Quarter-dose quadruple combination therapy for initial treatment of hypertension: placebo-controlled, crossover, randomised trial and systematic review

BACKGROUND

Globally, most patients with hypertension are treated with monotherapy, and control rates are poor because monotherapy only reduces blood pressure by around 9/5 mm Hg on average. There is a pressing need for blood pressure-control strategies with improved efficacy and tolerability. We aimed to assess whether ultra-low-dose combination therapy could meet these needs.

METHODS

We did a randomised, placebo-controlled, double-blind, crossover trial of a quadpill-a single capsule containing four blood pressure-lowering drugs each at quarter-dose (irbesartan 37·5 mg, amlodipine 1·25 mg, hydrochlorothiazide 6·25 mg, and atenolol 12·5 mg). Participants with untreated hypertension were enrolled from four centres in the community of western Sydney, NSW, Australia, mainly by general practitioners. Participants were randomly allocated by computer to either the quadpill or matching placebo for 4 weeks; this treatment was followed by a 2-week washout, then the other study treatment was administered for 4 weeks. Study staff and participants were unaware of treatment allocations, and masking was achieved by use of identical opaque capsules. The primary outcome was placebo-corrected 24-h systolic ambulatory blood pressure reduction after 4 weeks and analysis was by intention to treat. We also did a systematic review of trials evaluating the efficacy and safety of quarter-standard-dose blood pressure-lowering therapy against placebo. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614001057673. The trial ended after 1 year and this report presents the final analysis.

FINDINGS

Between November, 2014, and December, 2015, 55 patients were screened for our randomised trial, of whom 21 underwent randomisation. Mean age of participants was 58 years (SD 11) and mean baseline office and 24-h systolic and diastolic blood pressure levels were 154 (14)/90 (11) mm Hg and 140 (9)/87 (8) mm Hg, respectively. One individual declined participation after randomisation and two patients dropped out for administrative reasons. The placebo-corrected reduction in systolic 24-h blood pressure with the quadpill was 19 mm Hg (95% CI 14-23), and office blood pressure was reduced by 22/13 mm Hg (p<0·0001). During quadpill treatment, 18 (100%) of 18 participants achieved office blood pressure less than 140/90 mm Hg, compared with six (33%) of 18 during placebo treatment (p=0·0013). There were no serious adverse events and all patients reported that the quadpill was easy to swallow. Our systematic review identified 36 trials (n=4721 participants) of one drug at quarter-dose and six trials (n=312) of two drugs at quarter-dose, against placebo. The pooled placebo-corrected blood pressure-lowering effects were 5/2 mm Hg and 7/5 mm Hg, respectively (both p<0·0001), and there were no side-effects from either regimen.

INTERPRETATION

The findings of our small trial in the context of previous randomised evidence suggest that the benefits of quarter-dose therapy could be additive across classes and might confer a clinically important reduction in blood pressure. Further examination of the quadpill concept is needed to investigate effectiveness against usual treatment options and longer term tolerability.

FUNDING

National Heart Foundation, Australia; University of Sydney; and National Health and Medical Research Council of Australia.

Predictors of older drivers' involvement in high-range speeding behavior

OBJECTIVE

Even small increases in vehicle speed raise crash risk and resulting injury severity. Older drivers are at increased risk of involvement in casualty crashes and injury compared to younger drivers. However, there is little objective evidence about older drivers' speeding. This study investigates the nature and predictors of high-range speeding among drivers aged 75-94 years.

METHODS

Speed per second was estimated using Global Positioning System devices installed in participants' vehicles. High-range speeding events were defined as traveling an average 10+km/h above the speed limit over 30 seconds. Descriptive analysis examined speeding events by participant characteristics and mileage driven. Regression analyses were used to examine the association between involvement in high-range speeding events and possible predictive factors.

RESULTS

Most (96%, 182/190) participants agreed to have their vehicle instrumented, and speeding events were accurately recorded for 97% (177/182) of participants. While 77% (136/177) of participants were involved in one or more high-range events, 42% (75/177) were involved in greater than five events during 12-months of data collection. Participants involved in high-range events drove approximately twice as many kilometres as those not involved. High-range events tended to be infrequent (median = 6 per 10,000 km; IQR = 2-18). The rate of high-range speeding was associated with better cognitive function and attention to the driving environment.

CONCLUSION

This suggests those older drivers with poorer cognition and visual attention may drive more cautiously, thereby reducing their high-range speeding behavior.

The Association of Knowledge and Behaviours Related to Salt with 24-h Urinary Salt Excretion in a Population from North and South India

Consumer knowledge is understood to play a role in managing risk factors associated with cardiovascular disease and may be influenced by level of education. The association between population knowledge, behaviours and actual salt consumption was explored overall, and for more-educated compared to less-educated individuals. A cross-sectional survey was done in an age-and sex-stratified random sample of 1395 participants from urban and rural areas of North and South India. A single 24-h urine sample, participants' physical measurements and questionnaire data were collected. The mean age of participants was 40 years, 47% were women and mean 24-h urinary salt excretion was 9.27 (8.87-9.69) g/day. Many participants reported favourable knowledge and behaviours to minimise risks related to salt. Several of these behaviours were associated with reduced salt intake-less use of salt while cooking, avoidance of snacks, namkeens, and avoidance of pickles (all p < 0.003). Mean salt intake was comparable in more-educated (9.21, 8.55-9.87 g/day) versus less-educated (9.34, 8.57-10.12 g/day) individuals (p = 0.82). There was no substantively different pattern of knowledge and behaviours between more-versus less-educated groups and no clear evidence that level of education influenced salt intake. Several consumer behaviours related to use of salt during food preparation and consumption of salty products were related to actual salt consumption and therefore appear to offer an opportunity for intervention. These would be a reasonable focus for a government-led education campaign targeting salt.

PrevenTing Falls in a high-risk, vision-impaired population through specialist ORientation and Mobility services: protocol for the PlaTFORM randomised trial

Background

Older people with vision impairment have significant ongoing morbidity, including risk of falls, but are neglected in fall prevention programmes. PlaTFORM is a pragmatic evaluation of the Lifestyle-integrated Functional Exercise fall prevention programme for older people with vision impairment or blindness (v-LiFE). Implementation and scalability issues will also be investigated.

Methods

PlaTFORM is a single-blinded, randomised trial designed to evaluate the v-LiFE programme compared with usual care. Primary outcomes are fall rate over 12 months, measured using prospective monthly fall calendars, and function and participation assessed by the Late-Life Function and Disability Instrument (Late-Life FDI) Function component. The secondary outcome is rate of falls requiring medical care. Activity-normalised fall rate will be estimated using accelerometer-measured physical activity data. EuroQol 5-dimension 5-level questionnaire will measure quality of life and impact of falls. Health record linkage will estimate resource use associated with falls. v-LiFE cost-effectiveness will be determined compared with usual care. 500 participants (250 per group) can provide 90% power to detect a significant between-group difference in fall rates; 588 will be recruited to allow for drop-out. Falls per person-year and Late-Life FDI will be compared between groups.

Discussion

PlaTFORM will determine if falls can be prevented among older people with vision loss through a home-based exercise programme. v-LiFE embeds balance and strength training within everyday activities with the aim of preventing falls. The study will also determine whether the programme can be effectively delivered by personnel who provide Orientation and Mobility training for people with vision impairment.

Trial registration number

ACTRN12616001186448p.

Mean Dietary Salt Intake in Urban and Rural Areas in India: A Population Survey of 1395 Persons

BACKGROUND

The scientific evidence base in support of population-wide salt reduction is strong, but current high-quality data about salt intake levels in India are mostly absent. This project sought to estimate daily salt consumption levels in selected communities of Delhi and Haryana in north India and Andhra Pradesh in south India.

METHODS AND RESULTS

In this study, 24-hour urine samples were collected using an age- and sex-stratified sampling strategy in rural, urban, and slum areas. Salt intake estimates were made for the overall population of each region and for major subgroups by weighting the survey data for the populations of Delhi and Haryana, and Andhra Pradesh. Complete 24-hour urine samples were available for 637 participants from Delhi and Haryana and 758 from Andhra Pradesh (65% and 68% response rates, respectively). Weighted mean population 24-hour urine excretion of salt was 8.59 g/day (95% CI 7.68-9.51) in Delhi and Haryana and 9.46 g/day (95% CI 9.06-9.85) in Andhra Pradesh (P=0.097). Estimates inflated to account for the minimum likely nonurinary losses of sodium provided corresponding estimates of daily salt intake of 9.45 g/day (95% CI 8.45-10.46) and 10.41 g/day (95% CI 9.97-10.84), respectively.

CONCLUSIONS

Salt consumption in India is high, with mean population intake well above the World Health Organization recommended maximum of 5 g/day. A national salt reduction program would likely avert much premature death and disability.

Predictors of older drivers' involvement in rapid deceleration events

Rapid deceleration occurs when substantial force slows the speed of a vehicle. Rapid deceleration events (RDEs) have been proposed as a surrogate safety measure. As there is concern about crash involvement of older drivers and the effect of age-related declining visual and cognitive function on driving performance, we examined the relationship between RDEs and older driver's vision, cognitive function and driving confidence, using naturalistic driving measures. Participants aged 75 to 94 years had their vehicle instrumented for 12 months. To minimise the chance of identifying false positives, accelerometer data was processed to identify RDEs with a substantial deceleration of >750 milli-g (7.35m/s²). We examined the incidence of RDEs amongst older drivers, and how this behaviour is affected by differences in age; sex; visual function, cognitive function; driving confidence; and declines over the 12 months. Almost two-thirds (64%) of participants were involved in at least one RDE, and 22% of these participants experienced a meaningful decline in contrast sensitivity during the 12 months. We conducted regression modelling to examine associations between RDEs and predictive measures adjusted for (i) duration of monitoring and (ii) distance driven. We found the rate of RDEs per distance increased with age; although, this did not remain in the multivariate model. In the multivariate model, we found older drivers who experienced a decline in contrast sensitivity over the 12 months and those with lower baseline driving confidence were at increased risk of involvement in RDEs adjusted for distance driven. In other studies, contrast sensitivity has been associated with increased crash involvement for older drivers. These findings lend support for the use of RDEs as a surrogate safety measure, and demonstrate an association between a surrogate safety measure and a decline in contrast sensitivity of older drivers.

The Sydney Triage to Admission Risk Tool (START) to predict Emergency Department Disposition: A derivation and internal validation study using retrospective state-wide data from New South Wales, Australia

Background

Disposition decisions are critical to the functioning of Emergency Departments. The objectives of the present study were to derive and internally validate a prediction model for inpatient admission from the Emergency Department to assist with triage, patient flow and clinical decision making.

Methods

This was a retrospective analysis of State-wide Emergency Department data in New South Wales, Australia. Adult patients (age ≥ 16 years) were included if they presented to a Level five or six (tertiary level) Emergency Department in New South Wales, Australia between 2013 and 2014. The outcome of interest was in-patient admission from the Emergency Department. This included all admissions to short stay and medical assessment units and being transferred out to another hospital. Analyses were performed using logistic regression. Discrimination was assessed using area under curve and derived risk scores were plotted to assess calibration.

Results

1,721,294 presentations from twenty three Level five or six hospitals were analysed. Of these 49.38% were male and the mean (sd) age was 49.85 years (22.13). Level 6 hospitals accounted for 47.70% of cases and 40.74% of cases were classified as an in-patient admission based on their mode of separation. The final multivariable model including age, arrival by ambulance, triage category, previous admission and presenting problem had an AUC of 0.82 (95% CI 0.81, 0.82).

Conclusion

By deriving and internally validating a risk score model to predict the need for in-patient admission based on basic demographic and triage characteristics, patient flow in ED, clinical decision making and overall quality of care may be improved. Further studies are now required to establish clinical effectiveness of this risk score model.

Towards new material biomarkers for fracture risk

Osteoporosis is a prevalent bone condition, characterised by low bone mass and increased fracture risk. Currently, the gold standard for identifying osteoporosis and increased fracture risk is through quantification of bone mineral density (BMD) using dual energy X-ray absorption (DEXA). However, the risk of osteoporotic fracture is determined collectively by bone mass, architecture and physicochemistry of the mineral composite building blocks. Thus DEXA scans alone inevitably fail to fully discriminate individuals who will suffer a fragility fracture. This study examines trabecular bone at both ultrastructure and microarchitectural levels to provide a detailed material view of bone, and therefore provides a more comprehensive explanation of osteoporotic fracture risk. Physicochemical characterisation obtained through X-ray diffraction and infrared analysis indicated significant differences in apatite crystal chemistry and nanostructure between fracture and non-fracture groups. Further, this study, through considering the potential correlations between the chemical biomarkers and microarchitectural properties of trabecular bone, has investigated the relationship between bone mechanical properties (e.g. fragility) and physicochemical material features.

Effects of ischaemic conditioning on major clinical outcomes in people undergoing invasive procedures: systematic review and meta-analysis

OBJECTIVE

 To summarise the benefits and harms of ischaemic conditioning on major clinical outcomes in various settings.

DESIGN

 Systematic review and meta-analysis.

DATA SOURCES

 Medline, Embase, Cochrane databases, and International Clinical Trials Registry platform from inception through October 2015.

STUDY SELECTION

 All randomised controlled comparisons of the effect of ischaemic conditioning on clinical outcomes were included.

DATA EXTRACTION

 Two authors independently extracted data from individual reports. Reports of multiple intervention arms were treated as separate trials. Random effects models were used to calculate summary estimates for all cause mortality and other pre-specified clinical outcomes. All cause mortality and secondary outcomes with P<0.1 were examined for study quality by using the GRADE assessment tool, the effect of pre-specified characteristics by using meta-regression and Cochran C test, and trial sequential analysis by using the Copenhagen Trial Unit method.

RESULTS

 85 reports of 89 randomised comparisons were identified, with a median 80 (interquartile range 60-149) participants and median 1 (range 1 day-72 months) month intended duration. Ischaemic conditioning had no effect on all cause mortality (68 comparisons; 424 events; 11 619 participants; risk ratio 0.96, 95% confidence interval 0.80 to 1.16; P=0.68; moderate quality evidence) regardless of the clinical setting in which it was used or the particular intervention related characteristics. Ischaemic conditioning may reduce the rates of some secondary outcomes including stroke (18 trials; 5995 participants; 149 events; risk ratio 0.72, 0.52 to 1.00; P=0.048; very low quality evidence) and acute kidney injury (36 trials; 8493 participants; 1443 events; risk ratio 0.83, 0.71 to 0.97; P=0.02; low quality evidence), although the benefits seem to be confined to non-surgical settings and to mild episodes of acute kidney injury only.

CONCLUSIONS

 Ischaemic conditioning has no overall effect on the risk of death. Possible effects on stroke and acute kidney injury are uncertain given methodological concerns and low event rates. Adoption of ischaemic conditioning cannot be recommended for routine use unless further high quality and well powered evidence shows benefit.

Naturalistic rapid deceleration data: Drivers aged 75 years and older

The data presented in this article are related to the research manuscript “Predictors of older drivers’ involvement in rapid deceleration events”, which investigates potential predictors of older drivers’ involvement in rapid deceleration events including measures of vision, cognitive function and driving confidence (A. Chevalier et al., 2016) [1]. In naturalistic driving studies such as this, when sample size is not large enough to allow crashes to be used to investigate driver safety, rapid deceleration events may be used as a surrogate safety measure. Naturalistic driving data were collected for up to 52 weeks from 182 volunteer drivers aged 75–94 years (median 80 years, 52% male) living in the suburban outskirts of Sydney. Driving data were collected using an in-vehicle monitoring device. Accelerometer data were recorded 32 times per second and Global Positioning System (GPS) data each second. To measure rapid deceleration behavior, rapid deceleration events (RDEs) were defined as having at least one data point at or above the deceleration threshold of 750 milli-g (7.35 m/s²). All events were constrained to a maximum 5 s duration. The dataset provided with this article contains 473 events, with a row per RDE. This article also contains information about data processing, treatment and quality control. The methods and data presented here may assist with planning and analysis of future studies into rapid deceleration behaviour using in-vehicle monitoring.

Depressive symptoms in older adults awaiting cataract surgery

BACKGROUND

To assess the prevalence and predictors of depressive symptoms in a cohort of older adults awaiting cataract surgery and establish threshold vision at which depressive symptoms may emerge.

DESIGN

Analysis of cross-sectional baseline data from a longitudinal cohort study of patients aged ≥65 years on Australian public hospital cataract surgery waiting lists.

PARTICIPANTS

We included 329 participants enrolled October 2013-August 2015.

METHODS

Participants completed assessment of depressive symptoms, visual disability, quality of life, social participation and exercise frequency at least one month prior to cataract surgery. High and low contrast habitual vision was examined and systemic comorbidities noted.

MAIN OUTCOME MEASURE

Depressive symptoms prior to first eye cataract surgery.

RESULTS

The prevalence of depressive symptoms was 28.6% (94/329). Univariate analysis identified that participants with poorer high contrast vision, reduced quality of life, greater patient-reported visual disability, higher comorbidity score and who were taking more medications were more likely to exhibit signs of depression. Greater patient-reported visual disability (P = 0.02), reduced quality of life (P = 0.003) and a higher comorbidity score (P = 0.02) remained significantly associated with depressive symptoms in the multivariable model. Depressive symptoms emerged at a visual acuity of 6/12.

CONCLUSIONS

These findings demonstrate a high prevalence of depressive symptoms in older persons with cataract, emerging at modest levels of vision loss. Efficient referral processes, timely surgical management, and improved screening and coordinated treatment of depressive symptoms during the surgical wait may minimize the negative psychological effects of cataract in this already vulnerable population.

A longitudinal investigation of the predictors of older drivers' speeding behaviour

There is little objective evidence about the extent older drivers' are involved in speeding or factors that may influence this behaviour. Particular concern exists for the increasing number of older drivers with poor or declining cognitive and visual function. This study investigates whether a reduction in speeding forms part of the self-restrictive driving behaviour evident when older drivers experience poor cognitive and visual function. Driving data over 12 months were collected from 182 volunteers aged 75-94years. Driving speed was estimated using Global Positioning System location, and speed limit data was based on a service-provider database. Speed events were defined as driving 1km/h or more, with 3% tolerance, above a single speed limit, averaged over 30s. Almost all participants (99%) were involved in speed events. While, 16-31% of participants experienced a meaningful decline in cognitive or visual function during the 12-months, these declines were not predictive of a change in speed events. Our results indicate speeding behaviour in this age group was highly prevalent, but less so for the oldest drivers whereby the rate of speed events was 7% lower per year older (IRR=0.93, 95%CI=0.89-0.96). Older drivers with worse function were less involved in speed events (unadjusted for distance driven) during 12 months of observation. Weekly distance driven decreased over the year by approximately 0.45km with every week of monitoring for these older drivers. When distance driven was taken into account, decreased function was not predictive of involvement in speed events, indicating the reduction in speed events may be achieved by older drivers with lower function reducing distance driven. These results are important for developing policy to address speeding behaviour of the growing population of older drivers to reduce the incidence of crashes and resulting casualties.

Seat belt repositioning and use of vehicle seat cushions is increased among older drivers aged 75 years and older with morbidities

OBJECTIVE

Good seat belt fit and positioning is important for crash protection. Older drivers experience problems in achieving good seat belt fit and often reposition seat belts and/or use seat cushions. Comfort influences these behaviours. This work examines the impact of functional morbidities on belt positioning and accessory use and whether comfort mediates this relationship METHODS: Mediation analysis was used to examine the relationship between morbidities affecting physical function, comfort, belt repositions and seat cushion use among 380 drivers aged 75 years and older.

RESULTS

Musculoskeletal morbidities increase the likelihood of seat belt repositioning (OR 1.37, 95% CI 1.12-1.67) and comfort partially mediates this relationship (P = 0.03). Morbidities of any type also increase the likelihood of seat cushion use (OR 1.15 95% CI 1.04-1.27), but comfort plays no role in this relationship (P = 0.87).

CONCLUSION

Greater awareness among older drivers is needed, to ensure behavioural modifications do not impair their crash protection.

Maximising follow-up participation rates in a large scale 45 and Up Study in Australia

BACKGROUND

The issue of poor response rates to population surveys has existed for some decades, but few studies have explored methods to improve the response rate in follow-up population cohort studies.

METHODS

A sample of 100,000 adults from the 45 and Up Study, a large population cohort in Australia, were followed up 3.5 years after the baseline cohort was assembled. A pilot mail-out of 5000 surveys produced a response rate of only 41.7 %. This study tested methods of enhancing response rate, with three groups of 1000 each allocated to (1) receiving an advance notice postcard followed by a questionnaire, (2) receiving a questionnaire and then follow-up reminder letter, and (3) both these strategies.

RESULTS

The enhanced strategies all produced an improved response rate compared to the pilot, with a resulting mean response rate of 53.7 %. Highest response was found when both the postcard and questionnaire reminder were used (56.4 %) but this was only significantly higher when compared to postcard alone (50.5 %) but not reminder alone (54.1 %). The combined approach was used for recruitment among the remaining 92,000 participants, with a resultant further increased response rate of 61.6 %.

CONCLUSIONS

Survey prompting with a postcard and a reminder follow-up questionnaire, applied separately or combined can enhance follow-up rates in large scale survey-based epidemiological studies.

Implementation of a driver licensing support program in three Aboriginal communities: a brief report from a pilot program

Issue addressed: Aboriginal people face significant barriers to accessing the driver licensing system in New South Wales (NSW). Low rates of licence participation contribute to transport disadvantage and impede access to employment, education and essential health services. The Driving Change program has been piloted in three communities to increase licensing rates for young Aboriginal people. This brief report reviews implementation to determine whether Driving Change is being delivered as intended to the target population.Methods: Descriptive analysis of routinely collected program data collected between April 2013 and October 2014 to monitor client demographics (n = 194) and program-specific outcomes.Results: The target population is being reached with the majority of clients aged 16-24 years (76%) and being unemployed (53%). Licensing outcomes are being achieved at all pilot sites (learner licence 19%; provisional or unrestricted licence 16%). There is variation in program delivery across the three pilot sites demonstrating the intended flexibility of the program.Conclusions: Driving Change is delivering all aspects of the program as intended at the three pilot sites. The program is reaching the target population and providing a sufficiently flexible program that responds to community and client identified need.So what?: Reviewing implementation of community pilot programs is critical to ensure that the intervention is being delivered as intended to the target population. This brief report indicates that Driving Change is assisting young Aboriginal people to access licensing services in NSW. This review of program implementation will assist the subsequent expansion of the program to a further nine communities in NSW.

Mangrove Sedimentation and Response to Relative Sea-Level Rise

Mangroves occur on upper intertidal shorelines in the tropics and subtropics. Complex hydrodynamic and salinity conditions, related primarily to elevation and hydroperiod, influence mangrove distributions; this review considers how these distributions change over time. Accumulation rates of allochthonous and autochthonous sediment, both inorganic and organic, vary between and within different settings. Abundant terrigenous sediment can form dynamic mudbanks, and tides redistribute sediment, contrasting with mangrove peat in sediment-starved carbonate settings. Sediments underlying mangroves sequester carbon but also contain paleoenvironmental records of adjustments to past sea-level changes. Radiometric dating indicates long-term sedimentation, whereas measurements made using surface elevation tables and marker horizons provide shorter perspectives, indicating shallow subsurface processes of root growth and substrate autocompaction. Many tropical deltas also experience deep subsidence, which augments relative sea-level rise. The persistence of mangroves implies an ability to cope with moderately high rates of relative sea-level rise. However, many human pressures threaten mangroves, resulting in a continuing decline in their extent throughout the tropics.

Traditional and Emerging Lifestyle Risk Behaviors and All-Cause Mortality in Middle-Aged and Older Adults: Evidence from a Large Population-Based Australian Cohort

BACKGROUND

Lifestyle risk behaviors are responsible for a large proportion of disease burden worldwide. Behavioral risk factors, such as smoking, poor diet, and physical inactivity, tend to cluster within populations and may have synergistic effects on health. As evidence continues to accumulate on emerging lifestyle risk factors, such as prolonged sitting and unhealthy sleep patterns, incorporating these new risk factors will provide clinically relevant information on combinations of lifestyle risk factors.

METHODS AND FINDINGS

Using data from a large Australian cohort of middle-aged and older adults, this is the first study to our knowledge to examine a lifestyle risk index incorporating sedentary behavior and sleep in relation to all-cause mortality. Baseline data (February 2006- April 2009) were linked to mortality registration data until June 15, 2014. Smoking, high alcohol intake, poor diet, physical inactivity, prolonged sitting, and unhealthy (short/long) sleep duration were measured by questionnaires and summed into an index score. Cox proportional hazards analysis was used with the index score and each unique risk combination as exposure variables, adjusted for socio-demographic characteristics. During 6 y of follow-up of 231,048 participants for 1,409,591 person-years, 15,635 deaths were registered. Of all participants, 31.2%, 36.9%, 21.4%, and 10.6% reported 0, 1, 2, and 3+ risk factors, respectively. There was a strong relationship between the lifestyle risk index score and all-cause mortality. The index score had good predictive validity (c index = 0.763), and the partial population attributable risk was 31.3%. Out of all 96 possible risk combinations, the 30 most commonly occurring combinations accounted for more than 90% of the participants. Among those, combinations involving physical inactivity, prolonged sitting, and/or long sleep duration and combinations involving smoking and high alcohol intake had the strongest associations with all-cause mortality. Limitations of the study include self-reported and under-specified measures, dichotomized risk scores, lack of long-term patterns of lifestyle behaviors, and lack of cause-specific mortality data.

CONCLUSIONS

Adherence to healthy lifestyle behaviors could reduce the risk for death from all causes. Specific combinations of lifestyle risk behaviors may be more harmful than others, suggesting synergistic relationships among risk factors.

Trends in incidence and survival for anal cancer in New South Wales, Australia, 1972-2009

INTRODUCTION

Little is known about the incidence and survival of anal cancer in New South Wales (NSW), Australia, as anal cancer cases are often grouped together with other colorectal cancers in descriptive epidemiological analyses.

METHODS

We studied patterns and trends in the incidence and survival of people diagnosed with anal cancer in NSW, Australia, 1972-2009 (n=2724). We also predicted anal cancer incidence in NSW during 2010-2032. Given the human papilloma virus-associated aetiology for most anal cancers, we quantified these changes over time in incidence and survival by histological subtype: anal squamous cell carcinoma (ASCC); and anal adenocarcinoma (AAC).

RESULTS

There was a linear increase in incident anal cancer cases in NSW with an average annual percentage change (AAPC) of 1.6 (95% CI 1.1-2.0) such that, in combination with age-period-cohort modelling, we predict there will be 198 cases of anal cancer in the 2032 calendar year (95% CI 169-236). Almost all of these anal cancer cases are projected to be ASCC (94%). Survival improved over time regardless of histological subtype. However, five-year relative survival was substantially higher for people with ASCC (70% (95% CI 66-74%)) compared to AAC (51% (95% CI 43-59%)), a 37% difference. Survival was also greater for women (69% (95% CI 64-73%)) with ASCC compared to men (55% (95% CI 50-60%)). It was not possible to estimate survival by stage at diagnosis particularly given that 8% of all cases were recorded as having distant stage and 22% had missing stage data.

INTERPRETATION

Aetiological explanations, namely exposure to oncogenic types of human papillomavirus, along with demographic changes most likely explain the actual and projected increase in ASCC case numbers. Survival differences by gender and histological subtype point to areas where further research is warranted to improve treatment and outcomes for all anal cancer patients.

All-cause mortality effects of replacing sedentary time with physical activity and sleeping using an isotemporal substitution model: a prospective study of 201,129 mid-aged and older adults

Background

Sedentary behaviour, sleeping, and physical activity are thought to be independently associated with health outcomes but it is unclear whether these associations are due to the direct physiological effects of each behaviour or because, across a finite 24-hour day, engagement in one behavior requires displacement of another. The aim of this study was to examine the replacement effects of sedentary behaviour (total sitting, television/computer screen time combined), sleeping, standing, walking, and moderate-to-vigorous physical activity on all-cause mortality using isotemporal substitution modelling.

Methods

Longitudinal analysis (4.22 ± 0 · 9 years follow-up/849,369 person-years) of 201,129 participants of the 45 and Up study aged ≥45 years from New South Wales, Australia.

Results

Seven thousand four hundred and sixty deaths occurred over follow-up. There were beneficial associations for replacing total sitting time with standing (per-hour HR: 95 % CI: 0.95, 0.94–0.96), walking (0.86, 0.81–0.90), moderate-to-vigorous physical activity (0.88, 0.85–0.90), and sleeping in those sleeping ≤ 7 h/day (0.94, 0.90–0.98). Similar associations were noted for replacing screen time. Replacing one hour of walking or moderate-to-vigorous physical activity with any other activity class was associated with an increased mortality risk by 7–18 %. Excluding deaths in the first 24 months of the follow up and restricting analyses to those who were healthy at baseline did not materially change the above observations.

Conclusion

Although replacing sedentary behaviour with walking and moderate-to-vigorous physical activity are associated with the lowest mortality risk, replacements with equal amounts of standing and sleeping (in low sleepers only) are also linked to substantial mortality risk reductions.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-015-0280-7) contains supplementary material, which is available to authorized users.

Rat Cytomegalovirus Vaccine Prevents Accelerated Chronic Rejection in CMV-Naïve Recipients of Infected Donor Allograft Hearts

Cytomegalovirus accelerates transplant vascular sclerosis (TVS) and chronic rejection (CR) in solid organ transplants; however, the mechanisms involved are unclear. We determined the efficacy of a CMV vaccine in preventing CMV-accelerated rat cardiac allograft rejection in naïve recipients of CMV+ donor hearts. F344 donor rats were infected with RCMV 5 days prior to heterotopic cardiac transplantation into CMV-naïve or H2 O2 -inactivated RCMV-vaccinated Lewis recipients. Recipients of RCMV-infected donor hearts rejected at POD59, whereas vaccinated recipients exhibited a significantly prolonged time to rejection-POD97, similar to recipients of uninfected donor hearts (POD108). Although all of the donor hearts were preinfected, the vaccinated recipients had lower graft and PBMC viral loads at POD 7 compared to unvaccinated controls. Adoptive T cell and passive antibody transfers from vaccinated Lewis rats into naïve recipients demonstrate that both T-cell and B-cell arms of the adaptive immune response provide protection against CMV-accelerated rejection. Similar findings were obtained when testing three different adjuvants in passive transfer experiments. We have determined that the timing of the vaccine prior to transplantation and the specific adjuvant play critical roles in mediating anti-viral responses and promoting graft survival. CMV vaccination prior to transplantation may effectively increase graft survival.

Contribution of organized and nonorganized activity to children's motor skills and fitness

BACKGROUND

To examine the associations between children's organized physical activity (OPA), nonorganized physical activity (NOPA), and health-related outcomes (fundamental movement skill [FMS] fitness).

METHODS

Cross-sectional survey of children aged 10-16 years (N = 4273). Organized physical activity and NOPA were assessed by self-report, FMS by process-orientated criteria, and fitness by 20-m shuttle run test.

RESULTS

Boys spent 97.5 minutes and girls 86.6 minutes in daily physical activity with the majority spent in OPA (boys, 56.3%; girls 60.5%). Organized physical activity increased with grade, whereas NOPA decreased. Organized physical activity and NOPA were associated with fitness, and OPA was consistently associated with FMS competency. Boys' fitness was associated with OPA and NOPA (adjusted odds ratio [AOR] 1.42, 95% confidence interval [CI]: 1.04, 1.94; AOR 1.26, 95% CI: 1.03, 1.54, respectively), FMS competency (side gallop leap, kick) with OPA and catch, and over-arm throw with both OPA and NOPA. Girls' fitness (AOR 2.62, 95% CI: 1.88, 3.66) and FMS competency were consistently associated with OPA.

CONCLUSIONS

Both OPA and NOPA are important contributors to children's physical activity; however, for girls, OPA was more strongly associated with fitness and FMS competency. Our findings support the importance of providing children with opportunities to engage in daily OPA. School physical education programs are an ideal delivery vehicle for OPA and need to be central to education policy.

Revisiting lifestyle risk index assessment in a large Australian sample: should sedentary behavior and sleep be included as additional risk factors?

OBJECTIVE

Most studies on multiple health behaviors include physical inactivity, alcohol, diet, and smoking (PADS), with few including emerging lifestyle risks such as sleep or sitting. We examined whether adding sitting and sleep to a conventional lifestyle risk index improves the prediction of cross-sectional health outcomes (self-rated health, quality of life, psychological distress, and physical function). We also explored the demographic characteristics of adults with these multiple risk behaviors.

METHODS

We used baseline data of an Australian cohort study (n=191,853) conducted in 2006-2008 in New South Wales. Lifestyle risk index was operationalized as 1) PADS, 2) PADS+sitting, 3) PADS+sleep, and 4) PADS+sitting+sleep. We estimated receiver operating characteristic curve for self-reported binary health outcomes and calculated the area under the curve to illustrate how well each index classified the outcome. We used multiple logistic regression to determine the demographic characteristics of adults with multiple lifestyle risks.

RESULTS

Adding sleep duration but not sitting time to the PADS index significantly improved the classification of all health outcomes. Men, those aged 45-54years, those with 10 years of education or less, and those living in regional/remote areas had higher odds of multiple risk behaviors.

CONCLUSIONS

Future research on multiple health behaviors might benefit from including sleep as an additional behavior. In Australia, unhealthy lifestyles tend to cluster in adults with certain demographic characteristics.

Does playground improvement increase physical activity among children? A quasi-experimental study of a natural experiment

Outdoor recreational spaces have the potential to increase physical activity. This study used a quasi-experimental evaluation design to determine how a playground renovation impacts usage and physical activity of children and whether the visitations correlate with children's physical activity levels and parental impressions of the playground. Observational data and intercept interviews were collected simultaneously on park use and park-based activity among playground visitors at pre- and postrenovation at an intervention and a comparison park during three 2-hour periods each day over two weeks. No detectable difference in use between parks was observed at followup. In the intervention park, attendance increased among boys, but decreased among girls although this (nonsignificant) decline was less marked than in the comparison park. Following renovation, there was no detectable difference between parks in the number of children engaged in MVPA (interaction between park and time: P = 0.73). At the intervention park, there was a significant decline in girls engaging in MVPA at followup (P = 0.04). Usage was correlated with parental/carer perceptions of playground features but not with physical activity levels. Renovations have limited the potential to increase physical activity until factors influencing usage and physical activity behavior are better understood.

Intra-crystalline protein diagenesis (IcPD) in Patella vulgata. Part I: Isolation and testing of the closed system

This study successfully isolates a fraction of intra-crystalline proteins from shells of the marine gastropod Patella vulgata and assesses the suitability of these proteins for IcPD (Intra-crystalline Protein Diagenesis) geochronology. We discuss the mineralogical composition of this gastropod, investigated for the first time by X-ray diffraction mapping, and use the results to inform our sampling strategy. The potential of the calcitic rim and of a bulk sample (containing both apex and rim) of the shell to act as stable repositories for the intra-crystalline proteins during diagenesis is examined. The composition and the diagenetic behaviour of the intra-crystalline proteins isolated from different locations within the shell are compared, highlighting the necessity of targeting consistent sampling positions. We induced artificial diagenesis of both intra-crystalline and whole-shell proteins by conducting high-temperature experiments in hydrous environment; this allowed us to quantify the loss of amino acids by leaching and therefore evaluate the open- or closed-system behaviour of the different fractions of proteins. The results obtained provide further confirmation that patterns of diagenesis vary according to the protein sequence, structure, and location within or outside the intra-crystalline fraction. As Patella is frequently found in the fossil record, both in archaeological and geological contexts, the application of IcPD geochronology to this biomineral opens up the possibility to obtain reliable age information from a range of sites in different areas of the world.

Statin use and clinical outcomes in older men: a prospective population-based study

OBJECTIVE

The aim of this analysis was to investigate the relationship of statins with institutionalisation and death in older men living in the community, accounting for frailty.

DESIGN

Prospective cohort study.

SETTING

Community-dwelling men participating in the Concord Health and Ageing in Men Project, Sydney, Australia.

PARTICIPANTS

Men aged ≥70 years (n=1665).

MEASUREMENTS

Data collected during baseline assessments and follow-up (maximum of 6.79 years) were obtained. Information regarding statin use was captured at baseline, between 2005 and 2007. Proportional hazards regression analysis was conducted to estimate the risk of institutionalisation and death according to statin use (exposure, duration and dose) and frailty status, with adjustment for sociodemographics, medical diagnosis and other clinically relevant factors. A secondary analysis used propensity score matching to replicate covariate adjustment in regression models.

RESULTS

At baseline, 43% of participants reported taking statins. Over 6.79 years of follow-up, 132 (7.9%) participants were institutionalised and 358 (21.5%) participants had died. In the adjusted models, baseline statin use was not statistically associated with increased risk of institutionalisation (HR=1.60; 95% CI 0.98 to 2.63) or death (HR=0.88; 95% CI 0.66 to 1.18). There was no significant association between duration and dose of statins used with either outcome. Propensity scoring yielded similar findings. Compared with non-frail participants not prescribed statins, the adjusted HR for institutionalisation for non-frail participants prescribed statins was 1.43 (95% CI 0.81 to 2.51); for frail participants not prescribed statins, it was 2.07 (95% CI 1.11 to 3.86) and for frail participants prescribed statins, it was 4.34 (95% CI 2.02 to 9.33).

CONCLUSIONS

These data suggest a lack of significant association between statin use and institutionalisation or death in older men. These findings call for real-world trials specifically designed for frail older people to examine the impact of statins on clinical outcomes.

microRNA biogenesis and turnover in plants

microRNAs (miRNAs) are short RNAs that regulate gene expression in eukaryotes. The biogenesis and turnover of miRNAs determine their spatiotemporal accumulation within tissues. miRNA biogenesis is a multistep process that entails transcription, processing, nuclear export, and formation of the miRNA-ARGONAUTE complex. Factors that perform each of these steps have been identified. Generation of mature miRNAs from primary transcripts, i.e., miRNA processing, is a key step in miRNA biogenesis. Our understanding of miRNA processing has expanded beyond the enzyme that performs the reactions, as more and more additional factors that impact the efficiency and accuracy of miRNA processing are uncovered. In contrast to miRNA biogenesis, miRNA turnover is an important but poorly understood process that contributes to the steady-state levels of miRNAs. Enzymes responsible for miRNA degradation have only recently been identified. This review describes the processes of miRNA maturation and degradation in plants.

Ascertaining invasive breast cancer cases; the validity of administrative and self-reported data sources in Australia

Background

Statutory State-based cancer registries are considered the ‘gold standard’ for researchers identifying cancer cases in Australia, but research using self-report or administrative health datasets (e.g. hospital records) may not have linkage to a Cancer Registry and need to identify cases. This study investigated the validity of administrative and self-reported data compared with records in a State-wide Cancer Registry in identifying invasive breast cancer cases.

Methods

Cases of invasive breast cancer recorded on the New South Wales (NSW) Cancer Registry between July 2004 and December 2008 (the study period) were identified for women in the 45 and Up Study. Registry cases were separately compared with suspected cases ascertained from: i) administrative hospital separations records; ii) outpatient medical service claims; iii) prescription medicines claims; and iv) the 45 and Up Study baseline survey. Ascertainment flags included diagnosis codes, surgeries (e.g. lumpectomy), services (e.g. radiotherapy), and medicines used for breast cancer, as well as self-reported diagnosis. Positive predictive value (PPV), sensitivity and specificity were calculated for flags within individual datasets, and for combinations of flags across multiple datasets.

Results

Of 143,010 women in the 45 and Up Study, 2039 (1.4%) had an invasive breast tumour recorded on the NSW Cancer Registry during the study period. All of the breast cancer flags examined had high specificity (>97.5%). Of the flags from individual datasets, hospital-derived ‘lumpectomy and diagnosis of invasive breast cancer’ and ‘(lumpectomy or mastectomy) and diagnosis of invasive breast cancer’ had the greatest PPV (89% and 88%, respectively); the later having greater sensitivity (59% and 82%, respectively). The flag with the highest sensitivity and PPV ≥ 85% was 'diagnosis of invasive breast cancer' (both 86%). Self-reported breast cancer diagnosis had a PPV of 50% and sensitivity of 85%, and breast radiotherapy had a PPV of 73% and a sensitivity of 58% compared with Cancer Registry records. The combination of flags with the greatest PPV and sensitivity was ‘(lumpectomy or mastectomy) and (diagnosis of invasive breast cancer or breast radiotherapy)’ (PPV and sensitivity 83%).

Conclusions

In the absence of Cancer Registry data, administrative and self-reported data can be used to accurately identify cases of invasive breast cancer for sample identification, removing cases from a sample, or risk adjustment. Invasive breast cancer can be accurately identified using hospital-derived diagnosis alone or in combination with surgeries and breast radiotherapy.

Abstract P3-06-28: Use of the MiCK drug-induced apoptosis assay improves clinical outcomes in recurrent breast cancer (BRCA)

Background: The microculture kinetic (MiCK) assay (Correct Chemo™) correlates with outcomes in acute myelocytic leukemia and ovarian cancer (Cancer Research, in press). A prior trial suggested that its use in breast cancer could improve clinical outcomes (Cancer, in press). This study was designed to correlate MiCK assay results with clinical outcomes in recurrent or metastatic BRCA.

Methods: 30 patients with recurrent or metastatic breast cancer in 4 different institutions were evaluated. Each patient (pt) had a BRCA biopsy sent to a central laboratory, tumor cells were purified to over 90% homogeneity, and were then cultured with individual drugs or drug combinations. The induction of apoptosis was measured every five minutes continuously for 48 hours. The amount of apoptosis was expressed in kinetic units (KU), and results were sent to the attending oncologist within 72 hours of submission. Physicians were free to choose any treatment plan for the pts, and were free to add hormonal therapy or biotherapy. Clinical results were evaluated by oncologists using clinical criteria and the results of the MiCK assay were correlated with outcomes of complete (CR) or partial (PR) response, time-to-relapse (TTR), and overall survival (OS).

Results: Median age was 57 years, and number of lines of prior therapy was a median of 2 (range 1–8). Median ECOG performance status was 1. The total number of drugs tested in the assay was a median of 12 (range 3–31). The MiCK assay was used to help select therapy in 22 pts (73%). There was change between drugs originally planned before MiCK assay and drugs used after MiCK in 15 pts (50%). The best therapy from the MiCK assay was used for treatment in 16 pts (53%). In five pts (17%), a single drug was used in place of a combination. Generic drugs were used in place of proprietary drugs in nine pts (30%). Hormonal therapy was added to drugs selected based on the MiCK assay in seven pts (23%), and bio-therapy drugs were added to chemotherapy drugs in eight pts (27%). If the MiCK results were used to help select therapy, eight pts had a CR or PR (27%), compared to 0 pts with CR or PR if MiCK was not used (p = 0.04). If the MiCK assay was used to determine therapy, 17 pts (59%) had a CR, PR or stable disease compared to only 2 pts (6.9%) in whom the MiCK assay was not used (p &lt; 0.01). The TTR was significantly longer if the MiCK assay was used to select chemotherapy, 7.4 months, compared to only 2.2 months if the MiCK assay was not used (p &lt; 0.01). There was a trend toward longer survival if the MiCK assay was used, 16.8 months, compared to 13.1 months if the MiCK assay was not used, but the difference was not statistically significant (p = 0.3). If the best chemotherapy from the MiCK assay was used, there were trends for increased TTR (7.3 vs 3.9 mo if best not used p = 0.13) and increased rate of CR or PR or stable (54% vs 17% p = 0.11).

Conclusions: Use of the MiCK assay to determine chemotherapy was associated with a higher response rate and a longer time to relapse in pts with recurrent or metastatic BRCA. It is possible that OS is also improved, but longer follow up is needed. There was a trend for improved outcomes if the best chemotherapy based on the MiCK assay was used.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-06-28.

Characteristics of Australian cohort study participants who do and do not take up an additional invitation to join a long-term biobank: The 45 and Up Study

BACKGROUND

Large-scale population biobanks are critical for future research integrating epidemiology, genetic, biomarker and other factors. Little is known about the factors influencing participation in biobanks. This study compares the characteristics of biobank participants with those of non-participants, among members of an existing cohort study.

METHODS

Individuals aged 45 and over participating in The 45 and Up Study and living ≤20km from central Wagga Wagga, New South Wales (NSW), Australia (rural/regional area) or ≤10km from central Parramatta, NSW (urban area) (n=2340) were invited to join a biobank, giving a blood sample and having additional measures taken, including height, weight, waist circumference, heart rate and blood pressure.

RESULTS

The overall uptake of the invitation to participate was 33% (762/2340). The response rate was 41% (410/1002) among participants resident in the regional area, and 26% (352/1338) among those resident in the urban area. Characteristics associated with significantly decreased participation were being aged 80 and over versus being aged 45-64 (participation rate ratio: RR = 0.45, 95%CI 0.34-0.60), not being born in Australia versus being born in Australia (0.69, 0.59-0.81), having versus not having a major disability (0.54, 0.38-0.76), having full-time caregiving responsibilities versus not being a full-time carer (0.62, 0.42-0.93) and being a current smoker versus never having smoked (0.66, 0.50-0.89). Factors associated with increased participation were being in part-time work versus not being in paid work (1.24, 1.07-1.44) and having an annual household income of ≥$50,000 versus <$20,000 (1.50, 1.26-1.80).

CONCLUSIONS

A range of socio-economic, health and lifestyle factors are associated with biobank participation among members of an existing cohort study, with factors relating to health-seeking behaviours and access difficulties or time limitations being particularly important. If more widespread participation in biobanking is desired, particularly to ensure sufficient numbers among those most affected by these issues, specific efforts may be required to increase participation in certain groups such as migrants, the elderly, and those in poor health. Whilst caution should be exercised when generalising estimates of absolute prevalence from biobanks, estimates for many internal comparisons are likely to remain valid.

Randomised trial investigating the relationship of response rate for blood sample donation to site of biospecimen collection, fasting status and reminder letter: the 45 and Up Study

Background

Various options exist for collecting biospecimens and biomarkers from cohort study participants, and these have important logistic, resource and scientific implications. Evidence on how different collection methods affect participation and data quality is lacking. This parallel-design randomised trial, the Link-Up Study, involved blood sample donation and other data collection among participants in an existing cohort study, The 45 and Up Study. It aimed to investigate the relation of fasting status, reminder letters and data collection site to response rates, data quality and biospecimen yield.

Methods

Individuals aged 45 and over participating in The 45 and Up Study and living ≤20 km from central Wagga Wagga, NSW (regional area) or ≤10 km from central Parramatta, NSW (urban area) (n = 2340) were randomised, stratified by area of residence, to be invited to give a blood sample and additional data by attending either a clinic established specifically for the trial, with an appointment time (“dedicated clinic”, n = 1336) or an existing local commercial pathology centre (n = 1004). Within dedicated clinic groups, participants were randomised into fasting (n = 668) or non-fasting (n = 668) and, at the Parramatta pathology centre site, reminder letter after two weeks (n = 336) or no reminder (n = 334).

Results

Overall, 33% (762/2340) of invitees took part in the Link-Up Study; 41% (410/1002) among regional and 26% (352/1338) among urban-area residents (p < 0.0001). At the dedicated clinics, response rates were 38% (257/668) not fasting and 38% fasting (257/668) (participation rate ratio (RR) = 1.00, 95%CI 0.91-1.08, p = 0.98). The response rate was 22% among individuals randomised to attend the Parramatta pathology centre without a reminder and 23% among those sent a reminder letter (RR = 1.01, 0.93-1.09, p = 0.74). In total, the response rate was 38% (514/1336) at the dedicated clinics and 25% (248/1004) at the pathology centres (RR = 0.67, 0.56-0.78, p < 0.01); measures of height, weight and systolic and diastolic blood pressure did not vary materially between these groups, nor did the median number of aliquots of plasma, buffy coat and red cells collected.

Conclusions

Among cohort study participants, response rates for an additional study involving biospecimen collection, but not data quality or average biospecimen yield, were considerably higher at dedicated clinics than at existing commercial pathology sites.

Bone mineral crystallisation kinetics

The kinetics of bone apatite crystallisation are examined using a novel approach to obtain quantitative, direction dependence features such as growth rate and activation energy. X-ray diffraction was employed for analysis of bovine, porcine and 'anorganic' bone specimens. Apatite coherence length was utilised as the independent variable within a Johnson-Mehl-Avrami (JMA) model. A direction averaged crystallisation activation energy of 183 ± 8 kJ mol(-1) was observed for the three bone groups. The Johnson-Mehl-Avrami 'n' exponent decreased with increasing temperature for all bone groups, indicating that apatite crystallisation changes to a diffusion limited process at higher temperatures. The results revealed little evidence to support any organic component 'protective' effect, and, on the contrary indicated that the organic matrix promotes apatite crystallisation.

Monaural conductive hearing loss alters the expression of the GluA3 AMPA and glycine receptor α1 subunits in bushy and fusiform cells of the cochlear nucleus

The impact of conductive hearing loss (CHL), the second most common form of hearing loss, on neuronal plasticity in the central auditory pathway is unknown. After short-term (1 day) monaural earplugging, the GluA3 subunits of the AMPA receptor (AMPAR) are upregulated at auditory nerve synapses on the projection neurons of the cochlear nucleus; glycine receptor α1 (GlyRα1) subunits are downregulated at inhibitory synapses in the same neuronal population. These data suggest that CHL affects receptor trafficking at synapses. We examined the impact of 7 days of CHL on the general expression of excitatory and inhibitory receptors by quantitative biochemistry and immunohistochemistry, using specific antibodies to detect AMPAR subunits (GluA1, GluA2, GluA2/3, and GluA4), GlyRα1, and the GABA(A) receptor subunits β2/3. Following monaural earplugging and an elevation of the hearing threshold by approximately 35 dB, the immunolabeling of the antibody for the GluA2/3 subunits but not the GluA2 subunit increased on bushy cells (BCs) and fusiform cells (FCs) of the ipsilateral ventral and dorsal cochlear nuclei. These same cell types showed a downregulation of the GlyRα1 subunit. Similar results were observed in the contralateral nuclei. The expression levels of GABA(A) β2/3 were unchanged. These findings suggest that, following longer periods of monaural conductive hearing loss, the synthesis and subsequent composition of specific glutamate and glycine receptors in projection neurons and their synapses are altered; these changes may contribute to abnormal auditory processing.