Cardiac Rehabilitation (CR) and secondary prevention are effective components of evidence-based management for cardiac patients, resulting in improved clinical and behavioural outcomes. Mobile health ...(mHealth) is a rapidly growing health delivery method that has the potential to enhance CR and heart failure management. We undertook a systematic review to assess the evidence around mHealth interventions for CR and heart failure management for service and patient outcomes, cost effectiveness with a view to how mHealth could be utilized for rural, remote and Indigenous cardiac patients.
A comprehensive search of databases using key terms was conducted for the years 2000 to August 2016 to identify randomised and non-randomised trials utilizing smartphone functionality and a model of care that included CR and heart failure management. Included studies were assessed for quality and risk of bias and data extraction was undertaken by two independent reviewers.
Nine studies described a mix of mHealth interventions for CR (5 studies) and heart failure (4 studies) in the following categories: feasibility, utility and uptake studies; and randomised controlled trials. Studies showed that mHealth delivery for CR and heart failure management is feasible with high rates of participant engagement, acceptance, usage, and adherence. Moreover, mHealth delivery of CR was as effective as traditional centre-based CR (TCR) with significant improvement in quality of life. Hospital utilization for heart failure patients showed inconsistent reductions. There was limited inclusion of rural participants.
Mobile health delivery has the potential to improve access to CR and heart failure management for patients unable to attend TCR programs. Feasibility testing of culturally appropriate mHealth delivery for CR and heart failure management is required in rural and remote settings with subsequent implementation and evaluation into local health care services.
A Raman spectroscopy based method has been developed for measurement of trace airborne concentrations of respirable crystalline silica (RCS) using various aerosol sampling and analysis techniques. ...Three aerosol microconcentration techniques were investigated for effective coupling of collected particulate samples with micro-Raman spectroscopy: (i) direct analysis on a particulate filter after focused aerosol collection using a converging nozzle; (ii) analysis of dried particulate deposit on a filter obtained directly from the aerosol phase using the Spotsampler device; and (iii) analysis of a dried spot (∼1–3 mm diameter) obtained by redepositing the particulate sample, after low-temperature plasma ashing of the filter sample. The deposition characteristics (i.e., spot diameter, shape, and deposit uniformity) of each technique were investigated. Calibration curves were constructed and detection limits were estimated for α-quartz using the A 1 Raman Si–O–Si stretching–bending phonon mode at 465 cm–1. The measurement sensitivity could be substantially improved by increasing the signal integration time and by reducing the particle deposition area. Detection limits in the range of 8–55 ng could be achieved by microconcentrating the aerosol sample over a spot measuring 400–1000 μm in diameter. These detection limits were two to three orders of magnitude lower compared to those attainable using current standardized X-ray diffraction and infrared spectroscopy methods. The low detection limits suggest that near real-time measurements of RCS could be achieved with limits of quantification ranging from 2 to 18.5 μg/m3 (at 10 min collection time and 1.2 L/min sampling flow rate), depending on microconcentration technique used. The method was successfully extended to the measurement of α-quartz air concentration in representative workplace aerosol samples. This study demonstrates the potential of portable micro-Raman spectroscopy for near-real time measurement of trace RCS in air.
A novel micro-cellular polymer with a well-defined and uniform micro-architecture has been developed as a three-dimensional support matrix for in vitro tissue engineering applications. This material ...is manufactured through a high internal phase emulsion (HIPE) polymerization route and may be modified with hydroxyapatite. The generic form of the support is known as PolyHIPE Polymer (PHP). By changing the chemical composition of the emulsion and the processing conditions, the pore size can be altered from sub-micron range to a few hundred microns and the porosity varied from 70% to 97%. Our work has investigated the use of this micro-porous polymer as a biomaterial to support the growth of osteoblasts, the bone forming cells in vitro. Three groups of polymers were used that had pore sizes of 40, 60 and 100
μm. Results demonstrated in vitro cell–polymer compatibility, with osteoblasts forming multicellular layers on the polymer surface and also migrating to a maximum depth of 1.4
mm inside the scaffold after 35 days in culture. PHP was also able to support the differentiation of osteoblasts and the production of a bone-like matrix. The effect of modifying the polymer with hydroxyapatite was also studied and showed that there was a significant increase in osteoblast numbers penetrating into the polymer. There were few differences, between the pore sizes studied, on the overall penetration of osteoblasts into the polymer but the rate of movement into 100
μm PHP was significantly higher compared to the other sizes investigated. This study shows that osteoblasts seeded onto PHP demonstrate cellular attachment, proliferation and ingrowth leading to the support of an osteoblastic phenotype. Therefore this highly porous scaffold has a potential for bone tissue engineering.
The role of astrocytes in the progression of Alzheimer's disease (AD) remains poorly understood. We assessed the consequences of ablating astrocytic proliferation in 9 months old double transgenic ...APP23/GFAP‐TK mice. Treatment of these mice with the antiviral agent ganciclovir conditionally ablates proliferating reactive astrocytes. The loss of proliferating astrocytes resulted in significantly increased levels of monomeric amyloid‐β (Aβ) in brain homogenates, associated with reduced enzymatic degradation and clearance mechanisms. In addition, our data revealed exacerbated memory deficits in mice lacking proliferating astrocytes concomitant with decreased levels of synaptic markers and higher expression of pro‐inflammatory cytokines. Our data suggest that loss of reactive astrocytes in AD aggravates amyloid pathology and memory loss, possibly via disruption of amyloid clearance and enhanced neuroinflammation.
Main points
Depletion of proliferating astrocytes in APP23 mice leads to reduced amyloid degradation.
Loss of proliferating astrocytes results in increased memory deficits associated with synaptic and neuronal loss.
Ablation of proliferating astrocytes increases the expression of pro‐inflammatory cytokines.
Research protocols regarding the use of ActiGraph wGT3X+ accelerometers in care home residents are yet to be established. The purpose of this study was to identify the minimal wear time criteria ...required to achieve reliable estimates of physical activity (PA) and sedentary behaviour (SB) in older care home residents.
Ninety-four older adults from 14 care homes wore an ActiGraph wGT3X+ accelerometer on the right hip for 7 consecutive days. A pragmatic, staged approach was adopted in order to explore the effect of: monitoring day; minimum daily wear time and number of wear days on estimates of four outcomes derived from the accelerometer data: counts
day
, counts
minute
, PA time and SB time.
Data from 91 participants (mean age: 84 ± 9 years, 34% male) was included in the analysis. No effect of monitoring day was observed. Lowering the daily wear time to ≥ 8 h (compared to ≥10 h) had no effect on the outcomes of interest. Four days of monitoring was sufficient to provide reliable estimates of all four outcomes.
In this study, a minimum wear time criterion of ≥ 8 h on any 4 days was required to derive reliable estimates of PA and SB from ActiGraph wGT3X+ accelerometer data in older care home residents.
The elevated aerodynamic performance of insects has been attributed in part to the generation and maintenance of a stable region of vorticity known as the leading edge vortex (LEV). One explanation ...for the stability of the LEV is that spiraling axial flow within the vortex core drains energy into the tip vortex, forming a leading-edge spiral vortex analogous to the flow structure generated by delta wing aircraft. However, whereas spiral flow is a conspicuous feature of flapping wings at Reynolds numbers (Re) of 5000, similar experiments at Re=100 failed to identify a comparable structure. We used a dynamically scaled robot to investigate both the forces and the flows created by a wing undergoing identical motion at Re of approximately 120 and approximately 1400. In both cases, motion at constant angular velocity and fixed angle of attack generated a stable LEV with no evidence of shedding. At Re=1400, flow visualization indicated an intense narrow region of spanwise flow within the core of the LEV, a feature conspicuously absent at Re=120. The results suggest that the transport of vorticity from the leading edge to the wake that permits prolonged vortex attachment takes different forms at different Re.
Oxidative stress is the resultant damage that arises due to redox imbalances, more specifically an increase in destructive free radicals and reduction in protection from antioxidants and the ...antioxidant defence pathways. Oxidation of lipids by reactive oxygen species (ROS) can damage cellular structures and result in premature cell death. At low levels, ROS‐induced oxidative stress can be prevented through the action of antioxidants, however, when ROS are present in excess, inflammation and cytotoxicity eventually results leading to cellular oxidative stress damage. Increasing evidence for the role of oxidative stress in various diseases including neurological, dermatological, and cardiovascular diseases is now emerging. Mitochondria are the principal source (90%) of ROS in the cell, with superoxide radicals being generated when molecular oxygen is combined with free electrons. Given the key role of mitochondria in the generation of cellular oxidative stress it is worth considering this organelle and the process in more detail and to provide methods of intervention.
Résumé
Le stress oxydatif est l'ensemble des dommages crées par les déséquilibres redox, plus précisément une augmentation des radicaux libres destructeurs et une réduction de la protection contre les antioxydants et les voies de défense anti‐oxydantes. L'oxydation des lipides par les dérivés réactifs de l'oxygène peut endommager les structures cellulaires et entraîner la mort prématurée des cellules. À des taux bas, le stress oxydatif induit par les dérivés réactifs de l'oxygène peut être évitée grâce à l'action des antioxydants. Cependant, quand les dérivés réactifs de l'oxygène sont présents en excès, l'inflammation et la cytotoxicité conduisent à des dommages oxydatifs cellulaire. Il existe maintenant de plus en plus de preuves du rôle du stress oxydatif dans diverses maladies, notamment neurologiques, dermatologiques, et cardio‐vasculaires. Les mitochondries sont la source principale (90%) de dérivés réactifs de l'oxygène dans la cellule, avec des radicaux superoxydés générés lorsque de l'oxygène moléculaire est combinée à des électrons libres. Étant donné le rôle clé des mitochondries dans la génération de oxydatif cellulaire stress, il est utile d'examiner cet organite et le processus plus en détail et de proposer des méthodes d'intervention.
Randomized controlled trials (RCTs) suggest that supplementation with omega-3 polyunsaturated fatty acids (n-3PUFAs) may favourably modify cardiometabolic biomarkers in type 2 diabetes (T2DM). ...Previous meta-analyses are limited by insufficient sample sizes and omission of meta-regression techniques, and a large number of RCTs have subsequently been published since the last comprehensive meta-analysis. Updated information regarding the impact of dosage, duration or an interaction between these two factors is therefore warranted. The objective was to comprehensively assess the effect of n-3PUFAs supplementation on cardiometabolic biomarkers including lipid profiles, inflammatory parameters, blood pressure, and indices of glycaemic control, in people with T2DM, and identify whether treatment dosage, duration or an interaction thereof modify these effects.
Databases including PubMed and MEDLINE were searched until 13th July 2017 for RCTs investigating the effect of n-3PUFAs supplementation on lipid profiles, inflammatory parameters, blood pressure, and indices of glycaemic control. Data were pooled using random-effects meta-analysis and presented as standardised mean difference (Hedges g) with 95% confidence intervals (95% CI). Meta-regression analysis was performed to investigate the effects of duration of supplementation and total dosage of n-3PUFAs as moderator variables where appropriate.
A total of 45 RCTs were identified, involving 2674 people with T2DM. n-3PUFAs supplementation was associated with significant reductions in LDL ES: - 0.10, (95% CI - 0.17, - 0.03); p = 0.007, VLDL (ES: - 0.26 (- 0.51, - 0.01); p = 0.044, triglycerides (ES: - 0.39 (- 0.55, - 0.24; p ≤ 0.001 and HbA1c (ES: - 0.27 (- 0.48, - 0.06); p = 0.010. Moreover, n-3PUFAs supplementation was associated with reduction in plasma levels of TNF-α ES: - 0.59 (- 1.17, - 0.01); p = 0.045 and IL-6 (ES: - 1.67 (- 3.14, - 0.20); p = 0.026. All other lipid markers, indices of glycaemic control, inflammatory parameters, and blood pressure remained unchanged (p > 0.05).
n-3PUFAs supplementation produces favourable hypolipidemic effects, a reduction in pro-inflammatory cytokine levels and improvement in glycaemia. Neither duration nor dosage appear to explain the observed heterogeneity in response to n-3PUFAs. Trial registration This trial was registered at http://www.crd.york.ac.uk as CRD42016050802.
Carbon nanotubes and nanofibers (CNT/F) are increasingly used for diverse applications. Although animal studies suggest CNT/F exposure may cause deleterious health effects, human epidemiological ...studies have typically been small, confined to single workplaces, and limited in exposure assessment.
We conducted an industrywide cross-sectional epidemiological study of 108 workers from 12 U.S. sites to evaluate associations between occupational CNT/F exposure and sputum and blood biomarkers of early effect.
We assessed CNT/F exposure via personal breathing zone, filter-based air sampling to measure background-corrected elemental carbon (EC) (a CNT/F marker) mass and microscopy-based CNT/F structure count concentrations. We measured 36 sputum and 37 blood biomarkers. We used factor analyses with varimax rotation to derive factors among sputum and blood biomarkers separately. We used linear, Tobit, and unconditional logistic regression models to adjust for potential confounders and evaluate associations between CNT/F exposure and individual biomarkers and derived factors.
We derived three sputum and nine blood biomarker factors that explained 78% and 67%, respectively, of the variation. After adjusting for potential confounders, inhalable EC and total inhalable CNT/F structures were associated with the most sputum and blood biomarkers, respectively. Biomarkers associated with at least three CNT/F metrics were 72 kDa type IV collagenase/matrix metalloproteinase-2 (MMP-2), interleukin-18, glutathione peroxidase (GPx), myeloperoxidase, and superoxide dismutase (SOD) in sputum and MMP-2, matrix metalloproteinase-9, metalloproteinase inhibitor 1/tissue inhibitor of metalloproteinases 1, 8-hydroxy-2′-deoxyguanosine, GPx, SOD, endothelin-1, fibrinogen, intercellular adhesion molecule 1, vascular cell adhesion protein 1, and von Willebrand factor in blood, although directions of associations were not always as expected.
Inhalable rather than respirable CNT/F was more consistently associated with fibrosis, inflammation, oxidative stress, and cardiovascular biomarkers.
•We evaluated carbon nanotube/nanofiber (CNT/F) exposure in relation to biomarkers.•We assessed CNT/F exposure via personal breathing zone, filter-based air sampling.•We measured fibrosis, inflammation, oxidative stress, cardiovascular biomarkers.•Inhalable rather than respirable CNT/F was more often associated with biomarkers.•Sixteen biomarkers were associated with at least three CNT/F exposure metrics.
Commercial use of carbon nanotubes and nanofibers (CNT/F) in composites and electronics is increasing; however, little is known about health effects among workers. We conducted a cross-sectional ...study among 108 workers at 12 U.S. CNT/F facilities. We evaluated chest symptoms or respiratory allergies since starting work with CNT/F, lung function, resting blood pressure (BP), resting heart rate (RHR), and complete blood count (CBC) components.
We conducted multi-day, full-shift sampling to measure background-corrected elemental carbon (EC) and CNT/F structure count concentrations, and collected induced sputum to measure CNT/F in the respiratory tract. We measured (nonspecific) fine and ultrafine particulate matter mass and count concentrations. Concurrently, we conducted physical examinations, BP measurement, and spirometry, and collected whole blood. We evaluated associations between exposures and health measures, adjusting for confounders related to lifestyle and other occupational exposures.
CNT/F air concentrations were generally low, while 18% of participants had evidence of CNT/F in sputum. Respiratory allergy development was positively associated with inhalable EC (p=0.040) and number of years worked with CNT/F (p=0.008). No exposures were associated with spirometry-based metrics or pulmonary symptoms, nor were CNT/F-specific metrics related to BP or most CBC components. Systolic BP was positively associated with fine particulate matter (p-values: 0.015-0.054). RHR was positively associated with EC, at both the respirable (p=0.0074) and inhalable (p=0.0026) size fractions. Hematocrit was positively associated with the log of CNT/F structure counts (p=0.043).
Most health measures were not associated with CNT/F. The positive associations between CNT/F exposure and respiratory allergies, RHR, and hematocrit counts may not be causal and require examination in other studies.
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