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Introduction: According to the Food and Drugs Administration (FDA), dietary supplements (DS) are products taken by mouth that contain a “dietary ingredient.” Such dietary ingredients include minerals, vitamins, herbs or botanicals, amino acids as well as other substances used to supplement the diet. This study aims to determine the prevalence of usage and Knowledge, Attitudes, and Practices (KAP) of dietary supplements among medical and pharmacy students at the University of Cyberjaya, Malaysia. Methods: A cross-sectional study is done among 332 undergraduate medical and pharmacy students studying at the University of Cyberjaya, regardless of age and gender. Results: It was found that 39.4% of medical students and 28.7% of pharmacy students consume dietary supplements. Among the dietary supplement users, 44.3% consume dietary supplements to improve health meanwhile 34.6% to avoid dietary deficiency. 46.3% of medical students and 52.5% of pharmacy students who consume dietary supplements think the use of dietary supplements is not always safe (p

Sanju Bhattarai,1,2 Dikshya Wagle,2 Archana Shrestha,2– 4 Bjørn Olav Åsvold,1,5 Eva Skovlund,1 Abhijit Sen1,6 1Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; 2Institute of Implementation Science and Health, Kathmandu, Nepal; 3Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; 4Department of Chronic Disease Epidemiology, Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, 06510, USA; 5Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway; 6Center for Oral Health Services and Research (Tkmidt), Trondheim, NorwayCorrespondence: Sanju Bhattarai, Email sanju.bhattarai@ntnu.noIntroduction: Social support is considered vital for effective management of chronic conditions, but its role in improving adherence to antihypertensive medication and control of hypertension in urban Nepal is unknown. We examined the role of social support in adherence to antihypertensives and controlled blood pressure to inform future interventions for hypertension management.Methods: We analyzed cross-sectional data collected at baseline of a cluster randomized trial of hypertension patients (n=1252) in the community between May and November 2022. Multidimensional scale of perceived social support was used to measure social support, adherence to antihypertensives was measured using the Morisky medication adherence scale − 8, and individuals with systolic- and diastolic- blood pressure less than 140 and 90 mmHg respectively were considered to have controlled hypertension. Modified Poisson regression models were used to estimate the prevalence ratios and corresponding 95% confidence intervals.Results: We found that 914 (73%) individuals received moderate to high social support. Participants receiving high social support had a numerically lower proportion of controlled hypertension (51%) however not statistically significant. The proportion of good adherence to antihypertensives did not differ between the social support categories. There was no association in overall, family, friends, and significant other sub-scales of social support with controlled hypertension and adherence to antihypertensives.Discussion: Further studies to understand the quality and mechanisms through which social support contributes to blood pressure control are needed for the health system to include social support in designing and implementing community-based interventions for hypertension management.Keywords: hypertension control, adherence, social support, Nepal

Hypoxia, a state of reduced oxygen availability, exerts complex and often paradoxical effects on the heart. While chronic hypoxia is detrimental and leads to adverse cardiac remodeling and dysfunction, short-term or intermittent hypoxia can contribute towards protective adaptations that enhances the heart's ability to protect itself from ischemic injury. This protective adaptation, also known as hypoxic preconditioning, drives the activation of several essential signaling pathways, including the hypoxia-inducible factor (HIF) signaling, reactive oxygen species (ROS) signaling, nitric oxide (NO) regulation, and ATP-sensitive potassium channel (KATP) mediated regulation, leading to metabolic reprogramming, angiogenesis with vascular remodeling, and enhanced calcium handling, thereby increasing resistance to ischemic heart disease. We discuss strategies such as hypoxic conditioning and pharmacologically activated HIF signaling, along with targeted approaches to enhance glycolysis and KATP channel regulation and optimize sarcoplasmic reticulum calcium ATPase 2a (SERCA2a) mediated calcium handling in cardiomyocytes. In this review, we explore the mechanisms and therapeutic potential of short-term or intermittent hypoxia-mediated cardioprotection. Additionally, we highlight the importance of addressing challenges and limitations of using hypoxic preconditioning in clinical practice.

The carbon footprints are increasing in the environment at an alarming rate mainly due to unplanned human activities. The world’s population will continue to grow at a rapid pace in the future. As a result, our future generations may find it difficult to live on this planet in a healthy manner. The world’s developed and developing countries began to investigate various methods for reducing their carbon footprint. However, it will not be sustainable if it is also not economically viable. In this scenario, maintaining a good profit for businesses while reducing their carbon footprint necessitates a pragmatic strategy. In this article, we will try to find a way out that will provide us with a practical solution. We will simulate the profitability of an upstream oil manufacturer that has invested heavily in green technologies. Under a carbon tax system, we will use the production-inventory model. This system assumes that capital investment in green technology can reduce emissions, and increase profits. We used data from the Oil and Natural Gas Corporation of India, available in its annual reports. As a matter of fact, the Oil and Natural Gas Corporation of India accounts for 70% of crude oil production in India and is a major player in India’s upstream oil companies. The results were quite encouraging, with deviations between expected and actual values being less than 10%. The findings also led us to believe that the excise duty and the pollution control tax levied in India can be regarded as a Green Tax or Carbon Tax. We used a published research model to find the optimal solution.

Epilepsy is a prevalent brain disease, which is quite difficult-to-treat or cure. This study developed a novel automatic seizure detection method based on the persistent homology method. In this study, a Vietoris–Rips (VR) complex filtration model was constructed based on the EEG data. And the persistent homology method was applied to calculate the VR complex filtration barcodes to describe the topological changes of EEG recordings. Afterward, the barcodes as the topological characteristics of EEG signals were fed into the GoogLeNet for classification. The persistent homology is applicable for multi-channel EEG data analysis, where the global topological information is calculated and the features are extracted by considering the multi-channel EEG data as a whole, without the multiple calculations or the post-stitching. Three databases were used to evaluate the proposed approach and the results showed that the approach had high performances in the epilepsy detection. The results obtained from the CHB-MIT Database recordings revealed that the proposed approach can achieve a segment-based averaged accuracy, sensitivity and specificity values of 97.05%, 96.71% and 97.38%, and achieve an event-based averaged sensitivity value of 100% with 1.22 s average detection latency. In addition, on the Siena Scalp Database, the proposed method yields averaged accuracy, sensitivity and specificity values of 96.42%, 95.23% and 97.6%. Multiple tasks of the Bonn Database also showed achieved accuracy of 99.55%, 98.63%, 98.28% and 97.68%, respectively. The experimental results on these three EEG databases illustrate the efficiency and robustness of our approach for automatic detection of epileptic seizure.

[Objective] The accurate and rapid landslide susceptibility zoning method were studied in order to provide a reference for regional safety monitoring, and provide a scientific basis for the government to control landslide disasters. [Methods] The study was conducted in the Guichi District of Chizhou City, Anhui Province. The coupled model of gradient boosting decision tree-logistic regression (GBDT-LR) and an information value (I) model was used to determine the evaluation of regional landslide susceptibility. The model learns from the original samples and combines them to generate new simulation samples in order to enhance the fitting ability of the model to evaluate landslide susceptibility. The Borderline-Smote algorithm was used to solve the problem of sample data asymmetry. The slope unit divided by r.slopeunits software was selected as the minimum evaluation unit, and a total of 10 evaluation factors were selected: slope gradient, slope aspect, terrain curvature, profile curvature, plane curvature, topographic wetness index (TWI), topographic relief, normalized difference vegetation index (NDVI), distance from fault, and distance from river. The landslide susceptibility model was evaluated from three aspects: frequency ratio, density of landslide disaster points and hidden danger points, and the receiver operating characteristic (ROC) curve. [Results] The experimental results showed that the frequency ratio of the coupled model I-GBDT-LR was 10%, 13%, and 7% greater than that of the I, LR, and I-LR models, respectively. The density of landslide disaster points and hidden danger points in the high risk area increased by about 9, 11, and 7, respectively, and the ROC accuracy increased by about 10%, 9%, and 5%, respectively. [Conclusion] The accuracy of the coupled model was higher than that of the single model, and the accuracy of the coupled model proposed was higher than that of the I-LR coupled model, which provides an effective and new evaluation method for landslide susceptibility evaluation.

The purpose of this work is to predict the mechanical properties of single- to few-layered borophene (η-LB)/epoxy composites using molecular dynamics modelling. An epoxy matrix was used to hold borophene in layers, and a borophene sheet was homogeneously incorporated into the epoxy matrix to generate borophene/epoxy nanocomposites. In this work, the mechanical properties of borophene/epoxy nanocomposites have been analysed in further detail. In addition to the mechanical properties of the nanocomposites, the impacts of borophene on the density distribution of epoxy polymers in the nanocomposites led to the observation that the local density is relatively high near the borophene–β12 interface and gradually declines to the bulk value as one advances away from the interface. The mechanical properties of the borophene-layered nanocomposites were superior to those of their substitutes, with the former having a higher Young’s modulus and a lower thermal expansion coefficient. This is due to the fact that borophene layer loading may result in a significant quantity of high-density polymer being present in the nanocomposites, which enhances the overall properties of the nanocomposites. In addition, the interaction between the three to four layers of loaded borophene layer provides the greatest reinforcement among the two nanocomposites systems. Finite element analysis analyses on the preferred results of the β12 LB were in excellent agreement with those of the experimental simulation data, demonstrating that this computational technique may be used to reliably predict the characteristics of borophene/epoxy composites in the future.

As the fast development of wearable devices and Internet of things technologies, real-time monitoring of ECG signals is quite critical for cardiovascular diseases. However, dynamic ECG signals recorded in free-living conditions suffered from extremely serious noise pollution. Presently, most algorithms for ECG signal evaluation were designed to divide signals into acceptable and unacceptable. Such classifications were not enough for real-time cardiovascular disease monitoring. In the study, a wearable ECG quality database with 50,085 recordings was built, including A/B/C (or high quality/medium quality/low quality) three quality grades (A: high quality signals can be used for CVD detection; B: slight contaminated signals can be used for heart rate extracting; C: heavily polluted signals need to be abandoned). A new SQA classification method based on a three-layer wavelet scattering network and transfer learning LSTM was proposed in this study, which can extract more systematic and comprehensive characteristics by analyzing the signals thoroughly and deeply. Experimental results (mACC = 98.56%, mF1 = 98.55%, SeA = 97.90%, SeB = 98.16%, SeC = 99.60%, +PA = 98.52%, +PB = 97.60%, +PC = 99.54%, F1A = 98.20%, F1B = 97.90%, F1C = 99.60%) and real data validations proved that this proposed method showed the high accuracy, robustness, and computationally efficiency. It has the ability to evaluate the long-term dynamic ECG signal quality. It is advantageous to promoting cardiovascular disease monitoring by removing contaminating signals and selecting high-quality signal segments for further analysis.

Abhijit Sen,1 Akshay Shirish Mohankar,1 Abdulrahman Khamaj,2 Sougata Karmakar1 1Department of Design, Indian Institute of Technology (IIT) Guwahati, Guwahati, Assam, 781039, India; 2Department of Industrial Engineering, College of Engineering, Jazan University, Jazan, Saudi ArabiaCorrespondence: Sougata KarmakarDepartment of Design, Indian Institute of Technology (IIT) Guwahati, Assam, 781039, IndiaTel +91 361-2582464Email karmakar.sougata@gmail.comObjective: Emerging issues of occupational safety and health (OSH) in floating solar photovoltaic projects (FSPV) have rarely been addressed to achieve the Sustainable Development Goals (SDGs). The current scoping review has been planned to demonstrate OSH issues experienced by the workers engaged in the installation and maintenance of FSPV projects and existing ergonomics design interventions in the solar photovoltaic industry with a focus on the FSPV sector.Methods: A literature review was conducted from four major electronic databases (Science Direct, Google Scholar, Web of Science, and Scopus) using predefined keywords and following the PRISMA framework for the period 1965– 2020. A total of 49 studies under five headings, namely a) overview of key reasons for the emergence of floating solar photovoltaic projects, b) occupational risks of workers engaged in the solar PV industry/FSPV sector, c) occupational risks in workplaces/occupations similar to floating solar photovoltaics projects, d) availability of training modules and occupational standards, and e) design interventions/approaches in the solar PV industry/floating photovoltaics sector were analyzed.Results: It emerged that workers are exposed to multifarious occupational risk factors such as heat, solar radiation, ergonomic risks, electrocution, fire, hazardous substances, adverse weather conditions, and psychosocial factors. These risks have not been adequately addressed with required interventions in the FSPV sector. Intervention opportunities include designing innovative tools, lowering of loads, redesigning workplace layouts, introducing job aids, automation, task rotation, job enlargement, design of training modules, OSH standards and changes in work organization/shift, etc.Conclusion: This review is a first-of-its-kind effort to highlight the contextual risk factors in the emerging FSPV sector and the need for addressing them through ergonomics design interventions for successfully achieving the Sustainable Development Goals.Keywords: floating solar PV, renewable energy, occupational safety and health, industrial design, ergonomics design interventions, sustainable development goals

Abstract Background Inappropriate dosing of direct oral anticoagulants (DOACs) has been associated with clinical safety and efficacy; however, little is known about clinical data associated with an inappropriate DOAC dosing in Japan. In addition, there is no report in which the appropriateness of DOAC dosing between prescription for inpatients and for outpatients was examined. In this study, we aimed to investigate the prevalence and factors associated in the inappropriate dosing of DOACs in patients with atrial fibrillation (AF). Methods The retrospective cohort study was conducted at a single Japanese university hospital. Both inpatients and outpatients, who were diagnosed with AF and for whom treatment with either dabigatran, rivaroxaban, apixaban, or edoxaban was initiated between April 1, 2014 and March 31, 2018, were enrolled in the study. Appropriateness of DOAC dosing was assessed according to the manufacturer’s labeling recommendations (dose reduction criteria) of each DOAC. Inappropriate reduced dose, namely, underdosing, was defined as prescription of a reduced dose of DOAC despite the patient not meeting the dose reduction criteria. Inappropriate standard dose, namely, overdosing, was defined as prescription of a standard dose of DOAC despite the patient meeting the dose reduction criteria. Inappropriate DOAC dosing was defined as a deviation of the recommended dose (both underdosing and overdosing). Results A total of 316 patients (dabigatran, 28; rivaroxaban, 107; apixaban, 116; and edoxaban, 65) were included, with a median (interquartile range) age of 75 (66–81) years and 62.3% male. DOACs were prescribed at an appropriate standard dose in 39.2% of patients, an appropriate reduced dose in 36.7%, an inappropriate standard dose in 2.5%, and an inappropriate reduced dose in 19.3%. Multivariate analysis revealed that the inappropriate dosing of DOACs was significantly associated with prescriptions for outpatients (vs. inpatients; odds ratio [OR] 2.87, 95% confidence interval [CI] 1.53–5.62, p

Background: To the best of our knowledge, no study has yet focused on the association between the adenoid hypertrophy (AH) and the thiol-disulphide balance. Objectives: The purpose of this study is to evaluate the relation between AH and the thiol-disulphide balance, which is used as a marker of oxidative stress (OS), by measuring its exchange using a novel technique. Study design: Non-randomized and prospective clinical study. Material and methods: The present study consisted of 25 patients who presented to the otolaryngology outpatient clinic of our hospital with AH. An age- and sex-matched control group was composed of 24 healthy children. The effect of AH on the thiol-disulphide balance in children was evaluated. We also evaluated the total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSİ), ferric reducing/antioxidant power (FRAP), glutathione (GSH), lipid hydroperoxide (LOOH) and advanced oxidation protein products (AOPP) to assess the OS status of children. Results: The TOS was significantly higher in the AH group and the TAS was significantly higher in the control group (all p values

At present, it is challenging to extract landslides from high-resolution remote-sensing images using deep learning. Because landslides are very complex, the accuracy of traditional extraction methods is low. To improve the efficiency and accuracy of landslide extraction, a new model is proposed based on the U-Net model to automatically extract landslides from remote-sensing images: L-Unet. The main innovations are as follows: (1) A multi-scale feature-fusion (MFF) module is added at the end of the U-Net encoding network to improve the model’s ability to extract multi-scale landslide information. (2) A residual attention network is added to the U-Net model to deepen the network and improve the model’s ability to represent landslide features. (3) The bilinear interpolation algorithm in the decoding network of the U-Net model is replaced by data-dependent upsampling (DUpsampling) to improve the quality of the feature maps. Experimental results showed that the precision, recall, MIoU and F1 values of the L-Unet model are 4.15%, 2.65%, 4.82% and 3.37% higher than that of the baseline U-Net model, respectively. It was proven that the new model can extract landslides accurately and effectively.

Background: The Global Anticoagulant Registry in the FIELD–Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. Methods and results: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012–2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P

Aloe vera is a commonly used plant in both food and medicine industry. The potential toxicological side-effects of prolonged intake of Aloe extract have not been evaluated in detail. This work presents an in-depth toxicological study of the crude unprocessed A. vera gel in experimental rats. Acute and sub-chronic toxicity was evaluated in a 1 to 28-day long feeding schedule of the aqueous homogenized gel material. Hemoglobin, total protein, high density lipoprotein (HDL), low density lipoprotein (LDL), cholesterol, triglyceride, serum creatinine, serum alanine transaminase (SGPT), aspartate transaminase (SGOT) and alkaline phosphatase were examined and kidney and liver histology was performed. In the acute toxicity test, the behavioral aspects were also considered. A molecular docking assay was performed to investigate the binding affinities of pure A. vera compounds with liver and kidney toxicological marker enzymes, in order to assess the probable mode of action of selected Aloe constituents. Solubility factors for the active constituents were also studied to determine their possible miscibility with body fluids. The results from in vivo tests provided no major toxicological indications. Crude Aloe gel consumption up to 4 g/kg body weight (b.w.) showed no toxicological side effects. From the structural standpoint, Aloe-based bioactive molecules, such as Aloe-emodin, acetophenone, β-sitosterol, cholestenol and squalene showed promising binding affinity to qualify as alternative and complementary medicines. The synergistic roles of all A. vera constituents remain to be validated in human disease models.

Multiple sclerosis (MS) is an autoimmune disease of the human central nervous system. It is one of the most common neurological disorders around the world and there is still no complete cure for MS. Purification of a terpenoid from Capparis ovata was carried out and its structure was elucidated as stigmast-5,22-dien-3β-ol, myristate (3β,22E-stigmasteryl myristate; SDM) by NMR and mass spectral analyses. No information regarding its any health effect is available in the literature. In the present study, we have described its effects on inflammatory factors such as the expression levels of cytokines, chemokines and adhesion molecules as well as apoptosis/infiltration and myelination in SH-SY5Y cells. The expression levels of proinflammatory or inflammatory cytokines and chemokines such as NF-κB1, CCL5, CXCL9, CXCL10 and HIF1A along with T-cell activating cytokines such as IL-6 and TGFB1 were significantly downregulated with SDM treatment. Moreover, the expression levels of the main myelin proteins such as MBP, MAG and PLP that are essential for healthy myelin architecture were significantly up-regulated. The results presented in this study strongly suggest that the SDM offers a unique possibility to be used with autoimmune diseases, including MS due to its activity on the manipulation of cytokines and the promotion of myelin formation.

In the last decade, hydroxycinnamic acids (HCA) have gained increasing attention from researchers due to their antioxidant potential. The aim of this study was to examine in detail the impact of dietary HCA on particular types of P450 and also selected phase II and antioxidant enzymes in Wistar rat. HCA (10 mM/kg/day, i.p.) was administered for ten continuous days. Examination of the activities and mRNA and protein levels revealed that CYP2B, 2C6 and 3A enzyme activities were not altered significantly, with Western blot and qRT-PCR results corroborating this result. While treatment with HCA led to a significant reduction in CYP1A1/CYP1A2-associated enzyme activities, CYP1A1 protein, and mRNA levels were found to be unchanged. Aromatase (CYP19) activity, as well as protein and mRNA levels, were significantly reduced with HCA treatment. On the other hand, the NAD(P)H:quinone oxidoreductase 1 (NQO1), catalase (CAT), glutathione peroxidase (GPx) and glutathione S-transferases (GSTs) activities were increased significantly. Also, HCA treatment significantly increased the GST-mu and GST-theta mRNA levels. These observations may be of importance given the potential use of HCA as a chemopreventive and as an anticancer agent.

According to General Relativity, there are factors like mass, rotation, charge and presence of Cosmological constant that can influence the path of light ray. Apart from these factors, many authors have also reported the influence of gravitomagnetism on the path of light ray. In this study we have discussed the effect of a rotating Kerr-Taub-NUT body where the strength of the gravitomagnetic monopole is represented by the NUT factor or magnetic mass. We use the null geodesic of photon method to obtain the deflection angle of light ray for a Kerr-Taub-NUT body in equatorial plane upto the fourth order term. Our study shows that the NUT factor has a noticeable effect on the path of the light ray. By considering the magnetism to be zero, the expression of bending angle gets reduced to the Kerr bending angle. However, we obtained a non-zero bending angle for a hypothetical massless, magnetic body.

This study investigates the low-frequency (interannual and longer period) variability in three hydroclimatic records from east Central Europe. Two of these records consist of climate proxies derived from oak-tree rings in Bakta forest, and Balaton Highlands in Hungary, for the time interval 1783-2003. The third record consists of homogenized instrumental precipitation data from Budapest, Hungary, from 1842 to 2003. Using wavelet analysis, the three time series are analyzed and compared with one another. It is found that all three time series exhibit strong interannual variability at the 2-4 years timescales, and these variations occur intermittently throughout the length of each record. Significant variability is also observed in all the records at decadal timescales, but these variations persist for only two to three cycles. Wavelet coherence among the various time series is used to explore their time-varying correlation. The results reveal significant coherence at the 2-4 years band. At these timescales, the climatic variations are correlated to the tree-ring signal over different time intervals with changing phase. Increased (decreased) contribution of large-scale stratiform precipitation offers a potential explanation for enhanced (faded) coherence at the interannual timescale. Strong coherence was also observed occasionally at decadal timescales, however these coherences did not appear uniformly. These results reinforce the earlier assertion that neither the strength nor the rank of the similarity of the local hydroclimate signals is stable throughout the past two centuries.

Objective With the accelerating aging of the global population, the geriatrics has garnered significant attention in recent years. Geriatrics clinical specialty medical students represent a crucial talent pool for this field. Consequently, there is an increased emphasis on cultivating new clinical medical talents in geriatrics. The role of clinical instructors in medical schools extends beyond imparting medical knowledge; it encompasses the development of students' clinical reasoning and the shaping of their worldview, life perspective, and values. This paper reviews the current status of the moral and ethical framework within geriatric clinical practice at medical colleges and universities. It offers recommendations based on the unique characteristics and critical importance of this framework, aiming to cultivate well-rounded geriatric medicine professionals suited to meet the demands of an aging society in China.

We have studied cyclic heat release variability in a spark-ignition engine under exhaust gas recirculation (EGR), using nitrogen to simulate EGR. Five EGR levels are examined. We used wavelet analysis to identify the dominant modes of fluctuation and how these modes vary in time. It is found that at a low EGR level, the heat release variations exhibit high-frequency intermittent oscillations. As the EGR level increases, the high-frequency oscillations tend to become more persistent, occurring continuously over many cycles. When the EGR level is sufficiently high, intermittent oscillations are observed at both high and low frequencies. In addition, persistent low-frequency fluctuations are present at the high EGR level. We have fitted theoretical probability models to the empirical heat release distributions. Depending on the EGR level, a three-parameter probability density function such as the generalized logistic distribution, a four-parameter distribution such as Johnson SB, or the five-parameter Wakeby distribution is found to provide a good fit. The goodness of fit of the theoretical distributions is assessed by the Kolmogorov-Smirnov (KS) test statistics. A good understanding of cyclic variability is essential to develop effective control strategies for efficient combustion.

Mireya Wessolossky,1 Verna L Welch,2 Ajanta Sen,1 Tara M Babu,1 David R Luke21Division of Infectious Diseases, University of Massachusetts Medical School, Worcester, MA, USA; 2Medical Affairs, Pfizer Inc, Collegeville, PA, USABackground: Although invasive pulmonary aspergillosis (IPA) is more prevalent in immunocompromised patients, critical care clinicians need to be aware of the occurrence of IPA in the nontraditional host, such as a patient with chronic lung disease. The purpose of this study was to describe the IPA patient with chronic lung disease and compare the data with that of immunocompromised patients.Methods: The records of 351 patients with Aspergillus were evaluated in this single-center, retrospective study for evidence and outcomes of IPA. The outcomes of 57 patients with chronic lung disease and 56 immunocompromised patients were compared. Patients with chronic lung disease were defined by one of the following descriptive terms: emphysema, asthma, idiopathic lung disease, bronchitis, bronchiectasis, sarcoid, or pulmonary leukostasis.Results: Baseline demographics were similar between the two groups. Patients with chronic lung disease were primarily defined by emphysema (61%) and asthma (18%), and immunocompromised patients primarily had malignancies (27%) and bone marrow transplants (14%). A higher proportion of patients with chronic lung disease had a diagnosis of IPA by bronchoalveolar lavage versus the immunocompromised group (P < 0.03). The major risk factors for IPA were found to be steroid use in the chronic lung disease group and neutropenia and prior surgical procedures in the immunocompromised group. Overall, 53% and 69% of chronic lung disease and immunocompromised patients were cured (P = 0.14); 55% of chronic lung patients and 47% of immunocompromised patients survived one month (P = 0.75).Conclusion: Nontraditional patients with IPA, such as those with chronic lung disease, have outcomes and mortality similar to that in the more traditional immunocompromised population.Keywords: Aspergillus, moulds, intensive care units, chronic lung disease, antifungals

The modulatory effects of the Cyclamen trochopterantum tuber extract on hepatic drug-metabolizing enzymes, including aniline 4-hydroxylase (A4H; CYP2E1), ethoxyresorufin O-deethylase (EROD; CYP1A), methoxyresorufin O-demethylase (MROD; CYP1A), caffeine N-demethylase (C3ND; CYP1A2) aminopyrene N-demethylase (APND; CYP2C6), and erythromycin N-demethylase (ERND; CYP3A1), were examined in vivo in rats. The activities of all of these enzymes were induced by the cyclamen extract. In addition, Western-blot and RT-PCR results clearly showed that CYP2E1, CYP1A1/CYP1A2 and CYP2C6 protein and mRNA levels were substantially increased by four different doses of cyclamen. Although, the CYP3A1 protein level was increased significantly, the mRNA level was not changed. These results indicate that cyclamen tuber extract might have a potential not only to inhibit and/or induce the metabolism of certain co-administered drugs but also influence the development of toxicity and carcinogenesis due to the induction of the cytochrome P450-dependent drug-metabolizing enzymes.

Purpose: To ascertain whether the changes in intraocular pressure (IOP) that occur during hypobaric hypoxic exposure are related to plasma N-terminal pro-brain natriuretic peptide (BNP) levels. Materials and Methods: The study group comprised 26 healthy participants (all male, mean age 23.1 years). IOP was measured at local ground level, (792 m above sea level), then while in a chamber providing hypobaric hypoxic conditions (the subjects were exposed to a pressure equivalent to 9144 m for 1-3 min), and again after exit from the chamber. In each condition, the mean of three consecutive measurements of IOP was calculated for each eye. For BNP measurements, blood samples were drawn before the participants entered the chamber and just after they left the chamber. Results: IOP during hypobaric hypoxic exposure (18.00 ± 3.70 mmHg) was significantly greater than that before (15.66 ± 2.10 mmHg, P < 0.001) or after (16.10 ± 2.63 mmHg, P = 0.001) the exposure. IOP levels before and after the exposure were not significantly different (P = 0.136). Plasma BNP levels measured before and after exposure to hypobaric hypoxic conditions were not significantly different (P = 0.462). Conclusion: Plasma BNP levels did not change after short-term hypobaric hypoxic exposure, while the IOP increased. This increase may have been caused by some other systemic factors. As the hypobaric hypoxic conditions were reversed, IOP decreased to normal levels.

A helical tomotherapy machine combines a straight 6 MV linear accelerator mounted on a ring gantry with CT technology for image-guided intensity-modulated radiation therapy (IMRT) treatment. A fan beam created by the collimator and jaws produces a maximum of 40 Χ 5 cm 2 field size at the isocenter. The gantry and hence the fan beam rotates at a constant speed while the couch moves linearly into the gantry bore, thus producing a helical delivery. The beam is modulated by a 64-leaf binary multileaf collimator (MLC), which enables IMRT treatment. The linac can be operated at a lower voltage (3.5 MV) and dose rate to produce megavoltage CT images, which are used for image-guided patient setup. We have installed two such units since 2004 and treated more than 2000 patients. The machine comes "precommissioned" from the manufacturer, and the beam characteristics and IMRT plans on phantom are measured and compared with manufacturer′s data after acceptance tests are performed on site. Our experience with commissioning the machines and periodic quality assurance with tolerance limits for optimal performance are described.

Patient with a mediastinal mass may be diagnosed incidentally or following evaluation for the symptoms due to compressive effects on the adjoining structures. Pericardial cysts account to 6% of mediastinal masses. Echocardiography, computerised tomography and magnetic resonance imaging aid in accurate diagnosis and localization of these cysts. Anaesthesia for patients with these cysts may occasionally turn out to be catastrophic during induction or in postoperative period. Surgery is the preferred choice of treatment in these patients.

Este articulo revisa el estado actual de de las teorías de desarrollo teniendo en cuenta la experiencia histórica y la evolución interna de la teoría desde finales de la Segunda Guerra Mundial. Aunque la comprensión del desarrollo ha mejorado, se han hecho generalizaciones indebidas y extraído lecciones infundadas. Sen rechaza la oposición entre el Estado y mercado y entre planificación y rentabilidad, y pone de relieve las diferencias entre dos visiones ideales y extremas del desarrollo: la concepción BLAST, que lo considera como un proceso cruel, de 'sangre, sudor y lagrimas', y la concepción GALA, que lo considera amigable y cooperativo. Critica la idea de que la supresión de los derechos humanos y otros 'sacrificios' son necesarios en las primeras etapas de desarrollo. Muestra que el concepto de capital humano es un avance teórico y practico, pero aún insuficiente puesto que concibe al ser humano como mero instrumento y no como fin en si mismo. Y propone una visión mas profunda que acepta la importancia de la capacidad de la población para valorar, elegir y actuar libremente; así combinando la acción del Estado, la función del mercado y el papel de las organizaciones comunitarias, el desarrollo debe proporcionar a todas la población las oportunidades necesarias para vivir dignamente y ejercer una plena libertad.This article reviews the current state of development theory taking into account the historical experience and internal evolution of the theory since the end of the Second World War. Although understanding of development has improved, undue generalizations have been made and unfounded lessons have been extracted. Sen rejects the opposi tion between state and market and between planning and profitability, and emphasizes the differences between two ideal and extreme visions of development: the BLAST concepti, which he considers to be a cruel process of 'blood, sweat and tears', and the GALA concept, which he considers friendly and coopera tive. He critiques the idea that the suppression of human rights and other 'sacrifices' are necessary in the first stages of development. He demonstrates that the concept of human capital is a theoretical and practical advance, but still insufficient since it conceives of the human being as a mere instrument and not as an end in itself. He proposes a more profound vision which accepts the importance of the capability of the population to value, choose, and act freely; thus, combining the action of the sta te, the functioning of the market, and the role of community organizations, development should provide to the entire population the opportunities necessary to live with dignity and exercise full freedom.

En este articulo, Amartya Sen pone en escena una de las discusiones mas candentes en el debate económico de los años sesenta y setenta -la controversia de la teoría de capital entre las escuelas de Cambridge, la inglesa y la norteamericana- a traves de dos personajes: Euda y Subhuti, este ultimo un antiguo discípulo suyo que debido a algunos deslices debe reencarnar como economista en el siglo XX. La pieza esta llena de humor e ironía y, también, de agudas observaciones sobre este debate. Joan Robinson, (1954) abrio la discusión cuando pregunto como se media el capital en funcion de de producción agregada neoclásica. Sraffa (1960) mostro que la medida de capital no es independiente de la distribución y de los precios, y Garegnani (1970), que una funcion neoclasica bien comportada descansa en supuestos y restricciones demasiado exigentes e irreales. Sen , a traves de Buda, recomienda a su discípulo: "oh, Subhuti, no gastes tu vida en un problema que qiza sea trivial".In this article, Amartya Sen dramatizes one of the most heated discussions in the economic debates of the sixties and seventies the controversy over the theory of capital between the Cambridge schools of England and America- by means of two characters: Buddha and Subhuti, the latter an old disciple who, owing to some slips, must reincarnate as an economist in the twentieth century. The piece is full of humor and irony, as well as sharp observations about this debate. Joan Robinson (1954) opened the deba te when she asked how capital was measured in the neoclassical aggregated production function. Sraffa (1960) showed that the measurement of capital is not independent from the distribution of prices, and Garegnani (1970) showed that a well behaved neoclassical production function rests upon assumptions and restrictions that are too demanding and unreal. Sen, through Buddha, recommends to his disciple: "Do not spend your life, oh Subhuti, on a problem that may be trivial.

Julio Boltvinik, publicado en La Jornada, México, 28 y 29 de octubre de 1998. / Bernardo Kliksberg, profesor Honorario de la UBA, coordinador del Instituto Interamericano de Desarrollo Social-INDES-BID. / Mildred Largaespada, tomado de Confidencial, Nicaragua, primera semana de noviembre de 1998. de 1998. / David Montoya, tomado de Caretas, 22 de octubre de 1998, Perú. / Carlos Medina de Rebolledo, tomado de El Diario, Bolivia. / Libardo Sarmiento A., tomado de Caja de herramientas 59, noviembre / Mildred Largaespada, tomado de Confidencial, Nicaragua, primera semana de noviembre de 1998. de 1998.

La Academia Real de Ciencias de Suecia ha decidido otorgar el premio Banco de Suecia 1998 en Ciencias Económicas, en Memoria de Alfred Nobel, al Profesor Amartya Sen, del Trinity College, Reino Unido, y ciudadano indio, por sus contribuciones a la economía del bienestar.

El profesor Sen, tiene una amplia Trayectoria academica; con unos reconocimientos y disticiones profesionales, empleos, nombramientos, libros. nacido en 1993. India

Este articulo se propone un nuevo indicador de pobreza que evita algunas deficiencias de los indicadores que hoy utilizan. Para deducir el indicador se utiliza un enfoque axiomático. La concepción de bienestar usada para establecer el conjunto de axiomas es ordinal. La información requerida para el nuevo indicador es bastante limitada, lo que permite su utilización practica.The primary aim of this paper is to propose a new measure of poverty, which should avoid some of the shortcomings of the mea sures currently in use. An axiomatic approach is used to derive the measure. The conception of welfare in the axiom set is ordinal. The information required for the new measure is quite limited, permitting practical use.

EntrevistaEl economista Amartya Sen, de 64 años, fue galardonado el pasado miércoles con el Premio Nobel de Economía por sus trabajos sobre el hambre en el mundo y su relación entre la democracia y la satisfacción de las necesidades básicas de los seres humanos. Casado en terceras nupcias, Sen ha sido profesor en universidades de Asia, América del Norte y Europa. Actualmente enseña en el Trinity College, de la Universidad de Cambridge, en el Reino Unido.

En este articulo se examinan las relaciones y diferencias entre el concepto de 'capital humano' y el concepto de 'capacidad humana'. El concepto de capital humano es mas limitado puesto que solo concibe las cualidades humanas en su relación con el crecimiento económico mientras que el concepto de capacidades da énfasis a la expansión de libertad humana para vivir el tipo de vida que la gente considera valedera. Cuando se adopta esa visión mas amplia, el proceso de desarrollo no puede verse simplemente como un incremento del PIB sino como la expansión de la capacidad humana para llevar una vida mas libre y mas digna.In this article the relationships and the differences between the concept of 'human capital' and the concept of 'human capability' are examined. The concept of human capital is more limited since it only conceives human qualities in relation to economic growth, whereas the concept of capabili ties puts emphasis on the expansion of human freedom to live the kind of life that people judge valuable. Whenthis broader vision is adopted, the process of development cannot be seen as simply an increase in the GNP, but rather as the expansion of the human capability to live a more free and worthy life.

Rice (Oryza sativa) is a globally important staple food, but its production was influenced by various biotic and abiotic stresses. This study involved screening endophytic bacterial strains for their antagonistic activities and control efficacy against multiple rice pathogens in planta assays. Subsequent greenhouse investigations identified Bacillus velezensis LS123N as the most promising strain for effectively controlling various rice diseases, including bacterial blight, rice blast, bakanae disease, Pythium disease, and brown spot disease. Field trials further demonstrated that LS123N significantly reduced naturally occurring brown spot disease caused by Bipolaris oryzae in both seedlings and mature rice plants, and increased rice yields. For disease control against bacterial blight, Pythium disease, and brown spot, only a single treatment during seed germination resulted in significant disease control efficacy. The application of LS123N during seed germination aligns with common rice cultivation practices. Additionally, LS123N exhibited the capacity to improve rice resistance to wind stress and enhance rice growth during the seedling stage. Endophytic colonization of LS123N was evidenced from seed to mature rice plants after seed treatment. Interestingly, the expression of many rice defense genes was suppressed within 48 h of the LS123N introduction. In vitro assays showed that LS123N inhibited spore germination and normal growth of germ tubes of B. oryzae, produced multiple hydrolases, siderophores, and IAA, and had the ability to solubilize phosphorus compounds. In summary, these results indicate that B. velezensis LS123N is a promising biocontrol agent and has the potential to be developed into a biofungicide, biofertilizer, and biostimulator.

The central importance of the biopsychosocial model of chronic disease is increasingly recognised in the management of long-term conditions (LTC), which are often associated with chronic pain, fatigue and disability. Despite the physical and mental health impact, 'struggle' to maintain self-efficacy, gap in effective transition to adult pathways and long term consequences of poor disease control and lifestyle choices in young people with LTCs, innovation in this age range is rarely reported in generic journals. This paper explores the feasibility and acceptability of health coaching with young service users to increase engagement and self-management, achieved through multidisciplinary team (MDT) training in Adolescent Rheumatology.

Abstract Background Despite high levels of clinically significant persistent cancer related fatigue in breast cancer survivors few treatments are currently available and most pose a significant burden on the part of the woman. Acupressure, a component of Traditional Chinese Medicine, has been shown to decrease fatigue levels by as much as 70% in cancer survivors while being inexpensive, non-toxic and an easy to use intervention. The primary aim of this study was to determine the efficacy of two types of self-administered acupressure (relaxation acupressure and stimulating acupressure), compared to standard of care on fatigue severity. Secondary aims were to evaluate the efficacy of two types of acupressure on sleep and kinetic parameters required for implementation of acupressure in a clinical setting; The purpose of this paper is to share the methodology used including challenges and insights. Methods/design This study is a three group, randomized clinical trial. 375 breast cancer survivors at least 12 months after completion of cancer treatments, with moderate to severe persistent fatigue, are being randomized to one of 3 groups: self-administered relaxation acupressure; self-administered stimulating acupressure; or standard of care. Participants are assessed at baseline, 3 weeks, and 6 weeks followed by a 4-week follow-up period. The primary aim is to examine the effect of 6-weeks of relaxation acupressure compared to stimulatory acupressure or standard of care on fatigue as assessed by: weekly self-report using the Brief Fatigue Inventory; objective daytime physical activity on actigraph; or fatigue patterns assessed 4-times daily using a visual analog scale. Secondary endpoints include depression, anxiety, self-efficacy, and sleep quality. Discussion This study has the potential to develop a low-cost, self-care intervention for the most troubling of late-term effects in breast cancer populations, fatigue. The methods used may lend constructive ideas to other investigators working with this population and/or intervention. Trial registration ClinicalTrial.Gov Trials Register NCT01281904

Abstract Background Despite being the most commonly used herbal for sleep disorders, chamomile's (Matricaria recutita) efficacy and safety for treating chronic primary insomnia is unknown. We examined the preliminary efficacy and safety of chamomile for improving subjective sleep and daytime symptoms in patients with chronic insomnia. Methods We performed a randomized, double-blind, placebo-controlled pilot trial in 34 patients aged 18-65 years with DSM-IV primary insomnia for ≥ 6-months. Patients were randomized to 270 mg of chamomile twice daily or placebo for 28-days. The primary outcomes were sleep diary measures. Secondary outcomes included daytime symptoms, safety assessments, and effect size of these measures. Results There were no significant differences between groups in changes in sleep diary measures, including total sleep time (TST), sleep efficiency, sleep latency, wake after sleep onset (WASO), sleep quality, and number of awakenings. Chamomile did show modest advantage on daytime functioning, although these did not reach statistical significance. Effect sizes were generally small to moderate (Cohen's d ≤ 0.20 to < 0.60) with sleep latency, night time awakenings, and Fatigue Severity Scale (FSS), having moderate effect sizes in favor of chamomile. However, TST demonstrated a moderate effect size in favor of placebo. There were no differences in adverse events reported by the chamomile group compared to placebo. Conclusion Chamomile could provide modest benefits of daytime functioning and mixed benefits on sleep diary measures relative to placebo in adults with chronic primary insomnia. However, further studies in select insomnia patients would be needed to investigate these conclusions. Trial Registration ClinicalTrials.gov Identifier NCT01286324

Abstract Background Regular participation in physical activity can prevent many chronic health conditions. Computerized self-management programs are effective clinical tools to support patient participation in physical activity. This pilot study sought to develop and evaluate an online interface for primary care providers to refer patients to an Internet-mediated walking program called Stepping Up to Health (SUH) and to monitor participant progress in the program. Methods In Phase I of the study, we recruited six pairs of physicians and medical assistants from two family practice clinics to assist with the design of a clinical interface. During Phase II, providers used the developed interface to refer patients to a six-week pilot intervention. Provider perspectives were assessed regarding the feasibility of integrating the program into routine care. Assessment tools included quantitative and qualitative data gathered from semi-structured interviews, surveys, and online usage logs. Results In Phase I, 13 providers used SUH and participated in two interviews. Providers emphasized the need for alerts flagging patients who were not doing well and the ability to review participant progress. Additionally, providers asked for summary views of data across all enrolled clinic patients as well as advertising materials for intervention recruitment. In response to this input, an interface was developed containing three pages: 1) a recruitment page, 2) a summary page, and 3) a detailed patient page. In Phase II, providers used the interface to refer 139 patients to SUH and 37 (27%) enrolled in the intervention. Providers rarely used the interface to monitor enrolled patients. Barriers to regular use of the intervention included lack of integration with the medical record system, competing priorities, patient disinterest, and physician unease with exercise referrals. Intention-to-treat analyses showed that patients increased walking by an average of 1493 steps/day from pre- to post-intervention (t = (36) = 4.13, p < 0.01). Conclusions Providers successfully referred patients using the SUH provider interface, but were less willing to monitor patient compliance in the program. Patients who completed the program significantly increased their step counts. Future research is needed to test the effectiveness of integrating SUH with clinical information systems over a longer evaluation period.

Abstract Background Birth attendance by trained health workers is low in rural Nepal. Local participation in improving health services and increased interaction between health systems and communities may stimulate demand for health services. Significant increases in birth attendance by trained health workers may be affected through community mobilisation by local women's groups and health management committee strengthening. We will test the effect of community mobilisation through women's groups, and health management committee strengthening, on institutional deliveries and home deliveries attended by trained health workers in Makwanpur District. Design Cluster randomised controlled trial involving 43 village development committee clusters. 21 clusters will receive the intervention and 22 clusters will serve as control areas. In intervention areas, Female Community Health Volunteers are supported in convening monthly women's groups. The groups work through an action research cycle in which they consider barriers to institutional delivery, plan and implement strategies to address these barriers with their communities, and evaluate their progress. Health management committees participate in three-day workshops that use appreciative inquiry methods to explore and plan ways to improve maternal and newborn health services. Follow-up meetings are conducted every three months to review progress. Primary outcomes are institutional deliveries and home deliveries conducted by trained health workers. Secondary outcome measures include uptake of antenatal and postnatal care, neonatal mortality and stillbirth rates, and maternal morbidity. Trial registration number ISRCTN99834806

Abstract Background Recent studies suggest that glaucoma is a neurodegenerative disease in which secondary degenerative losses occur after primary insult by raised Intraocular pressure (IOP) or by other associated factors. It has been reported that polymorphisms in the IL1A and IL1B genes are associated with Primary Open Angle Glaucoma (POAG). The purpose of our study was to investigate the role of these polymorphisms in eastern Indian POAG patients. Methods The study involved 315 unrelated POAG patients, consisting of 116 High Tension Glaucoma (HTG) patients with intra ocular pressure (IOP) > 21 mmHg and 199 non-HTG patients (presenting IOP < 20 mmHg), and 301 healthy controls from eastern India. Genotypes were determined by polymerase chain reaction and restriction digestion for three single nucleotide polymorphisms (SNPs): IL1A (-889C/T; rs1800587), IL1B (-511C/T; rs16944) and IL1B (3953C/T; rs1143634). Haplotype frequency was determined by Haploview 4.1 software. The association of individual SNPs and major haplotypes was evaluated using chi-square statistics. The p-value was corrected for multiple tests by Bonferroni method. Results No significant difference was observed in the allele and genotype frequencies for IL1A and IL1B SNPs between total pool of POAG patients and controls. However, on segregating the patient pool to HTG and non-HTG groups, weak association was observed for IL1A polymorphism (-889C/T) where -889C allele was found to portray risk (OR = 1.380; 95% CI = 1.041-1.830; p = 0.025) for non-HTG patients. Similarly, 3953T allele of IL1B polymorphism (+3953C/T) was observed to confer risk to HTG group (OR = 1.561; 95% CI = 1.022-2.385; p = 0.039). On haplotype analysis it was observed that TTC was significantly underrepresented in non-HTG patients (OR = 0.538; 95% CI = 0.356- 0.815; p = 0.003) while TCT haplotype was overrepresented in HTG patients (OR = 1.784; 95% CI = 1.084- 2.937; p = 0.022) compared to control pool. However, after correction for multiple tests by Bonferroni method, an association of only TTC haplotype with non-HTG cases sustained (pcorrected = 0.015) and expected to confer protection. Conclusion The study suggests that the genomic region containing the IL1 gene cluster influences the POAG pathogenesis mostly in non-HTG patients in eastern India. A similar study in additional and larger cohorts of patients in other population groups is necessary to further substantiate the observation.

Abstract Background Studies in K-12 and college students show that their learning preferences have been strongly shaped by new media technologies like video games, virtual reality environments, the Internet, and social networks. However, there is no known research on medical students' game experiences or attitudes towards new media technologies in medical education. This investigation seeks to elucidate medical student experiences and attitudes, to see whether they warrant the development of new media teaching methods in medicine. Methods Medical students from two American universities participated. An anonymous, 30-item, cross-sectional survey addressed demographics, game play experience and attitudes on using new media technologies in medical education. Statistical analysis identified: 1) demographic characteristics; 2) differences between the two universities; 3) how video game play differs across gender, age, degree program and familiarity with computers; and 4) characteristics of students who play most frequently. Results 217 medical students participated. About half were female (53%). Respondents liked the idea of using technology to enhance healthcare education (98%), felt that education should make better use of new media technologies (96%), and believed that video games can have educational value (80%). A majority (77%) would use a multiplayer online healthcare simulation on their own time, provided that it helped them to accomplish an important goal. Men and women agreed that they were most inclined to use multiplayer simulations if they were fun (97%), and if they helped to develop skill in patient interactions (90%). However, there was significant gender dissonance over types of favorite games, the educational value of video games, and the desire to participate in games that realistically replicated the experience of clinical practice. Conclusions Overall, medical student respondents, including many who do not play video games, held highly favorable views about the use of video games and related new media technology in medical education. Significant gender differences in game play experience and attitudes may represent male video game design bias that stresses male cognitive aptitudes; medical educators hoping to create serious games that will appeal to both men and women must avoid this.

Abstract Background Engaging in regular physical activity can be challenging, particularly during the winter months. To promote physical activity at the University of Michigan during the winter months, an eight-week Internet-mediated program (Active U) was developed providing participants with an online physical activity log, goal setting, motivational emails, and optional team participation and competition. Methods This study is a program evaluation of Active U. Approximately 47,000 faculty, staff, and graduate students were invited to participate in the online Active U intervention in the winter of 2007. Participants were assigned a physical activity goal and were asked to record each physical activity episode into the activity log for eight weeks. Statistics for program reach, effectiveness, adoption, and implementation were calculated using the Re-Aim framework. Multilevel regression analyses were used to assess the decline in rates of data entry and goal attainment during the program, to assess the likelihood of joining a team by demographic characteristics, to test the association between various predictors and the number of weeks an individual met his or her goal, and to analyze server load. Results Overall, 7,483 individuals registered with the Active U website (≈16% of eligible), and 79% participated in the program by logging valid data at least once. Staff members, older participants, and those with a BMI < 25 were more likely to meet their weekly physical activity goals, and average rate of meeting goals was higher among participants who joined a competitive team compared to those who participated individually (IRR = 1.28, P < .001). Conclusion Internet-mediated physical activity interventions that focus on physical activity logging and goal setting while incorporating team competition may help a significant percentage of the target population maintain their physical activity during the winter months.

Abstract Background In the U.S., complementary and alternative medicine (CAM) use is most prevalent among reproductive age, educated women. We sought to determine general attitudes and approaches to CAM among obstetric and gynecology patients and physicians. Methods Obstetrician-gynecologist members of the American Medical Association in the state of Michigan and obstetric-gynecology patients at the University of Michigan were surveyed. Physician and patient attitudes and practices regarding CAM were characterized. Results Surveys were obtained from 401 physicians and 483 patients. Physicians appeared to have a more positive attitude towards CAM as compared to patients, and most reported routinely endorsing, providing or referring patients for at least one CAM modality. The most commonly used CAM interventions by patients were divergent from those rated highest among physicians, and most patients did not consult with a health care provider prior to starting CAM. Conclusion Although obstetrics/gynecology physicians and patients have a positive attitude towards CAM, physician and patients' view of the most effective CAM therapies were incongruent. Obstetrician/gynecologists should routinely ask their patients about their use of CAM with the goal of providing responsible, evidence-based advice to optimize patient care.

Abstract Background The majority of individuals with type 2 diabetes do not exercise regularly. Pedometer-based walking interventions can help; however, pedometer-based interventions targeting only total daily accumulated steps might not yield the same health benefits as physical activity programs specifying a minimum duration and intensity of physical activity bouts. Methods This pilot randomized trial compared two goal-setting strategies: 1) lifestyle goals targeting total daily accumulated step counts and 2) structured goals targeting bout steps defined as walking that lasts for 10 minutes or longer at a pace of at least 60 steps per minute. We sought to determine which goal-setting strategy was more effective at increasing bout steps. Participants were sedentary adults with type 2 diabetes. All participants: wore enhanced pedometers with embedded USB ports; uploaded detailed, time-stamped step-count data to a website called Stepping Up to Health; and received automated step-count feedback, automatically calculated goals, and tailored motivational messages throughout the six-week intervention. Only the automated goal calculations and step-count feedback differed between the two groups. The primary outcome of interest was increase in steps taken during the previously defined bouts of walking (lasting at least 10 minutes or longer at a pace of at least 60 steps per minute) between baseline and end of the intervention. Results Thirty-five participants were randomized and 30 (86%) completed the pilot study. Both groups significantly increased bout steps, but there was no statistically significant difference between groups. Among study completers, bout steps increased by 1921 ± 2729 steps a day. Those who received lifestyle goals were more satisfied with the intervention (p = 0.006) and wore the pedometer more often (p < 0.001) than those who received structured goals. Conclusion In this six-week intervention, Lifestyle Goals group participants achieved increases in bout steps comparable to the increases seen in the Structured Goals group, representing almost a mile a day of additional moderate intensity bout activity. Pedometer-based walking programs that emphasize total accumulated step counts are more acceptable to participants and are as effective at increasing moderate intensity bouts of physical activity as programs that use structured goals. Trial registration NCT00151021

Abstract The hypotheses that PKCepsilon is necessary for: 1) PGF2alpha to inhibit LH-stimulated progesterone (P4) secretion, and 2) for the expression of key prostaglandin synthesizing/metabolizing enzymes were tested in bovine luteal cells in which PKCepsilon expression had been ablated using a validated siRNA protocol. Steroidogenic cells from Day -6 bovine corpus luteum (CL) were isolated and transfected to reduce PKCepsilon expression after 48, 72 and 96 h. A third tested hypothesis was that an increase in intracellular calcium concentration ([Ca(2+)]i) is the cellular mechanism through which PGF2alpha inhibits luteal progesterone. The hypothesis was tested with two pharmacological agents. In the first test, the dose-dependent effects on raising the [Ca(2+)]i with the ionophore, A23187, on basal and LH-stimulated P4 secretion in cells collected from early (Day -4) and mid-cycle (Day -10) bovine CL was examined. In the second test, the ability of PGF2alpha to inhibit LH-stimulated P4 secretion in Day-10 luteal cells was examined under conditions in which an elevation in [Ca(2+)]i had been buffered by means of the intracellular calcium chelator, Bapta-AM. PKCepsilon expression was reduced 65 and 75% by 72 and 96 h after transfection, respectively. In cells in which PKCepsilon expression was ablated by 75%, the inhibitory effect of PGF2alpha on LH-stimulated P4 secretion was only 29% lower than in the LH-stimulated group. In contrast, it was reduced by 75% in the group where PKCepsilon expression had not been reduced (P < 0.05). Real time PCR analysis indicated that there were no differences in the expression of cyclooxygenase-2 (COX-2), aldoketoreductase 1B5 (AKR1B5), prostaglandin E synthase (PGES), hydroxyprostaglandin-15 dehydrogenase (PGDH) and PGE2 -9-reductase as a function of PKCepsilon down-regulation. Finally, LH stimulated secretion of P4 at each luteal stage (Day -4 and -10), and PGF2alpha inhibited this only in Day -10 cells (P < 0.05). When A23187 was used at concentrations greater than 0.1 μmol, the induced elevation in [Ca(2+)]i inhibited the effect of LH on secretion of P4 in Day -4 and -10 cells (P < 0.05, Fig. 5). The inhibitory effect of PGF2alpha on LH-stimulated P4 in Day -10 cells was reduced if an increase in [Ca(2+)]i was prevented with Bapta-AM. These results support the hypothesis that differential expression of PKCepsilon and an elevation of [Ca(2+)]i are important for acquisition of luteolytic response to PGF2alpha.

Abstract Background A randomised controlled trial of participatory women's groups in rural Nepal previously showed reductions in maternal and newborn mortality. In addition to the outcome data we also collected previously unreported information from the subgroup of women who had been pregnant prior to study commencement and conceived during the trial period. To determine the mechanisms via which the intervention worked we here examine the changes in perinatal care of these women. In particular we use the information to study factors affecting positive behaviour change in pregnancy, childbirth and newborn care. Methods Women's groups focusing on perinatal care were introduced into 12 of 24 study clusters (average cluster population 7000). A total of 5400 women of reproductive age enrolled in the trial had previously been pregnant and conceived during the trial period. For each of four outcomes (attendance at antenatal care; use of a boiled blade to cut the cord; appropriate dressing of the cord; not discarding colostrum) each of these women was classified as BETTER, GOOD, BAD or WORSE to describe whether and how she changed her pre-trial practice. Multilevel multinomial models were used to identify women most responsive to intervention. Results Among those not initially following good practice, women in intervention areas were significantly more likely to do so later for all four outcomes (OR 1.92 to 3.13). Within intervention clusters, women who attended groups were more likely to show a positive change than non-group members with regard to antenatal care utilisation and not discarding colostrum, but non-group members also benefited. Conclusion Women's groups promoted significant behaviour change for perinatal care amongst women not previously following good practice. Positive changes attributable to intervention were not restricted to specific demographic subgroups.

Abstract Phage N5 is one of the phages of Vibrio cholerae serovar O1 biotype El Tor (Ghosh, A. N., Ansari, M. Q., and Dutta, G. C. Isolation and morphological characterization of El Tor cholera phages. J. Gen. Virol. 70: 2241–2243, 1989). In the present communication the growth curve, molecular weight and confirmation of the genome, partial denaturation map and restriction endonuclease digestion pattern have been determined. Partial denaturation map indicates that the genome has non-permuted / invariant sequence. Presence of cohesive ends has also been documented.