Social change, migration and pregnancy intervals

Maternity histories from residents of a Pacific Island society, Tokelau, and migrants to New Zealand, are analysed using life table techniques. Inter-cohort differentials in patterns of family formation were found in the total Tokelau-origin population. The process of accelerated timing and spacing of pregnancies was more pronounced among migrants who tended to marry later, be pregnant at marriage, have shorter inter-pregnancy intervals at lower parities and to show evidence of family limitation occurring at higher parities. These results point to the significance of changing patterns of social control on strategies of family building

Oscillograms and their tests

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AEROBIC TRAINING WITH LIMBS INTERMITTENT ISCHEMIA IMPROVES MYOCARDIAL FUNCTION AND WALL STRETCH IN PATIENTS WITH CLAUDICATION

Background: peripheral arterial disease (PAD) is a chronic disease determining functional impairment and increased risk of cardiovascular events. Physical training improves cardiac performance and reduces NTproBNP concentration, marker of risk of cardiovascular events, in cardiac patients. Aim: we aimed to examine the effects training conducted till ischemic pain at the leg of PAD patients on myocardial function and peripheral flux.Methods: we enrolled 22 patients affected by peripheral arterial disease without cardiac disease. All patients undergone a physical training of 15 days, with treadmill test at the begin and at the end of training. Results: at the end of training patients increased walking distance (450\ub1180 m vs 250\ub1108 m; p<0.05). We documented at rest, at the end of physical training, an increase in flow volume of common femoral artery of the symptomatic leg (2,55\ub12,13 L/min vs 1,86\ub11,30 L/min; p<0.05); NTproBNP concentration at rest was lower al the end of training (210\ub1130 pg/mL vs 188\ub1108 pg/mL; p<0.005), an increase of NTproBNP concentration after maximal exercise on treadmill before treatment, with a reduced increase at the end of training period (24\ub121 vs 12\ub110 pg/mL; p<0.0005); a reduction of end-diastolic diameter of left ventricle at rest (48\ub14 mm vs 50\ub15 mm; p<0.05). The ejection fraction did not changed, while heart rate reduced after training (66\ub19 bpm vs 71\ub112 bpm; p<0.05). Conclusions: this study documented an improvement of hemodynamic and cardiac performance in response of physical training in peripheral arterial disease patients not affected by cardiac disease. Further trials will be necessary to evaluate the use of NTproBNP as a marker of good response to physical training in these patients

The effects of arthritis gloves on hand pain in people with rheumatoid or inflammatory arthritis : a randomised controlled trial (A-GLOVES TRIAL)

Background: Arthritis (compression) gloves are commonly provided to people with rheumatoid arthritis (RA) and undifferentiated inflammatory arthritis (IA) in the UK health service. These apply pressure and warmth to relieve hand pain, stiffness and improve hand function. A systematic review identified little evidence to support their use.[1] Objectives: This randomised controlled trial tested effectiveness and cost-effectiveness of mid-finger length compression (intervention) gloves (20% Lycra: commonest glove model provided) with control gloves (i.e. oedema gloves: 11% Lycra: fitted at least one size too big) in people with RA and IA. Methods: Both gloves, which had similar thermal qualities although the control gloves did not provide compression, were provided by rheumatology occupational therapists, following training.[2] Participants were also given brief advice on hand exercise and joint protection. Adults with RA/IA and persistent hand pain were randomised 1:1 to the two glove types, stratified by disease modifying anti-rheumatic drug (DMARD) change in previous 12 weeks. The primary outcome was dominant hand pain on activity Visual Analogue Scale (VAS:0–10); other outcomes included night hand pain, hand stiffness (both 0–10 VAS); Measure of Activity Performance Hand (MAP-HAND: 0–3). Multiple linear regression was undertaken to estimate the effect of group allocation on hand pain during activity, adjusting for the stratification variable and baseline values. Cost-effectiveness used individual patient level costs (intervention plus healthcare utilisation) and health benefit data (EQ-5D) to calculate costs and QALYs. Results: 206 participants were randomised (103 to each glove type): median age 59 years [IQR 51,67]; women:166 (81%); mean disease duration: 8.2 (SD 9.5) years; employed:76 (37%); right hand dominant:185 (90%). Of these, 163 (79%) completed 12 week follow-up questionnaires. Both groups reported similar adherence to glove wear (mean 5.2 days/week). At 12 w, hand pain scores in both groups similarly improved: the between-groups mean difference of 0.1 was not statistically significant (95% CI: −0.47 to 0.67; p=0.72). There were no significant differences between groups on any measures, with both groups improving similarly between baseline and 12 w. 73% in both groups considered gloves beneficial. Intervention gloves had higher costs (£552 (SD £464); control £391 (SD £543) but comparable benefits to control gloves. Intervention gloves would cost £83 700 to gain one QALY and were not likely to be cost-effective. Conclusions: Compression (intervention) and loose-fitting arthritis (control) gloves had similar effects on hand pain, stiffness and function. Therefore, compression is not the ‘active ingredient’ in arthritis gloves. Loose fitting gloves providing warmth were perceived as equally effective by participants. We do not know if the therapist effect is important or whether ordinary gloves providing warmth would provide similar results. References: Hammond, et al. Clin Rehabil 2016 30:213–24. Prior, et al. Rheumatology 2017. www.abstractsonline.com/pp8/#!/4205 Acknowledgements: This project was funded by the NIHR Research for Patient Benefit Programme (PB-PG-0214–33010). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health

Decoding RAS isoform and codon-specific signalling

RAS proteins are key signalling hubs that are oncogenically mutated in 30% of all cancer cases. Three genes encode almost identical isoforms that are ubiquitously expressed, but are not functionally redundant. The network responses associated with each isoform and individual oncogenic mutations remain to be fully characterized. In the present article, we review recent data defining the differences between the RAS isoforms and their most commonly mutated codons and discuss the underlying mechanisms

Splanchnic metabolism of nutrients and hormones in steers fed alfalfa under conditions of increased absorption of ammonia and L-arginine supply across the portal-drained viscera

Effects of increased ammonia and/or arginine absorption on net splanchnic (portal-drained viscera [PDV] plus liver) metabolism of nonnitrogenous nutrients and hormones in cattle were examined. Six Hereford × Angus steers (501 ± 1 kg BW) prepared with vascular catheters for measurements of net flux across the splanchnic bed were fed a 75% alfalfa:25% (as-fed basis) corn and soybean meal diet (0.523 MJ of ME/[kg BW0.75.d]) every 2 h without (27.0 g of N/kg of DM) and with 20 g of urea/kg of DM (35.7 g of N/kg of DM) in a split-plot design. Net flux measurements were made immediately before and after a 72-h mesenteric vein infusion of L-arginine (15 mmol/h). There were no treatment effects onPDVor hepaticO2 consumption. Dietary urea had no effect on splanchnic metabolism of glucose or L-lactate, but arginine infusion decreased net hepatic removal of L-lactate when urea was fed (P < 0.01). Net PDV appearance of n-butyrate was increased by arginine infusion (P < 0.07), and both dietary urea (P < 0.09) and arginine infusion (P < 0.05) increased net hepatic removal of n-butyrate. Dietary urea also increased total splanchnic acetate output (P < 0.06), tended to increase arterial glucagon concentration (P < 0.11), and decreased arterial ST concentration (P < 0.03). Arginine infusion increased arterial concentration (P < 0.07) and net PDV release (P < 0.10) and tended to increase hepatic removal (P < 0.11) of insulin, as well as arterial concentration (P < 0.01) and total splanchnic output (P < 0.01) of glucagon. Despite changes in splanchnic N metabolism, increased ammonia and arginine absorption had little measurable effect on splanchnic metabolism of glucose and other nonnitrogenous components of splanchnic energy metabolism

Paleostress evolution during the exhumation of high-p marbles, Samaná Complex, northern Hispaniola.

The marble of the Samaná complex presents a widespread foliation formed during its exhumation following a general decompressive strain path from high pressure (2.0>P>0.7 GPa) and low temperature (350 MPa during deformation. In contrast, mean flow stress during grain-boundary migration is estimated in |σ1-σ3| 110 MPa Ma-1). All of these data suggest that exhumation always occurred near the brittle-ductile regime of deformation. © 2017, Instituto Geologico y Minero de Espana. All rights reserved.El trabajo ha sido financiado por los proyectos de investigación CGL2010-14890 y CGL2011-23628, auspiciados por el plan nacional I+D+i del Ministerio de Economía y Competitividad del Gobierno de España.Peer reviewe

Supervised training improves endothelial function measured during induced ischemia in peripheral arterial disease.

Introduction: favorable effect of training on cardiovascular pathology is well documented in literature. Mechanisms evoked are the following: increased NO availability for reduction of oxidative stress, inflammation decrease, improvement of glucidic and lipidic metabolism, resetting of neuro-endocrine balance (1). These mechanism are also involved in the improvement of patients with peripheral arterial disease (PAD) treated with training. PAD is a model of inducible ischemia, in fact claudication is a condition in which ischemia/reperfusion phenomenon is present when walking is conducted till maximum pain (2). This phenomenon may produce a great amount of radical oxygen species with possible consequence on endothelium function. Xanthine oxidase is one of the most relevant enzyme involved in this process. Different types of training are proposed for PAD patients and there is not a consensus whether the ischemic pain should be reached during exercise. So we aimed to verify if maximal treadmill test (till pain) causes endothelial dysfunction, if oxidative stress is acutely aroused and if xanthine oxidase is involved. Therefore we aimed to verify if a training performed under the onset of ischemic pain can improve endothelial function ether at rest and after maximum tolerated exercise. Patients and methods: we enrolled 20 patients with PAD (16 males, 4 females, aged 65-77). Endothelium dependent dilation (EDD) was measured at humeral artery by ultrasound method, before and after maximal treadmill test (speed 3,2 km/h; slope 10%). We administered allopurinol 600 mg the day before and 600 mg 6 hours before a new treadmill test. Serum uric acid and lactate were determined throughout the study. Afterwards patients performed supervised training under pain onset for 20 days with physiotherapist overview. Every 7 days a new treadmill test was performed for updating training distance. At the end of the training period EDD was measured before and after a maximal treadmill test. Furthermore microcirculatory endothelium dependent dilation was measured at the skin of the forefoot by means of laser-Doppler (LD) after iontophoretic acetylcholine administration. Results: maximal treadmill test acutely reduced EDD (6,1\uf0b10,7 vs 9,2\uf0b10,9 %; p<0,05;). Allopurinol improved EDD (10,1\uf0b10,3 vs 9,4\uf0b10,6 %; p<0,05) with a reduced fall after maximal test (delta decrease -21,3\uf0b12,2 vs \u201333,2\uf0b11,2%; p<0,05). Training increased pain free walking distance (131\uf0b112 vs 66,6\uf0b121 m; p<0,05) and absolute walking distance (275\uf0b115 vs 125,8\uf0b140 m; p<0,05). EDD improved after training period (11,3\uf0b10,7 vs 9,2\uf0b10,9; p<0,05). The fall in EDD, observed during maximal treadmill test at the end of training period, was smaller than the one measured before training (delta decrease -15,5\uf0b12,4 vs \u201333,2\uf0b11,2%; p<0,005). Microcirculatory endothelium dependent dilation measured with LD increased after training (table). Table: microcirculatory flux with LD after iontophoretic acetylcholine. Acetylcholine 0,10 mA 10 s 20 s 40 s T 0 (% incr) 35\uf0b19 70\uf0b115 120\uf0b115 T 20 (%incr) 147\uf0b138* 182\uf0b122* 470\uf0b154* (*p<0.005 T20 vs T0) Conclusions: we demonstrate that walking through maximal pain causes impairment of EDD, this is caused by oxidative stress and can be reduced by inhibition of xanthine oxidase. Aerobic training improves EDD and microcirculatory endothelial function, furthermore training reduces the drop of EDD during maximal exercise and increased oxidative stress. As a consequence these results suggest the training should be performed under the maximal pain. References 1. Brendle DC, Joseph LJ, Corretti MC, Gardner AW, Katzel LI. Effects of exercise rehabilitation on endothelial reactivity in older patients with peripheral arterial disease. Am J Cardiol 2001;87:324-9. 2. Andreozzi GM, Leone A, Laudani R, Deinite G, Martini R. Acute impairment of the endothelial function by maximal treadmill exercise in patients with intermittent claudication, and its improvement after supervised physical training. Int Angiol. 2007; 26:12-7

Carbon K-shell Photo Ionization of CO: Molecular frame angular Distributions of normal and conjugate shakeup Satellites

We have measured the molecular frame angular distributions of photoelectrons emitted from the Carbon K shell of fixed-in-space CO molecules for the case of simultaneous excitation of the remaining molecular ion. Normal and conjugate shake up states are observed. Photo electrons belonging to normal \Sigma -satellite lines show an angular distribution resembling that observed for the main photoline at the same electron energy. Surprisingly a similar shape is found for conjugate shake up states with \Pi -symmetry. In our data we identify shake rather than electron scattering (PEVE) as the mechanism producing the conjugate lines. The angular distributions clearly show the presence of a \Sigma -shape resonance for all of the satellite lines.Comment: 8 pages, 2 figure

Linguistic validation and cultural adaptation of the valued life activities scale in Turkey in people with Rheumatoid Arthritis

Background The Valued Life Activities Scale (VLAs) was specifically developed for people with rheumatoid arthritis (RA)1 to measure daily activities and participatory roles. The original VLAs items (75) were derived from content analysis of diaries completed by patients with RA or osteoarthritis. Revisions have been made to the scoring, items grouped into domains using factor analysis and the items were revised (and reduced to 33) based on participants' responses as to which items are most important to them2-5. Objectives To conduct the linguistic and cultural adaptation of the VLAs to Turkish prior to psychometric testing to validate the use of this questionnaire in Turkish people with RA. Methods The linguistic and cultural adaptation of the VLAs was conducted following guidelines for the process of cross-cultural adaptation of self-reported measures4. This involved the (i) initial forward translation of the British-English version of VLAs by two (informed and uninformed) native Turkish speakers; (ii) synthesis through consensus; (iii) back translation by two native English speakers who were blinded to the content of the questionnaire, and did not have medical backgrounds; and (iv) a final review conducted by an expert panel which consolidated all the versions and developed a pre-final Turkish VLAs (TUR-VLAs). Following this, to ensure the TUR-VLAs content is understandable and relevant to Turkish people with RA, face-to-face cognitive de-briefing interviews were conducted. Participants were recruited from rheumatology clinics ensuring a broad range of demographics such as participants' age, employment status and functional abilities. Results At the end of a four staged translation and cross-cultural adaptation process only minimal changes (e.g. “going to café” were used instead of going to the pub) were made to the questionnaire. Following this, cognitive de-briefing interviews were conducted with six participants (age: 45.16 (SD11.30) years; female:5 (83%); disease duration:13.83 (SD6.46) years; HAQ:9 (SD 2.76). Of these three people were employed, two were home-makers and one was retired. Participants found the TUR-VLAs content easily understandable, and relevant to Turkish people. As a result, no items were removed and no new items were added to TUR-VLAs. Conclusions The linguistic and cross-cultural adaptation of the VLAs to Turkish provides a basis for the first rheumatology occupational therapy assessment in Turkey. Following the psychometric testing of TUR-VLAs this instrument will be freely accessible for Turkish health professionals working in rheumatology for both clinical assessment and research purposes. References 1. Katz P, Yelin E (1994) Arthritis Care and Research 7(2):69-77. 2. Katz P, Yelin E (1995) Arthritis and Rheumatism 38(1):49-56 3. Katz P (1995) Arthritis Care and Research 8(4):272-278. 4. Katz P et al. (2006) Annals of the Rheumatic Diseases 65:763-769. 5. Katz P et.al. (2008) Arthritis Rheum (Arthritis Care Res) 59:1416–1423. 6. Beaton et.al. (2000) Spine (Phila Pa 1976). 15;25(24):3186-91. Acknowledgements We would like to extend our thanks to participating patients and the administrative staff from the Marmara University Hospital. Also many thanks to the EULAR Health Professionals Grant for funding this study