A cohort study of duplex Doppler examinations of the carotid artery in primary open angle glaucoma

Objectives To explore the possibility of pathological change in the common carotid artery at the bifurcation and in the internal carotid artery beyond the bifurcation which could contribute to a reduced diastolic pressure as observed in primary open angle glaucoma. Design Duplex ultrasonic examinations of carotid bifurcations were conducted on 80 patients. Carotid artery defects were allocated into three types: no demonstrable flow defects, internal carotid artery abnormalities and disease in the carotid bulb. Setting Bristol Royal Infirmary Vascular Laboratory. Participants Eighty patients (mean age 69.6 years) providing a total of 160 sides to the analysis. Main outcome measures An estimated central retinal artery pressure, intraocular pressure and field loss were recorded for each side measured. Results Doppler investigations revealed significant levels of pathological change in the internal carotid distinct from changes at the carotid bulb. The disease revealed in the internal carotid artery was significantly associated with intraocular pressure (p = 0.032), with an effect small to medium in magnitude. The Q2 measure, derived from mean arterial pressure and intraocular pressure, was also substantively associated with disease in the internal carotid artery. Both intraocular pressure and the Q2 measure effectively discriminated between groups, with field loss providing rather less discriminating capability. There was a strong trend towards a higher intraocular pressures and a greater visual field loss with internal carotid artery disease. Conclusions Pathological changes in the extra cranial carotid artery in primary open angle glaucoma exceed those in the arteries classified as normal. The presence of disease specifically in the internal carotid artery emphasised the need for a mechanism for the evaluation of the internal carotid apart from the carotid bulb. A basis for clarifying the presence of an ischaemic zone is proposed

A systematic approach to atomicity decomposition in Event-B

Event-B is a state-based formal method that supports a refinement process in which an abstract model is elaborated towards an implementation in a step-wise manner. One weakness of Event-B is that control flow between events is typically modelled implicitly via variables and event guards. While this fits well with Event-B refinement, it can make models involving sequencing of events more difficult to specify and understand than if control flow was explicitly specified. New events may be introduced in Event-B refinement and these are often used to decompose the atomicity of an abstract event into a series of steps. A second weakness of Event-B is that there is no explicit link between such new events that represent a step in the decomposition of atomicity and the abstract event to which they contribute. To address these weaknesses, atomicity decomposition diagrams support the explicit modelling of control flow and refinement relationships for new events. In previous work,the atomicity decomposition approach has been evaluated manually in the development of two large case studies, a multi media protocol and a spacecraft sub-system. The evaluation results helped us to develop a systematic definition of the atomicity decomposition approach, and to develop a tool supporting the approach. In this paper we outline this systematic definition of the approach, the tool that supports it and evaluate the contribution that the tool makes

MyCare Card Development: Portable GUI Framework for the Personal Electronic Health Record Device

In most emergency situations, health professionals rely on patients to provide information about their medical history. However, in some cases patients might not be able to communicate this information, and in most countries an online integrated patient record system has not been adopted yet. Therefore, in order to address this issue the ongoing project MyCare Card (MyC2, www.myc2.org) has been established. The aim of this project is to design, implement, and evaluate a prototype patient held electronic health record device. Due to the wide range of user requirements, the device, its communication interface, and its software have to be compatible with many common platforms and operating systems. Thus, this paper is addressing one of the software compatibility matters-the cross-platform GUI implementation. It introduces a portable object-oriented GUI framework, suitable for a declarative layout definition, components customization, and fine model-view code separation. It also rationalizes the hardware and software solutions selected for this project implementation

Stacking Entropy of Hard Sphere Crystals

Classical hard spheres crystallize at equilibrium at high enough density. Crystals made up of stackings of 2-dimensional hexagonal close-packed layers (e.g. fcc, hcp, etc.) differ in entropy by only about $10^{-3}k_B$ per sphere (all configurations are degenerate in energy). To readily resolve and study these small entropy differences, we have implemented two different multicanonical Monte Carlo algorithms that allow direct equilibration between crystals with different stacking sequences. Recent work had demonstrated that the fcc stacking has higher entropy than the hcp stacking. We have studied other stackings to demonstrate that the fcc stacking does indeed have the highest entropy of ALL possible stackings. The entropic interactions we could detect involve three, four and (although with less statistical certainty) five consecutive layers of spheres. These interlayer entropic interactions fall off in strength with increasing distance, as expected; this fall-off appears to be much slower near the melting density than at the maximum (close-packing) density. At maximum density the entropy difference between fcc and hcp stackings is $0.00115 +/- 0.00004 k_B$ per sphere, which is roughly 30% higher than the same quantity measured near the melting transition.Comment: 15 page

Mortality, greenhouse gas emissions and consumer cost impacts of combined diet and physical activity scenarios: a health impact assessment study

$\textbf{Objective:}$ To quantify changes in mortality, greenhouse gas (GHG) emissions and consumer costs for physical activity and diet scenarios. $\textbf{Design:}$ For the physical activity scenarios, all car trips from <1 to <8 miles long were progressively replaced with cycling. For the diet scenarios, the study population was assumed to increase fruit and vegetable (F&V) consumption by 1–5 portions of F&V per day, or to eat at least 5 portions per day. Health effects were modelled with the comparative risk assessment method. Consumer costs were based on fuel cost savings and average costs of F&V, and GHG emissions to fuel usage and F&V production. $\textbf{Setting:}$ Working age population for England. $\textbf{Participants:}$ Data from the Health Survey for England, National Travel Survey and National Diet and Nutrition Survey. $\textbf{Primary outcomes measured:}$ Changes in premature deaths, consumer costs and GHG emissions stratified by age, gender and socioeconomic status (SES). $\textbf{Results:}$ Premature deaths were reduced by between 75 and 7648 cases per year for the physical activity scenarios, and 3255 and 6187 cases per year for the diet scenarios. Mortality reductions were greater among people of medium and high SES in the physical activity scenarios, whereas people with lower SES benefited more in the diet scenarios. Similarly, transport fuel costs fell more for people of high SES, whereas diet costs increased most for the lowest SES group. Net GHG emissions decreased by between 0.2 and 10.6 million tons of carbon dioxide equivalent (MtCO$_2$e) per year for the physical activity scenarios and increased by between 1.3 and 6.3 MtCO$_2$e/year for the diet scenarios. $\textbf{Conclusions:}$ Increasing F&V consumption offers the potential for large health benefits and reduces health inequalities. Replacing short car trips with cycling offers the potential for net benefits for health, GHG emissions and consumer costs.MT, PM, NJ and JW were supported by the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. JW is also supported by an MRC Population Health Scientist fellowship (grant number: MR/K021796/1). CB is supported by the UK Research Councils (grant number: EPSRC EP/L024756/1) as part of the Decision Making Theme of the UK Energy Research Centre Phase 3

Establishing user requirements for a patient held electronic record system in the United Kingdom

In the UK, in emergency situations, health professionals rely on patients to provide information about their medical history. However, in some cases patients may not remember their medication, long term illnesses or allergies, or be able to communicate this information. As a national on-line integrated patient record system has not yet been etablished, a patient held electronic health record has been proposed. This paper summarizes the results of a survey to establish the public’s and health care professionals` requirements for such a system

Ganciclovir Antiviral Therapy in Advanced Idiopathic Pulmonary Fibrosis: An Open Pilot Study

Hypothesis. Repeated epithelial cell injury secondary to viruses such as Epstein Barr and subsequent dysfunctional repair may be central to the pathogenesis of IPF. In this observational study, we evaluated whether a combination of standard and anti-viral therapy might have an impact on disease progression. Methods. Advanced IPF patients who failed standard therapy and had serological evidence of previous EBV, received ganciclovir (iv) at 5 mg/kg twice daily. Forced vital capacity (FVC), shuttle walk test, DTPA scan and prednisolone dose were measured before and 8 weeks post-treatment. Results. Fourteen patients were included. After ganciclovir, eight patients showed improvement in FVC and six deteriorated. The median reduction of prednisolone dose was 7.5 mg (44%). Nine patients were classified “responders” of whom four showed an improvement in all four criteria, while three of the five “non-responders” showed no response in any of the criteria. Responders showed reduction in prednisolone dosage (P = .02) and improved DTPA clearance (P = .001). Conclusion. This audit outcome suggests that 2-week course of ganciclovir (iv) may attenuate disease progression in a subgroup of advanced IPF patients. These observations do not suggest that anti-viral treatment is a substitute for the standard care, however, suggests the need to explore the efficacy of ganciclovir as adjunctive therapy in IPF

Time Scales for transitions between free energy minima of a hard sphere system

Time scales associated with activated transitions between glassy metastable states of a free energy functional appropriate for a dense hard sphere system are calculated by using a new Monte Carlo method for the local density variables. We calculate the time the system,initially placed in a shallow glassy minimum of the free energy, spends in the neighborhood of this minimum before making a transition to the basin of attarction of another free energy minimum. This time scale is found to increase with the average density. We find a crossover density near which this time scale increases very sharply and becomes longer than the longest times accessible in our simulation. This scale shows no evidence of dependence on sample size.Comment: 25 pages, Revtex, 6 postscript figures. Will appear in Phys Rev E, March 1996 or s

The macro-economic effects of health co-benefits associated with climate change mitigation strategies

The UK government has specific targets for greenhouse gas (GHG) emission reduction to lower the risk of dangerous climate change. Strategies to reduce GHG emissions are sometimes perceived as expensive and difficult to implement but previous work has demonstrated significant potential health co-benefits from ‘Active Travel and low carbon driving’, ‘Housing Insulation/Ventilation’, and ‘Healthy Diet’ scenarios which may be attractive to policymakers. Here a Computable General Equilibrium model is used to assess the financial effects of such health co-benefits on the wider economy including changes in labour force, social security payments and healthcare costs averted. Results suggest that for all scenarios the financial impacts of the health co-benefits will be positive and increased active travel in particular is likely to make a substantial contribution, largely due to health care costs averted. Strategies to reduce GHG emissions and improve health are likely to result in substantial and increasing positive contributions to the economy which may offset some potential economic costs and thereby be seen more favourably in times of economic austerity

Systematic review and meta-analysis of reduction in all-cause mortality from walking and cycling and shape of dose response relationship

BACKGROUND AND OBJECTIVE: Walking and cycling have shown beneficial effects on population risk of all-cause mortality (ACM). This paper aims to review the evidence and quantify these effects, adjusted for other physical activity (PA). DATA SOURCES: We conducted a systematic review to identify relevant studies. Searches were conducted in November 2013 using the following health databases of publications: Embase (OvidSP); Medline (OvidSP); Web of Knowledge; CINAHL; SCOPUS; SPORTDiscus. We also searched reference lists of relevant texts and reviews. STUDY ELIGIBILITY CRITERIA AND PARTICIPANTS: Eligible studies were prospective cohort design and reporting walking or cycling exposure and mortality as an outcome. Only cohorts of individuals healthy at baseline were considered eligible. STUDY APPRAISAL AND SYNTHESIS METHODS: Extracted data included study population and location, sample size, population characteristics (age and sex), follow-up in years, walking or cycling exposure, mortality outcome, and adjustment for other co-variables. We used random-effects meta-analyses to investigate the beneficial effects of regular walking and cycling. RESULTS: Walking (18 results from 14 studies) and cycling (8 results from 7 studies) were shown to reduce the risk of all-cause mortality, adjusted for other PA. For a standardised dose of 11.25 MET.hours per week (or 675 MET.minutes per week), the reduction in risk for ACM was 11% (95% CI = 4 to 17%) for walking and 10% (95% CI = 6 to 13%) for cycling. The estimates for walking are based on 280,000 participants and 2.6 million person-years and for cycling they are based on 187,000 individuals and 2.1 million person-years. The shape of the dose-response relationship was modelled through meta-analysis of pooled relative risks within three exposure intervals. The dose-response analysis showed that walking or cycling had the greatest effect on risk for ACM in the first (lowest) exposure interval. CONCLUSIONS AND IMPLICATIONS: The analysis shows that walking and cycling have population-level health benefits even after adjustment for other PA. Public health approaches would have the biggest impact if they are able to increase walking and cycling levels in the groups that have the lowest levels of these activities. REVIEW REGISTRATION: The review protocol was registered with PROSPERO (International database of prospectively registered systematic reviews in health and social care) PROSPERO 2013: CRD42013004266