Lower SD Research Articles

Association of Computed Tomographic Leg Muscle Characteristics With Lower Limb and Cardiovascular Events in Patients With Peripheral Artery Disease.

BackgroundPoor lower extremity physical performance is an independent predictor of unfavorable outcome in patients with peripheral artery disease (PAD); however, few studies have assessed muscle characteristics on imaging directly.Method and ResultsA novel 3‐dimensional semi‐automated protocol was developed to estimate leg muscle volume and density (mean attenuation) from computed tomography images. Patients with PAD who underwent a lower extremity computed tomography scan at a tertiary vascular surgery center were included, and were followed up using hospital records and linked data as part of a retrospective cohort study. The primary outcomes were lower limb events (major amputation or peripheral revascularization) and cardiovascular events (myocardial infarction, stroke, or cardiovascular death). Two hundred and twenty‐three patients with PAD were included (median age 69.0 years; 73% men) and followed for a median of 4.9 [2.6–7.0] years. During this time there were 99 index lower limb events and 97 cardiovascular events. Low leg muscle density was associated with increased risk of lower limb (rate ratio 1.41 [1.11–1.80] per SD reduction) and cardiovascular events (rate ratio 1.60 [1.29–1.99] per SD reduction). Low muscle density remained an independent predictor of cardiovascular (but not lower limb) events, after adjusting for age, sex, traditional cardiovascular risk factors, and angiographic PAD severity (rate ratio 1.39 [1.09–1.77] per lower SD). In contrast, leg muscle volume was not associated with outcomes after adjusting for risk factors and PAD severity.ConclusionsLow leg muscle density, but not volume, is a strong, independent predictor of major cardiovascular events among people with PAD. Further research is needed to understand the mechanisms underlying these associations.

The effect of hypoglycaemia on neurocognitive outcome in children and adolescents with transient or persistent congenital hyperinsulinism.

To examine the hypoglycaemic effect on neurodevelopmental outcome in patients with transient and persistent congenital hyperinsulinism (CHI) born in the 21st century. A cohort of 117 patients (66 males, 51 females) with CHI aged 5 to 16years (mean age 8y 11mo, SD 2y 7mo) were selected from a Finnish nationwide registry to examine all the patients with similar methods. Neurodevelopment was first evaluated retrospectively. The 83 patients with no risk factors for neurological impairment other than hypoglycaemia were recruited and 44 participated (24 males, 20 females; mean age 9y 7mo, SD 3y 1mo) in neuropsychological assessment with the Wechsler Intelligence Scale for Children, Fourth Edition and the Finnish version of the Developmental Neuropsychological Assessment, Second Edition domains of attention, language, memory, sensorimotor, and visual functioning. In retrospective analysis, transient and persistent CHI groups had similar prevalences of mild (22% and 18% respectively) or severe (5% and 7% respectively) neurodevelopmental difficulties. In clinical assessment, the neurocognitive profile was within the average range in both groups, but children with persistent CHI showed significant but restricted deficits in attention, memory, visual, and sensorimotor functions compared with the general population. The transient CHI group did not differ from the standardization samples. Besides the more apparent broader neurological deficits, children with persistent CHI have an increased risk for milder specific neurocognitive problems, which should be considered in the follow-up. Children with persistent congenital hyperinsulinism showed deficits in attention, memory, visual, and sensorimotor functions. The deficits were potentially of hypoglycaemic origin. Children with transient hyperinsulinism did not differ from the general population.

Histogram Analysis of Native T1 Mapping and Its Relationship to Left Ventricular Late Gadolinium Enhancement, Hypertrophy, and Segmental Myocardial Mechanics in Patients With Hypertrophic Cardiomyopathy.

The use of native T1 mapping for evaluation of hypertrophic cardiomyopathy (HCM) is being explored, and its combination with histogram analysis may benefit the accuracy of such assessments. To investigate the relationship of segmental left ventricular wall thickness (LVWT), myocardial fibrosis, and strain parameters with segmental histogram parameters of native T1 mapping in HCM patients. Retrospective. Ninety-three HCM patients without previous cardiovascular diseases were included. 3.0T cardiac MR. Steady-state free precession cine imaging, modified Look-Locker inversion recovery, phase-sensitive inversion recovery. Images were assessed by three experienced radiologists. Mann-Whitney U-tests, area under the curve (AUC), Spearman's rank correlation, intraclass correlation coefficient, and Bland-Altman test were used for statistical analysis. A higher LVWT value correlated with higher means, minimums, 10th /25th /50th /75th /90th percentiles, maximums, kurtosis, entropy, and lower SD and energy of T1 mapping (P < 0.05 for all), with the correlation being stronger for entropy and energy (Spearman's rho = 0.439 and -0.413, respectively) than other parameters. Late gadolinium enhancement positive (LGE+) segments exhibited higher mean, minimum, 10th /25th /50th /75th /90th percentiles, maximum, entropy, and lower energy of T1 times than late gadolinium enhancement negative (LGE-) segments (P < 0.001 for all). Impaired strain function parameters (peak thickening and thickening rate in radial, circumferential, and longitudinal directions) demonstrated a weak correlation with higher entropy (P < 0.001 for all) and lower energy (P < 0.001 for all). Histogram parameters of native T1 mapping provide more information than mean T1 times alone. Among these parameters, entropy and energy may correlate better with LVWT, myocardial late gadolinium enhancement, and strain parameters than mean T1 times in HCM patients. 2 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019;49:668-677.

Leptin and ghrelin in chronic kidney disease: their associations with protein-energy wasting.

This study aimed to evaluate plasma concentrations of leptin and total ghrelin in children with chronic kidney disease (CKD) and assess their roles in protein-energy wasting (PEW). This study consisted of three different CKD populations [CKD group (20 patients with non-dialysis CKD), dialysis group (39 patients on dialysis), and kidney transplant (KTx) group (35 KTx recipients)] and control group (18 healthy children). Plasma leptin and total ghrelin levels were measured. Multi-frequency bioimpedance analysis was used for the assessment of fat and lean mass. PEW was defined using criteria including body mass, muscle mass, growth, serum albumin level, and protein intake. While plasma leptin levels did not differ among the study groups, total ghrelin levels were significantly higher in the dialysis group (P< 0.001). Seven dialysis patients (18%) and one CKD patient (5%) but none of the KTx recipients met the criteria of PEW. Dialysis patients with PEW had lower plasma leptin levels compared to their counterparts (P= 0.018); however, total ghrelin levels did not differ between the two groups (P= 0.10). Low leptin level in dialysis patients was independently associated with lower fat mass index (P< 0.001) and lower height-specific SD scores of BMI (P= 0.019). PEW is prevalent in dialysis patients. Low levels of leptin seem to be associated with PEW. Our result suggests that low leptin levels may be a consequence rather than a cause of PEW. Longitudinal studies are required to investigate this complex relationship between leptin and PEW in pediatric dialysis patients.

Comparison of Attitudes Towards Meditation Healing Exercise between the Elderly Living with Chronic Illness in Bangkok and Surabaya

Introduction: Meditation healing exercise (MHE) using the SKT technique is popular in Bangkok, Thailand, while in Surabaya, Indonesia, it is relatively new and unpopular. The attitude towards MHE depends on various internal and external factors. This study aimed to compare the attitude towards MHE between the elderly who are living with hypertension (HT) and/or diabetes mellitus (DM) in Bangkok and Surabaya.Methods: This was a comparative study involving 96 and 100 elderly individuals with HT and/or DM in the communities of Surabaya and Bangkok respectively. The sample was chosen according to the aforementioned criteria. The sample size was 196. The instrument used was a valid and reliable questionnaire. Descriptive statistics, the Levene test, and an independent sample T test were used for the data analysis.Results: The majority showed a positive attitude towards MHE; the higher Mean and lower SD was found in Bangkok (19.43 and 2.41). Out of the total, 87.5% and 96.0% elderly had good attitude towards MHE in Surabaya and Bangkok respectively. There was a significant attitude difference in relation to the aspect of preferring to practice MHE between Bangkok and Surabaya (p=0.004). Overall, there was no significant attitude difference between Bangkok and Surabaya (p=0.17).Conclusion: The elderly attitude towards MHE was mostly positive and good. The elderly in Bangkok prefer to practice MHE more than in Surabaya. There was no significant attitude difference in the elderly who are living with HT and/or DM between Bangkok and Surabaya. The implementation of MHE using the SKT technique has a high possibility of being accepted personally by the elderly in both sites.

Continuing rise of Type 2 diabetes incidence in children and young people in the UK.

AimsTo estimate the incidence of Type 2 diabetes in children aged <17 years, compare this with similar data 10 years ago, and characterize clinical features at diagnosis in the UK and Republic of Ireland.MethodsUsing the British Paediatric Surveillance Unit reporting framework, cases of Type 2 diabetes diagnosed in children aged <17 years between 1 April 2015 and 30 April 2016 were reported each month.ResultsA total of 106 cases were reported, giving a UK incidence of 0.72/100 000 (95% CI 0.58–0.88). Children from ethnic minorities had significantly higher incidence compared with white children (0.44/100 000) with rates of 2.92/100 000 and 1.67/100 000, in Asian and BACBB (black/African/Caribbean/black British) children respectively. Sixty‐seven percent were girls and 81% had a family history of Type 2 diabetes. The mean BMI sd score at diagnosis was 2.89 (2.88, girls; 2.92, boys); 81% were obese. Children of Asian ethnicity had a significantly lower BMI sd score compared with white children (P<0.001). There was a trend in increased incidence from 2005 to 2015, with a rate ratio of 1.35 (95% CI 0.99–1.84), although this was not statistically significant (P=0.062). There was statistical evidence of increased incidence among girls (P=0.03) and children of South‐Asian ethnicity (P=0.01) when comparing the 2005 and 2015 surveys.ConclusionsType 2 diabetes remains far less common than Type 1 diabetes in childhood in the UK, but the number of cases continues to rise, with significantly increased incidence among girls and South‐Asian children over a decade. Female gender, family history, non‐white ethnicity and obesity were found to be strongly associated with the condition.

Is early life exposure to polyomaviruses and herpesviruses associated with obesity indices and metabolic traits in childhood?

Evidence for an infectious origin of obesity is emerging. We explored whether common viruses were associated with obesity and metabolic traits. We used cross-sectional (n = 674) and prospective (n = 440) data from children participating at the 4 and 6 years of age follow-up in the Rhea birth cohort. Presence of IgG antibodies to ten polyomaviruses (BKPyV, JCPyV, KIPyV, WUPyV, HPyV6, HPyV7, TSPyV, MCPyV, HPyV9, and HPyV10) and four herpesviruses (EBV, CMV, HSV-1, and HSV-2) were measured at age 4. Body mass index, waist circumference, and skinfold thickness were measured at age 4 and 6. Data on serum lipids, leptin, and adiponectin were also available. Multivariable linear regression models were used to explore the associations. At 4 years of age, seroprevalence to polyomaviruses ranged from 21.0% for HPyV9 to 82.0% for HPyV10. Seroprevalence for EBV, CMV, HSV-1, and HSV-2 was 53.0%, 26.0%, 3.6%, and 1.5% respectively. BKPyV seropositivity was associated with lower BMI SD score at age 4 [-0.21 (95% CI: -0.39, -0.03)] and 6 [-0.27 (95% CI:-0.48, -0.05)], waist circumference at age 4 [-1.12 cm (95% CI: -2.10, -0.15)] and 6 [-1.73 cm (95% CI: -3.33, -0.12)], sum of four skinfolds [-2.97 mm (95% CI: -5.70, -0.24)], and leptin levels at age 4 [ratio of geometric means, 0.83 (95% CI: 0.70, 0.98)]. CMV seropositivity was associated with higher BMI SD score at age 4 [0.28 (95% CI: 0.11, 0.45)] and 6 [0.24 (95% CI: 0.03, 0.45)] and sum of four skinfolds at age 6 [4.75 mm (95% CI: 0.67, 8.83)]. Having "2-3 herpesviruses infections" (versus "0 herpesvirus infections") was associated with higher BMI SD score [0.32, (95% CI: 0.12, 0.53)], waist circumference [1.22 cm (95% CI: 0.13, 2.31)], and sum of four skinfolds [3.26 mm (95% CI: 0.18, 6.35)] at age 4. Polyomaviruses burden was not associated with outcomes. A higher herpesviruses burden and CMV seropositivity were associated with obesity traits in childhood.

Blood Pressure Variability in Acute Ischemic Stroke: Influence of Infarct Location in the Insular Cortex

Background: The aim of this study was to elucidate the influence of insular infarction on blood pressure (BP) variability and outcomes according to the region of the insular cortex affected. Methods: A total of 90 patients diagnosed with acute unilateral ischemic stroke were registered. The BP variability was calculated over 24 h after admission (hyperacute) and for 2–3 days after admission (acute). Patients were classified into groups of right and left, and then right anterior, right posterior, left anterior, and left posterior insular infarction. Results: Patients with insular infarction showed a significantly larger infarct volume, higher modified Rankin scale scores, and lower SD and coefficient of variation (CV) of ­systolic BP in the hyperacute phase than shown by patients without insular infarction (p < 0.01, p < 0.01, p = 0.02, and p = 0.03, respectively). The SD and CV of systolic BP in the hyperacute phase showed significant differences among the 3 groups with right insular infarction, with left insular infarction, and without insular infarction (p < 0.05 and p < 0.05, respectively). There was a tendency for the systolic BP variability to be lower in patients with right anterior insular infarction than in patients with infarcts in other areas. Conclusion: The right insular cortex, especially the anterior part, might be a hub for autonomic nervous regulation.

Balancing search space partitions by sparse coding for distributed redundant media indexing and retrieval

Effective partitioning multimedia indexes is key for efficient kNN search. But existing algorithms are based on document similarity, without partition size or redundancy constraints. Our goal is to create an index partitioning algorithm that addresses the specific properties of a distributed system: load balancing across nodes, redundancy in node failure and efficient node usage under concurrent querying. We propose the representation of data with overcomplete codebooks. Each document is quantized into a small set of codewords and indexed on per-codeword partitions. Quantization algorithms are designed to fit data as best as possible, leading to a bias toward codewords that fit the principal directions of data in the original space. In this paper, we propose the balanced KSVD (B-KSVD) algorithm: It distributes data uniformly across codewords, according to the distribution in the original space. The comprehensive experiments focused on measuring the effectiveness of partition size balancing and retrieval quality. Results show that B-KSVD better balances partition sizes (i.e., lower SD in partition size distribution), compared to k-means and KSVD baselines. B-KSVD achieves 38% 1-recall by inspecting only 1% of the full index, distributed over 10 partitions. k-means creates partitions with higher size variation and requires either larger codebooks or the inspection of larger portions of the index to achieve similar retrieval performance.

Lower glycemic load meals reduce diurnal glycemic oscillations in women with risk factors for gestational diabetes

ObjectiveMaternal glycemia plays a key role in fetal growth. We hypothesized that lower glycemic load (GL) meals (lower glycemic index, modestly lower carbohydrate) would substantially reduce day-long glucose variability in...

Development of Probiotics Based Culture System of Macrobrachium rosenbergii Using Different Stocking Densities

Owing to the problem of antibiotic resistance and subsequent reluctance of using antibiotics, probiotics use in aquaculture is becoming popular day by day. One experimental design with 150 days culture period of Macrobrachium rosenbergii was conducted with 3 treatments maintaining stocking density of 02/m2, 03/m2 and 04/m2 in T1, T2 and T3 respectively. Each of the treatments was with 3 replicates where each replicate was segmented into two parts to separate probiotics and non-probiotics based culture system. The higher body weight of 63.7 g was recorded in lower SD of T1 in comparison to lower body weight of 55.7 g and 43.0 g in higher SD of T2 and T3 respectively for probiotics application segments. The average body weight of 55.7 g, 46.7 g and 37 g respectively were found for the same treatments in non-probiotics segments. The average survival rate of 69.3%, 62.7% and 58.3% were recorded in probiotics and 68.3%, 63% and 57.7% respectively in non-probiotics treatments. Average daily growth rate and gross production were found better in probiotics than that of non-probiotics segments in all the treatments. Average daily growth rate of T1 was found 0.41 g and 0.36 g respectively for probiotics and non-probiotics segments. Similarly, for T2 and T3 average daily growth rate were found 0.35 g and 0.27 g for probiotics and 0.30 g, 0.23 g for non-probiotics segments respectively. Gross average production showed better result of 103 g/m2/crop in T2 probiotics treated segment than that of other two results of 87.23 g/m2 and 98.10 g/m2 in T1 and T3 treatments respectively where as 74.62 g, 87.23 g and 84.26 g/m2/crop was recorded in T1, T2 and T3 respectively in nonprobiotics treatments. Abiotic parameters in all segments of 3 treatments were within the optimum ranges for M. rosenbergii culture during the study period.

Cardiac Autonomic Dysfunction and Incidence of Atrial Fibrillation: Results From 20 Years Follow-Up

BackgroundCardiac autonomic perturbations frequently antecede onset of paroxysmal atrial fibrillation (AF). Interventions that influence autonomic inputs to myocardium may prevent AF. However, whether low heart rate or heart rate variability (HRV), which are noninvasive measures of cardiac autonomic dysfunction, are associated with AF incidence is unclear. ObjectivesThis study sought to study the association between HRV and risk of AF. MethodsThis study included 11,715 middle-aged adults in the ARIC (Atherosclerosis Risk In Communities) cohort with heart rate and HRV measures obtained from 2-min electrocardiogram recordings performed at baseline (1987 to 1989). These measures included SD of normal-to-normal RR intervals, high-frequency (HF) (0.15 to 0.40 Hz), low-frequency (0.04 to 0.15 Hz), and the low-frequency/HF ratio (denoting a greater sympathetic to parasympathetic dominance). Incident AF cases were ascertained by electrocardiogram at ARIC follow-up visits, hospital discharge diagnosis, or death certificates through 2011. ResultsDuring an average follow-up of 19.4 years, 1,580 or 13.5% of participants developed AF. A baseline heart rate <60 beats/min was associated modestly with an increased risk of AF. Lower overall HRV as well as increased sympathetic/parasympathetic tone were associated independently with a higher risk of AF; the hazard ratio for each 1 SD lower SD of normal-to-normal RR intervals was 1.14 (95% confidence interval: 1.08 to 1.21), for HF was 1.12 (95% confidence interval: 1.06 to 1.17), and for low frequency/HF was 1.08 (95% confidence interval: 1.03 to 1.14). ConclusionsCardiac autonomic dysfunction denoted by low resting short-term HRV was associated with higher AF incidence. A low heart rate may be associated with higher AF risk. Further studies are needed to determine whether interventions in the general population to restore autonomic balance may prevent AF.

Fatigue Effect on Linear Center of Pressure Measures during Gait in People with Flat Feet.

BackgroundFlat foot, as one of the common foot deformities can affect gait biomechanics and risk of lower extremity injury. Fatigue, as a high load task, can also change biomechanical parameters of locomotion. Studying normal and flat footed individuals under high load tasks such as fatigue can elucidate their differences more easily.ObjectivesIn this study, center of pressure (CoP) changes were studied between individuals with flat and normal feet after fatigue. CoP is one of the important gait measures which can show various biomechanical behaviors of different foot shapes.MethodsSeventeen subjects with normal feet and 17 with flat feet walked across two force plates before and after a functional fatigue protocol. Standard deviation of CoP in mediolateral direction (SD of CoPx) and in anteroposterior direction (SD of CoPy), overall mean velocity of CoP and length of CoP construction line of both groups were analyzed. The values of SD of CoPy and length of CoP construction line were normalized to individual foot lengths prior to statistical analyses.ResultsThere were no significant between-subject effects for all CoP measures. The only significant finding was the within-subject effect for the SD of CoPy (P = 0.008) with a large effect size (partial eta squared = 0.21). Fatigue resulted in lower SD of CoPy in both groups.ConclusionsLower SD of CoPy indicates less fluctuation of CoPy and a probable less center of mass movement which could reduce the risk of injury. Furthermore, the similar fatigue response in both groups of individuals with normal and flat feet indicates a similar biomechanical behavior despite their different foot arch height.

Quantitative CT texture analysis for evaluating histologic grade of urothelial carcinoma.

To investigate the feasibility of using CT texture analysis (CTTA) to differentiate between low- versus high-grade urothelial carcinoma. A total of 105 patients with high-grade urothelial carcinoma (HGUC, n=106) and low-grade urothelial carcinoma (LGUC, n=18) were included in this retrospective study. Both unenhanced and enhanced CT images representing the largest cross-sectional area of the tumor were chosen for CTTA performed using TexRAD software. Comparison of texture parameters, mean gray-level intensity (Mean), standard deviation, entropy, mean of positive pixels (MPP), skewness, and kurtosis were made for the objective. Receiver operating characteristic (ROC) analysis was performed and the area under the ROC curve was calculated for texture parameters that were significantly different (P<0.05) for the purpose. Sensitivity (Se), specificity (Sp), positive predictive value, negative predictive value, and accuracy were calculated using the cut-off value of texture parameter with the highest AUC. Compared to HGUC, LGUC had significantly lower Mean (P=0.001), Entropy (P=0.002), and MPP (P<0.001) on unenhanced and enhanced images and lower SD (P=0.048) on enhanced images. There was no significant difference in skewness or kurtosis at any texture scale on unenhanced and enhanced images. A MPP<24.13 at fine texture scale on unenhanced images identified LGUC from HGUC with the highest AUC of 0.779±0.065 (Se=72.2%, Sp=84.9%, PPV=44.8%, NPV=94.7%, and accuracy=83.1%). CTTA proved to be a feasible tool for differentiating LGUC from HGUC. MPP quantified from fine texture scale on unenhanced images was the optimal diagnostic parameter for estimating histologic grade of urothelial carcinoma.

Social interaction patterns according to stocking density and time post-mixing in group-housed gestating sows

Housing systems should enable animals to interact socially while minimising aggression. This study investigated whether social interaction patterns in groups of indoor-housed gestating sows are affected by stocking density (‘SD’), by varying the number of sows per pen, and day after mixing. Unacquainted sows were grouped within 5 days of insemination at 1.45 (High; ‘H-SD’), 2.0 (Moderate; ‘M-SD’) or 2.9 m2 per sow (Low; ‘L-SD’) by placing 20, 14 or 10 sows per pen. Five pens per treatment were represented, and within each pen, 10 focal sows were observed. Social behaviours between focal sows were analysed continuously for 15 min after drop-feeding the day after mixing (Day 2) and 1 week later (Day 9), and plasma cortisol and progesterone concentrations analysed on Days 2 and 26. Overall, 587 interactions were observed, with 59% being short one reciprocal actions. Sows used more physical aggression at H-SD on Day 2 such as bites (vs M-SD and L-SD: both P &lt; 0.01), head knocks and pushes (vs L-SD: P = 0.01; vs M-SD: P = 0.06), whereas social interactions at lower SD were more frequent (L-SD vs H-SD: P = 0.004; L-SD vs M-SD: P = 0.02) and contained presumably neutral social behaviours such as nose contacts (L-SD vs H-SD: P = 0.06; M-SD vs H-SD: P = 0.07), or non-physical agonistic behaviours such as threats (L-SD vs H-SD: P = 0.07). A first-order Markov transitional analysis revealed positive feedback loops for bites and knocks or pushes at higher SD on Day 2 (all P &lt; 0.05). Cortisol concentration decreased as SD decreased (L-SD vs H-SD: P &lt; 0.001; L-SD vs M-SD: P = 0.02; M-SD vs H-SD: P = 0.07). Hence, interactions were more aggressive and less frequent at higher SD at Day 2 post-mixing, but differences vanished at Day 9. Valuable information can be gained from analysing the type of social behaviours and behavioural sequences, in addition to overall aggression frequency.

An Image-Based Reduction of Metal Artifacts in Computed Tomography.

Various strategies have been developed in the past to reduce the excessive effects of metal artifacts in computed tomography images. From straightforward sinogram inpainting-based methods to computationally expensive iterative methods, all have been successful in improving the image quality up to a certain degree. We propose a novel image-based metal artifact subtraction method that achieves a superior image quality and at the same time provides a quantitatively more accurate image. Our proposed method consists of prior image-based sinogram inpainting, metal sinogram extraction, and metal artifact image subtraction. Reconstructing the metal images from the extracted metal-contaminated portions in the sinogram yields a streaky image that eventually can be subtracted from the uncorrected image. The prior image is reconstructed from the sinogram that is free from the metal-contaminated portions by use of a total variation (TV) minimization algorithm, and the reconstructed prior image is fed into the forward projector so that the missing portions in the sinogram can be recovered. Image quality of the metal artifact-reduced images on selected areas was assessed by the structure similarity index for the simulated data and SD for the real dental data. Simulation phantom studies showed higher structure similarity index values for the proposed metal artifact reduction (MAR) images than the standard MAR images. Thus, more artifact suppression was observed in proposed MAR images. In real dental phantom data study, lower SD values were calculated from the proposed MAR images. The findings in real human arm study were also consistent with the results in all phantom studies. Thus, compared with standard MAR images, lesser artifact intensity was exhibited by the proposed MAR images. From the quantitative calculations, our proposed method has shown to be effective and superior to the conventional approach in both simulation and real dental phantom cases.

The tracking of active travel and its relationship with body composition in UK adolescents.

BackgroundTo examine the tracking of active travel through adolescence, and its association with body mass index (BMI) and fat mass at age 17 in a UK cohort.MethodsWe analysed data collected from the Avon Longitudinal Study of Parents and Children (ALSPAC). The analyses include all participants with self-reported travel mode to school at ages 12, 14 and 16 years, and measured height, weight and body composition at age 17 (n=2,026). Tracking coefficients were calculated for individual travel behaviours (including walking and cycling) through adolescence using Generalised Estimating Equations. Linear regression analyses examined associations between travel pattern (consistently passive, consistently active, active at two time points or active at one time point), BMI, and DXA-measured fat mass (expressed as internally derived standard deviation scores) at 17 years. Analyses were adjusted for height (where appropriate), sex, age, parental social class, and maternal education with interaction terms to assess sex differences.ResultsThere was substantial tracking in active travel through adolescence, with 38.5% of males and 32.3% of females consistently walking or cycling to school. In males, a consistently or predominantly active travel pattern was associated with a lower BMI SD score at age 17 (consistently active: adjusted β=−0.23; 95% CI −0.40, −0.06; active at two time points: adjusted β−0.30; 95% CI −0.50, −0.10) compared to those with a consistently passive pattern. No associations were seen in females.ConclusionsMaintenance of active travel behaviours throughout adolescence may help to protect against the development of excess BMI in males. In addition to encouraging the adoption of active travel to school, public health messages should aim to prevent drop out from active travel to promote good health in youth.

Routine use of continuous glucose monitoring in 10 501 people with diabetes mellitus.

AimsTo analyse blood glucose control according to continuous glucose monitoring use in data from the CareLink™ database, and to identify factors associated with continuation of sensor use during sensor‐augmented pump therapy.MethodsThe analysis used data from 10 501 people with Type 1 and 2 diabetes mellitus, of whom 7916 (61.7%) had used glucose sensors for ≥ 15 days during any 6‐month period over a 2‐year observation period. Data were analysed according to the extent of sensor use ( < 25%, 25–49%, 50–74% and ≥ 75% of the time). Time to discontinuation of sensor use was also analysed in new users of glucose sensors.ResultsCompared with patients in the lowest sensor usage group and non‐users, the highest glucose sensor usage group had significantly (P < 0.0001) lower mean blood glucose and blood glucose sd, were more likely to achieve a mean blood glucose concentration < 8.6 mmol/l, (odds ratio 1.5, 95% CI 1.3–1.7; P < 0.0001), and had 50% fewer hypoglycaemic (blood glucose concentration < 2.8 mmol/l) episodes. Among new users, sensor use during the first month of therapy was an important predictor of subsequent discontinuation. Lack of full reimbursement was also significantly associated with early discontinuation, whereas measures of glycaemic control were predictive of discontinuation during long‐term treatment.ConclusionsThe use of continuous glucose monitoring was significantly associated with reductions in hypoglycaemia and improved metabolic control during insulin pump therapy. Sensor use during the first month was strongly associated with long‐term adherence; patient education and training may be helpful in achieving this.

A perimetric test procedure that uses structural information.

To develop a perimetric test strategy, Structure Estimation of Minimum Uncertainty (SEMU), that uses structural information to drive stimulus choices. Structure Estimation of Minimum Uncertainty uses retinal nerve fiber layer (RNFL) thickness data as measured by optical coherence tomography to predict perimetric sensitivity. This prediction is used to set suprathreshold levels that then alter a prior probability distribution of the final test output. Using computer simulation, we studied SEMU's performance under three different patient error response conditions: No Error, Typical False Positive errors, and Extremely Unreliable patients. In experiment 1, SEMU was compared with an existing suprathreshold cum thresholding combination test procedure, Estimation of Minimum Uncertainty (EMU), on single visual field locations. We used these results to finalize SEMU parameters. In experiment 2, SEMU was compared with full threshold (FT) on 163 glaucomatous visual fields. On individual locations, SEMU has similar accuracy to EMU, but is, on average, one presentation faster than EMU. For the typical false-positive error condition, SEMU has significantly lower error compared with FT (SEMU average 0.33 dB lower; p < 0.001) and the 90% measured sensitivity range for SEMU is also smaller than that for FT. For unreliable patients, however, FT has lower mean and SD of error. Structure Estimation of Minimum Uncertainty makes significantly fewer presentations than FT (1.08 presentation on average fewer in a typical false-positive condition; p < 0.001). Assuming that a location in the field is marked abnormal if it falls below the 5th percentile of normal, SEMU has a false-positive rate of less than 10% for all error conditions compared with FT's rate of 20% or more. On average, simulations show that using RNFL information to guide stimulus placement in a perimetric test procedure maintains accuracy, improves precision, and decreases test duration for patients with less than 15% false-positive rates.

Patterns of growth after kidney transplantation among children with ESRD.

Poor linear growth is a frequent complication of CKD. This study evaluated the effect of kidney transplantation on age-related growth of linear body segments in pediatric renal transplant recipients who were enrolled from May 1998 until August 2013 in the CKD Growth and Development observational cohort study. Linear growth (height, sitting height, arm and leg lengths) was prospectively investigated during 1639 annual visits in a cohort of 389 pediatric renal transplant recipients ages 2-18 years with a median follow-up of 3.4 years (interquartile range, 1.9-5.9 years). Linear mixed-effects models were used to assess age-related changes and predictors of linear body segments. During early childhood, patients showed lower mean SD scores (SDS) for height (-1.7) and a markedly elevated sitting height index (ratio of sitting height to total body height) compared with healthy children (1.6 SDS), indicating disproportionate stunting (each P<0.001). After early childhood a sustained increase in standardized leg length and a constant decrease in standardized sitting height were noted (each P<0.001), resulting in significant catch-up growth and almost complete normalization of sitting height index by adult age (0.4 SDS; P<0.01 versus age 2-4 years). Time after transplantation, congenital renal disease, bone maturation, steroid exposure, degree of metabolic acidosis and anemia, intrauterine growth restriction, and parental height were significant predictors of linear body dimensions and body proportions (each P<0.05). Children with ESRD present with disproportionate stunting. In pediatric renal transplant recipients, a sustained increase in standardized leg length and total body height is observed from preschool until adult age, resulting in restoration of body proportions in most patients. Reduction of steroid exposure and optimal metabolic control before and after transplantation are promising measures to further improve growth outcome.