Hypertension in goldminers

Background. Reliable information about the prevalence of hypertension, which is a major contributor to cardiovascular disease in general and to coronary heart disease in particular, in different geographical regions is essential for its prevention and optimal control. In the mining industry, which comprises mainly urbanised black African men, the prevalence, impact, treatment and control of hypertension remains unexplored. Methods. We conducted a retrospective, descriptive 1-year hypertension prevalence study in Gauteng Harmony Mine Operations in South Africa. Patient profiles and blood pressure (BP) measurements were retrieved from the company electronic data systems. Follow-up entries made at all the different health facilities that serve this population were examined. Continuous variables were summarised using means or medians with standard deviations. Categorical deviations, including ethnicity, were summarised using percentages and/or frequencies. Results. Of the 4 297 subjects (100% of the mining population in the study period), 4 286 (99%) were black Africans; 90% were men; mean age was 44.62 years; and 39.5% (N=1 696) had hypertension, for which 42% (N=719) received pharmacological treatment, of which 31% (13% of the total hypertensive population) achieved an adequate BP control target of <140/90 mmHg. Pharmacological treatment included diuretics (38.5%), angiotensin-converting enzyme inhibitors (30.16%), calcium channel blockers (26%), beta-blockers (4.47%), angiotensin-receptor blockers (0.17%) and centrally acting agents (0.07%), usually taken in combination. Conclusion. We confirmed that hypertension is an important health challenge for the mining industry in South Africa. Detection, treatment and adequate control of hypertension should receive high priority from the mining authorities. S Afr Med J, 2012;102:30-3

Non-targeted metabolomics in sport and exercise science

Metabolomics incorporates the study of metabolites that are produced and released through physiological processes at both the systemic and cellular level. Biological compounds at the metabolite level are of paramount interest in the sport and exercise sciences, although research in this field has rarely been referred to with the global ‘omics terminology. Commonly studied metabolites in exercise science are notably within cellular pathways for ATP production such as glycolysis (e.g. pyruvate and lactate), β-oxidation of free fatty acids (e.g. palmitate) and ketone bodies (e.g. β-hydroxybutyrate). Non-targeted metabolomic technologies are able to simultaneously analyse the large numbers of metabolites present in human biological samples such as plasma, urine and saliva. These analytical technologies predominately employ nuclear magnetic resonance spectroscopy and chromatography coupled to mass spectrometry. Performing experiments based on non-targeted methods allows for systemic metabolite changes to be analysed and compared to a particular physiological state (e.g. pre/post-exercise) and provides an opportunity to prospect for metabolite signatures that offer beneficial information for translation into an exercise science context, for both elite performance and public health monitoring. This narrative review provides an introduction to non-targeted metabolomic technologies and discusses current and potential applications in sport and exercise science

Autistic girls and school exclusion: perspectives of students and their parents

BACKGROUND AND AIMS: If a child’s behaviour does not conform to school policy or causes harm to either peers or staff, they may be temporarily or permanently excluded from school. Whilst it is unlawful to exclude children due to their needs, school exclusion is common amongst children with special educational needs, including autism. Currently, little is known about experiences of school exclusion from the perspectives of autistic students and/or their parents. This is particularly the case for girls on the autism spectrum. METHODS: Semi-structured interviews were conducted with eight autistic girls and their parents (seven mothers, one father). Interviews explored experiences of mainstream schooling; alternative educational provisions that were offered (if any); the school exclusion process; and the girls’ current educational provision. As well as asking the girls and their parents about positive and negative aspects of their past and current experiences, participants were asked to reflect on areas for potential improvements. RESULTS: Interviews were analysed using thematic analysis and three key themes emerged from the data: inappropriate school environments (including problems with the sensory environment, difficulties when placed with inappropriate peers and general pressures of mainstream classrooms), tensions in school relationships (including problems with staff and peers, alongside a general lack of communication), and problems with staff responses (including a perceived lack of understanding of the girls’ needs and a lack of appropriate support being provided, resulting in ‘battles’ between parents and schools). CONCLUSIONS: The themes and subthemes that emerged from the interviews were not unique to autistic girls. Indeed, issues such as inappropriate school environments, a lack of staff understanding and breakdowns in relationships have been repeatedly raised by parents and young autistic people (mostly boys) in other studies, albeit in different environments. Nevertheless, the results highlight that more needs to be done to positively influence the direction of the girls’ educational journeys. IMPLICATIONS: To improve the inclusion of autistic girls, it is recommended that educational establishments be proactive in developing inclusive environments, build positive relationships (both in and outside of the classroom) and, if exclusion is unavoidable, better support students both before and after the process

Tubal Ectopic Gestation Associated with Genital Schistosomiasis: A Case Report

Schistosoma are trematode blood flukes of the family Schistosomidae affecting the urinary and gastro-intestinal tracts. Riverine areas of the world such as in Africa, Eastern Mediterranean, Central American and East Asia are endemic for the disease, with S. haematobium accounting for most of the symptomatic genital infection. A case of a 25-year-old woman with 8 weeks amenorrhoea, lower abdominal pain and per vaginal bleeding was managed for ruptured ectopic pregnancy and discovered to have tubal infection by Schistosoma on histological examination is presented. Afr J Reprod Health 2014; 18[2]: 144-146).Keywords: Ectopic Gestation, Genital Schistosomiasis Les schistosomes sont des douves sanguines de la famille Schistosomiase affectent les voies urinaires et gastro-intestinaux. Les zones riveraines du monde comme l'Afrique, la Méditerranée Orientale, l'Amérique Centrale et l’Asie de l'Est sont endémiques de la maladie, la S. hématobie étant responsable de la plupart des infections génitales symptomatiques. Un cas d'une femme de 25 ans qui présentaient des 8 semaines d'aménorrhée, des douleurs abdominales basses et par des saignements vaginaux a été géré pour la grossesse extra-utérine rompue et l’examen histologique a découvert une infection des trompes par le schistosome. Afr J Reprod Health 2014; 18[2]: 144-146).Mots clés: gestation extra-utérine, schistosomiase génital

Lifestyle and health factors associated with progressing and remitting trajectories of untreated lower urinary tract symptoms among elderly men.

BackgroundKnowledge of factors associated with the course of lower urinary tract symptoms (LUTS) before treatment is needed to inform preventive interventions. In a prospective study of elderly men untreated for LUTS, we identified factors associated with symptom progression and remission.MethodsIn community-dwelling US men aged ≥65 years, the American Urological Association Symptom Index (AUA-SI) was repeated four times, once at baseline (2000-2002) and then every 2 years thereafter. Analyses included 1740 men with all four AUA-SI assessments, who remained free from diagnosed prostate cancer, and who reported no treatment for LUTS or BPH during follow-up that averaged 6.9 (±0.4) years. LUTS change was determined with group-based trajectory modelingof the repeated AUA-SI measures. Multivariable logistic regression was then used to determine the baseline factors associated with progressing compared with stable trajectories, and with remitting compared with progressing trajectories. Lifestyle, body mass index (BMI) (kg/m(2)), mobility, mental health (Short-Form 12), medical history and prescription medications were considered for selection. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for variables in each model.ResultsWe identified 10 AUA-SI trajectories: 4 stable (1277 men, 73%), three progressing (345 men, 20%), two remitting (98 men, 6%) and one mixed (20 men, 1%). Men in progressing compared with stable trajectories were more likely to have mobility limitations (OR=2.0, 95% CI: 1.0-3.8), poor mental health (OR=1.9, 95% CI: 1.1-3.4), BMI≥25.0 kg m(-2) (OR=1.7, 95% CI: 1.0-2.8), hypertension (OR=1.5, 95% CI: 1.0-2.4) and back pain (OR=1.5, 95% CI: 1.0-2.4). Men in remitting compared with progressing trajectories more often used central nervous system medications (OR=2.3, 95% CI: 1.1-4.9) and less often had a history of problem drinking (OR=0.4, 95% CI: 0.2-0.9).ConclusionsSeveral non-urological lifestyle and health factors were independently associated with risk of LUTS progression in older men

Realizability of the Lorentzian (n,1)-Simplex

In a previous article [JHEP 1111 (2011) 072; arXiv:1108.4965] we have developed a Lorentzian version of the Quantum Regge Calculus in which the significant differences between simplices in Lorentzian signature and Euclidean signature are crucial. In this article we extend a central result used in the previous article, regarding the realizability of Lorentzian triangles, to arbitrary dimension. This technical step will be crucial for developing the Lorentzian model in the case of most physical interest: 3+1 dimensions. We first state (and derive in an appendix) the realizability conditions on the edge-lengths of a Lorentzian n-simplex in total dimension n=d+1, where d is the number of space-like dimensions. We then show that in any dimension there is a certain type of simplex which has all of its time-like edge lengths completely unconstrained by any sort of triangle inequality. This result is the d+1 dimensional analogue of the 1+1 dimensional case of the Lorentzian triangle.Comment: V1: 15 pages, 2 figures. V2: Minor clarifications added to Introduction and Discussion sections. 1 reference updated. This version accepted for publication in JHEP. V3: minor updates and clarifications, this version closely corresponds to the version published in JHE

Confluent Orthogonal Drawings of Syntax Diagrams

We provide a pipeline for generating syntax diagrams (also called railroad diagrams) from context free grammars. Syntax diagrams are a graphical representation of a context free language, which we formalize abstractly as a set of mutually recursive nondeterministic finite automata and draw by combining elements from the confluent drawing, layered drawing, and smooth orthogonal drawing styles. Within our pipeline we introduce several heuristics that modify the grammar but preserve the language, improving the aesthetics of the final drawing.Comment: GD 201

Do pre-diagnosis primary care consultation patterns explain deprivation-specific differences in net survival among women with breast cancer? An examination of individually-linked data from the UK West Midlands cancer registry, national screening programme and Clinical Practice Research Datalink.

BACKGROUND: In England and Wales breast cancer survival is higher among more affluent women. Our aim was to investigate the potential of pre-diagnostic factors for explaining deprivation-related differences in survival. METHODS: Individually-linked data from women aged 50-70 in the West Midlands region of England, diagnosed with breast cancer 1989-2006 and continuously eligible for screening, was retrieved from the cancer registry, screening service and Clinical Practice Research Datalink. Follow-up was to the end of July 2012. Deprivation was measured at small area level, based on the quintiles of the income domain of the English indices of deprivation. Consultation rates per woman per week, time from last breast-related GP consultation to diagnosis, and from diagnosis to first surgery were calculated. We estimated net survival using the non-parametric Pohar-Perme estimator. RESULTS: The rate of primary care consultations was similar during the 18 months prior to diagnosis in each deprivation group for breast and non-breast symptoms. Survival was lower for more deprived women from 4 years after diagnosis. Lower net survival was associated with more advanced extent of disease and being non-screen-detected. There was a persistent trend of lower net survival for more deprived women, irrespective of the woman's obesity, alcohol, smoking or comorbidity status. There was no significant variation in time from last breast symptom to diagnosis by deprivation. However, women in more deprived categories experienced significantly longer periods between cancer diagnosis and first surgery (mean = 21.5 vs. 28.4 days, p = 0.03). Those whose surgery occurred more than 12 weeks following their cancer diagnosis had substantially lower net survival. CONCLUSIONS: Our data suggest that although more deprived women with breast cancer display lifestyle factors associated with poorer outcomes, their consultation frequency, comorbidities and the breast cancer symptoms they present with are similar. We found weak evidence of extended times to surgical treatment among most deprived women who were not screen-detected but who presented with symptoms in primary care, which suggests that treatment delay may play a role. Further investigation of interrelationships between these variables within a larger dataset is warranted