Potential of electric bicycles to improve the health of people with Type 2 diabetes: a feasibility study.

AIM: To explore in a feasibility study whether 'e-cycling' was acceptable to, and could potentially improve the health of, people with Type 2 diabetes. METHODS: Twenty people with Type 2 diabetes were recruited and provided with an electric bicycle for 20 weeks. Participants completed a submaximal fitness test at baseline and follow-up to measure predicted maximal aerobic power, and semi-structured interviews were conducted to assess the acceptability of using an electric bicycle. Participants wore a heart rate monitor and a Global Positioning System (GPS) receiver in the first week of electric bicycle use to measure their heart-rate during e-cycling. RESULTS: Eighteen participants completed the study, cycling a median (interquartile range) of 21.4 (5.5-37.7) km per week. Predicted maximal aerobic power increased by 10.9%. Heart rate during electric bicycle journeys was 74.7% of maximum, compared with 64.3% of maximum when walking. Participants used the electric bicycles for commuting, shopping and recreation, and expressed how the electric bicycle helped them to overcome barriers to active travel/cycling, such as hills. Fourteen participants purchased an electric bicycle on study completion. CONCLUSIONS: There was evidence that e-cycling was acceptable, could increase fitness and elicited a heart rate that may lead to improvements in cardiometabolic risk factors in this population. Electric bicycles have potential as a health-improving intervention in people with Type 2 diabetes.

Inferring polydomy: a review of functional, spatial and genetic methods for identifying colony boundaries.

Identifying the boundaries of a social insect colony is vital for properly understanding its ecological function and evolution. Many species of ants are polydomous: colonies inhabit multiple, spatially separated, nests. Ascertaining which nests are parts of the same colony is an important consideration when studying polydomous populations. In this paper, we review the methods that are used to identify which nests are parts of the same polydomous colony and to determine the boundaries of colonies. Specifically, we define and discuss three broad categories of approach: identifying nests sharing resources, identifying nests sharing space, and identifying nests sharing genes. For each of these approaches, we review the theoretical basis, the limitations of the approach and the methods that can be used to implement it. We argue that all three broad approaches have merits and weaknesses, and provide a methodological comparison to help researchers select the tool appropriate for the biological question they are investigating.

The form of sexual selection arising from male-male competition depends on the presence of females in the social environment.

Sexual selection arises from social interactions, and if social environments vary so too should sexual selection. For example, male-male competition often occurs either in the presence or in the absence of females, and such changes in the social environment could affect the form and strength of sexual selection. Here we examine how the presence of a female influences selection arising from male-male competition in a leaf-footed cactus bug, Narnia femorata, which has a resource defence mating system. Males compete for territories on cacti because females lay eggs on the cactus plants. Females are not always present when this competition first occurs; however, the presence or absence of the female matters. We found that both the form and strength of selection on male traits, those traits that influenced success in intrasexual competition, depended on the social context. When a female was not present, male size and the area of the sexually dimorphic hind legs was only marginally important to winning a contest. However, males with larger overall size and leg area were more likely to win in the presence of a female. There was also positive quadratic selection on these traits when a female was present with both the largest and the smallest males winning. The implication is unexpected alternative strategies when females are present. Our results support the notion that sexual selection should be studied under all relevant social contexts.

An exploratory randomized controlled trial comparing telephone and hospital follow-up after treatment for colorectal cancer.

AIM: Following treatment for colorectal cancer it is common practice for patients to attend hospital clinics at regular intervals for routine monitoring, although debate persists on the benefits of this approach. Nurse-led telephone follow-up is effective in meeting information and psycho-social needs in other patient groups. We explored the potential benefits of nurse-led telephone follow-up for colorectal cancer patients. METHOD: Sixty-five patients were randomized to either telephone or hospital follow-up in an exploratory randomized trial. RESULTS: The telephone intervention was deliverable in clinical practice and acceptable to patients and health professionals. Seventy-five per cent of eligible patients agreed to randomization. High levels of satisfaction were evident in both study groups. Appointments in the hospital group were shorter (median 14.0 min, range 2.3-58.0) than appointments in the telephone group (median 28.9 min, range 6.1-48.3). Patients in the telephone arm were more likely to raise concerns during consultations. CONCLUSION: Historical approaches to follow-up unsupported by evidence of effectiveness and efficiency are not sustainable. Telephone follow-up by specialist nurses may be a feasible option. A main trial comparing hospital and telephone follow-up is justified, although consideration needs to be given to trial design and practical issues related to the availability of specialist nurses at study locations.

Colorectal cancer follow-up: patient satisfaction and amenability to telephone after care.

PURPOSE: To explore patient satisfaction on different aspects of follow-up service provision following treatment for colorectal cancer and amenability to an alternative strategy for follow-up care. METHODS AND SAMPLE: A postal survey was administered to 297 eligible patients who had been treated for colorectal cancer at a large hospital in the North West of England. Patients were asked to indicate responses to questions comprising likert scales, including views on organisation of care, information and advice, personal experience of care, satisfaction with information and care, views on specialist nursing services and amenability to telephone follow-up. KEY RESULTS: One hundred and eighty-seven completed surveys were returned (62.97% response rate). Analysis of scale data indicated high levels of satisfaction on all outcome measures but sub-optimal rates of satisfaction on some items. Respondents indicated high levels of satisfaction with information related to disease and treatment but lower levels of satisfaction for items related to genetic risk, sexual attractiveness and self care. Colorectal nurse specialists were highly rated, especially in terms of information provision and personal experience of care. Patients were generally amenable to telephone follow-up, although male patients indicated higher levels of willingness to accept this approach than females. CONCLUSIONS: Satisfaction with traditional medical based follow-up is generally high in this patient cohort but there is room for improvement in terms of service delivery. High levels of satisfaction with the care delivered by colorectal nurse specialists and patient acceptance of telephone follow-up suggests nurse-led telephone follow-up is a viable alternative to traditional hospital based follow-up.

Samarium(II)-mediated 4-exo-trig cyclization. A stereocontrolled approach to the core of pestalotiopsin A.

[reaction: see text] Pestalotiopsin A is a structurally unique caryophyllene-type sesquiterpene which has shown immunosuppressive activity and cytotoxicity in preliminary assays. A stereocontrolled approach to the functionalized 2-oxabicyclo[3.2.0]heptane core of pestalotiopsin A is described. The approach includes a samarium(II)-mediated 4-exo-trig cyclization and a trans-lactonization process triggered by the addition of alkylytterbium reagents to a cyclobutanone intermediate.

Sequential oesophago-bronchoscopy.

Combined sequential oesophago-bronchoscopy with the same fibre-optic instrument is described, and complete safety of this procedure emphasised. It has the great advantage of reducing hospitalisation time for the patients, usually avoiding general anaesthesia, and considerably reducing costs, without prejudicing the patient's safety and interests.

A new oesophageal dilator.

A new and safe oesophageal dilator, which eliminates most of the risks of known dilators, is described. The technique for its use is also described. A brief comparison with other dilators is made, and the satisfactory results of the new dilator are indicated.

Global Overview of the Functional Roles of Soil-living Nematodes in Terrestrial Communities and Ecosystems.

The role of soil-living nematodes in different ecosystems can be largely predicted by the intensity of nonbiotic stresses imposed by different temperature and moisture regimes. Assuming that tropical lowland rain forest experiences the most biologically equitable climate, increasing climate-related stress occurs as one proceeds through intervening biomes to low latitude lowland desert, high latitude desert, and alpine desert. Soil nematodes, being mostly relative generalists, show only moderate diversity and low densities in tropical lowland rain forests because of competition from many other more specialized organisms. On the other hand, nematode diversity and densities increase and remain relatively high as one proceeds to the most extreme ecosystems because nematodes show greater adaptability than do many other taxa to climate-induced stress. However, cold allows nematodes greater "ecological release" than does drought because nematodes, being essentially aquatic organisms, require moisture for activity. Thus, cold ecosystems have the greatest nematode diversities and densities.

Bile exclusion from the duodenum. Its effect on gastric and pancreatic function in the dog.

The effect of diverting bile from the duodenum in four dogs with cholecystojejunostomy was studied using a double-marker perfusion technique. After the diversion procedure, a liquid meal increased acid secretion from 0.8 mmol H+/min to 1.48 mmol H+/min (P less than 0.05, paired t test); there was an associated rise in serum levels of gastrin 120 min after feeding (P less than 0.001, paired t test). Pancreatic secretion of trypsin decreased from 3.91 IU/min to 2.66 IU/min after bile diversion (P less than 0.01, paired t test), and the level of CCK was significantly lower 60 min after feeding (P less than 0.05, paired t test). There was no significant change in the rate of gastric emptying after bile diversion, but the pH of duodenal contents was lower in the later stages of digestion. These changes may explain the reported increase of peptic ulcer after diverting bile from the duodenum, and the procedure should not be considered unless the consequences of acid hypersecretion and pancreatic inhibition have been anticipated.

Population growth and intrinsic rate of natural increase of the high arctic nematode Chiloplacus sp. at low and high temperatures.

Population growth of the High Arctic free-living soil nematode Chiloplacus sp. was measured at 0°, 2°, 5°, 10°, 15°, 20° and 25° C. The corresponding values of the intrinsic rate of natural increase, r, were 0, 0.0178, 0.0605, 0.0823, 0.1216, 0.1384 and 0.2131 respectively. The relation of r to temperature is described by the function r=0.0088+0.0075T. Chiloplacus sp. grows and reproduces at lower temperatures than do many other nematodes, and has shorter generation times at comparable low temperatures, suggesting rate compensation to low temperature.

Form of the individual growth curve and developmental rate of the high arctic nematode Chiloplacus sp.

The growth of Chiloplacus sp. at 10 degrees C is described by the logistic equation: (formula: see text) where W is dry weight in micrograms, 0.5085 is the asymptote in micrograms dry weight, 0.1725 is a constant which is proportional to over-all growth rate, t is time in days from hatching, and 23.7 is time in days from hatching to the point of inflection of growth curve. The point of inflection is at approximately 47% of the asymptote. Mean dry weight of newly laid eggs was 0.0092 micrograms, hatching weight was 0.0084 micrograms, and maximum adult weight was 0.5260 micrograms. The first eggs were laid 26 %/- 2 days after hatching by individuals weighing 0.3 micrograms. The first offspring hatched 38 +/- 2 days after their parents hatched. The growth curve of Chiloplacus sp. resembled the sigmoidal curves obtained by Ricklefs for many small birds, and was "intermediate" in terms of von Bertalanffy's metabolic/growth types. The growth of probable K strategists like the large, slow growing dorylaimids is probably best described by the von Bertalanffy growth equation (von Bertalanffy's "first" metabolic growth type). Extreme r strategists, including the small, rapidly growing rhabditids, probably tend towards exponential growth curves (von Bertalanffy's "second" metabolic/growth type). The growth rate and time of sexual maturity of Chiloplacus sp., like the growth curve, appeared "intermediate" compared with other nematodes.

Cost-sharing and prior authorization effects on Medicaid services in California: Part II: The providers' reactions.

Providers for California's Medical program were interviewed to determine their reaction to the copayment experiment. Private physicians, pharmacists, and nursing homes routinely collected the copayments and though it was not a particular hardship on the patients. Hospital outpatient departments often did not collect. Physicians both in hospitals and in private practice generally did not know which patients were copayers and hence copayment had no effect on their practice. Pharmacists reported some delay and some selectivity on the part of patients in the filling of their prescriptions. All providers felt as much more harassment and interference from the concurrent prior authorization requirements. This effect may have swamped copayment effects.

Cost-sharing and prior authorization effects on Medicaid services in California: part I. The beneficiaries' reactions.

In January 1972, California initiated a cost-sharing "experiment" as a means of containing rising costs of the Medicaid program. Beneficiaries who had some personal assets were required to pay a token amount for each doctor visit or prescription. This was expected to deter unnecessary services without affecting really needed care. An interview survey was made of beneficiaries continuously in copayment status throughout the 18 months of the experiment. Most beneficiaries had poor knowledge of the program, and tended to confuse copayment with the concurrent constraint of prior authorization for certain classes of service. The beneficiaries reported that the copayment was almost always collected, and most thought it had not affected their health care, but a significant 17 per cent throught it had reduced the care available to them, and these 17 per cent were for the most part in households with high medical need.