Body mass index and measures of body fat for defining obesity and underweight: a cross-sectional, population-based study

BACKGROUND: The body mass index (BMI) is commonly used as a surrogate marker for adiposity. However, the BMI indicates weight-for-height without considering differences in body composition and the contribution of body fat to overall body weight. The aim of this cross-sectional study was to identify sex-and-age-specific values for percentage body fat (%BF), measured using whole body dual energy x-ray absorptiometry (DXA), that correspond to BMI 18.5 kg/m(2) (threshold for underweight), 25.0 kg/m(2) (overweight) and 30.0 kg/m(2) (obesity) and compare the prevalence of underweight, overweight and obesity in the adult white Australian population using these BMI thresholds and equivalent values for %BF. These analyses utilise data from randomly-selected men (n = 1446) and women (n = 1045), age 20-96 years, who had concurrent anthropometry and DXA assessments as part of the Geelong Osteoporosis Study, 2001-2008. RESULTS: Values for %BF cut-points for underweight, overweight and obesity were predicted from sex, age and BMI. Using these cut-points, the age-standardised prevalence among men for underweight was 3.1% (95% CI 2.1, 4.1), overweight 40.4% (95% CI 37.7, 43.1) and obesity 24.7% (95% CI 22.2, 27.1); among women, prevalence for underweight was 3.8% (95% CI 2.6, 5.0), overweight 32.3% (95% CI 29.5, 35.2) and obesity 29.5% (95% CI 26.7, 32.3). Prevalence estimates using BMI criteria for men were: underweight 0.6% (95% CI 0.2, 1.1), overweight 45.5% (95% CI 42.7, 48.2) and obesity 19.7% (95% CI 17.5, 21.9); and for women, underweight 1.4% (95% CI 0.7, 2.0), overweight 30.3% (95% CI 27.5, 33.1) and obesity 28.2% (95% CI 25.4, 31.0). CONCLUSIONS: Utilising a single BMI threshold may underestimate the true extent of obesity in the white population, particularly among men. Similarly, the BMI underestimates the prevalence of underweight, suggesting that this body build is apparent in the population, albeit at a low prevalence. Optimal thresholds for defining underweight and obesity will ultimately depend on risk assessment for impaired health and early mortality

Fracture Risk and Use of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers

Medications used to treat hypertension may affect fracture risk. This study investigated fracture risk for users of angiotensin converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB). Participants (899 men, median age 70.3 yr (59.9-79.1), range 50.0-96.6 yr; 574 women, median age 65.5 yr (58.1-75.4), range 50.1-94.6 yr) were from the Geelong Osteoporosis Study. Medication use was self-reported and incident fractures were ascertained using radiological reports. Bone mineral density (BMD) was measured at the femoral neck. Participants were divided into four groups: (1) non-users without hypertension, (2) non-users with hypertension, (3) ACEI users and (4) ARB users. Dosage was calculated using the defined daily dose (DDD) criteria. Participants were followed from date of visit to first fracture, death or 31 December 2016, whichever occurred first. Cox proportional hazards models were used for analyses. At least one incident fracture was sustained by 156 men and 135 women over a median(IQR) of 11.5(6.2-13.2) and 10.9(6.3-11.6) years of follow-up, respectively. In unadjusted analyses, compared to non-users without hypertension, men in all three other groups had a higher risk of fracture (Hazard Ratio (HR, 95%CI) 1.54, 1.00-2.37; 1.90, 1.18-3.05; 2.15, 1.26-3.66), for non-users with hypertension, ACEI and ARB users, respectively). Following adjustment for age, prior fracture and BMD, these associations became non-significant. A dose effect for ARB use was observed; men using lower doses had a higher risk of fracture than non-users without hypertension, in both unadjusted (2.66, 1.34-5.29) and adjusted (2.03, 1.01-4.08) analyses, but this association was not observed at higher doses. For women, unadjusted analyses showed a higher risk for ACEI users compared to non-users without hypertension (1.74, 1.07-2.83). This was explained after adjustment for age, alcohol consumption, prior fracture and BMD (1.28, 0.74-2.22). No other differences were observed. In men, lower dose (0 < DDD ≤ 1) ARB use was associated with an increased risk of fracture. ACEI or ARB use was not associated with increased risk of incident fracture in women. These findings may be important for antihypertensive treatment decisions in individuals with a high risk of fracture. Keywords: Angiotensin II receptor blockers; Angiotensin converting enzyme inhibitors; Fracture risk

Detection and localisation of hesitant steps in people with Alzheimer's disease navigating routes of varying complexity.

People with Alzheimer's disease (AD) have characteristic problems navigating everyday environments. While patients may exhibit abnormal gait parameters, adaptive gait irregularities when navigating environments are little explored or understood. The aim of this study was to assess adaptive locomotor responses of AD subjects in a complex environment requiring spatial navigation. A controlled environment of three corridors was set up: straight (I), U-shaped (U) and dog-leg (S). Participants were asked to walk along corridors as part of a counterbalanced repeated-measures design. Three groups were studied: 11 people with posterior cortical atrophy (PCA), 10 with typical Alzheimer's disease (tAD) and 13 controls. Spatio-temporal gait parameters and position within the corridors were monitored with shoe-mounted inertial measurement units (IMUs). Hesitant steps were identified from statistical analysis of the distribution of step time data. Walking paths were generated from position data calculated by double integration of IMU acceleration. People with PCA and tAD had similar gait characteristics, having shorter steps and longer step times than controls. Hesitant steps tended to be clustered within certain regions of the walking paths. IMUs enabled identification of key gait characteristics in this clinical population (step time, length and step hesitancy) and environmental conditions (route complexity) modifying their expression

Navigational cue effects in Alzheimer's disease and posterior cortical atrophy.

OBJECTIVE: Deficits in spatial navigation are characteristic and disabling features of typical Alzheimer's disease (tAD) and posterior cortical atrophy (PCA). Visual cues have been proposed to mitigate such deficits; however, there is currently little empirical evidence for their use. METHODS: The effect of visual cues on visually guided navigation was assessed within a simplified real-world setting in individuals with tAD (n = 10), PCA (n = 8), and healthy controls (n = 12). In a repeated-measures design comprising 36 trials, participants walked to a visible target destination (an open door within a built environment), with or without the presence of an obstacle. Contrast and motion-based cues were evaluated; both aimed to facilitate performance by applying perceptual changes to target destinations without carrying explicit information. The primary outcome was completion time; secondary outcomes were measures of fixation position and walking path directness during consecutive task phases, determined using mobile eyetracking and motion capture methods. RESULTS: Results illustrate marked deficits in patients' navigational ability, with patient groups taking an estimated two to three times longer to reach target destinations than controls and exhibiting tortuous walking paths. There were no significant differences between tAD and PCA task performance. Overall, patients took less time to reach target destinations under cue conditions (contrast-cue: 11.8%; 95% CI: [2.5, 20.3]) and were more likely initially to fixate on targets. INTERPRETATION: The study evaluated navigation to destinations within a real-world environment. There is evidence that introducing perceptual changes to the environment may improve patients' navigational ability

Foot and ankle fracture incidence in South-Eastern Australia: an epidemiological study

Objective: The aim of this study was to report the incidence of all foot and ankle fractures during 2006 and 2007 among residents from the Barwon Statistical Division, located in south-eastern Australia.Methods: Incident fractures were ascertained using X-ray reports from the imaging centres serving the region during the years 2006 and 2007. All fractures with ICD-9 code 824 (ankle) or 825 (foot) were included in this study. Age, proportions of left/right side fractures, cause of fracture and incidence rates (per 10,000 person-years) were all determined for foot and ankle fractures separately as well as for the two sites combined.Results: There were 312 males and 274 females identified with foot fractures and 344 males and 410 females with ankle fractures. The median age for both foot and ankle fracture was lower in males compared to females. The proportions of left and right side fractures were approximately equal; no sex or site (foot or ankle) showed higher proportions of either left or right side fractures. Among those for whom cause of fracture was known, most foot or ankle fractures (&gt;75%) in both sexes were caused by an accidental fall. For both sexes, there was a bimodal pattern of incidence across the age groups, with peaks around adolescence/early adulthood and in the elderly. Incidence rates (per 10,000 person-years) for foot and ankle fractures combined were similar in both sexes; 25.85 and 25.88 for males and females, respectively. However, the incidence rate for foot/ankle fractures combined in those aged 50 years or over was lower in males than in females.Conclusion: Males sustained foot and ankle fractures at a lower median age than females and most fractures were the result of an accidental fall. Males sustain fractures mainly during adolescence and young adulthood, whereas fractures in females were sustained largely by individuals over 50 years of age. Despite this, the overall incidence rates were similar for both sexes

Last Men Standing: Chlamydatus Portraits and Public Life in Late Antique Corinth

Notable among the marble sculptures excavated at Corinth are seven portraits of men wearing the long chlamys of Late Antique imperial office. This unusual costume, contemporary portrait heads, and inscribed statue bases all help confirm that new public statuary was created and erected at Corinth during the 4th and 5th centuries. These chlamydatus portraits, published together here for the first time, are likely to represent the Governor of Achaia in his capital city, in the company of local benefactors. Among the last works of the ancient sculptural tradition, they form a valuable source of information on public life in Late Antique Corinth

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Efficacy and safety of baricitinib or ravulizumab in adult patients with severe COVID-19 (TACTIC-R): a randomised, parallel-arm, open-label, phase 4 trial

Background From early in the COVID-19 pandemic, evidence suggested a role for cytokine dysregulation and complement activation in severe disease. In the TACTIC-R trial, we evaluated the efficacy and safety of baricitinib, an inhibitor of Janus kinase 1 (JAK1) and JAK2, and ravulizumab, a monoclonal inhibitor of complement C5 activation, as an adjunct to standard of care for the treatment of adult patients hospitalised with COVID-19. Methods TACTIC-R was a phase 4, randomised, parallel-arm, open-label platform trial that was undertaken in the UK with urgent public health designation to assess the potential of repurposing immunosuppressants for the treatment of severe COVID-19, stratified by a risk score. Adult participants (aged ≥18 years) were enrolled from 22 hospitals across the UK. Patients with a risk score indicating a 40% risk of admission to an intensive care unit or death were randomly assigned 1:1:1 to standard of care alone, standard of care with baricitinib, or standard of care with ravulizumab. The composite primary outcome was the time from randomisation to incidence (up to and including day 14) of the first event of death, invasive mechanical ventilation, extracorporeal membrane oxygenation, cardiovascular organ support, or renal failure. The primary interim analysis was triggered when 125 patient datasets were available up to day 14 in each study group and we included in the analysis all participants who were randomly assigned. The trial was registered on ClinicalTrials.gov (NCT04390464). Findings Between May 8, 2020, and May 7, 2021, 417 participants were recruited and randomly assigned to standard of care alone (145 patients), baricitinib (137 patients), or ravulizumab (135 patients). Only 54 (39%) of 137 patients in the baricitinib group received the maximum 14-day course, whereas 132 (98%) of 135 patients in the ravulizumab group received the intended dose. The trial was stopped after the primary interim analysis on grounds of futility. The estimated hazard ratio (HR) for reaching the composite primary endpoint was 1·11 (95% CI 0·62–1·99) for patients on baricitinib compared with standard of care alone, and 1·53 (0·88–2·67) for ravulizumab compared with standard of care alone. 45 serious adverse events (21 deaths) were reported in the standard-of-care group, 57 (24 deaths) in the baricitinib group, and 60 (18 deaths) in the ravulizumab group. Interpretation Neither baricitinib nor ravulizumab, as administered in this study, was effective in reducing disease severity in patients selected for severe COVID-19. Safety was similar between treatments and standard of care. The short period of dosing with baricitinib might explain the discrepancy between our findings and those of other trials. The therapeutic potential of targeting complement C5 activation product C5a, rather than the cleavage of C5, warrants further evaluation

Examining the influence of international large-scale assessments on national education policies

This paper examines whether, to what extent, and how international large-scale assessments (ILSAs) have influenced education policy-making at the national level. Based on an exploratory review of the research and policy literature on ILSAs and two surveys administered to educational policy experts, researchers, policymakers, and educators, our research found that ILSAs, with their multiple and ambiguous uses, increasingly function as solutions in search for the right problem – that is, they appear to be used as tools to legitimize educational reforms. The survey results pointed to a growing perception among stakeholders that ILSAs are having an effect on national educational policies, with 38% of respondents stating that ILSAs were generally misused in national policy contexts. However, while the ILSA literature indicates that these assessments are having some influence, there is little evidence that any positive or negative causal relationship exists between ILSA participation and the implementation of education reforms. Perhaps the most significant change associated with the use of ILSAs in the literature reviewed is the way in which new conditions for educational comparison have been made possible at the national, regional, and global levels