Statin-associated muscle symptoms (SAMS) in primary prevention for cardiovascular disease in older adults:A protocol for a systematic review and meta-analysis of randomised controlled trials

IntroductionAlthough statins are commonly used for prevention of cardiovascular disease, there is limited evidence about statin-related adverse effects in older people. Statin-related adverse events (AEs), especially the statin-associated muscle symptoms (SAMS), are the most common reasons for their discontinuation. Therefore, it is important to determine the risk of SAMS in the older population. We will undertake a systematic review and meta-analysis primarily focusing on the risk of SAMS and secondarily targeting myopathy, rhabdomyolysis, AEs and serious AEs, dropouts due to SAMS in run-in period, related permanent discontinuation rate of statins and creatine kinase level, among older people who received statins for primary prevention.Methods and analysisThis study has been developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement. We will include randomised controlled trials in which statin was compared with placebo with at least 1 year follow-up among older adults aged ≥65. This review is an update of a Cochrane systematic review that included the articles published before 2012. Cochrane Central Register of Controlled Trials, Medline OvidSP and Embase electronic database searches will be performed to identify relevant articles, limiting the publication date from 1 January 2012 to 13 February 2017. There will be no language limitation. Two independent reviewers will screen titles and abstracts and full text in duplicate. Risk of bias and evidence quality will be assessed using the Cochrane Collaboration’s tool and the Grading of Recommendations Assessment, Development and Evaluation approach, respectively. A meta-analysis using pooled data will be undertaken, if appropriate. We will also perform metaregression and subgroup analyses to identify sources of heterogeneity.Ethics and disseminationThis study is exempt from ethics approval due to the anonymous and aggregated data used. The outcomes will be disseminated by conference presentations and published in a peer-reviewed journal.Trial registration numberCRD42017058436.</jats:sec

Systematic review of trends in emergency department attendances : an Australian perspective

Emergency departments (EDs) in many developed countries are experiencing increasing pressure due to rising numbers of patient presentations and emergency admissions. Reported increases range up to 7% annually. Together with limited inpatient bed capacity, this contributes to prolonged lengths of stay in the ED; disrupting timely access to urgent care, posing a threat to patient safety. The aim of this review is to summarise the findings of studies that have investigated the extent of and the reasons for increasing emergency presentations. To do this, a systematic review and synthesis of published and unpublished reports describing trends and underlying drivers associated with the increase in ED presentations in developed countries was conducted. Most published studies provided evidence of increasing ED attendances within developed countries. A series of inter-related factors have been proposed to explain the increase in emergency demand. These include changes in demography and in the organisation and delivery of healthcare services, as well as improved health awareness and community expectations arising from health promotion campaigns. The factors associated with increasing ED presentations are complex and inter-related and include rising community expectations regarding access to emergency care in acute hospitals. A systematic investigation of the demographic, socioeconomic and health-related factors highlighted by this review is recommended. This would facilitate untangling the dynamics of the increase in emergency demand

Predicting Feedlot Growth Performance over the Feeding Period Utilizing Steer Age and Body Weight

A pooled- analysis of UNL feedlot pens examined the effects of steer age and body weight on feedlot growth performance. For data analysis, pens were divided into 3 subclasses based on steer age (calf- fed, short yearling, or long yearling) and, grouped based upon initial body weight (500 to 1200 lb, in 100 lb increments) within each age class. As initial body weight increased, DMI (lb/d) for the whole feeding period increased quadratically in calf-fed steers and increased linearly in short and long yearlings. A quadratic increase in ADG was observed in calf- feds as initial body weight increased. No differences in ADG were observed for short and long yearlings due to initial body weight. As heavier cattle were placed within age group, feed conversion increased linearly. Predicting DMI is more consistent when expressed as % of body weight. Predicting intake and growth performance over the entire feeding period, in order to facilitate management decisions, is dependent upon steer age and initial weight when starting the finishing diet

Incidence of WHO stage 3 and 4 conditions following initiation of Anti-Retroviral Therapy in resource limited settings

To determine the incidence of WHO clinical stage 3 and 4 conditions during early anti-retroviral therapy (ART) in resource limited settings (RLS)

The rotation - Lithium depletion correlation in the beta Pictoris association and LDB age determination

There is evidence in the 125-Myr Pleiades cluster, and more recently in the 5-Myr NGC 2264 cluster, that rotation plays a key role in the Lithium (Li) depletion processes among low-mass stars. Fast rotators appear to be less Li-depleted than equal-mass slow rotators. We intend to explore the existence of a Li depletion - rotation connection among the beta Pictoris members at an age of about 24 Myr, and to use such correlation either to confirm or to improve the age estimate based on the Lithium Depletion Boundary (LDB) modeling. We have photometrically monitored all the known members of the beta Pictoris association with at least one Lithium equivalent width (Li EW) measurement from the literature. We measured the rotation periods of 30 members for the first time and retrieved from the literature the rotation periods for other 36 members, building a catalogue of 66 members with measured rotation period and Li EW. We find that in the 0.3 < M < 0.8 Msun range, there is a strong correlation between rotation and Li EW. For higher mass stars, no significant correlation is found. For very low mass stars in the Li depletion onset, at about 0.1 Msun, data are too few to infer a significant correlation. The observed Li EWs are compared with those predicted by the Dartmouth stellar evolutionary models that incorporate the effects of magnetic fields. After decorrelating the Li EW from the rotation period, we find that the hot side of the LDB is fitted well by Li EW values corresponding to an age of 25±3 Myr in good agreement with independent estimates from the literature.Fil: Messina, S.. Catania Astrophysical Observatory; ItaliaFil: Lanzafame, A. C.. Catania Astrophysical Observatory; ItaliaFil: Feiden, G. A.. Uppsala University; SueciaFil: Millward, M.. York Creek Observatory; AustraliaFil: Desidera, S.. Osservatorio Astronomico Di Padova; ItaliaFil: Buccino, Andrea Paola. Consejo Nacional de Investigaciónes Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Astronomía y Física del Espacio. - Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Astronomía y Física del Espacio; ArgentinaFil: Curtis, I.. Minor Planet Center; AustraliaFil: Jofre, Jorge Emiliano. Universidad Nacional de Córdoba. Observatorio Astronómico de Córdoba. Departamento de Astrofísica Estelar; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Kehusmaa, P.. Harlingten Atacama Observatory; ChileFil: Medhi, B. J.. Aryabhatta Research Institute Of Observational Sciences; IndiaFil: Monard, B.. Klein Karoo Observatory; SudáfricaFil: Petrucci, Romina Paola. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Córdoba. Observatorio Astronómico de Córdoba. Departamento de Astrofísica Estelar; Argentin

Impact of HIV-Associated Conditions on Mortality in People Commencing Anti-Retroviral Therapy in Resource Limited Settings

To identify associations between specific WHO stage 3 and 4 conditions diagnosed after ART initiation and all cause mortality for patients in resource-limited settings (RLS). DESIGN, SETTING: Analysis of routine program data collected prospectively from 25 programs in eight countries between 2002 and 2010

Analysis of antibiotic resistance genes in multidrug-resistant acinetobacter sp. isolates from military and civilian patients treated at the Walter Reed Army Medical Center

Military medical facilities treating patients injured in Iraq and Afghanistan have identified a large number of multidrug-resistant (MDR) Acinetobacter baumannii isolates. In order to anticipate the impact of these pathogens on patient care, we analyzed the antibiotic resistance genes responsible for the MDR phenotype in Acinetobacter sp. isolates collected from patients at the Walter Reed Army Medical Center (WRAMC). Susceptibility testing, PCR amplification of the genetic determinants of resistance, and clonality were determined. Seventy-five unique patient isolates were included in this study: 53% were from bloodstream infections, 89% were resistant to at least three classes of antibiotics, and 15% were resistant to all nine antibiotics tested. Thirty-seven percent of the isolates were recovered from patients nosocomially infected or colonized at the WRAMC. Sixteen unique resistance genes or gene families and four mobile genetic elements were detected. In addition, this is the first report of blaOXA-58-like and blaPER-like genes in the U.S. MDR A. baumannii isolates with at least eight identified resistance determinants were recovered from 49 of the 75 patients. Molecular typing revealed multiple clones, with eight major clonal types being nosocomially acquired and with more than 60% of the isolates being related to three pan-European types. This report gives a “snapshot” of the complex genetic background responsible for antimicrobial resistance in Acinetobacter spp. from the WRAMC. Identifying genes associated with the MDR phenotype and defining patterns of transmission serve as a starting point for devising strategies to limit the clinical impact of these serious infections. © 2006, American Society for Microbiolog

Anomalous Couplings in Double Higgs Production

The process of gluon-initiated double Higgs production is sensitive to non-linear interactions of the Higgs boson. In the context of the Standard Model, studies of this process focused on the extraction of the Higgs trilinear coupling. In a general parametrization of New Physics effects, however, an even more interesting interaction that can be tested through this channel is the (ttbar hh) coupling. This interaction vanishes in the Standard Model and is a genuine signature of theories in which the Higgs boson emerges from a strongly-interacting sector. In this paper we perform a model-independent estimate of the LHC potential to detect anomalous Higgs couplings in gluon-fusion double Higgs production. We find that while the sensitivity to the trilinear is poor, the perspectives of measuring the new (ttbar hh) coupling are rather promising.Comment: 22 pages, 9 figures. v2: plots of Figs.8 and 9 redone to include experimental uncertainty on the Higgs couplings, references adde

Insecticide resistance and the future of malaria control in Zambia.

BACKGROUND: In line with the Global trend to improve malaria control efforts a major campaign of insecticide treated net distribution was initiated in 1999 and indoor residual spraying with DDT or pyrethroids was reintroduced in 2000 in Zambia. In 2006, these efforts were strengthened by the President's Malaria Initiative. This manuscript reports on the monitoring and evaluation of these activities and the potential impact of emerging insecticide resistance on disease transmission. METHODS: Mosquitoes were captured daily through a series of 108 window exit traps located at 18 sentinel sites. Specimens were identified to species and analyzed for sporozoites. Adult Anopheles mosquitoes were collected resting indoors and larva collected in breeding sites were reared to F1 and F0 generations in the lab and tested for insecticide resistance following the standard WHO susceptibility assay protocol. Annual cross sectional household parasite surveys were carried out to monitor the impact of the control programme on prevalence of Plasmodium falciparum in children aged 1 to 14 years. RESULTS: A total of 619 Anopheles gambiae s.l. and 228 Anopheles funestus s.l. were captured from window exit traps throughout the period, of which 203 were An. gambiae malaria vectors and 14 An. funestus s.s.. In 2010 resistance to DDT and the pyrethroids deltamethrin, lambda-cyhalothrin and permethrin was detected in both An. gambiae s.s. and An. funestus s.s.. No sporozoites were detected in either species. Prevalence of P. falciparum in the sentinel sites remained below 10% throughout the study period. CONCLUSION: Both An. gambiae s.s. and An. funestus s.s. were controlled effectively with the ITN and IRS programme in Zambia, maintaining a reduced disease transmission and burden. However, the discovery of DDT and pyrethroid resistance in the country threatens the sustainability of the vector control programme