Abstract Background Walking speed has implications for community functioning and is predictive of important outcomes. Determining whether an individual's walking speed is limited requires normal ...values for comparison. Objectives To use meta-analysis to describe normal gait speed for healthy individuals within age and gender strata. Data sources PubMed, the Cumulative Index of Nursing and Allied Health (CINAHL), Scopus, Science Citation Index and articles identified by hand searches. Study selection criteria Inclusion required that the gait speed of apparently healthy adults was documented as they walked at a normal pace over a course of 3 to 30 m. Summary data were excluded unless obtained from at least 10 participants within a gender and decade stratum. Study appraisal and synthesis methods The two authors independently reviewed articles and extracted data. Accuracy was confirmed by the other author. Data were grouped within gender and decade strata. A meta-analysis macro was used to consolidate data by strata and to determine homogeneity. Results Forty-one articles contributed data to the analysis. Combined, they provided data from 23 111 subjects. The gait speed was homogeneous within strata and ranged from a mean of 143.4 cm/second for men aged 40 to 49 years to a mean of 94.3 cm/second for women aged 80 to 99 years. Limitations The data presented herein may not be useful as a standard of normal if gait is measured over short distances from the command ‘go’ or if a turn is involved. Conclusions and implications The consolidation of data from multiple studies reported in this meta-analysis provides normative data that can serve as a standard against which individuals can be compared. Doing so will aid the interpretation of their performance.
Pain is a subjective sensory experience that can, mostly, be reported but cannot be directly measured or quantified. Nevertheless, a suite of biomarkers related to mechanisms, neural activity, and ...susceptibility offer the possibility—especially when used in combination—to produce objective pain-related indicators with the specificity and sensitivity required for diagnosis and for evaluation of risk of developing pain and of analgesic efficacy. Such composite biomarkers will also provide improved understanding of pain pathophysiology.
This Perspective highlights the significance of chronic pain, its underpinning biology, and the need for composite biomarker signatures alongside self-report. Combining evidence from animal and human research spanning genetics through to neuroimaging, Tracey et al. highlight a few key areas of promise.
The second meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (2005) regarding the outbreak of novel coronavirus 2019 in the People's ...Republic of China on January 30, 2020, declared COVID-19 outbreak as Public Health Emergency of International Concern (PHEIC)5. In the Emergency department in General Hospital, she was afebrile with a pulse rate of 82/min, blood pressure 130/80 mmHg, temperature 98.5°F and oxygen saturation 96 per cent while the patient was breathing ambient air. On day 1 of illness, the total white blood cell count was towards the low normal side, but on days 5 and 20, the count showed a rise which was consistent with a viral infection.
The worldwide detection of pharmaceuticals and personal care products (PPCPs) in the aquatic environment and drinking water has been a cause for concern in recent years. The possibility for ...concurrent formation of nitrosamine DBPs (disinfection by-products) during chloramine disinfection has become another significant concern for delivered drinking water quality because of their potent carcinogenicity. This study demonstrates that a group of PPCPs containing amine groups can serve as nitrosamine precursors during chloramine disinfection. Molar yields higher than 1% are observed for eight pharmaceuticals, with ranitidine showing the strongest potential to form N-nitrosodimethylamine (NDMA). The molar conversion increases with the Cl2:N mass ratio, suggesting that dichloramine is relevant to the formation of NDMA from these precursors. Although the trace level of PPCPs in the environment suggests that they may not account for the majority of nitrosamine precursors during the disinfection process, this study demonstrates a connection between the transformation of PPCPs and the formation of nitrosamines during chloramine disinfection. This both expands the pool of potential nitrosamine precursors, and provides a possible link between the presence of trace levels of certain PPCPs in drinking water sources and potential adverse health effects.
A growing body of research highlights the limitations of traditional methods for studying the process of change in psychotherapy. The science of complex systems offers a useful paradigm for studying ...patterns of psychopathology and the development of more functional patterns in psychotherapy. Some basic principles of change are presented from subdisciplines of complexity science that are particularly relevant to psychotherapy: dynamical systems theory, synergetics, and network theory. Two early warning signs of system transition that have been identified across sciences (critical fluctuations and critical slowing) are also described. The network destabilization and transition (NDT) model of therapeutic change is presented as a conceptual framework to import these principles to psychotherapy research and to suggest future research directions.
A complex systems approach has a number of implications for psychotherapy research. We describe important design considerations, targets for research, and analytic tools that can be used to conduct this type of research.
A complex systems approach to psychotherapy research is both viable and necessary to more fully capture the dynamics of human change processes. Research to date suggests that the process of change in psychotherapy can be nonlinear and that periods of increased variability and critical slowing might be early warning signals of transition in psychotherapy, as they are in other systems in nature. Psychotherapy research has been limited by small samples and infrequent assessment, but ambulatory and electronic methods now allow researchers to more fully realize the potential of concepts and methods from complexity science.
The purpose of this study was to examine the efficacy of cognitive behavioral therapy (CBT) for anxiety‐related disorders based on randomized placebo‐controlled trials. We included 41 studies that ...randomly assigned patients (N = 2,843) with acute stress disorder, generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD), panic disorder (PD), posttraumatic stress disorder (PTSD), or social anxiety disorder (SAD) to CBT or a psychological or pill placebo condition. Findings demonstrated moderate placebo‐controlled effects of CBT on target disorder symptoms (Hedges’ g = 0.56), and small to moderate effects on other anxiety symptoms (Hedges’ g = 0.38), depression (Hedges’ g = 0.31), and quality of life (Hedges’ g = 0.30). Response rates in CBT compared to placebo were associated with an odds ratio of 2.97. Effects on the target disorder were significantly stronger for completer samples than intent‐to‐treat samples, and for individuals compared to group CBT in SAD and PTSD studies. Large effect sizes were found for OCD, GAD, and acute stress disorder, and small to moderate effect sizes were found for PTSD, SAD, and PD. In PTSD studies, dropout rates were greater in CBT (29.0%) compared to placebo (17.2%), but no difference in dropout was found across other disorders. Interventions primarily using exposure strategies had larger effect sizes than those using cognitive or cognitive and behavioral techniques, though this difference did not reach significance. Findings demonstrate that CBT is a moderately efficacious treatment for anxiety disorders when compared to placebo. More effective treatments are especially needed for PTSD, SAD, and PD.
Disinfection by-product (DBP) formation may be a concern when applying ultraviolet light and free chlorine (UV/chlorine) as an advanced oxidation process (AOP) for drinking water treatment, due to ...typically large chlorine doses (e.g. 5–10mgL−1 as free chlorine). A potential mitigating factor is the low chlorine contact times for this AOP treatment (e.g. seconds). Full-scale and pilot-scale test results showed minimal trihalomethane (THM) and haloacetic acid (HAA) formation during UV/chlorine treatment, while dichloroacetonitrile (DCAN) and bromochloroacetonitrile (BCAN) were produced rapidly. Adsorbable organic halide (AOX) formation was significant when applying the UV/chlorine process in water that had not been previously chlorinated, while little additional formation was observed in prechlorinated water. Chlorine photolysis led to chlorate and bromate formation, equivalent to approximately 2–17% and 0.01–0.05% of the photolyzed chlorine, respectively. No perchlorate or chlorite formation was observed. During simulated secondary disinfection of AOP-treated water, DBP formation potential for THMs, HAAs, HANs, and AOX was observed to increase approximately to the same extent as was observed for pretreatment using the more common AOP of UV combined with hydrogen peroxide (UV/H2O2).
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•UV/chlorine leads to low organic DBP formation for a <1min reaction time.•HAN formation was fast, but overall concentration was below 6μg/L.•UV/chlorine increases 24h DBP formation potential to the same extent as UV/H2O2.•Chlorine photolysis leads to low bromate formation of less than 2μg/L.•Approximately 2–17% of photolyzed chlorine converts to chlorate.
To characterize the use of laser and incisional glaucoma surgeries among Medicare beneficiaries from 2008 through 2016 and to compare the use of these surgeries by glaucoma subspecialists versus ...nonsubspecialists.
Retrospective, observational analysis.
Medicare beneficiaries (n = 1 468 035) undergoing ≥1 laser or incisional glaucoma surgery procedure during 2008 through 2016.
Claims data from a 20% sample of enrollees in fee-for-service Medicare throughout the United States were analyzed to identify all laser and incisional glaucoma surgeries performed from 2008 through 2016. We assessed use of traditional incisional glaucoma surgery techniques (trabeculectomy and glaucoma drainage implant GDI procedure) and microinvasive glaucoma surgery (MIGS). Enrollee and procedure counts were multiplied by 5 to estimate use throughout all of Medicare. Linear regression was used to compare trends in use of glaucoma surgeries between ophthalmologists who could be characterized as glaucoma subspecialists versus nonsubspecialists.
Numbers of laser and incisional glaucoma surgeries performed overall and stratified by glaucoma subspecialist status.
The number of Medicare beneficiaries undergoing any glaucoma therapeutic procedure increased by 10.6%, from 218 375 in 2008 to 241 565 in 2016. The total number of traditional incisional glaucoma surgeries decreased by 11.7%, from 37 225 to 32 885 (P = 0.02). The total number of MIGS procedures increased by 426% from 13 705 in 2012 (the first year MIGS codes were available) to 58 345 in 2016 (P = 0.001). Throughout the study period, glaucoma subspecialists performed most of the trabeculectomies (76.7% in 2008, 83.1% in 2016) and GDI procedures (77.7% in 2008, 80.6% in 2016). Many MIGS procedures were performed by nonsubspecialists. The proportions of endocyclophotocoagulations, iStent (Glaukos; San Clemente, CA) insertions, goniotomies, and canaloplasties performed by glaucoma subspecialists in 2016 were 22.0%, 25.2%, 56.9%, and 62.8%, respectively.
From 2008 through 2016, a large shift in practice from traditional incisional glaucoma surgeries to MIGS procedures was observed. Although glaucoma subspecialists continue to perform most traditional incisional glaucoma surgeries, many MIGS procedures are performed by nonsubspecialists. These results highlight the importance of training residents in performing MIGS procedures and managing these patients perioperatively. Future studies should explore the impact of this shift in care on outcomes and costs.
Loss-of-function mutations in PINK1, which encodes a mitochondrially targeted serine/threonine kinase, result in an early-onset heritable form of Parkinson's disease. Previous work has shown that ...PINK1 is constitutively degraded in healthy cells, but selectively accumulates on the surface of depolarized mitochondria, thereby initiating their autophagic degradation. Although PINK1 is known to be a cleavage target of several mitochondrial proteases, whether these proteases account for the constitutive degradation of PINK1 in healthy mitochondria remains unclear. To explore the mechanism by which PINK1 is degraded, we performed a screen for mitochondrial proteases that influence PINK1 abundance in the fruit fly Drosophila melanogaster. We found that genetic perturbations targeting the matrix-localized protease Lon caused dramatic accumulation of processed PINK1 species in several mitochondrial compartments, including the matrix. Knockdown of Lon did not decrease mitochondrial membrane potential or trigger activation of the mitochondrial unfolded protein stress response (UPRmt), indicating that PINK1 accumulation in Lon-deficient animals is not a secondary consequence of mitochondrial depolarization or the UPRmt. Moreover, the influence of Lon on PINK1 abundance was highly specific, as Lon inactivation had little or no effect on the abundance of other mitochondrial proteins. Further studies indicated that the processed forms of PINK1 that accumulate upon Lon inactivation are capable of activating the PINK1-Parkin pathway in vivo. Our findings thus suggest that Lon plays an essential role in regulating the PINK1-Parkin pathway by promoting the degradation of PINK1 in the matrix of healthy mitochondria.
Disinfection by-products (DBPs) are formed when naturally occurring organic matter reacts with chlorine used in drinking water treatment, and DBPs formed in chlorinated drinking water samples have ...been shown to cause a genotoxic response. The objective of the current study was to further understand the principles of biofiltration and the resulting impacts on the formation of DBPs and genotoxicity. Pilot-scale systems were utilized to assess the performance of engineered biofilters enhanced with hydrogen peroxide, in-line coagulants, and nutrients when compared to passively operated biofilters and conventional treatment (coagulation, flocculation, sedimentation, non-biological filtration). Organic fractionation was completed using liquid chromatography-organic carbon detection (LC-OCD). Water samples were chlorinated after collection and examined for the removal of trihalomethane (THM), haloacetic acid (HAA), and adsorbable organic halide (AOX) precursors. Additionally, the formation potential of two halogenated furanones, 3-chloro-4(dichloromethyl)-2(5H)-furanone (MX) and mucochloric acid (MCA), and genotoxicity was determined. Biofiltration was shown to preferentially remove more DBP precursors than dissolved organic carbon (DOC). Formation potential of the unregulated DBPs, including MX and MCA, and genotoxic response was shown to be correlated to THM formation. These results infer that monitoring for THMs and HAAs provide insight to the formation of more mutagenic DBPs such as halogenated furanones, and that biofiltration may preferentially remove precursors to DBPs at a rate exceeding the removal of DOC.
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•Enhanced and passive biofilters were examined at two pilot plants in Ontario, Canada.•The average formation of THMs, HAAs, and AOX were correlated at each location.•The formation of MX and MCA was correlated to THM and HAA formation at each location.•The average genotoxicity was correlated to the average formation of THMs and HAAs.
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