Sugar-sweetened beverage consumption and height loss in adults: a longitudinal analysis in the EPIC-Norfolk study.

BACKGROUND: Height loss in ageing has been recognized to reflect a decline in musculoskeletal health but not investigated in relation to dietary factors, such as sugar-sweetened beverages (SSBs), which consumption may deteriorate musculoskeletal health. OBJECTIVE: To evaluate the longitudinal association of habitual consumption of total SSBs and its subtypes with height loss and examine effect-modification by age, sex and anthropometry. METHODS: We evaluated 16,230 adults aged 40-79 years in the European Prospective Investigation into Cancer and Nutrition-Norfolk cohort. At baseline (1993-1997), SSB consumption (soft drinks, squashes, sweetened milk beverages, sweetened coffee/tea, sweetened alcoholic beverages) was assessed using 7-day food diaries. Height was objectively measured at the baseline, second (1997-2000), and third (2004-2011) health checks. Multivariable linear regression was used to relate baseline SSB consumption to the rate of height change over the follow-up. RESULTS: The median (IQR) height change was -1.07 (-2.09, -0.28) cm/10 years. Adjusted for potential confounders including behavioral factors, medications, and baseline body mass index (BMI), total SSB consumption was associated with height loss (ß=-0.024 cm/10 years per 250 grams/day of SSB [95% confidence interval: -0.046, -0.001]), and similar results were seen for the individual beverages, except for sweetened milk beverages (ß=+0.07 [-0.16, 0.30]), with wide confidence intervals. No effect-modification by pre-specified factors was evident, except for baseline BMI (pinteraction=0.037). Total SSB consumption was associated with height loss (-0.038 [-0.073, -0.004]) in participants with BMI≤25 kg/m2 but not apparently in those with BMI over 25 kg/m2. CONCLUSIONS: SSB consumption was modestly associated with height loss, particularly in adults with normal weight status.

Global seroprevalence and prevalence of infection of influenza in dogs (Canis familiaris): A systematic review and meta-analysis.

Influenza in dogs holds considerable public health significance due to their close companionship with humans, yet several facets of this phenomenon remain largely unexplored. This study undertook a systematic review and meta-analysis of observational studies to gauge the global seroprevalence of influenza in dogs. We also assessed whether pet dogs exhibited a higher seroprevalence of influenza compared to non-pet dogs, explored seasonal variations in seroprevalence, scrutinised the design and reporting standards of existing studies, and elucidated the geographical distribution of canine influenza virus (cIV). A comprehensive analysis of 97 studies spanning 27 countries revealed that seroprevalence of various influenza strains in dogs consistently registered below 10% and exhibited relative stability over the past decade. Significantly, we noted that seroprevalence of human influenza virus was notably higher in pet dogs compared to their non-pet counterparts, whereas seroprevalence of other influenza strains remained relatively uniform among both categories of dogs. Seasonal variations in seroprevalence of cIV were not observed. In summary, our findings indicated the global circulation of cIV strains H3N2 and H3N8, with other strains primarily confined to China. Given the lack of reported cases of the transmission of cIV from dogs to humans, our findings suggest a higher risk of reverse zoonosis than zoonosis. Finally, we strongly advocate for standardised reporting guidelines to underpin future canine influenza research endeavours.

The burden of costs on health services from patients with venous leg ulcers in Singapore.

Healthcare costs arising from venous leg ulcers (VLU) are expected to increase due to an aging population and increased prevalence of comorbidities. We aim to estimate the healthcare resources incurred by VLU patients, and to quantify the extent to which predictors explain variation in cost-related outcomes. Retrospective patient-level cohort data for VLU patients were analysed using generalised linear regression models. Data were extracted from a tertiary hospital registry in Singapore, between 2013 and 2017. The outcome variables were length of stay per admission; inpatient and outpatient bill per admission; whether a patient underwent a surgical treatment of the venous system; and, whether they visited the emergency department. Cost outcomes were reported in Singapore dollars (S$). A total of 162 VLU patients were included with a mean age of 67.5 (±14.4). For the inpatient setting the mean length of stay was 8.1 days and the mean inpatient bill was S$7886. For outpatients, the mean number of dressings was 29.4, and mean outpatient bill was S$6962. Heart disease patients incurred longer hospital stays and larger inpatient bills per admission and females had greater odds of undergoing a surgical procedure on the venous system. Certain VLU patient groups were found to be associated with larger cost outcomes.

Effects of Initial Morphology on Growth Kinetics of Cu6Sn5 at SAC305/Cu Interface during Isothermal Aging.

Solder/Cu joints are important components responsible for interconnection in microelectronics. Construction of the solder/Cu joints through liquid/solid (L/S) reactions accompanies the formation of the Cu-Sn intermetallic compounds (IMCs) at the joint interface. The Cu6Sn5 IMC exhibits remarkable distinctions in thickness and morphology upon increasing the L/S reaction time. Effects of the initial characteristics of thickness and morphology on the growth kinetics of Cu6Sn5 during subsequent isothermal aging were investigated. SAC305 solder was reflowed on a Cu electroplated layer at 265 °C for 1 to 60 min to produce the Cu6Sn5 IMC with different thickness and morphology at the SAC305/Cu interface. The as-fabricated SAC305/Cu joint samples were aged at 200 °C for 72 to 360 h to investigate the growth kinetics of Cu6Sn5. The results show that the initial characteristics of thickness and morphology significantly influenced the growth kinetics of Cu6Sn5 during the subsequent solid/solid (S/S) reaction. A prolonged L/S reaction time of 60 min (L/S-60) produced a scallop-type Cu6Sn5 IMC with a larger grain size and a thicker thickness, which reduced the quantity of fast diffusion path (grain boundary) and the magnitude of concentration gradient, thus slowing down the growth rate of Cu6Sn5. According to the growth kinetics analysis, the growth rate constant of Cu6Sn5 could be remarkably reduced to 0.151 µm/h0.5 for the L/S-60 sample, representing a significant reduction of 70 % compared to that of the L/S-1 sample (0.508 µm/h0.5 for L/S reaction time of 1 min).

Major limb amputation and mortality in patients with neuro-ischaemic lower extremity wounds managed in a tertiary hospital: Focus on the differences among patients with diabetes, peripheral arterial disease and both.

A majority of lower extremities neuro-ischaemic wounds (NIU) are related to: (a) only diabetes (DM); (b) only peripheral artery disease (PAD); (c) co-existing diabetes and peripheral artery disease (DM-PAD). This study aims to characterise the major clinical outcomes of forementioned three groups of lower extremity wound patients in Singapore. Patients hospitalised for lower extremity NIU between January 2014 and October 2017 in a tertiary hospital in Singapore were analysed. Patients' major limb amputation and mortality were assessed using Cox regression models. Cumulative survival and amputation-free survival among the three classified groups were calculated using Kaplan-Meier analysis. Compared with patients with only DM, those in the PAD group and the DM-PAD group had higher risk of major limb amputation (adjusted hazard ratio: 2.47, 95% CI: 1.65-3.70; adjusted hazard ratio: 2.01, 95% CI: 1.53-2.65 respectively) and mortality (adjusted hazard ratio: 2.36, 95% CI: 1.57-3.55; adjusted hazard ratio: 2.46, 95% CI: 1.86-3.26 respectively). The 3-year survival and amputation-free survival were lowest in the DM-PAD group (52.1% and 41.5% respectively), followed by the PAD group (53.3% and 44.6% respectively) and the DM group (74.2% and 68.5% respectively). Lower extremity NIU patients with PAD or DM-PAD were found to have poorer clinical prognosis than those with DM only.

Ultrasound needle segmentation and trajectory prediction using excitation network.

PURPOSE: Ultrasound (US)-guided percutaneous kidney biopsy is a challenge for interventionists as US artefacts prevent accurate viewing of the biopsy needle tip. Automatic needle tracking and trajectory prediction can increase operator confidence in performing biopsies, reduce procedure time, minimize the risk of inadvertent biopsy bleedings, and enable future image-guided robotic procedures. METHODS: In this paper, we propose a tracking-by-segmentation model with spatial and channel "Squeeze and Excitation" (scSE) for US needle detection and trajectory prediction. We adopt a light deep learning architecture (e.g. LinkNet) as our segmentation baseline network and integrate the scSE module to learn spatial information for better prediction. The proposed model is trained with the US images of anonymized kidney biopsy clips from 8 patients. The contour is obtained using the border-following algorithm and area calculated using Green formula. Trajectory prediction is made by extrapolating from the smallest bounding box that can capture the contour. RESULTS: We train and test our model on a total of 996 images extracted from 102 short videos at a rate of 3 frames per second from each video. A set of 794 images is used for training and 202 images for testing. Our model has achieved IOU of 41.01%, dice accuracy of 56.65%, F1-score of 36.61%, and root-mean-square angle error of 13.3[Formula: see text]. We are thus able to predict and extrapolate the trajectory of the biopsy needle with decent accuracy for interventionists to better perform biopsies. CONCLUSION: Our novel model combining LinkNet and scSE shows a promising result for kidney biopsy application, which implies potential to other similar ultrasound-guided biopsies that require needle tracking and trajectory prediction.

Using Adherence-Contingent Rebates on Chronic Disease Treatment Costs to Promote Medication Adherence: Results from a Randomized Controlled Trial.

BACKGROUND: Poor adherence to medications is a global public health concern with substantial health and cost implications, especially for chronic conditions. In the USA, poor adherence is estimated to cause 125,000 deaths and cost $US100 billion annually. The most successful adherence-promoting strategies that have been identified so far have moderate effect, are relatively costly, and raise availability, feasibility, and/or scalability issues. OBJECTIVE: The main objective of SIGMA (Study on Incentives for Glaucoma Medication Adherence) was to measure the effectiveness on medication adherence of a novel incentive strategy based on behavioral economics that we refer to as adherence-contingent rebates. These rebates offered patients a near-term benefit while leveraging loss aversion and regret and increasing the salience of adherence. METHODS: SIGMA is a 6-month randomized, controlled, open-label, single-center superiority trial with two parallel arms. A total of 100 non-adherent glaucoma patients from the Singapore National Eye Centre were randomized into intervention (adherence-contingent rebates) and usual care (no rebates) arms in a 1:1 ratio. The primary outcome was the mean change from baseline in percentage of adherent days at Month 6. The trial registration number is NCT02271269 and a detailed study protocol has been published elsewhere. FINDINGS: We found that participants who were offered adherence-contingent rebates were adherent to all their medications on 73.1% of the days after 6 months, which is 12.2 percentage points (p = 0.027) higher than in those not receiving the rebates after controlling for baseline differences. This better behavioral outcome was achieved by rebates averaging 8.07 Singapore dollars ($US5.94 as of 2 November 2017) per month during the intervention period. CONCLUSION: This study shows that simultaneously leveraging several insights from behavioral economics can significantly improve medication adherence rates. The relatively low cost of the rebates and significant health and cost implications of medication non-adherence suggest that this strategy has the potential to cost-effectively improve health outcomes for many conditions.

Study on Incentives for Glaucoma Medication Adherence (SIGMA): study protocol for a randomized controlled trial to increase glaucoma medication adherence using value pricing.

BACKGROUND: Many glaucoma patients do not adhere to their medication regimens because they fail to internalize the (health) costs of non-adherence, which may not occur until years or decades later. Behavioural economic theory suggests that adherence rates can be improved by offering patients a near-term benefit. Our proposed strategy is to offer adherence-contingent rebates on medication and check-up costs. This form of value pricing (VP) ensures that rebates are granted only to those most likely to benefit. Moreover, by leveraging loss aversion, rebates are expected to generate a stronger behavioural response than equivalent financial rewards. METHODS/DESIGN: The main objective of the Study on Incentives for Glaucoma Medication Adherence (SIGMA) is to test the VP approach relative to usual care (UC) in improving medication adherence. SIGMA is a randomized, controlled, open-label, single-centre superiority trial with two parallel arms. A total of 100 non-adherent (Morisky Medication Adherence Scale ≤6) glaucoma patients from the Singapore National Eye Centre are block-randomized (blocking factor: single versus multiple medications users) into the VP and UC arms in a 1:1 ratio. The treatment received by VP patients will be strictly identical to that received by UC patients, with the only exception being that VP patients can earn either a 50 % or 25 % rebate on their glaucoma-related healthcare costs conditional on being adherent on at least 90 % or 75 % of days as measured by a medication event monitoring system. Masking the arm allocation will be precluded by the behavioural nature of the intervention but blocking size will not be disclosed to protect concealment. The primary outcome is the mean change from baseline in percentage of adherent days at month 6. A day will be counted as adherent when the patients take all their medication(s) within the appropriate dosing windows. DISCUSSION: This trial will provide evidence on whether adherence-contingent rebates can improve medication adherence among non-adherent glaucoma patients, and more generally whether this approach represents a promising strategy to cost-effectively improve chronic disease management. TRIAL REGISTRATION: NCT02271269 . Registered on 19 October 2014.

Interdigitated electrodes based on impedance biosensor for sensing peptide LL-37.

An antimicrobial peptide, LL-37, is found in an innate defense system of humans. Patients who suffer urinary tract infection (UTI) will generate LL-37 and which is released into urine. LL-37 can be used as an indicator for the diagnosis of UTI. We have designed a biosensor with an interdigitated electrode on a printed-circuit board (PCB). The surface of the electrode was modified with 3-mercaptopropionic acid and immobilized with anti-LL37 antibody to improve the specificity of the biosensor. By de-embedding jig impedance, the impedance associated with the change of LL-37 concentration was calculated. The sensitivity of this biosensor for LL-37 in a urine sample can reach 50 µg/mL.