The cost-effectiveness of exercise referral schemes

Background Exercise referral schemes (ERS) aim to identify inactive adults in the primary care setting. The primary care professional refers the patient to a third party service, with this service taking responsibility for prescribing and monitoring an exercise programme tailored to the needs of the patient. This paper examines the cost-effectiveness of ERS in promoting physical activity compared with usual care in primary care setting. Methods A decision analytic model was developed to estimate the cost-effectiveness of ERS from a UK NHS perspective. The costs and outcomes of ERS were modelled over the patient's lifetime. Data were derived from a systematic review of the literature on the clinical and cost-effectiveness of ERS, and on parameter inputs in the modelling framework. Outcomes were expressed as incremental cost per quality-adjusted life-year (QALY). Deterministic and probabilistic sensitivity analyses investigated the impact of varying ERS cost and effectiveness assumptions. Sub-group analyses explored the cost-effectiveness of ERS in sedentary people with an underlying condition. Results Compared with usual care, the mean incremental lifetime cost per patient for ERS was £169 and the mean incremental QALY was 0.008, generating a base-case incremental cost-effectiveness ratio (ICER) for ERS at £20,876 per QALY in sedentary individuals without a diagnosed medical condition. There was a 51% probability that ERS was cost-effective at £20,000 per QALY and 88% probability that ERS was cost-effective at £30,000 per QALY. In sub-group analyses, cost per QALY for ERS in sedentary obese individuals was £14,618, and in sedentary hypertensives and sedentary individuals with depression the estimated cost per QALY was £12,834 and £8,414 respectively. Incremental lifetime costs and benefits associated with ERS were small, reflecting the preventative public health context of the intervention, with this resulting in estimates of cost-effectiveness that are sensitive to variations in the relative risk of becoming physically active and cost of ERS. Conclusions ERS is associated with modest increase in lifetime costs and benefits. The cost-effectiveness of ERS is highly sensitive to small changes in the effectiveness and cost of ERS and is subject to some significant uncertainty mainly due to limitations in the clinical effectiveness evidence base.

Does vigorous physical activity provide additional benefits beyond those of moderate?

Background Although guidelines suggest that vigorous physical activity (PA) confers “extra” benefits compared with those from moderate-intensity activity alone, the magnitude of this additional benefit is unclear. The aim was to compare the reduction in risk of hypertension (HT) and depressive symptoms (DS) for 12 yr in middle-age women who reported (a) only moderate-intensity PA (MOPA) and (b) a combination of moderate and vigorous PA (MVPA), after controlling for overall volume of activity. Methods The study involved 11,285 participants in the Australian Longitudinal Study on Women’s Health, who completed surveys in 1998 (age = 46–52 yr), 2001, 2004, 2007, and 2010. Generalized estimating equation models (with 3-yr time lag) were used to examine the relationship between PA in seven categories from 0 to >2000 MET·min·wk−1 and occurrence of HT and DS for women who reported MOPA or MVPA. Results For HT, risk was slightly lower for MVPA than for MOPA across the entire range of PA levels, but this difference was only significant at the highest PA level (>2000; odds ratio [OR] = 0.80 MOPA and 0.56 MVPA). For DS, OR values were similar in both groups up to 500 MET·min·wk−1, then slightly lower for MVPA than for MOPA at higher PA levels. Again, this difference was only significant at the highest PA level (>2000; OR = 0.57 MOPA and 0.42 MVPA). OR values were slightly attenuated in adjusted models. Conclusions Doing both vigorous and moderate activity does not have significant additional benefits in terms of HT and DS, above those from moderate-intensity activity alone, except at very high levels of PA.

Republished research: Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis

Study question Can exercise referral schemes improve health outcomes in individuals with or without pre-existing conditions? Summary answer We found weak evidence of a short term increase in physical activity and reduction in levels of depression in sedentary individuals after participation in exercise referral schemes, compared with after usual care. What is known and what this paper adds Exercise referral schemes are commonly used in primary care to promote physical activity. Evidence indicating a health benefit of these schemes is limited, so their value in primary care remains to be ascertained.

Physical activity in mid-age and older women: Lessons from the Australian longitudinal study on women’s health

The Australian Longitudinal Study on Women’s Health (ALSWH) commenced in Australia in 1996 when researchers recruited approximately 40,000 women in three birth cohorts: 1973–1978, 1946–1951, and 1921–1926. Since then participants have completed surveys on a wide range of health issues, at approximately three-year intervals. This overview describes changes in physical activity (PA) over time in the mid-age and older ALSWH cohorts, and summarizes the findings of studies published to date on the determinants of PA, and its associated health outcomes in Australian women. The ALSWH data show a significant increase in PA during mid-age, and a rapid decline in activity levels when women are in their 80s. The study has demonstrated the importance of life stages and key life events as determinants of activity, the additional benefits of vigorous activity for mid-age women, and the health benefits of ‘only walking’ for older women. ALSWH researchers have also drawn attention to the benefits of activity in terms of a wide range of physical and mental health outcomes, as well as overall vitality and well-being. The data indicate that maintaining a high level of PA throughout mid and older age will not only reduce the risk of premature death, but also significantly extend the number of years of healthy life.

Prospective relationships between physical activity and optimism in young and mid-aged women

BACKGROUND: There is growing evidence that regular physical activity (PA) reduces the risk of poor mental health. Less research has focused on the relationship between PA and positive wellbeing. The study aims were to assess the prospective associations between PA and optimism, in both young and mid-aged women. METHODS: 9688 young women (born 1973-1978) completed self-report surveys in 2000 (age 22 to 27), 2003, 2006, and 2009; and 11,226 mid-aged women (born 1946-1951) completed surveys in 2001 (age 50-55) 2004, 2007, and 2010, as part of the Australian Longitudinal Study on Women's Health. Generalized estimating equation models (with 3-year time lag) were used to examine the relationship between PA and optimism in both cohorts. RESULTS: In both cohorts, women reporting higher levels of PA had greater odds of reporting higher optimism over the 9-year period, (young, OR = 5.04, 95% CI: 3.85-6.59; mid-age, OR = 5.77, 95% CI: 4.76-7.00) than women who reported no PA. Odds were attenuated in adjusted models, with depression accounting for a large amount of this attenuation (young, OR = 2.00, 95% CI: 1.57-2.55; mid-age, OR = 1.64 95% CI: 1.38-1.94). CONCLUSIONS: Physical activity can promote optimism in young and mid-aged women over time, even after accounting for the negative effects of other psychosocial indicators such as depression.

Effect of vitamin A deprivation on the cholesterol side-chain cleavage enzyme activity of testes and ovaries of rats (Short Communication)

The cholesterol side-chain cleavage enzyme activity is decreased considerably at the mild stage of vitamin A deficiency in rat testes and ovaries and the decrease in activity becomes more pronounced with progress of deficiency. Supplementation of the deficient rats with retinyl acetate, but not retinoic acid, restores the enzyme activity to normal values. The cholesterol side-chain cleavage enzyme of adrenals is not affected by any of the above treatments.

Mesospheric temperature response to variations in geomagnetic activity

Temperature data collected over several years from rocket grenade and other experiments at Point Barrow (Alaska), Fort Churchill (Canada) and Wallops Island (Virginia) have been analysed to determine the effect of geomagnetic activity on the neutral temperature in the mesosphere and to study the latitudinal variation of this effect. An analysis carried out has revealed almost certainly significant correlations between the temperature and the geomagnetic indicies Kp and Ap at Fort Churchill and marginally significant correlations at Barrow and Wallops. This has also been substantiated by a linear regression analysis. The results indicate two types of interdependence between mesospheric temperature and geomagnetic field variations. The first type is the direct heating effect, during a geomagnetic disturbance, which has been observed in the present analysis with a time lag of 3–15 hr at the high latitudes and 36 hr at the middle latitudes. The magnitude of this heating effect has been found to decrease at the lower altitudes. The second type of interrelation which has been observed is temperature perturbations preceding geomagnetic field variations, both presumably caused by a disturbance in atmospheric circulation at these levels.

The effect of solar activity on temperatures in the equatorial mesosphere

A study of the response of neutral temperatures in the equatorial mesosphere to variations in solar activity has been carried out by investigating the correlation between the 10.7 cm solar radio flux and temperatures obtained from a series of 51 rocket soundings conducted over Thumba, India (8°N, 77°E) during the period December 1970–December 1971. A strong positive correlation between these two parameters has been obtained, indicating mesospheric heating effects caused by day-to-day variations in solar EUV emission. The correlation analysis indicates that this response persists over several days and that the peak correlation between the temperatures and the F10.7 index occurs with a time lag of less than 24 hr.

Applications of a sugar-based surveillance system to track arboviruses in wild mosquito populations

Effective arbovirus surveillance is essential to ensure the implementation of control strategies, such as mosquito suppression, vaccination, or dissemination of public warnings. Traditional strategies employed for arbovirus surveillance, such as detection of virus or virus-specific antibodies in sentinel animals, or detection of virus in hematophagous arthropods, have limitations as an early-warning system. A system was recently developed that involves collecting mosquitoes in CO2-baited traps, where the insects expectorate virus on sugar-baited nucleic acid preservation cards. The cards are then submitted for virus detection using molecular assays. We report the application of this system for detecting flaviviruses and alphaviruses in wild mosquito populations in northern Australia. This study was the first to employ nonpowered passive box traps (PBTs) that were designed to house cards baited with honey as the sugar source. Overall, 20/144 (13.9%) of PBTs from different weeks contained at least one virus-positive card. West Nile virus Kunjin subtype (WNVKUN), Ross River virus (RRV), and Barmah Forest virus (BFV) were detected, being identified in 13/20, 5/20, and 2/20 of positive PBTs, respectively. Importantly, sentinel chickens deployed to detect flavivirus activity did not seroconvert at two Northern Territory sites where four PBTs yielded WNVKUN. Sufficient WNVKUN and RRV RNA was expectorated onto some of the honey-soaked cards to provide a template for gene sequencing, enhancing the utility of the sugar-bait surveillance system for investigating the ecology, emergence, and movement of arboviruses. © 2014, Mary Ann Liebert, Inc.

Alk (en) ylresorcinol concentrations in'Kensington Pride'mango peel and antifungal activity against Colletotrichum gloeosporioides

Two preformed alk(en)ylresorcinols, 5-n-heptadecenylresorcinol and 5-n-pentadecylresorcinol, were identified in ‘Kensington Pride’ mango fruit peel. The alk(en)ylresorcinols had antifungal activity against C. gloeosporioides, as determined from thin layer chromatography bioassays. Soil-applied activators of plant defence (Acibenzolar at 150 mg L-1, and soluble potassium silicate at 200 and 1000 mg L-1) did not influence concentrations of 5-n-heptadecenylresorcinol or 5-n-pentadecyl¬resorcinol in mango peel when applied 2 months after fruit set and one month later. Concentrations of both alk(en)ylresorcinols were high 2 months after fruit set but levels declined by 50% within 1 month (2 months before commercial harvest) and did not change significantly from commercial harvest until eating-ripe.

Promoting innovation and development by rethinking the role of copyright limitations and exceptions in Vietnam

This thesis examines how Vietnamese copyright law should develop to promote innovation and development in the digital age. It focuses on the important role of limitations and exceptions to copyright in encouraging access to and reuse of copyright material. This research provide important recommendations for how the scope of copyright limitations and exceptions might be expanded by adopting fair use in order to embrace new opportunities provided by the digital economy. Furthermore, it suggests that Vietnam should extend the scope of some important provisions that provide privileges for education, libraries and people with disabilities.

Monitoring healing progression and characterizing the mechanical environment in preclinical models for bone tissue engineering

The treatment of large segmental bone defects remains a significant clinical challenge. Due to limitations surrounding the use of bone grafts, tissue-engineered constructs for the repair of large bone defects could offer an alternative. Before translation of any newly developed tissue engineering (TE) approach to the clinic, efficacy of the treatment must be shown in a validated preclinical large animal model. Currently, biomechanical testing, histology, and microcomputed tomography are performed to assess the quality and quantity of the regenerated bone. However, in vivo monitoring of the progression of healing is seldom performed, which could reveal important information regarding time to restoration of mechanical function and acceleration of regeneration. Furthermore, since the mechanical environment is known to influence bone regeneration, and limb loading of the animals can poorly be controlled, characterizing activity and load history could provide the ability to explain variability in the acquired data sets and potentially outliers based on abnormal loading. Many approaches have been devised to monitor the progression of healing and characterize the mechanical environment in fracture healing studies. In this article, we review previous methods and share results of recent work of our group toward developing and implementing a comprehensive biomechanical monitoring system to study bone regeneration in preclinical TE studies.

Synthesis, Reactivity and Biological Activity of 17β-HSD1 Inhibitors Based on a Thieno[2,3-d]pryrimidin-4(3H)-one Core

Breast cancer is the most common cancer in women in Western countries. In the early stages of development most breast cancers are hormone-dependent, and estrogens, especially estradiol, have a pivotal role in their development and progression. One approach to the treatment of hormone-dependent breast cancers is to block the formation of the active estrogens by inhibiting the action of the steroid metabolising enzymes. 17beta-Hydroxysteroid dehydrogenase type 1 (17beta-HSD1) is a key enzyme in the biosynthesis of estradiol, the most potent female sex hormone. The 17beta-HSD1 enzyme catalyses the final step and converts estrone into the biologically active estradiol. Blocking 17beta-HSD1 activity with a specific enzyme inhibitor could provide a means to reduce circulating and tumour estradiol levels and thus promote tumour regression. In recent years 17beta-HSD1 has been recognised as an important drug target. Some inhibitors of 17beta-HSD1 have been reported, however, there are no inhibitors on the market nor have clinical trials been announced. The majority of known 17beta-HSD1 inhibitors are based on steroidal structures, while relatively little has been reported on non-steroidal inhibitors. As compared with 17beta-HSD1 inhibitors based on steroidal structures, non-steroidal compounds could have advantages of synthetic accessibility, drug-likeness, selectivity and non-estrogenicity. This study describes the synthesis of large group of novel 17beta-HSD1 inhibitors based on a non-steroidal thieno[2,3-d]pyrimidin-4(3H)-one core. An efficient synthesis route was developed for the lead compound and subsequently employed in the synthesis of thieno[2,3-d]pyrimidin-4(3H)-one based molecule library. The biological activities and binding of these inhibitors to 17beta-HSD1 and, finally, the quantitative structure activity relationship (QSAR) model are also reported. In this study, several potent and selective 17beta-HSD1 inhibitors without estrogenic activity were identified. This establishment of a novel class of inhibitors is a progressive achievement in 17beta-HSD1 inhibitor development. Furthermore, the 3D-QSAR model, constructed on the basis of this study, offers a powerful tool for future 17beta-HSD1 inhibitor development. As part of the fundamental science underpinning this research, the chemical reactivity of fused (di)cycloalkeno thieno[2,3-d]pyrimidin-4(3H)-ones with electrophilic reagents, i.e. Vilsmeier reagent and dimethylformamide dimethylacetal, was investigated. These findings resulted in a revision of the reaction mechanism of Vilsmeier haloformylation and further contributed to understanding the chemical reactivity of this compound class. This study revealed that the reactivity is dependent upon a stereoelectronic effect arising from different ring conformations.

Information flow, trading activity and commodity futures volatility

Based on unique news data relating to gold and crude oil, we investigate how news volume and sentiment, shocks in trading activity, market depth and trader positions unrelated to information flow covary with realized volatility. Positive shocks to the rate of news arrival, and negative shocks to news sentiment exhibit the largest effects. After controlling for the level of news flow and cross-correlations, net trader positions play only a minor role. These findings are at odds with those of [Wang (2002a). The Journal of Futures Markets, 22, 427–450; Wang (2002b). The Financial Review, 37, 295–316], but are consistent with the previous literature which doesn't find a strong link between volatility and trader positions.

Novel Biginelli dihydropyrimidines with potential anticancer activity: A parallel synthesis and CoMSIA study

Novel Biginelli dihydropyrimidines of biological interest were prepared using p-toluene sulphonic acid as an efficient catalyst. All the thirty-two synthesised dihydropyrimidines were evaluated for their in vitro antioxidant activity using DPPH method. Only, compounds 28 and 29 exhibited reasonably good antioxidant activity. Furthermore, the synthesised Biginelli compounds were subjected for their in vitro anticancer activity against MCF-7 human breast cancer cells. The title compounds were tested at the concentration of 10 μg. Compounds exhibited activity ranging from weak to moderate and, from moderate to high in terms of percentage cytotoxicity. Among them, compounds 10 and 11 exhibited significant anticancer activity. In order to elucidate the three-dimensional structure–activity relationships (3D QSAR) towards their anticancer activity, we subjected them for comparative molecular similarity indices analysis (CoMSIA). Illustration regarding their synthesis, analysis, antioxidant activity, anticancer activity and 3D QSAR study is described.