Effects of a falls exercise intervention on strength, power, functional ability and bone in older frequent fallers: FaME (Falls Management Exercise) RCT secondary analysis

OBJECTIVES: Falls Management Exercise (FaME) has been shown to reduce falls in frequent fallers and in lower risk sedentary older people. The effects of FaME on the strength, power, physical function and bone health of frequently falling older women are yet to be established. METHODS: This paper reports secondary analysis of data from the original randomised controlled trial of FaME in 100 community dwelling women aged ≥65 years with a history of ≥3 falls in the previous year. Intervention was group delivered, weekly one hour tailored dynamic balance and strength exercise classes and home exercise for nine months. OUTCOME MEASURES INCLUDED: strength (handgrip, quadriceps, hamstrings, hip abductors, ankles), lower limb explosive power and functional tests (timed up and go, functional reach, timed floor rise and balance), analysed using Linear Mixed Model analysis. Bone Mineral Density (BMD) at hip and spine was measured in a smaller sub-group and analysed using t-tests. RESULTS: Significant time*group interactions in all measures of strength, except isometric ankle dorsiflexion, concentric hamstring and eccentric quadriceps strength. These improvements in strength equated to average improvements of 7-45%. There were also significant improvements in explosive power (W/kg) (18%, p=0.000), timed up and go (16%, p=0.000), functional reach (17%, p=0.000), floor rise (10%, p=0.002) and eyes closed static balance (56%, p=0.000). There was a significant loss of hip BMD in the control group (neck of femur p<0.05; ward's triangle p<0.02). CONCLUSION: The FaME intervention improves lower limb strength, power and clinically relevant functional outcomes in frequently falling older women

Habitat Associations of Nebraska Birds

In the fall of 2003 we set out to assign habitat associations to 363 species of birds that regularly occur in Nebraska for the purpose of evaluating the relative importance of each of Nebraska\u27s major habitats to the state\u27s breeding, migrating, and wintering birds. It is our hope that this information will (1) provide the first thorough investigation of Nebraska\u27s birds and the habitats they use, and (2) provide a method for prioritizing the conservation of Nebraska\u27s varied habitats for birds

Health and Physical Education and the Online Tertiary Environment at Two Universities: Pre-service Teachers’ Perceived ‘Readiness’ to Teach HPE

In recent years in tertiary institutions in Australia, there has been a large increase of enrolments in Education courses delivered via an online/external mode. This has raised a number of concerns around the nexus of theory and practice and whether pre-service teachers feel ready to teach after completing Education study online. The purpose of this study is to examine pre-service teachers’ perceived readiness to teach Health and Physical Education (HPE) after engaging with the subject fully in an online tertiary environment. 26 pre-service teachers studying education online from two separate were involved in this study. Upon completion of the University semester and also after a practicum placement, qualitative data was collected detailing the pre-service teachers’ perceptions in regard to their readiness to teach HPE. Pre-service teachers’ perceptions are used as the primary data highlighting the varying levels of readiness to teach HPE

Early-life stress induces persistent alterations in 5-HT1A receptor and serotonin transporter mRNA expression in the adult rat brain

Early-life experience plays a major role in the stress response throughout life. Neonatal maternal separation (MS) is an animal model of depression with an altered serotonergic response. We hypothesize that this alteration may be caused by differences in 5-HT(1A) receptor and serotonin transporter (SERT) mRNA expression in brain areas involved in the control of emotions, memory, and fear as well as in regions controlling the central serotonergic tone. To test this, Sprague–Dawley rats were subjected to MS for 3 h daily during postnatal days 2–12. As control, age matched rats were non-separated (NS) from their dams. When animals reached adulthood (11–13 weeks) brain was extracted and mRNA expression of 5-HT(1A) receptor in amygdala, hippocampus and dorsal raphé nucleus (DRN) and SERT in the DRN was analyzed through in situ hybridisation. Densitometric analysis revealed that MS increased 5-HT(1A) receptor mRNA expression in the amygdala, and reduced its expression in the DRN, but no changes were observed in the hippocampus in comparison to NS controls. Also, MS reduced SERT mRNA expression in the DRN when compared to NS rats. These results suggest that early-life stress induces persistent changes in 5-HT(1A) receptor and SERT mRNA expression in key brain regions involved in the development of stress-related psychiatric disorders. The reduction in SERT mRNA indicates an alteration that is in line with clinical findings such as polymorphic variants in individuals with higher risk of depression. These data may help to understand how early-life stress contributes to the development of mood disorders in adulthood

The effect of increased PET imaging on the staging, outcomes, and health care utilization of Medicare non-small cell lung cancer patients

Positron Emission Tomography (PET) is an advanced imaging modality that was first approved by Medicare in 1998 to differentiate between malignant and benign solitary pulmonary nodules. It has since has experienced rapid uptake in clinical practice among both Medicare and privately-insured non-small cell lung cancer (NSCLC) patients, despite a lack of large randomized trials examining how the use of PET affects NSCLC patient outcomes. The three studies in this dissertation used Surveillance Epidemiology and End Results (SEER)-Medicare data from 1992 to 2005 to examine how the widespread adoption of PET has affected the evaluation, staging, treatment, and health care utilization of Medicare beneficiaries with NSCLC. By 2005, more than half of all NSCLC patients received one or more PET scans. Despite widespread adoption of PET overall, differential rates of PET utilization within sociodemographic and regional subgroups persisted through 2005, with lower rates of PET use observed among blacks, patients older than age 80, and patients living outside the Northeast. Widespread adoption of PET was accompanied by an increase in the proportion of cancers staged as unresectable, reduced rates of lung resection, and decreased inpatient health care expenditures by 2005. During the same period, the proportion of patients undergoing chemotherapy increased, resulting in an overall increase in expenditures for Medicare beneficiaries with NSCLC. The widespread use of PET among the Medicare NSCLC occurred non-uniformly, induced stage migration, changed patient treatment and costs, but did not improve overall survival. In the era of individualized medicine, the role of PET may shift from an initial diagnosis and staging modality to a role in treatment evaluation. The increased use of PET in the Medicare NSCLC patient population and how it affects patient management and health care utilization remains an important area of ongoing research and evolving health policy

Variations in cesarean deliveries associated with payer type

Objective: The rates of cesarean deliveries (CD) in the United States (U.S.) have been increasing since the 1990s making it the most common operating room procedure in U.S. hospitals. CD may be necessary due to a variety of medical indications; however, it is not clear whether socioeconomic factors affect CD rates. This study examines the association between type of insurance coverage pregnant women have and rates of CD in the U.S.Methods: This is a retrospective analysis of the discharge records of pregnant women admitted to U.S. hospitals between 2012 and 2014 extracted from the National Inpatient Sample dataset. The study population was divided into two groups according to insurance coverage (public vs private). Logistic regression analysis was used to examine the association between type of insurance and CD rates while controlling for an array of demographic, medical, social and behavioral confounding factors.Results: 12,450,349 subjects were included in the analysis, of those, 29.9% had a CD. 82.6% of women are between 18-34 years old and 49.5% are Caucasians. 48.9% of women have private insurance. Women with private insurance received a higher percentage of cesarean deliveries (31.8%) compared to women with public insurance (28.3%), adjusted odds ratio (aOR): 1.30 (CI: 1.29-1.30, p<0.001). This ratio was more significant in AMA women (aOR: 1.37) but not among teenagers. Although, higher in all race/ethnicity groups, African American, Hispanic and Native American women have more significant association to receive CD when covered by private insurance compared to Caucasian women. Giving birth at an urban-teaching hospital was associated with a higher CD rate (31.9% vs. 27.4%), aOR: 1.42. Delivery in the Northeast was associated with increased CD rates (32.8% vs. 27.5%) when covered with private insurance, aOR: 1.43, while in the West, private insurance was associated with less CD, aOR: 1.17.Conclusion: After controlling for demographic, clinical, behavioral, and system variables, private insurance was associated with a 30% increase in rate of CD compared to public insurance

Maternal inflammatory bowel disease, racial diversity and adverse birth outcomes

Background: Inflammatory bowel disease (IBD) is a term used to describe two conditions, Crohn’s disease and ulcerative colitis (UC), that currently have no definite cure. The incidence of IBD worldwide has increased, frequently affecting women during their reproductive years. Objectives: This study examines the association of Crohn\u27s disease and ulcerative colitis (UC) with adverse pregnancy outcomes and looks at the interactions of race/ethnicity on these associations. Study Design: We examined hospital birth records in the National Inpatient Sample (NIS) data sets in 2011 and 2012. We identified maternal demographics and clinical characteristics using international classification of disease-9 codes. Chi-square and Fisher exact tests were used to examine associations and logistic regression models were used to control for confounders. Results: Crohn\u27s disease is associated with small for gestational age, aOR 1.70(CI:1.53-1.89,p<0.001) but not premature delivery, whereas UC was associated with prematurity, aOR 1.5(CI:1.36-1.66,p<0.001) to a greater extent than with SGA. Analyses by race/ethnicity showed Crohn’s disease to be associated with SGA among newborns of all racial groups, but most evident among African Americans, aOR 2.55(CI:2.06-3.15,p<.001). Crohn’s disease was associated with prematurity only in Caucasian women, aOR 1.21(CI:1.10-1.34,p<.001). UC was associated with SGA newborns only in Hispanic mothers, aOR 3.40(CI:2.24-5.15,p<0.001), and with premature delivery only among Caucasian mothers, aOR 1.60(CI:1.42-1.80,p<.001). Conclusion: Both Crohn\u27s disease and ulcerative colitis are associated with prematurity and small for gestational age in a way that is significantly affected by maternal race. Qualitative studies are needed to understand mechanisms for these associations and the role of race/ethnicity

SplicerAV: a tool for mining microarray expression data for changes in RNA processing

<p>Abstract</p> <p>Background</p> <p>Over the past two decades more than fifty thousand unique clinical and biological samples have been assayed using the Affymetrix HG-U133 and HG-U95 GeneChip microarray platforms. This substantial repository has been used extensively to characterize changes in gene expression between biological samples, but has not been previously mined <it>en masse </it>for changes in mRNA processing. We explored the possibility of using HG-U133 microarray data to identify changes in alternative mRNA processing in several available archival datasets.</p> <p>Results</p> <p>Data from these and other gene expression microarrays can now be mined for changes in transcript isoform abundance using a program described here, SplicerAV. Using <it>in vivo </it>and <it>in vitro </it>breast cancer microarray datasets, SplicerAV was able to perform both gene and isoform specific expression profiling within the same microarray dataset. Our reanalysis of Affymetrix U133 plus 2.0 data generated by <it>in vitro </it>over-expression of HRAS, E2F3, beta-catenin (CTNNB1), SRC, and MYC identified several hundred oncogene-induced mRNA isoform changes, one of which recognized a previously unknown mechanism of <it>EGFR </it>family activation. Using clinical data, SplicerAV predicted 241 isoform changes between low and high grade breast tumors; with changes enriched among genes coding for guanyl-nucleotide exchange factors, metalloprotease inhibitors, and mRNA processing factors. Isoform changes in 15 genes were associated with aggressive cancer across the three breast cancer datasets.</p> <p>Conclusions</p> <p>Using SplicerAV, we identified several hundred previously uncharacterized isoform changes induced by <it>in vitro </it>oncogene over-expression and revealed a previously unknown mechanism of EGFR activation in human mammary epithelial cells. We analyzed Affymetrix GeneChip data from over 400 human breast tumors in three independent studies, making this the largest clinical dataset analyzed for <it>en masse </it>changes in alternative mRNA processing. The capacity to detect RNA isoform changes in archival microarray data using SplicerAV allowed us to carry out the first analysis of isoform specific mRNA changes directly associated with cancer survival.</p