A comparison of measured height and demi-span equivalent height in the assessment of body mass index among people aged 65 years and over in England

Objectives: to examine differences between measured height and demi-span equivalent height (DEH) among people aged >= 65 and investigate the impact on body mass index (BMI) of using DEH.Design and Setting: nationally representative cross-sectional sample of adults living in England.Participants: 3,346 non-institutionalised adults aged >= 65, taking part in the Health Survey for England (HSE) 2001.Measurements: height, weight and demi-span measurements were taken according to standardised HSE protocols. DEH was calculated using Basseys equation.Results: the height measurement was lower than the DEH from age group 70-74 years onwards in men and in each age group in women. No significant differences in mean DEH and measured height were found for men (0.46) or women (2.64). BMI derived from measured height did not differ significantly from BMI derived from DEH. The prevalence of underweight was lower when using measured height than when using DEH in women aged >= 65, particularly in those aged 80 years and over. The prevalence of overweight and obesity was higher using measured height than DEH in women aged >= 65.Conclusion: we confirmed in a large nationally representative sample that demi-span measurement may be a useful estimate of stature in people (particularly women) aged >= 65 for BMI calculations

Nutritional and Post-Transplantation Outcomes of Enteral versus Parenteral Nutrition in Pediatric Hematopoietic Stem Cell Transplantation: A Systematic Review of Randomized and Nonrandomized Studies

Hematopoietic stem cell transplantation (HSCT) involves the administration of chemotherapy followed by the infusion of donor stem cells. After treatment, children can consequently experience nausea, vomiting, diarrhea, anorexia, and mucositis, which negatively impact oral intake, leading to rapid deterioration in nutritional status and risk of malnutrition. Nutrition support therefore becomes necessary to circumvent these adverse effects. This has traditionally been provided via parenteral nutrition (PN), but pediatric evidence is increasingly advocating enteral nutrition (EN) as a preferential alternative. The objective of this review is to determine the efficacy of any forms of EN versus PN provided during admission to children aged ≤ 18 years undergoing HSCT. Primary outcomes considered efficacy in relation to various nutritional parameters, and secondary outcomes included a range of post-transplantation parameters. Data sources included English and non-English articles from the start date of MEDLINE, EMBASE, AMED, CINAHL and Cochrane Controlled Trials register, up to July 2018. Key journals were also hand searched, reference lists scanned, clinical experts contacted, and gray literature searched using EThOS and Open Grey. Randomized and observational studies comparing any forms of EN versus PN in children aged ≤ 18 years undergoing HSCT investigating nutritional or post-transplantation outcomes were eligible. Data were extracted from included studies using a custom extraction form that had previously been piloted. Because included studies were observational, risk of bias was assessed using Risk of Bias in Non-randomised Studies of Interventions. Because only a small number of heterogenous studies reporting a wide range of differently defined outcomes were included, meta-analyses were not performed and data were presented in narrative form. Conflicting results in favor of either method of nutrition support or no difference between methods were seen for duration of interventions, nutritional intakes, biochemical and anthropometric changes, mortality, infections, length of admission, and neutrophil engraftment. EN may provide favorable benefits over PN regarding acute graft-versus-host-disease (aGVHD) and platelet engraftment. A paucity of studies was found investigating the question posed by this review. Included studies were clinically heterogenous regarding populations, interventions, and outcomes, at moderate to serious risk of bias due to the absence of randomization, confounding parameters, statistical control, retrospective designs, and participant selection. Some studies were more than 15 years old. Despite the limited number and poor quality of identified studies, results support the growing body of pediatric evidence that EN is feasible during HSCT. Similar differences regarding many nutritional and post-transplantation outcomes were seen in both forms of nutrition support, but EN could provide benefits above PN including reduced incidence of aGVHD and faster platelet engraftment

Challenges in Patient Recruitment, Implementation, and Fidelity in a Mobile Telehealth Study

Introduction: Mobile telehealth (MTH) evaluations in diabetes have been conducted, but few report details and issues related to recruitment, implementation (intervention delivery), fidelity, and context. These have important implications on the interpretation of the findings and effectiveness of the intervention. This article reports these data from an MTH study and describes the challenges experienced in running an intervention such as this in an active clinical environment. Materials and Methods: We conducted a mixed-methods MTH study that included a 9-month randomized controlled trial in people with poorly controlled diabetes. Detailed recruitment data were recorded during the study. Data on contacts between MTH participants and the MTH team were collected and used to report on intervention delivery and fidelity. Meeting and field notes, as well as communications between research team members during the study, were used to report on the contextual factors that affected recruitment, implementation, and fidelity. Results: The recruited sample size represented 6% of the total clinic population (n = 1,360) and 10.7% of the number of potentially eligible people at the clinic (n = 802) identified at the beginning of the study. Contextual factors related to patients, healthcare providers, the institution, or the recruitment protocol contributed to influence access to study participants and the number of participants randomized (n = 81). Technical and device-related aspects of the MTH intervention were delivered successfully, but the expected education and clinical feedback by the MTH nurse were not delivered according to the protocol. Although 92.5% of introductory calls were made by the MTH nurses, only 13.3% of expected educational calls were performed. Changes to the MTH nursing staff affected intervention participants differently and contributed to the low fidelity of intervention delivery. Conclusions: The current article presents data on the influence of contextual factors on the conduct of this MTH study and underlines the need for these processes to be assessed and reported adequately in future MTH research

A randomised, controlled trial of the effects of a mobile telehealth intervention on clinical and patient-reported outcomes in people with poorly controlled diabetes

Objective The objective of this research is to determine the effects of mobile telehealth (MTH) on glycosylated haemoglobin (HbA1c) and other clinical and patient-reported outcomes in insulin-requiring people with diabetes. Methods A nine-month randomised, controlled trial compared standard care to standard care supplemented with MTH (self-monitoring, mobile-phone data transmissions, graphical and nurse-initiated feedback, and educational calls). Clinical (HbA1c, blood pressure, daily insulin dose, diabetes outpatient appointments (DOAs)) and questionnaire data (health-related quality of life, depression, anxiety) were collected. Mean group changes over time were compared using hierarchical linear models and Mann-Whitney tests. Results Eighty-one participants with a baseline HbA1c of 8.98% ± 1.82 were randomised to the intervention ( n = 45) and standard care ( n = 36). The Group by Time effect revealed MTH did not significantly influence HbA1c ( p = 0.228), but p values were borderline significant for blood pressure ( p = 0.054) and mental-health related quality of life ( p = 0.057). Examination of effect sizes and 95% confidence intervals for mean group differences at nine months supported the existence of a protective effect of MTH on mental health-related quality of life as well as depression. None of the other measured outcomes were found to be affected by the MTH intervention. Conclusions Findings from this study must be interpreted with caution given the small sample size, but they do not support the widespread adoption of MTH to achieve clinically significant changes in HbA1c. MTH may, however, have positive effects on blood pressure and protective effects on some aspects of mental health

Knowledge, attitudes and practices of medical staff towards obesity management in patients with spinal cord injuries: an International survey of four western European countries

Objective: To (1) examine the opinions of medical staff working in spinal cord injury (SCI) centres (SCICs); (2) evaluate their knowledge, attitudes and practices towards obesity prevention and management; (3) report the number of beds and dietitians available at each SCIC. Methods: A 37-item questionnaire was sent to 23 SCICs in the UK, the Netherlands, Belgium and the Republic of Ireland between September 2012 and January 2013. Results: Eighteen SCICs returned the questionnaires for analysis. All respondents stated that they had an interest in obesity treatment but only 2.3% of the respondents received training in obesity management. Sixty-one percent of staff did not consider body mass index (BMI) to be appropriate for use in SCI patients and subsequently less than half of the respondents use BMI routinely. The majority of respondents reported that they are confident in dealing with overweight (74.5%) and obese (66.1%) SCI adults, less than half (44.1%) are confident in treating overweight and obese SCI children. Respondents also indicated the need for nationally adopted guidelines and a lack of physical activity provision. There were 17.5 whole-time equivalent (WTE) dietitians recorded in 22 SCICs, equivalent to 47.8 beds per WTE dietitians (range 10–420). Non-UK SCIC dietitians are significantly better resourced than in UK SCICs (beds per WTE dietitian: 36 vs 124, P=0.035). Conclusion: Medical staff expressed the need to participate in obesity prevention and management. Appropriate training should be considered for all medical staff and the development of specific weight management guidelines and dietetic provision should be considered

Knowledge based requirements specification for reconfigurable assembly systems

Automated assembly technology may be the key to sustaining manufacturing industry in more developed countries. Currently this comprises dedicated systems that can assemble single products at high volumes and flexible systems to assemble a wide variety of products in low volumes. However, competitive forces demand a compromise between the two and Reconfigurable Assembly Systems are an avenue for achieving high volume and high variety production. Although this technology is coming to the fore, there is a distinct lack of tools and methods that make the prospect attractive to key decision makers in organisations. Reconfigurable solutions, which may be profitable in the long term, are rejected in favour of short term solutions, which prove to be more expensive over time. The benefits of requirements engineering have been exploited in software engineering and this work demonstrates how these can be adapted to an assembly environment to form a new basis for communication between the system vendors, who supply assembly system solutions, and system users, who use them. Knowledge Engineering has become a key aspect in industry due to the challenges of retaining personnel and their knowledge within organisations. This is because employees take their knowledge of the organisation with them when they leave. The retention of this knowledge would help to maintain the continuity within organisations. This thesis reports on research that aims to provide a means to integrate these three aspects to form a basis for sustaining competitive manufacture in more developed countries. Moreover, Knowledge Based Requirements Specification for Reconfigurable Assembly Systems will provide a vital medium for promoting Reconfigurable Assembly Systems and encourage their implementation by providing a knowledge-based platform for the specification of Reconfigurable Assembly Systems

Laryngeal manual therapy: a preliminary study to examine its treatment effects in the management of muscle tension dysphonia

The objectives of this study were to determine appropriate acoustic and outcome measures for the evaluation of a method of laryngeal manual therapy (LMT) used in the treatment of patients with muscle tension dysphonia (MTD). The effects of this technique were also investigated. The study was based on the hypotheses that the vertical position of the larynx in the vocal tract would lower, that the quality of the voice would normalize, and that a reduction in any vocal tract discomfort (VTD) would occur after LMT. This was a small, prospective, repeated measures pilot study in which each member of the research team was "blinded" to all other stages of the study and during which all data were anonymized until the final stage of data analysis. Ten subjects presenting with MTD completed outcome measures and provided audiorecordings immediately before, immediately after, and 1 week after LMT. The Kay CSL 4150 was used for signal acquisition and for some acoustic measurements. Spectrographic evaluation was accomplished with Praat. A new perceptual, self-rating scale, the VTD scale, and a new proforma for use by the clinician for palpatory evaluation, were developed for the study. Relative average perturbation during connected speech was significantly reduced after LMT, indicating a reduction in abnormal vocal function. The severity and frequency of VTD was shown to have reduced after LMT. This pilot study showed positive evidence for LMT as a method of therapy in the treatment of hyperfunctional voice disorders. Its effects were shown to be measurable with both acoustical analysis and the VTD scale

Major role of pKpQIL-like plasmids in the early dissemination of KPC-type carbapenemases in the UK

Objectives: KPC-producing Enterobacteriaceae were first seen in the UK in 2003 and have been increasingly reported since 2010, largely owing to an ongoing outbreak in North-West England. We examined the role of clonal spread and plasmid transmission in their emergence. Methods: Isolates comprised KPC-positive Klebsiella pneumoniae (n=33), Escherichia coli (n=7) and Enterobacter spp. (n=4) referred to the national reference laboratory between 2008 and 2010 from 17 UK centres, including three in North-West England. Isolates were typed by MLST. Plasmids were transferred by electroporation and characterised by PCR or sequencing. PCR screening assays were developed to distinguish plasmid pKpQIL variants. Results: The K. pneumoniae isolates included 10 STs, of which three belonged to clonal group (CG) 258. CG258 (n=19) isolates were detected in 13 centres but accounted for only 7/19 (36.8%) of those from North-West England. Most KPC-producers (37/44, 84.1%), including 16/19 CG258 K. pneumoniae carried blaKPC on IncFIIK2 plasmids. Sequencing of a subset of these plasmids (n=11) revealed similarities with published pKpQIL. One variant, pKpQIL-UK - identified in K. pneumoniae CG258 (n=5) and ST468 (n=1) isolates from distinct centres - had only a few nucleotide changes from classical pKpQIL, whereas pKpQIL-D1 (n=1) and pKpQIL-D2 (n=4), from isolates of various species in the North-West, harboured large variations reflecting replacement of the partitioning and replication functions and potentially thereby facilitating spread. PCR revealed that 36/37 (97.3%) IncFIIK2-type plasmids in KPC-positive isolates had pKpQIL markers. Conclusions: pKpQIL-like plasmids played a major role in the early dissemination of KPC enzymes in the UK

Cohort Profile: The Health Survey for England

To monitor the health of the public in England, UK, the Central Health Monitoring Unit within the UK Department of Health commissioned an annual health examination survey, which became known as the Health Survey for England (HSE). The first survey was completed in 1991. The HSE covers all of England and is a nationally representative sample of those residing at private residential addresses. Each survey year consists of a new sample of private residential addresses and people. The HSE collects detailed information on mental and physical health, health-related behaviour, and objective physical and biological measures in relation to demographic and socio-economic characteristics of people aged 16 years and over at private residential addresses. There are two parts to the HSE; an interviewer visit, to conduct an interview and measure height and weight, then a nurse visit, to carry out further measurements and take biological samples. Since 1994, survey participants aged 16 years and over have been asked for consent to follow-up through linkage to mortality and cancer registration data, and from 2003, to the Hospital Episode Statistics database, thus converting annual cross-sectional survey data into a longitudinal study. Annual survey data (1994–2009) are available through the UK Data Archive

A comparison of remote therapy, face to face therapy and an attention control intervention for people with aphasia: A quasi-randomised controlled feasibility study

Objective: To test the feasibility of a Randomised Controlled Trial comparing face to face and remotely delivered word finding therapy for people with aphasia Design: A quasi-randomised controlled feasibility study comparing remote therapy delivered from a University lab, remote therapy delivered from a clinical site, face to face therapy and an attention control condition Setting: A University lab and NHS outpatient service Participants: Twenty-one people with aphasia following left hemisphere stroke Interventions: Eight sessions of word finding therapy, delivered either face to face or remotely, were compared to an attention control condition comprising eight sessions of remotely delivered supported conversation. The remote conditions used mainstream video conferencing technology. Outcome measures: Feasibility was assessed by recruitment and attrition rates, participant observations and interviews, and treatment fidelity checking. Effects of therapy on word retrieval were assessed by tests of picture naming and naming in conversation. Results: Twenty-one participants were recruited over 17 months, with one lost at baseline. Compliance and satisfaction with the intervention was good. Treatment fidelity was high for both remote and face to face delivery (1251/1421 therapist behaviours were compliant with the protocol). Participants who received therapy improved on picture naming significantly more than controls (mean numerical gains: 20.2 (remote from University); 41 (remote from clinical site); 30.8 (face to face); 5.8 (attention control); p <.001). There were no significant differences between groups in the assessment of conversation. Conclusions: Word finding therapy can be delivered via mainstream internet video conferencing. Therapy improved picture naming, but not naming in conversation