Lack of effect of lowering LDL cholesterol on cancer: meta-analysis of individual data from 175,000 people in 27 randomised trials of statin therapy

Background: Statin therapy reduces the risk of occlusive vascular events, but uncertainty remains about potential effects on cancer. We sought to provide a detailed assessment of any effects on cancer of lowering LDL cholesterol (LDL-C) with a statin using individual patient records from 175,000 patients in 27 large-scale statin trials. Methods and Findings: Individual records of 134,537 participants in 22 randomised trials of statin versus control (median duration 4.8 years) and 39,612 participants in 5 trials of more intensive versus less intensive statin therapy (median duration 5.1 years) were obtained. Reducing LDL-C with a statin for about 5 years had no effect on newly diagnosed cancer or on death from such cancers in either the trials of statin versus control (cancer incidence: 3755 [1.4% per year [py]] versus 3738 [1.4% py], RR 1.00 [95% CI 0.96-1.05]; cancer mortality: 1365 [0.5% py] versus 1358 [0.5% py], RR 1.00 [95% CI 0.93-1.08]) or in the trials of more versus less statin (cancer incidence: 1466 [1.6% py] vs 1472 [1.6% py], RR 1.00 [95% CI 0.93-1.07]; cancer mortality: 447 [0.5% py] versus 481 [0.5% py], RR 0.93 [95% CI 0.82-1.06]). Moreover, there was no evidence of any effect of reducing LDL-C with statin therapy on cancer incidence or mortality at any of 23 individual categories of sites, with increasing years of treatment, for any individual statin, or in any given subgroup. In particular, among individuals with low baseline LDL-C (<2 mmol/L), there was no evidence that further LDL-C reduction (from about 1.7 to 1.3 mmol/L) increased cancer risk (381 [1.6% py] versus 408 [1.7% py]; RR 0.92 [99% CI 0.76-1.10]). Conclusions: In 27 randomised trials, a median of five years of statin therapy had no effect on the incidence of, or mortality from, any type of cancer (or the aggregate of all cancer).

Seismic Performance of Hybrid Fiber Reinforced Polymer-Concrete Pier Frame Systems

As an alternative to transverse spiral or hoop steel reinforcement, fiber reinforced polymers (FRPs) were introduced to the construction industry in the 1980's. The concept of concrete-filled FRP tube (CFFT) has raised great interest amongst researchers in the last decade. FRP tube can act as a pour form, protective jacket, and shear and flexural reinforcement for concrete. However, seismic performance of CFFT bridge substructure has not yet been fully investigated. Experimental work in this study included four two-column bent tests, several component tests and coupon tests. Four 1/6-scale bridge pier frames, consisting of a control reinforced concrete frame (RCF), glass FRP-concrete frame (GFF), carbon FRP-concrete frame (CFF), and hybrid glass/carbon FRP-concrete frame (HFF) were tested under reverse cyclic lateral loading with constant axial loads. Specimen GFF did not show any sign of cracking at a drift ratio as high as 15% with considerable loading capacity, whereas Specimen CFF showed that lowest ductility with similar load capacity as in Specimen GFF. FRP-concrete columns and pier cap beams were then cut from the pier frame specimens, and were tested again in three point flexure under monotonic loading with no axial load. The tests indicated that bonding between FRP and concrete and yielding of steel both affect the flexural strength and ductility of the components. The coupon tests were carried out to establish the tensile strength and elastic modulus of each FRP tube and the FRP mold for the pier cap beam in the two principle directions of loading. A nonlinear analytical model was developed to predict the load-deflection responses of the pier frames. The model was validated against test results. Subsequently, a parametric study was conducted with variables such as frame height to span ratio, steel reinforcement ratio, FRP tube thickness, axial force, and compressive strength of concrete. A typical bridge was also simulated under three different ground acceleration records and damping ratios. Based on the analytical damage index, the RCF bridge was most severely damaged, whereas the GFF bridge only suffered minor repairable damages. Damping ratio was shown to have a pronounced effect on FRP-concrete bridges, just the same as in conventional bridges. This research was part of a multi-university project, which is founded by the National Science Foundation (NSF) Network for Earthquake Engineering Simulation Research (NEESR) program.

(Table 1) Water column silicic acid concentrations and Si isotopic composition during Marion Dufresne cruise MD166 off South Africa

Silicon isotopic signatures (d30Si) of water column silicic acid (Si(OH)4) were measured in the Southern Ocean, along a meridional transect from South Africa (Subtropical Zone) down to 57° S (northern Weddell Gyre). This provides the first reported data of a summer transect across the whole Antarctic Circumpolar Current (ACC). d30Si variations are large in the upper 1000 m, reflecting the effect of the silica pump superimposed upon meridional water transfer across the ACC: the transport of Antarctic surface waters northward by a net Ekman drift and their convergence and mixing with warmer upper-ocean Si-depleted waters to the north. Using Si isotopic signatures, we determine different mixing interfaces: the Antarctic Surface Water (AASW), the Antarctic Intermediate Water (AAIW), and thermoclines in the low latitude areas. The residual silicic acid concentrations of end-members control the d30Si alteration of the mixing products and with the exception of AASW, all mixing interfaces have a highly Si-depleted mixed layer end-member. These processes deplete the silicic acid AASW concentration northward, across the different interfaces, without significantly changing the AASW d30Si composition. By comparing our new results with a previous study in the Australian sector we show that during the circumpolar transport of the ACC eastward, the d30Si composition of the silicic acid pools is getting slightly, but significantly lighter from the Atlantic to the Australian sectors. This results either from the dissolution of biogenic silica in the deeper layers and/or from an isopycnal mixing with the deep water masses in the different oceanic basins: North Atlantic Deep Water in the Atlantic, and Indian Ocean deep water in the Indo-Australian sector. This isotopic trend is further transmitted to the subsurface waters, representing mixing interfaces between the surface and deeper layers. Through the use of d30Si constraints, net biogenic silica production (representative of annual export), at the Greenwich Meridian is estimated to be 5.2 ± 1.3 and 1.1 ± 0.3 mol Si/m**2 for the Antarctic Zone and Polar Front Zone, respectively. This is in good agreement with previous estimations. Furthermore, summertime Si-supply into the mixed layer of both zones, via vertical mixing, is estimated to be 1.6 ± 0.4 and 0.1 ± 0.5 mol Si/m**2, respectively.

Stable isotope record, calcium carbonate conentrations, and sea surface temperture reconstructions of sediment cores from the North Atlantic

We analyze five high-resolution time series spanning the last 1.65 m.y.: benthic foraminiferal delta18O and delta13O, percent CaCO3, and estimated sea surface temperature (SST) at North Atlantic Deep Sea Drilling Project site 607 and percent CaCO3 at site 609. Each record is a multicore composite verified for continuity by splicing among multiple holes. These climatic indices portray changes in northern hemisphere ice sheet size and in North Atlantic surface and deep circulation. By tuning obliquity and precession components in the delta18O record to orbital variations, we have devised a time scale (TP607) for the entire Pleistocene that agrees in age with all K/Ar-dated magnetic reversals to within 1.5%. The Brunhes time scale is taken from Imbrie et al. [1984], except for differences near the stage 17/16 transition (0.70 to 0.64 Ma). All indicators show a similar evolution from the Matuyama to the Brunhes chrons: orbital eccentricity and precession responses increased in amplitude; those at orbital obliquity decreased. The change in dominance from obliquity to eccentricity occurred over several hundred thousand years, with fastest changes around 0.7 to 0.6 Ma. The coherent, in-phase responses of delta18O, delta13O, CaCO3 and SST at these rhythms indicate that northern hemisphere ice volume changes have controlled most of the North Atlantic surface-ocean and deep-ocean responses for the last 1.6 m.y. The delta13O, percent CaCO3, and SST records at site 607 also show prominent changes at low frequencies, including a prominent long-wavelength oscillation toward glacial conditions that is centered between 0.9 and 0.6 Ma. These changes appear to be associated neither with orbital forcing nor with changes in ice volume.

Fear of Falling and Balance Confidence in Older Adults with Diabetes Mellitus

Several determinants of fear of falling (FoF) and low balance confidence overlap with the consequences/complications of diabetes mellitus (DM). FoF is strongly associated with low balance confidence, and balance confidence mediates the relationship between FoF and balance and physical function. The purpose of this thesis was two-fold: (1) to examine the prevalence, severity and determinants of FoF in older adults (aged≥65) with DM, and (2) to evaluate the validity of the short version of the Activities-specific Balance Confidence scale (ABC-6) and its association with balance and postural control in older adults with DM. Three separate studies were conducted of older adults with DM (DM-group) and without DM (noDM-group). Study I revealed that although FoF prevalence adjusted for age and sex was not different between-groups, the DM-group had 8.8% fewer participants in the low and 8.4% more in the high Falls-Efficacy Scale International categories when compared to the noDM-group. Higher FoF severity in the DM-group was associated with poor physical performance, being female, fall history and clinical depressive symptoms. Study II provided evidence of convergent, discriminant and concurrent validity of the ABC-6 for use in older adults with DM with and without diabetic peripheral neuropathy (DPN). Notably, the ABC-6 was more sensitive in detecting subtle differences in balance confidence between the DM-group and noDM-group when compared to the original ABC scale (ABC-16), and can be administered in less time. Study III explored balance confidence (ABC-6) and its association with balance and postural control in older adults with DM. Subtle differences in axial segmental control (i.e., lower trunk roll velocity and higher head-trunk correlations) while walking and lower balance confidence were apparent in the DM-group, even in the absence of DPN, when compared to the noDM-group. Balance confidence partially explained the variance in head-trunk stiffening between-groups, and consequently low balance confidence in older adults with DM may contribute to the dependence on postural control strategies that are normally only utilized in high-risk situations. Findings from this thesis will help to guide the development of protocols for screening and intervention recommendations of patient education and targeted rehabilitation programs for older adults with DM.

Coralline algae in a changing world: integrating ecological, physiological, and geochemical responses to global change

Coralline algae are globally distributed benthic primary producers that secrete calcium carbonate skeletons. In the context of ocean acidification, they have received much recent attention due to the potential vulnerability of their high-Mg calcite skeletons and their many important ecological roles. Herein, we summarize what is known about coralline algal ecology and physiology, providing context to understand their responses to global climate change. We review the impacts of these changes, including ocean acidification, rising temperatures, and pollution, on coralline algal growth and calcification. We also assess the ongoing use of coralline algae as marine climate proxies via calibration of skeletal morphology and geochemistry to environmental conditions. Finally, we indicate critical gaps in our understanding of coralline algal calcification and physiology and highlight key areas for future research. These include analytical areas that recently have become more accessible, such as resolving phylogenetic relationships at all taxonomic ranks, elucidating the genes regulating algal photosynthesis and calcification, and calibrating skeletal geochemical metrics, as well as research directions that are broadly applicable to global change ecology, such as the importance of community-scale and long-term experiments in stress response.

Coralline algae (Rhodophyta) in a changing world: integrating ecological, physiological, and geochemical responses to global change

Coralline algae are globally distributed benthic primary producers that secrete calcium carbonate skeletons. In the context of ocean acidification, they have received much recent attention due to the potential vulnerability of their high-Mg calcite skeletons and their many important ecological roles. Herein, we summarize what is known about coralline algal ecology and physiology, providing context to understand their responses to global climate change. We review the impacts of these changes, including ocean acidification, rising temperatures, and pollution, on coralline algal growth and calcification. We also assess the ongoing use of coralline algae as marine climate proxies via calibration of skeletal morphology and geochemistry to environmental conditions. Finally, we indicate critical gaps in our understanding of coralline algal calcification and physiology and highlight key areas for future research. These include analytical areas that recently have become more accessible, such as resolving phylogenetic relationships at all taxonomic ranks, elucidating the genes regulating algal photosynthesis and calcification, and calibrating skeletal geochemical metrics, as well as research directions that are broadly applicable to global change ecology, such as the importance of community-scale and long-term experiments in stress response.

Effect of accelerated rehabilitation on function after ankle sprain:randomised controlled trial

OBJECTIVE: To compare an accelerated intervention incorporating early therapeutic exercise after acute ankle sprains with a standard protection, rest, ice, compression, and elevation intervention.

DESIGN: Randomised controlled trial with blinded outcome assessor.

SETTING: Accident and emergency department and university based sports injury clinic.

PARTICIPANTS: 101 patients with an acute grade 1 or 2 ankle sprain.

INTERVENTIONS: Participants were randomised to an accelerated intervention with early therapeutic exercise (exercise group) or a standard protection, rest, ice, compression, and elevation intervention (standard group).

MAIN OUTCOME MEASURES: The primary outcome was subjective ankle function (lower extremity functional scale). Secondary outcomes were pain at rest and on activity, swelling, and physical activity at baseline and at one, two, three, and four weeks after injury. Ankle function and rate of reinjury were assessed at 16 weeks.

RESULTS: An overall treatment effect was in favour of the exercise group (P=0.0077); this was significant at both week 1 (baseline adjusted difference in treatment 5.28, 98.75% confidence interval 0.31 to 10.26; P=0.008) and week 2 (4.92, 0.27 to 9.57; P=0.0083). Activity level was significantly higher in the exercise group as measured by time spent walking (1.2 hours, 95% confidence interval 0.9 to 1.4 v 1.6, 1.3 to 1.9), step count (5621 steps, 95% confidence interval 4399 to 6843 v 7886, 6357 to 9416), and time spent in light intensity activity (53 minutes, 95% confidence interval 44 to 60 v 76, 58 to 95). The groups did not differ at any other time point for pain at rest, pain on activity, or swelling. The reinjury rate was 4% (two in each group).

CONCLUSION: An accelerated exercise protocol during the first week after ankle sprain improved ankle function; the group receiving this intervention was more active during that week than the group receiving standard care.

TRIAL REGISTRATION: Current Controlled Trials ISRCTN13903946.

Stratégie d'amélioration de la résistance mécanique des zones de connecteurs

Le bois subit une demande croissante comme matériau de construction dans les bâtiments de grandes dimensions. Ses qualités de matériau renouvelable et esthétique le rendent attrayant pour les architectes. Lorsque comparé à des produits fonctionnellement équivalents, il apparait que le bois permet de réduire la consommation d’énergie non-renouvelable. Sa transformation nécessite une quantité d’énergie inférieure que l’acier et le béton. Par ailleurs, par son origine biologique, une structure en bois permet de stocker du carbone biogénique pour la durée de vie du bâtiment. Maintenant permis jusqu’à six étages de hauteur au Canada, les bâtiments de grande taille en bois relèvent des défis de conception. Lors du dimensionnement des structures, les zones des connecteurs sont souvent les points critiques. Effectivement, les contraintes y sont maximales. Les structures peuvent alors apparaitre massives et diminuer l’innovation architecturale. De nouvelles stratégies doivent donc être développées afin d’améliorer la résistance mécanique dans les zones de connecteurs. Différents travaux ont récemment porté sur la création ou l’amélioration de types d’assemblage. Dans cette étude, l’accent est mis sur le renforcement du bois utilisé dans la région de connexion. L’imprégnation a été choisie comme solution de renfort puisque la littérature démontre qu’il est possible d’augmenter la dureté du bois avec cette technique. L’utilisation de cette stratégie de renfort sur l’épinette noire (Picea Mariana (Mill.) BSP) pour une application structurale est l’élément de nouveauté dans cette recherche. À défaut d’effectuer une imprégnation jusqu’au coeur des pièces, l’essence peu perméable de bois employée favorise la création d’une mince couche en surface traitée sans avoir à utiliser une quantité importante de produits chimiques. L’agent d’imprégnation est composé de 1,6 hexanediol diacrylate, de triméthylopropane tricacrylate et d’un oligomère de polyester acrylate. Une deuxième formulation contenant des nanoparticules de SiO2 a permis de vérifier l’effet des nanoparticules sur l’augmentation de la résistance mécanique du bois. Ainsi, dans ce projet, un procédé d’imprégnation vide-pression a servi à modifier un nouveau matériau à base de bois permettant des assemblages plus résistants mécaniquement. Le test de portance locale à l’enfoncement parallèle au fil d’un connecteur de type tige a été réalisé afin de déterminer l’apport du traitement sur le bois utilisé comme élément de connexion. L’effet d’échelle a été observé par la réalisation du test avec trois diamètres de boulons différents (9,525 mm, 12,700 mm et 15,875 mm). En outre, le test a été effectué selon un chargement perpendiculaire au fil pour le boulon de moyen diamètre (12,700 mm). La corrélation d’images numériques a été utilisée comme outil d’analyse de la répartition des contraintes dans le bois. Les résultats ont démontré une portance du bois plus élevée suite au traitement. Par ailleurs, l’efficacité est croissante lorsque le diamètre du boulon diminue. C’est un produit avec une valeur caractéristique de la portance locale parallèle au fil de 79% supérieure qui a été créé dans le cas du test avec le boulon de 9,525 mm. La raideur du bois a subi une augmentation avoisinant les 30%. Suite au traitement, la présence d’une rupture par fissuration est moins fréquente. Les contraintes se distribuent plus largement autour de la région de connexion. Le traitement n’a pas produit d’effet significatif sur la résistance mécanique de l’assemblage dans le cas d’un enfoncement du boulon perpendiculairement au fil du bois. De même, l’effet des nanoparticules en solution n’est pas ressorti significatif. Malgré une pénétration très faible du liquide à l’intérieur du bois, la couche densifiée en surface créée suite au traitement est suffisante pour produire un nouveau matériau plus résistant dans les zones de connexion. Le renfort du bois dans la région des connecteurs doit influencer le dimensionnement des structures de grande taille. Avec des éléments de connexion renforcés, il sera possible d’allonger les portées des poutres, multipliant ainsi les possibilités architecturales. Le renfort pourra aussi permettre de réduire les sections des poutres et d’utiliser une quantité moindre de bois dans un bâtiment. Cela engendrera des coûts de transport et des coûts reliés au temps d’assemblage réduits. De plus, un connecteur plus résistant permettra d’être utilisé en moins grande quantité dans un assemblage. Les coûts d’approvisionnement en éléments métalliques et le temps de pose sur le site pourront être revus à la baisse. Les avantages d’un nouveau matériau à base de bois plus performant utilisé dans les connexions permettront de promouvoir le bois dans les constructions de grande taille et de réduire l’impact environnemental des bâtiments.

Produção de isolado proteico proveniente de subprodutos da indústria de aves em diferentes escalas

A indústria de aves brasileira destaca-se economicamente, onde um total de 12,3 milhões de toneladas foi produzido no país em 2013. Esta produção em larga escala gera considerável volume de subprodutos, chegando até 35% da ave viva. Tais resíduos são convertidos, por processos tradicionais, em produtos de baixo valor comercial, como por exemplo, farinhas. O processo de variação de pH constitui um importante processo alternativo de obtenção de proteínas com melhores características funcionais e nutricionais. Estudar as variáveis do processo, efetuando aumento dimensional, é fundamental para aplicação das tecnologias desenvolvidas no laboratório e posterior definição final de processos industriais. A produção de isolados proteicos seria uma tecnologia atraente no aproveitamento de subprodutos da indústria de frango, convertendo-os em uma ótima fonte proteica, agregando valor ao produto obtido. Este trabalho teve por objetivo produzir isolados proteicos em diferentes escalas, utilizando subprodutos não comestíveis da indústria de frango. Foi estudada a solubilização das proteínas da matéria-prima (MP) para definir pHs de solubilização e de precipitação isoelétrica. A curva apontou um pH alcalino de 11,0 para etapa de solubilização e de 5,25 para etapa de precipitação proteica. As proteínas obtidas foram caracterizadas quanto sua composição proximal, índice de acidez (IA), índice de peróxidos (IP) e substâncias reativas ao ácido tiobarbitúrico (TBARS) além de propriedades funcionais de solubilidade, capacidade de retenção de água (CRA) e capacidade de retenção de óleo (CRO); e nutricionais de digestibilidade proteica. Comparativamente foram analisadas farinhas de vísceras comerciais nos mesmos parâmetros. Um aumento de escala do processo foi realizado e avaliado pelas mesmas respostas do produto da escala laboratorial. Foi obtido um teor proteico de 82 e 85% em escala laboratorial e aumento de escala, respectivamente, e também uma redução lipídica de 75%, e de cinzas de 85%, em relação à MP. A composição proximal das farinhas analisadas ficou entre 67-72% para proteína bruta, 17-22% para lipídios e 9-15% para cinzas. O IA, apresentou valores de 2,2 e 3,1 meq/g de isolado e de 1,6 a 2,0 meq/g de farinha. Já para IP, obteve-se valores de 0,003 a 0,005 meq/g de isolado e de 0,002 a 0,049 meq/g de farinha. Os índices de TBARS apontaram valores de 0,081 e 0,214 mg MA/g de isolado e 0,041 a 0,128 mg MA/g de farinha. A solubilidade das proteínas do isolado apontou 84 e 81% em pH 3 e 11 respectivamente e de 5% em pH 5, já para farinhas variaram de 22 a 31% em pH de 3 a 11. A CRA obtida no isolado foi 3,1 a 16,5 g água/g de proteína e de 3,8 a 10,9 g água/g de proteína nas farinhas. A CRO ficou em 4,2 mL de óleo/g de proteína do isolados e 2,6 mL de óleo/g de proteína da farinhas. Os isolados proteicos apresentaram 92 e 95% de digestibilidade das proteínas, em comparação aos 84% das farinhas comerciais. Os índices acumulados e apresentados neste trabalho concluíram que foi possível aumentar a escala do processo de variação de pH, sem perder qualidade nos índices físico-químicos e de digestibilidade proteica.

Increased frequency of the autism broader phenotype in mothers transmitting etiological CNVs to sons affected by Autism Spectrum Disorder (ASD)

Autism Spectrum Disorder (ASD) is a frequent and complex neurodevelopmental disorder, characterized by impairments in social communication and repetitive behaviors and with a high male to female ratio: ~4:1. Genetic factors, including rare Copy Number Variants (CNVs), have a substantial impact in ASD risk1, and are associated with specific phenotypic manifestations2. Recent studies reported that rare inherited CNVs are enriched in mothers of ASD children compared with mothers of controls and are preferentially transmitted from mothers to ASD children suggesting a sex bias in CNV transmission; further, the imbalanced transmission of small pathogenic CNVs from unaffected mothers to their sons with ASD has been described3,4. An increased prevalence of autism-like personality traits is found in unaffected relatives of ASD children, suggesting a genetic liability of a broader autism phenotype (BAP)5. The BAP in parents of autistic children can be assessed by the Social Responsiveness Scale (SRS)6 and Broad Autism Phenotype Questionnaire (BAPQ)7 reports. The SRS is 65-item questionnaire to identify sub-clinical social impairments and interpersonal behaviour in individuals. The BAPQ is a 36-item questionnaire measures social aloofness, rigid personality, and pragmatic language deficits in both parents and children.

New York 1:50,000. West Point & vicinity /

Scale 1:50,000.

New York 1:50,000. West Point & vicinity /

Scale 1:50,000.

New York 1:25,000. West Point and vicinity /

Scale 1:25,000.

Efficacy of early skin-to-skin contact on the rate of exclusive breastfeeding in term neonates: a randomized controlled trial

Background: Despite multiple benefits of breast milk, the rates of exclusive breastfeeding in developing countries are low. Objective: To evaluate the efficacy of early skin -to -skin contact (SSC) on the rate of exclusive breastfeeding (EBF) at 6 weeks of age among term neonates born by vaginal delivery. Methods: Term neonates born by vaginal delivery and did not require any resuscitation were randomized at birth to SSC (n=100) and control (n=100) group. Immediately after clamping the umbilical cord, SSC group neonates were placed on the bare bosom of mother and control group neonates were placed under a radiant warmer for a period of 45 minutes each while mothers underwent management of the third stage of labor and episiotomy repair. Pain experienced by mother during episiotomy repair was recorded using a numerical pain scale The primary outcome evaluated was the rate of exclusive breastfeeding at 6 weeks of postnatal age. Results: A significantly higher proportion of neonates were exclusively breastfeed at 6 weeks of age in the SSC group than in the control group (72% vs. 57.6%, p=0.04, relative risk: 1.3, 95% confidence interval: 1.0 -1.6). The pain score during episiotomy repair in mothers of the SSC group was significantly lower than the control group (4.74±0.85 versus 5.34±0.81; P <0.01). Conclusions: Early SSC significantly improved the rate of exclusively breastfeeding at 6 weeks of age among healthy term neonates. An important additional effect was a decrease in the amount of pain that mothers in the SSC group experienced during episiotomy repair.