The PRO-AGE study: an international randomised controlled study of health risk appraisal for older persons based in general practice

BACKGROUND: This paper describes the study protocol, the recruitment, and base-line data for evaluating the success of randomisation of the PRO-AGE (PRevention in Older people-Assessment in GEneralists' practices) project. METHODS/DESIGN: A group of general practitioners (GPs) in London (U.K.), Hamburg (Germany) and Solothurn (Switzerland) were trained in risk identification, health promotion, and prevention in older people. Their non-disabled older patients were invited to participate in a randomised controlled study. Participants allocated to the intervention group were offered the Health Risk Appraisal for Older Persons (HRA-O) instrument with a site-specific method for reinforcement (London: physician reminders in electronic medical record; Hamburg: one group session or two preventive home visits; Solothurn: six-monthly preventive home visits over a two-year period). Participants allocated to the control group received usual care. At each site, an additional group of GPs did not receive the training, and their eligible patients were invited to participate in a concurrent comparison group. Primary outcomes are self-reported health behaviour and preventative care use at one-year follow-up. In Solothurn, an additional follow-up was conducted at two years. The number of older persons agreeing to participate (% of eligible persons) in the randomised controlled study was 2503 (66.0%) in London, 2580 (53.6%) in Hamburg, and 2284 (67.5%) in Solothurn. Base-line findings confirm that randomisation of participants was successful, with comparable characteristics between intervention and control groups. The number of persons (% of eligible) enrolled in the concurrent comparison group was 636 (48.8%) in London, 746 (35.7%) in Hamburg, and 1171 (63.0%) in Solothurn. DISCUSSION: PRO-AGE is the first large-scale randomised controlled trial of health risk appraisal for older people in Europe. Its results will inform about the effects of implementing HRA-O with different methods of reinforcement.

[Fixed-combination of losartan/hydrochlorothiazide 100 mg/25 mg. Tolerability and efficacy on blood pressure measured in the practice and for 24 hours]

BACKGROUND: A high proportion of patients with essential hypertension need a combination therapy to reach the therapeutic goal. In the present study, the tolerability and efficacy of a fixed, once daily combination of the AT1 blocker Losartan (100 mg) and the diuretic hydrochlorothiazide (HCTZ) (25 mg) for patients in the real-life situation was investigated. Special consideration was given to the results of ambulatory 24-hourblood pressure (ABP) measurements. METHODS: The open label, prospective non-interventional surveillance study took place from October 2005 to June 2006. A total of 1139 patients over 18 years in age were included whose blood pressures could not be adequately treated with HCTZ alone and for whom an individual dose titration for Losartan and HCTZ had already been performed. RESULTS: The average age (+/- standard deviation) of the patients was 61.2 +/- 11.6 years; 55.8% were men. Comorbidities were common. Specifically, left ventricular hypertrophy was present in 3.1% of the patients, coronary heart disease in 30.1%, chronic heart failure in 11.8% and status post myocardial infarction in 10.5%, respectively. In addition to the Losartan/HCTZ treatment, 61.0% of the patients received a second antihypertensive medicine. After an average treatment duration of 50.4 +/- 17.2 days, the base line systolic blood pressure of 160.8 +/- 16.3 mmHg decreased by 24.0 +/- 17.0 mmHg (-14.4%) and the diastolic blood pressure of 94.4 +/- 9.9 mmHg decreased by 11.8 +/- 10.2 mmHg (-11.8%). For the ABP measurements, the overall average systolic and diastolic blood pressures fell by 16.9 +/- 14.2 mmHg and 8.8 +/-10.3 mmHg, the day average by 17.3 +/- 14.8 mmHg and 9.0 +/- 10.2 mmHg and the night average by 15.1 +/- 17.6 mmHg and 7.8 +/- 11.7 mmHg, respectively. In twelve of the 1139 patients (1.1%), a total of 15 adverse events occurred. A causal connection with the medication was suspected in only in one case (one patient with three). CONCLUSION: The combination of Losartan/HCTZ 100/25 mg, as the exclusive therapy or in addition to other antihypertensive medicines, was for patients, many of whom who had comorbidities, in the real-life situation well tolerated and effective. The efficacy was demonstrated also during the night through ABP.

Immunohistochemical demonstration of interleukin-1 beta induced changes in acute-phase proteins and albumin in rat liver

Interleukin-1 beta is a potent mediator of the acute-phase response. However, the effects of interleukin-1 beta administration on the topic in vivo production of acute-phase proteins and albumin are so far not well understood. Overnight fasted rats were subcutaneously injected with 0.2 mL 0.9% NaCl (control group) or 6.25 micrograms recombinant human interleukin-1 beta, and rectal temperature was measured at intervals up to 48 h. Livers were perfused-fixed in vivo prior to injection (base-line), and at 9, 24, and 48 h following the interleukin-1 beta injection. Fibrinogen, orosomucoid (alpha 1-acid glycoprotein) and albumin were immunostained using a streptavidin-biotin-immunoperoxidase technique. Rectal temperature peaked 5 h after the single interleukin-1 beta injection, and fell gradually to base-line values by 24 h. Prior to injection only a few hepatocytes, randomly scattered throughout the liver lobule, stained positive for fibrinogen and orosomucoid. In contrast, all hepatocytes stained uniformly positive for fibrinogen and orosomucoid 9 h after interleukin-1 beta injection, whereas at 24 h a predominant centrilobular staining pattern occurred. Due to fasting, albumin positive hepatocytes were already reduced at base-line in both groups. Interleukin-1 beta induced a further significant loss of albumin positive cells in the periportal zone (35 +/- 21%) at 9 h when compared with controls (58 +/- 11%, p = 0.037). In conclusion, subcutaneous interleukin-1 beta (probably by stimulation of interleukin-6) strongly induces fibrinogen and orosomucoid expression in rat liver, and suppresses immunohistochemically stainable albumin in a heterogenous way, mainly in the periportal zone.

Performance and emissions testing of a small two stroke engine using mid-level ethanol blends

With the introduction of the mid-level ethanol blend gasoline fuel for commercial sale, the compatibility of different off-road engines is needed. This report details the test study of using one mid-level ethanol fuel in a two stroke hand held gasoline engine used to power line trimmers. The study sponsored by E3 is to test the effectiveness of an aftermarket spark plug from E3 Spark Plug when using a mid-level ethanol blend gasoline. A 15% ethanol by volume (E15) is the test mid-level ethanol used and the 10% ethanol by volume (E10) was used as the baseline fuel. The testing comprises running the engine at different load points and throttle positions to evaluate the cylinder head temperature, exhaust temperature and engine speed. Raw gas emissions were also measured to determine the impact of the performance spark plug. The low calorific value of the E15 fuel decreased the speed of the engine along with reduction in the fuel consumption and exhaust gas temperature. The HC emissions for E15 fuel and E3 spark plug increased when compared to the base line in most of the cases and NO formation was dependent on the cylinder head temperature. The E3 spark plug had a tendency to increase the temperature of the cylinder head irrespective of fuel type while reducing engine speed.

Prevalence of nephrolithiasis in patients with ileal bladder substitutes

OBJECTIVES: To assess the effect of ileal bladder substitutes with preservation of the ileocecal valve and distal 25 cm of ileum on nephrolithiasis. METHODS: We reviewed a consecutive series of 518 patients (44 women and 474 men) with ileal orthotopic bladder substitution in whom 55 to 65 cm of ileum was resected but with preservation of the ileocecal valve and distal 25 cm of ileum, to determine prevalence of nephrolithiasis as well as bicarbonate, base excess, creatinine levels, and urinary pH at time of stone diagnosis and 2 years before it. RESULTS: Four male patients with a median age of 66 years (range, 50 to 70 years) developed nephrolithiasis after ileal bladder substitute, for a total of five calculi. The prevalence of nephrolithiasis in this retrospective cohort is thus 1% (5 of 518). They developed the calculi after a median follow-up of 8 years (range, 4 to 17 years). The four patients were diagnosed with calculi at 2.3, 3, 10, 10.3, and 14 years after bladder substitute. Two of the stones were uric acid calculi; the remaining three were calcium oxalate. None of our patients were acidotic or had elevated serum creatinines at time of stone formation. Urinary pH determined once in spontaneously voided urine at the time of stone diagnosis was pH 6.0 for the two uric acid calculi and pH 7.0 for the remaining calculi. CONCLUSIONS: The present study demonstrates a low prevalence of calculi in our cohort.

Vancomycin: Predictive risk factors for nephrotoxicity and implication for monitoring

The increased use of vancomycin in hospitals has resulted in a standard practice to monitor serum vancomycin levels because of possible nephrotoxicity. However, the routine monitoring of vancomycin serum concentration is under criticism and the cost effectiveness of such routine monitoring is in question because frequent monitoring neither results in increase efficacy nor decrease nephrotoxicity. The purpose of the present study is to determine factors that may place patients at increased risk of developing vancomycin induced nephrotoxicity and for whom monitoring may be most beneficial.^ From September to December 1992, 752 consecutive in patients at The University of Texas M. D. Anderson Cancer Center, Houston, were prospectively evaluated for nephrotoxicity in order to describe predictive risk factors for developing vancomycin related nephrotoxicity. Ninety-five patients (13 percent) developed nephrotoxicity. A total of 299 patients (40 percent) were considered monitored (vancomycin serum levels determined during the course of therapy), and 346 patients (46 percent) were receiving concurrent moderate to highly nephrotoxic drugs.^ Factors that were found to be significantly associated with nephrotoxicity in univariate analysis were: gender, base serum creatinine greater than 1.5mg/dl, monitor, leukemia, concurrent moderate to highly nephrotoxic drugs, and APACHE III scores of 40 or more. Significant factors in the univariate analysis were then entered into a stepwise logistic regression analysis to determine independent predictive risk factors for vancomycin induced nephrotoxicity.^ Factors, with their corresponding odds ratios and 95% confidence limits, selected by stepwise logistic regression analysis to be predictive of vancomycin induced nephrotoxicity were: Concurrent therapy with moderate to highly nephrotoxic drugs (2.89; 1.76-4.74), APACHE III scores of 40 or more (1.98; 1.16-3.38), and male gender (1.98; 1.04-2.71).^ Subgroup (monitor and non-monitor) analysis showed that male (OR = 1.87; 95% CI = 1.01, 3.45) and moderate to highly nephrotoxic drugs (OR = 4.58; 95% CI = 2.11, 9.94) were significant for nephrotoxicity in monitored patients. However, only APACHE III score (OR = 2.67; 95% CI = 1.13,6.29) was significant for nephrotoxicity in non-monitored patients.^ The conclusion drawn from this study is that not every patient receiving vancomycin therapy needs frequent monitoring of vancomycin serum levels. Such routine monitoring may be appropriate in patients with one or more of the identified risk factors and low risk patients do not need to be subjected to the discomfort and added cost of multiple blood sampling. Such prudent selection of patients to monitor may decrease cost to patients and hospital. ^

Is family medicine meeting the HIV/AIDS challenge? A national survey of family physicians' beliefs, clinical competence, and experience regarding HIV disease

A national sample of family physicians was surveyed to (1) assess family physicians' beliefs about the human immunodeficiency virus (HIV) and individuals at risk for infection, their clinical competence regarding HIV-related issues, and their experiences with HIV disease; (2) present conclusions to the American Academy of Family Physicians (AAFP) to effect the development of an early clinical care protocol and a continuing medical education curriculum; and (3) collect base-line data for use in the evaluation of an early clinical care protocol and a continuing medical education curriculum, in the case that such programs are developed and disseminated. After considering retired or deceased respondents, of the 2,660 physicians surveyed, 1,678 (63.7%) responded. The resulting sample was representative of the active members of the AAFP. About 77% of the respondents were unable to accurately identify the universal precautions for blood and body fluids to prevent occupational transmission of HIV or hepatitis B virus (HBV). Residency trained and board certified physicians expressed fewer "external constraints," such as fear of losing patients, obviating them from providing treatment to individuals with HIV disease (p =.004 and p $<$.001, respectively). These physicians also manifested fewer "internal constraints" to the provision of HIV treatment, such as fear of becoming infected (p $<$.001 and p =.012, respectively). Residency trained physicians also expressed a greater comfort with discussing sexually-related topics with their patients than did non-residency trained physicians (p $<$.001). There were 67.1% of the physicians surveyed who reported never providing treatment to an individual with HIV disease. Residency trained and board certified physicians expressed a greater likelihood to provide treatment to HIV-infected patients (p $<$.001) than non-residency trained and non-board certified physicians.^ Among the various primary care specialties, family medicine is especially vulnerable to the current challenges of HIV/AIDS. These challenges are augmented by the epidemiologic pattern that characterizes AIDS. For the past several years, we have seen AIDS in this country assume a similar pattern to that seen in most other countries; HIV is becoming increasingly prevalent in the heterosexual population as well as in locations removed from metropolitan centers. This current phase of the epidemic generates greater pressures upon primary care physicians, particularly family physicians, to become better acquainted with the means to provide early care to HIV/AIDS patients and to prevent HIV/AIDS among their patients. Family medicine is especially appropriate for providing care to HIV patients because family medicine involves treatment to all age groups and conditions; other primary care specialties focus on limited patient populations or specific conditions. Family physicians should be armed with the expertise to confront HIV/AIDS. However, family physicians' clinical competence and experience with HIV is not known. The data collected in this survey describes their competencies, attitudes, and experiences. ^

Case study on mobile applications UX: effect of the usage of a crosss-platform development framework

Cross-platform development frameworks for mobile applications promise important advantages in cost cuttings and easy maintenance, posing as a very good option for organizations interested in the design of mobile applications for several platforms. Given that platform conventions are especially important for the User eXperience (UX) of mobile applications, the usage of framework where the same code defines the behavior of the app in different platforms could have negative impact in the UX. The objetive of this study is comparing the cross-platform and the native approach for being able to determine if the selected development approach has any impact on the users in terms of UX. To be able to set a base line under this subject, study on cross-platform frameworks was performed to select the most appropriate one from a UX point of view. In order to achieve the objectives of this work, two development teams have developed two versions of the same application; one using framework that generates Android and iOS versions automatically, and another team developing native versions of the same application. The alternative versions for each platform have been evaluated with 37 users with a combination of a laboratory usability test and a longitudinal study. The results show that differences are minimal in the Android version, but in iOS, even if a reasonable good UX can be obtained with the usage of this framework by an UX-conscious design team, a higher level of UX can be obtained directly developing in native code.

A tyrosine kinase profile of prostate carcinoma.

Tyrosine kinases play central roles in the growth and differentiation of normal and tumor cells. In this study, we have analyzed the general tyrosine kinase expression profile of a prostate carcinoma (PCA) xenograft, CWR22. We describe here an improved reverse transcriptase-PCR approach that permits identification of nearly 40 different kinases in a single screening; several of these kinases are newly cloned kinases and some are novel. According to this, there are 11 receptor kinases, 9 nonreceptor kinases, and at least 7 dual kinases expressed in the xenograft tissue. The receptor kinases include erbB2, erbB3, Ret, platelet-derived growth factor receptor, sky, nyk, eph, htk, sek (eph), ddr, and tkt. The nonreceptor kinases are lck, yes, abl, arg, JakI, tyk2, and etk/bmx. Most of the dual kinases are in the mitogen-activating protein (MAP) kinase-kinase (MKK) family, which includes MKK3, MKK4, MEK5, and a novel one. As a complementary approach, we also analyzed by specific reverse transcriptase-PCR primers the expression profile of erbB/epidermal growth factor receptor family receptors in a variety of PCA specimens, cell lines, and benign prostatic hyperplasia. We found that erbB1, -2, and -3 are often coexpressed in prostate tissues, but not in erbB4. The information established here should provide a base line to study the possible growth and oncogenic signals of PCA.

Chemical composition of plagioclase from DSDP Legs 45 and 46, Atlantic Ocean

Phyric basalts recovered from DSDP Legs 45 and 46 contain abundant plagioclase phenocrysts which occur as either discrete single grains (megacrysts) or aggregates (glomerocrysts) and which are too abundant and too anorthitic to have crystallized from a liquid with the observed bulk rock composition. Almost all the plagioclase crystals are complexly zoned. In most cases two abrupt and relatively large compositional changes associated with continuous internal morphologic boundaries divide the plagioclase crystals into three parts: core, mantle and rim. The cores exhibit two major types of morphology: tabular, with a euhedral to slightly rounded outline; or a skeletal inner core wrapped by a slightly rounded homogeneous outer core. The mantle region is characterized by a zoning pattern composed of one to several spikes/plateaus superimposed on a gently zoned base line, with one large plateau always at the outside of the mantle, and by, in most cases, a rounded internal morphology. The inner rim is typically oscillatory zoned. The width of the outer rim can be correlated with the position of the individual crystal in the basalt pillow. The presence of a skeletal inner core and the concentration of glass inclusions in low-An zones in the mantle region suggest that the liquid in which these parts of the crystals were growing was undercooled some amount. The resorption features at the outer margins of low-An zones indicate superheating of the liquid with respect to the crystal. It is proposed that the plagioclase cores formed during injection of primitive magma into a previously existing magma chamber, that the mantle formed during mixing of a partially mixed magma and the remaining magma already in the chamber, and that the inner rim formed when the mixed magma was in a sheeted dike system. The large plateau at the outside of the mantle may have formed during the injection of the next batch of primitive magma into the main chamber, which may trigger an eruption. This model is consistent with fluid dynamic calculations and geochemically based magma mixing models, and is suggested to be the major mechanism for generating the disequilibrium conditions in the magma.

Analysis of coastal sediment transport processes from Wrightsville Beach to Fort Fisher, North Carolina /

A comprehensive engineering analysis of the coastal sediment transport processes along a 42-kilometer segment of the North Carolina shoreline from Wrightsville Beach to Fort Fisher is presented. Included in the analysis is an interpretation of the littoral processes, longshore transport, and the behavior and success of beach nourishment projects at Wrightsville Beach and Carolina Beach, North Carolina. The historical position of the MLW, MSL, and MHW contours, relative to a fixed base line, is plotted for the period between 1964 and 1975. An equivalent volumetric erosion or accretion between successive surveys is determined by multiplying the average excursion distance of the contours by a constant of proportionality. The plots of excursion distance versus time for the MLW, MSL, and MHW contours also show the time response of the beach fills. This response is described by a mathematical function. The alongshore components of wave-induced energy flux are also determined within the study area through wave refraction analysis. This information, together with the information on volumetric change, is used in a sediment budget analysis to determine the coefficient of alongshore sediment transport and the inlet trapping characteristics. (Author).

Long-term effects of beach nourishment on the benthic fauna of Panama City Beach, Florida /

The long-term effects of beach nourishment on the benthic infauna and surface sediments of Panama City beaches were investigated. Forty-seven stations located on nine transects between West Pass and Philips Inlet, and two nourishment borrow sites were sampled in November-December 1979 and May 1980. The data collected were compared to prenourishment base-line information collected by Saloman (1976). Abiotic parameters, water temperature, dissolved oxygen and salinity were measured. Sediments were analyzed for particle-size distribution, percent organic carbon and percent carbonate. Benthic macroinvertebrates were represented by 162 taxa of 14 major animal phyla. Species composition and faunal densities varied seasonally. Polychaetes and amphipods were the most abundant animal groups; a small number of species were dominant at nearly all stations. Species diversity was lowest in the swash zone and sandbar stations and highest offshore. Sediment composition was similar to that of Saloman's (1976) study within limits of sampling and processing errors. Faunal composition was found to be different from 1976 but was attributed to normal seasonal and spatial variations. Based on benthic community analyses and sediment parameters, no significant differences were found between nourishment borrow sites and surrounding areas and in the nearshore areas where beach nourishment was conducted. No long-term adverse effects of beach nourishment were detected. (Author).

Account of the operations of the Great trigonometrical survey of India ...

XVIII. Astronomical observations for latitude made during the period 1885 to 1895 and deduced values of the deflections of the plumb-line. Prepared under the directions of...S.G. Burrard. 1906.--XIX. Levelling of precision in India (1858-190) by S.G. Burrard..1910.--XIXA. Descriptions and heights of bench-marks on southern lines of levelling. Prepared under the directions of S.G. Burrard. 1910.--XIXB. Descriptions and heights of bench-marks on the northern lines of levelling. Prepared under the directions of S.G. Burrard. 1910.

Dopamine, empathy and the neurobiology of leadership

Objectives: Organisational Psychologists have long sought after methods by which to train individuals to become more effective leaders. Indeed considerable sums of money are spent on the design of such training programs. Yet it is not clear whether or not leadership skills can be taught or whether they are innate. Social leadership is a varied construct consisting of many diverse aspects, yet the ability to empathise with subordinates is a core skill that underpins effective transformational leadership. This type of leadership consists of four characteristics which are labelled ‘idealized influence’, ‘inspirational motivation’, ‘intellectual stimulation’ and ‘individualized consideration’. This is distinct from the transactional style of leadership, which is based on offering contingent rewards for completion of specific tasks. By identifying a specific gene that mediates distinct leadership traits, more effective training regimes can be designed. Design: There are two likely candidate genes that may mediate empathic leadership. The first is catechol-O-methyltransferase (COMT) which is involved with dopamine synthesis, and the second is the serotonin transporter promoter gene (5-HTTLPR). Both these genes mostly appear in the general population in their heterozygotic form. Thus by comparing phenotypes in leadership traits a measure of base line differences can be examined. Methods: 115 volunteers completed the Multifactor Leadership questionnaire (MLQ), which is a standard 12-item leadership psychometric scale and also underwent buccal swab for subsequent genotyping. Results: Of the 115 subjects 37 were heterozygotic for the COMT gene and 47 heterozygotic for 5-HTTLPR. Of the 12 MLQ subscales, the scores for two of the subscales only differed between the two participant groups. Individuals who were heterozygotic for the COMT gene scored higher on the ‘Inspirational motivation’ t(84)=1.99, p=0.05 and ‘Intellectual stimulation’ t(82)=1.94, p=0.05 scales compared to the carriers for the heterozygotic 5HTPP gene. Conclusions: Given that the behaviours described by these two MLQ subscales require leaders to empathise with subordinates, the current results suggest that dopamine may play a role in this important social task. The fact that both heterozygotic carriers for COMT and 5HTPP were compared allows a comparison to be made between the genotypes most prevalent in the general population.