Africa’s oesophageal cancer corridor: geographic variations in incidence correlate with certain micronutrient deficiencies

Background The aetiology of Africa’s easterly-lying corridor of squamous cell oesophageal cancer is poorly understood. Micronutrient deficiencies have been implicated in this cancer in other areas of the world, but their role in Africa is unclear. Without prospective cohorts, timely insights can instead be gained through ecological studies. Methods Across Africa we assessed associations between a country’s oesophageal cancer incidence rate and food balance sheet-derived estimates of mean national dietary supplies of 7 nutrients: calcium (Ca), copper (Cu), iron (Fe), iodine (I), magnesium (Mg), selenium (Se) and zinc (Zn). We included 32 countries which had estimates of dietary nutrient supplies and of better-quality GLOBCAN 2012 cancer incidence rates. Bayesian hierarchical Poisson lognormal models were used to estimate incidence rate ratios for oesophageal cancer associated with each nutrient, adjusted for age, gender, energy intake, phytate, smoking and alcohol consumption, as well as their 95% posterior credible intervals (CI). Adult dietary deficiencies were quantified using an estimated average requirements (EAR) cut-point approach. Results Adjusted incidence rate ratios for oesophageal cancer associated with a doubling of mean nutrient supply were: for Fe 0.49 (95% CI: 0.29–0.82); Mg 0.58 (0.31–1.08); Se 0.40 (0.18–0.90); and Zn 0.29 (0.11–0.74). There were no associations with Ca, Cu and I. Mean national nutrient supplies exceeded adult EARs for Mg and Fe in most countries. For Se, mean supplies were less than EARs (both sexes) in 7 of the 10 highest oesophageal cancer ranking countries, compared to 23% of remaining countries. For Zn, mean supplies were less than the male EARs in 8 of these 10 highest ranking countries compared to in 36% of other countries

Massachusetts Education Partnership: Policy, Leadership, Labor-Management Collaboration

The Massachusetts Education Partnership (MEP) is a collaborative endeavor on the part of four education-related organizations representing teachers, superintendents, and school committees and four research institutions. By working together, the Partnership aims to improve student achievement through labor-management collaboration and to foster the development of collaborative cultures in Massachusetts school districts. As of March 1, 2014, the MEP has trained labor and management leaders from 34 school districts in interest-based bargaining (IBB) and provided intensive facilitation to seven school districts where labor and management are working collaboratively on a program or issue of their choosing

MassResults – Building a more effective, accountable, and open state government

Through strategic plans, performance reports, and a program-based performance budget, the Patrick administration is using data to manage, making government more transparent and accountable. Working with the Executive Office of Administration & Finance, and partnering with the Commonwealth Performance, Accountability and Transparency office, the Collins Center at UMass Boston has been charged with implementing the MassResults program throughout the executive branch

Excess Post-Exercise Oxygen Consumption (Epoc) Following Multiple Effort Sprint and Moderate Aerobic Exercise

The purpose of this study was to investigate the effects of 30-second all-out sprint interval exercise (SIE) vs. moderate aerobic exercise (MA) on excess post-exercise oxygen consumption (EPOC). Six recreationally-trained males (age=23.3 +/- 1.4 yrs, weight=81.8 +/- 9.9 kg, height=180.8 +/- 6.3 cm) completed a sprint interval exercise session consisting of three repeated 30-second Wingate cycling tests separated by four minutes (duration similar to 11minutes) as well as a moderate aerobic exercise session consisting of 30-minute cycling at 60% heart rate reserve (HRR) in a random counterbalanced design. Baseline oxygen consumption (VO2) was determined by an average VO2 from the final five minutes of a 30-minute supine rest period prior to each trial. Following each protocol, VO2 was measured for 30 minutes or until baseline measures were reached. EPOC was determined by subtracting baseline VO2 from post-exercise VO2 measurements. Energy expenditure (kJ) was determined by multiplying kJ per liter of oxygen by the average VO2 during recovery. EPOC values were significantly higher in SIE (7.5 +/- 1.3 L) than MA (1.8 +/- 0.7 L). SIE produced a higher recovery caloric expenditure (156.9 kJ) compared to MA (41.0 kJ) and remained significantly elevated (p=.024) over resting levels during the entire recovery period (30 minutes) compared to MA (6 minutes, p=.003). The energy required to recover from three repeated maximal effort 30-second Wingate cycling tests was greater than 30 minutes of moderate aerobic exercise. Future studies should examine the chronic effects of maximal effort sprint training protocol on cardiovascular fitness and body composition

Reliability of the Dynavision (TM) D2 for Assessing Reaction Time Performance

Recently, the Dynavision (TM) D2 Visuomotor Training Device (D2) has emerged as a tool in the assessment of reaction time (RT); however, information regarding the reliability of the D2 have been limited, and to date, reliability data have been limited to non-generalizable samples. Therefore, the purpose of this study was to establish intraclass correlation coefficients (ICC2,1) for the D2 that are generalizable across a population of recreationally active young adults. Forty-two recreationally active men and women (age: 23.41 +/- 4.84 years; height: 1.72 +/- 0.11 m; mass: 76.62 +/- 18.26 Kg) completed 6 trials for three RT tasks of increasing complexity. Each trial was separated by at least 48-hours. A repeated measures ANOVA was used to detect differences in performance across the six trials. Intraclass correlation coefficients (ICC2,1) standard error of measurement (SEM), and minimal differences (MD) were used to determine the reliability of the D2 from the two sessions with the least significant difference score. Moderate to strong reliability was demonstrated for visual RT (ICC2,1: 0.84, SEM: 0.033), and reactive ability in both Mode A and Mode B tasks (Mode A hits: ICC2,1: 0.75, SEM: 5.44; Mode B hits: ICC2,1: 0.73, SEM: 8.57). Motor RT (ICC2,1: 0.63, SEM: 0.035s) showed fair reliability, while average RT per hit for Modes A and B showed moderate reliability (ICC2,1: 0.68, SEM: 0.43 s and ICC2,1: 0.72, SEM: 0.03 s respectively). It appears that one familiarization trial is necessary for the choice reaction time (CRT) task while three familiarization trials are necessary for reactive RT tasks. In conclusion, results indicate that the Dynavision (TM) D2 is a reliable device to assess neuromuscular reactivity given that an adequate practice is provided. The data presented are generalizable to a population of recreationally active young adults

Reliability of the Woodway Curve (TM) Non-Motorized Treadmill for Assessing Anaerobic Performance

A curved treadmill offers a practical method of assessing anaerobic power by enabling unrestricted running motion and greater sport specificity. The purpose of this research was to determine reliability of a curved treadmill (cTM) sprint test and to compare performance measures to the traditional Wingate anaerobic power test (WAnT) performed on a cycle ergometer. Thirty-two recreationally active men and women (22.4 +/- 2.8 yrs; 1.73 +/- 0.08 m; 74.2 +/- 13.2 kg) performed four familiarization trials on cTM, followed by two randomly assigned experimental trials consisting of one 30-second maximum effort on either cTM or WAnT. Each trial was separated by at least 48 hours. Repeated measures analysis of variance (ANOVA), interclass correlations (ICC), standard error of measurement (SEM), and minimal differences (MD) were used to determine reliability of familiarization trials on cTM, and Pearson product moment correlations were calculated to compare cTM and WAnT. ANOVA results showed significant differences (p \u3c 0.05) during the four familiarization trials. Post hoc analysis showed significant differences (p \u3c 0.05) between the first two trials. Familiarization trials 3 and 4 showed a high reliability for each performance variable (distance: ICC2,1 = 0.969, %SEM = 2.645, p = 0.157; mean velocity: ICC2,1 = 0.969, %SEM = 2.622, p = 0.173; peak velocity: ICC2,1 = 0.966, %SEM = 3.142, p = 0.033; mean power: ICC2,1 = 0.940, %SEM = 4.140, p = 0.093; and peak power: ICC2,1 = 0.887, %SEM = 11.244, p = 0.669). Participants elicited an average peak power of 1050.4 +/- 338.5 Watts on cTM and 1031.4 +/- 349.8 Watts on WAnT. Pearson product moment coefficients indicated high correlations between peak power, mean power, and peak velocity (r = 0.75, p \u3c 0.001; r = 0.84, p \u3c 0.001; and r = 0.76, p \u3c 0.001, respectively) derived from cTM and WAnT. In conclusion, results suggest that after two familiarization trials, cTM is a reliable sprint test for recreationally active men and women. In addition, there are strong relationships between cTM and WAnT in assessing anaerobic performance

Inapparent infections and cholera dynamics

In many infectious diseases, an unknown fraction of infections produce symptoms mild enough to go unrecorded, a fact that can seriously compromise the interpretation of epidemiological records. This is true for cholera, a pandemic bacterial disease, where estimates of the ratio of asymptomatic to symptomatic infections have ranged from 3 to 100 (refs 1-5). In the absence of direct evidence, understanding of fundamental aspects of cholera transmission, immunology and control has been based on assumptions about this ratio and about the immunological consequences of inapparent infections. Here we show that a model incorporating high asymptomatic ratio and rapidly waning immunity, with infection both from human and environmental sources, explains 50 yr of mortality data from 26 districts of Bengal, the pathogen's endemic home. We find that the asymptomatic ratio in cholera is far higher than had been previously supposed and that the immunity derived from mild infections wanes much more rapidly than earlier analyses have indicated. We find, too, that the environmental reservoir(5,6) (free-living pathogen) is directly responsible for relatively few infections but that it may be critical to the disease's endemicity. Our results demonstrate that inapparent infections can hold the key to interpreting the patterns of disease outbreaks. New statistical methods(7), which allow rigorous maximum likelihood inference based on dynamical models incorporating multiple sources and outcomes of infection, seasonality, process noise, hidden variables and measurement error, make it possible to test more precise hypotheses and obtain unexpected results. Our experience suggests that the confrontation of time-series data with mechanistic models is likely to revise our understanding of the ecology of many infectious diseases.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/62519/1/nature07084.pd

Smoking reduces surfactant protein D and phospholipids in patients with and without chronic obstructive pulmonary disease

<p>Abstract</p> <p>Background</p> <p>Pulmonary surfactant D (SP-D) has important regulatory functions for innate immunity and has been implicated as a biomarker for chronic obstructive pulmonary disease (COPD). We hypothesized that COPD patients would have reduced bronchoalveolar lavage (BAL) fluid SP-D levels compared to healthy smoking and non-smoking controls.</p> <p>Methods</p> <p>BAL SP-D and phospholipids were quantified and corrected for dilution in 110 subjects (65 healthy never smokers, 23 smokers with normal spirometry, and 22 smokers with COPD).</p> <p>Results</p> <p>BAL SP-D was highest in never smokers (mean 51.9 μg/mL ± 7.1 μg/mL standard error) compared to both smokers with normal spirometry (16.0 μg/mL ± 11.8 μg/mL) and subjects with COPD (19.1 μg/mL ± 12.9 μg/mL; P < 0.0001). Among smokers with COPD, BAL SP-D correlated significantly with FEV₁% predicted (R = 0.43; P < 0.05); however, the strongest predictor of BAL SP-D was smoking status. BAL SP-D levels were lowest in current smokers (12.8 μg/mL ± 11.0 μg/mL), intermediate in former smokers (25.2 μg/mL ± 14.2 μg/mL; P < 0.008), and highest in never smokers. BAL phospholipids were also lowest in current smokers (6.5 nmol ± 1.5 nmol), intermediate in former smokers (13.1 nmol ± 2.1 nmol), and highest in never smokers (14.8 nmol ± 1.1 nmol; P < 0.0001).</p> <p>Conclusions</p> <p>These data suggest that smokers, and especially current smokers, exhibit significantly reduced BAL SP-D and phospholipids compared to nonsmokers. Our findings may help better explain the mechanism that leads to the rapid progression of disease and increased incidence of infection in smokers.</p

Povećana potrošnja kisika nakon vježbanja (epoc) zabilježena nakon višekratnih sprintova i umjerene aerobne aktivnosti

The purpose of this study was to investigate the effects of 30-second all out sprint interval exercise (SIE) vs. moderate aerobic exercise (MA) on excess post-exercise oxygen consumption (EPOC). Six recreationally-trained males (age=23.3±1.4 yrs, weight=81.8±9.9 kg, height=180.8±6.3cm) completed a sprint interval exercise session consisting of three repeated 30-second Wingate cycling tests separated by four minutes (duration~11minutes) as well as a moderate aerobic exercise session consisting of 30-minute cycling at 60% heart rate reserve (HRR) in a random counterbalanced design. Baseline oxygen consumption (VO2) was determined by an average VO2 from the final five minutes of a 30-minute supine rest period prior to each trial. Following each protocol, VO2 was measured for 30-minutes or until baseline measures were reached. EPOC was determined by subtracting baseline VO2 from post-exercise VO2 measurements. Energy expenditure (kJ) was determined by multiplying kJ per liter of oxygen by the average VO2 during recovery. EPOC values were significantly higher in SIE (7.5±1.3 L) than MA (1.8±0.7 L). SIE produced a higher recovery caloric expenditure (156.9 kJ) compared to MA (41.0 kJ) and remained significantly elevated (p=.024) over resting levels during the entire recovery period (30 minutes) compared to MA (6 minutes, p=.003). The energy required to recover from three repeated maximal effort 30-second Wingate cycling tests was greater than 30-minutes of moderate aerobic exercise. Future studies should examine the chronic effects of maximal effort sprint training protocol on cardiovascular fitness and body composition.Cilj je ovog istraživanja bio utvrditi učinke maksimalnog intervalnog sprintanja po 30 sekunda (SIE) i usporediti ih s umjerenim aerobnim treniranjem (MA) na povišenu potrošnju kisika nakon vježbanja. Šest muškaraca rekreativaca (23.3±1.4 godina, 81.8 ± 9.9 kg i 180.8 ± 6.3 cm) je, u slučajnom uravnoteženom nacrtu eksperimenta, provelo intervalni sprinterski trening koji se sastojao od tri ponavljanja Wingate testa (30 sekunda) na biciklu sa odmorima po 4 minute (ukupno trajanje zadatka približno 11 minuta) te umjereni aerobni trening koji se sastojao od 30 minuta bicikliranja intenzitetom od 60% rezerve srčane frekvencije. Početni primitak kisika (VO2) je bio utvrđen kao prosječna vrijednost VO2 zabilježena u zadnjih 5 minuta 30-minutnog odmora u ležećem položaju koji se primjenjivao prije svakog eksperimentalnog protokola. Nakon svakog protokola, VO2 je bio mjeren tijekom 30 minuta ili do trenutka kada se VO2 spustio na početnu vrijednost. EPOC je utvrđen oduzimanjem početne vrijednosti VO2 od vrijednosti VO2 zabilježenih nakon eksperimentalnih protokola. Energetska potrošnja (kJ) je bila utvrđena množenjem potrošenih kJ po litri kisika sa prosječnim VO2 tijekom oporavka. Vrijednosti EPOC-a bile su značajno više u sprinterskoj grupi (SIE 7,5±1,3 l) u odnosu na vrijednosti u grupi MA (1,8±0,7). Sprinterski zadatak je proizveo višu kalorijsku potrošnju tijekom oporavka (156,9 kJ) u usporedbi s umjerenim aerobnim zadatkom MA (41,0 kJ) te je ona ostala značajno povišena (p=0,024) u odnosu na razinu u mirovanju tijekom cijelog perioda oporavka (30 minuta) za razliku od MA (6 minuta, p=0,003). Potrebna energija za oporavak nakon 3 ponovljena maksimalna Wingate testa od 30 sekunda bila je viša nego nakon 30 minuta umjerene aerobne aktivnosti. Buduća istraživanja trebala bi ispitati kronične učinke protokola maksimalnih sprinterskih napora na kardiovaskularni fitnes i sastav tijela

The influence of contextual factors on healthcare quality improvement initiatives:a realist review

Background Recognising the influence of context and the context-sensitive nature of quality improvement (QI) interventions is crucial to implementing effective improvements and successfully replicating them in new settings, yet context is still poorly understood. To address this challenge, it is necessary to capture generalisable knowledge, first to understand which aspects of context are most important to QI and why, and secondly, to explore how these factors can be managed to support healthcare improvement, in terms of implementing successful improvement initiatives, achieving sustainability and scaling interventions. The research question was how and why does context influence quality improvement initiatives in healthcare? Methods A realist review explored the contextual conditions that influence healthcare improvement. Realist methodology integrates theoretical understanding and stakeholder input with empirical research findings. The review aimed to identify and understand the role of context during the improvement cycle, i.e. planning, implementation, sustainability and transferability; and distil new knowledge to inform the design and development of context-sensitive QI initiatives. We developed a preliminary theory of the influence of context to arrive at a conceptual and theoretical framework. Results Thirty-five studies were included in the review, demonstrating the interaction of key contextual factors across healthcare system levels during the improvement cycle. An evidence-based explanatory theoretical model is proposed to illustrate the interaction between contextual factors, system levels (macro, meso, micro) and the stages of the improvement journey. Findings indicate that the consideration of these contextual factors would enhance the design and delivery of improvement initiatives, across a range of improvement settings. Conclusions This is the first realist review of context in QI and contributes to a deeper understanding of how context influences quality improvement initiatives. The distillation of key contextual factors offers the potential to inform the design and development of context-sensitive interventions to enhance improvement initiatives and address the challenge of spread and sustainability. Future research should explore the application of our conceptual model to enhance improvement-planning processes