872 research outputs found
Application of Framingham risk estimates to ethnic minorities in United Kingdom and implications for primary prevention of heart disease in general practice : cross sectional population based study
Objective To compare the 10 year risk of coronary
heart disease (CHD), stroke, and combined
cardiovascular disease (CVD) estimated from the
Framingham equations.
Design Population based cross sectional survey.
Setting Nine general practices in south London.
Population 1386 men and women, age 4059 years,
with no history of CVD (475 white people, 447 south
Asian people, and 464 people of African origin), and
a subgroup of 1069 without known diabetes, left
ventricular hypertrophy, peripheral vascular disease,
renal impairment, or target organ damage.
Main outcome measures 10 year risk estimates.
Results People of African origin had the lowest 10
year risk estimate of CHD adjusted for age and sex
(7.0%, 95% confidence interval 6.5 to 7.5) compared
with white people (8.8%, 8.2 to 9.5) and south Asians
(9.2%, 8.6 to 9.9) and the highest estimated risk of
stroke (1.7% (1.5 to 1.9), 1.4% (1.3 to 1.6), 1.6% (1.5 to
1.8), respectively). The estimate risk of combined
CVD, however, was highest in south Asians (12.5%,
11.6 to 13.4) compared with white people (11.9%,
11.0 to 12.7) and people of African origin (10.5%, 9.7
to 11.2). In the subgroup of 1069, the probability that
a risk of CHD >15% would identify risk of combined
CVD >20% was 91% in white people and 81% in
both south Asians and people of African origin. The
use of thresholds for risk of CHD of 12% in south
Asians and 10% in people of African origin would
increase the probability of identifying those at risk to
100% and 97%, respectively.
Conclusion Primary care doctors should use a lower
threshold of CHD risk when treating mild
uncomplicated hypertension in people of African or
south Asian origin
Phase--coherence Effects in Antidot Lattices: A Semiclassical Approach to Bulk Conductivity
We derive semiclassical expressions for the Kubo conductivity tensor. Within
our approach the oscillatory parts of the diagonal and Hall conductivity are
given as sums over contributions from classical periodic orbits in close
relation to Gutzwiller's trace formula for the density of states. Taking into
account the effects of weak disorder and temperature we reproduce recently
observed anomalous phase coherence oscillations in the conductivity of large
antidot arrays.Comment: 11 pages, 2 figures available under request, RevTe
Lifestyle in adults aged 35 years who were born with open spina bifida: prospective cohort study
BACKGROUND AND METHODS: From 1963 to 1971, 117 babies with open spina bifida were treated non-selectively from birth. In 2002 we reviewed all the survivors by postal questionnaire and telephone call. The aims were to find out how many were living independently in the community or were in open employment or drove a car. In addition to these achievements we recorded health, medication and admissions to hospital and asked how much daily help they needed. RESULTS: Ascertainment was 100%. There had been 63 deaths, mainly of the most severely affected. The mean age of the 54 survivors was 35 years. The outcome in terms of disability ranged from apparent normality to total dependency. It reflected both the neurological deficit, which had been recorded in infancy in terms of sensory level, and events in the CSF shunt history. Overall about 2 in 5 of the survivors lived independently in the community, 2 in 5 drove a car, 1 in 5 was in competitive employment and 1 in 5 could walk 50 metres. CONCLUSION: Although those who survived to age 35 years tended to be less disabled, 2 in 5 continued to need daily care
Tracking invasion and invasiveness in queensland fruit flies: From classical genetics to ‘omics’
Three Australian tephritid fruit flies (Bactrocera tryoni – Q-fly, Bactrocera neohumeralis – NEO, and Bactrocera jarvisi – JAR) are promising models for genetic studies of pest status and invasiveness. The long history of ecological and physiological studies of the three species has been augmented by the development of a range of genetic and genomic tools, including the capacity for forced multigeneration crosses between the three species followed by selection experiments, a draft genome for Q-fly, and tissue- and stage-specific transcriptomes. The Q-fly and NEO species pair is of particular interest. The distribution of NEO is contained entirely within the wider distribution of Q-fly and the two species are ecologically extremely similar, with no known differences in pheromones, temperature tolerance, or host-fruit utilisation. However there are three clear differences between them: humeral callus colour, complete pre-mating isolation based on mating time-of-day, and invasiveness. NEO is much less invasive, whereas in historical times Q-fly has invaded southeastern Australia and areas of Western Australia and the Northern Territory. In southeastern fruit-growing regions, microsatellites suggest that some of these outbreaks might derive from genetically differentiated populations overwintering in or near the invaded area. Q-fly and NEO show very limited genome differentiation, so comparative genomic analyses and QTL mapping should be able to identify the regions of the genome controlling mating time and invasiveness, to assess the genetic bases for the invasive strains of Q-fly, and to facilitate a variety of improvements to current sterile insect control strategies for that species
‘Test n Treat (TnT)’– Rapid testing and same-day, on-site treatment to reduce rates of chlamydia in sexually active further education college students: study protocol for a cluster randomised feasibility trial
Background
Sexually active young people attending London further education (FE) colleges have high rates of chlamydia, but screening rates are low. We will conduct a cluster randomised feasibility trial of frequent, rapid, on-site chlamydia testing and same-day treatment (Test and Treat (TnT)) in six FE colleges (with parallel qualitative and economic assessments) to assess the feasibility of conducting a future trial to investigate if TnT reduces chlamydia rates.
Methods
We will recruit 80 sexually active students aged 16–24 years from public areas at each of six colleges. All participants (total n = 480) will be asked to provide samples (urine for males, self-taken vaginal swabs for females) and complete questionnaires on sexual lifestyle and healthcare use at baseline and after 7 months. Participants will be informed that baseline samples will not be tested for 7 months and be advised to get screened separately. Colleges will be randomly allocated to the intervention (TnT) or the control group (no TnT).
One and 4 months after recruitment, participants at each intervention college (n = 3) will be texted and invited for on-site chlamydia tests using the 90-min Cepheid GeneXpert system. Students with positive results will be asked to see a visiting nurse health adviser for same-day treatment and partner notification, (backed by genitourinary medicine follow-up). Participants in control colleges (n = 3) will receive ‘thank you’ texts 1 and 4 months after recruitment.
Seven months after recruitment, participants from both groups will be invited to complete questionnaires and provide samples for TnT. All samples will be tested, and same-day treatment offered to students with positive results.
Acceptability of TnT will be assessed by qualitative interviews of purposively sampled students (n = 30) and college staff (n = 12). We will collect data on costs of TnT and usual healthcare.
Discussion
Findings will provide key values to inform feasibility, sample size and timescales of a future definitive trial of TnT in FE colleges, including:
Recruitment rates
TnT uptake rates
Follow-up rates
Prevalence of chlamydia in participants at baseline and 7 months
Acceptability of TnT to students and college staff
Estimate of the cost per person screened/treated in TnT versus usual care
Trial registration
International Standard Randomised Controlled Trials Registry, ID: ISRCTN58038795, Registered on 31 August 2016
Near patient chlamydia and gonorrhoea screening and treatment in further education/technical colleges : a cost analysis of the 'Test n Treat' feasibility trial
Background
Community-based screening may be one solution to increase testing and treatment of sexually transmitted infections in sexually active teenagers, but there are few data on the practicalities and cost of running such a service. We estimate the cost of running a ‘Test n Treat’ service providing rapid chlamydia (CT) and gonorrhoea (NG) testing and same day on-site CT treatment in technical colleges.
Methods
Process data from a 2016/17 cluster randomised feasibility trial were used to estimate total costs and service uptake. Pathway mapping was used to model different uptake scenarios. Participants, from six London colleges, provided self-taken genitourinary samples in the nearest toilet. Included in the study were 509 sexually active students (mean 85/college): median age 17.9 years, 49% male, 50% black ethnicity, with a baseline CT and NG prevalence of 6 and 0.5%, respectively. All participants received information about CT and NG infections at recruitment. When the Test n Treat team visited, participants were texted/emailed invitations to attend for confidential testing. Three colleges were randomly allocated the intervention, to host (non-incentivised) Test n Treat one and four months after baseline. All six colleges hosted follow-up Test n Treat seven months after baseline when students received a £10 incentive (to participate).
Results
The mean non-incentivised daily uptake per college was 5 students (range 1 to 17), which cost £237 (range £1082 to £88) per student screened, and £4657 (range £21,281 to £1723) per CT infection detected, or £13,970 (range £63,842 to £5169) per NG infection detected.
The mean incentivised daily uptake was 19 students which cost £91 per student screened, and £1408/CT infection or £7042/NG infection detected.
If daily capacity for screening were achieved (49 students/day), costs including incentives would be £47 per person screened and £925/CT infection or £2774/NG infection detected.
Conclusions
Delivering non-incentivised Test n Treat in technical colleges is more expensive per person screened than CT and NG screening in clinics. Targeting areas with high infection rates, combined with high, incentivised uptake could make costs comparable
Weak-Localization and Integrability in Ballistic Cavities
We demonstrate the existence of an interference contribution to the average
magnetoconductance, G(B), of ballistic cavities and use it to test the
semiclassical theory of quantum billiards. G(B) is qualitatively different for
chaotic and regular cavities, an effect explained semiclassically by the
differing classical distribution of areas. The magnitude of G(B) is poorly
explained by the semiclassical theory of coherent backscattering (elastic
enhancement factor)-- correlations beyond time-reversed pairs of trajectories
must be included-- but is in agreement with random matrix theory.Comment: 12 pages + 3 figures, revtex, hub-92-w
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