In vivo precision of the GE Lunar iDXA for the measurement of visceral adipose tissue in adults: the influence of body mass index.

CoreScan is a new software for the GE Lunar iDXA, which provides a quantification of visceral adipose tissue (VAT). The objective of this study was to determine the in vivo precision of CoreScan for the measurement of VAT mass in a heterogeneous group of adults. Forty-five adults (aged 34.6 (8.6) years), ranging widely in body mass index (BMI 26.0 (5.2)  kg/m(2); 16.7-42.4 kg/m(2)), received two consecutive total body scans with repositioning. The sample was divided into two subgroups based on BMI, normal-weight and overweight/obese, for precision analyses. Subgroup analyses revealed that precision errors (RMSSD:%CV; root mean square standard deviation:% coefficient of variation) for VAT mass were 20.9 g:17.0% in the normal-weight group and 43.7 g:5.4% in overweight/obese groups. Our findings indicate that precision for DXA-VAT mass measurements increases with BMI, but caution should be used with %CV-derived precision error in normal BMI subjects.European Journal of Clinical Nutrition advance online publication, 15 October 2014; doi:10.1038/ejcn.2014.213

Fractional flow reserve vs. angiography in guiding management to optimize outcomes in non-ST-segment elevation myocardial infarction: the British Heart Foundation FAMOUS-NSTEMI randomized trial

Aim: We assessed the management and outcomes of non-ST segment elevation myocardial infarction (NSTEMI) patients randomly assigned to fractional flow reserve (FFR)-guided management or angiography-guided standard care. Methods and results: We conducted a prospective, multicentre, parallel group, 1 : 1 randomized, controlled trial in 350 NSTEMI patients with ≥ coronary stenosis ≥30% of the lumen diameter assessed visually (threshold for FFR measurement) (NCT01764334). Enrolment took place in six UK hospitals from October 2011 to May 2013. Fractional flow reserve was disclosed to the operator in the FFR-guided group (n = 176). Fractional flow reserve was measured but not disclosed in the angiography-guided group (n = 174). Fractional flow reserve ≤0.80 was an indication for revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). The median (IQR) time from the index episode of myocardial ischaemia to angiography was 3 (2, 5) days. For the primary outcome, the proportion of patients treated initially by medical therapy was higher in the FFR-guided group than in the angiography-guided group [40 (22.7%) vs. 23 (13.2%), difference 95% (95% CI: 1.4%, 17.7%), P = 0.022]. Fractional flow reserve disclosure resulted in a change in treatment between medical therapy, PCI or CABG in 38 (21.6%) patients. At 12 months, revascularization remained lower in the FFR-guided group [79.0 vs. 86.8%, difference 7.8% (−0.2%, 15.8%), P = 0.054]. There were no statistically significant differences in health outcomes and quality of life between the groups. Conclusion: In NSTEMI patients, angiography-guided management was associated with higher rates of coronary revascularization compared with FFR-guided management. A larger trial is necessary to assess health outcomes and cost-effectiveness

Influence of contrast media dose and osmolality on the diagnostic performance of contrast fractional flow reserve

Background—Contrast fractional flow reserve (cFFR) is a method for assessing functional significance of coronary stenoses, which is more accurate than resting indices and does not require adenosine. However, contrast media volume and osmolality may affect the degree of hyperemia and therefore diagnostic performance. Methods and Results—cFFR, instantaneous wave–free ratio, distal pressure/aortic pressure at rest, and FFR were measured in 763 patients from 12 centers. We compared the diagnostic performance of cFFR between patients receiving low or iso-osmolality contrast (n=574 versus 189) and low or high contrast volume (n=341 versus 422) using FFR≤0.80 as a reference standard. The sensitivity, specificity, and overall accuracy of cFFR for the low versus iso-osmolality groups were 73%, 93%, and 85% versus 87%, 90%, and 89%, and for the low versus high contrast volume groups were 69%, 99%, and 83% versus 82%, 93%, and 88%. By receiver operating characteristics (ROC) analysis, cFFR provided better diagnostic performance than resting indices regardless of contrast osmolality and volume (P<0.001 for all groups). There was no significant difference between the area under the curve of cFFR in the low- and iso-osmolality groups (0.938 versus 0.957; P=0.40) and in the low- and high-volume groups (0.939 versus 0.949; P=0.61). Multivariable logistic regression analysis showed that neither contrast osmolality nor volume affected the overall accuracy of cFFR; however, both affected the sensitivity and specificity. Conclusions—The overall accuracy of cFFR is greater than instantaneous wave–free ratio and distal pressure/aortic pressure and not significantly affected by contrast volume and osmolality. However, contrast volume and osmolality do affect the sensitivity and specificity of cFFR

Development of three dimensional constitutive theories based on lower dimensional experimental data

Most three dimensional constitutive relations that have been developed to describe the behavior of bodies are correlated against one dimensional and two dimensional experiments. What is usually lost sight of is the fact that infinity of such three dimensional models may be able to explain these experiments that are lower dimensional. Recently, the notion of maximization of the rate of entropy production has been used to obtain constitutive relations based on the choice of the stored energy and rate of entropy production, etc. In this paper we show different choices for the manner in which the body stores energy and dissipates energy and satisfies the requirement of maximization of the rate of entropy production that leads to many three dimensional models. All of these models, in one dimension, reduce to the model proposed by Burgers to describe the viscoelastic behavior of bodies.Comment: 23 pages, 6 figure

Impact of proctoring on success rates for percutaneous revascularisation of coronary chronic total occlusions.

OBJECTIVE: To assess the impact of proctoring for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in six UK centres. METHODS: We retrospectively analysed 587 CTO procedures from six UK centres and compared success rates of operators who had received proctorship with success rates of the same operators before proctorship (pre-proctored) and operators in the same institutions who had not been proctored (non-proctored). There were 232 patients in the pre-proctored/non-proctored group and 355 patients in the post-proctored group. Complexity was assessed by calculating the Japanese CTO (JCTO) score for each case. RESULTS: CTO PCI success was greater in the post-proctored compared with the pre-proctored/non-proctored group (77.5% vs 62.1%, p<0.0001). In more complex cases where JCTO≥2, the difference in success was greater (70.7% vs 49.5%, p=0.0003). After proctoring, there was an increase in CTO PCI activity in centres from 2.5% to 3.5%, p<0.0001 (as a proportion of total PCI), and the proportion of very difficult cases with JCTO score ≥3 increased from 15.3% (35/229) to 29.7% (105/354), p<0.0001. CONCLUSIONS: Proctoring resulted in an increase in procedural success for CTO PCI, an increase in complex CTO PCI and an increase in total CTO PCI activity. Proctoring may be a valuable way to improve access to CTO PCI and the likelihood of procedural success

Interpretation of dual energy X-ray absorptiometry-derived body composition change in athletes : a review and recommendations for best practice

Dual energy X-ray absorptiometry (DXA) is a medical imaging device which has become the method of choice for the measurement of body composition in athletes. The objectives of this review were to evaluate published longitudinal DXA body composition studies in athletic populations for interpretation of 'meaningful' change, and to propose a best practice measurement protocol. An online search of PubMed and CINAHL via EBSCO Host and Web of Science enabled the identification of studies published until November 2016. Those which met the inclusion criteria were reviewed independently by two authors according to their methodological quality and interpretation of body composition change. Twenty-five studies published between 1996 and November 2016 were reviewed (male athletes: 13, female athletes: 3, mixed: 9) and sample sizes ranged from n = 1 to 212. The same number of eligible studies were published between 2013 - 2016, as over the 16 years prior (1996 - 2012). Seven did not include precision error, and fewer than half provided athlete-specific precision error. There were shortfalls in the sample sizes on which precision estimates were based and inconsistencies in the level of pre-scan standardisation, with some reporting full standardisation protocols and others reporting only single (e.g. overnight fast) or no control measures. There is a need for standardised practice and reporting in athletic populations for the longitudinal measurement of body composition using DXA. Based on this review and that of others, plus the official position of the International Society for Clinical Densitometry, our recommendations and protocol are proposed as a guide to support best practice

Social Waves in Giant Honeybees Repel Hornets

Giant honeybees (Apis dorsata) nest in the open and have evolved a plethora of defence behaviors. Against predatory wasps, including hornets, they display highly coordinated Mexican wave-like cascades termed ‘shimmering’. Shimmering starts at distinct spots on the nest surface and then spreads across the nest within a split second whereby hundreds of individual bees flip their abdomens upwards. However, so far it is not known whether prey and predator interact and if shimmering has anti-predatory significance. This article reports on the complex spatial and temporal patterns of interaction between Giant honeybee and hornet exemplified in 450 filmed episodes of two A. dorsata colonies and hornets (Vespa sp.). Detailed frame-by-frame analysis showed that shimmering elicits an avoidance response from the hornets showing a strong temporal correlation with the time course of shimmering. In turn, the strength and the rate of the bees' shimmering are modulated by the hornets' flight speed and proximity. The findings suggest that shimmering creates a ‘shelter zone’ of around 50 cm that prevents predatory wasps from foraging bees directly from the nest surface. Thus shimmering appears to be a key defence strategy that supports the Giant honeybees' open-nesting life-style

Continuum of vasodilator stress from rest to contrast medium to adenosine hyperemia for fractional flow reserve assessment

Objectives: This study compared the diagnostic performance with adenosine-derived fractional flow reserve (FFR) ≤0.8 of contrast-based FFR (cFFR), resting distal pressure (Pd)/aortic pressure (Pa), and the instantaneous wave-free ratio (iFR). Background: FFR objectively identifies lesions that benefit from medical therapy versus revascularization. However, FFR requires maximal vasodilation, usually achieved with adenosine. Radiographic contrast injection causes submaximal coronary hyperemia. Therefore, intracoronary contrast could provide an easy and inexpensive tool for predicting FFR. Methods: We recruited patients undergoing routine FFR assessment and made paired, repeated measurements of all physiology metrics (Pd/Pa, iFR, cFFR, and FFR). Contrast medium and dose were per local practice, as was the dose of intracoronary adenosine. Operators were encouraged to perform both intracoronary and intravenous adenosine assessments and a final drift check to assess wire calibration. A central core lab analyzed blinded pressure tracings in a standardized fashion. Results: A total of 763 subjects were enrolled from 12 international centers. Contrast volume was 8 ± 2 ml per measurement, and 8 different contrast media were used. Repeated measurements of each metric showed a bias &lt;0.005, but a lower SD (less variability) for cFFR than resting indexes. Although Pd/Pa and iFR demonstrated equivalent performance against FFR ≤0.8 (78.5% vs. 79.9% accuracy; p = 0.78; area under the receiver-operating characteristic curve: 0.875 vs. 0.881; p = 0.35), cFFR improved both metrics (85.8% accuracy and 0.930 area; p &lt; 0.001 for each) with an optimal binary threshold of 0.83. A hybrid decision-making strategy using cFFR required adenosine less often than when based on either Pd/Pa or iFR. Conclusions: cFFR provides diagnostic performance superior to that of Pd/Pa or iFR for predicting FFR. For clinical scenarios or health care systems in which adenosine is contraindicated or prohibitively expensive, cFFR offers a universal technique to simplify invasive coronary physiological assessments. Yet FFR remains the reference standard for diagnostic certainty as even cFFR reached only ∼85% agreement

Landscape science: a Russian geographical tradition

The Russian geographical tradition of landscape science (landshaftovedenie) is analyzed with particular reference to its initiator, Lev Semenovich Berg (1876-1950). The differences between prevailing Russian and Western concepts of landscape in geography are discussed, and their common origins in German geographical thought in the late nineteenth and early twentieth centuries are delineated. It is argued that the principal differences are accounted for by a number of factors, of which Russia's own distinctive tradition in environmental science deriving from the work of V. V. Dokuchaev (1846-1903), the activities of certain key individuals (such as Berg and C. O. Sauer), and the very different social and political circumstances in different parts of the world appear to be the most significant. At the same time it is noted that neither in Russia nor in the West have geographers succeeded in specifying an agreed and unproblematic understanding of landscape, or more broadly in promoting a common geographical conception of human-environment relationships. In light of such uncertainties, the latter part of the article argues for closer international links between the variant landscape traditions in geography as an important contribution to the quest for sustainability