Tinned fruit consumption and mortality in three prospective cohorts.

Dietary recommendations to promote health include fresh, frozen and tinned fruit, but few studies have examined the health benefits of tinned fruit. We therefore studied the association between tinned fruit consumption and mortality. We followed up participants from three prospective cohorts in the United Kingdom: 22,421 participants from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk cohort (1993-2012), 52,625 participants from the EPIC-Oxford cohort (1993-2012), and 7440 participants from the Whitehall II cohort (1991-2012), all reporting no history of heart attack, stroke, or cancer when entering these studies. We estimated the association between frequency of tinned fruit consumption and all cause mortality (primary outcome measure) using Cox regression models within each cohort, and pooled hazard ratios across cohorts using random-effects meta-analysis. Tinned fruit consumption was assessed with validated food frequency questionnaires including specific questions about tinned fruit. During 1,305,330 person years of follow-up, 8857 deaths occurred. After adjustment for lifestyle factors and risk markers the pooled hazard ratios (95% confidence interval) of all cause mortality compared with the reference group of tinned fruit consumption less often than one serving per month were: 1.05 (0.99, 1.12) for one to three servings per month, 1.10 (1.03, 1.18) for one serving per week, and 1.13 (1.04, 1.23) for two or more servings per week. Analysis of cause-specific mortality showed that tinned fruit consumption was associated with mortality from cardiovascular causes and from non-cardiovascular, non-cancer causes. In a pooled analysis of three prospective cohorts from the United Kingdom self-reported tinned fruit consumption in the 1990s was weakly but positively associated with mortality during long-term follow-up. These findings raise questions about the evidence underlying dietary recommendations to promote tinned fruit consumption as part of a healthy diet.EPIC-Norfolk is supported by the Medical Research Council (grant numbers G1000143, G0401527, G9502233, G0300128) and Cancer Research UK (grant numbers C864/A14136, C865/A2883). EPIC-Oxford is supported by Cancer Research UK (C570/A11691). Whitehall II has been supported by grants from the Medical Research Council; the British Heart Foundation; the British Health and Safety Executive; the British Department of Health; the National Heart, Lung, and Blood Institute (R01HL036310); and the National Institute on Aging at the US National Institutes of Health (NIH). ETA is supported by an academic clinical fellowship awarded by the United Kingdom National Institute for Health Research. EB is funded by the British Heart Foundation. MAHL received grants from Cancer Research UK, and Medical Research Council. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.This is the final published version. It first appeared in PLoS ONE 10(2): e0117796. doi: 10.1371/journal.pone.0117796

Physical activity as a treatment for depression: the TREAD randomised trial protocol

Published version. Copyright © 2010 BioMed CentralBackground: Depression is one of the most common reasons for consulting a General Practitioner (GP) within the UK. Whilst antidepressants have been shown to be clinically effective, many patients and healthcare professionals would like to access other forms of treatment as an alternative or adjunct to drug therapy for depression. A recent systematic review presented some evidence that physical activity could offer one such option, although further investigation is needed to test its effectiveness within the context of the National Health Service. The aim of this paper is to describe the protocol for a randomised, controlled trial (RCT) designed to evaluate an intervention developed to increase physical activity as a treatment for depression within primary care. Methods/design: The TREAD study is a pragmatic, multi-centre, two-arm RCT which targets patients presenting with a new episode of depression. Patients were approached if they were aged 18-69, had recently consulted their GP for depression and, where appropriate, had been taking antidepressants for less than one month. Only those patients with a confirmed diagnosis of a depressive episode as assessed by the Clinical Interview Schedule-Revised (CIS-R), a Beck Depression Inventory (BDI) score of at least 14 and informed written consent were included in the study. Eligible patients were individually randomised to one of two treatment groups; usual GP care or usual GP care plus facilitated physical activity. The primary outcome of the trial is clinical symptoms of depression assessed using the BDI four months after randomisation. A number of secondary outcomes are also measured at the 4-, 8- and 12-month follow-up points including quality of life, attitude to and involvement in physical activity and antidepressant use/adherence. Outcomes will be analysed on an intention-to-treat (ITT) basis and will use linear and logistic regression models to compare treatments. Discussion: The results of the trial will provide information about the effectiveness of physical activity as a treatment for depression. Given the current prevalence of depression and its associated economic burden, it is hoped that TREAD will provide a timely contribution to the evidence on treatment options for patients, clinicians and policy-makers

Validity, reliability, and responsiveness of a self-reported foot and ankle score (SEFAS)

Background and purpose A questionnaire was introduced by the New Zealand Arthroplasty Registry for use when evaluating the outcome of total ankle replacement surgery. We evaluated the reliability, validity, and responsiveness of the modified Swedish version of the questionnaire (SEFAS) in patients with osteoarthritis or inflammatory arthritis before and/or after their ankle was replaced or fused. Patients and methods The questionnaire was translated into Swedish and cross-culturally adapted according to a standardized procedure. It was sent to 135 patients with ankle arthritis who were scheduled for or had undergone surgery, together with the foot and ankle outcome score (FAOS), the short form 36 (SF-36) score, and the EuroQol (EQ-5D) score. Construct validity was evaluated with Spearman's correlation coefficient when comparing SEFAS with FAOS, SF-36, and EQ-5D, content validity by calculating floor and ceiling effects, test-retest reliability with intraclass correlation coefficient (ICC), internal consistency with Cronbach's alpha (n = 62), agreement by Bland-Altman plot, and responsiveness by effect size and standardized response mean (n = 37). Results For construct validity, we correlated SEFAS with the other scores and 70% or more of our predefined hypotheses concerning correlations could be confirmed. There were no floor or ceiling effects. ICC was 0.92 (CI 95%: 0.88-0.95), Cronbach's alpha 0.96, effect size was 1.44, and the standardized response mean was 1.00. Interpretation SEFAS is a self-reported foot and ankle score with good validity, reliability and responsiveness, indicating that the score can be used to evaluate patients with osteoarthritis or inflammatory arthritis of the ankle and outcome of surgery

Modelo de rentabilidade das explorações leiteiras em S. Miguel : influência dos fatores de produção : da classificação morfológica e da produção leiteira dos bovinos

Dissertação de Mestrado em Engenharia Zootécnica.Tendo presente que a situação económica das explorações leiteiras dos Açores está a atravessar grandes dificuldades económicas e financeiras, e com o aproximar do fim anunciado das quotas leiteiras e consequente liberalização total na produção de leite (PL) na Europa, a pecuária açoriana necessita de se preparar para esta nova mudança de estratégia europeia sob o risco de falência da atividade. Dessa forma, pretende-se conhecer a situação técnico-económica e a eficiência técnica das explorações, avaliar o efeito que a produção de leite aos 305 dias (PL305) e a classificação morfológica (CM) terão na rentabilidade líquida (RL), para depois criar um modelo que possa explicar a rentabilidade das explorações. Foram realizadas a análise não paramétrica de eficiência, a análise de variância, a análise cluster e a regressão linear dos registos da PL305, gordura aos 305 dias (PG305), proteína aos 305 dias (PP305) e a CM de 91 explorações que realizaram contraste leiteiro (CL) e foram inscritas em regime de contabilidade organizada no ano de 2010. Constatou-se que as explorações tinham auferindo um RL anual de 1.002,93€/ha, representando um lucro médio de 19,80%. Contudo, cada exploração recebe de subsídios por hectare (Subs/ha) 1.090,06€/ha, o que representa 22,43% do total das receitas e uma clara dependência das explorações aos subsídios (Subs), caso contrário, o lucro médio passaria a -4,20%. Com a certeza do fim anunciado das quotas leiteiras e o corte do Subs aos Produtos Lácteos, prevê-se uma quebra média dos rendimentos em 10,36%. Do lado das despesas, os custos alimentares (CAlim) são os que representam a maior percentagem da despesa com 25,32%. Após a análise não paramétrica de eficiência dos registos verificou-se, que apenas 7,69% das explorações estudadas são eficientes, baixando para os 5,49% quando se retira os Subs/ha atribuídos como forma de rendimento. Na análise de variância observou-se, que não existe qualquer efeito significativo da PL 305 e a Pontuação Final (PF) das explorações na RL das mesmas. Em contrapartida, existe uma forte correlação e um efeito significativo entre a PL305 e a PF (r=0,748, p<0,001) comprovando, que as explorações com as melhores PF são ao mesmo tempo as melhores produtoras de leite. O mesmo se passa na PG305 e na PP305. Na análise de cluster constatou-se, que as explorações mais rentáveis têm um PL305 de 9.188,56 kg, venda de leite (VL) de 5.146,29€, CAlim de 771,65€, Cabeças Normais/ha (CNha) de 3,07e PF de 82,3 pontos. A confirmar estes dados, o modelo criado pela regressão linear múltipla com R2=0,736 estabelece, que de todas as variáveis independentes somente a VL (p<0,001), Calim (p<0,001), Custos com Salários (CSalár, p<0,001), Custos com as Rendas (CRend, p<0,01) e a CNha (p<0,05) são as variáveis com efeito significativo na RL das explorações leiteiras. Assim, os dados revelam que as explorações necessitam de melhorar a qualidade morfológica das vacas leiteiras, de forma a aumentar a PL, proteína e gordura, levando a um aumento da VL, atendendo ao limite máximo dos CAlim e do CNha, de forma a melhorar a eficiência técnica e serem rentáveis sem Subs.ABSTRACT: As we know the dairy farms in Azores are crossing some economical and financial difficulties and with the announced order of milk quotas and complete liberalization of the markets, the farmers in Azores need to be well prepared to face this change in Europe. Because if they don't, they may crash. That is why, it is very important to know the real economical and technical conditions of the farms, as well as the technical efficiency of the farms, and evaluate the effect that the milk production has at 305 days (PL305) and the morphological classification (CM) will have in the net profitability (RL). After that it is important to create a model that can explain the profitability of farms. In order to do that, several things have been made such as: non-parametric analysis of efficiency, analysis of variance, analysis of the cluster, the linear regression of the records of PL305, fat at 305 days (PG305), protein at 305 days (PP305) and the CM of 91 farms that have made their milk recording (CL) and have made their proper accounting in 2010. We found that the farms have earned around 1.002,93€ per hectare, which represented an average profit of 19,80%. However, each farm receives 1.090,06€ per hectare of EU subsidies (Subs/ha), representing 22,43% of the profits and shows a clear dependence on EU subsidies (Subs), because without them, the average profit would be -4.20%. With the end of the milk quotas and the cut in subs for Dairy Products we anticipate an average break in profits around 10.36%.Speaking about the expense, the food costs (CAlim) represent the major percentage of the expense: 25,32%. After the non-parametric analysis of efficiency, we found that only 7,69% of the analyses farms are efficient, decreasing for 5,49%, if we take out the subs/ha. In the analysis of variance we noticed that there isn't any significant effect of the PL305 and the final score (PF) in the RL of the farms. On the other hand, there is a strong relation between the PL 305 and the PF (r=0,748, p<0,001) proving that the farms with the best PF are at the same time the best milk producers. The same happens at PG305 and at PP305. In the cluster analysis we observed that the most profitable farms have a 9.188,56kg of PL305, milk sales (VL) of 5.146,29€, CAlim 771,65€, normal heads /ha (CNha) of 3,07 and PF of 82,3 points. Confirming this facts, the model created by the multiple linear regression with R2=0,736 sets that between all the independent variables only the VL (p<0,001), CAlim (p<0,001), wage costs (CSalár, p<0,001), costs with rents (CRend, p<0,01) and the CNha (p<0,05) are the variables with significant effect in the RL of the farms. Therefore, data shows that the farms need to improve the morphological quality of cows, in order to increase the PL, proteins and fat, taking to an increase of VL, so that they could improve the technical efficiency and be rentable without subs

A mammalianized synthetic nitroreductase gene for high-level expression

Background The nitroreductase/5-(azaridin-1-yl)-2,4-dinitrobenzamide (NTR/CB1954) enzyme/prodrug system is considered as a promising candidate for anti-cancer strategies by gene-directed enzyme prodrug therapy (GDEPT) and has recently entered clinical trials. It requires the genetic modification of tumor cells to express the E. coli enzyme nitroreductase that bioactivates the prodrug CB1954 to a powerful cytotoxin. This metabolite causes apoptotic cell death by DNA interstrand crosslinking. Enhancing the enzymatic NTR activity for CB1954 should improve the therapeutical potential of this enzyme-prodrug combination in cancer gene therapy. Methods We performed de novo synthesis of the bacterial nitroreductase gene adapting codon usage to mammalian preferences. The synthetic gene was investigated for its expression efficacy and ability to sensitize mammalian cells to CB1954 using western blotting analysis and cytotoxicity assays. Results In our study, we detected cytoplasmic protein aggregates by expressing GFP-tagged NTR in COS-7 cells, suggesting an impaired translation by divergent codon usage between prokaryotes and eukaryotes. Therefore, we generated a synthetic variant of the nitroreductase gene, called ntro, adapted for high-level expression in mammalian cells. A total of 144 silent base substitutions were made within the bacterial ntr gene to change its codon usage to mammalian preferences. The codon-optimized ntro either tagged to gfp or c-myc showed higher expression levels in mammalian cell lines. Furthermore, the ntro rendered several cell lines ten times more sensitive to the prodrug CB1954 and also resulted in an improved bystander effect. Conclusion Our results show that codon optimization overcomes expression limitations of the bacterial ntr gene in mammalian cells, thereby improving the NTR/CB1954 system at translational level for cancer gene therapy in humans

Introductory programming: a systematic literature review

As computing becomes a mainstream discipline embedded in the school curriculum and acts as an enabler for an increasing range of academic disciplines in higher education, the literature on introductory programming is growing. Although there have been several reviews that focus on specific aspects of introductory programming, there has been no broad overview of the literature exploring recent trends across the breadth of introductory programming. This paper is the report of an ITiCSE working group that conducted a systematic review in order to gain an overview of the introductory programming literature. Partitioning the literature into papers addressing the student, teaching, the curriculum, and assessment, we explore trends, highlight advances in knowledge over the past 15 years, and indicate possible directions for future research

The association between clinical integration of care and transfer of veterans with acute coronary syndromes from primary care VHA hospitals

BACKGROUND: Few studies report on the effect of organizational factors facilitating transfer between primary and tertiary care hospitals either within an integrated health care system or outside it. In this paper, we report on the relationship between degree of clinical integration of cardiology services and transfer rates of acute coronary syndrome (ACS) patients from primary to tertiary hospitals within and outside the Veterans Health Administration (VHA) system. METHODS: Prospective cohort study. Transfer rates were obtained for all patients with ACS diagnoses admitted to 12 primary VHA hospitals between 1998 and 1999. Binary variables measuring clinical integration were constructed for each primary VHA hospital reflecting: presence of on-site VHA cardiologist; referral coordinator at the associated tertiary VHA hospital; and/or referral coordinator at the primary VHA hospital. We assessed the association between the integration variables and overall transfer from primary to tertiary hospitals, using random effects logistic regression, controlling for clustering at two levels and adjusting for patient characteristics. RESULTS: Three of twelve hospitals had a VHA cardiologist on site, six had a referral coordinator at the tertiary VHA hospital, and four had a referral coordinator at the primary hospital. Presence of a VHA staff cardiologist on site and a referral coordinator at the tertiary VHA hospital decreased the likelihood of any transfer (OR 0.45, 95% CI 0.27–0.77, and 0.46, p = 0.002, CI 0.27–0.78). Conversely, having a referral coordinator at the primary VHA hospital increased the likelihood of transfer (OR 6.28, CI 2.92–13.48). CONCLUSIONS: Elements of clinical integration are associated with transfer, an important process in the care of ACS patients. In promoting optimal patient care, clinical integration factors should be considered in addition to patient characteristics