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Concept: The Higher


To investigate whether less-healthy work-family life histories contribute to the higher cardiovascular disease prevalence in older American compared with European women.

Concepts: Epidemiology, Disease, Medical statistics, Blood vessel, Cardiovascular disease, Prevalence, The Higher, Statistical ratios


Aim: The purpose of this study was to clarify training-related risk factors for overuse injuries. Methods: This was twelve-month retrospective study which was done by self-reported postal questionnaire. The study group consisted of 446 men and women top-level Finnish athletes representing three different endurance sports (cross-country skiing, swimming, long-distance running) between the ages of 15-35. Self-reported anthropometric and training-related variables (such as starting age of training, years of active training, hours trained yearly, competition hours and weekly resting days) and occurrence of overuse injuries. Results: Athletes with less than 2 rest days per week during the training season had 5.2-fold risk (95% confidence intervals [CI] 1.89-14.06, P=0.001) for an overuse injury, and athletes who trained more than 700 hours during a year had 2.1-fold risk (95% CI 1.21-3.61, P=0.008) for an overuse injury compared to the others. Athletes who reported a tendon injury were on average two years older than athletes without such an injury (P<0.001). Conclusion: We found that low number of recovery days and a high amount of training are training-related risk factors for overuse injuries in top-level endurance athletes. The higher number of tendon overuse injuries in older than younger athletes may indicate that age-related degeneration plays an important role in the etiology of tendon injuries. These findings should be taken into account when planning exercise programs for endurance athletes.

Concepts: Training, Injuries, Injury, Confidence interval, The Higher, Tendon


Background From 2011 through 2014, the Federally Qualified Health Center Advanced Primary Care Practice Demonstration provided care management fees and technical assistance to a nationwide sample of 503 federally qualified health centers to help them achieve the highest (level 3) medical-home recognition by the National Committee for Quality Assurance, a designation that requires the implementation of processes to improve access, continuity, and coordination. Methods We examined the achievement of medical-home recognition and used Medicare claims and beneficiary surveys to measure utilization of services, quality of care, patients' experiences, and Medicare expenditures in demonstration sites versus comparison sites. Using difference-in-differences analyses, we compared changes in outcomes in the two groups of sites during a 3-year period. Results Level 3 medical-home recognition was awarded to 70% of demonstration sites and to 11% of comparison sites. Although the number of visits to federally qualified health centers decreased in the two groups, smaller reductions among demonstration sites than among comparison sites led to a relative increase of 83 visits per 1000 beneficiaries per year at demonstration sites (P<0.001). Similar trends explained the higher performance of demonstration sites with respect to annual eye examinations and nephropathy tests (P<0.001 for both comparisons); there were no significant differences with respect to three other process measures. Demonstration sites had larger increases than comparison sites in emergency department visits (30.3 more per 1000 beneficiaries per year, P<0.001), inpatient admissions (5.7 more per 1000 beneficiaries per year, P=0.02), and Medicare Part B expenditures ($37 more per beneficiary per year, P=0.02). Demonstration-site participation was not associated with relative improvements in most measures of patients' experiences. Conclusions Demonstration sites had higher rates of medical-home recognition and smaller decreases in the number of patients' visits to federally qualified health centers than did comparison sites, findings that may reflect better access to primary care relative to comparison sites. Demonstration sites had larger increases in emergency department visits, inpatient admissions, and Medicare Part B expenditures. (Funded by the Centers for Medicare and Medicaid Services.).

Concepts: Better, Medicare, Health insurance, The Higher, Centers for Medicare and Medicaid Services, Medicaid, Health insurance in the United States, Medicare and Medicaid


Aguiar, MVD, Botelho, GMA, Gonçalves, BSV, and Sampaio, JE. Physiological responses and activity profiles of football small-sided games. J Strength Cond Res 27(5): 1287-1294, 2013-The aim of this study was to identify the acute physiological responses and activity profiles of football small-sided games (SSG) formats. Ten professional football players participated in 4 variations of SSG (2-, 3-, 4-, and 5-a-side) with an intermittent regime involving 3 × 6-minute bouts with 1 minute of passive planned rest in which the heart rate (HR), rating of perceived exertion (RPE), activity profile, and body load were recorded. The higher percentage of maximum HR values were found in 2- and 3-a-side formats (p ≤ 0.05). The lowest RPE value was found at the 5-a-side, and the highest was found at the 2-a-side (13.48 ± 2.67 and 17.01 ± 1.80, respectively, p ≤ 0.05). The distance covered in the 2-a-side format (598.97 ± 78.91 m) was smaller than in all other formats. The 2-a-side format presented the lowest number of sprints (0.71 ± 0.86) and the 3-a-side the highest (2.50 ± 1.65). Statistically significant differences were found across SSG in the total body load. The 4-a-side presented the highest and the 5-a-side the lowest values (95.18 ± 17.54 and 86.43 ± 14.47, respectively). The body load per minute declined each 2 minutes of play. Maintaining a constant area:player ratio, coaches can use lower number of players (2- and 3-a-side) to increase cardiovascular effects but use higher number of players (4- and 5-a-side) to increase variability and specificity according to the competition demands.

Concepts: Physiology, Heart, Statistical significance, The Higher, American football, File format, Format, Body load


Purpose: Our previous work proposed a rehabilitation robot to support bimanual-coordinated training not only in active-assisted and passive-driven modes but also in active-resisted mode. However, assessment of training effect was only focused on the improvements of subjects' motion-tracking precisions. This paper presents an evaluation strategy based on variations in both cerebral activation level (CAL) and motion-tracking precision. Method:Fourteen healthy subjects participated in motion-tracking training in bimanual active-assisted and active-resisted modes, and in single right-limb and left-limb modes, with haemoglobin concentration and motion-tracking errors being measured simultaneously. Analyses of variance (ANOVA) of the CAL and motion-tracking errors were performed to investigate bimanual training effect and the difference between bimanual and single-limb trainings in activating the brain.Results: In the bimanual modes, both the CAL and motion-tracking precision significantly increased after training. And the CAL induced in the bimanual trainings were significantly greater than in the single-limb trainings. Conclusions:Significant enhancement of the CAL and motion-tracking precision confirmed a positive training effect on enhancing the bimanual-coordination capability of healthy subjects. Compared to the single-limb modes, the higher CAL in the bimanual modes demonstrated the potential of the proposed bimanual training for improving the functional integrity of the two hemispheres. [Box: see text].

Concepts: Improve, Mode, Evaluation, Training, Normal distribution, Accuracy and precision, Analysis of variance, The Higher


The higher order structure of protein therapeutics can be interrogated with hydrogen/deuterium exchange mass spectrometry (HDX-MS). HDX-MS is now a widely used tool in the structural characterization of protein therapeutics. In this review, HDX-MS-based workflows designed for protein therapeutic discovery and development processes are presented, focusing on the specific applications of epitope mapping for protein and/or drug interactions and biopharmaceutical comparability studies. Future trends in the application of HDX-MS in protein therapeutics characterization are also described.

Concepts: Pharmacology, Mass spectrometry, Structure, Therapy, Computer program, The Higher, Musical form, Application software


Objective The purpose of this study was to examine the heart rate reserve (HRR) at first and second ventilatory thresholds (VT’s) in postmenopausal women and compare it with optimal intensity range recommended by the ACSM (40-84%HRR). An additional aim was to evaluate whether a higher aerobic power level corresponded to a higher HRR at VT’s. Methods Fifty-eight postmenopausal women participated in this study (aged 48-69). A graded 25Wmin(-2) cycle ergometer (Monark E839) exercise protocol was performed in order to assess aerobic power. The heart rate and gas-exchange variables were measured continuously using a portable gas analyzer system (Cosmed K4b). The first (VT(1)) and the second (VT(2)) VT’s were determined by the time course curves of ventilation and O(2) and CO(2) ventilatory equivalents. A K-means clustering analysis was used in order to identify VO(2max) groups (cut-off of 30.5mlkg(-1)min(-1)) and differences were evaluated by an independent sample t-test. Bland-Altman plots were performed to illustrate the agreement between methods. Results The women’s HRR values at VT(1) were similar to 40%HRR in both VO(2max) groups. At VT(2) both VO(2max) groups exhibited negative differences (P<0.01) for the predicted 84%HRR intensity (-14.46% in the lower VO(2max) group and -16.32% in the higher VO(2max) group). Conclusions An upper limit of 84% overestimates the %HRR value for the second ventilatory threshold, suggesting that the cardiorespiratory target zone for this population should be lower and narrower (40-70%HRR).

Concepts: Pulse, Student's t-test, Heart rate, The Higher, Thresholds, Threshold, Limit superior and limit inferior, K-means clustering


Previous researches have demonstrated that biological phosphorus removal (BPR) from wastewater could be driven by the aerobic/extended-idle (A/EI) regime. This study further investigated temperature effects on phosphorus removal performance in six A/EI sequencing batch reactors (SBRs) operated at temperatures ranging from 5 to 30 °C. The results showed that phosphorus removal efficiency increased with temperature increasing from 5 to 20 °C but slightly decreased when temperature continually increased to 30 °C. The highest phosphorus removal rate of 97.1 % was obtained at 20 °C. The biomass cultured at 20 °C contained more polyphosphate accumulating organisms (PAO) and less glycogen accumulating organisms (GAO) than that cultured at any other temperatures investigated. The mechanism studies revealed that temperature affected the transformations of glycogen and polyhydroxyalkanoates, and the activities of exopolyphosphatase and polyphosphate kinase activities. In addition, phosphorus removal performances of the A/EI and traditional anaerobic/oxic (A/O) SBRs were compared at 5 and 20 °C, respectively. The results showed the A/EI regime drove better phosphorus removal than the A/O regime at both 5 and 20 °C, and more PAO and less GAO abundances in the biomass might be the principal reason for the higher BPR in the A/EI SBRs as compared with the A/O SBRs.

Concepts: Biology, Organism, Temperature, The Higher, Enhanced biological phosphorus removal, Batch reactor


Multimodal nanoprobes that integrate different imaging modalities in one nano-system could offer synergistic effect over any modality alone to satisfy the higher requirements on the efficiency and accuracy for clinical diagnosis and medical research. Upconversion nanoparticles (UCNPs), particularly lanthanide (Ln)-based NPs have been regarded as an ideal building block for constructing multimodal bioprobes due to their fascinating properties. In this review, we first summarize recent advances in the optimizations of existing UCNPs. In particular, we highlight the applications of Ln-based UCNPs for multimodal cancer imaging in vitro and in vivo. The explorations of UCNPs-based multimodal nanoprobes for targeting diagnosis and imaging-guided therapeutics are also presented. Finally, the challenges and perspectives of Ln-based UCNPs in this rapid growing field are discussed.

Concepts: Medicine, In vivo, In vitro, Metaphysics, The Higher, Modality


The aim of the work was to study the influence of particle size in the composition, physicochemical, techno-functional and physio-functional properties of two flours obtained from persimmon (Diospyros kaki Trumb. cvs. ‘Rojo Brillante’ (RBF) and ‘Triump’ (THF) coproducts. The cultivar (RBF and THF) and particle size significantly affected all parameters under study, although depending on the evaluated property, only one of these effects predominated. Carbohydrates (38.07-46.98 g/100 g) and total dietary fiber (32.07-43.57 g/100 g) were the main components in both flours (RBF and THF). Furthermore, insoluble dietary fiber represented more than 68% of total dietary fiber content. All color properties studied were influenced by cultivar and particle size. For both cultivars, the lower particle size, the higher lightness and hue values. RBF flours showed high values for emulsifying activity (69.33-74.00 mL/mL), while THF presented high values for water holding capacity (WHC: 9.47-12.19 g water/g sample). The bile holding capacity (BHC) and fat/oil binding values were, in general, higher in RBF (19.61-12.19 g bile/g sample and 11.98-9.07, respectively) than THF (16.12-12.40 g bile/g sample and 9.78-7.96, respectively). The effect of particle size was really evident in both WHC and BHC. Due to their dietary fiber content, techno-functional and physio-functional properties, persimmon flours seem to have a good profile to be used as potential functional ingredient.

Concepts: Nutrition, Effect, Persimmon, Dietary fiber, The Higher, Cultivar, American rock music groups