Nationwide implementation of the self-management program "Living well with COPD": Process and effectiveness evaluation using a mixed-methods approach.

To evaluate the nationwide implementation of the "Living well with COPD" program by the Swiss Lung Association in various cantons in Switzerland. For the process evaluation, we used qualitative (interview, focus group) and quantitative (questionnaires, documentation analysis) methods to assess the implementation outcomes reach, dose, fidelity and acceptability. For the effectiveness, we performed a pre-post analysis of patient data collected at baseline and program end (after 14 months). Seven Cantonal Lung Associations implemented the program into their services according to plan, conducted it 13 times and included 122 COPD patients. Patients' attendance rate was 81% and coaches' fidelity to protocol 94%. Acceptance and satisfaction of all involved persons was high. Integration of the coaches' additional workload, uncertainties regarding roles and responsibilities and sustainable reimbursement were major challenges. Patients significantly improved in COPD specific quality of life and increased exercise capacity with on average 3.2 more repetitions in the 1-minute sit-to-stand test. The program was successfully implemented throughout Switzerland with high acceptability and positive association with patients' quality of life. Our findings support the broader multiplication throughout Switzerland and serves the international community since it is one of the first nationwide implementations beyond study settings

The association of innate and adaptive immunity, subclinical atherosclerosis, and cardiovascular disease in the Rotterdam Study: A prospective cohort study

BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is driven by multifaceted contributions of the immune system. However, the dysregulation of immune cells that leads to ASCVD is poorly understood. We determined the association of components of innate and adaptive immunity longitudinally with ASCVD, and assessed whether arterial calcifications play a role in this association. METHODS AND FINDINGS: Granulocyte (innate immunity) and lymphocyte (adaptive immunity) counts were determined 3 times (2002-2008, mean age 65.2 years; 2009-2013, mean age 69.0 years; and 2014-2015, mean age 78.5 years) in participants of the population-based Rotterdam Study without ASCVD at baseline. Participants were followed-up for ASCVD or death until 1 January 2015. A random sample of 2,366 underwent computed tomography at baseline to quantify arterial calcification volume in 4 vessel beds. We studied the association between immunity components with risk of ASCVD and assessed whether immunity components were related to arterial calcifications at baseline. Of 7,730 participants (59.4% women), 801 developed ASCVD during a median follow-up of 8.1 years. Having an increased granulocyte count increased ASCVD risk (adjusted hazard ratio for doubled granulocyte count [95% CI] = 1.78 [1.34-2.37], P < 0.001). Higher granulocyte counts were related to larger calcification volumes in all vessels, most prominently in the coronary arteries (mean difference in calcium volume [mm3] per SD increase in granulocyte count [95% CI] = 32.3 [9.9-54.7], P < 0.001). Respectively, the association between granulocyte count and incident coronary heart disease and stroke was partly mediated by coronary artery calcification (overall proportion mediated [95% CI] = 19.0% [-10% to 32.3%], P = 0.08) and intracranial artery calcification (14.9% [-10.9% to 19.1%], P = 0.05). A limitation of our study is that studying the etiology of ASCVD remains difficult within an epidemiological setting due to the limited availability of surrogates for innate and especially adaptive immunity. CONCLUSIONS: In this study, we found that an increased granulocyte count was associated with a higher risk of ASCVD in the general population. Moreover, higher levels of granulocytes were associated with larger volumes of arterial calcification. Arterial calcifications may explain a proportion of the link between granulocytes and ASCVD

Feasibility and Safety of Multicenter Tissue and Biofluid Sampling for α-Synuclein in Parkinson's Disease: The Systemic Synuclein Sampling Study (S4)

BACKGROUND: α-synuclein is a lead Parkinson's disease (PD) biomarker. There are conflicting reports regarding accuracy of α-synuclein in different tissues and biofluids as a PD biomarker, and the within-subject anatomical distribution of α-synuclein is not well described. The Systemic Synuclein Sampling Study (S4) aims to address these gaps in knowledge. The S4 is a multicenter, cross-sectional, observational study evaluating α-synuclein in multiple tissues and biofluids in PD and healthy controls (HC). OBJECTIVE: To describe the baseline characteristics of the S4 cohort and safety and feasibility of this study. METHODS: Participants underwent motor and non-motor clinical assessments, dopamine transporter SPECT, biofluid collection (cerebrospinal fluid, saliva, and blood), and tissue biopsies (skin, sigmoid colon, and submandibular gland). Biopsy adequacy was determined based on presence of adequate target tissue. Tissue sections were stained with the 5C12 monoclonal antibody against unmodified α-synuclein. All specimens were acquired and processed in a standardized manner. Adverse events were systematically recorded. RESULTS: The final cohort consists of 82 participants (61 PD, 21 HC). In 68 subjects (83%), all types of specimens were obtained but only 50 (61%) of subjects had all specimens both collected and evaluable for α-synuclein. Mild adverse events were common, especially for submandibular gland biopsy, but only 1 severe adverse event occurred. CONCLUSION: Multicenter tissue and biofluid sampling for α-synuclein is feasible and generally safe. S4 will inform understanding of the concurrent distribution of α-synuclein pathology and biomarkers in biofluids and peripheral nervous system in PD

Alzheimer’s disease as a multistage process: an analysis from a population-based cohort study

In cancer research, multistage models are used to assess the multistep process that leads to the onset of cancer. In view of biological and clinical similarities between cancer and dementia, we used these models to study Alzheimer's disease (AD). From the population-based Rotterdam Study, we included 9,362 non-demented participants, of whom 1,124 developed AD during up to 26 years of follow-up. Under a multistage model, we regressed the logarithm of AD incidence rate against the logarithm of five-year age categories. The slope in this model reflects the number of steps (n-1) required for disease onset before the final step leading to disease manifestation. A linear relationship between log incidence rate and log age was observed, with a slope of 12.82 (95% confidence interval: 9.01-16.62), equivalent to 14 steps. We observed fewer steps for those at high genetically determined risk: 12 steps for APOE-ε4 carriers, and 10 steps for those at highest genetic risk based on APOE and a genetic risk score. The pathogenesis of AD complies with a multistage disease-model, requiring 14 steps before disease manifestation. Genetically predisposed individuals require fewer steps indicating that they already inherited multiple of these steps. Unravelling these steps in AD pathogenesis could benefit the development of intervention strategies

Variation in vegetation cover and seedling performance of tree species in a forest-savanna ecotone

Differential tree seedling recruitment across forest-savanna ecotones is poorly understood, but hypothesized to be influenced by vegetation cover and associated factors. In a 3-y-long field transplant experiment in the forest-savanna ecotone of Ghana, we assessed performance and root allocation of 864 seedlings for two forest (Khaya ivorensis and Terminalia superba) and two savanna (Khaya senegalensis and Terminalia macroptera) species in savanna woodland, closed-woodland and forest. Herbaceous vegetation biomass was significantly higher in savanna woodland (1.0 ± 0.4 kg m-2 vs 0.2 ± 0.1 kg m-2 in forest) and hence expected fire intensities, while some soil properties were improved in forest. Regardless, seedling survival declined significantly in the first-year dry-season for all species with huge declines for the forest species (50% vs 6% for Khaya and 16% vs 2% for Terminalia) by year 2. After 3 y, only savanna species survived in savanna woodland. However, best performance for savanna Khaya was in forest, but in savanna woodland for savanna Terminalia which also had the highest biomass fraction (0.8 ± 0.1 g g-1 vs 0.6 ± 0.1 g g-1 and 0.4 ± 0.1 g g-1) and starch concentration (27% ± 10% vs 15% ± 7% and 10% ± 4%) in roots relative to savanna and forest Khaya respectively. Our results demonstrate that tree cover variation has species-specific effects on tree seedling recruitment which is related to root storage functions.</p

Variation in vegetation cover and seedling performance of tree species in a forest-savanna ecotone

Differential tree seedling recruitment across forest-savanna ecotones is poorly understood, but hypothesized to be influenced by vegetation cover and associated factors. In a 3-y-long field transplant experiment in the forest-savanna ecotone of Ghana, we assessed performance and root allocation of 864 seedlings for two forest (Khaya ivorensis and Terminalia superba) and two savanna (Khaya senegalensis and Terminalia macroptera) species in savanna woodland, closed-woodland and forest. Herbaceous vegetation biomass was significantly higher in savanna woodland (1.0 ± 0.4 kg m-2 vs 0.2 ± 0.1 kg m-2 in forest) and hence expected fire intensities, while some soil properties were improved in forest. Regardless, seedling survival declined significantly in the first-year dry-season for all species with huge declines for the forest species (50% vs 6% for Khaya and 16% vs 2% for Terminalia) by year 2. After 3 y, only savanna species survived in savanna woodland. However, best performance for savanna Khaya was in forest, but in savanna woodland for savanna Terminalia which also had the highest biomass fraction (0.8 ± 0.1 g g-1 vs 0.6 ± 0.1 g g-1 and 0.4 ± 0.1 g g-1) and starch concentration (27% ± 10% vs 15% ± 7% and 10% ± 4%) in roots relative to savanna and forest Khaya respectively. Our results demonstrate that tree cover variation has species-specific effects on tree seedling recruitment which is related to root storage functions.</p

Fontes de carboidratos e ionóforo em dietas contendo óleo vegetal para ovinos: digestibilidade, balanço de nitrogênio e fluxo portal de nutrientes Carbohydrate sources and ionophore in sheep diets with vegetal oil: digestibility, nitrogen balance and portal flux of nutrients

Os objetivos neste trabalho foram avaliar a utilização de duas fontes de carboidratos (casca de soja e milho), com a utilização ou não de monensina em dietas com alta densidade lipídica, e seus efeitos sobre a digestibilidade dos nutrientes, o balanço de nitrogênio e o fluxo portal de nutrientes em ovinos. Adotou-se o método de coleta total de fezes e urina para determinação da digestibilidade e do balanço de nitrogênio. O fluxo líquido de nutrientes foi calculado pelo princípio de Fick. Foram utilizados quatro ovinos (54 kg de PV) da raça Corriedale com três cateteres implantados (veia e artéria mesentérica e veia porta). A ingestão, a excreção fecal, a digestão e a digestibilidade de MS, MO e EE não foram influenciadas pelos tratamentos. A ingestão, a digestão e a digestibilidade da FDN foram maiores para as dietas com casca de soja (757,0; 531,1 g/dia e 70,2%) que para aquelas com milho (392,3; 199,9 g/dia e 51,0%), enquanto a dos carboidratos não-fibrosos (CNF), foram maiores para as dietas com milho (474,6, 416,8 g/dia e 87,8%) que para aquelas com casca de soja (148,0; 97,8 g/dia e 66,1%). A concentração de energia expressa como NDT foi maior nas dietas com milho (80,2%) que naquelas com casca de soja (76,7%). Não houve efeito da utilização da monensina nos parâmetros de digestibilidade e balanço de nitrogênio. A excreção fecal da proteína foi menor e a digestibilidade maior para as dietas com milho. A concentração portal e arterial de nitrogênio alfa amino (N alfa-amino) foi menor para as dietas com monensina (3,161 e 2,922 e 3,530 e 3,218 mM, respectivamente). A concentração portal (0,419 vs 0,516 mM), a diferença venosa-arterial (0,230 vs 0,317 mM) e o fluxo portal de amônia (26,119 vs 37,041 mM/h) foram menores para as dietas com milho.<br>The objectives of this trial were to evaluate the effects of two carbohydrate sources (soybean hulls and corn grain) with and without monensin on digestibility, nitrogen balance and portal nutrient flux in sheep fed high vegetable oil diets. Four Corriedale wethers averaging 54 kg of body weight and fitted with catheters in the mesenteric and portal veins and also in the mesenteric artery were used. Digestibility and nitrogen balance were determined using total collection of feces and urine. Net nutrient flux was calculated using the Fick principle. Intake, fecal excretion, digestion and digestibility of dry matter (DM), organic matter (OM) and ether extract (EE) were not affected by treatments. However, intake, digestion and digestibility of neutral detergent fiber (NDF) were higher when animals were fed soybean hulls (757.0 g/d, 531.1 g/d and 70.2%) rather than corn grain (392.3, 199.9 g/d and 51.0%). Conversely, intake, digestion and digestibility of nonfiber carbohydrates (NFC) as well as TDN content were greater on corn (474.6 g/d, 416.8 g/d, 87.8%, 80.2%) than on soybean hulls diets (148.0 g/d, 97.8 g/d and 66.1%, 76.7%). There was no effect of monensin on nutrient digestibility and nitrogen balance. Fecal excretion of protein was lower and protein digestibility was higher for corn diets. Alpha-amino-nitrogen concentration in arterial and portal plasma was lower for diets supplemented with monensin (3.161 and 2.922 mM) compared to non-supplemented monsesin diets (3.530 and 3.218 mM), respectively. Portal concentration (0.419 vs. 0.516 mM), venous-arterial difference (0.230 vs. 0.317 mM), and portal flux (26.119 vs. 37.041 mM/h) of ammonia were all lower on corn diets

Níveis de lisina com dois balanços eletrolíticos para frangos de corte na fase de crescimento (22 a 40 dias) Lysine level with two electrolytes balance for broiler chickens in the growing phase (22 a 40 day)

Objetivou-se avaliar os níveis de lisina para frangos de corte na fase de crescimento (22 a 40 dias de idade) utilizando-se dois balanços eletrolíticos. Foram utilizados 640 frangos de corte machos de 21 dias de idade, linhagem Cobb, distribuídos em delineamento inteiramente casualizado, em esquema fatorial 5 × 2, composto de cinco níveis de lisina (1,062, 20, 40 e 60% acima e 20% abaixo do recomendado) e dois balanços eletrolíticos (190 e 255 mEq/kg), com quatro repetições e 16 aves por unidade experimental. Não foi observada interação das variáveis estudadas, porém, os níveis de lisina influenciaram o peso final, o ganho de peso e a conversão alimentar e afetaram de forma linear o consumo de ração. Os melhores ajustes foram observados quando se utilizou o modelo descontinuo LRP, no qual valores acima de 1,089 e 1,14% de lisina não melhoraram o ganho de peso e tampouco a conversão alimentar. Entre os parâmetros sangüíneos avaliados, apenas o ácido úrico foi influenciado pelos níveis de lisina. Os rendimentos de carcaça e de cortes nobres não diferiram significativamente entre os níveis de lisina e os balanços eletrolíticos, contudo, a gordura abdominal foi influenciada pelo balanço eletrolítico da dieta. Níveis acima de 1,089 e 1,14% de lisina, respectivamente, não melhoram o desempenho das aves. Os níveis de lisina testados não influenciaram o rendimento de carcaça nem de cortes nobres.<br>The lysine levels for chickens in the growing phase (22 to 40 days of age) by using two different electrolytes balance were evaluated. Sixty-four hundred Cobb broiler male of 21 days old were allotted to a completely randomized design as a factorial arrangement of treatments, five lysine levels (1.062, 20, 40, and 60% above and 20% below of recommended levels) and two electrolytes balance (190 and 255 mEq/kg), with four replicates and 16 broilers for experimental unit. There was no interaction among the variables studied, however the lysine levels affected final weight, weight gain and the feed:gain ratio and feed intake, however, the best adjustments were observed when the discontinue LRP model was used, where values above 1.089 and 1.14% of lysine did not increase weight gain and feed:gain ratio. Concerning the blood parameters, only uric acid was affected by lysine levels, but no difference was observed for carcass and prime cuts yield, the abdominal fat was influenced by the dietary electrolyte balance. Lysine levels above 1.089 and 1.14 for weight gain and feed:gain ratio, respectively, did not impair broiler performance. The lysine levels affected neither carcass yield and nor prime cuts yield