The factor VII activating protease G511E (Marburg) variant and cardiovascular risk

A previous study had shown a strong relationship between a variant in factor VII activating protease (FSAP G511E) and advanced carotid atheroma. In-vitro, the variant has reduced fibrinolytic but normal pro-coagulant activity, which may constitute a prothrombotic state. The current study has addressed risk for coronary heart disease in a prospective study of cardio vascular disorders (Northwick Park Heart Study II). An interactive effect upon risk was found between the 511E allele and elevated levels of cholesterol and triglyceride. Fibrinogen could substitute for triglyceride levels in this risk-interaction analysis. The findings support the proposal that the FSAP 511E allele exacerbates atherosclerosis or its clinical sequelae

Increased plasma markers of oxidative stress are associated with coronary heart disease in males with diabetes mellitus and with 10-year risk in a prospective sample of males

Background: Increased oxidative stress is associated with coronary heart disease (CHD). We examined the association between plasma markers of oxidative stress and CHD in a cross-sectional sample of patients with diabetes and prospective CHD risk in a sample of men predominantly without diabetes. Methods: Plasma total antioxidant status (TAOS) and the ratio of oxidized LDL (Ox-LDL) to LDL-cholesterol (LDL-C) were determined in a cross-section of 761 Caucasian individuals with diabetes (UDACS study). Plasma TAOS was also determined in 310 baseline samples from a 10-year prospective cohort of 3012 healthy males (NPHSII). Results: Within UDACS, males with CHD had lower mean (SD) plasma TAOS [no CHD, 43.4 (13.2)%; CHD, 40.3 (13.8)%; P = 0.04]. The prevalence of CHD was higher in the lowest compared with the upper quartiles (32.7% vs 19.7%; P = 0.004). We observed a significant association between plasma Ox-LDL:LDL-C and CHD status [no CHD vs CHD, 16.9 (3.1) vs 19.3 (5.0) units/mmol; P = 0.04], with the prevalence of CHD being higher among men in the upper compared with lower quartiles (18.4% vs 35.1%; P = 0.003). No association was observed in females. In NPHSII, TAOS was lower in those who developed CHD [35.1 (8.0)% vs 37.1 (7.9)%; P = 0.04]. The odds ratio for CHD in the lowest compared with the upper quartile was 1.91 (95% confidence interval, 0.99–3.70; P = 0.04). This remained unchanged after adjustment for classic risk factors. Conclusions: A cross-sectional and prospective association exists between baseline plasma measures of oxidative stress and CHD risk. The association with prospective CHD risk remained after adjustment for "traditional" risk factors, implying an independent role for oxidative stress in CHD risk

Pruning and prioritising: a case study of a pragmatic method for managing a rapid systematic review with limited resources

Full systematic reviews are time and resource heavy. We describe a method successfully used to produce a rapid review of yoga for health and wellbeing, with limited resources, using mapping methods. Inclusion and exclusion criteria were developed a priori and refined post hoc, with the review team blind to the study results to minimise the introduction of bias. This method allowed the review to be tailored to make use of the best available evidence and the health topics of most relevance to the commissioners, and to enable the evidence base to be disseminated to practitioners in a timely fashion

Clyde tributaries : report of urban stream sediment and surface water geochemistry for Glasgow

This report presents the results of an urban drainage geochemical survey carried out jointly by the British Geological Survey (BGS) and Glasgow City Council (GCC) during June 2003. 118 stream sediment and 122 surface water samples were collected at a sample density of 1 per 1 km2 from all tributaries draining into the River Clyde within the GCC administrative area. The study was carried out as part of the BGS systematic Geochemical Surveys of Urban Environments (GSUE) programme. Stream sediment and surface water samples underwent analysis for approximately 46 chemical elements including contaminants such as As, Al, Cd, Cu, Cr, Ni, Pb, Se, V and Zn according to standard GSUE procedures. In addition, parameters such as ammonium, asbestos and Hg as well as organic contaminants such as total petroleum hydrocarbons (TPH), polycyclic aromatic hydrocarbons (PAH), poly-chlorinated biphenyls (PCB) and organo-tin compounds were assessed. The aim of the project was to provide an overview of urban drainage geochemistry in Glasgow to link to an on-going sister project, which is investigating the geochemistry of the Clyde estuary. This report presents the initial findings of the Clyde tributaries survey but it is envisaged that the data will be interpreted in more detail as part of a wider Clyde basin study once the Clyde estuary survey is completed

The ACTN3 Gene and Differences between Playing Positions in Bone Mineral Content, Fat Mass and Lean Tissue Mass in the Arms, Legs and Trunk Of Rugby Union Football Players

Aim: The function of the present study was to identify differences between individual playing positions in bone mineral content, fat mass, and lean tissue mass, in the arms, trunk and legs of young adult Rugby Union football players who carried the ACTN3 gene. Subjects and methods: A cross-sectional case control study was carried out using a candidate gene approach (n=55). Individuals belonged to a homogeneous group of players relative to age, gender, ability, and ethnicity. Players were allocated to their preferred playing position. These were the front row (n=14), second and back rows (n=16), scrum and outside-half (n=11), and centres, wings and fullbacks (n=14). A 5 ml sample of saliva was obtained from each player and specimens stored at 4oC until buccal cell DNA extraction was carried out. Height was measured to the nearest 0.1 cm and body mass to the closest 0.1 kg. Dual-energy X-ray absorptiometry was measured using a Hologic QDR Discovery fan beam model. Statistical analyses were undertaken using ANOVA, ANCOVA and MANOVA. Results: The study sample comprised 22% RR, 60% RX, and 18% XX genotypes of the ACTN3 gene respectively. Players in the second and back rows were significantly taller than other positions. Body mass differences, were significantly greater in forwards than backs. There were non-significant differences between positions in adjusted bone mineral content or adjusted lean tissue mass. Adjusted fat mass reflected differences between left and right arms, but not left and right legs. Conclusion: At a developmental level of performance, an understanding and practical application of the structural, physiological and body composition characteristics of individual players, will facilitate personal and team accomplishment, efficiency of training and conditioning, and nurture the potential of young adult players

Human perception in segmentation of sketches

In this paper, we study the segmentation of sketched engineering drawings into a set of straight and curved segments. Our immediate objective is to produce a benchmarking method for segmentation algorithms. The criterion is to minimise the differences between what the algorithm detects and what human beings perceive. We have created a set of sketched drawings and have asked people to segment them. By analysis of the produced segmentations, we have obtained the number and locations of the segmentation points which people perceive. Evidence collected during our experiments supports useful hypotheses, for example that not all kinds of segmentation points are equally difficult to perceive. The resulting methodology can be repeated with other drawings to obtain a set of sketches and segmentation data which could be used as a benchmark for segmentation algorithms, to evaluate their capability to emulate human perception of sketches

A review of the tractive performance of wheeled tractors and soil management in lowland intensive rice production.

This paper reviews the cultivation practices and tractive performance using wheeled tractors, and how these interact with soil management, in lowland intensive rice production. The paper explores the issues of long term sustainable soil use, the energy inputs required, environmental impact and changes in approach to agronomy and links these to the tractor operations carried out as part of rice production. The paddy soil environment demonstrates very significant changes in soil properties with depth, in particular soil density, penetrometer resistance, soil structure and pore interconnectivity, water content and movement, and soil biology. This is related to the management of the soil hard pan in relation to machinery operations and machinery use. One of the issues appears to be that the hard pan can be deeper than required with consequently unnecessarily high energy inputs. The tractive performance of wheeled tractors on different surface conditions is considered with respect to tractive efficiency and maintenance of a soil hard pan that has the required characteristics for sustainable production. Alternatives to conventional tyres, cage wheels and tracks, are considered. The cultivation operations are evaluated in relation to soil management, crop requirements and energy use. Variation in hard pan characteristics may be disadvantageous and provides opportunities for precision operations

Magnetic resonance for assessment of axillary lymph node status in early breast cancer: A systematic review and meta-analysis

Introduction Current methods of identifying axillary node metastases in breast cancer patients are highly accurate, but are associated with several adverse events. This review evaluates the diagnostic accuracy of magnetic resonance imaging (MRI) techniques for identification of axillary metastases in early stage newly diagnosed breast cancer patients. Methods Comprehensive searches were conducted in April 2009. Study quality was assessed. Sensitivity and specificity were meta-analysed using a bivariate random effects approach, utilising pathological diagnosis via node biopsy as the comparative gold standard. Results Based on the highest sensitivity and specificity reported in each of the nine studies evaluating MRI (n = 307 patients), mean sensitivity was 90% (95% CI: 78–96%; range 65–100%) and mean specificity 90% (95% CI: 75–96%; range 54–100%). Across five studies evaluating ultrasmall super-paramagnetic iron oxide (USPIO)-enhanced MRI (n = 93), mean sensitivity was 98% (95% CI: 61–100%) and mean specificity 96% (95% CI: 72–100%). Across three studies of gadolinium-enhanced MRI (n = 187), mean sensitivity was 88% (95% CI: 78–94%) and mean specificity 73% (95% CI: 63–81%). In the single study of in-vivo proton MR spectroscopy (n = 27), sensitivity was 65% (95% CI: 38–86%) and specificity 100% (95% CI: 69–100%). Conclusions USPIO-enhanced MRI showed a trend towards higher sensitivity and specificity and may make a useful addition to the current diagnostic pathway. Additional larger studies with standardised methods and standardised criteria for classifying a node as positive are needed. Current estimates of sensitivity and specificity do not support replacement of SLNB with any current MRI technology in this patient group

Implementing evidence-based recommended practices for the management of patients with mild traumatic brain injuries in Australian emergency care departments: study protocol for a cluster randomised controlled trial

Background: Mild head injuries commonly present to emergency departments. The challenges facing clinicians in emergency departments include identifying which patients have traumatic brain injury, and which patients can safely be sent home. Traumatic brain injuries may exist with subtle symptoms or signs, but can still lead to adverse outcomes. Despite the existence of several high quality clinical practice guidelines, internationally and in Australia, research shows inconsistent implementation of these recommendations. The aim of this trial is to test the effectiveness of a targeted, theory- and evidence-informed implementation intervention to increase the uptake of three key clinical recommendations regarding the emergency department management of adult patients (18 years of age or older) who present following mild head injuries (concussion), compared with passive dissemination of these recommendations. The primary objective is to establish whether the intervention is effective in increasing the percentage of patients for which appropriate post-traumatic amnesia screening is performed. Methods/design: The design of this study is a cluster randomised trial. We aim to include 34 Australian 24-hour emergency departments, which will be randomised to an intervention or control group. Control group departments will receive a copy of the most recent Australian evidence-based clinical practice guideline on the acute management of patients with mild head injuries. The intervention group will receive an implementation intervention based on an analysis of influencing factors, which include local stakeholder meetings, identification of nursing and medical opinion leaders in each site, a train-the-trainer day and standardised education and interactive workshops delivered by the opinion leaders during a 3 month period of time. Clinical practice outcomes will be collected retrospectively from medical records by independent chart auditors over the 2 month period following intervention delivery (patient level outcomes). In consenting hospitals, eligible patients will be recruited for a follow-up telephone interview conducted by trained researchers. A cost-effectiveness analysis and process evaluation using mixed-methods will be conducted. Sample size calculations are based on including 30 patients on average per department. Outcome assessors will be blinded to group allocation