Physical activity levels of adolescents with congenital heart disease

Regular physical activity prevents chronic disease and moderate to vigorous participation provides additional health benefits. Therefore, adolescents with congenital heart disease risk developing latent diseases due to real or perceived physical activity restrictions. Habitual physical activity levels, psychological determinants and advice received were examined by postal survey of 434 West Australian adolescents aged 12–18 years with congenital heart disease. Survey results (n = 153) were compared with published normative adolescent data. Total activity was classified as vigorous, adequate or inadequate according to metabolic equivalents, reported frequency and duration. Comparable numbers of respondents and healthy peers were active (winter 62% vs 74%; and summer 73% vs 82% respectively, p = 0.27). However, significantly fewer male respondents were classified as vigorously active compared with healthy peers, in both winter (48% vs 67%, p < 0.02), and summer (48% vs 69%, p = 0.04). Similar, but non-significant, trends were found when comparing female respondents with healthy peers and for mild versus severe disease groups. Self-efficacy ratings did not explain differences in physical activity intensity. Congenital heart disease may impact on the intensity of physical activity undertaken by affected adolescents thus denying additional health benefits. Physiotherapists could facilitate these adolescents to achieve more moderate to vigorous physical activity, to offset adult sedentary behaviour

Bulk superconducting nano-composites with high critical currents

Flux pinning sites are most effective if their size is comparable to the superconducting coherence length, which is on the nano-meter scale for RE-Ba-Cu-O superconductors [RE = rare earth element]. Introducing nano-phase inclusions directly into the bulk superconducting material has only been partially successful to date, however, due primarily to the absence of chemically stable phases that can co-exist with RE-Ba-Cu-O without suppressing its key superconducting properties. We have identified novel isostructural phases based on (RE)2Ba4CuMOy (where M = W, Zr, Nb, Ag and Bi) and have fabricated successfully superconducting bulk nano-composites with a high current carrying capability. The average size of the nano-inclusions is observed to vary from 20 nm to 300 nm depending on element M. An observed improvement in Jc under low and high external magnetic fields at 77 K correlates directly with an increased density of nano-inclusions in the superconducting matrix

Responses to threat in a freshwater invader: Longitudinal data reveal personality, habituation and robustness to changing water temperatures in the ‘killer shrimp’ Dikerogammarus villosus (Crustacea: Amphipoda).

Freshwater biodiversity and ecosystem integrity are under threat from biological invasions. The ‘killer shrimp’ Dikerogammarus villosus is a highly predatory amphipod which has spread readily across Central Europe and recently the U.K. and its arrival has been associated with the significant loss of resident species. Despite this, studies of its behavioural ecology are sparse, even though its behaviour may contribute to its invasion success. For the first time we investigated anti-predator ‘fleeing’ behaviour in D. villosus and how this changed with water temperature. Three key patterns emerged from our analysis. First, within a particular temperature condition there are moderate but consistent among-individual differences in behaviour. These are driven by a combination of mean level among-individual differences and within-individual relative consistency in behaviour, and provide the key marker for animal personalities. Second, the fleeing responses were not influenced by temperature and thirdly, regardless of temperature, all individuals appeared to habituate to a repeated non-dangerous stimulus, indicating a capacity for individual-learning. We suggest that the anti-predator behaviour of D. villosus contributes to its rapid spread and that consistent among-individual differences in behaviour may promote biological invasions across heterogeneous conditions. Robustness to changing water temperatures may also be potentially advantageous, particularly in an era of global climate change, where average temperatures could be elevated and less predictabl

The employment of Patient-Reported Outcome Measures to communicate the likely benefits of surgery

Decision aids as part of shared care are underutilized in surgery. Patient-Reported Outcome Measures (PROMS) are rapidly gaining interest as useful tools for various purposes in all fields of surgery. In this article, the author describes how PROMS can be used as decision aids in shared care between patients and health care workers, including surgeons

Upper back pain in postmenopausal women and associated physical characteristics

The physical characteristics of postmenopausal women that are associated with upper back pain are not well-understood. The aim of this cross-sectional study was to identify the physical characteristics associated with presence and severity of upper back pain in healthy postmenopausal women. Self-reported upper back pain presence (within the previous month) and severity (numerical rating scale) were examined against the physical characteristics: height; weight; body mass index; breast size; breast ptosis; upper back extensor muscle endurance (isometric chest raise test); head, shoulder and upper back posture (photogrammetry); thoracic extension mobility (photogrammetry); bone mineral density (dual-energy x-ray absorptiometry (DXA)); body composition (DXA); and thoracic kyphosis, thoracic osteoarthritis and thoracic vertebral fracture (all radiography). A multivariable logistic regression model, adjusted for age, was built using physical characteristics with a significant univariate association with upper back pain. Censored Tobit regression, adjusted for age, was used to examine each physical characteristic against upper back pain severity. Postmenopausal women (n = 119) with a mean (SD) age of 61.4 (7.0) years participated in the study. After adjusting for age, the physical characteristics independently associated with upper back pain were: height (OR: 0.50, 95% CI: 0.31–0.79); and upper back extensor muscle endurance (OR: 0.46, 95%CI: 0.28–0.75). This model explained 31% of the variance in upper back pain (p<0.001). After adjusting for age, being taller and having better upper back extensor muscle endurance were associated with lower odds for upper back pain. After adjusting for age, differences in upper back pain severity were explained by upper back extensor muscle endurance (p = <0.001) and lean mass (p = 0.01). Conclusion: As a modifiable physical characteristic of postmenopausal women with upper back pain, upper back extensor muscle endurance is worth considering clinically

Portable ultrasound assessment of jugular venous pressure is an accurate method for estimating volaemic status in patients with cardiac disease

Purpose The objective of this study was to determine whether ultrasound-measured jugular venous pressure (U-JVP) could accurately estimate central venous pressure (CVP). Methods This prospective, diagnostic, single-centre study was performed at the Cardiac Intensive Care Unit of the Northern General Hospital, Sheffield, UK. Post-cardiac surgery patients were recruited from January to May 2019. The investigators were blinded to the central venous pressure when measuring the jugular venous pressure. U-JVP and direct CVP were measured simultaneously. Measurements were taken whilst the patient was ventilated and then repeated when the patient was extubated, providing non-ventilated readings. Results One-hundred and fourteen consecutive participants with a male predominance of 71% and mean age of 65 ± 12 years were included in the analysis. Bland–Altman plots revealed that U-JVP marginally overestimated CVP by 0.91 mmHg (95% limits of agreement were −2.936 to 4.754) in ventilated patients and by 0.11 mmHg (95% limits of agreement between −2.481 and 2.695) in non-ventilated patients. Reasonable sensitivity and specificity of ultrasound-measured jugular venous pressure was achieved for low and high central venous pressure in both ventilated and non-ventilated patients. Conclusion U-JVP accurately estimates cardiac filling pressure and fluid status in patients after cardiac surgery, irrespective of their ventilatory status. Jugular venous pressure measurement by insonation is a reliable technique that can be taught to medical students and other health professionals to non-invasively estimate central venous pressure and may be useful for assessment of volaemic status in patients with heart failure. Trial registration ClinicalTrials.gov public (identifier NCT03815188)

The nature of the charge density waves in under-doped YBa2_2Cu3_3O6.54_{6.54} revealed by X-ray measurements of the ionic displacements

All underdoped high-temperature cuprate superconductors appear to exhibit charge density wave (CDW) order, but both the underlying symmetry breaking and the origin of the CDW remain unclear. We use X-ray diffraction to determine the microscopic structure of the CDW in an archetypical cuprate YBa$_2$Cu$_3$O$_{6.54}$ at its superconducting transition temperature Tc ~ 60 K. We find that the CDWs present in this material break the mirror symmetry of the CuO2 bilayers. The ionic displacements in a CDW have two components: one perpendicular to the CuO$_2$ planes, and another parallel to these planes, which is out of phase with the first. The largest displacements are those of the planar oxygen atoms and are perpendicular to the CuO$_2$ planes. Our results allow many electronic properties of the underdoped cuprates to be understood. For instance, the CDW will lead to local variations in the doping (or electronic structure) giving an explicit explanation of the appearance of density-wave states with broken symmetry in scanning tunnelling microscopy (STM) and soft X-ray measurements

Borehole climate reconstructions: Spatial structure and hemispheric averages

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95092/1/jgrd11014.pd

Preliminary development and validation of a new endof-life patient-reported outcome measure assessing the ability of patients to finalise their affairs at the end of life

Introduction:The ability of patients to finalise their affairs at the end of life is an often neglected aspect of quality of life (QOL) measurement in palliative care effectiveness research despite compelling evidence of the high value patients place on this domain. Objective: This paper describes the preliminary development and evaluation of a new, single-item, end-of-life patientreported outcome measure (EOLPRO) designed to capture changes in the ability of patients to finalise their affairs at the end of life. Methods: Cognitive interviews with purposively sampled Australian palliative care patients (N = 9) were analysed thematically to explore content validity. Simultaneously, secondary analysis of data from a randomised controlled trial comparing ketamine and placebo for the management of cancer pain (N = 185) evaluated: construct validity; test-retest reliability; and responsiveness. Results:Preliminary findings suggest patients interpret the new measure consistently. The EOLPRO captures the ability to complete physical tasks and finalise practical matters although it is unclear whether emotional tasks or resolution of relationship issues are considered. Personal and financial affairs should be separated to allow for differences in ability for these two types of affairs. The significant correlation between performance status and EOLPRO scores (r = 0.41, p,<.01, n = 137) and expected relationships between EOLPRO and proximity to death and constipation demonstrated construct validity. Pre-and post-treatment EOLPRO scores moderately agreed (n = 14, k = 0.52 [95% CI 0.19, 0.84]) supporting reliability. The measure's apparent lack of sensitivity to discriminate between treatment responders and non-responders may be confounded. Conclusion:Based on the preliminary findings, the EOLPRO should be separated into 'personal' and 'financial' affairs with further testing suggested, particularly to verify coverage and responsiveness. Initial evaluation suggests that the single-item EOLPRO is a useful addition to QOL outcome measurement in palliative care effectiveness research because common palliative care specific QOL questionnaires do not include or explicitly capture this domain. © 2014 McCaffrey et al