New exercise-integrated technology can monitor the dosage and quality of exercise performed against an elastic resistance band by adolescents with patellofemoral pain:an observational study

Question: Is the exercise-integrated Bandcizer™ system feasible for recording exercise dosage (time under tension (TUT) and repetitions) and pain scores among adolescents with patellofemoral pain? Do adolescents practise the exercises as prescribed (TUT and repetitions)? Do adolescents accurately report the exercises they do in an exercise diary? Design: Observational feasibility study. Participants: Twenty adolescents between 15 and 19 years of age with patellofemoral pain. Intervention: Participants were prescribed three exercise sessions per week (one with and two without supervision) for 6 weeks. The exercises included three hip and one knee exercise with an elastic resistance band. Participants were instructed to perform three sets with a predefined TUT (3 seconds concentric; 2 seconds isometric; 3 seconds eccentric; 2 seconds pause), equating to 80 seconds for 10 repetitions (one set). Outcome measures: The exercise-integrated system consisted of a sensor attached to the elastic resistance band that was connected to the Bandtrainer app on an electronic tablet device. Pain intensity was reported on a visual analogue scale on the app. Participants also completed a self-report exercise diary. Results: No major problems were reported with the system. Participants performed 2541 exercise sets during the 6 weeks; 5% were performed with the predefined TUT (ie, within 10 seconds of the 80-second target) and 90% were performed below the target TUT. On average, the participants received 15% of the instructed exercise dosage based on TUT. The exercise dosage reported in the exercise diaries was 2.3 times higher than the TUT data from the electronic system. Pain intensity was successfully collected in 100% of the exercise sets. Conclusion: The system was feasible for adolescents with patellofemoral pain. The system made it possible to capture detailed data about the TUT, repetitions and sets during home-based exercises together with pain intensity before and after each exercise. [Rathleff MS, Bandholm T, McGirr KA, Harring SI, Sørensen AS, Thorborg K (2016) New exercise-integrated technology can monitor the dosage and quality of exercise performed against an elastic resistance band by adolescents with patellofemoral pain: an observational study. Journal of Physiotherapy 62: 159–163

The relationship between HbA1c and hypoglycaemia in patients with diabetes treated with insulin degludec versus insulin glargine 100 units/mL

Aim Treat‐to‐target, randomized controlled trials have confirmed lower rates of hypoglycaemia at equivalent glycaemic control with insulin degludec (degludec) versus insulin glargine 100 units/mL (glargine U100) in patients with type 1 (T1D) or type 2 diabetes (T2D). Treat‐to‐target trials are designed to enable comparisons of safety and tolerability at a similar HbA1c level. In this post hoc analysis of the SWITCH 1 and 2 trials, we utilised a patient‐level modelling approach to compare how glycaemic control might differ between basal insulins at a similar rate of hypoglycaemia. Materials and Methods Data for HbA1c and symptomatic hypoglycaemia from the SWITCH 1 and SWITCH 2 trials were analyzed separately for patients with type 1 diabetes and type 2 diabetes, respectively. The association between the individual patient‐level risk of hypoglycaemia and HbA1c was investigated using a Poisson regression model and used to estimate potential differences in glycaemic control with degludec versus glargine U100, at the same rate of hypoglycaemia. Results Improvements in glycaemic control increased the incidence of hypoglycaemia with both basal insulins across diabetes types. Our analysis suggests that patients could achieve a mean HbA1c reduction of 0.70 [0.05; 2.20]95% CI (for type 1 diabetes) or 0.96 [0.39; 1.99]95% CI (for type 2 diabetes) percentage points (8 [1; 24]95% CI or 10 [4; 22]95% CI mmol/mol, respectively) further with degludec than with glargine U100 before incurring an equivalent risk of hypoglycaemia. Conclusion Our findings suggest that patients in clinical practice may be able to achieve lower glycaemia targets with degludec versus glargine U100, before incurring an equivalent risk of hypoglycaemia

Is There a Causal Association between Genotoxicity and the Imposex Effect?

There is a growing body of evidence that indicates common environmental pollutants are capable of disrupting reproductive and developmental processes by interfering with the actions of endogenous hormones. Many reports of endocrine disruption describe changes in the normal development of organs and tissues that are consistent with genetic damage, and recent studies confirm that many chemicals classified to have hormone-modulating effects also possess carcinogenic and mutagenic potential. To date, however, there have been no conclusive examples linking genetic damage with perturbation of endocrine function and adverse effects in vivo. Here, we provide the first evidence of DNA damage associated with the development of imposex (the masculinization of female gastropods considered to be the result of alterations to endocrine-mediated pathways) in the dog-whelk Nucella lapillus. Animals (n = 257) that displayed various stages of tributyltin (TBT)-induced imposex were collected from sites in southwest England, and their imposex status was determined by physical examination. Linear regression analysis revealed a very strong relationship (correlation coefficient of 0.935, p < 0.0001) between the degree of imposex and the extent of DNA damage (micronucleus formation) in hemocytes. Moreover, histological examination of a larger number of dog-whelks collected from sites throughout Europe confirmed the presence of hyperplastic growths, primarily on the vas deferens and penis in both TBT-exposed male snails and in females that exhibited imposex. A strong association was found between TBT body burden and the prevalence of abnormal growths, thereby providing compelling evidence to support the hypothesis that environmental chemicals that affect reproductive processes do so partly through DNA damage pathways

Policy Options for Sustainable Food Consumption – Review and Recommendations for Sweden. Mistra Sustainable Consumption report 1:10

The environmental impact of the average Swede’s diet exceeds the planetary limits for the food system in most areas. Over 15% of consumption-based greenhouse gas emissions come from food in Sweden. Sweden’s agricultural landscape has the largest proportion of European Red List species of all landscape types in Sweden and food imports are associated with high rates of land use, pesticides and veterinary antibiotics in other countries. Our diet is also not sustainable in terms of health – for example, 51% of Swedes are overweight and many of the most common diseases and causes of death are linked to diet.This report identifies and discusses policy instruments that the state and other public actors could introduce to steer food consumption in Sweden towards a more environmentally sustainable diet. Seventeen policy instruments operating either through knowledge and support, changes in relative prices, or regulation and requirements have been identified and previous research on policy effectiveness, costs and acceptance has been mapped out in a way that we hope is clear and easy to understand. Based on the current state of knowledge, we have formulated three recommendations on what public actors could do to accelerate the transition to a more sustainable food system.1.Intensify work in the public sector2.Develop national targets for sustainable food consumption3.Develop and implement effective and attractive policy instrument packagesThe mapping and analysis show that there is a need for research on policy instruments for environmentally sustainable food consumption, particularly when it comes to combinations of instruments. However, there is a sufficient evidence base for the immediate development and implementation of policy instruments to deal with the climate, environmental and health impacts of food. A focus on targets and policy instruments in the food area, as outlined above, is also fully in line with the EU’s new Farm-to-Fork strategy. The policy instruments discussed in the report can probably achieve only part of the huge, transformative changes required to limit the production and consumption of food to planetary limits, but a central issue is how to do this. Part of the answer lies in a change in food consumption and here we believe that we know where the answer lies: public actors ought to develop and implement a variety of policy instruments and systematically evaluate them – it is in this more large-scale implementation that the real need for research lies. The challenge of reducing the environmental impact of food consumption in Sweden is considerable, but there are good opportunities for nudging the trend towards more environment-friendly and health-friendly sustainable food consumption through the deployment of new policy instruments

Predictive potential of angiopoietin-2 in a mCRC subpopulation treated with vanucizumab in the McCAVE trial

IntroductionAngiopoetin-2 (Ang-2) is a key mediator of tumour angiogenesis. When upregulated it is associated with tumour progression and poor prognosis. Anti-vascular endothelial growth factor (VEGF) therapy has been widely used in the treatment of metastatic colorectal cancer (mCRC). The potential benefit of combined inhibition of Ang-2 and VEGF-A in previously untreated patients with mCRC was evaluated in the phase II McCAVE study (NCT02141295), assessing vanucizumab versus bevacizumab (VEGF-A inhibitor), both in combination with mFOLFOX-6 (modified folinic acid [leucovorin], fluorouracil and oxaliplatin) chemotherapy. To date, there are no known predictors of outcome of anti-angiogenic treatment in patients with mCRC. In this exploratory analysis, we investigate potential predictive biomarkers in baseline samples from McCAVE participants.MethodsTumour tissue samples underwent immunohistochemistry staining for different biomarkers, including Ang-2. Biomarker densities were scored on the tissue images using dedicated machine learning algorithms. Ang-2 levels were additionally assessed in plasma. Patients were stratified by KRAS mutation status determined using next generation sequencing. Median progression-free survival (PFS) for each treatment group by biomarker and KRAS mutation was estimated using Kaplan–Meier plots. PFS hazard ratios (and 95% confidence intervals) were compared using Cox regression.ResultsOverall low tissue baseline levels of Ang-2 were associated with longer PFS, especially in patients with wild-type KRAS status. In addition, our analysis identified a new subgroup of patients with KRAS wild-type mCRC and high levels of Ang-2 in whom vanucizumab/mFOLFOX-6 prolonged PFS significantly (log-rank p=0.01) by ~5.5 months versus bevacizumab/mFOLFOX-6. Similar findings were seen in plasma samples.DiscussionThis analysis demonstrates that additional Ang-2 inhibition provided by vanucizumab shows a greater effect than single VEGF-A inhibition in this subpopulation. These data suggest that Ang-2 may be both a prognostic biomarker in mCRC and a predictive biomarker for vanucizumab in KRAS wild-type mCRC. Thus, this evidence can potentially support the establishment of more tailored treatment approaches for patients with mCRC

Citizens Show Strong Support for Climate Policy, But Are They Also Willing to Pay?

To what extent citizens are willing not only to support ambitious climate policy, but also willing to pay for such policy remains subject to debate. Our analysis addresses three issues in this regard: whether, as is widely assumed but not empirically established, willingness to support (WTS) is higher than willingness to pay (WTP); whether the determinants of the two are similar; and what accounts for within-subject similarity between WTS and WTP. We address these issues based on data from an original nationally representative survey (N=2500) on forest conservation in Brazil, arguably the key climate policy issue in the country. The findings reveal that WTP is much lower than WTS. The determinants differ to some extent as well; regarding the effects of age, gender, and trust in government. The analysis also provides insights into factors influencing how much WTS and WTP line up within individuals, with respect to age, education, political ideology, salience of the deforestation issue, and trust in government. Our findings provide a more nuanced picture of how strong public support for climate change policy is, and a starting point for more targeted climate policy communication