Computer-Assisted versus Oral-and-Written History Taking for the Prevention and Management of Cardiovascular Disease: a Systematic Review of the Literature

Background and objectives: CVD is an important global healthcare issue; it is the leading cause of global mortality, with an increasing incidence identified in both developed and developing countries. It is also an extremely costly disease for healthcare systems unless managed effectively. In this review we aimed to: – Assess the effect of computer-assisted versus oral-and-written history taking on the quality of collected information for the prevention and management of CVD. – Assess the effect of computer-assisted versus oral-and-written history taking on the prevention and management of CVD. Methods: Randomised controlled trials that included participants of 16 years or older at the beginning of the study, who were at risk of CVD (prevention) or were either previously diagnosed with CVD (management). We searched all major databases. We assessed risk of bias using the Cochrane Collaboration tool. Results: We identified two studies. One comparing the two methods of history-taking for the prevention of cardiovascular disease n = 75. The study shows that generally the patients in the experimental group underwent more laboratory procedures, had more biomarker readings recorded and/or were given (or had reviewed), more dietary changes than the control group. The other study compares the two methods of history-taking for the management of cardiovascular disease (n = 479). The study showed that the computerized decision aid appears to increase the proportion of patients who responded to invitations to discuss CVD prevention with their doctor. The Computer-Assisted History Taking Systems (CAHTS) increased the proportion of patients who discussed CHD risk reduction with their doctor from 24% to 40% and increased the proportion who had a specific plan to reduce their risk from 24% to 37%. Discussion: With only one study meeting the inclusion criteria, for prevention of CVD and one study for management of CVD we did not gather sufficient evidence to address all of the objectives of the review. We were unable to report on most of the secondary patient outcomes in our protocol. Conclusions: We tentatively conclude that CAHTS can provide individually-tailored information about CVD prevention. However, further primary studies are needed to confirm these findings. We cannot draw any conclusions in relation to any other clinical outcomes at this stage. There is a need to develop an evidence base to support the effective development and use of CAHTS in this area of practice. In the absence of evidence on effectiveness, the implementation of computer-assisted history taking may only rely on the clinicians’ tacit knowledge, published monographs and viewpoint articles

Evidence for Small-Scale Mantle Convection in the Upper Mantle beneath the Baikal Rift Zone

Inversion of teleseismic P wave travel time residuals collected along a 1280-km-long profile traversing the Baikal rift zone (BRZ) reveals the existence of an upwarped lithosphere/asthenosphere interface, which causes a travel time delay of about 1 s at the rift axis ( central high ). An area with early arrivals relative to the stable Siberian platform of up to 0.5 s is observed on each side of the rift, about 200 km from the rift axis ( flank lows ). While the location of the central high is approximately fixed in the vicinity of the rift axis, those of the flank lows vary as much as 200 km with the azimuth of the arriving rays. We use three techniques to invert the travel time residuals for velocity anomalies beneath the profile. Two of the techniques assume an isotropic velocity structure, and one of them considers a transversely isotropic velocity model with a vertical axis of symmetry. We use independent geophysical observations such as gravity, active source seismic exploration, and crustal thickness measurements to compare the applicability of the models. Other types of geophysical measurements suggest that the model involving transverse isotropy is a plausible one, which suggests that the central high and flank lows are caused by the combined effects of an upwarped asthenosphere with a 2.5% lateral velocity reduction, and a velocity increase due to transverse isotropy with a vertical axis of symmetry. We consider the anisotropy to be the result of the vertical component of a lithosphere/asthenosphere small-scale mantle convection system that is associated with the rifting

Asymmetric Upwarp of the Asthenosphere beneath the Baikal Rift Zone, Siberia

In the summer of 1991 we installed 27 seismic stations about lake Baikal, Siberia, aimed at obtaining accurately timed digital seismic data to investigate the deep structure and geodynamics of the Baikal rift zone and adjacent regions. Sixty-six teleseismic events with high signal-to-noise ratio were recorded. Travel time and Q analysis of teleseisms characterize an upwarp of the lithosphere-asthenosphere boundary under Baikal. Theoretical arrival times were calculated by using the International Association of Seismology and Physics of the Earth\u27s interior 1991 Earth model, and travel time residuals were found by subtracting computed arrival times from observed ones. A three-dimensional downward projection inversion method is used to invert the P wave velocity structure with constraints from deep seismic sounding data. Our results suggest that (1) the lithosphere-asthenosphere transition upwarps beneath the rift zone, (2) the upwarp has an asymmetric shape, (3) the velocity contrast is -4.9% in the asthenosphere, (4) the density contrast is -0.6%, and (5) the P wave attenuation contrast t* is 0.1 s

S K S Splitting beneath Continental Rift Zones

We present measurements of S K S splitting at 28 digital seismic stations and 35 analog stations in the Baikal rift zone, Siberia, and adjacent areas, and at 17 stations in the East African Rift in Kenya and compare them with previous measurements from the Rio Grande Rift of North America. Fast directions in the inner region of the Baikal rift zone are distributed in two orthogonal directions, NE and NW, approximately parallel and perpendicular to the NE strike of the rift. In the adjacent Siberian platform and northern Mongolian fold belt, only the rift-orthogonal fast direction is observed. In southcentral Mongolia, the dominant fast direction changes to rift-parallel again, although a small number of measurements are still rift-orthogonal. For the axial zones of the East African and Rio Grande Rifts, fast directions are oriented on average NNE, that is, rotated clockwise from the N-S trending rift. All three rifts are underlain by low-velocity upper mantle as determined from teleseismic tomography. Rift-related mantle flow provides a plausible interpretation for the rift-orthogonal fast directions. The rift-parallel fast directions near the rift axes can be interpreted by oriented magmatic cracks in the mantle or small-scale mantle convection with rift-parallel flow. The agreement between stress estimates and corresponding crack orientations lends some weight to the suggestion that the rift-parallel fast directions are caused by oriented magmatic cracks

Colorectal Cancer Metastases Settle in the Hepatic Microenvironment Through \u3b15\u3b21 Integrin

Colorectal cancer (CRC) metastasis dissemination to secondary sites represents the critical point for the patient0s survival. The microenvironment is crucial to cancer progression, influencing tumour cell behaviour by modulating the expression and activation of molecules such as integrins, the cell-extracellular matrix interacting proteins participating in different steps of the tumour metastatic process. In this work, we investigated the role of a5b1 integrin and how the microenvironment influences this adhesion molecule, in a model of colon cancer progression to the liver. The culture medium conditioned by the IHH hepatic cell line, and the extracellular matrix (ECM) proteins, modulate the activation of a5b1 integrin in the colon cancer cell line HCT-116, and drives FAK phosphorylation during the process of cell adhesion to fibronectin, one of the main components of liver ECM. In these conditions, a5b1 modulates the expression/activity of another integrin, a2b1, involved in the cell adhesion to collagen I. These results suggest that a5b1 integrin holds a leading role in HCT-116 colorectal cancer cells adhesion to the ECM through the modulation of the intracellular focal adhesion kinase FAK and the a2b1 integrin activity. The driving role of the tumour microenvironment on CRC dissemination, here detected, and described, strengthens and adds new value to the concept that a5b1 integrin can be an appropriate and relevant therapeutic target for the control of CRC metastases

Reply [to “Comment on “SKS Splitting beneath Continental Rifts Zones” by Gao et al.”]

Vauchez et al. [this issue] (hereinafter refered to as VBN) interpret the petrologic, tomographic, and anisotropy data from continental rifts to support a model of continental rifting [Nicolas, 1993; Nicolas et al., 1994] in which the lithosphere splits along the rift axis and asthenosphere flows in from the sides to fill the resulting gap. We suggest here that the data can also be described by a model in which the lower lithosphere is modified or eroded by active mantle upwelling over a region of significantly greater dimensions than the rift graben and that partial melt developing in the upwelling region can account for the widespread volcanism, as well as the seismic properties. Nicolas [1993] argued that rift-aligned anisotropy could be explained by rift-parallel mantle flow. We thank VBN for bringing this relevant paper to our attention. Volcanism about the East African Rift and the Rio Grande is not confined to the rifts but extends hundreds of kilometers from the rift axes (Mount Kilimanjaro, Mount Elgon, Mount Kenya in East Africa, The Jemez Lineament on the Rio Grande) in regions uplifted relative to their surroundings. The low-velocity tomographic anomalies also extend beneath the uplifted regions and are thought to be related to the uplift possibly supporting it by thermostatic buoyancy. The size of the P and S velocity contrasts and attenuation of high frequencies have led to the suggestion that large regions of the anomalous bodies have temperatures at or above the solidus [Achauer et al, 1994; Slack et al., 1994, 1996]. The wide extent of the anomalous regions is not explicable as resulting from an abyssal lithospheric dike beneath the rift intruded by asthenosphere. The extension of the East African, Baikal, and Rio Grande rift grabens has been estimated to be about 10 km [Baker et al., 1972; Baldridge et al., 1984; Morgan and Golombek, 1984; Logatchev and Florensov, 1978]. Passive influx of asthenosphere into a 10 km lithospheric dike is insufficient to explain the tomographic anomalies [Davis, 1991]. In addition, the amount of finite strain from lithospheric diking is insufficient to explain the anisotropy anomalies. Active replacement or modification of lower lithosphere either prior to, or contemporaneous with, rifting could generate tomographic anomalies of this magnitude

Matrix Rigidity Regulates Cancer Cell Growth and Cellular Phenotype

Background: The mechanical properties of the extracellular matrix have an important role in cell growth and differentiation. However, it is unclear as to what extent cancer cells respond to changes in the mechanical properties (rigidity/stiffness) of the microenvironment and how this response varies among cancer cell lines. Methodology/Principal Findings: In this study we used a recently developed 96-well plate system that arrays extracellular matrix-conjugated polyacrylamide gels that increase in stiffness by at least 50-fold across the plate. This plate was used to determine how changes in the rigidity of the extracellular matrix modulate the biological properties of tumor cells. The cell lines tested fall into one of two categories based on their proliferation on substrates of differing stiffness: ‘‘rigidity dependent’ ’ (those which show an increase in cell growth as extracellular rigidity is increased), and ‘‘rigidity independent’’ (those which grow equally on both soft and stiff substrates). Cells which grew poorly on soft gels also showed decreased spreading and migration under these conditions. More importantly, seeding the cell lines into the lungs of nude mice revealed that the ability of cells to grow on soft gels in vitro correlated with their ability to grow in a soft tissue environment in vivo. The lung carcinoma line A549 responded to culture on soft gels by expressing the differentiated epithelial marker E-cadherin and decreasing the expression of the mesenchymal transcription factor Slug. Conclusions/Significance: These observations suggest that the mechanical properties of the matrix environment play

Families Coping With Financial Loss Following the Deepwater Horizon Oil Spill

Objective: This study examines family strategies for coping and adaptation to social disruption from the 2010 Deepwater Horizon oil spill (DHOS) in south Louisiana. Background: The DHOS is a technological disaster of unprecedented scale and ongoing impact, including the socioeconomic disruption of families. Method: Using data from focus groups, grounded‐theory methods informed a thematic analysis of spill‐related economic loss and coping mechanisms among families in the spill‐affected region. Results: Key findings were as follows: (a) long‐term economic impacts persisted but were nuanced and differed across places; (b) for families living in multistressor environments, concerns about the DHOS spilled over into other aspects of social functioning and became enmeshed with perceptions of other environmental stressors; and (c) economic exposure after the DHOS affected families differently based on social position and community social structure. Conclusion: This study contributes to existing knowledge on technological disaster and family resilience in the face of environmental shocks and stressors, underscoring the utility of the conservation of resources model of stress in this area of research. Implications: This research offers information about family‐level response to oil spill impacts and may be of interest to policymakers and practitioners who work to support resilience in disaster contexts

Ear wound regeneration in the African spiny mouse Acomys cahirinus

While regeneration occurs in a number of taxonomic groups across the Metazoa, there are very few reports of regeneration in mammals, which generally respond to wounding with fibrotic scarring rather than regeneration. A recent report described skin shedding, skin regeneration and extensive ear punch closure in two rodent species, Acomys kempi and Acomys percivali. We examined these striking results by testing the capacity for regeneration of a third species, Acomys cahirinus, and found a remarkable capacity to repair full thickness circular punches in the ear pinna. Four-millimeter-diameter wounds closed completely in 2 months in 100% of ear punches tested. Histology showed extensive formation of elastic cartilage, adipose tissue, dermis, epidermis and abundant hair follicles in the repaired region. Furthermore, we demonstrated abundant angiogenesis and unequivocal presence of both muscle and nerve fibers in the reconstituted region; in contrast, similar wounds in C57BL/6 mice simply healed the borders of the cut by fibrotic scarring. Our results confirm the regenerative capabilities of Acomys, and suggest this model merits further attention

Activation of a PAK-MEK signalling pathway in malaria parasite-infected erythrocytes

Merozoites of malaria parasites invade red blood cells (RBCs), where they multiply by schizogony, undergoing development through ring, trophozoite and schizont stages that are responsible for malaria pathogenesis. Here, we report that a protein kinase-mediated signalling pathway involving host RBC PAK1 and MEK1, which do not have orthologues in the Plasmodium kinome, is selectively stimulated in Plasmodium falciparum-infected (versus uninfected) RBCs, as determined by the use of phospho-specific antibodies directed against the activated forms of these enzymes. Pharmacological interference with host MEK and PAK function using highly specific allosteric inhibitors in their known cellular IC50 ranges results in parasite death. Furthermore, MEK inhibitors have parasiticidal effects in vitro on hepatocyte and erythrocyte stages of the rodent malaria parasite Plasmodium berghei, indicating conservation of this subversive strategy in malaria parasites. These findings have profound implications for the development of novel strategies for antimalarial chemotherapy