Morning compared to afternoon school-based exercise on cognitive function in adolescents

PURPOSE

Adolescents may be less ready to learn in the mornings due to a propensity for waking up later. High-intensity interval exercise (HIIE) has been shown to acutely improve cognitive functioning in teenagers. This within-measures study explored whether the benefit of HIIE differs when delivered in the morning or afternoon.

METHODS

37 teenagers (19 boys, 13.7 ± 0.4 years) each completed 3 trials in school; morning HIIE (MORN), afternoon HIIE (AFTER) and a no-exercise control trial (CON). The HIIE involved 10x10 second sprints, interspersed by 50 s of walking. Cognitive function was assessed using a battery of computerised tasks four times over the course of the day.

RESULTS

Z scores for reaction time, but not proportion of correct responses, were improved 45 min post exercise in the MORN trial (P < 0.01, d = 0.47), and this improvement persisted until the third (P = 0.04, d = 0.34), but not final (P = 0.93, d = 0.01), time point. Global reaction time was not improved 45 min post exercise in the AFTER trial (P = 0.17, d = 0.20). Global reaction time was quicker 45 min post morning exercise compared to the same time point in CON (P = 0.02, d = 0.56) and AFTER (P = 0.01, d = 0.72).

CONCLUSION

HIIE may be more effectual in improving cognitive functioning when delivered in the morning.

Protocol for the TRANSLATE prospective, multicentre, randomised clinical trial of prostate biopsy technique

OBJECTIVES

Primary objectives: to determine whether local anaesthetic transperineal prostate (LATP) biopsy improves the detection of clinically significant prostate cancer (csPCa), defined as International Society of Urological Pathology (ISUP) Grade Group ≥2 disease (i.e., any Gleason pattern 4 disease), compared to transrectal ultrasound-guided (TRUS) prostate biopsy, in biopsy-naïve men undergoing biopsy based on suspicion of csPCa.

SECONDARY OBJECTIVES

to compare (i) infection rates, (ii) health-related quality of life, (iii) patient-reported procedure tolerability, (iv) patient-reported biopsy-related complications (including bleeding, bruising, pain, loss of erectile function), (v) number of subsequent prostate biopsy procedures required, (vi) cost-effectiveness, (vii) other histological parameters, and (viii) burden and rate of detection of clinically insignificant PCa (ISUP Grade Group 1 disease) in men undergoing these two types of prostate biopsy.

PATIENTS AND METHODS

The TRANSLATE trial is a UK-wide, multicentre, randomised clinical trial that meets the criteria for level-one evidence in diagnostic test evaluation. TRANSLATE is investigating whether LATP biopsy leads to a higher rate of detection of csPCa compared to TRUS prostate biopsy. Both biopsies are being performed with an average of 12 systematic cores in six sectors (depending on prostate size), plus three to five target cores per multiparametric/bi-parametric magnetic resonance imaging lesion. LATP biopsy is performed using an ultrasound probe-mounted needle-guidance device (either the 'Precision-Point' or BK UA1232 system). TRUS biopsy is performed according to each hospital's standard practice. The study is 90% powered to detect a 10% difference (LATP biopsy hypothesised at 55% detection rate for csPCa vs 45% for TRUS biopsy). A total of 1042 biopsy-naïve men referred with suspected PCa need to be recruited.

CONCLUSIONS

This trial will provide robust prospective data to determine the diagnostic ability of LATP biopsy vs TRUS biopsy in the primary diagnostic setting.

Linear body measurements and productivity of subtropical Holstein-Friesian dairy calves

OBJECTIVE

The study aimed to describe growth parameters and to quantify the association between linear body measurements as predictors of liveweight (LW) of Holstein-Friesian (HF), and HF crossbred dairy calves in Queensland. A secondary objective was to quantify the effect of disease events on LW change.

STUDY DESIGN

Longitudinal study.

METHODS

Fortnightly LW, hip height (HH), hip width (HW) and heart girth (HG) measurements were recorded from 16 male and 28 female HF calves from birth until weaning. The association between linear body measurement and the effect of a disease event on LW change were explored using linear mixed-effects modelling with random intercepts and random slopes.

RESULTS

HG was the best body measure used individually as a predictor of calf LW (R2 = 82%; P < 0.001), while the combined use of HG, HW and HH was the most accurate predictor of calf LW between birth and weaning (R2 = 90%; P < 0.001). HW, average feed intake and total feed intake were significantly affected by disease events (P < 0.05). On average, total average LW loss associated with a single pneumonia event was estimated at 14.6 kg (95% CI = 10.5 to 18.7 kg; P < 0.05).

CONCLUSIONS

Calves of this study performed at a level consistent with the previously published reports. Growth performance was significantly compromised by pneumonia. HW was found to be the least predictive individual measure, and the combined use of HH, HW and HG had the most accurate prediction of calf liveweight from birth to weaning.

Dose-response between frequency of interruption of sedentary time and fasting glucose, the dawn phenomenon and night-time glucose in Type 2 diabetes

AIM

To explore the dose-response between frequency of interruption of sedentary time and basal glucose (fasting glucose, the dawn phenomenon and night-time glucose) in Type 2 diabetes.

METHODS

In a randomized three-treatment, two-period balanced incomplete block trial, 12 people with Type 2 diabetes (age, 60.0 ± 3.2 years; BMI, 30.2 ± 1.4 kg/m² ) completed two of three conditions: sitting for 7 h interrupted every 60 min (Condition 1), 30 min (Condition 2), and 15 min (Condition 3) by 3-min light-intensity walking breaks. The activPAL3 and FreeStyle Libre were used to assess physical activity/sedentary behaviour and continuous glucose profile. Standardized meals were provided, and changes in basal glucose of the nights and early mornings before and after treatment conditions were calculated (mean ± SE).

RESULTS

After treatment conditions, fasting glucose and duration of the dawn phenomenon were lower for Condition 3 (-1.0 ± 0.2 mmol/l, P < 0.02; -3.1 ± 1.3 h, P = 0.004) compared with Condition 1 (-0.1 ± 0.2 mmol/l; 1.9 ± 1.2 h). The magnitude of the dawn phenomenon was reduced in Condition 3 (-0.6 ± 0.4 mmol/l, P = 0.041) compared with Condition 2 (0.6 ± 0.3 mmol/l). Night-time glycaemic variability (coefficient of variation) was reduced in Condition 3 (-9.7 ± 3.9%) relative to Condition 2 (6.1 ± 4.8%, P < 0.03) and Condition 1 (2.5 ± 1.8%, P = 0.02). There was no change in night-time mean glucose.

CONCLUSIONS

Frequent interruptions of prolonged sitting with 3 min of light-intensity walking breaks every 15 min improves fasting glucose, the dawn phenomenon and night-time glycaemic variability, and this might be a simple therapeutic intervention to improve glucose control. Clinicaltrials.gov Identifier: NCT02738996.

Isolated conjugate gaze palsy after frontal lobe tumour surgery

Isolated conjugate gaze palsy following unilateral frontal lobe surgery is uncommon. When it does occur, usually it recovers within hours. We report a case of isolated conjugate gaze palsy which persisted for four weeks post-operatively before recovery commenced.

Improved outcome for children with disseminated adenoviral infection following allogeneic stem cell transplantation

Adenovirus (AdV) infections are a frequent cause of morbidity and mortality following allogeneic stem cell transplantation (SCT), and disseminated infection is associated with high mortality, particularly in paediatric SCT. Here, we describe an approach to reduce mortality from adenoviraemia by combining prospective monitoring for the occurrence of adenoviraemia using a sensitive polymerase chain reaction method, early antiviral therapy and prompt withdrawal of immunosuppression. A total of 155 consecutive paediatric SCT procedures were prospectively monitored, of which 113 (73%) transplants involved donors other than matched siblings and 126 (83%) employed T-cell depletion. Adenoviraemia was detected in 26/155 (17%) transplants and developed exclusively in patients who had received T-cell-depleted grafts. Withdrawal of immunosuppression coupled with early antiviral therapy led to resolution of adenoviraemia in 19/26 (81%) patients with only five patients succumbing to disseminate AdV infection. Survival from adenoviraemia was associated with lymphocyte recovery to above 0.3x10(9)/l. Mortality was closely linked with the absence of lymphocyte recovery because of profound T-cell depletion of the graft with CD34+ magnetic-activated cell sorting. Mortality from disseminated AdV infection was 5/26 (19%) in this study, which is significantly lower than previously reported.

Systematic review of interventions to reduce delay in patients with suspected heart attack

OBJECTIVES

To evaluate the effectiveness of interventions aiming to reduce time from onset of signs and symptoms of an acute myocardial infarction (AMI) to seeking medical help/arrival at hospital.

METHODS

A systematic review was conducted. Fifteen electronic databases, the internet, and bibliographies of included studies were searched, and experts in the field of cardiac care were contacted. Randomised controlled trials (RCTs), controlled trials, and before and after studies conducted in any setting that assessed an intervention aimed at reducing time from onset of signs and symptoms of an AMI to seeking medical help and/or arrival in hospital were eligible for inclusion.

RESULTS

Eleven media/public education intervention studies met the inclusion criteria. Five (one controlled and four before and after studies) reported the intervention to have a statistically positive effect on delay time and six (two RCTs and four before and after studies) reported no statistically significant effect. Three (one RCT and two before and after studies) of five studies evaluating the effect of the intervention on emergency department visits reported an increase in this outcome as a result of the intervention, and both studies (one RCT and one before and after study) examining calls made to emergency switchboards reported an increase in this outcome after the intervention.

CONCLUSIONS

There was little evidence that media/public education interventions reduced delay. There is some evidence that they may result in an increase in emergency switchboard calls and emergency department visits. Despite substantial expenditure of time and effort, methodological deficiencies of the studies mean that it is not possible to make definitive recommendations.

Visual outcomes for remote Australian Aboriginal people after cataract surgery

PURPOSE

To assess the visual outcomes and quality of life after cataract surgery in Aborig nal people and compare them with a case-matched population of non-Aborginal people living in remote and rural areas in the Top End of the Northern Territory.

METHODS

Patients living in remote areas of the Top End of the Northern Territory who underwent cataract surgery between 1994 and 1999 were identified from records at the three major hospitals in the region. Eighty-three patients were included in the study. Each patient underwent a complete ocular assessment and then was administered a standardized, field-tested, 12-item questionnaire concerning visual function. This was analyzed and the results of the Aboriginal and matched non-Aboriginal populations compared.

RESULTS

Sixty one Aboriginal and 22 non-Aboriginal people from a total of 295 patients who underwent cataract surgery were included in the study. The two study groups were closely matched by sex, age at the time of surgery, time of follow up from surgery and the number who had undergone bilateral surgeryThe median preoperative visual acuity for the Aboriginal group was 6/60 against 6/24 of the non-Aboriginal group. After surgery, at the time of follow up, 26% of eyes in Aboriginal patients did not correct to 6/12 or better with pinhole approximation. Posterior capsule opacities were the most common principal postoperative cause for a deterioration of visual acuity in both groups. Postoperatve trauma was a common cause for a low best-corrected visual acuity n the Aboriginal group but not in the non-Aboriginal group. The majority (75.5%) of Aboriginal patients were satisfied with their operated eyes. Patients who were dissatisfied all had a visual acuity worse than 6/36. Aborigina patients reported worse visual function than did those in the non-Aboriginal group.

CONCLUSIONS

Cataract surgery has a beneficial effect on the visual acuity and quality of life of Aboriginal and non-Aboriginal people. As compared to their non-Aboriginal counterparts, most Aboriginal people underwent surgery when they were legally blind, had a lower level of attained postoperative visual acuity and a high incidence of uncorrected refractive errors and posterior capsular opacification requiring laser capsulotomy. The positive mpact of cataract surgery on the lives of the majority of Aboriginal patients is highlighted, as is the need for continued postoperative follow up.

Early catheter removal following radical perineal prostatectomy: a randomized clinical trial

Radical perineal prostatectomy allows for a watertight closure of the urethrovesical anastomosis. This trial determined that early catheter removal may be feasible and desirable in patients undergoing radical perineal prostatectomy. Early catheter removal can lead to improved patient comfort and well-being.

Staff recruitment challenges and interventions in agencies supporting people with developmental disabilities

Recruitment challenges and costs were identified by administrators from 129 randomly selected agencies that provide residential, vocational, and other services to persons with developmental disabilities in Minnesota. Finding qualified applicants was the most difficult staffing problem reported. Common recruitment incentives included providing competitive benefits, allowing time off without pay, and offering paid leave time. Relatively few agencies used innovative strategies (e.g., bonuses for employees who recruit new workers). The average agency had vacancy rates of 6% in direct-support positions and 4% in first-line supervisor positions. On the basis of these findings, one could determine that the cost of advertising and overtime for vacant positions in Minnesota could approach $6.7 million per year.

A cancer and neutropenia database study

The economic cost of treating febrile neutropenic cancer patients in Canada has not been defined. Amgen Canada Inc., the distributor of filgrastim (Neupogen Amgen Canada Inc.) was interested in determining this cost in order to evaluate the potential economic impact of filgrastim in the Canadian healthcare setting. Filgrastim is indicated to decrease the incidence of infection, as manifested by febrile neutropenia, in patients with nonmyeloid malignancies who receive myelosuppressive antineoplastic drugs. In addition, the company sought to determine which demographic factors influenced the cost. This was done to characterize which patients could derive clinical benefit from filgrastim while at the same time producing cost offsets through anticipated reductions in hospitalizations. In order to address these issues a study was commissioned to collect demographic data on patients diagnosed with both cancer and neutropenia in Canadian acute care hospitals. This cancer/neutropenia database was created from patient discharge abstracts contained in the 1990/91 Hospital Medical Records Institute national acute-care hospital database. The data presented in the HMRI report are consistent with the concept that subgroups of cancer patients exist in whom clinical benefits and cost off-sets may be realized from the use of growth factors.