Physical activity counseling in overweight and obese primary care patients: Outcomes of the VA-STRIDE randomized controlled trial.

The purpose of this 2-arm randomized clinical trial was to evaluate the effectiveness of a 12-month, expert system-based, print-delivered physical activity intervention in a primary care Veteran population in Pittsburgh, Pennsylvania. Participants were not excluded for many health conditions that typically are exclusionary criteria in physical activity trials. The primary outcome measures were physical activity reported using the Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire and an accelerometer-based activity assessment at baseline, 6, and 12 months. Of the 232 Veterans enrolled in the study, 208 (89.7%) were retained at the 6-month follow-up and 203 (87.5%) were retained at 12 months. Compared to the attention control, intervention participants had significantly increased odds of meeting the U.S. recommended guideline of ≥ 150 min/week of at least moderate-intensity physical activity at 12 months for the modified CHAMPS (odds ratio [OR] = 2.86; 95% CI: 1.03-7.96; p = 0.04) but not at 6 months (OR = 1.54; 95% CI: 0.56-4.23; p = 0.40). Based on accelerometer data, intervention participants had significantly increased odds of meeting ≥ 150 min/week of moderate-equivalent physical activity at 6 months (OR = 6.26; 95% CI: 1.26-31.22; p = 0.03) and borderline significantly increased odds at 12 months (OR = 4.73; 95% CI: 0.98-22.76; p = 0.053). An expert system physical activity counseling intervention can increase or sustain the proportion of Veterans in primary care meeting current recommendations for moderate-intensity physical activity. Trial Registration Clinical trials.gov identifier: NCT00731094 URL: http://www.clinicaltrials.gov/ct2/show/NCT00731094

Cumulative fatigue damage of stress below the fatigue limit in weldment steel under block loading

To investigate the cumulative fatigue damage below the fatigue limit of multipass weldment martensitic stainless steel, and to clarify the effect of cycle ratios and high‐stress level in the statement, fatigue tests were conducted under constant and combined high‐ and low‐stress amplitude relative to stress above and below the fatigue limit. The outcomes indicate that neither modified Miner's nor Haibach's approach provided accurate evaluation under repeated two‐step amplitude loading. Moreover, effect of cycle ratios has been determined. Additionally, the cumulative fatigue damage saturated model is established and validated. Cumulative fatigue damage contributed by low‐stress below the fatigue limit in high stress of 700 MPa is higher than that with 650 MPa at identical conditions (fatigue limit 575 MPa). Thus, high stress affects fatigue damage behaviour below the fatigue limit. A new predicted approach has been proposed based on Corten‐Dolan law, whose accuracy and applicability have been proven

Clinical value of a combined multi-phase contrast enhanced DOPA-PET/CT in neuroendocrine tumours with emphasis on the diagnostic CT component

Objective: To assess the clinical value of multi-phase, contrast-enhanced DOPA-PET/CT with emphasis on the diagnostic CT component in patients with neuroendocrine tumours (NET). Methods: Sixty-five patients with NET underwent DOPA-cePET/CT. The DOPA-PET, multi-phase CT and combined DOPA cePET/CT data were evaluated and diagnostic accuracies compared. The value of ceCT in DOPA cePET/CT concerning lesion detection and therapeutic impact was evaluated. Sensitivities, specificities and accuracies were calculated. Histopathology and clinical follow-up served as the standard of reference. Differences were tested for statistical significance by McNemar's test. Results: In 40 patients metastatic and/or primary tumour lesions were detected. Lesion-based analysis for the DOPA-PET showed sensitivity, specificity and accuracy of 66%, 100% and 67%, for the ceCT data 85%, 71% and 85%, and for the combined DOPA cePET/CT data 97%, 71% and 96%. DOPA cePET/CT was significantly more accurate compared with dual-phase CT (p < 0.05) and PET alone (p < 0.05). Additional lesion detection was based on ceCT in 12 patients; three patients underwent significant therapeutic changes based on the ceCT findings. Conclusion: DOPA cePET/CT was significantly more accurate than DOPA-PET alone and ceCT alone. The CT component itself had a diagnostic impact in a small percentage but contributed to the therapeutic strategies in selected patient

Diagnostic accuracy of computed tomography coronary angiography and evaluation of stress-only single-photon emission computed tomography/computed tomography hybrid imaging: comparison of prospective electrocardiogram-triggering vs. retrospective gating

Aims To determine diagnostic accuracy, effective radiation dose, and potential value of computed tomography coronary angiography (CTCA) for hybrid imaging with single-photon emission computed tomography (SPECT) comparing prospective electrocardiogram (ECG)-triggering vs. retrospective ECG-gating. Methods and results Two hundred patients underwent standard myocardial stress/rest- SPECT perfusion imaging, which served as standard of reference. One hundred consecutive patients underwent 64-slice CTCA using prospective ECG-gating, and were compared with 100 patients who had previously undergone CTCA using retrospective ECG-gating. For predicting ischaemia, CTCA with prospective ECG-triggering and a stenosis cut-off >50% had a per-vessel sensitivity, specificity, negative, and positive predictive value of 100, 84, 100, and 30%; respective values for CTCA with retrospective ECG-gating were similar (P = n.s.): 86, 83, 98, and 33%. Combining CTCA with stress-only SPECT revealed 100% clinical agreement with regard to perfusion defects, and provided additional information in half the patients on preclinical coronary findings. Effective radiation dose was 2.2 ± 0.7 mSv for CTCA with prospective ECG-triggering, and 19.7 ± 4.2 mSv with retrospective ECG-gating (P < 0.001) (5.4 ± 0.8 vs. 24.1 ± 4.3 mSv for hybrid imaging). Conclusion Prospective ECG-triggering for CTCA reduces radiation dose by almost 90% without affecting diagnostic performance. Combined imaging with stress-only SPECT is an attractive alternative to standard stress/rest-SPECT for evaluation of coronary artery disease, offering additional information on preclinical atherosclerosi

Hodgkin's lymphoma in remission after first-line therapy: which patients need FDG-PET/CT for follow-up?

Background: The purpose of the study was to evaluate the impact of 2-[fluorine-18]fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET)/computed tomography (CT) during follow-up of patients with Hodgkin's lymphoma. Patients and methods: Patients in complete remission or an unconfirmed complete remission after first-line therapy who received FDG-PET/CT during their follow-up were analyzed retrospectively. Confirmatory biopsy was mandatory in case of recurrence. Results: Overall, 134 patients were analyzed. Forty-two (31.3%) patients had a recurrence. The positive predictive value of FDG-PET/CT was 0.98. Single-factor analysis identified morphological residual mass [P = 0.0005, hazard ratio (HR) 3.4, 95% confidence interval (CI) 1.7-6.6] and symptoms (P 24 months). Conclusions: Asymptomatic patients without morphological residues and an early stage of disease do not need a routine FDG-PET/CT for follow-up. Asymptomatic patients with morphological residues should receive routine follow-up FDG-PET/CT for the first 24 months. Only patients with advanced initial stage do need a routine follow-up FDG-PET/CT beyond 24 month

Risk-adapted FDG-PET/CT-based follow-up in patients with diffuse large B-cell lymphoma after first-line therapy

Background: The purpose of this study was to evaluate the impact of 2-[fluorine-18]fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) during follow-up of patients with diffuse large B-cell lymphoma (DLBCL) being in complete remission or unconfirmed complete remission after first-line therapy. Patients and methods: DLBCL patients receiving FDG-PET/CT during follow-up were analyzed retrospectively. Confirmatory biopsy was mandatory in cases of suspected disease recurrence. Results: Seventy-five patients were analyzed and 23 (30%) had disease recurrence. The positive predictive value (PPV) of FDG-PET/CT was 0.85. Patients >60 years [P = 0.036, hazard ratio (HR) = 3.82, 95% confidence interval (CI) 1.02-7.77] and patients with symptoms indicative of a relapse (P = 0.015; HR = 4.1; 95% CI 1.20-14.03) had a significantly higher risk for relapse. A risk score on the basis of signs of relapse, age >60 years, or a combination of these factors identified patients at high risk for recurrence (P = 0.041). Conclusions: FDG-PET/CT detects recurrent DLBCL after first-line therapy with high PPV. However, it should not be used routinely and if only in selected high-risk patients to reduce radiation burden and costs. On the basis of our retrospective data, FDG-PET/CT during follow-up is indicated for patients 60 years with and without clinical signs of relaps

Investigating in-service failures of water pipes from a multiaxial notch fatigue point of view: A conceptual study

Many mechanisms and processes can cause deterioration and ultimately failure of water distribution pipes during in-service operation, amongst these is damage caused by metal fatigue. This paper summarises an attempt at formalising a novel methodology suitable for estimating the number of years taken for a through thickness fatigue crack to form in this complex scenario. The devised method is based on the so-called modified Wo¨hler curve method and can be applied to estimate fatigue damage of water pipes independently from the degree of multiaxiality and non-proportionality of the load history. The computational approach of the proposed fatigue life estimation technique makes full use of an incremental procedure: fatigue damage is evaluated year by year by assuming that all variable involved in the process can change over time. The detrimental effect of corrosion pits is directly accounted for by treating them as conventional notches whose size increases with time. Finally, by taking as reference information the number of years for a blowout hole to form, the proposed approach is used to show how the lifetime of grey cast iron pipes can be remarkably shortened by fatigue

Feasibility of low-dose coronary CT angiography: first experience with prospective ECG-gating

AIMS: To determine the feasibility of prospective electrocardiogram (ECG)-gating to achieve low-dose computed tomography coronary angiography (CTCA). METHODS AND RESULTS: Forty-one consecutive patients with suspected (n = 35) or known coronary artery disease (n = 6) underwent 64-slice CTCA using prospective ECG-gating. Individual radiation dose exposure was estimated from the dose-length product. Two independent readers semi-quantitatively assessed the overall image quality on a five-point scale and measured vessel attenuation in each coronary segment. One patient was excluded for atrial fibrillation. Mean effective radiation dose was 2.1 +/- 0.6 mSv (range, 1.1-3.0 mSv). Image quality was inversely related to heart rate (HR) (57.3 +/- 6.2, range 39-66 b.p.m.; r = 0.58, P 63 b.p.m. (P < 0.001). CONCLUSION: This first experience documents the feasibility of prospective ECG-gating for CTCA with diagnostic image quality at a low radiation dose (1.1-3.0 mSv), favouring HR <63 b.p.

Feasibility of low-dose coronary CT angiography: first experience with prospective ECG-gating

AIMS: To determine the feasibility of prospective electrocardiogram (ECG)-gating to achieve low-dose computed tomography coronary angiography (CTCA). METHODS AND RESULTS: Forty-one consecutive patients with suspected (n = 35) or known coronary artery disease (n = 6) underwent 64-slice CTCA using prospective ECG-gating. Individual radiation dose exposure was estimated from the dose-length product. Two independent readers semi-quantitatively assessed the overall image quality on a five-point scale and measured vessel attenuation in each coronary segment. One patient was excluded for atrial fibrillation. Mean effective radiation dose was 2.1 +/- 0.6 mSv (range, 1.1-3.0 mSv). Image quality was inversely related to heart rate (HR) (57.3 +/- 6.2, range 39-66 b.p.m.; r = 0.58, P 63 b.p.m. (P < 0.001). CONCLUSION: This first experience documents the feasibility of prospective ECG-gating for CTCA with diagnostic image quality at a low radiation dose (1.1-3.0 mSv), favouring HR <63 b.p.