The effects of drinks made from simple sugars on blood pressure in healthy older people

The objective of the research was to determine the blood pressure (BP) lowering effects in older people of 50 g carbohydrate drinks with varying carbohydrate content using a randomised, cross-over study with ten (six females) healthy older subjects (mean age 72·20 (SEM 1·50) years). BP, heart rate and glucometer-derived blood glucose levels were determined at baseline and following the ingestion of equal volumes (300 ml) of water and carbohydrate drinks with varying nutrient content (glucose, sucrose and fructose). A significant decline in BP over the first 60 min was seen following glucose (systolic BP (SBP) P,0·01, diastolic BP (DBP) P,0·01, mean arterial BP (MAP) P¼0·03) and sucrose (SBP P,0·01, DBP P,0·01, MAP P,0·01) ingestion, although the decrease occurred earlier after glucose than sucrose ingestion (SBP 7·33 (SEM 2·19) v. 21·00 (SEM 4·30) min (P¼0·03) and MAP 11·22 (SEM 3·10) v. 17·00 (SEM 3·78) min (P¼0·03)). BP increased after water ingestion (SBP P¼0·04, DBP P¼0·18, MAP P¼0·02) but did not change after fructose ingestion (SBP P¼0·36, DBP P¼0·81, MAP P¼0·34). Post hoc analyses revealed that the BP (SBP, DBP and MAP) decrease following glucose and sucrose ingestion were similar but significantly greater than following fructose or water ingestion. Sucrose, which is used widely (table sugar), reduces BP as much as glucose. In contrast to this, fructose ingestion causes no change in BP. Further studies are required to determine if the substitution of glucose or sucrose with fructose may be beneficial in the medical management of older people with severe symptomatic postprandial hypotension.R. Visvanathan, R. Chen, M. Garcia, M. Horowitz and I. Chapma

Optical Polarization of 52 Radio-Loud QSOs and BL Lac Objects

Polarization measurements are presented for 52 radio-loud QSOs and BL Lac objects. For 9 highly polarized (p >3%) AGN, these are the first published polarization measurements. Of these 9, 7 are highly-polarized QSOs (HPQs), one is a BL Lac object and another is a likely BL Lac object. Polarization variability is confirmed for some of these new and previously known highly-polarized AGN. While 6 of the HPQs have flat radio spectra are almost certainly blazars, PKS 1452-217 is probably a new member of the rare class of radio-loud QSOs that show high polarization by scattering, and is therefore important for testing orientation Unified Schemes. In competition for the highest redshift HPQ are the well-observed QSO PKS 0438-43 at z = 2.85, with maximum p = 4.7%, and PKS 0046-315 at z = 2.72, for which we find p = 13%.Comment: 6 pages. Astronomical Journal, in pres

Markers of inflammation and bone remodelling associated with improvement in clinical response measures in psoriatic arthritis patients treated with golimumab

<p>Objective To determine serum biomarker associations with clinical response to golimumab treatment in patients with psoriatic arthritis (PsA).</p> <p>Methods GO–REVEAL was a randomised, placebo-controlled study of golimumab in patients with active PsA. Samples were collected from 100 patients at baseline, week 4 and week 14, and analysed for serum-based biomarkers and protein profiling (total 92 markers); data were correlated with clinical measures at week 14.</p> <p>Results Serum levels of a subset of proteins (apolipoprotein C III, ENRAGE, IL-16, myeloperoxidase, vascular endothelial growth factor, pyridinoline, matrix metalloproteinase 3, C-reactive protein (CRP), carcinoembryonic antigen, intercellular adhesion molecule 1 and macrophage inflammatory protein 1α) at baseline or week 4 were strongly associated with American College of Rheumatology 20% improvement (ACR20) response and/or disease activity score in 28 joints (DAS28) at week 14. A smaller subset of proteins was significantly associated with a 75% improvement in the psoriasis area and severity index score (PASI75) at week 14, (adiponectin, apolipoprotein CIII, serum glutamic oxaloacetic transaminase, and tumour necrosis factor α). Subsets of proteins were identified as potentially predictive of clinical response for each of the clinical measures, and the power of these biomarker panels to predict clinical response to golimumab treatment was stronger than for CRP alone.</p> <p>Conclusions This analysis provides insight into several panels of markers that may have utility in identifying PsA patients likely to have ACR20, DAS28, or PASI75 responses following golimumab treatment.</p&gt

Comparative effects of glucose and water drinks on blood pressure and cardiac function in older subjects with and without postprandial hypotension

Postprandial hypotension (PPH) occurs frequently and is thought to reflect an inadequate increase in cardiac output to compensate for the rise in splanchnic blood flow after a meal. Gastric distension by water attenuates the postprandial fall in blood pressure (BP). Cardiac hemodynamics (stroke volume (SV), cardiac output (CO), and global longitudinal strain (GLS)) have hitherto not been measured in PPH We sought to determine the comparative effects of water and glucose drinks on cardiac hemodynamics in healthy older subjects and individuals with PPH Eight healthy older subjects (age 71.0 ± 1.7 years) and eight subjects with PPH (age 75.5 ± 1.0 years) consumed a 300 mL drink of either water or 75 g glucose (including 150 mg 13C-acetate) in randomized order. BP and heart rate (HR) were measured using an automatic device, SV, CO, and GLS by transthoracic echocardiography and gastric emptying by measurement of 13CO2 In both groups, glucose decreased systolic BP (P < 0.001) and increased HR, SV, and CO (P < 0.05 for all). The fall in systolic BP was greater (P < 0.05), and increase in HR less (P < 0.05), in the PPH group, with no difference in SV or CO Water increased systolic BP (P < 0.05) in subjects with PPH and, in both groups, decreased HR (P < 0.05) without affecting SV, CO, or GLS In subjects with PPH, the hypotensive response to glucose and the pressor response to water were related (R = -0.75, P < 0.05). These observations indicate that, in PPH, the hypotensive response to oral glucose is associated with inadequate compensatory increases in CO and HR, whereas the pressor response to water ingestion is maintained and, possibly, exaggerated.Laurence G. Trahair, Sharmalar Rajendran, Renuka Visvanathan, Matthew Chapman, Daniel Stadler, Michael Horowitz and Karen L. Jone

Perspectives of frailty and frailty screening: Protocol for a collaborative knowledge translation approach and qualitative study of stakeholder understandings and experiences

Accompanying the unprecedented growth in the older adult population worldwide is an increase in the prevalence of frailty, an age-related clinical state of increased vulnerability to stressor events. This increased vulnerability results in lower social engagement and quality of life, increased dependency, and higher rates of morbidity, health service utilization and mortality. Early identification of frailty is necessary to guide implementation of interventions to prevent associated functional decline. Consensus is lacking on how to clinically recognize and manage frailty. It is unknown how healthcare providers and healthcare consumers understand and perceive frailty, whether or not they regard frailty as a public health concern; and information on the indirect and direct experiences of consumer and healthcare provider groups towards frailty are markedly limited.We will conduct a qualitative study of consumer, practice nurse, general practitioner, emergency department physician, and orthopedic surgeons' perspectives of frailty and frailty screening in metropolitan and non-metropolitan South Australia. We will use tailored combinations of semi-structured interviews and arts-based data collection methods depending on each stakeholder group, followed by inductive and iterative analysis of data using qualitative description.Using stakeholder driven approaches to understanding and addressing frailty and frailty screening in context is critical as the prevalence and burden of frailty is likely to increase worldwide. We will use the findings from the Perceptions of Frailty and Frailty Screening study to inform a context-driven identification, implementation and evaluation of a frailty-screening tool; drive awareness, knowledge, and skills development strategies across stakeholder groups; and guide future efforts to embed emerging knowledge about frailty and its management across diverse South Australian contexts using a collaborative knowledge translation approach. Study findings will help achieve a coordinated frailty and healthy ageing strategy with relevance to other jurisdictions in Australia and abroad, and application of the stakeholder driven approach will help illuminate how its applicability to other jurisdictions.Mandy M. Archibald, Rachel Ambagtsheer, Justin Beilby, Mellick J. Chehade, Tiffany K. Gill, Renuka Visvanathan, and Alison L. Kitso

An Old Cluster in NGC 6822

We present spectroscopy of two clusters in the dwarf irregular galaxy NGC 6822. From these we deduce an age for Cluster VII of 11 Gyr and [Fe/H] = -1.95 +/- 0.15 dex. Cluster VII appears to be an analog of the metal-poor galactic globular clusters. Cluster VI is found to be much younger and more metal rich, with an age of approximately 2 Gyr. Its derived metallicity, [Fe/H], of approximately -1.0 dex is comparable to that of the gas seen today in NGC 6822. The existence of a metal-poor old cluster in NGC 6822 rules out models for the chemical evolution of this galaxy with significant prompt initial enhancement. We find that a star formation rate which is constant with time and is within a factor of two of the present star formation rate can reproduce the two points on the age-metallicity relationship for NGC 6822 over the past 10 Gyr defined by these two clusters.Comment: 8 pages; accepted for publication in A

The Red-Sequence Luminosity Function in Galaxy Clusters since z~1

We use a statistical sample of ~500 rich clusters taken from 72 square degrees of the Red-Sequence Cluster Survey (RCS-1) to study the evolution of ~30,000 red-sequence galaxies in clusters over the redshift range 0.35<z<0.95. We construct red-sequence luminosity functions (RSLFs) for a well-defined, homogeneously selected, richness limited sample. The RSLF at higher redshifts shows a deficit of faint red galaxies (to M_V=> -19.7) with their numbers increasing towards the present epoch. This is consistent with the `down-sizing` picture in which star-formation ended at earlier times for the most massive (luminous) galaxies and more recently for less massive (fainter) galaxies. We observe a richness dependence to the down-sizing effect in the sense that, at a given redshift, the drop-off of faint red galaxies is greater for poorer (less massive) clusters, suggesting that star-formation ended earlier for galaxies in more massive clusters. The decrease in faint red-sequence galaxies is accompanied by an increase in faint blue galaxies, implying that the process responsible for this evolution of faint galaxies is the termination of star-formation, possibly with little or no need for merging. At the bright end, we also see an increase in the number of blue galaxies with increasing redshift, suggesting that termination of star-formation in higher mass galaxies may also be an important formation mechanism for higher mass ellipticals. By comparing with a low-redshift Abell Cluster sample, we find that the down-sizing trend seen within RCS-1 has continued to the local universe.Comment: ApJ accepted. 11 pages, 5 figure

Low energy trauma in older persons: where to next?

The global population is increasing rapidly with older persons accounting for the greatest proportion. Associated with this rise is an increased rate of injury, including polytrauma, for which low energy falls has become the main cause. The resultant growing impact on trauma resources represents a major burden to the health system. Frailty, with its related issues of cognitive dysfunction and sarcopenia, is emerging as the unifying concept that relates both to the initial event and subsequent outcomes. Strategies to better assess and manage frailty are key to both preventing injury and improving trauma outcomes in the older population and research that links measures of frailty to trauma outcomes will be critical to informing future directions and health policy. The introduction of “Geriatric Emergency Departments” and the development of “Fracture Units” for frail older people will facilitate increased involvement of Geriatricians in trauma care and aid in the education of other health disciplines in the core principles of geriatric assessment and management. Collectively these should lead to improved care and outcomes for both survivors and those requiring end of life decisions and palliation.Mellick Chehade, Tiffany K Gill, Renuka Visvanatha