decrease in paddy profits by USD 0.31 and 0.15 per hectare in the Aman and Boro seasons, respectively. The findings of this study call for policy measures to address the externalities posed by shrimp aquaculture to paddy farmers.

Trend of emergency department presentations with a mental health diagnosis in Australia by diagnostic group, 2004-05 to 2016-17.

To examine trends of ED presentations with a mental health (MH) diagnosis in Australia and its jurisdictions by diagnostic group between 2004-05 and 2016-17. Data comprised ED presentations with a principal diagnosis of ICD-10-AM F00-F99 (MHdx ) captured within the National Non-Admitted Patient Emergency Department Care Database. Trends in absolute number and rates of MHdx presentations per 10 000 population were assessed as differences (x-fold) and annual growth rates (average and compound). Increased presentation rates were observed for most diagnostic groups, except for mental retardation (F70-F79) and mood disorders (F30-F39). The greatest absolute increase was for psychoactive substance use-related disorders (F10-F19), and relative increase, unspecified mental disorder (F99). There was differentiation across jurisdictions regarding rates of and growth in presentations. In 2016-17, rates at least twice the national average were observed for psychoactive substance-use (F10-F19), schizophrenia and psychotic disorders (F20-F29) and childhood and adolescence onset disorders (F90-F98) in the Northern Territory, F90-F98 in South Australia, personality disorders (F60-F69) in Tasmania and unspecified mental disorder (F99) in New South Wales. The most marked growth was observed for F99 in New South Wales. Between 2004-05 and 2016-17, rates of ED presentations increased across most MH diagnostic groups, but particularly psychoactive substance use-related disorders. To reduce the need for MH crisis care in Australian EDs, strategies are required to reduce psychoactive substance use in the community, and policies may be needed to strengthen the capability of community MH services and primary care professionals to recognise, diagnose and treat earlier in the course of illness.

Role of Total Ankle Arthroplasty in Stiff Ankles – Long Term Follow-Up

Category:Ankle, Ankle ArthritisIntroduction/Purpose:Operative treatment of end-stage ankle arthritis involves either ankle arthrodesis (AA) or total ankle arthroplasty (TAA). The theoretical benefit of TAA is the ability to preserve range of motion (ROM) at the tibiotalar joint.Previous studies have questioned whether it is justified to perform TAA over AA in stiff, arthritic ankles. However, a recent study showed that patients who underwent TAA with stiff ankles preoperatively experienced significant clinical improvement in range of motion and gait function compared to more flexible groups at 1-year follow-up. We retrospectively assessed these same gait and functional parameters to see if these improvements held up in long-term follow-up.Methods:A retrospective study of long-term, prospectively collected functional gait data in 33 TAA patients at a mean of 7.6 years postoperatively (range 4.8-13.3) used a multivariate regression model to determine the effect of ankle stiffness on the long- term, objective outcomes of TAA. Data was analyzed by quartiles (Q1, Q2+Q3, Q4) of preoperative sagittal ROM using one-way analysis of variance (ANOVA) to compare both preop and postop gait parameters. The two middle quartiles were combined to conform to distribution of the data. The multivariate analysis determined the independent effect of age, gender, BMI, years post- surgery, and preop ROM on every preop and postop parameter of gait.Results:Statistically significant differences were found in all three gait parameter categories, including temporal-spatial (step length and walking speed), kinematic (total sagittal ROM and maximum plantarflexion), and kinetic (peak ankle power). The stiffest ankles preoperatively (Q1) had the greatest absolute increase in total sagittal ROM postoperatively, +5.3o, compared to -1.3o (p<0.0174) in Q4 (most flexible). However, Q1 had the lowest absolute total postoperative sagittal ROM of 13.1 o, compared to 19.7 o (p<0.0108) in Q4. Q1 also had the lowest preoperative step length, walking speed, maximal plantarflexion, and peak ankle power when compared to the other subgroups. There was no difference in any of these same parameters postoperatively. BMI and years post-surgery had no effect on outcomes, while age and gender had a minimal effect.Conclusion:Preoperative range of motion was once again predictive of overall postoperative gait function in long-term follow-up at an average of 7.2 years. A greater degree of preoperative sagittal range of motion was predictive of greater postoperative sagittal range of motion in long-term follow-up. Patients with the stiffest ankles preoperatively once again had a statistically and clinically greater improvement in function as measured by multiple parameters of gait. This shows that the clinically meaningful improvement in gait function after total ankle arthroplasty holds up in long-term follow-up, even in the setting of limited preoperative sagittal range of motion.

The Role of Voice Therapy and Phonosurgery in Transgender Vocal Feminization.

Nonsurgical and surgical options are available for transgender vocal feminization. This systematic review explores the efficacy of feminizing voice therapy and phonosurgery. A systematic review was performed using PubMed, Cinahl Plus, Ovid SP, Web of Science, Science Direct, and Google Scholar with terms related to transgender phonosurgery and voice therapy. Included studies were outcomes-based vocal feminization interventions for transgender women. Data were collected on pre- and postintervention fundamental frequency (F0), externally measured vocal femininity, patient satisfaction, and complications. Two hundred twelve studies were identified and 20 met inclusion criteria. Postintervention patient satisfaction was approximately 80% to 85% for voice therapy, endoscopic shortening, and cricothyroid approximation. Complications were reported for each phonosurgery technique, most commonly decreased mean phonation time and loudness. Of the 20 studies, 17 were used for meta-analysis of F0 change. F0 increased by 31 Hz with voice therapy alone, 26 Hz with laser reduction glottoplasty, 39 Hz with cricothyroid approximation, and 72 Hz with endoscopic shortening. The literature supports both voice therapy and phonosurgery, depending on a patient's magnitude of desired pitch change and tolerance for cost and potential complications. Most will likely benefit from voice therapy, as it is highly satisfactory, raises vocal pitch, and is noninvasive. However, endoscopic shortening is also highly satisfactory and provides the greatest absolute increase in vocal pitch. If surgery is chosen, postoperative voice therapy may additionally increase F0, stabilize the voice, and create a more female timbre. However, further studies will be necessary to provide definitive clinical recommendations.

Association of Multiple Enrichment Criteria With Ischemic and Bleeding Risks Among COMPASS-Eligible Patients

BackgroundThe COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial found clinical benefit of low-dose rivaroxaban plus aspirin, but at the expense of increased bleeding risk in patients with stable vascular disease. ObjectivesThis study evaluated the balance of ischemic and bleeding risks according to the presence of ≥1 enrichment criteria in “COMPASS-eligible” patients. MethodsKey COMPASS selection criteria were applied to identify a COMPASS-eligible population (n = 16,875) from the REACH (REduction of Atherothrombosis for Continued Health) Registry of stable atherothrombotic patients. Ischemic outcome was the composite of cardiovascular death, myocardial infarction, or stroke. Bleeding outcome was serious bleeding (hemorrhagic stroke, hospitalization for bleeding, transfusion). ResultsPatients were categorized according to the enrichment criteria: age >65 years (81.5%), diabetes (41.0%), moderate renal failure (40.2%), peripheral artery disease (33.7%), current smoker (13.8%), heart failure (13.3%), ischemic stroke (11.1%), and asymptomatic carotid stenosis (8.7%). Each criterion was associated with a consistent increase in ischemic and bleeding events, but no individual subgroup derived a more favorable trade-off. Patients with multiple criteria had a dramatic increase in ischemic risk (7.0% [95% confidence interval (CI): 5.6% to 8.7%], 12.5% [95% CI: 11.1% to 14.1%], 16.6% [95% CI: 14.7% to 18.6%], and 21.8% [95% CI: 19.9% to 23.9%] with 1, 2, 3, and ≥4 enrichment criteria, respectively), but a more modest absolute increase in bleeding risk (1.5% [95% CI: 0.9% to 2.1%], 1.8% [95% CI: 1.3% to 2.2%], 2.0% [95% CI: 1.5% to 2.6%], 3.2% [95% CI: 2.6% to 3.9%]). ConclusionsIn a population of stable vascular patients at high risk of atherothrombotic events, the subset with multiple enrichment criteria had a greater absolute increase in ischemic than in bleeding risk and may be good candidates for low-dose rivaroxaban in addition to aspirin.

Trends in the Use of Permanent Pacemakers in Australia: A Nationwide Study from 2008–2017

Background: There is an increasingly ageing and comorbid population in Australia. Although prior studies have demonstrated that permanent pacemaker (PPM) insertions were rising in this context, there is a lack of contemporary data. Methods: Data from the Australian Institute of Health and Welfare were analysed to determine the annual nationwide number of PPM generator and electrode insertions, plus replacement, removal and adjustment procedures between 2008–2017. Rates were calculated using the mid-year estimated population from the Australian Bureau of Statistics. Results: PPM generator insertions increased from 12,153 in 2008–09 to 17,862 in 2016–17. As a percentage of all cardiovascular procedures, generator insertion increased from 2.14% to 2.99%. Generator insertion rates increased from 55.3 to 72.6 per 100,000 with rises seen in all age groups. In contrast, generator replacements decreased from 20.5 to 18.3 per 100,000. The highest proportion of generator insertions was in the 80+ age group (46.6%) and in males (58.4%). Although the rate of generator insertions increased in all age groups and both genders, the proportion of insertions appeared stable across age groups and gender, with the greatest absolute increase seen in the 80+ age group. Conclusions: The rate and number of PPMs increased in Australia between 2008–2017, while the rate of PPM generator replacements decreased. This increasing demand for pacing services is in large part driven by an ageing population, in addition to rising insertion rates across all age groups. Our evidence supports a continued increase in future pacing demand and has significant implications for healthcare planning.

Pediatric emergency medical services in privately insured patients: A 10-year national claims analysis

ObjectiveTo characterize pediatric Emergency Medicine Service (EMS) transports to the Emergency Department (ED) using a national claims database. MethodsWe included children, 18 years and younger, transported by EMS to an ED, from 2007 to 2016 in the OptumLabs Data Warehouse. ICD-9 and ICD-10 diagnosis codes were used to categorize disease system involvement. Interventions performed were extracted using procedure codes. ED visit severity was measured by the Minnesota Algorithm. ResultsOver a 10-year period, 239,243 children were transported. Trauma was the most frequent diagnosis category for transport for children ≥5 years of age, 35.1% (age 6–13) and 32.7% (age 14–18). The most common diagnosis category in children <6 years of age was neurologic (29.3%), followed by respiratory (23.1%). Over 10 years, transports for mental disorders represented 15.3% in children age 14 to 18, and had the greatest absolute increase (rate difference + 10.4 per 10,000) across all diagnoses categories. Neurologic transports also significantly increased in children age 14 to 18 (rate difference + 6.9 per 10,000). Trauma rates decreased across all age groups and had its greatest reduction among children age 14 to 18 (rate difference − 6.8 per 10,000). Across all age groups, an intervention was performed in 15.6%. Most children (83.3%) were deemed to have ED care needed type of visit, and 15.8% of the transports resulted in a hospital admission. ConclusionTrauma is the most frequent diagnosis for transport in children older than 5 years of age. Mental health and neurologic transports have markedly increased, while trauma transports have decreased. Most children arriving by ambulance were classified as requiring ED level of care. These changes might have significant implication for EMS personnel and policy makers.

A cost analysis of early biliary strictures following orthotopic liver transplantation in the United States.

To date, the financial burden of biliary strictures (BS) after orthotopic liver transplantation (OLT) has remained largely unassessed. This study sought to approximate perioperative costs associated with early BS and delineate where in the hospital these costs are incurred. The Premier Healthcare Database was queried for patients undergoing OLT between 2010 and 2016. Patients who did and did not develop early BS were compared with respect to perioperative costs and outcome variables. Multivariable regression models were used to estimate differences between groups. Patients who developed early BS had a longer length of stay (LOS) (35.3days vs 17.8days, P<0.001) and were less likely to be discharged home (odds ratio=0.45, P=0.003). Development of early BS was associated with an incremental cost increase of $81881 (45.8%, P<0.001). The greatest relative cost increases were in radiology (+163.5%) and respiratory therapy (+157.1%), while the greatest absolute increase was in room and board (+$27589). Early BS after OLT result in higher costs stemming from longer LOS and increased need for various diagnostic studies and therapies. In addition to incentivizing measures that may prevent early BS, hospitals should account for these factors when developing payment schemes for OLT with payors.

Future southcentral US wildfire probability due to climate change

Globally, changing fire regimes due to climate is one of the greatest threats to ecosystems and society. In this paper, we present projections of future fire probability for the southcentral USA using downscaled climate projections and the Physical Chemistry Fire Frequency Model (PC2FM). Future fire probability is projected to both increase and decrease across the study region of Oklahoma, New Mexico, and Texas. Among all end-of-century projections, change in fire probabilities (CFPs) range from − 51 to + 240%. Greatest absolute increases in fire probability are shown for areas within the range of approximately 75 to 160 cm mean annual precipitation (MAP), regardless of climate model. Although fire is likely to become more frequent across the southcentral USA, spatial patterns may remain similar unless significant increases in precipitation occur, whereby more extensive areas with increased fire probability are predicted. Perhaps one of the most important results is illumination of climate changes where fire probability response (+, −) may deviate (i.e., tipping points). Fire regimes of southcentral US ecosystems occur in a geographic transition zone from reactant- to reaction-limited conditions, potentially making them uniquely responsive to different scenarios of temperature and precipitation changes. Identification and description of these conditions may help anticipate fire regime changes that will affect human health, agriculture, species conservation, and nutrient and water cycling.

Are changes in heart rate, observed during dobutamine stress echocardiography, associated with a response to cardiac resynchronisation therapy in patients with severe heart failure? Results of a multicentre ViaCRT study.

According to current European Society of Cardiology guidelines for the diagnosis and treatment of heart failure (HF), cardiac resynchronisation therapy (CRT) is indicated in patients suffering from HF with reduced ejection fraction (EF) with significantly widened QRS complexes. The presence of vital myocardium proven by dobutamine stress echocardiography (DSE) is considered as a good prognostic factor for responsiveness to this treatment. Chronotropic incompetence is, on the other hand, a known factor of unfavourable outcome in HF. The aim of this study was to analyse the relationship between heart rate (HR) response during DSE and resultant changes in echocardiographic parameters determined prior to CRT and six weeks post-implantation of the CRT system. The study included 72 men and 25 women with chronic HF and markedly deteriorated left ventricular (LV) sys-tolic function (EF < 35%). Low-dose DSE was performed prior to the CRT system implantation. Baseline echocardiographic parameters determined before CRT were compared to those measured six weeks after implantation. Implantation of the CRT system resulted in an improvement of LV systolic function. DSE showed a significant in-crease in HR, by 16.3 bpm on average. Patients with the least prominent increase in HR during DSE (< 7 bpm) presented with significantly greater end-diastolic LV dimension and volume, as well as with significantly lower EF than the subjects with the most evident increase in HR (> 24 bpm). Improvement in EF at six weeks was associated with lower baseline HR and its greater absolute and relative increase during DSE. Greater absolute increase in HR during DSE was also associated with more prominent decrease in systolic/diastolic LV volumes. Patients with better chronotropic response during DSE show significant improvement in LV parameters determined by echocardiography within six weeks of CRT. Chronotropic response to pharmacologic stress test may serve as a predictive factor in patients qualified for CRT.

The Impact of Climate Change on Hazardous Convective Weather in the United States: Insight from High-Resolution Dynamical Downscaling

This study explores the potential impact anthropogenic climate change may have upon hazardous convective weather (HCW; i.e., tornadoes, large hail, and damaging wind gusts) in the United States. Utilizing the Weather Research and Forecasting (WRF) Model, high-resolution (4 km) dynamically downscaled simulations of the Geophysical Fluid Dynamics Laboratory Climate Model, version 3 (GFDL CM3), are produced for a historical (1971–2000) and future (2071–2100) period. Synthetic HCW day climatologies are created using upward vertical velocity (UVV) exceeding 22 m s−1 as a proxy for HCW occurrence and subsequently compared to the environmental approach of estimating changes in daily frequency of convective environments favorable for HCW (NDSEV) from the driving climate model. Results from the WRF simulations demonstrate that the proxy for HCW becomes more frequent by the end of the twenty-first century, with the greatest absolute increases in daily frequency occurring during the spring and summer. Compared to NDSEV from GFDL CM3, both approaches suggest a longer HCW season, perhaps lengthening by more than a month. The change in environmental estimates are 2–4 times larger than that gauged from WRF; further analyses show that the conditional probability of HCW given NDSEV declines during summer for much of the central United States, a result that may be attributed to both an increase in the magnitude of convective inhibition (CIN) and decreased forcing for ascent, hindering convective initiation. Such an outcome supports the motivation for continued use of dynamical downscaling to overcome the limitations of the GCM-based environmental analysis.

Effects of multiaged silvicultural systems on reserve tree growth 19 years after establishment across multiple species in the Acadian forest in Maine, USA

This study investigated the growth response of mature, isolated reserve trees (n = 528) in two multiaged silvicultural systems in the Acadian Forest Ecosystem Research Project (AFERP). Absolute and percent increases in basal area increment (BAI; cm2·year−1) were assessed for the five predominant reserve tree species in AFERP: Acer rubrum L., Picea rubens Sarg., Pinus strobus L., Thuja occidentalis L., and Tsuga canadensis (L.) Carrière. Absolute growth was significantly greater in the large-gap treatment (23.7 ± 1.1 cm2·year−1; mean ± SE) than in the small-gap treatment (16.3 ± 0.9 cm2·year−1). Percent growth increase was greater in the small-gap treatment (187.6% ± 15.8%) than in the large-gap treatment (143.4% ± 19.3%), and both treatments had greater percent increases than the unharvested control (9.6% ± 5.2%). Species differed in their response to treatment. Pinus strobus had the greatest absolute increase (large-gap, 52.5 cm2·year−1), while Tsuga canadensis (large-gap, 270% ± 71.6%) and Acer rubrum (small-gap, 262% ± 42.4%) had the greatest percent increases. Growth responses typically diminished with increasing tree size and pretreatment growth rate; however, reserve trees showed greater growth responses than their paired analogues in the control across all initial tree sizes and prior growth rates. The results suggest that these silivicultural systems accelerate the development of large trees.

The Risk for Cardiovascular Events Associated with Hyperlipdemia among Patients with and Without Rheumatoid Arthritis.

To determine, using data from a real-world setting, the overall and sex-specific risk of cardiovascular (CV) events in patients with rheumatoid arthritis (RA), with or without comorbid hyperlipidemia, relative to those in a non-RA cohort. This retrospective cohort study using claims data from a US commercial health plan (2005-2011) included patients with RA and a matched non-RA cohort. Cox proportional hazards regression model determined the hazard ratio (HR) for CV events (myocardial infarction, stroke, revascularization procedures), using the presence of RA and hyperlipidemia as the independent variables, controlling for other covariates (age, sex, diabetes, and hypertension). The incidence of CV events per 1000 person-years was 10.19 for the RA cohort and 6.41 for the non-RA cohort (crude rate ratio [RR] =1.59). Within the RA cohort, incidence was 15.54 for patients with hyperlipidemia and 7.05 for patients without hyperlipidemia (crude RR=2.21); in the non-RA cohort, incidence was 10.55 and 3.82 for those with and without hyperlipidemia, respectively (crude RR=2.76). After controlling for covariates, the HR of CV events among RA patients was 1.68 (95% CI: 1.50, 1.87) relative to non-RA patients. After multivariable adjustment, hyperlipidemia conferred a significant risk of CV events in both RA and non-RA patients; the interaction between RA and hyperlipidemia was not significant (p=0.13). This real-world analysis demonstrates that patients with RA have an increased risk of CV events. Similar to a non-RA cohort, CV event rates were incrementally higher for those patients with hyperlipidemia. Cardiovascular disease is an increasingly visible topic of concern in the rheumatoid arthritis community. However, there are only limited data that informs both the absolute and relative rates of CVD events, and the contribution of various risk factors such as hyperlipidemia, compared to non-RA populationsThe 'lipid paradox' hypothesis in RA suggests that elevated LDL cholesterol has a negligible effect on CVD risk in RA, unlikely in the general population where it is a well-accepted CVD risk factorThe incidence of CVD events in RA patients was 10/1000 patient years, a 1.6 fold greater risk compared to non-RA patientsThe contribution of hyperlipidemia to CVD risk was associated with comparable or greater absolute increases in the rate of CV events compared to non RA patients, a finding that does not support the lipid paradox.

Immunogenicity of a three dose and five dose oral human rotavirus vaccine (RIX4414) schedule in south Indian infants

AimThis study was undertaken to compare the immunogenicity of a three dose and five dose schedule of an oral live-attenuated human rotavirus vaccine, Rotarix® in south Indian infants. MethodHealthy infants (N=90), six to seven weeks of age were enrolled to receive three doses (n=45) or five doses of Rotarix vaccine (n=45) along with other scheduled vaccines, each dose separated by a four week interval. Blood samples were taken before vaccination and one month post-dose three in the Rotarix three dose group and one month post-dose five in the Rotarix five dose group; all were tested for anti-rotavirus IgA by an antibody sandwich enzyme immunoassay. ResultsAt baseline, >50% of infants had >20units of anti-rotavirus IgA. The seroconversion rates after three and five doses were low and not significantly different in the two groups. However, among vaccine responders, children seropositive at baseline showed a much greater absolute increase in IgA antibody levels than children seronegative at baseline. ConclusionsRotarix vaccine showed low immunogenicity in south Indian children and increasing the number of doses did not increase the proportion of infants seroconverting after vaccination.

Phytochemicals for treatment of diabetes.

Diabetes Mellitus (DM) is one of the most prevalent metabolic disorders characterized by increased blood glucose levels and improper primary metabolism resulting from the defects in insulin secretion, insulin action, or both. It is one of the most common health problems worldwide, and the prevalence of this disease is rapidly increasing, leading to microvascular (retinopathy, neuropathy and nephropathy) and macrovascular (heart attack, stroke and peripheral vascular disease) complications (Umar et al., 2010[18]). The number of individuals with diabetes is increasing due to population growth, aging, urbanization and increasing prevalence of obesity and physical inactivity. According to recent estimates, the greatest absolute increase in the number of patients with diabetes will be in India and the total number is projected to 79.4 million in 2030. It is expected that about 366 million are likely to be diabetic by the year 2030 (Rahman and Zaman, 1989[14]). Medicinal plants are the main source of organic compounds such as polyphenols, tannins, alkaloids, carbohydrates, terpenoids, steroids and flavonoids. These organic compounds represent a source for the discovery and development of new types of antidiabetic molecules. Many compounds isolated from plant sources have been reported to show antidiabetic activity. The key messages summarize some recent information in the field of antidiabetic phytochemicals.

Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer

BackgroundRadiotherapy for breast cancer often involves some incidental exposure of the heart to ionizing radiation. The effect of this exposure on the subsequent risk of ischemic heart disease is uncertain.MethodsWe conducted a population-based case–control study of major coronary events (i.e., myocardial infarction, coronary revascularization, or death from ischemic heart disease) in 2168 women who underwent radiotherapy for breast cancer between 1958 and 2001 in Sweden and Denmark; the study included 963 women with major coronary events and 1205 controls. Individual patient information was obtained from hospital records. For each woman, the mean radiation doses to the whole heart and to the left anterior descending coronary artery were estimated from her radiotherapy chart.ResultsThe overall average of the mean doses to the whole heart was 4.9 Gy (range, 0.03 to 27.72). Rates of major coronary events increased linearly with the mean dose to the heart by 7.4% per gray (95% confidence interval, 2.9 to 14.5; P<0.001), with no apparent threshold. The increase started within the first 5 years after radiotherapy and continued into the third decade after radiotherapy. The proportional increase in the rate of major coronary events per gray was similar in women with and women without cardiac risk factors at the time of radiotherapy.ConclusionsExposure of the heart to ionizing radiation during radiotherapy for breast cancer increases the subsequent rate of ischemic heart disease. The increase is proportional to the mean dose to the heart, begins within a few years after exposure, and continues for at least 20 years. Women with preexisting cardiac risk factors have greater absolute increases in risk from radiotherapy than other women. (Funded by Cancer Research UK and others.)

Observed changes in precipitation on the wettest days of the year in China, 1960–2000

AbstractPrevious studies have suggested that extreme precipitation events accounted for a disproportionate share of the nearly 2% increase in precipitation in China over the period of 1960–2000. Michaels et al. challenged a similar finding in the USA, arguing that fixed‐bin methods for analysing extreme events obscure underlying precipitation patterns, and proposing a method that focusses on trends of the 10 wettest days of the year. Applying this method to China, we find that trends of precipitation on the 10 wettest days are generally proportional to changes in annual total precipitation. Regionally, a disproportionate increase is observed in southwest China. While the greatest absolute increase in precipitation on the wettest 10 days is seen in east China, the trend as a percentage of the annual total is not statistically significant. In the other six climate regions, the annual total rainfall is increasing at a proportionally greater rate than the 10 wettest days. Seasonally, the changes in precipitation on the five wettest days show increasing trend both nationally and for most of the climate regions. The greatest absolute increase in precipitation on the wettest five days is seen in east China in both summer and winter half‐years. Only in southwest China during the summer half‐year do we see a significant, disproportional increase in the precipitation falling on the five wettest days. Nationally, there has been an increasing trend in the frequency of precipitation exceeding the long‐term mean 97.5th percentile and 99th percentile values. Although the annual increasing precipitation on the 10 wettest days corresponds with a similar increase in water vapour pressure in China nationally, regional results suggest that change in humidity is not the only factor that influences the changes in heavy precipitation. Copyright © 2010 Royal Meteorological Society