Single mini-incision total hip replacement for the management of arthritic disease of the hip : a systematic review and meta-analysis of randomized controlled trials

Peer reviewedPublisher PD

Adaptive antenna selection and Tx/Rx beamforming for large-scale MIMO systems in 60 GHz channels

We consider a large-scale MIMO system operating in the 60 GHz band employing beamforming for high-speed data transmission. We assume that the number of RF chains is smaller than the number of antennas, which motivates the use of antenna selection to exploit the beamforming gain afforded by the large-scale antenna array. However, the system constraint that at the receiver, only a linear combination of the receive antenna outputs is available, which together with the large dimension of the MIMO system makes it challenging to devise an efficient antenna selection algorithm. By exploiting the strong line-of-sight property of the 60 GHz channels, we propose an iterative antenna selection algorithm based on discrete stochastic approximation that can quickly lock onto a near-optimal antenna subset. Moreover, given a selected antenna subset, we propose an adaptive transmit and receive beamforming algorithm based on the stochastic gradient method that makes use of a low-rate feedback channel to inform the transmitter about the selected beams. Simulation results show that both the proposed antenna selection and the adaptive beamforming techniques exhibit fast convergence and near-optimal performance

Social and environmental determinants of child health in Mongolia across years of rapid economic growth: 2000-2010

Abstract Background To understand the effect of economic growth on health, we investigated the trend in socio-economic and regional determinants of child health in Mongolia. This Central Asian country had the fastest economic growth amongst low and middle-income countries (LMICs) from 2000 to 2010 and a healthcare system in transition. Methods Data was from Mongolian multiple indicator cluster surveys (MICS) in 2000, 2005 and 2010. Child nutrition/growth was measured by height-for-age z-score (HAZ), weight-for-age z-score (WAZ), prevalence of stunted (HAZ < −2) and underweight (WAZ < −2) children. Access to health care was measured by prevalence of fully immunised children <5 years. Multivariate multi-level logistic mixed modelling was used to estimate the effect of socio-economic and environmental health determinants on each outcome in each year; 2000, 2005 and 2010. T-tests were used to measure significant change in HAZ and WAZ over the decade. Results Overall, from 2000 to 2010, there was a significant improvement (p < 0.001) in all three outcomes, but the effect of socio-economic factors increased on both stunting and weight. In 2000, region was a significant determinant: children living in three provinces were significantly more likely to be stunted and less likely to be immunised than Ulaanbaatar, but this was not significant by 2010. By 2010, none of the factors were significant determinants of immunisation in children. In 2000, economic status had no effect on stunting (OR = 0.91; 95%CI:0.49,1.66), however by 2010, children in the poorest economic quintile were 4 times more likely to be stunted than the richest (OR = 0.24; 95% CI:0.13,0.45; p < 0.001). The effect of maternal education on stunting prevalence continued over the 10 years, in both 2000 and 2010 children were twice as likely to be stunted if their mother had no education compared to university education (2000 OR = 0.45; 95% CI:0.28,0.73, p < 0.01,2010 OR =0.55; 95% CI:0.35,0.87, p < 0.05). Conclusion Economic growth in Mongolia from 2000 to 2010 resulted in an increase in the effect of social determinants of child health; whilst focused policy improved access to immunisation. Children with less educated mothers and lower household incomes should be targeted in interventions to reduce health inequity

Structural and Functional Characterization of the FadR Regulatory Protein from Vibrio alginolyticus

The structure of Vibrio cholerae FadR (VcFadR) complexed with the ligand oleoyl-CoA suggests an additional ligand-binding site. However, the fatty acid metabolism and its regulation is poorly addressed in Vibrio alginolyticus, a species closely-related to V. cholerae. Here, we show crystal structures of V. alginolyticus FadR (ValFadR) alone and its complex with the palmitoyl-CoA, a long-chain fatty acyl ligand different from the oleoyl-CoA occupied by VcFadR. Structural comparison indicates that both VcFadR and ValFadR consistently have an additional ligand-binding site (called site 2), which leads to more dramatic conformational-change of DNA-binding domain than that of the E. coli FadR (EcFadR). Isothermal titration calorimetry (ITC) analyses defines that the ligand-binding pattern of ValFadR (2:1) is distinct from that of EcFadR (1:1). Together with surface plasmon resonance (SPR), electrophoresis mobility shift assay (EMSA) demonstrates that ValFadR binds fabA, an important gene of unsaturated fatty acid (UFA) synthesis. The removal of fadR from V. cholerae attenuates fabA transcription and results in the unbalance of UFA/SFA incorporated into membrane phospholipids. Genetic complementation of the mutant version of fadR (Δ42, 136-177) lacking site 2 cannot restore the defective phenotypes of ΔfadR while the wild-type fadR gene and addition of exogenous oleate can restore them. Mice experiments reveals that VcFadR and its site 2 have roles in bacterial colonizing. Together, the results might represent an additional example that illustrates the Vibrio FadR-mediated lipid regulation and its role in pathogenesis

An internet-based intervention with brief nurse support to manage obesity in primary care (POWeR+): a pragmatic, parallel-group, randomised controlled trial

Background The obesity epidemic has major public health consequences. Expert dietetic and behavioural counselling with intensive follow-up is effective, but resource requirements severely restrict widespread implementation in primary care, where most patients are managed. We aimed to estimate the effectiveness and cost-effectiveness of an internet-based behavioural intervention (POWeR+) combined with brief practice nurse support in primary care. Methods We did this pragmatic, parallel-group, randomised controlled trial at 56 primary care practices in central and south England. Eligible adults aged 18 years or older with a BMI of 30 kg/m2 or more (or ≥28 kg/m2 with hypertension, hypercholesterolaemia, or diabetes) registered online with POWeR+—a 24 session, web-based, weight management intervention lasting 6 months. After registration, the website automatically randomly assigned patients (1:1:1), via computer-generated random numbers, to receive evidence-based dietetic advice to swap foods for similar, but healthier, choices and increase fruit and vegetable intake, in addition to 6 monthly nurse follow-up (control group); web-based intervention and face-to-face nurse support (POWeR+Face-to-face [POWeR+F]; up to seven nurse contacts over 6 months); or web-based intervention and remote nurse support (POWeR+Remote [POWeR+R]; up to five emails or brief phone calls over 6 months). Participants and investigators were masked to group allocation at the point of randomisation; masking of participants was not possible after randomisation. The primary outcome was weight loss averaged over 12 months. We did a secondary analysis of weight to measure maintenance of 5% weight loss at months 6 and 12. We modelled the cost-effectiveness of each intervention. We did analysis by intention to treat, with multiple imputation for missing data. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN21244703. Findings Between Jan 30, 2013, and March 20, 2014, 818 participants were randomly assigned to the control group (n=279), the POWeR+F group (n=269), or the POWeR+R group (n=270). Weight loss averaged over 12 months was recorded in 666 (81%) participants. The control group lost almost 3 kg over 12 months (crude mean weight: baseline 104·38 kg [SD 21·11; n=279], 6 months 101·91 kg [19·35; n=136], 12 months 101·74 kg [19·57; n=227]). The primary imputed analysis showed that compared with the control group, patients in the POWeR+F group achieved an additional weight reduction of 1·5 kg (95% CI 0·6–2·4; p=0·001) averaged over 12 months, and patients in the POWeR+R group achieved an additional 1·3 kg (0·34–2·2; p=0·007). 21% of patients in the control group had maintained a clinically important 5% weight reduction at month 12, compared with 29% of patients in the POWeR+F group (risk ratio 1·56, 0·96–2·51; p=0·070) and 32% of patients in the POWeR+R group (1·82, 1·31–2·74; p=0·004). The incremental overall cost to the health service per kg weight lost with the POWeR+ interventions versus the control strategy was £18 (95% CI −129 to 195) for POWeR+F and –£25 (−268 to 157) for POWeR+R; the probability of being cost-effective at a threshold of £100 per kg lost was 88% and 98%, respectively. No adverse events were reported. Interpretation Weight loss can be maintained in some individuals by use of novel written material with occasional brief nurse follow-up. However, more people can maintain clinically important weight reductions with a web-based behavioural program and brief remote follow-up, with no increase in health service costs. Future research should assess the extent to which clinically important weight loss can be maintained beyond 1 year

Quantifying public preferences for different bowel preparation options prior to screening CT colonography: a discrete choice experiment

Objectives: CT colonography (CTC) may be an acceptable test for colorectal cancer screening but bowel preparation can be a barrier to uptake. This study tested the hypothesis that prospective screening invitees would prefer full-laxative preparation with higher sensitivity and specificity for polyps, despite greater burden, over less burdensome reduced-laxative or non-laxative alternatives with lower sensitivity and specificity. Design: Discrete choice experiment. Setting: Online, web-based survey. Participants: 2819 adults (45–54 years) from the UK responded to an online invitation to take part in a cancer screening study. Quota sampling ensured that the sample reflected key demographics of the target population and had no relevant bowel disease or medical qualifications. The analysis comprised 607 participants. Interventions: After receiving information about screening and CTC, participants completed 3–4 choice scenarios. Scenarios showed two hypothetical forms of CTC with different permutations of three attributes: preparation, sensitivity and specificity for polyps. Primary outcome measures: Participants considered the trade-offs in each scenario and stated their preferred test (or chose neither). Results: Preparation and sensitivity for polyps were both significant predictors of preferences (coefficients: −3.834 to −6.346 for preparation, 0.207–0.257 for sensitivity; p<0.0005). These attributes predicted preferences to a similar extent. Realistic specificity values were non-significant (−0.002 to 0.025; p=0.953). Contrary to our hypothesis, probabilities of selecting tests were similar for realistic forms of full-laxative, reduced-laxative and non-laxative preparations (0.362–0.421). However, they were substantially higher for hypothetical improved forms of reduced-laxative or non-laxative preparations with better sensitivity for polyps (0.584–0.837). Conclusions: Uptake of CTC following non-laxative or reduced-laxative preparations is unlikely to be greater than following full-laxative preparation as perceived gains from reduced burden may be diminished by reduced sensitivity. However, both attributes are important so a more sensitive form of reduced-laxative or non-laxative preparation might improve uptake substantially.JRC.I.2-Public Health Policy Suppor

Mutant Ahi1 Affects Retinal Axon Projection in Zebrafish via Toxic Gain of Function

Joubert syndrome (JBTS) is an inherited autosomal recessive disorder associated with cerebellum and brainstem malformation and can be caused by mutations in the Abelson helper integration site-1 (AHI1) gene. Although AHI1 mutations in humans cause abnormal cerebellar development and impaired axonal decussation in JBTS, these phenotypes are not robust or are absent in various mouse models with Ahi1 mutations. AHI1 contains an N-terminal coiled-coil domain, multiple WD40 repeats, and a C-terminal Src homology 3 (SH3) domain, suggesting that AHI1 functions as a signaling or scaffolding protein. Since most AHI1 mutations in humans can result in truncated AHI1 proteins lacking WD40 repeats and the SH3 domain, it remains unclear whether mutant AHI1 elicits toxicity via a gain-of-function mechanism by the truncated AHI1. Because Ahi1 in zebrafish and humans share a similar N-terminal region with a coiled-coil domain that is absent in mouse Ahi1, we used zebrafish as a model to investigate whether Ahi1 mutations could affect axonal decussation. Using in situ hybridization, we found that ahi1 is highly expressed in zebrafish ocular tissues, especially in retina, allowing us to examine its effect on retinal ganglion cell (RGC) projection and eye morphology. We injected a morpholino to zebrafish embryos, which can generate mutant Ahi1 lacking the intact WD40 repeats, and found RGC axon misprojection and ocular dysplasia in 4 dpf (days post-fertilization) larvae after the injection. However, ahi1 null zebrafish showed normal RGC axon projection and ocular morphology. We then used CRISPR/Cas9 to generate truncated ahi1 and also found similar defects in the RGC axon projection as seen in those injected with ahi1 morpholino. Thus, the aberrant retinal axon projection in zebrafish is caused by the presence of mutant ahi1 rather than the loss of ahi1, suggesting that mutant Ahi1 may affect axonal decussation via toxic gain of function

Impact of meteorological factors on the COVID-19 transmission: A multicity study in China

The purpose of the present study is to explore the associations between novel coronavirus disease 2019 (COVID- 19) case counts and meteorological factors in 30 provincial capital cities of China. We compiled a daily dataset including confirmed case counts, ambient temperature (AT), diurnal temperature range (DTR), absolute humidity (AH) and migration scale index (MSI) for each city during the period of January 20th to March 2nd, 2020. First, we explored the associations between COVID-19 confirmed case counts, meteorological factors, and MSI using non-linear regression. Then, we conducted a two-stage analysis for 17 cities with more than 50 confirmed cases. In the first stage, generalized linear models with negative binomial distribution were fitted to estimate city-specific effects of meteorological factors on confirmed case counts. In the second stage, the meta-analysis was conducted to estimate the pooled effects. Our results showed that among 13 cities that have less than 50 confirmed cases, 9 cities locate in the Northern China with average AT below0 °C, 12 cities had average AHbelow4 g/m3, and one city (Haikou) had the highest AH (14.05 g/m3). Those 17 cities with 50 and more cases accounted for 90.6% of all cases in our study. Each 1 °C increase in AT and DTR was related to the decline of daily confirmed case counts, and the corresponding pooled RRs were 0.80 (95% CI: 0.75, 0.85) and 0.90 (95% CI: 0.86, 0.95), respectively. For AH, the association with COVID-19 case counts were statistically significant in lag 07 and lag 014. In addition,we found the all these associations increased with accumulated time duration up to 14 days. In conclusions, meteorological factors play an independent role in the COVID-19 transmission after controlling population migration. Local weather condition with low temperature, mild diurnal temperature range and low humidity likely favor the transmission