Explaining trends in alcohol-related harms in Scotland 1991–2011 (II): policy, social norms, the alcohol market, clinical changes and a synthesis

Objective: To provide a basis for evaluating post-2007 alcohol policy in Scotland, this paper tests the extent to which pre-2007 policy, the alcohol market, culture or clinical changes might explain differences in the magnitude and trends in alcohol-related mortality outcomes in Scotland compared to England & Wales (E&W). Study design: Rapid literature reviews, descriptive analysis of routine data and narrative synthesis. Methods: We assessed the impact of pre-2007 Scottish policy and policy in the comparison areas in relation to the literature on effective alcohol policy. Rapid literature reviews were conducted to assess cultural changes and the potential role of substitution effects between alcohol and illicit drugs. The availability of alcohol was assessed by examining the trends in the number of alcohol outlets over time. The impact of clinical changes was assessed in consultation with key informants. The impact of all the identified factors were then summarised and synthesised narratively. Results: The companion paper showed that part of the rise and fall in alcohol-related mortality in Scotland, and part of the differing trend to E&W, were predicted by a model linking income trends and alcohol-related mortality. Lagged effects from historical deindustrialisation and socio-economic changes exposures also remain plausible from the available data. This paper shows that policy differences or changes prior to 2007 are unlikely to have been important in explaining the trends. There is some evidence that aspects of alcohol culture in Scotland may be different (more concentrated and home drinking) but it seems unlikely that this has been an important driver of the trends or the differences with E&W other than through interaction with changing incomes and lagged socio-economic effects. Substitution effects with illicit drugs and clinical changes are unlikely to have substantially changed alcohol-related harms: however, the increase in alcohol availability across the UK is likely to partly explain the rise in alcohol-related mortality during the 1990s. Conclusions: Future policy should ensure that alcohol affordability and availability, as well as socio-economic inequality, are reduced, in order to maintain downward trends in alcohol-related mortality in Scotland

Applications of aerospace technology in biology and medicine

Utilization of National Aeronautics and Space Administration (NASA) technology in medicine is discussed. The objective is best obtained by stimulation of the introduction of new or improved commercially available medical products incorporating aerospace technology. A bipolar donor/recipient model of medical technology transfer is presented to provide a basis for the team's methodology. That methodology is designed to: (1) identify medical problems and NASA technology that, in combination, constitute opportunities for successful medical products; (2) obtain the early participation of industry in the transfer process; and (3) obtain acceptance by the medical community of new medical products based on NASA technology. Two commercial transfers were completed: the Stowaway, a lightweight wheelchair that provides mobility for the disabled and elderly in the cabin of commercial aircraft, and Micromed, a portable medication infusion pump for the reliable, continuous infusion of medications such as heparin or insulin. The marketing and manufacturing factors critical to the commercialization of the lightweight walker incorporating composite materials were studied. Progress was made in the development and commercialization of each of the 18 currently active projects

An Empirical Chart Analysis of the Suitability of Telemedicine for Hospice Visits

This is the publisher's version, also available electronically from http://online.liebertpub.com/doi/abs/10.1089/tmj.2005.11.90.Telehospice® (TH) utilizes telemedicine technology to provide care at the end of life. A bistate project was launched in 1998 to study the use of home-based telemedicine for routine hospice care. Videophones were deployed for telenursing visits and evaluations by social workers. In order to determine what proportion of home hospice visits could be performed using currently available telemedicine technology, we reviewed clinical records retrospectively for hospice nurse home visits. Clinical notes documenting home nursing visits were obtained from two large hospices, one based in Kansas, and the other in Michigan. Records were randomly selected for patients who received hospice nurse visits during the month of January 2000. The charts were reviewed for patient demographic information, patient assessments, teaching activities, and interventions. Five hundred ninety-seven nursing notes were analyzed using an 85-item coding instrument. After careful review of the records, the coders also made a subjective observation regarding the suitability of each visit for telemedicine. As part of this analysis, we found that 64.5% of home hospice nursing visits could be performed by telemedicine. Using TH, it is possible to reduce the number of in-person visits, thereby significantly decreasing the cost of providing hospice care

An Estimation of Periconceptional Under-reporting of Dietary Energy Intake

Background The purpose of this cross-sectional study was to examine periconceptional misreporting of energy intake (EI) using the Willet food frequency questionnaire (WFFQ). Methods Women were recruited in the first trimester. Women completed a semi-quantitative WFFQ. Maternal body composition was measured using eight-electrode bioelectrical impedance analysis. Under-reporters were those whose ratio of EI to their calculated basal metabolic rate fell below the calculated plausible threshold for their physical activity category. Results The mean age was 30.1+5.3 years (n ¼ 524). The mean body mass index (BMI) was 25.4+5.6 kg/m2 , and 16.6% were obese (BMI 30.0 kg/m2 ). Under-reported EI was observed in 122 women (23.3%) with no over-reporters in the sample. Under-reporters were younger (P , 0.001), less likely to have a normal BMI (P ¼ 0.002) and more likely to be obese (P , 0.001) than plausible reporters. Under-reporters had higher percentage of body-fat and lower percentage of body fat-free mass (P , 0.001), were more likely to be at risk of relative deprivation (P ¼ 0.001) and reported a higher percentage of EI from carbohydrate (P ¼ 0.02) than plausible reporters. Conclusions Observed differences between under-reporters and plausible reporters suggest that the exclusion of these under-reporters represents an important potential source of bias in obesity research among women in the periconceptional period

Maternal Nutrient Intakes From Food and Drinks Consumed in Early Pregnancy in Ireland

Background: The aim of this observational study was to measure food, macronutrient and micronutrient intakes of women presenting for antenatal care and assess compliance with current nutritional recommendations

Relationship between fasting plasma glucose levels and maternal food group and macronutrient intakes in pregnancy

Aim Increased maternal body mass index (BMI) has been consistently associated with elevated blood glucose levels during pregnancy. Studies to date investigating the relationship between maternal blood glucose levels and dietary intake have shown mixed results. We investigated the association between maternal fasting plasma glucose (FPG) levels and food group and macronutrient intakes in the first trimester of pregnancy, after adjustment for maternal bodyweight. Methods Women were recruited after sonographic confirmation of an ongoing singleton pregnancy in the first trimester. Dietary information was collected using the validated Willett Food Frequency Questionnaire. Maternal height and weight were measured and BMI calculated. Body composition was measured using advanced bioelectrical impedance analysis. FPG levels were obtained for women who were selectively screened with a 75 g oral glucose tolerance test. Results No associations were observed between maternal FPG levels and food group or macronutrient intakes but higher energy and starch intakes were found in obese subjects (P = 0.009 and P = 0.03 respectively). On univariate analysis, higher FPG levels were associated positively with higher maternal bodyweight, BMI, body fat, fat free mass and visceral fat (all P \u3c 0.001). However, on multivariate regression analysis, higher FPG levels remained associated only with maternal BMI \u3e 29.9 kg/m2 (OR 7.4, P = 0.01). Conclusions Our findings indicate that maternal BMI is the key determinant of maternal glycaemia. Interventions which focus on overall energy restriction and especially the limitation of dietary starch to optimise prepregnancy maternal bodyweight are likely to be useful in improving glycaemic control in higher risk pregnancies

Intellectual ability in tuberous sclerosis complex correlates with predicted effects of mutations on TSC1 and TSC2 proteins.

BACKGROUND: Tuberous sclerosis complex is a multisystem genetic disease, caused by mutation in the TSC1 or TSC2 genes, associated with many features, including intellectual disability (ID). We examined psychometric profiles of patients with TSC1 or TSC2 mutations and tested whether different mutation types were associated with different degrees of intellectual ability. METHODS: One hundred subjects with known TSC1/TSC2 mutations were assessed using a range of IQ or developmental quotient (DQ) measures. Effects of mutations on TSC1/TSC2 proteins were inferred from sequence data and published biochemical studies. RESULTS: Most individuals with TSC1 mutations fell on a normal distribution identical to the general population, with ∼10% showing profound ID. Of individuals with TSC2 mutations, 34% showed profound ID, and the remainder a pattern of IQ/DQ more variable and shifted to the left than in TSC1 or the general population. Truncating TSC1 mutations were all predicted to be subject to nonsense-mediated mRNA decay. Mutations predicted to result in unstable protein were associated with less severe effects on IQ/DQ. There was a statistically significant negative correlation between length of predicted aberrant C-terminal tails arising from frameshift mutations in TSC1 and IQ/DQ; for TSC2 a positive but not statistically significant correlation was observed. CONCLUSION: We propose a model where (i) IQ/DQ correlates inversely with predicted levels and/or deleterious biochemical effects of mutant TSC1 or TSC2 protein, and (ii) longer aberrant C-terminal tails arising from frameshift mutations are more detrimental for TSC1 and less for TSC2. Predictions of the model require replication and biochemical testing.We thank the Tuberous Sclerosis Association, the Wales Gene Park, the National Research Foundation of South Africa and the Struengmann Fund for financial support. We thank Prof Chris Smith for helpful comments on the manuscript.This is the author accepted manuscript. The final version is available from the British Medical Journal via http://dx.doi.org/10.1136/jmedgenet-2015-10315

An Evaluation of The Effectiveness of Adaptive Histogram Equalization for Contrast Enhancement

Adaptive Histogram Equalization (AHE), a method of contrast enhancement which is sensitive to local spatial information in an image, has been proposed as a solution to the problem of the inability of ordinary display devices to depict the full dynamic intensity range in some medical images. This method is automatic, reproducible, and simultaneously displays most of the information contained in the grey-scale contrast of the image. However, it has not been known whether the use of AHE causes the loss of diagnostic information relative to the commonly-used method intensity windowing. In the current work, AHE and intensity windowing are compared using psychophysical observer studies. In studies performed at North Carolina Memorial Hospital, experienced radiologists were shown clinical CT images of the chest. Into some of the images, appropriate artificial lesion were introduced; the physicians were then shown the images processed with both AHE and intensity windowing. They were asked to assess the probability that as given image contained the artificial lesion, and their accurate was measured. The results of these experiments shown that for this particular diagnostic task, there was no significant difference in the ability of the two methods to depict luminance contrast; thus, further evaluation of AHE using controlled clinical trials is indicated

Ion Collisions in Very Strong Electric Fields

A Classical Trajectory Monte Carlo (CTMC) simulation has been made of processes of charge exchange and ionization between an hydrogen atom and fully stripped ions embedded in very strong static electric fields ($O(10^{10}$ V/m$)$), which are thought to exist in cosmic and laser--produced plasmas. Calculations show that the presence of the field affects absolute values of the cross sections, enhancing ionization and reducing charge exchange. Moreover, the overall effect depends upon the relative orientation between the field and the nuclear motion. Other features of a null-field situation, such as scaling laws, are revisited.Comment: Latex, 13 pages, 11 figures (available upon request), to be published in Journal of Physics