Electronic health (eHealth) interventions for weight management among racial/ethnic minority adults: a systematic review.

Electronic health (eHealth) interventions have demonstrated efficacy for weight management. However, little is known about their efficacy among racial/ethnic minority populations, in whom there is a disproportionate prevalence of obesity. This systematic review evaluated the efficacy of eHealth weight management interventions among overweight and obese racial/ethnic minority adults. We required that trial samples be comprised of at least 50% racial/ethnic minorities or report outcomes by race/ethnicity. We searched five electronic databases for trials conducted through June 2012. Six papers met our eligibility criteria. These studies provide suggestive evidence that eHealth interventions can produce low magnitude, short-term weight loss among racial/ethnic minorities. Trials were methodologically sound, with high retention and participant engagement. There was no evidence detailing the efficacy of mobile health approaches, although this area is promising given high utilization rates of mobile devices among racial/ethnic minorities. More evidence, particularly from longer-term trials, is necessary to demonstrate that eHealth intervention approaches can produce clinically meaningful (≥ 5% of initial body weight) weight loss among racial/ethnic minority populations.

Implementing the national invasive cervical cancer audit: a local perspective.

OBJECTIVE: To monitor the effectiveness of the cervical screening programme and identify suboptimal management in order to improve patient care. DESIGN: Retrospective study. SETTING: A university hospital serving a population of 1 million people. POPULATION: All women diagnosed with a cervical cancer between 2003 and 2006. METHODS: Analysis of data from invasive cervical cancer reviews. MAIN OUTCOME MEASURE: Categorisation of cervical cancer cases according to the Invasive Cervical Cancer Audit classification. RESULTS: Eighty-seven women were diagnosed with cervical cancer during the 3-year study period. The 'lapsed attender' group accounted for the greatest number of cases (30%), followed by screen detected (26%), interval cancers (13%), never attended (12%), lost to follow-up (10%) and never invited (9%). Women who had never attended for cytology presented with higher stage disease, stage-II or above, compared with the screen-detected cases: 60% were stage II or above, compared with 13.0%, Chi-square P = 0.018. The most frequently identified screening programme problem was patient compliance, which was determined to be the principle contributing factor in 39 cases (45%) and a secondary factor in a further ten cases. CONCLUSIONS: The categorisation of cervical cancer cases has the potential of yielding invaluable information for improving programme effectiveness. Patient compliance is the greatest challenge to the screening programme, and the need for regular screening and adherence to follow-up regimens needs to be reinforced in order to maximise the efficacy of the national screening programme.

Implementing the national invasive cervical cancer audit: correlation between local and regional classification.

OBJECTIVE: To determine the accuracy of information recorded regionally and locally on the screening classification of cervical cancer cases using the national invasive cervical cancer audit categories. METHODS: Comparison of the audit categorization of all cervical cancer cases diagnosed at the University Hospital of North Staffordshire (UHNS) between January 2003 and December 2006 with the classification assigned by the West Midlands Cervical Screening Quality Assurance Reference Centre (WMQARC). RESULTS: Eighty-seven cases of cervical cancer were diagnosed during the three-year study period. There was agreement between the UHNS and WMQARC classification of cases in 52 cases (59.7%), moderate agreement κ = 0.51 (95% CI 0.39-0.63). The greatest disparity was seen in the classification of lapsed attenders, with nine of the 26 cases categorized as 'lapsed' by the UHNS being assigned to the 'lost to follow-up' category by WMQARC. Three cases were deemed unclassifiable by WMQARC using the national classification since the women were over the age of 70 years but had previously been enrolled in the screening programme, and currently there is no national category for these women. CONCLUSIONS: Accurate and consistent classification of invasive cervical cancer cases is essential in order to obtain useful information on the efficiency of the national screening programme at a local, regional and national level. The use of a national algorithm would provide reassurance that all data used in the national evaluation of the NHS Cervical Screening Programme are consistent, meaning that robust conclusions could then be drawn from the data.

Total selenium and selenomethionine in pharmaceutical yeast tablets: assessment of the state of the art of measurement capabilities through international intercomparison CCQM-P86.

Results of an international intercomparison study (CCQM-P86) to assess the analytical capabilities of national metrology institutes (NMIs) and selected expert laboratories worldwide to accurately quantitate the mass fraction of selenomethionine (SeMet) and total Se in pharmaceutical tablets of selenised-yeast supplements (produced by Pharma Nord, Denmark) are presented. The study, jointly coordinated by LGC Ltd., UK, and the Institute for National Measurement Standards, National Research Council of Canada (NRCC), was conducted under the auspices of the Comité Consultatif pour la Quantité de Matière (CCQM) Inorganic Analysis Working Group and involved 15 laboratories (from 12 countries), of which ten were NMIs. Apart from a protocol for determination of moisture content and the provision of the certified reference material (CRM) SELM-1 to be used as the quality control sample, no sample preparation/extraction method was prescribed. A variety of approaches was thus used, including single-step and multiple-step enzymatic hydrolysis, enzymatic probe sonication and hydrolysis with methanesulfonic acid for SeMet, as well as microwave-assisted acid digestion and enzymatic probe sonication for total Se. For total Se, detection techniques included inductively coupled plasma (ICP) mass spectrometry (MS) with external calibration, standard additions or isotope dilution MS (IDMS), inductively coupled plasma optical emission spectrometry , flame atomic absorption spectrometry and instrumental neutron activation analysis. For determination of SeMet in the tablets, five NMIs and three academic/institute laboratories (of a total of five) relied upon measurements using IDMS. For species-specific IDMS measurements, an isotopically enriched standard of SeMet (76Se-enriched SeMet) was made available. A novel aspect of this study relies on the approach used to distinguish any errors which arise during analysis of a SeMet calibration solution from those which occur during analysis of the matrix. To help those participants undertaking SeMet analysis to do this, a blind sample in the form of a standard solution of natural abundance SeMet in 0.1 M HCl (with an expected value of 956 mg kg(-1) SeMet) was provided. Both high-performance liquid chromatography (HPLC)-ICP-MS or gas chromatography (GC)-ICP-MS and GC-MS techniques were used for quantitation of SeMet. Several advances in analytical methods for determination of SeMet were identified, including the combined use of double IDMS with HPLC-ICP-MS following extraction with methanesulfonic acid and simplified two-step enzymatic hydrolysis with protease/lipase/driselase followed by HPLC-ICP-IDMS, both using a species-specific IDMS approach. Overall, satisfactory agreement amongst participants was achieved; results averaged 337.6 mg kg(-1) (n = 13, with a standard deviation of 9.7 mg kg(-1)) and 561.5 mg kg(-1) (n = 11, with a standard deviation of 44.3 mg kg(-1)) with median values of 337.6 and 575.0 mg kg(-1) for total Se and SeMet, respectively. Recovery of SeMet from SELM-1 averaged 95.0% (n = 9). The ability of NMIs and expert laboratories worldwide to deliver accurate results for total Se and SeMet in such materials (selensied-yeast tablets containing approximately 300 mg kg(-1) Se) with 10% expanded uncertainty was demonstrated. The problems addressed in achieving accurate quantitation of SeMet in this product are representative of those encountered with a wide range of organometallic species in a number of common matrices.

Spectroscopic analysis of changes in remitted illumination: the response to increased neural activity in brain.

Imaging of neural activation has been used to produce maps of functional architecture and metabolic activity. There is some uncertainty associated with the sources underlying the intrinsic signals. It has been reported that following increased neural activity there was little increased oxygen consumption ( approximately 5%), although glucose consumption increased by approximately 50%. The research we describe uses a modification of the Beer-Lambert Law called path-length scaling analysis (PLSA) to analyze the spectra of the hemodynamic and metabolic responses to vibrissal stimulation in rat somatosensory cortex. The results of the PLSA algorithm were compared with those obtained using a linear spectrographic analysis method (we refer to this as LMCA). There are differences in the results of the analysis depending on which of the two algorithms (PLSA or LMCA) is used. Using the LMCA algorithm, we obtain results showing an increase in the volume of Hbr at approximately 2 s, following onset of stimulation but no complementary decrease in oxygenated haemoglobin (HbO(2)). These results are similar to a previous report. In contrast, after using the PLSA algorithm, the time series of the chromophore changes shows no evidence for an increase in the volume of deoxygenated haemoglobin (Hbr). However, after further analysis of the time series from the PLSA using general linear models (GLM) to remove contributions from low frequency baseline oscillations, both the HbO(2) and Hbr times series of the response to stimulation were found to be biphasic with an early decrease in saturation peaking approximately 1 s after onset of stimulation followed by a larger increase in saturation peaking at approximately 3 s. Finally, following the PLSA-then-GLM analysis procedure, we do not find convincing evidence for an increase in cytochrome oxidation following stimulation, though we demonstrate the PLSA algorithm to be capable of disassociating changes in cytochrome oxidation state from changes in hemoglobin oxygenation.

An evaluation of linear model analysis techniques for processing images of microcirculation activity.

Sequences of images of the cortical surface can be processed to reveal information about the cortical microcirculation, regional cerebral blood flow (rCBF), and changes induced by neuronal activity. This study examined the use of different analysis methodologies on intrinsic optical images taken from rat sensory motor cortex and testes. Generalized linear model (GLM) analysis was used and compared with standard signal processing methods including principal component analysis. The GLM method has been used by Friston et al. (1994, Hum. Brain Map., 1: 214-220) in the analysis of functional magnetic resonance imagery to identify regions of focal activity. We investigated the use of this method to analyze video image data of the modulation of rCBF from rat cortex. The results revealed spatiotemporal variations in rCBF in response to stimulation within local regions of cortex. The advantage of the GLM method is that it augments ordinary signal processing methods with an estimate of statistical reliability. The use of different wavelengths of illumination reveals spatial structures with different temporal relationships. In image time series data collected under green and red illumination a phase difference was found in the low frequency approximately 0.1 Hz vasomotion oscillation. This phase difference occurred in data from both cortex and testes. A possible explanation of these differences is that the spectral absorption characteristics of the tissue reflect changes in the volume proportions of the different hemoglobin derivatives in interacting with the modulation of the volume of blood. It is suggested that the combination of these effects produces the phase differences we detect.

Cerebral vasomotion: a 0.1-Hz oscillation in reflected light imaging of neural activity.

Imaging of scattered and reflected light from the surface of neural structures can reveal the functional architecture within large populations of neurons. These techniques exploit, as one of the principal signal sources, reflectance changes produced by local variation in blood volume and oxygen saturation related to neural activity. We found that a major source of variability in the captured light signal is a pervasive low-frequency (0.1-Hz) oscillation which apparently results from regional cerebral blood flow. This signal is present in brain parenchyma as well as the microvasculature and exhibits many characteristics of the low-frequency "vasomotion" signals observed in peripheral microcirculation. Concurrent measurements in brain with a laser Doppler flow meter contained an almost identical low-frequency signal. The presence of the 0.1-Hz oscillation in the cerebral microcirculation could underlie a portion of the previously described characteristics reported in reflected-light imaging studies. The prevalence of the oscillatory phenomena in the brain raises substantial temporal sampling issues for optical imaging and for other visualization techniques which depend on changes in regional cerebral blood dynamics, such as functional magnetic resonance imaging.

Chemical mechanisms underlying the vasodilator and platelet anti-aggregating properties of S-nitroso-N-acetyl-DL-penicillamine and S-nitrosoglutathione.

The chemistries of S-nitroso-DL-penicillamine (SNAP) and S-nitrosoglutathione (GSNO) in relation to their ability to relax vascular smooth muscle and prevent platelet aggregation have been investigated. Metal ion catalysis greatly accelerates the decomposition of SNAP, but has little effect on GSNO. Instead, NO release from GSNO is effected either by NO transfer to a free thiol (e.g. cysteine), or by enzymatic cleavage of the glutamyl-cystyl peptide bond. In both cases the resulting nitrosothiol (i.e. S-nitrosocysteine and S-nitrosocystylglycine, respectively) is susceptible to metal ion catalysed NO release. We conclude that transnitrosation or enzymatic cleavage are obligatory steps in the mechanism of NO release from GSNO, whereas SNAP needs only the presence of metal ions to effect this process. The different modes of NO production may go some way towards explaining the different physiological effectiveness of these S-nitrosothiols as vasodilators and inhibitors of platelet aggregation.

Comparative pharmacology of analogues of S-nitroso-N-acetyl-DL-penicillamine on human platelets.

1. The effects of two new analogues of S-nitroso-N-acetyl-DL-penicillamine (SNAP), S-nitroso-N-formyl-DL-penicillamine (SNFP) and S-nitroso-DL-penicillamine (SNPL), on platelet function were examined in vitro. 2. SNAP and its analogues were potent inhibitors of platelet aggregation and inducers of disaggregation. 3. All compounds inhibited fibrinogen binding to platelets. 4. They also decreased the release of P-selectin from platelets. 5. Both inhibition of fibrinogen binding and release of P-selectin correlated with an increase in intraplatelet cyclic GMP concentrations. 6. At concentrations sufficient to inhibit platelet function and induce cyclic GMP formation (0.01-3 microM), the release of NO could be detected from SNPL but not from SNAP and SNFP. 7. Release of NO from all compounds was detected at concentrations > or = 10 microM. 8. Thus, the spontaneous release of NO from SNPL explains the actions of this compound on platelet function; however, platelet-mediated mechanisms may be involved in the release of NO from SNAP and SNFP.

Handedness distribution and figure drawing ability in a deaf school population, with severe learning difficulties: a research note.

The handedness distribution of 71 deaf pupils with severe learning difficulties, was found to be similar to that reported by Soper et al. (1987, American Journal of Mental Deficiency, 92, 94-102) in a mentally handicapped sample, who also found a high incidence of ambiguously handed individuals. Soper's theory, however, that the "acquired" left-handed and the ambiguously-handed are more handicapped and so, we might infer, draw more primitive human figures, was not supported. The left, ambiguously-handed and right-handed had the same scores on human figure drawing. Neither was there a difference in handedness or figure drawing between the "acquired", the "genetic" and the "unknown" cause groups; nor between males and females.