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Correlation of esophageal pressure-flow analysis findings with bolus transit patterns on videofluoroscopy
No full textThis is a pre-copyedited, author-produced version of an article accepted for publication in Diseases of the Esophagus following peer review.
The version of record Omari TI, Szczesniak MM, Maclean J, Myers JC, Rommel N, Cock C and Cook IJ. Correlation of esophageal pressure-flow analysis findings with bolus transit patterns on videofluoroscopy. Dis Esophagus. 2016 Feb-Mar;29(2):166-73.
and is available online at:
http://dx.doi.org/10.1111/dote.12300
Copyright © 2017 The International Society for Diseases of the EsophagusPressure-flow analysis quantifies the interactions between bolus transport and pressure generation. We undertook a pilot study to assess the interrelationships between pressure-flow metrics and fluoroscopically determined bolus clearance and bolus transport across the esophagogastric junction (EGJ). We hypothesized that findings of abnormal pressure-flow metrics would correlate with impaired bolus clearance and reduced flow across the EGJ. Videofluoroscopic images, impedance, and pressure were recorded simultaneously in nine patients with dysphagia (62–82 years, seven male) tested with liquid barium boluses. A 3.6 mm diameter solid-state catheter with 25 × 1 cm pressure/12 × 2 cm impedance was utilized. Swallowed bolus clearance was assessed using a validated 7-point radiological bolus transport scale. The cumulative period of bolus flow across the EGJ was also fluoroscopically measured (EGJ flow time). Pressure only parameters included the length of breaks in the 20 mmHg iso-contour and the 4 second integrated EGJ relaxation pressure (IRP4s). Pressure-flow metrics were calculated for the distal esophagus, these were: time from nadir impedance to peak pressure (TNadImp to PeakP) to quantify bolus flow timing; pressure flow index (PFI) to integrate bolus pressurization and flow timing; and impedance ratio (IR) to assess bolus clearance. When compared with controls, patients had longer peristaltic breaks, higher IRs, and higher residual EGJ relaxation pressures (break length of 8 [2, 13] vs. 2 [0, 2] cm, P = 0.027; IR 0.5 ± 0.1 vs. 0.3 ± 0.0, P = 0.019; IRP4s 11 ± 2 vs. 6 ± 1 mmHg, P = 0.070). There was a significant positive correlation between higher bolus transport scores and longer peristaltic breaks (Spearman correlation r = 0.895, P < 0.001) and with higher IRs (r = 0.661, P < 0.05). Diminished EGJ flow times correlated with a shorter TNadImp to PeakP (r = −0.733, P < 0.05) and a higher IR (r = −0.750, P < 0.05). Longer peristaltic breaks and higher IR correlate with failed bolus clearance on videofluoroscopy. The metric TNadImp to PeakP appears to be a marker of the period of time over which the bolus flows across the EGJ
Efficacy of the Flinders chronic condition management program in obese patients with hip or knee osteoarthritis: A study rationale and protocol
No full textOriginally published by Australasian Medical Journal. Sahafi, L., Smith, D., Georgiou, K., Krishnan, J., & Battersby, M. (2016). Efficacy of the Flinders chronic condition management program in obese patients with hip or knee osteoarthritis: A study rationale and protocol. Australasian Medical Journal (Online), 9(9), 297-307.Background
Obesity is a risk factor for osteoarthritis and total hip/knee joint replacement and can also lead to poorer outcomes following surgical interventions. Self-management programs are a recommended approach for addressing clinical features of osteoarthritis and obesity.
Aims
This study investigates the relative efficacy of the Flinders chronic condition self-management program versus treatment as usual in obese patients with hip or knee osteoarthritis on a knee/hip joint replacement waiting list.
Methods
Obese (Body Mass Index or BMI≥30) osteoarthritis patients on a knee/hip joint replacement waiting list will be assessed for study eligibility. 95 consented patients will provide 80 per cent power to detect an effect size of 0.6 in the primary outcome measure of quality of life at 6 months and 10 months, at α=10 per cent level. A randomised sequence, stratified by gender and obesity class will be generated and administered by a computer-based system. Health-related quality of life outcomes will be collected using Short Form SF-36 and OAKHQOL at 6 and 10 months pre- and post-operatively. The main analysis will investigate differences in SF-36 scores between the intervention and treatment as usual groups on an intention-to-treat basis. Linear mixed effect models will be used to analyse outcome data.
Conclusion
This study is designed to provide robust and transparent findings including randomisation sequence generation, allocation concealment and implementation and will therefore provide much needed quality evidence in the field of self-management and osteoarthritis.1 The Flinders Program has not been used in this type of patient cohort before and since it has been proven a successful self-management tool for other chronic conditions in Australian communities, the results of this study will add valuable knowledge to the chronic condition management
Local Electrical Dyssynchrony during Atrial Fibrillation: Theoretical Considerations and Initial Catheter Ablation Results
No full textCopyright: © 2016 Kuklik et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and
reproduction in any medium, provided the original author and source are credited.Background
Electrogram-based identification of the regions maintaining persistent Atrial Fibrillation (AF) is a subject of ongoing debate. Here, we explore the concept of local electrical dyssynchrony to identify AF drivers.
Methods and Results
Local electrical dyssynchrony was calculated using mean phase coherence. High-density epicardial mapping along with mathematical model were used to explore the link between local dyssynchrony and properties of wave conduction. High-density mapping showed a positive correlation between the dyssynchrony and number of fibrillatory waves (R2 = 0.68, p<0.001). In the mathematical model, virtual ablation at high dyssynchrony regions resulted in conduction regularization. The clinical study consisted of eighteen patients undergoing catheter ablation of persistent AF. High-density maps of left atrial (LA) were constructed using a circular mapping catheter. After pulmonary vein isolation, regions with the top 10% of the highest dyssynchrony in LA were targeted during ablation and followed with ablation of complex atrial electrograms. Catheter ablation resulted in termination during ablation at high dyssynchrony regions in 7 (41%) patients. In another 4 (24%) patients, transient organization was observed. In 6 (35%) there was no clear effect. Long-term follow-up showed 65% AF freedom at 1 year and 22% at 2 years.
Conclusions
Local electrical dyssynchrony provides a reasonable estimator of regional AF complexity
defined as the number of fibrillatory waves. Additionally, it points to regions of dynamical instability related with action potential alternans. However, despite those characteristics, its utility in guiding catheter ablation of AF is limited suggesting other factors are responsible for AF persistence
Addressing Smoking in Supported Residential Facilities for People with Severe Mental Illness: Has Any Progress Been Achieved?
No full text© 2016 by the authors; licensee MDPI, Basel, Switzerland. This article is an open access
article distributed under the terms and conditions of the Creative Commons Attribution
(CC-BY) license (http://creativecommons.org/licenses/by/4.0/).Background: Smoking rates for people with severe mental illness have remained high despite significant declines in smoking rates in the general population, particularly for residents of community supported residential facilities (SRFs) where smoking has been largely neglected and institutionalized. Methods: Two studies undertaken 10 years apart (2000 and 2010) with SRFs in Adelaide, Australia looked at historical trends to determine whether any progress has been made to address smoking for this population. The first study was ethnographic and involved narrative description and analysis of the social milieu of smoking following multiple observations of smoking behaviours in two SRFs. The second study involved an eight-week smoking cessation group program providing tailored support and free nicotine replacement therapy to residents across six SRFs. Changes in smoking behaviours were measured using pre and post surveys with residents, with outcomes verified by also seeking SRF staff and smoking cessation group facilitator qualitative feedback and reflection on their observations of residents and the setting. Results: The culture of smoking in mental health SRFs is a complex part of the social milieu of these settings. There appears to have been little change in smoking behaviours of residents and attitudes and support responses by staff of SRFs since 2000 despite smoking rates declining in the general community. Tailored smoking cessation group programs for this population were well received and did help SRF residents to quit or cut down their smoking. They did challenge staff negative attitudes to residents’ capacity to smoke less or quit. Conclusions: A more systematic approach that addresses SRF regulations, smoke-free policies, staff attitudes and training, and consistent smoking cessation support to residents is needed. View Full-Tex
Semi-quantitative digital analysis of polymerase chain reactionelectrophoresis gel: Potential applications in low-income veterinary laboratories
No full textThe articles in Veterinary World are open access articles licensed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution and reproduction in any medium, provided the work is properly cited.Aim: The interpretation of conventional polymerase chain reaction (PCR) assay results is often limited to either positive or negative (non-detectable). The more robust quantitative PCR (qPCR) method is mostly reserved for quantitation studies and not a readily accessible technology in laboratories across developing nations. The aim of this study was to evaluate a semi-quantitative method for conventional PCR amplicons using digital image analysis of electrophoretic gel. The potential applications are also discussed.
Materials and Methods: This study describes standard conditions for the digital image analysis of PCR amplicons using the freely available ImageJ software and confirmed using the qPCR assay.
Results and Conclusion: Comparison of ImageJ analysis of PCR-electrophoresis gel and qPCR methods showed similar trends in the Fusobacterium necrophorum DNA concentration associated with healthy and periodontal disease infected wallabies (p≤0.03). Based on these empirical data, this study adds descriptive attributes (“more” or “less”) to the interpretation of conventional PCR results. The potential applications in low-income veterinary laboratories are suggested, and guidelines for the adoption of the method are also highlighted
Detection of Campylobacter jejuni in Lizard Faeces from Central Australia Using Quantitative PCR
No full textThis is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).Worldwide, Campylobacter is a significant cause of gastrointestinal illness. It is predominately considered a foodborne pathogen, with human exposure via non-food transmission routes generally overlooked. Current literature has been exploring environmental reservoirs of campylobacteriosis including potential wildlife reservoirs. Given the close proximity between lizards and human habitats in Central Australia, this study examined the presence of Campylobacter jejuni from lizard faeces collected from this region. Of the 51 samples collected, 17 (33%) (this included 14/46 (30%) wild and 3/5 (60%) captive lizard samples) were positive for C. jejuni using quantitative PCR (qPCR). This was the first study to investigate the presence of C. jejuni in Australian lizards. This has public health implications regarding the risk of campylobacteriosis from handling of pet reptiles and through cross-contamination or contact with wild lizard faeces. Additionally this has implication for horizontal transmission via lizards of C. jejuni to food production farms. Further research is needed on this environmental reservoir and potential transmission routes to reduce the risk to public health. View Full-Tex
Sex differences in the response to resistance exercise training in older people
No full textThis is an open access article under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits use, distribution and reproduction in any medium, provided the original work is properly cited.Resistance exercise training is known to be effective in increasing muscle mass in older people. Acute measurement of protein metabolism data has indicated that the magnitude of response may differ between sexes. We compared adaptive responses in muscle mass and function to 18 weeks resistance exercise training in a cohort of older (>65 years) men and women. Resistance exercise training improved knee extensor maximal torque, 4 m walk time, time to complete five chair rises, muscle anatomical cross-sectional area (ACSA) and muscle quality with no effect on muscle fat/water ratio or plasma glucose, insulin, triacylglycerol, IL-6, and TNF-α Differences between sexes were observed for knee extensor maximal torque and muscle quality with greater increases observed in men versus women (P < 0.05). Maximal torque increased by 15.8 ± 10.6% in women and 41.7 ± 25.5% in men, whereas muscle quality increased by 8.8 ± 17.5% in women and by 33.7 ± 25.6% in men. In conclusion, this study has demonstrated a difference in the magnitude of adaptation, of some of the outcome measures employed, in response to 18 weeks of resistance exercise training between men and women. The mechanisms underlying this observation remain to be established
Consumption of the Soluble Dietary Fibre Complex PolyGlycopleX® Reduces Glycaemia and Increases Satiety of a Standard Meal Postprandially
No full textThis article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/).The effect of consumption of PolyGlycopleX® (PGX®) was compared to wheat dextrin
(WD) in combination with a standard meal, on postprandial satiety and glycaemia in a double-blind,
randomised crossover trial, of 14 healthy subjects trained as a satiety panel. At each of six two-hour
satiety sessions, subjects consumed one of three different test meals on two separate occasions.
The test meals were: a standard meal plus 5 g PGX; a standard meal plus 4.5 g of PGX as softgels;
and a standard meal plus 5 g of WD. Subjects recorded fullness using a labelled magnitude scale at 0,
15, 30, 45, 60, 90, and 120 min and the total area under the curve (AUC), mean fullness vs. time was
calculated. The meals with PGX (in granular and softgel form) gave higher satiety (AUC) (477 121
and 454 242 cm min), than the meal with WD (215 261 cm min) (p < 0.001). Subjects had blood
glucose levels measured after the meals with PGX (granules) and WD. Glucose response (AUC) was
significantly lower (p < 0.001) after the PGX meal than for the WD meal. The high viscosity reported
for PGX is a likely mechanism behind the significant satiety and blood glucose modulating effects
observed in this study
Length–weight relationship and condition factor of giant tiger shrimp, Penaeus monodon (Fabricius, 1798) from four breeding families
No full textThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License
(http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium,
provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.Background: Length–weight relationships and condition factors of giant tiger shrimp Penaeus monodon (Fabricius,
1798) from four breeding families (family S: South China seas family, family A: African family, family SA: ♂ South China
seas family × ♀ Africa family, family AS: ♂ Africa family × ♀ South China seas family) were evaluated in this study.
Findings and conclusion: Length–weight relationships can be expressed as W = 0.0239BL2.789 (R2 = 0.8977) in family
S, W = 0.0206BL2.9107 (R2 = 0.9107) in family A, W = 0.0211BL2.831 (R2 = 0.8869) in family SA, and W = 0.0249BL2.781
(R2 = 0.9159) in family AS. The growth of P. monodon from four breeding families follows a negative allometric trend.
Fulton’s body condition factor (K) was not significantly different in males, while in females, the highest K (3.07) was
observed in family AS, and the lowest K was found in family A (1.88). Results from the present study indicate that the
cross group family AS (♂ Africa family × ♀ South China seas family) has obvious heterosis in females. This may suggest
that the direction of further breeding of P. monodon, should be conducted by using Africa family as male parent, and
South China seas family as female parent. Results from the present study will provide valuable information on selective
breeding in P. monodon. Methodology used in the present study can also be applied in other similar species
Effectiveness of the Local Adaptation Plan of Action to support climate change adaptation in Nepal
No full textThe final publication is available at Springer via: http://dx.doi.org/10.1007/s11027-014-9610-3A key challenge in climate change adaptation in developing countries as a whole, and to handling global change in particular, is to link local adaptation needs on the one hand, with national adaptation initiatives on the other, so that vulnerable households and communities can directly benefit. This study assesses the impact of the Nepal government’s efforts to promote its Local Adaptation Plan of Action (LAPA) and its applicability to other least developed countries (LDCs). Based on data gathered from two field studies in Nepal, the research shows that the Nepal’s LAPA has succeeded in mobilizing local institutions and community groups in adaptation planning and recognizing their role in adaptation. However, the LAPA approach and implementation have been constrained by sociostructural and governance barriers that have failed to successfully integrate local adaptation needs in local planning and increase the adaptive capacity of vulnerable households. This paper describes the mechanisms of suitable governance strategies for climate change adaptation specific to Nepal and other LDCs. It also argues the need to adopt an adaptive comanagement approach, where the government and all stakeholders identify common local- and national-level mainstreaming strategy for knowledge management, resource mobilization, and institutional development, ultimately using adaptation as a tool to handle global change