February 27, 2014

A smartphone platform for the quantification of vitamin D levels.

A smartphone platform for the quantification of vitamin D levels.
Lab Chip. 2014 Feb 25;
Authors: Lee S, Oncescu V, Mancuso M, Mehta S, Erickson D

Vitamin D deficiency has been linked to a number of diseases and adverse outcomes including: osteoporosis, infections, diabetes, cardiovascular diseases, and even cancer. At present the vast majority of vitamin D testing is performed in large-scale laboratories at the request of a physician as part of an annual panel of blood tests. Here we present a system for rapid quantification of vitamin D levels on a smartphone. The system consists of a smartphone accessory, an app, and a test strip that allows the colorimetric detection of 25-hydroxyvitamin D using a novel gold nanoparticle-based immunoassay. We show that the system can be used to accurately measure physiological levels of 25-hydroxyvitamin D with accuracy better than 15 nM and a precision of 10 nM. We compare our system with well-established ELISA test kits for serum samples of unknown concentration and demonstrate equivalency of the results. We envision this as the first step towards the development of the NutriPhone, a comprehensive system for the analysis of multiple vitamins and micronutrients on a smartphone.

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Parents' knowledge, attitudes, and practice in childhood fever: an internet-based survey.


Parents' knowledge, attitudes, and practice in childhood fever: an internet-based survey.
Br J Gen Pract. 2014 Jan;64(618):e10-6
Authors: de Bont EG, Francis NA, Dinant GJ, Cals JW

BACKGROUND Fever in children is common and mostly caused by self-limiting infections. However, the number of (re)consultations in primary care is high, driven by lack of knowledge and fear among parents. These drivers have only been studied in parents when consulting with their sick child. AIM To study knowledge, attitudes, and practice in childhood fever in parents within the general population. DESIGN AND SETTING Internet-based survey of a sample of 1000 parents from the general population of the Netherlands. METHOD A 26-item cross-sectional survey was conducted of parents with one or more children aged < 5 years. RESULTS Of 625 responders (average age 34.9 years), 63.4% and 43.7% indicated ever visiting their GP or GP's out-of-hours centre with a febrile child, respectively: 88.3% knew the definition of fever (>38°C), 55.2% correctly stated that antibiotics are effective in treating bacterial infections and not viral infections, and 72.0% knew that not every child with a fever needs treatment with antibiotics or paracetamol. When asked to prioritise aspects of a GP's consultation, 53.6% considered physical examination as most important. Obtaining a prescription for antibiotics or antipyretics was considered least important. CONCLUSION Knowledge, attitudes, and practices concerning childhood fever varied among parents with young children. Parents generally expect thorough physical examination and information, but not a prescription for medication (antibiotics or antipyretics) when consulting with a feverish child. GPs must be aware of these expectations as these provide opportunities to enhance consultations in general and prescription strategies in particular.

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Quality of patient health information on the Internet: reviewing a complex and evolving landscape.


Quality of patient health information on the Internet: reviewing a complex and evolving landscape.
Australas Med J. 2014;7(1):24-28
Authors: Fahy E, Hardikar R, Fox A, Mackay S

BACKGROUND: The popularity of the Internet has enabled unprecedented access to health information. As a largely unregulated source, there is potential for inconsistency in the quality of information that reaches the patient.
AIMS: To review the literature relating to the quality indicators of health information for patients on the Internet.
METHOD: A search of English language literature was conducted using PubMed, Google Scholar and EMBASE databases.
RESULTS: Many articles have been published which assess the quality of information relating to specific medical conditions. Indicators of quality have been defined in an attempt to predict higher quality health information on the Internet. Quality evaluation tools are scoring systems based on indicators of quality. Established tools such as the HONcode may help patients navigate to more reliable information. Google and Wikipedia are important emerging sources of patient health information.
CONCLUSION: The Internet is crucial for modern dissemination of health information, but it is clear that quality varies significantly between sources. Quality indicators for web-information have been developed but there is no agreed standard yet. We envisage that reliable rating tools, effective search engine ranking and progress in crowd-edited websites will enhance patient access to health information on the Internet.

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February 26, 2014

Using Internet to Recruit Immigrants with Language and Culture Barriers for Tobacco and Alcohol Use Screening: A Study Among Brazilians.


Using Internet to Recruit Immigrants with Language and Culture Barriers for Tobacco and Alcohol Use Screening: A Study Among Brazilians.
J Immigr Minor Health. 2014 Feb 23;
Authors: Carlini BH, Safioti L, Rue TC, Miles L

Limited English proficient (LEP) individuals face disparities in accessing substance abuse treatment, but little is known on how to reach this population. This study aimed to test online recruitment methods for tobacco and alcohol screening among LEP Portuguese speakers. The study was advertised in Portuguese using Facebook, Google, online newsletters and E-mail. Participants clicked ads to consent and access a screening for tobacco and alcohol dependence. Ads yielded 690 screening responses in 90 days. Respondents had a mean age of 42.7 (SD 12), with a higher proportion of women than men, 95 % born in Brazil with high levels of LEP and low levels of acculturation. Facebook ads yielded 41.4 % of responses, and were the lowest cost recruitment channel ($8.9, $31.10 and $20.40 per respondent, hazardous drinker and smoker, respectively). Online recruitment of LEP populations is feasible. Future studies should test similar strategies in other LEP groups.

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Surfing for Hip Replacements: Has the "Internet Tidal Wave" Led to Better Quality Information?


Surfing for Hip Replacements: Has the "Internet Tidal Wave" Led to Better Quality Information.
J Arthroplasty. 2014 Jan 21;
Authors: Nassiri M, Bruce-Brand RA, O'Neill F, Chenouri S, Curtin PT

This study aimed to determine the quality of information available on the internet regarding Total Hip Replacement (THR). The unique websites identified were categorised by type and assessed using the DISCERN score, the Journal of the American Medical Association (JAMA) benchmark criteria, and a novel (THR)-specific content score. The presence of the Health On the Net (HON) code, a reported quality assurance marker, was noted. Commercial websites predominate. Governmental & Non-Profit Organizations websites attained the highest DISCERN score. Sites that bore the HONcode seal obtained significantly higher DISCERN and THR content scores than those without the certification. Physicians should recommend the HONcode seal to their patients as a reliable indicator of website quality or, better yet, refer patients to sites they have personally reviewed.

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February 23, 2014

Healthcall for the smartphone: technology enhancement of brief intervention in HIV alcohol dependent patients.


Healthcall for the smartphone: technology enhancement of brief intervention in HIV alcohol dependent patients.
Addict Sci Clin Pract. 2014 Feb 17;9(1):5
Authors: Hasin DS, Aharonovich E, Greenstein E

BACKGROUND: Heavy drinking jeopardizes the health of patients in HIV primary care. In alcohol dependent patients in HIV primary care, a technological enhancement of brief intervention, HealthCall administered via interactive voice response (HealthCall-IVR) was effective at reducing heavy drinking. The smartphone offered a technology platform to improve HealthCall.
METHODS: Working with input from patients, technology experts, and HIV clinic personnel, we further developed HealthCall, harnessing smartphone technological capacities (HealthCall-S). In a pilot study, we compared rates of HealthCall-S daily use and drinking outcomes in 41 alcohol dependent HIV-infected patients with the 43 alcohol dependent HIV-infected patients who used HealthCall-IVR in our previous efficacy study. Procedures, clinic, personnel, and measures were largely the same in the two studies, and the two groups of patients were demographically similar (~90% minority).
RESULTS: Pilot patients used HealthCall-S a median of 85.0% of the 60 days of treatment, significantly greater than the corresponding rate (63.8%) among comparison patients using HealthCall-IVR (p < .001). Mean end-of-treatment drinks per drinking day was similar in the two groups. Patients were highly satisfied with HealthCall-S (i.e., 92% reported that they liked using HealthCall-S).
CONCLUSIONS: Among alcohol dependent patients in HIV primary care, HealthCall delivered via smartphone is feasible, obtains better patient engagement than HealthCall-IVR, and is associated with decreased drinking. In HIV primary care settings, HealthCall-S may offer a way to improve drinking outcomes after brief intervention by extending patient engagement with little additional demands on staff time.

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Internet-delivered eye movement desensitization and reprocessing (iEMDR): an open trial.

Internet-delivered eye movement desensitization and reprocessing (iEMDR): an open trial.
F1000Res. 2013;2:79
Authors: Spence J, Titov N, Johnston L, Dear BF, Wootton B, Terides M, Zou J

Recent research indicates internet-delivered cognitive behavioural therapy (iCBT) can reduce symptoms of post traumatic stress disorder (PTSD). This study examined the efficacy of an internet-delivered treatment protocol that combined iCBT and internet-delivered eye movement desensitization and reprocessing (iEMDR), in an uncontrolled trial. Eleven of the 15 participants completed post-treatment questionnaires. Large effect sizes were found from pre-treatment to 3-month follow-up ( d = 1.03 - 1.61) on clinician-assessed and self-reported measures of PTSD, anxiety and distress, with moderate effect sizes ( d = 0.59 - 0.70) found on measures of depression and disability. At post-treatment, 55% of the participants no longer met criteria for PTSD and this was sustained at follow-up. Symptom worsening occurred in 3 of 15 (20%) of the sample from pre- to post-treatment; however, these participants reported overall symptom improvement by follow-up. Future research directions for iEMDR are discussed.

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Mobile App versus Web App: a Comparison Using 2008-2012 "PubMed for Handhelds" Server Data.


Mobile App versus Web App: a Comparison Using 2008-2012 "PubMed for Handhelds" Server Data.
AMIA Annu Symp Proc. 2013;2013:445-50
Authors: Fontelo P, Liu F

Recent surveys show that mobile apps are more popular than Web apps. Apple's iTunes Store, now has about 800,000 apps and reported to have about 40 billion downloads. Android apps, although fewer, is available to the most number of smartphones today. About 40,000 apps are medical or health related. We developed a PubMed4Hh mobile app for iPhone/iPad users to search MEDLINE/PubMed with same features as our Web-based search tools, in use since 2002. Five-year (2008-2012) server data for PubMed4Hh and Web app were analyzed. Searches using the mobile app significantly increased compared to the same five-year time period. Month-by-month comparison showed a 3 to 5-fold increase in queries. The six-month total accesses comparison increased 280% from the previous four-year average. A review of 500 randomly selected queries revealed that the majority of queries were clinical questions ((97.8%) and 61% of these queries are searches related to therapy.

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February 21, 2014

Web-based hypothermia information: a critical assessment of Internet resources and a comparison to peer-reviewed literature.


Web-based hypothermia information: a critical assessment of Internet resources and a comparison to peer-reviewed literature.
Perspect Public Health. 2014 Feb 14;
Authors: Spencer JM, Sheridan SC

Aims:Hypothermia is a medical condition characterized by a drop in core body temperature, and it is a considerable source of winter weather-related vulnerability in mid-/high-latitude areas. Heat vulnerability research, including assessments of internet-based resources, is more thoroughly represented in the peer-reviewed literature than cold-related vulnerability research. This study was undertaken to summarize available web-based hypothermia information, and then determine its scientific validity compared to the peer-reviewed literature.Methods:This research takes a similar approach used by Hajat et al. for web-based heat vulnerability research, and utilizes this framework to assess hypothermia information found on the internet. Hypothermia-related search terms were used to obtain websites containing hypothermia information, and PubMed (medical literature search engine) and Google Scholar were used to identify peer-reviewed hypothermia literature. The internet information was aggregated into categories (vulnerable populations, symptoms, prevention), which were then compared to the hypothermia literature to determine the scientific validity of the web-based guidance. The internet information was assigned a Strength of Recommendation Taxonomy (SORT) grade (developed by the American Academy of Family Practitioners) of A, B, or C based on the peer-reviewed evidence.Results:Overall, 25 different pieces of guidance within the three categories were identified on 49 websites. Guidance concerning hypothermia symptoms most frequently appeared on websites, with six symptoms appearing on 50% or greater of websites. No piece of guidance within the vulnerable population categories appeared on greater than 60% of the websites, and prevention-related guidance was characterized by varied SORT grades.Conclusions:Hypothermia information on the internet was not entirely congruent with the information within the peer-reviewed medical literature. Several suggestions for improving web-based hypothermia resources include clearly listing sources for users to see and eliminating guidance with lower SORT grades and replacing with evidence-based information.

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February 19, 2014

Learning leadership skills in practice through quality improvement.

Learning leadership skills in practice through quality improvement.
Clin Med. 2014 Feb;14(1):12-15
Authors: Gamble J, Vaux E

The development of leadership skills in doctors in training is essential to support both their professional development and the future supply of clinical leaders the NHS so desperately needs. There is, however, limited opportunity in current training programmes for trainees to learn and develop these skills, and what opportunity there is has often focused on management rather than leadership skills. Involvement in trainee-led supported quality improvement projects can teach these skills. We summarise the current limitations in leadership training and discuss how the College's 'Learning To Make a Difference' programme, and others like it, are helping to teach leadership.

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February 18, 2014

Effect of body mass index on outcome in patients with suspected coronary artery disease referred for stress echocardiography.

Effect of body mass index on outcome in patients with suspected coronary artery disease referred for stress echocardiography.
Am J Cardiol. 2013 Nov 1;112(9):1355-60
Authors: Weinberg CR, Supariwala A, Mian Z, Otokiti A, Sangli S, Thammaiah Y, Pai P, Yao SS, Chaudhry FA

In patients with hypertension, heart failure, or coronary artery disease (CAD), obese patients have been shown to have a lower cardiac event rate compared with normal weight counterparts. This phenomenon has been termed the "obesity paradox." We sought to determine whether the obesity paradox exists in a cohort of patients referred for stress echocardiography. We evaluated 4,103 patients with suspected CAD (58 ± 13 years; 42% men) undergoing stress echocardiography (52% exercise and 47% dobutamine). Patients were divided into 3 groups on the basis of body mass index (BMI): 18.5 to 24.9, 25 to 29.9, and >30 kg/m(2). During the follow-up of 8.2 ± 3.6 years, there were 683 deaths (17%). Myocardial ischemia was present in 21% of the population. Myocardial ischemia was more prevalent in patients with a BMI of 18.5 to 24.9 kg/m(2) (26%) than those with a BMI of 25 to 29.9 kg/m(2) (21%) and >30 kg/m(2) (18%). Patients with a BMI of >30 kg/m(2) had the lowest death rate (1.2%/year) compared with those with a BMI of 25 to 29.9 kg/m(2) (1.75%/year) and 18.5 to 24.9 kg/m(2) (2.9%/year; p <0.001). After adjusting for significant clinical variables including exercise capacity, patients with higher BMI (>30 kg/m(2) and 25 to 29! .9 kg/m(2)) had less risk of mortality compared with those with a BMI of 18.5 to 24.9 kg/m(2) (hazard ratio 0.58, 95% confidence interval 0.47 to 0.72, p <0.0001 and hazard ratio 0.69, 95% confidence interval 0.57 to 0.82, p <0.0001, respectively). In conclusion, higher survival rate in patients with higher BMI as previously described in patients with hypertension, heart failure, and CAD extends to patients with suspected CAD referred for stress echocardiography, independent of exercise capacity.

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Fused images ease cardiac diagnoses

Fusing cardiac CT with nuclear myocardial perfusion scans has great potential in improving the diagnosis and management of obstructive coronary artery disease. Fused images ease cardiac diagnoses Read More

Conflicts of interest in approvals of additives to food determined to be generally recognized as safe: out of balance.

Conflicts of interest in approvals of additives to food determined to be generally recognized as safe: out of balance.
JAMA Intern Med. 2013 Dec 9-23;173(22):2032-6
Authors: Neltner TG, Alger HM, O'Reilly JT, Krimsky S, Bero LA, Maffini MV

IMPORTANCE: Food and Drug Administration (FDA) guidance allows food manufacturers to determine whether additives to food are "generally recognized as safe" (GRAS). Manufacturers are not required to notify the FDA of a GRAS determination, although in some instances they notify the agency. The individuals that companies select to make these determinations may have financial conflicts of interest.
OBJECTIVE: To determine the extent to which individuals selected by manufacturers to make GRAS determinations have conflicts of interest between their obligations to ensure that the use of the additive is safe and their financial relationships to the company. DESIGN Using conflict of interest criteria developed by a committee of the Institute of Medicine, we analyzed 451 GRAS notifications that were voluntarily submitted to the FDA between 1997 and 2012.
MAIN OUTCOMES AND MEASURES: Number of GRAS notices submitted to the FDA; frequency of various types of relationships between decision maker and additive manufacturer; frequency of participation on GRAS panels by individuals; and number of GRAS safety determinations identified by the FDA that were not submitted to the agency.
RESULTS: For the 451 GR! AS notifications, 22.4% of the safety assessments were made by an employee of an additive manufacturer, 13.3% by an employee of a consulting firm selected by the manufacturer, and 64.3% by an expert panel selected by either a consulting firm or the manufacturer. A standing expert panel selected by a third party made none of these safety assessments. The 290 panels that made GRAS determinations had an average of 3.5 members, with a maximum of 7. Ten individuals served on 27 or more panels; 1 individual served on 128 panels (44.1%). At least 1 of the 10 individuals with the most frequent service was a member of 225 panels (77.6%).
CONCLUSIONS AND RELEVANCE: Between 1997 and 2012, financial conflicts of interest were ubiquitous in determinations that an additive to food was GRAS. The lack of independent review in GRAS determinations raises concerns about the integrity of the process and whether it ensures the safety of the food supply, particularly in instances where the manufacturer does not notify the FDA of the determination. The FDA should address these concerns.

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Reaction time following yoga bellows-type breathing and breath awareness.


Reaction time following yoga bellows-type breathing and breath awareness.
Percept Mot Skills. 2013 Aug;117(1):1131-40
Authors: Telles S, Yadav A, Gupta RK, Balkrishna A

The reaction time (RT) was assessed in two groups of healthy males, yoga group (M age = 29.0 yr.) and non-yoga or control group (M age = 29.0 yr.), with 35 participants each. The yoga group had an average experience of 6 months, while the control group was yoga-naïve. The yoga group was assessed in two sessions, (i) bhastrika pranayama or bellows breathing and (ii) breath awareness, while the control group had a single control session. The two experimental sessions, one with each type of breathing, and the control session consisted of pre- (5 min.), during (18 min.), and post-session epochs (5 min.). Assessments were made in the pre- and post-session epochs using a Multi-Operational Apparatus for Reaction Time. Following 18 min. of bhastrika pranayama there was a statistically significant reduction in number of anticipatory responses compared to before the practice. This suggests that the immediate effect of bhastrika pranayama is to inhibit unnecessary responding to stimuli.

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February 17, 2014

Tai chi for well-being of breast cancer survivors with aromatase inhibitor-associated arthralgias: a feasibility study.


Tai chi for well-being of breast cancer survivors with aromatase inhibitor-associated arthralgias: a feasibility study.
Altern Ther Health Med. 2013 Nov-Dec;19(6):38-44
Authors: Galantino ML, Callens ML, Cardena GJ, Piela NL, Mao JJ

CONTEXT: Arthralgia is common and debilitating for a significant proportion of breast cancer survivors (BCSs) and leads to poor adherence to aromatase inhibitors (AIs). Despite increased recognition of the negative impact of arthralgia on function and the poor adherence that results, very few interventions have been developed to target this side effect.
OBJECTIVE: This study aimed to determine the feasibility of tai chi to improve well-being for women experiencing AI-associated arthralgias (AIAAs).
DESIGN: The study was a pilot to (1) demonstrate the feasibility of recruitment and retention for a tai chi trial, (2) determine the safety of tai chi, and (3) identify the outcomes (function, pain, and quality of life[QOL]) that tai chi may impact.
SETTING: The study took place at the Gilda's Club South Jersey in Linwood, NJ, USA.
PARTICIPANTS: Postmenopausal women with a history of stage I-III breast cancer reporting AIAA were enrolled.
INTERVENTION: Group tai chi was practiced for 1 h 2 ×/wk for 8 wks.
OUTCOME MEASURES: Functional outcomes included (1) sit-and-reach (SR), (2) functional reach (FR), (3) the Berg Balance Scale (BBS), and (4) timed up-and-go (TUG). The following patient-reported outcomes (PROs) were evaluated pre- and postintervention: (1) the Hospital Anxiety and Depression Scale (HADS), (2) the Functional Assessment of Cancer Therapy-Breast (FACT-B), (3) the Functional Assessment of Chronic Illness The! rapy Fatigue (FACIT-Fatigue), (4) the Brief Pain Inventory (BPI), (5) the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT-GOG-Ntx), and (6) the Functional Assessment of Chronic Illness Therapy- Spiritual Well-being Scale (FACIT-Sp). Participants also recorded their tai chi experiences in a journal.
RESULTS: For the 12 participants, adherence to the classes was 75%, with no adverse events reported. Participants experienced significant improvement from baseline to follow-up for the HADS anxiety (P = .003) and depression (P = .020) scales, the emotional well-being scale of the FACT-B (P = .027), the FACIT-Fatigue (P = .030), and the sit-and-teach test (P = .016). The BBS (P = .090), TUG (P = .241), BPI severity subscale (P = .058), and physical well-being subscale of the FACT-B (P = .052) showed no significant improvement. Participants reported increased relaxation, reduced stress, and enhanced sleep quality and duration. They valued the group's and the instructor's support.
CONCLUSION: The research team demonstrated the feasibility of a tai chi intervention for improving well being for breast cancer patients with AIAA and identified measures that may be sensitive to the impact of a tai chi intervention in this population.

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COMMENT: this was not a case-control study, only an observational study. Beware of the Hawthorne effect !   Read More

Why we should let "evidence-based medicine" rest in peace.



Clin Dermatol. 2013 Nov-Dec;31(6):806-10

Evidence-based medicine is a redundant term to the extent that doctors have always claimed they practiced medicine on the basis of evidence. They have, however, disagreed about what exactly constitutes legitimate evidence and how to synthesize the totality of evidence in a way that supports clinical action. Despite claims to the contrary, little progress has been made in solving this hard problem in any sort of formal way. The reification of randomized clinical trials (RCTs) and the tight linkage of such evidence to the development of clinical guidelines have led to error. In part, this relates to statistical and funding issues, but it also reflects the fact that the clinical events that comprise RCTs are not isomorphic with most clinical practice. Two possible and partial solutions are proposed: (1) to test empirically in new patient populations whether guidelines have the desired effects and (2) to accept that a distributed ecosystem of opinion rather than a hierarchical or consensus model of truth might better underwrite good clinical practice.

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Applications of statistics to medical science (1) Fundamental concepts.

Applications of statistics to medical science (1) Fundamental concepts.
J Nippon Med Sch. 2011;78(5):274-9
Authors: Watanabe H

The conceptual framework of statistical tests and statistical inferences are discussed, and the epidemiological background of statistics is briefly reviewed. This study is one of a series in which we survey the basics of statistics and practical methods used in medical statistics. Arguments related to actual statistical analysis procedures will be made in subsequent papers.

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Resolving confusion of tongues in statistics and machine learning: a primer for biologists and bioinformaticians.

Resolving confusion of tongues in statistics and machine learning: a primer for biologists and bioinformaticians.
Proteomics. 2012 Feb;12(4-5):543-9
Authors: van Iterson M, van Haagen HH, Goeman JJ

Bioinformatics is the field where computational methods from various domains have come together for analysis of biological data. Each domain has introduced its own specific jargon. However, in closely related domains, e.g. machine learning and statistics, concordant and discordant terminology occurs, the later can lead to confusion. This article aims to help solve the confusion of tongues arising from these two closely related domains, which are frequently used in bioinformatics. We provide a short summary of the most commonly applied machine learning and statistical approaches to data analysis in bioinformatics, i.e. classification and statistical hypothesis testing. We explain differences and similarities in common terminology used in various domains, such as precision, recall, sensitivity and true positive rate. This primer can serve as a guide to the terminology used in these fields.

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February 16, 2014

The reliability of suicide statistics: a systematic review.

The reliability of suicide statistics: a systematic review.
BMC Psychiatry. 2012;12:9
Authors: Tøllefsen IM, Hem E, Ekeberg Ø

BACKGROUND: Reliable suicide statistics are a prerequisite for suicide monitoring and prevention. The aim of this study was to assess the reliability of suicide statistics through a systematic review of the international literature.
METHODS: We searched for relevant publications in EMBASE, Ovid Medline, PubMed, PsycINFO and the Cochrane Library up to October 2010. In addition, we screened related studies and reference lists of identified studies. We included studies published in English, German, French, Spanish, Norwegian, Swedish and Danish that assessed the reliability of suicide statistics. We excluded case reports, editorials, letters, comments, abstracts and statistical analyses. All three authors independently screened the abstracts, and then the relevant full-text articles. Disagreements were resolved through consensus.
RESULTS: The primary search yielded 127 potential studies, of which 31 studies met the inclusion criteria and were included in the final review. The included studies were published between 1963 and 2009. Twenty were from Europe, seven from North America, two from Asia and two from Oceania. The manner of death had been re-e! valuated in 23 studies (40-3,993 cases), and there were six registry studies (195-17,412 cases) and two combined registry and re-evaluation studies. The study conclusions varied, from findings of fairly reliable to poor suicide statistics. Thirteen studies reported fairly reliable suicide statistics or under-reporting of 0-10%. Of the 31 studies during the 46-year period, 52% found more than 10% under-reporting, and 39% found more than 30% under-reporting or poor suicide statistics. Eleven studies reassessed a nationwide representative sample, although these samples were limited to suicide within subgroups. Only two studies compared data from two countries.
CONCLUSIONS: The main finding was that there is a lack of systematic assessment of the reliability of suicide statistics. Few studies have been done, and few countries have been covered. The findings support the general under-reporting of suicide. In particular, nationwide studies and comparisons between countries are lacking.

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Childhood eye examination.

Vision screening in children: HISTORY: a) check PMH for premature birth, Down syndrome, or cerebral palsy. b) check Family History for strabismus, amblyopia, retinoblastoma, childhood glaucoma, childhood cataracts, or ocular or genetic systemic disease. PHYSICAL: visual acuity, external ocular exam (refractive error, childhood glaucoma), evaluate fixation and alignment (amblyopia, strabismus), and red reflex (retinoblastoma, childhood cataracts).
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Cancer doctors have opportunities to cut costs without risk to patients, experts say

In a review article published, experts identify three major sources of high cancer costs and argue that cancer doctors can likely reduce them without harm to patients. The cost-cutting proposals call for changes in routine clinical practice involved in end-of-life care, medical imaging and drug pricing.Read More

Studies using English administrative data (Hospital Episode Statistics) to assess health-care outcomes--systematic review and recommendations for reporting.

Studies using English administrative data (Hospital Episode Statistics) to assess health-care outcomes--systematic review and recommendations for reporting.

Eur J Public Health. 2013 Feb;23(1):86-92

Authors: Sinha S, Peach G, Poloniecki JD, Thompson MM, Holt PJ


BACKGROUND: Studies using English administrative data from the Hospital Episode Statistics (HES) are increasingly used for the assessment of health-care quality. This study aims to catalogue the published body of studies using HES data to assess health-care outcomes, to assess their methodological qualities and to determine if reporting recommendations can be formulated.
METHODS: Systematic searches of the EMBASE, Medline and Cochrane databases were performed using defined search terms. Included studies were those that described the use of HES data extracts to assess health-care outcomes.
RESULTS: A total of 148 studies were included. The majority of published studies were on surgical specialties (60.8%), and the most common analytic theme was of inequalities and variations in treatment or outcome (27%). The volume of published studies has increased with time (r = 0.82, P < 0.0001), as has the length of study period (r = 0.76, P < 0.001) and the number of outcomes assessed per study (r = 0.72, P = 0.0023). Age (80%) and gender (57.4%) were the most commonly used factors in risk adjustment, and regression modelling was u! sed most commonly (65.2%) to adjust for confounders. Generic methodologic data were better reported than those specific to HES data extraction. For the majority of parameters, there were no improvements with time.
CONCLUSIONS: Studies published using HES data to report health-care outcomes have increased in volume, scope and complexity with time. However, persisting deficiencies related to both generic and context-specific reporting have been identified. Recommendations have been made to improve these aspects as it is likely that the role of these studies in assessing health care, benchmarking practice and planning service delivery will continue to increase.

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February 15, 2014

The mediating effect of chronic pain on the relationship between obesity and physical function and disability in older adults.

The mediating effect of chronic pain on the relationship between obesity and physical function and disability in older adults.

J Am Geriatr Soc. 2013 Dec;61(12):2079-86

Authors: Fowler-Brown A, Wee CC, Marcantonio E, Ngo L, Leveille S


OBJECTIVES: To determine the extent to which bodily pain mediates the effect of obesity on disability and physical function.
DESIGN: Cross-sectional analysis.
SETTING: Population-based sample of residents in the greater Boston area.
PARTICIPANTS: Community-dwelling adults aged 70 and older (N=736).
MEASUREMENTS: Body mass index (BMI), obtained from measured height and weight, was categorized as normal weight (19.0-24.9 kg/m2), overweight (25.0-29.9 kg/m2), or obese (≥30.0 kg/m2). Main outcome measures were the Physical Component Summary of the Medical Outcomes Study 12-item Short-Form Survey (PCS), activity of daily living (ADL) disability, and Short Physical Performance Battery (SPPB) score. Chronic pain was assessed according to the number of weight-bearing joint sites that had pain (hips, knees, feet and pain all over).
RESULTS: Older obese adults had greater ADL disability and lower SPPB and PCS scores than their nonobese counterparts, although in sex-stratified adjusted analyses, obesity was adversely associated with outcomes only in wo! men. Obesity was associated with greater number of pain sites; and more pain sites were associated with greater odds of disability. Mediation analysis suggests that pain is a significant mediator (22-44%) of the adverse effect of obesity on disability and physical function in women.
CONCLUSION: Bodily pain may be an important treatable mediator of the adverse effect of obesity on disability and physical function in women.

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February 14, 2014

Reducing stigma in reproductive health.

Reducing stigma in reproductive health.

Int J Gynaecol Obstet. 2014 Jan 21;

Authors: Cook RJ, Dickens BM


Stigmatization marks individuals for disgrace, shame, and even disgust-spoiling or tarnishing their social identities. It can be imposed accidentally by thoughtlessness or insensitivity; incidentally to another purpose; or deliberately to deter or punish conduct considered harmful to actors themselves, others, society, or moral values. Stigma has permeated attitudes toward recipients of sexual and reproductive health services, and at times to service providers. Resort to contraceptive products, to voluntary sterilization and abortion, and now to medically assisted reproductive care to overcome infertility has attracted stigma. Unmarried motherhood has a long history of shame, projected onto the "illegitimate" (bastard) child. The stigma of contracting sexually transmitted infections has been reinvigorated with HIV infection. Gynecologists and their professional associations, ethically committed to uphold human dignity and equality, especially for vulnerable women for whom they care, should be active to guard against, counteract, and relieve stigmatization of their patients and of related service providers.

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February 13, 2014

Acoustic and photoacoustic molecular imaging of cancer.

Acoustic and photoacoustic molecular imaging of cancer.

J Nucl Med. 2013 Nov;54(11):1851-4

Authors: Wilson KE, Wang TY, Willmann JK


Ultrasound and combined optical and ultrasonic (photoacoustic) molecular imaging have shown great promise in the visualization and monitoring of cancer through imaging of vascular and extravascular molecular targets. Contrast-enhanced ultrasound with molecularly targeted microbubbles can detect early-stage cancer through the visualization of targets expressed on the angiogenic vasculature of tumors. Ultrasonic molecular imaging can be extended to the imaging of extravascular targets through use of nanoscale, phase-change droplets and photoacoustic imaging, which provides further molecular information on cancer given by the chemical composition of tissues and by targeted nanoparticles that can interact with extravascular tissues at the receptor level. A new generation of targeted contrast agents goes beyond merely increasing imaging signal at the site of target expression but shows activatable and differential contrast depending on their interactions with the tumor microenvironment. These innovations may further improve our ability to detect and characterize tumors. In this review, recent developments in acoustic and photoacoustic molecular imaging of cancer are discussed.

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February 12, 2014

Contextual and perceptual brain processes underlying moral cognition: a quantitative meta-analysis of moral reasoning and moral emotions.

Contextual and perceptual brain processes underlying moral cognition: a quantitative meta-analysis of moral reasoning and moral emotions.

PLoS One. 2014;9(2):e87427

Authors: Sevinc G, Spreng RN


BACKGROUND AND OBJECTIVES: Human morality has been investigated using a variety of tasks ranging from judgments of hypothetical dilemmas to viewing morally salient stimuli. These experiments have provided insight into neural correlates of moral judgments and emotions, yet these approaches reveal important differences in moral cognition. Moral reasoning tasks require active deliberation while moral emotion tasks involve the perception of stimuli with moral implications. We examined convergent and divergent brain activity associated with these experimental paradigms taking a quantitative meta-analytic approach.
DATA SOURCE: A systematic search of the literature yielded 40 studies. Studies involving explicit decisions in a moral situation were categorized as active (n = 22); studies evoking moral emotions were categorized as passive (n = 18). We conducted a coordinate-based meta-analysis using the Activation Likelihood Estimation to determine reliable patterns of brain activity.
RESULTS & CONCLUSIONS: Results revealed a convergent pattern of! reliable brain activity for both task categories in regions of the default network, consistent with the social and contextual information processes supported by this brain network. Active tasks revealed more reliable activity in the temporoparietal junction, angular gyrus and temporal pole. Active tasks demand deliberative reasoning and may disproportionately involve the retrieval of social knowledge from memory, mental state attribution, and construction of the context through associative processes. In contrast, passive tasks reliably engaged regions associated with visual and emotional information processing, including lingual gyrus and the amygdala. A laterality effect was observed in dorsomedial prefrontal cortex, with active tasks engaging the left, and passive tasks engaging the right. While overlapping activity patterns suggest a shared neural network for both tasks, differential activity suggests that processing of moral input is affected by task demands. The results provide novel insight into distinct features of moral cognition, including the generation of moral context through associative processes and the perceptual detection of moral salience.

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Resveratrol suppresses cancer cell glucose uptake by targeting reactive oxygen species-mediated hypoxia-inducible factor-1α activation.

Resveratrol suppresses cancer cell glucose uptake by targeting reactive oxygen species-mediated hypoxia-inducible factor-1α activation.
J Nucl Med. 2013 Dec;54(12):2161-7
Authors: Jung KH, Lee JH, Thien Quach CH, Paik JY, Oh H, Park JW, Lee EJ, Moon SH, Lee KH

UNLABELLED: Resveratrol is gaining attention for its anticancer effects and is also recognized for its antioxidant properties and influence on glucose metabolism. Augmented reactive oxygen species (ROS) and high glycolytic flux are common characteristics of malignant cells. We thus evaluated the effect of resveratrol on cancer cell glucose metabolism and investigated the role of ROS in the response.
METHODS: Cancer cells were measured for cell content and (18)F-FDG uptake. Assays were performed for lactate production; hexokinase activity and intracellular ROS; and immunoblotting for hypoxia-inducible factor-1α(HIF-1α), Akt, mammalian target of rapamycin, and glucose transporter type 1 (Glut-1). Animal studies were performed with small-animal PET imaging of Lewis lung carcinoma tumor-bearing mice.
RESULTS: Resveratrol mildly decreased cell content and more pronouncedly suppressed (18)F-FDG uptake in Lewis lung carcinoma, HT-29 colon, and T47D breast cancer cells. Hence, (18)F-FDG uptake normalized to cell content was reduced to less than half of controls by 24-h exposure to resveratrol. This reduction was attributed to reduced glycolytic flux and Glut-1 expression. Resveratrol also decreased intracellular ROS in patterns tha! t closely paralleled (18)F-FDG uptake. Scavenging of ROS with N-acetyl cysteine, but not inhibition of nicotinamide adenine dinucleotide phosphate oxidase, was sufficient to suppress (18)F-FDG uptake. Conversely, ROS inducers effectively reversed the metabolic response of resveratrol. HIF-1α protein was markedly reduced by resveratrol, and inhibiting HIF-1α expression with cycloheximide or specific small interfering RNAs suppressed (18)F-FDG uptake. The proteosomal inhibitor MG132 partly restored HIF-1α level and (18)F-FDG uptake in resveratrol-treated cells. Resveratrol also inhibited Akt activation; in addition, inhibitors and small interfering RNAs against phosphoinositide 3-kinase decreased (18)F-FDG uptake. Finally, small-animal PET results showed resveratrol treatment to suppress tumor (18)F-FDG uptake in vivo.
CONCLUSION: Resveratrol suppresses cancer cell (18)F-FDG uptake and glycolytic metabolism in a manner that depends on the capacity of resveratrol to inhibit intracellular ROS, which downregulates HIF-1α accumulation.

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February 11, 2014

Preventive roles of swimming exercise and pioglitazone treatment on hepatic dysfunction in a rat model of metabolic syndrome.


Preventive roles of swimming exercise and pioglitazone treatment on hepatic dysfunction in a rat model of metabolic syndrome.
Can J Physiol Pharmacol. 2014 Feb;92(2):162-70
Authors: Sakr HF, Al-Hashem FH, El-Naby WM, Alkhateeb MA, Zaki MS, Refaey HM, Morsy MD

Pioglitazone (Pio) and swimming exercise (SE) are insulin sensitisers. This investigation was suggested because of the significant side effects associated with Pio treatment in metabolic syndrome (MetS). This study was, therefore, designed to investigate the preventive role of Pio treatment and SE in terms of efficiency and pathological changes in MetS in a rat model. Sixty male Sprague-Dawley rats were distributed equally among 6 groups: (i) control group (C), (ii) exercised control group (C+E), (iii) Pio-treated control group (C+Pio), (iv) group with MetS, (v) group with MetS treated with Pio (MetS+Pio), and (vi) exercised MetS group (MetS+E). Systolic blood pressure and heart rate were measured at the end of the experiments (16 weeks). Retro-orbital blood samples were used to determine the serum levels of glucose, insulin, lipids, gamma glutamyl transferase, alanine transaminase, aspartate transaminase, alkaline phosphatase, fetuin-A, and adiponectin. Semiquantitative reverse transcriptase - PCR insulin gene expression assays and hepatic histopathological examination were conducted. Swimming exercise significantly improved all of the aforementioned parameters, more so than the Pio treatment. In particular, the serum hepatic enzyme levels and hepatic histopathological changes were improved compared with the MetS group. These results suggested that swimming exercise might be an alternative physiological preventive tool against hepatic dysfunction to avoid the side effects asso! ciated with Pio treatment, and this could be demonstrated in a rat model of metabolic syndrome.

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February 10, 2014

Prevalence and determinants of hyperuricemia in type 2 diabetes mellitus patients with central obesity in Guangdong Province in China.

Prevalence and determinants of hyperuricemia in type 2 diabetes mellitus patients with central obesity in Guangdong Province in China.

Asia Pac J Clin Nutr. 2013;22(4):590-8

Authors: Wang J, Chen RP, Lei L, Song QQ, Zhang RY, Li YB, Yang C, Lin SD, Chen LS, Wang YL, Zhao F, Liang GX, Hu BC, Lin JC, Cai DH

Abstract
This study investigated the prevalence and determinants of hyperuricemia in Chinese type 2 diabetes mellitus (T2DM) patients with central obesity. A multicentric hospital-based cross-sectional study was carried out in Guangdong Province between August 2011 and March 2012. At each hospital, Chinese T2DM patients with central obesity who were aged over 20 years, whose serum uric acid levels were measured, and who had lived in Guangdong Province for >=1 year, were recruited. Hyperuricemia was defined as serum uric acid >420 μmol/L in men and >360 μmol/L in women. Binary logistic regression was used to assess associated risk factors for hyperu-ricemia. A total of 2,917 T2DM patients with central obesity took part. The overall prevalence of hyperuricemia was 32.6% (36.1% for women, 28.4% for men). Binary logistic regression analyses demonstrated that women (OR: 1.576; 95% confidence interval (CI): 1.231, 2.018), high BMI (OR: 1.228; 95% CI: 1.094, 1.379), waist cir-cumference (OR: 1.135; 95% CI: 1.009, 1.276), hypertension (OR: 1.603; 95% CI: 1.263, 2.035), high total cho-lesterol (OR: 1.133; 95% CI: 1.002, 1.281), triglycerides (OR: 1.134; 95% CI: 1.069, 1.203), low HDL-cholesterol (OR: 0.820; 95% CI: 0.677, 0.995) and low estimated glomerular filtration rate (OR: 0.840; 95% CI: 0.815, 0.866) were risk factors associated with hyperuricemia. Hyperu! ricemia is prevalent in Chinese T2DM patients with central obesity and is significantly positively associated with women, cardiovascular risk factors such as obesity, hypertension and dyslipidemia, and low eGFR.

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Statistics: are we related?

Statistics: are we related?

J Small Anim Pract. 2013 Mar;54(3):124-8

Authors: Scott M, Flaherty D, Currall J

Abstract
This short addition to our series on clinical statistics concerns relationships, and answering questions such as "are blood pressure and weight related?" In a later article, we will answer the more interesting question about how they might be related. This article follows on logically from the previous one dealing with categorical data, the major difference being here that we will consider two continuous variables, which naturally leads to the use of a Pearson correlation or occasionally to a Spearman rank correlation coefficient.

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Differential effects of weight bias experiences and internalization on exercise among women with overweight and obesity.

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Differential effects of weight bias experiences and internalization on exercise among women with overweight and obesity.

J Health Psychol. 2014 Feb 6;

Authors: Pearl RL, Puhl RM, Dovidio JF

Abstract
This study investigated the effects of experiences with weight stigma and weight bias internalization on exercise. An online sample of 177 women with overweight and obesity (M age = 35.48 years, M BMI = 32.81) completed questionnaires assessing exercise behavior, self-efficacy, and motivation; experiences of weight stigmatization; weight bias internalization; and weight-stigmatizing attitudes toward others. Weight stigma experiences positively correlated with exercise behavior, but weight bias internalization was negatively associated with all exercise variables. Weight bias internalization was a partial mediator between weight stigma experiences and exercise behavior. The distinct effects of experiencing versus internalizing weight bias carry implications for clinical practice and public health.

PMID: 24505060 [PubMed - as supplied by publisher]

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Food-dependent exercise-induced anaphylaxis with negative allergy testing.

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Food-dependent exercise-induced anaphylaxis with negative allergy testing.

BMJ Case Rep. 2014;2014

Authors: Kleiman J, Ben-Shoshan M

Abstract
Food-dependent exercise-induced anaphylaxis (FDEIA) is a disorder where exercise following allergen ingestion triggers anaphylaxis although exercise and allergen exposure are independently tolerated. The diagnosis of FDEIA is based on a characteristic clinical history. The culprit allergen is usually confirmed through the use of skin prick testing (SPT) serum-specific IgE levels and a food-exercise challenge. We present a case of FDEIA suggested by clinical history and open food-exercise challenge with negative specific IgE levels and SPT that highlights the challenges involved in diagnosing and managing this rare disorder.

PMID: 24503659 [PubMed - in process]

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The effect of prior eccentric exercise on heavy-intensity cycling: the role of gender and oral contraceptives.


PURPOSE: To determine if gender and/or the use of oral contraceptives alter
cycling performance with exercise-induced muscle damage (EiMD).
METHODS: Nine male adults (MEN), nine normally menstruating female adults
(WomenNM), and nine female adults using oral contraceptives (WomenOC)
participated. Gas exchange and time to exhaustion were measured during continuous
cycling performed at three distinct power outputs before (pre) and 48 h after
(post) 240 maximal effort eccentric contractions of the quadriceps muscles
designed to induce muscle damage (i.e., EiMD).
RESULTS: The change in muscle damage (i.e., range of motion about the knee joint
and serum creatine kinase activity) from pre- compared to post-EiMD was greater
in MEN and WomenOC compared to the WomenNM. Time to exhaustion decreased after
EiMD in MEN (5.19 Â± 4.58 min, p = 0.01) and in WomenOC (2.86 Â± 2.83 min,
p = 0.02) but did not change in WomenNM (0.98 Â± 2.28 min, p = 0.43). Accordingly,
the slow component of O2 uptake, expressed relative to time to exhaustion (i.e.,
 % min(-1)), was greater in post- compared to pre-EiMD for MEN (p = 0.02) and the
WomenOC (p = 0.03), but not for the WomenNM (p = 0.12).
CONCLUSION: The preservation of exercise tolerance during heavy-intensity cycling
performed after intense eccentric exercise is improved in women compared to men.
Furthermore, the preservation of exercise tolerance is exclusive to 17β-estradiol
and cannot be replicated with an exogenous synthetic estrogen replacement
delivered in an oral contraceptive.
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February 9, 2014

Whey Protein Improves Exercise Performance and Biochemical Profiles in Trained Mice.


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Whey Protein Improves Exercise Performance and Biochemical Profiles in Trained Mice.
Med Sci Sports Exerc. 2014 Feb 5;
Authors: Chen WC, Huang WC, Chiu CC, Chang YK, Huang CC
Abstract
PURPOSE: To verify the beneficial effects of whey protein (WP) supplementation on health promotion and enhancing exercise performance in an aerobic-exercise training protocol.
METHODS: In total, 40 male ICR mice (4 weeks old) were divided into 4 groups (n=10 per group): sedentary control with vehicle (SC) or WP supplementation (4.1 g/‹…kg, SC+WP), and exercise training with vehicle (ET) or WP supplementation (4.1 g/‹…kg, ET+WP). Animals in the ET and ET+WP groups underwent swim endurance training for 6 weeks, 5 days per week. Exercise performance was evaluated by forelimb grip strength and exhaustive swim time as well as by changes in body composition and biochemical parameters at the end of the experiment.
RESULTS: ET significantly decreased final body and muscle weight and levels of albumin, total protein, blood urea nitrogen, creatinine, total cholesterol, and triacylglycerol. ET significantly increased grip strength; relative weight (%) of liver, heart, brown adipose tissue (BAT) and levels of aspartate aminotransferase (AST), alanine aminotransferase, alkaline phosphatase, lactate dehydrogenase (LDH), creatine kinase (CK), and total bilirubin. WP supplementation significantly decreased final body, muscle, liver, BAT, and kidney weight, and relative weight (%) of muscle, liver, and BAT as well as levels of AST, LDH, CK, and uric acid. In addition, WP supplementation slightly increased endurance time and significantly increased grip strength and levels of albumin and total protein.
CONCLUSION: WP! supplementation improved exercise performance, body composition and biochemical assessments in mice and may be an effective ergogenic aid in aerobic exercise training.

PMID: 24504433 [PubMed - as supplied by publisher]
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Eccentric exercise - mechanisms and effects when used as training regime or training adjunct.

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Eccentric exercise - mechanisms and effects when used as training regime or training adjunct.

J Appl Physiol (1985). 2014 Feb 6;

Authors: Vogt M, Hoppeler HH

Abstract
The aim of the current review is to discuss applications and mechanism of eccentric exercise in training regimes of competitive sports. Eccentric muscle work is important in most sports. Eccentric muscle contractions enhance the performance during the concentric phase of stretch shortening cycles, which is important in disciplines like sprinting, jumping, throwing and running. Muscles activated during lengthening movements can also function as shock absorbers, to decelerate during landings tasks or to precisely deal with high external loading in sports like alpine skiing. Of the few studies available on trained subjects reveal that eccentric training can further enhance maximal muscle strength and power. It can further optimize muscle length for maximal tension development at a greater degree of extension, and has potential to improve muscle coordination during eccentric tasks. In skeletal muscles, these functional adaptations are based on increases in muscle mass, fascicles length, number of sarcomeres and cross sectional area of type II fibers. Identified modalities for eccentric loading in athletic populations involve classical isotonic exercises, accentuated jumping exercises, eccentric overloading exercises and eccentric cycle ergometry. We conclude that eccentric exercise offers a promising training modality to enhance performance and to prevent injuries in athletes. However, further research is necessary to better understand how the neuromuscular system adapts to eccentric loading in athletes.

PMID: 2450! 5103 [PubMed - as supplied by publisher]

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February 6, 2014

Statistics: using regression models.

Related Articles

Statistics: using regression models.

J Small Anim Pract. 2013 Jun;54(6):285-90

Authors: Scott M, Flaherty D, Currall J

Abstract
In a previous article, we asked the simple question "Are we related?" and used scatterplots and correlation coefficients to provide an answer. In this article, we will take this question and reword it to "How are we related?" and will demonstrate the statistical techniques required to reach a conclusion.

PMID: 23656306 [PubMed - indexed for MEDLINE]

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Obesity, outcomes and quality of care: body mass index increases the risk of wound-related complications in colon cancer surgery.

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Obesity, outcomes and quality of care: body mass index increases the risk of wound-related complications in colon cancer surgery.

Am J Surg. 2014 Jan;207(1):17-23

Authors: Amri R, Bordeianou LG, Sylla P, Berger DL

Abstract
BACKGROUND: Obese patients may face higher complication rates during surgical treatment of colon cancer. The aim of this study was to measure this effect at a high-volume tertiary care center.
METHODS: All patients with colon cancer treated surgically at a single center from 2004 through 2011 were reviewed. Multivariate regression assessed relationships of complications and stay outcomes with body mass index (BMI) controlling for age, gender, comorbidity score, surgical approach, and history of smoking.
RESULTS: In 1,048 included patients, BMI was a predictor of several complications in both laparoscopic and open procedures. For every increase of BMI by one World Health Organization category, the odds ratios were 1.61 (P < .001) for wound infection and 1.54 (P < .001) for slow healing. Additionally, right colectomies had an odds ratio of 3.23 (P = .017) for wound dehiscence. No further associations with BMI were found.
CONCLUSIONS: BMI was incrementally associated with wound-related complications, illustrating how the proliferation of obesity relates to a growing risk for surgical complications. As the surgical community strives to improve the quality of care, patient-controllable factors will play an increasingly i! mportant role in cost containment and quality improvement.

PMID: 24139555 [PubMed - indexed for MEDLINE]

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Impact of cardiovascular calcifications on the detrimental effect of continued smoking on cardiovascular risk in male lung cancer screening participants.

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Impact of cardiovascular calcifications on the detrimental effect of continued smoking on cardiovascular risk in male lung cancer screening participants.

PLoS One. 2013;8(6):e66484

Authors: Jairam PM, de Jong PA, Mali WP, Isgum I, de Koning HJ, van der Aalst C, Oudkerk M, Vliegenthart R, van der Graaf Y

Abstract
BACKGROUND: Current smokers have an increased cardiovascular disease (CVD) risk compared to ex-smokers due to reversible as well as irreversible effects of smoking. We investigated if current smokers remain to have an increased CVD risk compared to ex-smokers in subjects with a long and intense smoking history. We in addition studied if the effect of smoking continuation on CVD risk is independent of or modified by the presence of cardiovascular calcifications.
METHODS: The cohort used comprised a sample of 3559 male lung cancer screening trial participants. We conducted a case-cohort study using all CVD cases and a random sample of 10% (n = 341) from the baseline cohort (subcohort). A weighted Cox proportional hazards model was used to estimate the hazard ratios for current smoking status in relation to CVD events.
RESULTS: During a median follow-up of 2.6 years (max. 3.7 years), 263 fatal and non-fatal cardiovascular events (cases) were identified. Age,! packyears and cardiovascular calcification adjusted hazard ratio of current smokers compared to former smokers was 1.33 (95% confidence interval 1.00-1.77). In additional analyses that incorporated multiplicative interaction terms, neither coronary nor aortic calcifications modified the association between smoking status and cardiovascular risk (P = 0.08).
CONCLUSIONS: Current smokers have an increased CVD risk compared to former smokers even in subjects with a long and intense smoking history. Smoking exerts its hazardous effects on CVD risk by pathways partly independent of cardiovascular calcifications.

PMID: 23840486 [PubMed - indexed for MEDLINE]

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The Mediterranean Diet for Every Day: 4 Weeks of Recipes & Meal Plans to Lose Weight


The Mediterranean Diet for Every Day
The Mediterranean Diet for Every Day: 4 Weeks of Recipes & Meal Plans to Lose Weight









COMMENT: the Mediterranean Diet has been well evaluated, and consistently found to be healthy. Some of the studies show that people on this diet tend to live longer.
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February 4, 2014

Influence of trial sample size on treatment effect estimates

This study makes sense... trials with large sample sizes frequently will get a significant p-value in spite of a small effect size. This highlights the importance of not only looking at the p-value but the size of the effect when determining clinical significance and value.

Influence of trial sample size on treatment effect estim... [BMJ. 2013] - PubMed - NCBI... Read More

Exercise and Brain Function

Physical exercise appears to protect against neurocognitive decline in the elderly according to this review published December 18, 2013 by the journal Clinical Interventions in Aging. Authors Kirk-Sanchez and McGough state that "Exercise programs that are structured, individualized, higher intensity, longer duration, and multicomponent show promise for preserving cognitive performance in older adults."

SOURCE: PMID: 24379659
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Tetanus Vaccination in Pregnancy

Tdap vaccination is now recommended by the CDC Advisory Committee for for Immunization Practices (ACIP) for all pregnant women, regardless of previous vaccination status. 
 
CDC Press Release October 24, 2012 
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Obesity and Quality of Life

Increased body mass index is associated with a reduced health-related quality of life, even in the absence of metabolic comorbidity. This casts doubt on the notion of "healthy obesity". 

BMC Public Health. 2012;12:143 
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Initial therapy in hypertension

Antihypertensive therapy usually should not be initiated with diuretics, as this tends to result in the need for a greater number of medications while not achieving better blood pressure control.


COMMENT: this is an interesting study, however, current recommendations still suggest that it is appropriate to initiate antihypertensive therapy with diuretics in many cases (reference: epocrates "essential hypertension" and uptodate.com article "Choice of therapy in primary (essential) hypertension: Recommendations", both accessed 1/28/2014). Right now, I usually default to an ACE inhibitor plus lifestyle recommendations (primarily more exercise)
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Shingles

The herpes zoster (shingles) vaccine given to persons 60 to 69 years of age reduces the incidence of shingles by up to 50%.

Cochrane Library. DOI: 10.1002/14651858.CD008858.pub2  
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Cerebral hemodynamics of the aging brain: risk of Alzheimer disease and benefit of aerobic exercise.

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Cerebral hemodynamics of the aging brain: risk of Alzheimer disease and benefit of aerobic exercise.

Front Physiol. 2014;5:6

Authors: Tarumi T, Zhang R

Abstract
Alzheimer disease (AD) and cerebrovascular disease often coexist with advanced age. Mounting evidence indicates that the presence of vascular disease and its risk factors increase the risk of AD, suggesting a potential overlap of the underlying pathophysiological mechanisms. In particular, atherosclerosis, endothelial dysfunction, and stiffening of central elastic arteries have been shown to associate with AD. Currently, there are no effective treatments for the cure and prevention of AD. Vascular risk factors are modifiable via either pharmacological or lifestyle intervention. In this regard, habitual aerobic exercise is increasingly recognized for its benefits on brain structure and cognitive function. Considering the well-established benefits of regular aerobic exercise on vascular health, exercise-related improvements in brain structure and cognitive function may be mediated by vascular adaptations. In this review, we will present the current evidence for the physiological mechanisms by which vascular health alters the structural and functional integrity of the aging brain and how improvements in vascular health, via regular aerobic exercise, potentially benefits cognitive function.

PMID: 24478719 [PubMed - as supplied by publisher]



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Sildenafil Improves Exercise Hemodynamics in Fontan Patients.

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Sildenafil Improves Exercise Hemodynamics in Fontan Patients.

Circ Cardiovasc Imaging. 2014 Jan 29;

Authors: Van De Bruaene A, La Gerche A, Claessen G, De Meester P, Devroe S, Gillijns H, Bogaert J, Claus P, Heidbüchel H, Gewillig M, Budts W

Abstract
BACKGROUND: -Patients with Fontan circulation have reduced exercise capacity. The absence of a pre-systemic pump may limit flow through the pulmonary circulation restricting ventricular filling and cardiac output. We evaluated exercise hemodynamics and the effect of sildenafil on exercise hemodynamics in Fontan patients.
METHODS AND RESULTS: -Ten Fontan patients (6 male, 20±4 years) underwent cardiac magnetic resonance (CMR) imaging at rest and during supine bicycle exercise before and after sildenafil. Systemic ventricular volumes were obtained at rest and during low (34±15 Watt), moderate (69±29 Watt), and high (97±36 Watt) intensity exercise using an ungated, free-breathing CMR sequence and analyzed correcting for cardiac phase and respiratory translation. Radial and pulmonary artery pressures and cGMP were measured. Before sildenafil, cardiac index (CI) increased throughout exercise (4.0±0.9, 5.9±1.1, 7.0±1.6, 7.4±1.7 L/min.m&sup2;; P<0.0001) with 106±49% increase in heart rate. Stroke volume (SVi)(P=0.015) and end-diastolic volume (EDVi)(P=0.001) decreased during exercise. End-systolic volume (ESVi) remained unchanged (P=0.8). Total pulmonary resistance (TPRi)(P=0.005) increased whereas systemic vascular resistance (SVRi) decreased during exercise (P<0.0001). Sildenafil increased CI (P<0.0001) and SVi (P=0.003) especially at high-intensity exercise (interaction P=0.004 and P=0.003 respect! ively). SVRi was reduced (P<0.0001-interaction P=0.1) whereas TPRi was reduced at rest and reduced further during exercise (P=0.008-interaction P=0.029). Whereas cGMP remained unchanged before sildenafil (P=0.9), it increased significantly after sildenafil (P=0.019).
CONCLUSIONS: -In Fontan patients, sildenafil improved CI during exercise with a decrease in TPRi and an increase in SVi. This implies that pulmonary vasculature represents a physiological limitation, which can be attenuated by sildenafil, the clinical significance of which warrants further study.

PMID: 24478333 [PubMed - as supplied by publisher]



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Exercise and Bone Macro-architecture: Is Childhood a Window of Opportunity for Osteoporosis Prevention?

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Exercise and Bone Macro-architecture: Is Childhood a Window of Opportunity for Osteoporosis Prevention?

Int J Body Compos Res. 2010 Dec;8:1-9

Authors: Going SB, Farr JN

PMID: 24478595 [PubMed - as supplied by publisher]



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February 3, 2014

Clinical results after ultrasound-guided intratissue percutaneous electrolysis (EPI(®)) and eccentric exercise in the treatment of patellar tendinopathy.

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Clinical results after ultrasound-guided intratissue percutaneous electrolysis (EPI(®)) and eccentric exercise in the treatment of patellar tendinopathy.

Knee Surg Sports Traumatol Arthrosc. 2014 Jan 30;

Authors: Abat F, Gelber PE, Polidori F, Monllau JC, Sanchez-Ibañez JM

Abstract
PURPOSE: To investigate the outcome of ultrasound (US)-guided intratissue percutaneous electrolysis (EPI(®)) and eccentric exercise in the treatment of patellar tendinopathy during a long-term follow-up.
METHODS: Forty patients with patellar tendinopathy were prospectively evaluated over a 10-year follow-up period. Pain and function were evaluated before treatment, at 3 months and at 2, 5 and 10 years using the Victorian Institute of Sport Assessment-Patella (VISA-P) score, the Tegner score and Blazina's classification. According to VISA-P score at baseline, patients were also dichotomized into Group 1 (<50 points) and Group 2 (≥50 points). There were 21 patients in Group 1 and 19 in Group 2. Patient satisfaction was measured according to the Roles and Maudsley score.
RESULTS: The VISA-P score improved globally by 41.2 points (p < 0.01) after a mean 4.1 procedures. In Group 1, VISA-P score improved from 33.1 ± 13 to 78.9 ± 14.4 at 3-month and to 88.8 ± 10.1 at 10-year follow-up (p < 0.001). In Group 2, VISA-P score improved from 69.3 ± 10.5 to 84.9 ± 9 at 3-month and to 96.0 ± 4.3 at 10-year follow-up (p < 0.001). After 10 years, 91.2 % of the patients had a VISA-P score >80 points. The same level (80 % of patients) or the Tegner score at no more than one level lower (20 % ! of patients) was restored, and 97.5 % of the patients were satisfied with the procedure.
CONCLUSION: Treatment with the US-guided EPI(®) technique and eccentric exercises in patellar tendinopathy resulted in a great improvement in knee function and a rapid return to the previous level of activity after few sessions. The procedure has proved to be safe with no recurrences on a long-term basis.
LEVEL OF EVIDENCE: Therapeutic study, Level IV.

PMID: 24477495 [PubMed - as supplied by publisher]



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Long-term strenuous exercise induces a hypercoagulable state through contact activation.

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Long-term strenuous exercise induces a hypercoagulable state through contact activation.

Thromb Haemost. 2014 Jan 30;111(6)

Authors: Posthuma JJ, Loeffen R, van Oerle R, Henskens YM, Ten Cate H, Spronk HM, van der Meijden PE

PMID: 24477547 [PubMed - as supplied by publisher]



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The validity of the Moxus Modular metabolic system during incremental exercise tests: impacts on detection of small changes in oxygen consumption.

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The validity of the Moxus Modular metabolic system during incremental exercise tests: impacts on detection of small changes in oxygen consumption.

Eur J Appl Physiol. 2014 Jan 30;

Authors: Beltrami FG, Froyd C, Mamen A, Noakes TD

Abstract
PURPOSE: We investigated the accuracy of the Moxus Modular Metabolic System (MOXUS) against the Douglas Bag Method (DBM) during high-intensity exercise, and whether the two methods agreed when detecting small changes in [Formula: see text] between two consecutive workloads ([Formula: see text]).
METHODS: Twelve trained male runners performed two maximal incremental running tests while gas exchange was analyzed simultaneously by the two systems using a serial setup for four consecutive intervals of 30 s on each test. Comparisons between methods were performed for [Formula: see text], [Formula: see text], fractions of expired O2 (FeO2) and CO2 (FeCO2) and [Formula: see text].
RESULTS: The MOXUS produced significant higher (mean ± SD, n = 54) readings for [Formula: see text] (80 ± 200 mL min(-1), p = 0.005) and [Formula: see text] (2.9 ± 4.2 L min(-1), p < 0.0001), but not FeO2 (-0.01 ± 0.09). Log-transformed 95 % limits of agreement for readings between methods were 94-110 % for [Formula: see text], 97-108 % for [Formula: see text] and 99-101 % for FeO2. [Formula: see text] for two consecutive measurements was not different between systems (120 ± 110 vs. 90 ± 190 mL min(-1) for MOXUS and DBM, respectively, p = 0.26), but agreement between methods was very low (r = 0.25, p = 0.12).
DISCUSSION: Altho! ugh it was tested during high-intensity exercise and short sampling intervals, the MOXUS performed within the acceptable range of accuracy reported for automated analyzers. Most of the differences between equipments were due to differences in [Formula: see text]. Detecting small changes in [Formula: see text] during an incremental test with small changes in workload, however, might be beyond the equipment's accuracy.

PMID: 24477571 [PubMed - as supplied by publisher]



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The Effect of Pre-exercise Galactose and Glucose Ingestion on High-Intensity Endurance Cycling.

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The Effect of Pre-exercise Galactose and Glucose Ingestion on High-Intensity Endurance Cycling.

J Strength Cond Res. 2014 Jan 28;

Authors: O'Hara JP, Carroll S, Cooke CB, King RF

Abstract
This study evaluated the effects of the pre-exercise (30 minutes) ingestion of galactose (Gal) or glucose (Glu) on endurance capacity as well as glycaemic and insulinaemic responses. Ten trained male cyclists completed three randomised high-intensity cycling endurance tests. Thirty minutes prior to each trial cyclists ingested 1 litre of either 40g of glucose, 40g of galactose, or a placebo in a double blind manner. The protocol comprised: 20 minutes of progressive incremental exercise (70% to 85% maximal power output (Wmax)); ten 90 second bouts at 90% Wmax, separated by 180 seconds at 55% Wmax; 90% Wmax until exhaustion. Blood samples were drawn throughout the protocol. Times to exhaustion were longer with Gal (68.7±10.2 minutes, P=0.005) compared to Glu (58.5±24.9 minutes), with neither being different to placebo (63.9±16.2 minutes). Twenty-eight minutes following Glu consumption, plasma glucose and serum insulin concentrations were higher than with Gal and placebo (P<0.001). Following the initial 20 minutes of exercise, plasma glucose concentrations increased to a relative hyperglycaemia during the Gal and placebo, compared to Glu condition. Higher plasma glucose concentrations during exercise, and the attenuated serum insulin response at rest, may explain the significantly longer times to exhaustion produced by Gal compared to Glu. However, neither carbohydrate treatment produced significantly longer times to exhaustion than placebo, suggesting that the pre-exercise ingestion of galactose and g! lucose alone is not sufficient to support this type of endurance performance.

PMID: 24476772 [PubMed - as supplied by publisher]



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Preventing obesity: exercise and daily activities of low-income pregnant women.

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Preventing obesity: exercise and daily activities of low-income pregnant women.

J Perinat Neonatal Nurs. 2014 Jan-Mar;28(1):17-25

Authors: Yeo S, Logan JG

Abstract
Low-income women are at risk for excessive gestational weight gain. Inactive lifestyle and lack of regular moderate exercise may contribute to the risk of weight gain. This study was conducted to (1) determine the rate and characteristics of low-income pregnant women who exercised regularly and met the American College of Obstetricians and Gynecologists recommendation and (2) describe how these women spent time for other physical activities compared with those who did not exercise regularly. Medicaid-recipient or uninsured pregnant women (n = 816) were asked to complete a physical activity questionnaire at rural and urban county health departments located in North Carolina. Twenty percent of low-income women met the American College of Obstetricians and Gynecologists recommendation for moderate exercise (≥10 METs-h/wk [metabolic equivalent task-hours per week]). The women who met the recommendation spent 3 hours 45 minutes per week walking as exercise, whereas those who did not meet the recommendation spent 1 hour per week (P < .0001). Women who exercised regularly spent longer hours at work (4.25 vs 1.75 hours per day; P = .019) and on household tasks (5.25 vs 4.0 hours per day; P = .002) than women who did not exercise regularly. Time spent on domestic and occupation activities does not seem to prohibit low-income women from engaging in moderate exercise on a regular basis.

PMID: 24476648 [PubMed - in process]



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