Higher Rate Of Decline Research Articles

Information sources and attitudes of Polish migrants accepting or declining vaccination in Scotland

Abstract Background Poland has the lowest EU vaccine confidence scores. The Polish are the largest migrant group in Scotland (91,000) with a high decline rate of nasal influenza vaccination. A new Polish language information leaflet in the 2018 school influenza programme saw consent form return increase but uptake remained low. We compare vaccination attitudes of accepting and declining parents. Methods A questionnaire to 365 Polish parents after vaccination asked about the leaflet, vaccination, time in UK and included WHO Vaccine Hesitancy statements. Accepting and declining parents were compared. Results 128 (37%) responded - 42% of vaccinating and 39% declining parents. 90% were long term UK resident, 72% speak Polish at home. Previous experience had most influence in vaccination decision-making, with social media and personal contacts in Poland and Scotland also key. Decliners were more likely to cite social media than accepters. Concerns about new vaccines, side effects and ’currently uncommon conditions’ are high in the Polish community and decliners hold more negative and scientifically ’incorrect’ opinions. Parents know that Polish and UK immunisation schedules differ for influenza, a condition thought less serious in Poland than UK. Conclusions Polish norms strongly influence this migrant group. Differences in how Polish migrants who accept or decline the vaccination respond to vaccine hesitancy statements plus knowing that Polish media and the Polish community shape their views can be used by health authorities to target health messages. It is important to be aware of immunisation status and vaccination beliefs of mobile migrant groups, such as the Polish, to prevent spread of vaccine preventable diseases in Europe. Linking vaccine hesitancy statement responses and behaviour can highlight national characteristics and particular concerns of vaccine hesitant parents. This information could be used to improve vaccine uptake rates among different ethnic minorities. Key messages Polish migrant children have low nasal influenza vaccine uptake. Vaccine hesitancy statements show decliners are particularly likely to distrust new vaccines and worry about vaccine side effects. Migrants access Polish social media and information and retain vaccination beliefs and norms post migration. Knowing this allows targeting of information campaigns to increase uptake.

Sarcopenic obesity is associated with a faster decline in renal function in people with type 2 diabetes.

To evaluate the association between sarcopenic obesity and the decline in estimated GFR in people with type 2 diabetes. We enrolled 745 people with type 2 diabetes (mean age 64.6 years, 53.6% men). Body composition was evaluated using dual-energy X-ray absorptiometry. Skeletal muscle index, calculated as appendicular non-fat mass (kg) divided by height squared (m2 ), was used to determine sarcopenia. Sarcopenic obesity was defined as the coexistence of sarcopenia and a ratio of android to gynoid fat mass greater than the median values in each gender. The association of sarcopenic obesity both with the annual rate of decline in estimated GFR and a >30% decline in estimated GFR was evaluated using multivariate linear regression models and Cox proportional hazard models, respectively. Participants with sarcopenic obesity were at an increased risk of a high annual rate of decline in estimated GFR, even after adjustment for the confounding variables (standardized β = -0.228, P <0.001). Sarcopenic obesity was also significantly associated with risk of a >30% decline in estimated GFR (hazard ratio 4.52, 95% CI 2.16-9.47; P < 0.01) in multivariate model. Sarcopenic obesity evaluated by dual energy X-ray absorptiometry is associated with a faster decline in renal function in people with type 2 diabetes.

Trastorno por estrés agudo y postraumático

Acute and post-traumatic stress disorderAcute stress disorder (ASD) and post-traumatic stress disorder (PTSD) arise as a result of the experience of a trauma or traumatic event that poses a significant threat (physical, emotional or psychological) to the safety of a patient or a beloved person. Are included in the category «Trauma-and stressor-related disorders» of DSM-5. In both, stress and anxiety increase, but their timeline are different: in ASD symptomatology appears in last month, whereas in PTSD symptoms last more than a month. Symptom are encompassed in four diagnostic groups: re-experimentation, avoidance, negative cognition/mood and hyperarousal. Worldwide prevalence estimates of PTSD in general population is around 3.9%, increasing to 5.6% in trauma exposed population. High rates of functional decline, somatic complaints, suicide risk and psychiatric comorbidity are related with PTSD. Treatment includes psychotherapy and psychotropic agents (selective serotonin reuptake inhibitor [SSRI] are the first-line treatment). In those cases of risk of suicide, poor treatment response or comorbidities, patients will, patients referred to a psychiatrist.

Predictors of Respiratory Decline Following Stereotactic Ablative Radiotherapy to Multiple Lung Tumors

IntroductionStereotactic ablative radiotherapy (SABR) is highly effective at controlling early stage primary lung cancer and lung metastases. Although previous studies have suggested that treating multiple lung tumors with SABR is safe, post-treatment changes in respiratory function have not been analyzed in detail. Patients and MethodsWe retrospectively identified patients with 2 or more primary lung cancers or lung metastases treated with SABR and analyzed clinical outcomes and predictors of toxicity. We defined a composite respiratory decline endpoint to include increased oxygen requirement, increased dyspnea scale, or death from respiratory failure not owing to disease progression. ResultsA total of 86 patients treated with SABR to 203 lung tumors were analyzed. A total of 21.8% and 41.8% of patients developed composite respiratory decline at 2 and 4 years, respectively. When accounting for intrathoracic disease progression, 12.7% of patients developed composite respiratory decline at 2 years. Of the patients, 7.9% experienced grade 2 or greater radiation pneumonitis. No patient- or treatment-related factor predicted development of respiratory decline. The median overall survival was 46.9 months, and the median progression-free survival was 14.8 months. The cumulative incidence of local failure was 9.7% at 2 years. ConclusionAlthough our results confirm that SABR is an effective treatment modality for patients with multiple lung tumors, we observed a high rate of respiratory decline after treatment, which may be owing to a combination of treatment and disease effects. Future studies may help to determine ways to avoid pulmonary toxicity from SABR.

Longitudinal cognitive decline in mild cognitive impairment subjects with early amyloid-β neocortical deposition.

The rate of clinical progression of cognitive impairment in subjects with early amyloid deposition is unknown. The primary aim of the study was to follow the rate of cognitive decline over 1year in patients with amnestic mild cognitive impairment (aMCI) by determining amyloid retention levels in terms of standardized uptake value ratios (SUVr) that ranged from 0.85 to 1.57. The secondary objective was to compare the rate of cognitive decline between subjects with and without early amyloid positivity. Of 66 aMCI subjects evaluated with [18F]florbetaben PET imaging and neuropsychological tests at baseline, 41 completed the 1-year follow-up. Amyloid status was determined with SUVr cut-off values generated from baseline images by visual assessment by three independent certified readers. Repeated-measures ANOVA with amyloid load and neuropsychological scores as the main effects was use to test group, time and group-by-time interactions. The Tukey post-hoc test was used to analyse all significant interactions. Of the 41 aMCI subjects, 38 completed the assessment according to the study protocol. Amyloid-positive (Aβ+ ) subjects (N = 18, age 75.6 ± 5.8years, six men, 12 women) showed greater clinical deterioration according to the Mattis Dementia Rating Scale (MDRS) score (p = 0.006). Amyloid-negative (Aβ-) subjects (N = 20, age 72.4 ± 5.8years, 11 men, 6 women) showed no significant changes in MDRS score over 1year. MDRS score significantly decreased (MDRS+) in 37% of the aMCI subjects, and remained stable (MDRS-) in the remaining 63%. Among subjects with cognitive deterioration, 86% were Aβ+ and 14% were Aβ-, while 25% of the MDRS- subjects were Aβ+ and 75% were Aβ- (χ2 = 13, P = 0.0003). SUVr above 1.21 identified individuals who would show significant progression over 1year, with a sensitivity of 67% and a specificity of 90%, as compared to Aβ- subjects. The positive predictive value, negative predictive value, and likelihood ratio were 86% (95% CI 70-94%), 75% (95% CI 58-87%), 7 (95% CI 5-10). This study demonstrated that early amyloid deposition predicts cognitive decline in subjects with aMCI, with a higher rate of decline in those with SUVr above a threshold of 1.21. Detection of early amyloid positivity may help in selecting the target population for preventive therapeutic interventions and in designing treatment trials (Trial number, EudraCT 2015-001184-39).

Abstract CT097: Phase I trial of apalutamide plus abiraterone acetate, docetaxel, and prednisone in patients with metastatic castration-resistant prostate cancer (mCRPC)

Abstract Background: Prostate cancer is driven by the androgen receptor (AR) pathway, which may be targeted by inhibition of androgen synthesis (e.g. abiraterone = Abi), AR signaling (e.g. apalutmide = Apa), and/or translocation of AR to the nucleus (e.g. docetaxel = Doce). The combination of AR inhibition plus taxane chemotherapy has already demonstrated clinical benefit (CHAARTED, STAMPEDE), lending weight to the theory that combining drugs targeting different points in the AR signaling pathway is effective. We hypothesize that the combination of Apa, Abi, and Doce will be safe and efficacious. Methods: Men with progressive mCRPC, intact organ function, and no prior exposure to Apa (ever) or Doce within 3 years were enrolled. Standard Abi 1000 mg daily, Doce 75 mg/m2 q3 weeks, and prednisone 5 mg BID was administered with different doses of Apa. Cohort 1 = Apa 120 mg daily, Cohort 2 = Apa 240 mg daily, Cohort 3 (if necessary) = Apa 180 mg daily in modified 3+3 design. The primary endpoint of the Phase I dose-escalation portion of the study was determination of dose-limiting toxicity (over 6 weeks) and recommended Phase II dose (RP2D). Results: Nine men (3 Apa 120 mg, 6 Apa 240 mg) with mCRPC and median age 69, median PSA 8.18 (range 0.07 - 278.5) were treated. 67% with bone, 78% LN, 11% lung, 11% other metastases. No DLT occurred with Apa 120 mg and 1 of 6 with Apa 240 mg had possibly related grade 3 hypertension. All had &amp;gt;95% PSA decline (78% with &amp;gt; 99% decline). Of 5 with measureable disease, 100% had RECIST response. 6 of 7 with post-treatment CTC counts were undetectable. Conclusions: The combination of apalutamide plus abiraterone, docetaxel, and prednisone at full doses is tolerable, with the RP2D of the regimen Apa 240 mg daily, Abi 1000 mg daily, docetaxel 75 mg/m2 q3 wks, and prednisone 5 mg BID. The combination appears to be associated with a high rate of PSA decline, measurable disease response, and CTC count control. Tumor tissue, plasma ctDNA, and CTCs are being collected for analysis. Enrollment to the expansion phase of study to further refine efficacy and toxicity at PCCTC sites is ongoing including assessment of response and resistance biomarkers [NCT02913196] Citation Format: Ana Molina, Paul Christos, Amy Hackett, Luke Nordquist, Edward Gelmann, Mark Stein, Cora Sternberg, Himisha Beltran, Lauren Gracey, Giuseppe Galletti, Paraskevi Giannakakou, David M. Nanus, Scott T. Tagawa. Phase I trial of apalutamide plus abiraterone acetate, docetaxel, and prednisone in patients with metastatic castration-resistant prostate cancer (mCRPC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr CT097.

Application of Multidisciplinary Oil Reservoir Research Technique in Complex Fractured Oil Reservoir -- Taking Xinzhan Oil Field as an Example

Xinzhan Oil Field is a complex fractured oil reservoir. Due to the influence brought by natural fracture, after water breakthrough, water content moved upward quickly in those oil wells, thus causing the obvious contradiction between layers and an increasingly high natural decline rate. This paper focuses on the research of fracture distribution and remaining oil, taking geologic model building and numerical modeling as the main research means. By describing regularities of distribution about fractures as well as remaining oil in a quantitative and qualitative way, this paper designs a flexible adjustment scheme aiming at the encryption and injection-production of complex fractured oil reservoir so as to improve the results of oil field exploration.

The Effect of Donors' Demographic Characteristics in Renal Function Post-Living Kidney Donation. Analysis of a UK Single Centre Cohort.

Introduction: There is a great need to increase the organ donor pool, particularly for living donors. This study analyses the difference in post-living donation kidney function according to pre-donation characteristics of age, genetic relationship with the recipient, sex, ethnicity, and Body Mass Index (BMI). Methods: Retrospective single centre analysis of the trajectory of estimated Glomerular Filtration Rate (eGFR) post-living kidney donation, as a measure of kidney function. Mean eGFR of the different groups was compared at 6 months and during the 60 months follow up. Results: Mean age was 46 ± 13 years, 57% were female, and 60% Caucasian. Mean BMI was 27 ± 5 kg/m2, with more than a quarter of the cohort having a BMI > 30 (26%), and the majority of the donors genetically related to their recipients (56%). The higher decline rate in eGFR was at 6 months after donation, with female sex, non-Caucasian ethnicity, and age lower than 60 years being independently associated with higher recovery in kidney function (p < 0.05). In the 60 months follow up, older age, genetic relationship with the recipient, and male sex led to higher percentual difference in eGFR post-donation. Conclusion: In this study, with a high proportion of high BMI living kidney donors, female sex, age lower than 60 years, and non-genetic relationship with recipient were persistently associated with higher increase in post-donation kidney function. Ethnicity and BMI, per se, should not be a barrier to increasing the living donor kidney pool.

Prognostic Value of the Estimated Glomerular Filtration Rate Decline in Hypertensive Patients Without Chronic Kidney Disease.

Our objective of this study was to determine if rate of estimated glomerular filtration rate (eGFR) decline and its intensity was associated with cardiovascular risk and death in patients with hypertension whose baseline eGFR was higher than 60 ml/minute/1.73 m2. This study comprised 2,516 patients with hypertension who had had at least 2 serum creatinine measurements over a 4-year period. An eGFR reduction of ≥10% per year has been deemed as high eGFR and a reduction in eGFR of less than 10% per year as a low decline. The end points were coronary artery disease, stroke, transitory ischemic accident, peripheral arterial disease, heart failure, atrial fibrillation, and death from any cause. Cox regression analyses adjusted for potentially confounding factors were conducted. A total of 2,354 patients with low rate of eGFR decline and 149 with high rate of eGFR decline were analyzed. The adjusted model shows that a -10% rate of eGFR decline per year is associated with a higher risk of the primary end point (HR 1.9; 95% CI 1.1-3.5; P = 0.02) and arteriosclerotic vascular disease (HR 2.2; 95% CI 1.2-4.2; P < 0.001) in all hypertensive groups. The variables associated to high/low rate of eGFR decline in the logistic regression model were serum creatinine (OR 3.35; P < 0.001), gender, women (OR 15.3; P < 0.001), tobacco user (OR 1.9; P < 0.002), and pulse pressure (OR 0.99; P < 0.05). A rate of eGFR decline equal to or higher than -10% per year is a marker of cardiovascular risk for patients with arterial hypertension without chronic kidney disease at baseline. It may be useful to consider intensifying the global risk approach for these patients.

Research of changes in individual physico-chemical parameters of yoghurts using whey protein concentrates

The purpose of the work was to investigate the effect of whey proteins and dry whey concentrates on the change of titrated and active acidity during digestion. In order to stabilize the consistency in the production of low-fat yogurts, dry whey was selected that met the requirements of State Standard 4552:2006. It is used to improve the taste of finished products, to add flavor, to improve the texture, as well as to improve overall quality. In addition, dry whey protein concentrate WPC 80 Milkiland was used. The addition of whey protein concentrate does not detract from the organoleptic characteristics of a normalized mixture, which allows it to be used in yogurt technology. The addition of whey proteins has a significant effect on the duration of gel formation. Whey protein concentrate and dry whey reduce the duration of latent fermentation and flocculation stages. The data obtained allows us to predict that they accelerate the coagulation process. This effect is enhanced by increasing the dose of protein concentrates. Conducted coagulation of milk with a different dose and observed changes in titrated and active acidity during the fermentation. Yogurt culture YF-L903, which includes Streptococcus salivarius subsp., Thermophilus, Lactobacillus delbrűeckii subsp. Bulgaricus were used for fermentation. The highest growth rate of titrated acidity is recorded for option 1 (0.5% dry sucrose) and controls that for 4 hours. the fermentation reached 80 °T. The highest rate of decline in active acidity is recorded in option 1 (0.5% dry sucrose serum). All samples for 4 hours of fermentation reached 4.65–4.72 units. pH. Thus, the acidity slightly increases with increasing the dose of serum protein concentrate and does not increase with the use of dry whey.

Econometric modeling of productivity and technical efficiency in the Chilean manufacturing industry

This research presents models for assessing productivity and technical efficiency of the Chilean manufacturing sector by using a factor analysis as a methodological alternative to the standard model of productive factors, generating latent factors or input variables such as those proposed in the literature on the topic. The factor analysis allows us to synthesize the number of inputs available as latent factors, showing satisfactory quite results. Econometric and stochastic frontier analyses are performed (i) to determine the influential factors of the Chilean manufacturing output and (ii) to evaluate the levels of technical efficiency for each Chilean industrial sector. The results obtained show that, for both the standard model and the proposed factorial model, the economic theory is validated in terms of the importance of the inputs that form the manufacturing outputs. Moreover, a functional structure is defined as an adequate representation of the manufacturing outputs in Chile. The manufacturing sector of the country presents a downward trend in technical efficiency during the study period, with higher decline rates in the lowest efficient ratings. The results show a period of productivity growth from 1986 to 1996, a slowdown from 1998, and only a slight increase in 2004. Similarly, important intra-group variations in the manufacturing sector are observed, especially in the of food group, in which average efficiencies from 19% to 91% are reported. Innovative discussion, implications and recommendations concerning our investigation, as well as issues associated with industrial policies, are provided and suited within the “Industry 4.0” context.

The Trends of Cardiovascular and Cancer Mortality in Russian Men and Women from 2000 to 2016 years

Aim. To compare trends from CVD and cancer mortality in the Russian Federation from 2000 to 2016. depending on age and gender.Material and methods. The official statistics on mortality of Federal state statistics Service and the data obtained in the Russian database of fertility and mortality of the Center for Demographic Studies of the Russian Economic School, Moscow (Russia) were used. Mortality from CVD, including coronary heart disease (CHD), cerebrovascular disease (CerVD), other CVD, and cancer, including prostate cancer in men and breast cancer in women, stomach cancer, trachea, bronchus and lung cancer were analyzed from 2000 to 2016.Results. From 2000 to 2016 CVD mortality leads in comparison with deaths from cancer both in absolute number of deaths and in standardized deaths rates (SDR). There was a decrease in SDR from CVD and cancer between 2003 and 2016, however, rate of decline in the mortality rate from cancer was much less pronounced compared to CVD. At the same time, there is a trend towards a convergence in mortality from both causes in all age groups, with the exception of 75 years and older. For women in the age group of 35–64 years in 2016, the SDR from CVD was slightly lower than from cancer. The decrease in mortality from CVD was accompanied by a decrease in mortality from CHD and the CerVD, the latter was more pronounced in women. The overall mortality rate from cancer was characterized by a decrease in gastric cancer in people of both sexes, trachea, bronchus and lung cancer in men and breast cancer in women and an increase in prostate cancer in men.Conclusion. The ratio of mortality of CVD to cancer and their age characteristics are important for health care. Keeping in mind a present high rate of CVD deaths and cancer deaths rate decline is still not enough, there are now already two big problems for the health care and prevention is a key, especially with common risk factors. These changing trends in mortality may support evidence for changes in the policy of resource allocation in the country.

Epidemiology and prognosis of the level of morbidity and mortality from stroke in different age groups according to the territorial-population register

To analyze epidemiological data and predict the morbidity and mortality of stroke for a 5-year period in different age groups. The study of indicators of morbidity and mortality of stroke was conducted on the basis of data on the population aged 25 years and older from the territorial population register for 2009-2016 and covered 8 study areas. A total of 25.504 cases of primary stroke were analyzed in four age groups: young age, middle age, old age, oldest age. The prognosis of indicators of morbidity and mortality was made using the ARIMA (autoregressive integrated moving average) method. The study revealed positive dynamics for 2009-2016 to reduce the incidence of stroke in middle age and old age. The morbidity in the group of young people in 2016 was lower than in 2009, though the difference was not significant. In the group of oldest age, there was a tendency to increase the incidence rate since 2012, the growth rate reached 10% per year. Prediction of stroke incidence for 5 years was impossible in all age groups due to the lack of significant autocorrelations. Positive dynamics of reduction of mortality of stroke was observed among middle, old and oldest age. The highest rate of decline in mortality was observed in middle aged and old people amounting to about 30% in 2012. Among the oldest age, the dynamics of the reduction of mortality rate was less pronounced. Among young people, the death rate has not changed since 2009 by 2016 and amounted to 0.05 per 1000 people. Prediction of the mortality rate for middle age assumes a decrease in mortality by 2019 inclusive with further stabilization of the indicator until 2021. The prognosis of mortality in old age suggests a gradual slight increase (about 1.5%) over the entire forecast horizon. Taking into account the progress in the 8-year decline by 81%, the projected growth does not change the burden of stroke in the old age.

Apolipoprotein E Genotypes, Age, Race, and Cognitive Decline in a Population Sample.

To examine the effects of age and race on the association of apolipoprotein E (APOE) genotypes with cognitive decline in a population sample. Longitudinal study of 18 years' duration. Biracial urban US population sample. There were a total of 5807 participants, 60% African American (AA) and 40% European American (EA). A composite cognitive function based on individual tests of episodic memory, perceptual speed, and the Mini-Mental State Examination. The frequencies of APOE ε2/ε3 (14% vs 12%), ε2/ε4 (4% vs 2%), ε3/ε4 (29% vs 22%), and ε4/ε4 (4% vs 2%) genotypes were higher among AAs than EAs. After adjusting for demographic factors, the rate of decline in global cognition was twice as high among participants with the APOE ε4/ε4 genotype compared to participants with the APOE ε3/ε3 genotype (0.097 vs 0.048 SD units [SDUs] per year; P < .0001). This doubling was not different between AAs (0.091 vs 0.045 SDUs per year) and EAs (0.118 vs 0.059 SDUs per year) (Pinteraction = .63). The APOE ε3/ε4 genotype was associated with a higher rate of decline with age (Pinteraction = .021), while the APOE ε2/ε4 genotype (Pinteraction = .016) and the APOE ε2/ε3 genotype (Pinteraction = .043) were associated with a lower rate of decline with higher age. The APOE ε2/ε2 genotype was associated with a lower rate of decline in episodic memory, while the APOE ε2/ε4 was associated with a higher rate of decline in episodic memory and perceptual speed. The association of the APOE genotypes with cognitive decline was not different between AAs and EAs. However, individuals with different APOE genotypes showed a lower or a higher rate of decline with age. J Am Geriatr Soc 67:734-740, 2019.

Effect of a home-based exercise program on functional mobility and quality of life in elderly people: protocol of a single-blind, randomized controlled trial

BackgroundElderly people have high rates of functional decline, which compromises independence, self-confidence, and quality of life (QoL). Physical exercise leads to significant improvements in strength, balance, functional mobility, and QoL, but there is still reduced access to this therapeutic strategy due to difficulties in locomotion to training centers or lack of adaptation to the exercise environment.Methods/designThe purpose of this clinical trial will be to verify the effect of a progressive and semi-supervised, home-based exercise program on the functional mobility, and in the QoL of sedentary elderly people. This is a protocol of a consecutive, single-center, single-blind, and randomized controlled trial. The design, conduct, and report follows the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) guidelines. Sedentary elderly people will be enrolled, and randomly allocated into two groups. The intervention group will perform exercises in their own home and the control group will not perform exercises. The evaluations will occur at study enrollment and after 3 months of intervention, and will be performed using the functional mobility Timed Up & Go (TUG) test and sociodemographic and QoL questionnaires. In the statistical analysis, comparisons of mean and correlation analyses will be performed. The primary expected outcome is the improvement in functional mobility verified through the TUG test and the secondary outcome is the improvement in QoL verified by the WHOQOL-OLD.DiscussionThe lack of scientific evidence demonstrating the benefits of semi-supervised home exercise on functional mobility and QoL in elderly people represents an obstacle to the development of guidelines for clinical practice and for policy-makers. The World Health Organization highlighted the importance of musculoskeletal health programs for elderly people, and the exercise program described in this protocol was designed to be viable, easy to implement, and inexpensive, and could be performed at the home of elderly subjects after receiving only guidelines and follow-up via periodic visits. Based on these facts, we hope that this study will demonstrate that a well-structured, home-based exercise program can be effective in improving functional mobility and QoL of sedentary elderly people, even without constant supervision during exercise.Trial registrationRegistro Brasileiro de Ensaios Clínicos (ReBEC), Identifier: RBR-3cqzfy. Registered on 2 December 2016.

Lung hyperinflation and functional exercise capacity in patients with COPD \u2013 a three-year longitudinal study

BackgroundLung hyperinflation contributes to dyspnea, morbidity and mortality in chronic obstructive pulmonary disease (COPD). The inspiratory-to-total lung capacity (IC/TLC) ratio is a measure of lung hyperinflation and is associated with exercise intolerance. However, knowledge of its effect on longitudinal change in the 6-min walk distance (6MWD) in patients with COPD is scarce. We aimed to study whether the IC/TLC ratio predicts longitudinal change in 6MWD in patients with COPD.MethodsThis prospective cohort study included 389 patients aged 40–75 years with clinically stable COPD in Global Initiative for Chronic Obstructive Lung Disease stages II-IV. The 6MWD was measured at baseline, and after one and 3 years. We performed generalized estimating equation regression analyses to examine predictors for longitudinal change in 6MWD. Predictors at baseline were: IC/TLC ratio, age, gender, pack years, fat mass index (FMI), fat-free mass index (FFMI), number of exacerbations within 12 months prior to inclusion, Charlson index for comorbidities, forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and light and hard self-reported physical activity.ResultsReduced IC/TLC ratio (p < 0.001) was a statistically significant predictor for decline in 6MWD. With a 0.1-unit decrease in baseline IC/TLC ratio, the annual decline in 6MWD was 12.7 m (p < 0.001). Study participants with an IC/TLC ratio in the upper quartiles maintained their 6MWD from baseline to year 3, while it was significantly reduced for the patients with an IC/TLC ratio in the lower quartiles. Absence of light and hard physical activity, increased age and FMI, decreased FEV1 and FVC, more frequent exacerbations and higher Charlson comorbidity index were also predictors for lower 6MWD at any given time, but did not predict higher rate of decline over the timespan of the study.ConclusionOur findings demonstrated that patients with less lung hyperinflation at baseline maintained their functional exercise capacity during the follow-up period, and that it was significantly reduced for patients with increased lung hyperinflation.

Performance analysis of TPM implementation through Overall Equipment Effectiveness (OEE) and Six Big Losses

PT. TMI is a company engaged in the field of automotive that has implemented Total Productive Maintenance to improve efficiency and effectiveness of manufacturing companies as a whole. But it turns out that targets that are not achieved still often occur due to engine trouble. This study aims to determine the maintenance system of Press 2A machine that has a high rate of decline in speed. This study begins by measuring the achievement of Overall Equipment Effectiveness (OEE) value by first calculating the Availability, Performance Rate and Rate of Quality, then identifying the Six Big Losses that occur. The results showed that the average value of OEE on 2A Stamping machine is 70%, the effectiveness value is moderate and still below the standard of OEE value for world class company that is 85%. While the factor of Six Big Losses most influential on the low effectiveness of Press 2A machine is Reduced Speed Loss with total loss for a year of 56.411 minutes or 53% of all losses.

Seven decades of mountain hare counts show severe declines where high‐yield recreational game bird hunting is practised

Abstract Recreational hunting is widespread and can benefit nature conservation when well‐practised, monitored, and regulated. Management for recreational red grouse Lagopus lagopus scotica shooting on upland heathland in the UK causes conservation conflict because the intensive habitat, predator, and disease management needed to maintain high‐grouse densities for “driven” shooting has detrimental environmental impacts, notably for raptor populations. Sustainable management of mountain hares Lepus timidus scoticus, a game species in the same landscapes, poses a challenge. Control of transmission to grouse of a viral disease, louping‐ill, for which mountain hares are a host, has become an additional motivation to kill mountain hares since research during 1993–2001 suggested that culls might reduce infection rates in grouse. We analysed population trends of mountain hares from spring counts on moorland managed for grouse shooting and on contiguous alpine land. On moorland sites, a long‐term decline (4.6% per annum) from 1954 to 1999 increased to 30.7% per annum from then until 2017, with a density index falling to &lt;1% of initial levels after 2008. Before 1999, declines were associated with conifer planting and were least severe where heather burning characteristic of grouse management was present. Grouse moors had the highest rate of decline after 1999. On alpine sites, the density index increased by 2.0% per annum from 1954 to 2007, then declined by 12.3% per annum but remained within the previous range of variation. Despite lack of evidence that it increases grouse numbers, reduction of louping‐ill transmission to grouse became a more frequent justification for mountain hare culls at a time consistent with it causing these recent, rapid mountain hare declines on grouse moors. Synthesis and applications. Long‐term field counts suggest that intensification of game bird management has resulted in severe, recent declines in mountain hare numbers, exacerbating longer term declines associated with land‐use change. Management practices founded on misinterpretation of earlier research are the probable cause. Regulation of hare culling would provide a framework for formal tests of whether culls affect grouse surpluses. It would also provide an opportunity to examine mountain hare populations' resilience to culls of varying size and seasonal timing.

Surface deformation monitoring of Sinabung volcano using multi temporal InSAR method and GIS analysis for affected area assessment

Sinabung Volcano which located in northern part of Sumatera island is part of a hundred active volcano in Indonesia. Surface deformation is detected over Sinabung Volcano and surrounded area since the first eruption in 2010 after 400 years long rest. We present multi temporal Interferometric Synthetic Aperture Radar (InSAR) time-series method of ALOS-2 L-band SAR data acquired from December 2014 to July 2017 to reveal surface deformation with high spatial resolution. The method includes focusing the SAR data, generating interferogram and phase unwrapping using SNAPHU tools. The result reveal significant deformation over Sinabung Volcano areas at rates up to 10 cm during observation period and the highest deformation occurs in western part which is trajectory of lava. We concluded the observed deformation primarily caused by volcanic activity respectively after long period of rest. In addition, Geographic Information System (GIS) analysis produces disaster affected areas of Sinabung eruption. GIS is reliable technique to estimate the impact of the hazard scenario to the exposure data and develop scenarios of disaster impacts to inform their contingency and emergency plan. The GIS results include the estimated affected area divided into 3 zones based on pyroclastic lava flow and pyroclastic fall (incandescent rock and ash). The highest impact is occurred in zone II due to many settlements are scattered in this zone. This information will be support stakeholders to take emergency preparation for disaster reduction. The continuation of this high rate of decline tends to endanger the population in next periods.

Rapid decline of anti-hepatitis C virus (HCV) antibodies following early treatment of incident HCV infections in HIV-infected men who have sex with men.

Following clearance of incident hepatitis C virus (HCV) infections, HCV antibody levels may decline, resulting in seroreversion. It is unclear to what extent HCV antibody level trajectories differ between patients with treatment-induced sustained virological response (SVR), those with spontaneous clearance and those with untreated replicating HCV infection. We investigated HCV antibody level dynamics in HIV-infected MSM with different clinical outcomes. We investigated anti-HCV antibody level dynamics following an incident HCV infection in 67 HIV-infected men who have sex with men (MSM) with different clinical outcomes: SVR (n = 33), spontaneous clearance (n = 12), and untreated replicating infection (n = 22). Antibody levels were measured at the time of HCV diagnosis, and at yearly intervals for 3 years thereafter. At baseline, median HCV antibody levels were similar in the three groups: 13.4, 13.8 and 13.5 sample to cut-off (S/CO) for SVR, spontaneous clearance and untreated infection, respectively. Over 3 years of follow-up, SVR was associated with a more pronounced decrease in anti-HCV levels compared with spontaneous clearance and untreated infection [median decline 71% [interquartile range (IQR: 43-87%), 38% (IQR: 29-60%) and 12% (IQR: 9-22%), respectively; P < 0.001]. Seroreversions occurred in five of 33 (15%) patients with SVR and in one of 12 (8%) with spontaneous clearance. A shorter delay between time of infection and treatment start correlated with higher rates of decline in antibody levels. Seven patients experienced a reinfection. Treatment-induced HCV clearance was associated with a more pronounced decline in anti-HCV antibody levels and with higher rates of seroreversion compared with spontaneous clearance or untreated replicating HCV infection among HIV-infected MSM with incident HCV infections. Rapid clearance of HCV RNA following early HCV treatment might impair the development of persistent antibody titres.