Lower Nutritional Status and Higher Food Insufficiency in Frail Older US Adults

Frailty is a state of decreased physical functioning and a significant complication of ageing. We examined frailty, energy and macronutrient intake, biomarkers of nutritional status and food insufficiency in US older adult (age ≥ 60 years) participants of the Third National Health and Nutrition Examination Survey (4731). Frailty was defined as meeting ≥ 2 and pre-frailty as meeting one of the following four-item criteria: (1) slow walking; (2) muscular weakness; (3) exhaustion and (4) low physical activity. Intake was assessed by 24 h dietary recall. Food insufficiency was self-reported as ‘sometimes’ or ‘often’ not having enough food to eat. Analyses were adjusted for sex, race, age, smoking, education, income, BMI, other co-morbid conditions and complex survey design. Prevalence of frailty was highest among people who were obese (20•8 %), followed by overweight (18•4 %), normal weight (16•1 %) and lowest among people who were under- weight (13•8 %). Independent of BMI, daily energy intake was lowest in people who were frail, followed by pre-frail and highest in people who were not frail (6648 (SE 130), 6966 (SE 79) and 7280 (SE 84) kJ, respectively, P, 0•01). Energy-adjusted macronutrient intakes were similar in people with and without frailty. Frail (adjusted OR (AOR) 4•7; 95 % CI 1•7, 12•7) and pre-frail (AOR 2•1; 95 % CI 0•8, 5•8) people were more likely to report being food insufficient than not frail people. Serum albumin, carotenoids and Se levels were lower in frail adults than not frail adults. Research is needed on targeted interventions to improve nutritional status and food insufficiency among frail older adults, while not necessarily increasing BMI

Long-Term Factors Associated With Falls and Fractures Poststroke

Background: Risk factors for poststroke falls and fractures remain poorly understood. This study aimed to evaluate which factors increased risk of these events after stroke. Methods: Data from 7,267 hospitalized stroke patients were acquired from the Norfolk and Norwich University Hospital Stroke Register from 2003–2015. The impacts of multiple patient level and stroke characteristics and comorbidities on post-discharge falls and fractures were assessed. Univariate and multivariable models were constructed, adjusting for multiple confounders, using binary logistic regression for short-term analysis (up to 1-year post-discharge) and Cox-proportional hazard models for longer term analysis (1–3, 3–5, and 0–10 years follow-up). Results: The mean age (SD) was 76.3 ± 12.1 years at baseline. 1,138 (15.7%) participants had an incident fall; and 666 (9.2%) an incident fracture during the 10-year follow-up (total person years = 64,447.99 for falls and 67,726.70 for fractures). Half of the sample population were females (50.6%) and the majority had an ischemic stroke (89.8%). After adjusting for confounders: age, sex, previous history of falls, and atrial fibrillation were associated with an increased risk of both falls and fractures during follow-up. Furthermore, chronic kidney disease and hyperlipidemia were associated with an increased risk of falls, while previous stroke/transient ischemic attack increased fracture risk. Total anterior circulation stroke and a prestroke modified Rankin Scale score of 3–5 were associated with decreased risk of both events, with hypertension and cancer decreasing risk of falls only. Conclusion: We identified demographic, stroke-related, and comorbid factors associated with poststroke falls and fracture incidence. Further studies are required to examine and establish the relationship between reversible factors and further explore the role of preventative measures to prevent poststroke falls and fractures

Radiative and interelectronic-interaction corrections to the hyperfine splitting in highly charged B-like ions

The ground-state hyperfine splitting values of high-Z boronlike ions are calculated. Calculation of the interelectronic-interaction contribution is based on a combination of the 1/Z perturbation theory and the large-scale configuration-interaction Dirac-Fock-Sturm method. The screened QED corrections are evaluated utilizing an effective screening potential approach. Total hyperfine splitting energies are presented for several B-like ions of particular interest: {}^{45}Sc{}^{16+}, {}^{57}Fe{}^{21+}, {}^{207}Pb{}^{77+}, and {}^{209}Bi{}^{78+}. For lead and bismuth the experimental values of the 1s hyperfine splitting are employed to improve significantly the theoretical results by reducing the uncertainty due to the nuclear effects.Comment: 12 pages, 2 figures, 3 table

On internal wave breaking and tidal dissipation near the centre of a solar-type star

We study the fate of internal gravity waves, which are excited by tidal forcing by a short-period planet at the interface of convection and radiation zones, approaching the centre of a solar-type star. We study at what amplitude these wave are subject to instabilities. These instabilities lead to wave breaking whenever the amplitude exceeds a critical value. Below this value, the wave reflects perfectly from the centre of the star. Wave breaking results in spinning up the central regions of the star, and the formation of a critical layer, which acts as an absorbing barrier for ingoing waves. As these waves are absorbed, the star is spun up from the inside out. This results in an important amplitude dependence of the tidal quality factor Q'. If the tidal forcing amplitude exceeds the value required for wave breaking, efficient dissipation results over a continuous range of tidal frequencies, leading to Q' \approx 10^5 (P/1day)^(8/3), for the current Sun. This varies by less than a factor of 5 throughout the range of G and K type main sequence stars, for a given orbit. We predict fewer giant planets with orbital periods of less than about 2 days around such stars, if they cause breaking at the centre, due to the efficiency of this process. This mechanism would, however, be ineffective in stars with a convective core, such as WASP-18, WASP-12 and OGLE-TR-56, perhaps partly explaining the survival of their close planetary companions.Comment: 22 pages, 10 figures, accepted in MNRAS, abstract shortened (!

Physical Activity and Survival After Prostate Cancer

AbstractBackgroundDespite the high global prevalence of prostate cancer (PCa), few epidemiologic studies have assessed physical activity in relation to PCa survival.ObjectiveTo evaluate different types, intensities, and timing of physical activity relative to PCa survival.Design, setting, and participantsA prospective study was conducted in Alberta, Canada, in a cohort of 830 stage II–IV incident PCa cases diagnosed between 1997 and 2000 with follow-up to 2014 (up to 17 yr). Prediagnosis lifetime activity was self-reported at diagnosis. Postdiagnosis activity was self-reported up to three times during follow-up.Outcome measurements and statistical analysisCox proportional hazards models related physical activity to all-cause and PCa-specific deaths and to first recurrence/progression of PCa.Results and limitationsA total of 458 deaths, 170 PCa-specific deaths, and, after first follow-up, 239 first recurrences/progressions occurred. Postdiagnosis total activity (>119 vs ≤42 metabolic equivalent [MET]-hours/week per year) was associated with a significantly lower all-cause mortality risk (hazard ratio [HR]: 0.58; 95% confidence interval [CI], 0.42–0.79; p value for trend <0.01). Postdiagnosis recreational activity (>26 vs ≤4 MET-hours/week per year) was associated with a significantly lower PCa-specific mortality risk (HR: 0.56; 95% CI, 0.35–0.90; p value for trend = 0.01). Sustained recreational activity before and after diagnosis (>18–20 vs <7–8 MET-hours/week per year) was associated with a lower risk of all-cause mortality (HR: 0.66; 95% CI, 0.49–0.88). Limitations included generalisability to healthier cases and an observational study design.ConclusionsThese findings support emerging recommendations to increase physical activity after the diagnosis of PCa and would inform a future exercise intervention trial examining PCa outcomes.Patient summaryIn a 17-yr prostate cancer (PCa) survival study, men who survived at least 2 yr who were more physically active postdiagnosis or performed more recreational physical activity before and after diagnosis survived longer. Recreational physical activity after diagnosis was associated with a lower risk of PCa death

On the dynamics of planetesimals embedded in turbulent protoplanetary discs

(abridged) Angular momentum transport and accretion in protoplanetary discs are generally believed to be driven by MHD turbulence via the magneto-rotational instability (MRI). The dynamics of solid bodies embedded in such discs (dust grains, boulders, planetesimals and planets) may be strongly affected by the turbulence, such that the formation pathways for planetary systems are determined in part by the strength and spatial distribution of the turbulent flow. We examine the dynamics of planetesimals, with radii between 1m \^a 10 km, embedded in turbulent protoplanetary discs, using three dimensional MHD simulations. The planetesimals experience gas drag and stochastic gravitational forces due to the turbulent disc. We use, and compare the results from, local shearing box simulations and global models in this study. The main aims of this work are to examine: the growth, and possible saturation, of the velocity dispersion of embedded planetesimals as a function of their size and disc parameters; the rate of radial migration and diffusion of planetesimals; the conditions under which the results from shearing box and global simulations agree. We find good agreement between local and global simulations when shearing boxes of dimension 4H x 16H x 2H are used (H being the local scale height). The magnitude of the density fluctuations obtained is sensitive to the box size, due to the excitation and propagation of spiral density waves. This affects the stochastic forcing experienced by planetesimals. [...] Our models show that fully developed MHD turbulence in protoplanetary discs would have a destructive effect on embedded planetesimals. Relatively low levels of turbulence are required for traditional models of planetesimal accretion to operate, this being consistent with the existence of a dead zone in protoplanetary discs.Comment: 23 pages, 28 figures, 3 tables, accepted for publication in MNRA

Get screened: a pragmatic randomized controlled trial to increase mammography and colorectal cancer screening in a large, safety net practice

Abstract Background Most randomized controlled trials of interventions designed to promote cancer screening, particularly those targeting poor and minority patients, enroll selected patients. Relatively little is known about the benefits of these interventions among unselected patients. Methods/Design "Get Screened" is an American Cancer Society-sponsored randomized controlled trial designed to promote mammography and colorectal cancer screening in a primary care practice serving low-income patients. Eligible patients who are past due for mammography or colorectal cancer screening are entered into a tracking registry and randomly assigned to early or delayed intervention. This 6-month intervention is multimodal, involving patient prompts, clinician prompts, and outreach. At the time of the patient visit, eligible patients receive a low-literacy patient education tool. At the same time, clinicians receive a prompt to remind them to order the test and, when appropriate, a tool designed to simplify colorectal cancer screening decision-making. Patient outreach consists of personalized letters, automated telephone reminders, assistance with scheduling, and linkage of uninsured patients to the local National Breast and Cervical Cancer Early Detection program. Interventions are repeated for patients who fail to respond to early interventions. We will compare rates of screening between randomized groups, as well as planned secondary analyses of minority patients and uninsured patients. Data from the pilot phase show that this multimodal intervention triples rates of cancer screening (adjusted odds ratio 3.63; 95% CI 2.35 - 5.61). Discussion This study protocol is designed to assess a multimodal approach to promotion of breast and colorectal cancer screening among underserved patients. We hypothesize that a multimodal approach will significantly improve cancer screening rates. The trial was registered at Clinical Trials.gov NCT00818857http://deepblue.lib.umich.edu/bitstream/2027.42/78264/1/1472-6963-10-280.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78264/2/1472-6963-10-280.pdfPeer Reviewe

A comprehensive review of 46 exercise treatment studies in fibromyalgia (1988–2005)

The purpose of this review was to: (1) locate all exercise treatment studies of fibromyalgia (FM) patients from 1988 through 2005, (2) present in tabular format the key details of each study and (3) to provide a summary and evaluation of each study for exercise and health outcomes researchers. Exercise intervention studies in FM were retrieved through Cochrane Collaboration Reviews and key word searches of the medical literature, conference proceedings and bibliographies. Studies were reviewed for inclusion using a standardized process. A table summarizing subject characteristics, exercise mode, timing, duration, frequency, intensity, attrition and outcome variables was developed. Results, conclusions and comments were made for each study. Forty-six exercise treatment studies were found with a total of 3035 subjects. The strongest evidence was in support of aerobic exercise a treatment prescription for fitness and symptom and improvement. In general, the greatest effect and lowest attrition occurred in exercise programs that were of lower intensity than those of higher intensity. Exercise is a crucial part of treatment for people with FM. Increased health and fitness, along with symptom reduction, can be expected with exercise that is of appropriate intensity, self-modified, and symptom-limited. Exercise and health outcomes researchers are encouraged to use the extant literature to develop effective health enhancing programs for people with FM and to target research to as yet understudied FM subpopulations, such as children, men, older adults, ethnic minorities and those with common comorbidities of osteoarthritis and obesity

Theory of disk accretion onto supermassive black holes

Accretion onto supermassive black holes produces both the dramatic phenomena associated with active galactic nuclei and the underwhelming displays seen in the Galactic Center and most other nearby galaxies. I review selected aspects of the current theoretical understanding of black hole accretion, emphasizing the role of magnetohydrodynamic turbulence and gravitational instabilities in driving the actual accretion and the importance of the efficacy of cooling in determining the structure and observational appearance of the accretion flow. Ongoing investigations into the dynamics of the plunging region, the origin of variability in the accretion process, and the evolution of warped, twisted, or eccentric disks are summarized.Comment: Mostly introductory review, to appear in "Supermassive black holes in the distant Universe", ed. A.J. Barger, Kluwer Academic Publishers, in pres

Heterosexual couples and prostate cancer support groups: a gender relations analysis.

Introduction: Men diagnosed with prostate cancer (PCa) can receive supportive care from an array of sources including female partners and prostate cancer support groups (PCSGs). However, little is known about how heterosexual gender relations and supportive care play out among couples who attend PCSGs. Distilling such gender relation patterns is a key to understanding and advancing supportive care for men who experience PCa and their families