Pedometers to enhance physical activity in COPD: a randomised controlled trial

Physical inactivity is a cardinal feature of chronic obstructive pulmonary disease (COPD), and is associated with increased morbidity and mortality. Pedometers, which have been used in healthy populations, might also increase physical activity in patients with COPD. COPD patients taking part in a 3-month individualised programme to promote an increase in their daily physical activity were randomised to either a standard programme of physical activity encouragement alone, or a pedometer-based programme. Assessments were performed by investigators blinded to treatment allocation. Change in average 1-week daily step count, 6-min walking distance (6MWD), modified Medical Research Council scale, St George’s respiratory questionnaire (SGRQ) and COPD assessment test (CAT) were compared between groups. 102 patients were recruited, of whom 97 completed the programme (pedometer group: n=50; control group: n=47); 60.8% were male with a mean±sd age of 68.7±8.5 years, and forced expiratory volume in 1 s (FEV1) 66.1±19.4% and FEV1/forced vital capacity 55.2±9.5%. Both groups had comparable characteristics at baseline. The pedometer group had significantly greater improvements in: physical activity 3080±3254 steps·day−1 versus 138.3±1950 steps·day−1 (p<0.001); SGRQ −8.8±12.2 versus −3.8±10.9 (p=0.01); CAT score −3.5±5.5 versus −0.6±6.6 (p=0.001); and 6MWD 12.4±34.6 versus −0.7±24.4 m (p=0.02) than patients receiving activity encouragement only. A simple physical activity enhancement programme using pedometers can effectively improve physical activity level and quality of life in COPD patients

Costs and consequences of chronic pain due to musculoskeletal disorders from a health system perspective in Chile

Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain. Background: Chronic pain is a prevalent and distressing condition caused by an unceasing pain lasting more than 3 months or a pain that persists beyond the normal healing time. There is evidence of inadequate management partly explained by the unawareness regarding the magnitude of the problem. Objectives: To estimate the annual expected costs and consequences of chronic pain caused by musculoskeletal diseases from the health system perspective in Chile. Methods: A Markov cohort model was built to represent chronic pain and estimate expected costs and consequences over 1-year time horizon. Transition probabilities were obtained through expert elicitation. Consequences examined were: years lost to disability (YLD), depression, anxiety, and productivity losses. Direct health care costs were estimated using local sources. Probabilistic sensitivity analysis was performed to characterize second-order uncertainty. Results: The annual expected cost due to musculoskeletal chronic pain was estimated in USD $1387.2 million, equivalent to 0.417$94 million (Bayesian credibility interval 95% $49.1-$156.26). Productivity losses were also important cost, although early retirement and presenteeism were not measured. Chronic pain causes 137,037 YLDs. Conclusion: Chronic pain is not only an important cause of disability but also responsible for high social and financial burden in Chile. Public health programs focused on managing chronic pain may decrease burden of disease and possibly reduce costs.

Evolution of the solar irradiance during the Holocene

Aims. We present a physically consistent reconstruction of the total solar irradiance for the Holocene. Methods. We extend the SATIRE models to estimate the evolution of the total (and partly spectral) solar irradiance over the Holocene. The basic assumption is that the variations of the solar irradiance are due to the evolution of the dark and bright magnetic features on the solar surface. The evolution of the decadally averaged magnetic flux is computed from decadal values of cosmogenic isotope concentrations recorded in natural archives employing a series of physics-based models connecting the processes from the modulation of the cosmic ray flux in the heliosphere to their record in natural archives. We then compute the total solar irradiance (TSI) as a linear combination of the jth and jth + 1 decadal values of the open magnetic flux. Results. Reconstructions of the TSI over the Holocene, each valid for a di_erent paleomagnetic time series, are presented. Our analysis suggests that major sources of uncertainty in the TSI in this model are the heritage of the uncertainty of the TSI since 1610 reconstructed from sunspot data and the uncertainty of the evolution of the Earth's magnetic dipole moment. The analysis of the distribution functions of the reconstructed irradiance for the last 3000 years indicates that the estimates based on the virtual axial dipole moment are significantly lower at earlier times than the reconstructions based on the virtual dipole moment. Conclusions. We present the first physics-based reconstruction of the total solar irradiance over the Holocene, which will be of interest for studies of climate change over the last 11500 years. The reconstruction indicates that the decadally averaged total solar irradiance ranges over approximately 1.5 W/m2 from grand maxima to grand minima

Solar energetic electron events measured by MESSENGER and Solar Orbiter. Peak intensity and energy spectrum radial dependences: statistical analysis

Context/Aims: We present a list of 61 solar energetic electron (SEE) events measured by the MESSENGER mission and the radial dependences of the electron peak intensity and the peak-intensity energy spectrum. The analysis comprises the period from 2010 to 2015, when MESSENGER heliocentric distance varied between 0.31 and 0.47 au. We also show the radial dependencies for a shorter list of 12 SEE events measured in February and March 2022 by spacecraft near 1 au and by Solar Orbiter around its first close perihelion at 0.32 au. Results: Due to the elevated background intensity level of the particle instrument on board MESSENGER, the SEE events measured by this mission are necessarily large and intense; most of them accompanied by a CME-driven shock, being widespread in heliolongitude, and displaying relativistic ($\sim$1 MeV) electron intensity enhancements. The two main conclusions derived from the analysis of the large SEE events measured by MESSENGER, which are generally supported by Solar Orbiter's data results, are: (1) There is a wide variability in the radial dependence of the electron peak intensity between $\sim$0.3 au and $\sim$1 au, but the peak intensities of the energetic electrons decrease with radial distance from the Sun in 27 out of 28 events. On average and within the uncertainties, we find a radial dependence consistent with $R^{-3}$. (2) The electron spectral index found in the energy range around 200 keV ($\delta$200) of the backward-scattered population near 0.3 au measured by MESSENGER is harder in 19 out of 20 (15 out of 18) events by a median factor of $\sim$20% ($\sim$10%) when comparing to the anti-sunward propagating beam (backward-scattered population) near 1 au.Comment: 20 pages, 13 figure

Armenia and Belarus: caught between the EU's and Russia's conditionalities?

This article looks into Armenia's and Belarus’ engagement with the European Union's (EU) and Russia's conditionalities, the two EU Eastern Partnership (EaP) countries that are also members of the Russia-led Eurasian Economic Union (EAEU). While paying attention to political, economic (including energy and technical) as well as security dimensions of the EU's and Russia's approaches, as proposed in the present special section, the article demonstrates that the conditionalities extended by the EU and Russia to the two countries in question have differed. In their turn, Armenia and Belarus have reacted differently to Russia's and the EU's conditionalities. Against the backdrop of the changing significance ascribed to both the EU's and Russia's policies towards their common neighbourhood since the 1990s, the present contribution identifies and analyses factors that account for the diverging positions of Armenia and Belarus, including the type of regime, the geopolitical considerations, the stakes in the economic and energy spheres and the predisposition to integration. The article shows that in the resulting complex context, Armenia and Belarus have been able to influence the shape and content of the EU's and Russia's conditionalities, although in a different way and to a different extent.Ministry of Education and Science (UID/CPO/ 00758/2013

First near-relativistic solar electron events observed by EPD onboard Solar Orbiter

Context. Solar Orbiter, launched in February 2020, started its cruise phase in June 2020, in coincidence with its first perihelion at 0.51 au from the Sun. The in situ instruments onboard, including the Energetic Particle Detector (EPD), operate continuously during the cruise phase enabling the observation of solar energetic particles. Aims. In situ measurements of the first near-relativistic solar electron events observed in July 2020 by EPD are analyzed and the solar origins and the conditions for the interplanetary transport of these particles investigated. Methods. Electron observations from keV energies to the near-relativistic range were combined with the detection of type III radio bursts and extreme ultraviolet (EUV) observations from multiple spacecraft in order to identify the solar origin of the electron events. Electron anisotropies and timing as well as the plasma and magnetic field environment were evaluated to characterize the interplanetary transport conditions. Results. All electron events were clearly associated with type III radio bursts. EUV jets were also found in association with all of them except one. A diversity of time profiles and pitch-angle distributions was observed. Different source locations and different magnetic connectivity and transport conditions were likely involved. The July 11 event was also detected by Wind, separated 107 degrees in longitude from Solar Orbiter. For the July 22 event, the Suprathermal Electron and Proton (STEP) sensor of EPD allowed for us to not only resolve multiple electron injections at low energies, but it also provided an exceptionally high pitch-angle resolution of a very anisotropic beam. This, together with radio observations of local Langmuir waves suggest a very good magnetic connection during the July 22 event. This scenario is challenged by a high-frequency occultation of the type III radio burst and a nominally non-direct connection to the source; therefore, magnetic connectivity requires further investigation

A homogeneous database of sunspot areas covering more than 130 years

The historical record of sunspot areas is a valuable and widely used proxy of solar activity and variability. The Royal Greenwich Observatory (RGO) regularly measured this and other parameters between 1874 and 1976. After that time records from a number of different observatories are available. These, however, show systematic differences and often have significants gaps. Our goal is to obtain a uniform and complete sunspot area time series by combining different data sets. A homogeneus composite of sunspot areas is essential for different applications in solar physics, among others for irradiance reconstructions. Data recorded simultaneously at different observatories are statistically compared in order to determine the intercalibration factors. Using these data we compile a complete and cross-calibrated time series. The Greenwich data set is used as a basis until 1976, the Russian data (a compilation of observations made at stations in the former USSR) between 1977 and 1985 and data compiled by the USAF network since 1986. Other data sets (Rome, Yunnan, Catania) are used to fill up the remaining gaps. Using the final sunspot areas record the Photometric Sunspot Index is calculated. We also show that the use of uncalibrated sunspot areas data sets can seriously affect the estimate of irradiance variations. Our analysis implies that there is no basis for the claim that UV irradiance variations have a much smaller influence on climate than total solar irradiance variations.Comment: 40 pages, 8 figures; JGR - Space Physics, publishe

The unusual widespread solar energetic particle event on 2013 August 19 Solar origin and particle longitudinal distribution

Context: Late on 2013 August 19, STEREO-A, STEREO-B, MESSENGER, Mars Odyssey, and the L1 spacecraft, spanning a longitudinal range of 222 degrees in the ecliptic plane, observed an energetic particle flux increase. The widespread solar energetic particle (SEP) event was associated with a coronal mass ejection (CME) that came from a region located near the far-side central meridian from Earth's perspective. The CME erupted in two stages, and was accompanied by a late M-class flare observed as a post-eruptive arcade, persisting low-frequency (interplanetary) type II and groups of shock-accelerated type III radio bursts, all of them making this SEP event unusual.Aims: There are two main objectives of this study, disentangling the reasons for the different intensity-time profiles observed by the spacecraft, especially at MESSENGER and STEREO-A locations, longitudinally separated by only 15 degrees, and unravelling the single solar source related with the widespread SEP event.Methods: The analysis of in situ data, such as particle fluxes, anisotropies and timing, and plasma and magnetic field data, is compared with the remote-sensing observations. A spheroid model is applied for the CME-driven shock reconstruction and the ENLIL model is used to characterize the heliospheric conditions, including the evolution of the magnetic connectivity to the shock.Results: The solar source associated with the widespread SEP event is the shock driven by the CME, as the flare observed as a post-eruptive arcade is too late to explain the estimated particle onset. The different intensity-time profiles observed by STEREO-A, located at 0.97 au, and MESSENGER, at 0.33 au, can be interpreted as enhanced particle scattering beyond Mercury's orbit. The longitudinal extent of the shock does not explain by itself the wide spread of particles in the heliosphere. The particle increase observed at L1 may be attributed to cross-field diffusion transport, and this is also the case for STEREO-B, at least until the spacecraft is eventually magnetically connected to the shock when it reaches similar to 0.6 au.</p

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London