The effect of exercise referral schemes upon health and wellbeing: Initial observational insights using individual patient data meta-analysis from The National Referral Database

Objectives: To examine if exercise referral schemes (ERS)s are associated with meaningful changes in health and wellbeing in a large cohort of individuals throughout England, Scotland, and Wales from The National Referral Database. Methods: Data were obtained from 23,731 participants from 13 different ERSs lasting 6 weeks to 3 months. Changes from pre- to post-ERS in health and wellbeing outcomes were examined including body mass index (BMI), blood pressure (SBP & DBP), resting heart rate (RHR), short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS), World Health Organization Well-Being Index (WHO-5), Exercise Related Quality of Life scale (ERQoL), and Exercise Self-Efficacy Scale (ESES). Two-stage individual patient data meta-analysis was used to generate effect estimates. Results: Estimates [95%CIs] revealed statistically significant changes occurred compared to point nulls for BMI (-0.55 kg.m2 [-0.69 to -0.41]), SBP (-2.95 mmHg [-3.97 to -1.92]), SWEMWBS (2.99 pts [1.61 to 4.36]), WHO-5 (8.78 pts [6.84 to 10.63]), ERQoL (15.26 pts [4.71 to 25.82]), ESES (2.58 pts [1.76 to 3.40]), but not RHR (0.22 fc [-1.57 to 1.12]), DBP (-0.93 mmHg [-1.51 to -0.35]). However, comparisons of estimates [95%CIs] against null intervals suggested the majority of outcomes may not improve meaningfully. Conclusions: We considered whether meaningful health and wellbeing changes occur in people who are undergoing ERSs? Regarding this broad question, these results demonstrate that, although many health and wellbeing outcomes improved, the changes be not achieve meaningful levels. This suggests the need to consider the implementation of ERSs more critically to discern how to maximize their effectiveness

Advanced CO2 Removal and Reduction System

An advanced system for removing CO2 and H2O from cabin air, reducing the CO2, and returning the resulting O2 to the air is less massive than is a prior system that includes two assemblies . one for removal and one for reduction. Also, in this system, unlike in the prior system, there is no need to compress and temporarily store CO2. In this present system, removal and reduction take place within a single assembly, wherein removal is effected by use of an alkali sorbent and reduction is effected using a supply of H2 and Ru catalyst, by means of the Sabatier reaction, which is CO2 + 4H2 CH4 + O2. The assembly contains two fixed-bed reactors operating in alternation: At first, air is blown through the first bed, which absorbs CO2 and H2O. Once the first bed is saturated with CO2 and H2O, the flow of air is diverted through the second bed and the first bed is regenerated by supplying it with H2 for the Sabatier reaction. Initially, the H2 is heated to provide heat for the regeneration reaction, which is endothermic. In the later stages of regeneration, the Sabatier reaction, which is exothermic, supplies the heat for regeneration

Lightweight Radiator System for a Spacecraft

Three documents describe various aspects of a proposed lightweight, deployable radiator system for dissipating excess heat from the life-support system of a habitable spacecraft. The first document focuses on a radiator tube that would include a thin metal liner surrounded and supported by a thicker carbon-fiber-reinforced composite tubular structure that, in turn, would be formed as part of a unitary composite radiator-fin structure consisting mostly of a sheet of reticulated vitreous carbon laminated between carbon-fiber-reinforced face sheets. The thermal and mechanical properties, including the anisotropies, of the component materials are taken into account in the design. The second document describes thermo-structural bumpers, in the form of exterior multiple-ply carbon-fiber sheets enclosing hollows on opposite sides of a radiator fin, which would protect the radiator tube against impinging micrometeors and orbital debris. The third document describes a radiator system that would include multiple panels containing the aforementioned components, among others. The system would also include mechanisms for deploying the panels from compact stowage. Deployment would not involve breaking and remaking of fluid connections to the radiator panels

Searching for Signatures of Cosmic Superstrings in the CMB

Because cosmic superstrings generically form junctions and gauge theoretic strings typically do not, junctions may provide a signature to distinguish between cosmic superstrings and gauge theoretic cosmic strings. In cosmic microwave background anisotropy maps, cosmic strings lead to distinctive line discontinuities. String junctions lead to junctions in these line discontinuities. In turn, edge detection algorithms such as the Canny algorithm can be used to search for signatures of strings in anisotropy maps. We apply the Canny algorithm to simulated maps which contain the effects of cosmic strings with and without string junctions. The Canny algorithm produces edge maps. To distinguish between edge maps from string simulations with and without junctions, we examine the density distribution of edges and pixels crossed by edges. We find that in string simulations without Gaussian noise (such as produced by the dominant inflationary fluctuations) our analysis of the output data from the Canny algorithm can clearly distinguish between simulations with and without string junctions. In the presence of Gaussian noise at the level expected from the current bounds on the contribution of cosmic strings to the total power spectrum of density fluctuations, the distinction between models with and without junctions is more difficult. However, by carefully analyzing the data the models can still be differentiated.Comment: 15 page

Intragastric balloon as an adjunct to lifestyle programme in severely obese adolescents: Impact on biomedical outcomes, and skeletal health"

Intragastric Balloons are a temporary, reversible, and safer option compared to bariatric surgery to promote significant weight loss leading to improved metabolic outcomes. However due to subsequent weight regain, alternative procedures are now preferred in adults. In adolescents, more amenable to lifestyle change, balloons may be an alternative to less reversible procedures. Our aim was to assess the tolerability and efficacy of the intragastric balloon in severely obese adolescents and the impact of associated weight loss on biomedical outcomes (glucose metabolism, blood pressure, lipid profiles) and bone density. A 2-year cohort study of 12 adolescents (BMI >3.5 s.d., Tanner stage >4) following 6 months intragastric balloon placement was carried out. Subjects underwent anthropometry, oral glucose tolerance test, and DEXA scans at 0, 6 and 24 months. Results showed clinically relevant improvements in blood pressure, insulin: glucose metabolism, liver function and sleep apnoea at 6 months. Changes were not sustained at 2 years though some parameters (Diastolic BP, HBA1c, insulin AUC) demonstrated longer-term improvement despite weight regain. Despite weight loss, bone mass accrual showed age appropriate increases. In conclusion, the intra-gastric balloon was safe, well tolerated and effective in supporting short-term weight loss and clinically relevant improvement in obesity related complications, which resolved in some individuals. Benefits were not sustained in the majority at 2 years.International Journal of Obesity accepted article preview online, 05 September 2017. doi:10.1038/ijo.2017.215

Induction heating coupler and annealer

An induction heating device includes a handle having a hollow interior and two opposite ends, a wrist connected to one end of the handle, a U-shaped pole piece having- two spaced apart ends, a tank circuit including an induction coil wrapped around the pole piece and a capacitor connected to the induction coil, a head connected to the wrist and including a housing for receiving the U-shaped pole piece, the two spaced apart ends of the pole piece extending outwardly beyond the housing, and a power source connected to the tank circuit. When the tank circuit is energized and a susceptor is placed in juxtaposition to the ends of the U-shaped pole piece, the susceptor is heated by induction heating due to a magnetic flux passing between the two ends of the pole piece

Perfluorooctanoic Acid–Induced Immunomodulation in Adult C57BL/6J or C57BL/6N Female Mice

BackgroundPerfluorooctanoic acid (PFOA), an environmentally persistent compound of regulatory concern, has been reported to reduce antibody responses in mice at a single dose.ObjectiveThe aim of this study was to evaluate PFOA effects on humoral and cellular immunity using standard assays for assessing immune function, and to derive dose–response data.MethodsC57BL/6J mice received 0 or 30 mg PFOA/kg/day for 10 days; half of the exposed groups were switched to vehicle and half continued on PFOA for five days. C57BL/6N mice received 0–30 mg/kg/day of PFOA in drinking water for 15 days. Mice were immunized with sheep red blood cells or sensitized to bovine serum albumin in Freund’s complete adjuvant on day 10 of exposure; immune responses were determined 1 day post-exposure.ResultsWe found that 30 mg PFOA/kg/day given for 10 or 15 days reduced IgM synthesis; serum collected 1 day postexposure contained 8.4 × 104 or 2.7 × 105 ng PFOA/mL, respectively. IgM synthesis was suppressed at exposures ≥ 3.75 mg PFOA/kg/day in a dose-dependent manner, and IgG titers were elevated at 3.75 and 7.5 mg PFOA/kg/day. Serum PFOA at 3.75 mg/kg/day was 7.4 × 104 ng/mL 1 day postexposure, or 150-fold greater than the levels reported in individuals living near a PFOA production site. Using a second-degree polynomial model, we calculated a benchmark dose of 3 mg/kg/day, with a lower bound (95% confidence limit) of 1.75 mg/kg/day. Cell-mediated function was not affected.ConclusionsIgM antibodies were suppressed after PFOA exposure. The margin of exposure for reduced IgM antibody synthesis was approximately 150 for highly exposed human populations

The Effect of Salsalate Therapy on Endothelial Function in a Broad Range of Subjects

Background: Inflammation is fundamental to the development of atherosclerosis. We examined the effect of anti‐inflammatory doses of salicylate on endothelium‐dependent vasodilation, a biomarker of cardiovascular risk, in a broad range of subjects. Methods and Results: We performed a randomized, double‐blind, placebo‐controlled crossover trial evaluating the effects of 4 weeks of high‐dose salsalate (disalicylate) therapy on endothelium‐dependent flow‐mediated and endothelium‐independent vasodilation. Fifty‐eight subjects, including 17 with metabolic syndrome, 13 with atherosclerosis, and 28 healthy controls, were studied. Among all subjects, endothelium‐dependent flow‐mediated vasodilation decreased after salsalate compared with placebo therapy (P=0.01), whereas nitroglycerin‐mediated, endothelium‐independent vasodilation was unchanged (P=0.97). Endothelium‐dependent flow‐mediated vasodilation after salsalate therapy was impaired compared with placebo therapy in subjects with therapeutic salicylate levels (n=31, P0.2). Conclusions: Salsalate therapy, particularly when therapeutic salicylate levels are achieved, impairs endothelium‐dependent vasodilation in a broad range of subjects. These data raise concern about the possible deleterious effects of anti‐inflammatory doses of salsalate on cardiovascular risk. Clinical Trial Registration URL: www.clinicaltrials.gov. Unique Identifiers: NCT00760019 and NCT00762827