The instruments used to code communication factors included: audi

The instruments used to code communication factors included: audiotapes

( Carter et al 1982, Fiscella et al 2004, Takayama and Yamazaki 2004), videotapes ( Harrigan et al 1985), real-time observation ( Perry 1975), and questionnaires ( Berrios-Rivera et al 2006, Garcia-Gonzalez et al 2009, Keating et al 2004, Keating et al 2002, Ommen et al 2008, Tarrant et al 2003, Thom 2001). The coders were patients in seven studies (Berrios- Rivera et al 2006, Garcia-Gonzalez et al 2009, Keating et al 2004, Keating et al 2002, Ommen et al 2008, Tarrant et al 2003, Thom 2001), and neutral observers in five studies ( Carter et al 1982, Fiscella et al 2004, Harrigan et al Afatinib 1985, Perry 1975, Takayama and

Yamazaki 2004). Further details about study characteristics are summarised in Table 2. Therapeutic alliance constructs: The constructs of therapeutic alliance included in the analysis were trust ( Berrios-Rivera et al 2006, Fiscella et al 2004, Garcia-Gonzalez et al 2009, Keating et al 2004, Keating et al 2002, Ommen et al 2008, Thom 2001), agreement ( Carter et al 1982), communicative success ( Takayama and Yamazaki 2004), and rapport ( Harrigan et al 1985, Perry 1975). Measure of association used in each study varied considerably including correlation coefficients (Pearson, Spearman and Point-biserial), relative risks, odds ratio, and parameters from multivariate http://www.selleckchem.com/products/pd-0332991-palbociclib-isethionate.html analysis (parameter estimates and r-square). For those communication factors with correlation r, the magnitude of association was reported in forest plots ( Figures 2 and 3). Pooling was possible for only two interaction styles ( Figure 2). All communication factors found, including measures of association and whether the factor was statistically significant (p < 0.05) or not, are described in Appendices 2, 3 and 4 (available on the eAddenda.) For rating constructs of therapeutic alliance, in the majority of included studies (n = 9) patients

rated the outcomes ( Berrios-Rivera et al 2006, Fiscella Org 27569 et al 2004, Garcia-Gonzalez et al 2009, Harrigan et al 1985, Keating et al 2004, Keating et al 2002, Ommen et al 2008, Takayama and Yamazaki 2004, Tarrant et al 2003, Thom 2001), two studies used neutral observers ( Harrigan et al 1985, Perry 1975), and one study considered the concordance between patients and practitioner ratings ( Carter et al 1982). Further details about study characteristics are summarised in Table 2. Verbal factors: Seventeen verbal factors were included in this review. Of these, two were categorised as information gathering, seven were categorised as patient involving, one as patient facilitating, one as patient supporting, and six as patient education.

From several independent

From several independent EPZ5676 price measurements, means and standard deviations were calculated. Data are shown as mean ± SD from at least three separate

experiments. Testing for significant differences between means was carried out using one-way ANOVA and Dunnett’s Multiple Comparison test at a probability of error of 5% (*), 1% (**) and 0.1% (***). Two silica-based NPs were investigated: 1. Sicastar Red (amorphous silica; primary particles ca. 30 nm in diameter) and 2. AmOrSil [(poly(organosiloxane) with a shell of poly(ethylene oxide), PEO, to ensure particle solubility in water; primary particles ca. 60 nm in diameter)]. Fig. 1A depicts the viability (MTS assay) and membrane integrity (LDH assay) of the lung epithelial cell line H441 and the microvascular endothelial

cell line ISO-HAS-1 cultured in conventional monocultures (MC) after exposure to Sicastar Red and AmOrSil for 4 h in serum-free medium. According to MTS, H441 showed a significantly reduced viability at high concentrations of Sicastar Red (100 μg/ml: 14 ± 12%; 300 μg/ml: 60 ± 12% compared to untreated control uc), whereas AmOrSil did not have any effect (e.g. 300 μg/ml: 109 ± 12% compared to uc). Similar observations have been made for the microvascular endothelial cell line ISO-HAS-1 with Sicastar Red (300 μg/ml: 36 ± 18% and 100 μg/ml: 34 ± 4% of uc) as well as AmOrSil (300 μg/ml 111 ± 15% of uc). Sicastar Red did not cause a significant decrease in the mitochondrial activity at 60 μg/ml for both cell types (H441: 98 ± 15%

and ISO-HAS-1: 99 ± 12% of uc). With respect to GW3965 viability, similar effects were obtained for the membrane integrity after NP exposure. H441 showed a significant release of LDH after 4 h exposure to Sicastar Montelukast Sodium Red (300 μg/ml: 90 ± 7.5%, 100 μg/ml: 70 ± 13.6%, 60 μg/ml: 46 ± 22% of lysis control lc), whereas 6 μg/ml Sicastar Red did not show any toxic effects (14.2 ± 12% of lc). Similar to H441, ISO-HAS-1 also displayed a high LDH release at high concentrations (300 μg/ml: 77 ± 7.5%, 100 μg/ml: 57 ± 18% of lc) but not at 60 μg/ml (12 ± 5% of lc). AmOrSil did not cause a change in membrane integrity even at high concentrations of 300 μg/ml in H441 or ISO-HAS-1 (H441: 13 ± 11% and ISO-HAS-1: 4 ± 2.8% of lc). According to Fig. 1B, LDH release into the apical compartment (H441) of the coculture (CC) was firstly detected at a concentration of 100 μg/ml Sicastar Red (30 ± 5.6% of lysis control, 2-fold of untreated control uc), but to a lower extent as observed for the H441 in MC (57 ± 18% of lc). The LDH release of the H441 in CC further increased with increasing concentrations (300 μg/ml: 49.3 ± 12.4% of lc), which is also lower compared to the MC (90 ± 7.5% of lc). A concentration of 60 μg did not yield higher LDH levels (10.4 ± 2.5% of lc) on the contrary to the MC (46 ± 22% of lc).

This difference may be due to our use of SVP that contained R848

This difference may be due to our use of SVP that contained R848 covalently linked to the PLGA polymer with an acid-labile bond, a design intended to constrain R848 release to the acidic environment within the

endosome. SVP encapsulation of a TLR9 agonist, CpG-1826, also provided significant benefit. CpG-1826 belongs to type B CpG, capable of activating B cells and inducing the production of proinflammatory cytokines [14], [72] and [73]. CpG-1826 encapsulation within SVP provided for higher local cytokine production and, when co-delivered with encapsulated antigen, resulted in higher immune responses than antigen admixed with free CpG-1826. Unmodified CpG contains a nuclease-labile phophodiester backbone (PO-CpG) which is known to be rapidly degraded in vivo,

thus parenterally Olaparib datasheet administered free CpG must be modified to contain a nuclease resistant phosphorothioate backbone (PS-CpG) to be active in vivo. Importantly, SVP encapsulation enabled utilization of the non-phosphorothioate form of CpG (i.e., PO-CpG) with EPZ5676 purchase the same efficiency as PS-CpG. The use of PO-CpG in SVPs may further reduce the potential for systemic immune activation, as any PO-CpG that leaks out of the nanoparticles will be rapidly degraded. Nanoparticle encapsulation of both antigen and adjuvant may have a synergistic benefit by enabling co-delivery Adenylyl cyclase of both antigen and adjuvant to APC. The SVP technology allows for

either covalent or non-covalent entrapment of a TLR agonist as well as covalent and non-covalent presentation of antigen on the surface or within the nanoparticle. The SVPs are designed to release their payload in the low pH environment of the endolysosomal compartment of APC, which contains TLR7, 8, and 9 as well as MHC class II molecules. The sustained and concomitant release of antigen and adjuvant from SVPs could also contribute to more potent immune responses and better memory cell generation. Our data show that adjuvant and antigen can be delivered in separate nanoparticles. The ability to utilize independently formulated antigen- and TLR-agonist-carrying nanoparticles may be advantageous for modular and flexible vaccine design. For example, a two particle approach can provide flexibility in dosing to optimize the ratio of adjuvant-to-antigen for a particular application. While vaccines have been an effective and cost-efficient health care intervention for the prophylaxis of many infectious pathogens, new vaccine technology and more potent adjuvants may be required to develop effective therapeutic vaccines for chronic infections, intracellular pathogens, and non-infectious diseases, such as cancer. The immune system is keyed to respond to particulate antigens, such as viruses and bacteria.

Après 35 ans, se pose le problème de la détection de la maladie c

Après 35 ans, se pose le problème de la détection de la maladie coronaire, donc de la place de l’épreuve d’effort (EE) qui sera détaillée ci-dessous. Légalement, le coût de la VNCI est à la charge du sportif, de son club ou de sa fédération. Il regroupe l’interrogatoire et l’examen physique. L’interrogatoire

est essentiel. Il peut s’appuyer sur un questionnaire téléchargeable sur le site internet de learn more la Société française de l’exercice et de médecine du sport (www.sfms.asso.fr). Il doit être complété par un interrogatoire personnalisé. Les éléments cardiovasculaires majeurs sont la recherche chez un membre de la fratrie (premier degré) d’un antécédent de mort subite (< 50 ans) et/ou d’une cardiopathie génétique et, sur le plan personnel,

des facteurs de risque cardiovasculaire individuels et la prise de traitements ou de compléments nutritionnels. Il précise de manière « policière », car parfois minimisés ou oubliés, les signes fonctionnels (douleur thoracique, fatigue ou essoufflement anormaux, palpitations, malaise) liés à l’effort. L’examen physique, classiquement complet, repose sur une auscultation cardiaque du sujet couché ou assis puis debout, de la vérification de la symétrie des pouls aux membres supérieurs et inférieurs pour éliminer une coarctation aortique, la recherche Anti-diabetic Compound Library nmr de signes de Marfan et la mesure de la pression artérielle aux deux bras à distance d’une séance d’entraînement. La réalisation et l’interprétation de l’ECG doivent être classiques. Le praticien ne doit se poser qu’une seule question : l’ECG est-il normal ou non ? Le but n’est pas de faire un diagnostic étiologique, mais de guider d’éventuels examens complémentaires cardiovasculaires en cas d’anomalie. Si l’ECG est anormal, un avis cardiologique doit être demandé. Il est trop classiquement rapporté que l’ECG du sportif présente des particularités. Cette affirmation mérite d’être tempérée. En effet, il ne faut pas relier trop facilement des « anomalies » électrocardiographiques à la pratique sportive. Une pratique sportive

moyenne, à savoir moins de 4 h de sport intense par semaine (environ 80 % des sportifs qui consultent), ne modifie pas significativement l’ECG, en dehors d’une baisse modeste et facultative however de la fréquence cardiaque et d’un bloc de branche droit incomplet [28]. Des particularités ECG significatives ne peuvent se voir que chez certains sportifs qui pratiquent au moins 6 h par semaine de sport intense et depuis plus de 6 mois (tableau I et figure 1). Toutes les autres anomalies ECG nécessitent un avis cardiologique, ce qui n’est pas synonyme d’une interdiction de pratique sportive. Compte tenu du risque vital potentiel d’une cardiopathie ignorée, aucun doute n’est acceptable pour autoriser la pratique d’un sport intense. Ainsi, la présence de symptômes chez un sportif ne doit jamais être banalisée et impose toujours un bilan cardiovasculaire.

Higher

scores for neighborhood safety for riding were ass

Higher

scores for neighborhood safety for riding were associated with lower projected changes in riding frequency. Reported street connectivity, however, was associated with higher projected changes in riding frequency. Objective built environment features were unrelated to projected changes in riding frequency. LDK378 nmr Although 71% of participants had access to a bicycle, 60% of owners reported never riding. Because concern about traffic danger was previously reported as the major barrier to bicycling (Dill, 2009, Handy et al., 2002, Shenassa et al., 2006 and Wood et al., 2007), all participants were asked to project how much they would bicycle if they thought they were safe from cars. Considering both bicycle owners and non-owners, the projected percent who never rode might decrease from Akt inhibitor 71% to 34%, and the percent who would ride at least weekly might increase from about 9% to 39%. Improving safety from cars has the potential to attract many new riders, because about 44% of non-owners and 59% of owners who never rode stated they would start riding at least once per week. Although these projected increases may not translate exactly into behavior change,

the large self-projected increases imply that interventions to improve safety from cars have the potential to substantially increase the number of bicyclists and their frequency of bicycling. One recommendation is to make efforts to protect bicyclists from cars a central goal of multi-strategy bicycle interventions. Improving safety from traffic might provide the most benefits to those most in need. Multivariable analyses showed non-Whites (including Hispanics), those who perceive their neighborhoods

as least safe for bike riding, and those reporting higher street connectivity would have larger projected increases in cycling if they felt safe from traffic. Most of these variables were Ketanserin correlated with lower current frequency of cycling. Targeting traffic safety and bicycle infrastructure interventions to racial-ethnic minority neighborhoods and areas that are least safe for bicycling could be expected to be effective and cost-efficient. In general, bicycle owners appeared to be affluent and have demographic profiles consistent with a low risk of chronic diseases (LaVeist, 2005), compared to non-owners. Bicycle owners were more likely to live in places rated better for pedestrian safety. Though places that are safe from traffic may encourage people to purchase bicycles, the role of walkability, if any, is unclear. Neighborhood environment characteristics were not strong or consistent correlates of bicycling frequency. This may be due to lack of detailed assessment of bicycling facilities such as separated bike paths.

The dried extract was dissolved in respective solvents prior to a

The dried extract was dissolved in respective solvents prior to assay. The total phenolic content (mg of catechin/1 mg) was determined

using Folin–Ciocalteu reagent5 and total flavonoid content (catechol equivalents/1 mg) was determined by aluminium chloride method.6 The reductive ability of the extracts was determined by potassium ferricyanide reduction method.7 The hydrogen or electron donation ability of the plant extracts was measured from bleaching of the purple colour of DPPH.8 Scavenging activity of extracts on superoxide anion radicals was determined based on the reduction of nitroblue tetrazolium (NBT).9 Hydroxyl radical scavenging and the ferrous ion-chelating potential of the extracts were measured following deoxyribose assay10 and ferrozine assay11 respectively. Thiobarbituric acid reactive substance assay PD-1/PD-L1 inhibitor 2 was employed R428 research buy to determine anti-lipid peroxidation assay using goat liver homogenate.12 All analyses were carried

out in triplicates. Data were presented as mean ± SD. Radical scavenging activity of extracts was expressed in terms of percentage of inhibition. DPPH, superoxide radical scavenging, hydroxyl radical scavenging and metal ion-chelating assay were calculated using the following equation: % Inhibition = (Absorbance of control − Absorbance of sample)/Absorbance of control × 100, and the anti-lipid peroxidation percentage was calculated using the formula: % ALP = (Absorbance of Fe2+ induced peroxidation-Absorbance of sample)/Absorbance of Fe2+ induced peroxidation-Absorbance of control × 100. The IC50 value was determined using Easy Plot software. The total phenolic contents of aqueous and methanolic extracts of A. solanacea leaves were 0.030 ± 0.01 and 0.040 ± 0.02 mg of catechin equivalents/1 mg dried extract respectively and the corresponding flavonoid contents were 0.257 ± 0.02 and 0.404 ± 0.03 mg of catechol equivalents/1 mg dried aqueous and methanolic extracts. Both the extracts showed powerful reducing power that increased linearly with concentration. The methanolic extract demonstrated powerful reduction

potential as compared to aqueous extract (Fig. 1). The IC50 values of methanolic and aqueous extracts for DPPH radical scavenging activity were 198.43 ± 1.30 CYTH4 and 378.67 ± 2.5 μg/ml (Fig. 2) respectively which showed a marked difference with ascorbic acid standard (IC50 = 7.6 ± 0.20 μg/ml). The methanolic extract exhibited superoxide radical scavenging activity (Fig. 3) with an IC50 value of 1634. 97 ± 4.08 μg/ml and showed a significant difference when compared with butylated hydroxy anisole (IC50 value of 23.6 ± 0.86 μg/ml). The percentage inhibition of hydroxyl radical scavenging activity of the aqueous and methanolic extracts was found to be 62.81% and 92.89% respectively at 2000 μg/ml. Compared to all the other assays, at the lowest concentration (25 μg/ml) tested, the methanolic extract of A. solanacea was the one that showed higher (86.71%) free radical scavenging ability.

Osteoarthritis is a leading cause of musculoskeletal pain and dis

Osteoarthritis is a leading cause of musculoskeletal pain and disability. The most recent Global Burden of Diseases study, published in The Lancet in 2012, found that, of

the musculoskeletal conditions, the burden associated with Cell Cycle inhibitor osteoarthritis is amongst the most rapidly increasing ( Vos et al 2012). Hip osteoarthritis is extremely debilitating for affected individuals. Pain is a dominant symptom, becoming persistent and more limiting as disease progresses. Patients with hip osteoarthritis also report difficulty with functional activities such as walking, driving, stair-climbing, gardening, and housekeeping ( Guccione et al 1994) as well as higher levels of anxiety and depression ( Murphy et al 2012). Work productivity is affected with greater absenteeism, while fatigue and sleep problems are common ( Murphy et al 2011). Furthermore, people with osteoarthritis typically suffer from a range of co-morbid diseases that further increases their likelihood of poor physical function ( Guh et al 2009). Hip osteoarthritis

imposes a substantial economic burden, with most costs related to a range of conservative and surgical treatments, lost productivity, and substantial loss of quality of life (Dibonaventura et al 2011). In particular, rates of costly hip joint replacement surgery for advanced disease are increasing including a shift in the demographic of recipients to younger patients (Australian Orthopaedic Association National Joint Replacement Registry 2012, Ravi et LBH589 ic50 al 2012). Clearly hip osteoarthritis

Rebamipide is associated with considerable individual and societal burden and, given that there is currently no cure for the disease, treatments that reduce symptoms and slow functional decline are needed. The development of hip osteoarthritis results from a combination of local joint-specific factors that increase load across the joint acting in the context of factors that increase systemic susceptibility (Figure 1). Age is a well-established risk factor for hip osteoarthritis as are developmental disorders such as congenital hip dislocation, slipped capital femoral epiphysis, Perthes disease, and hip dysplasia (Harris-Hayes and Royer 2011). More recently, femoroacetabular impingement, which refers to friction between the proximal femur and acetabular rim due to abnormal hip morphology and is seen in younger active individuals, has been implicated as increasing the risk of hip osteoarthritis (Harris-Hayes and Royer 2011). Caucasians appear to have a higher prevalence of hip osteoarthritis compared to Asian, African, and East Indian populations. Albeit based on limited or inconsistent evidence, hip osteoarthritis also appears to be associated with obesity, occupations involving heavy lifting and farming, high volume and intensity of training particularly in impact sports, and leg length discrepancy (Suri et al 2012).

4B) or functional “quality”, demonstrating the potential at least

4B) or functional “quality”, demonstrating the potential at least in mice for these subunit vaccine platforms to be combined and administered using a single formulation. Adenoviral prime–MVA boost regimes induce antibody and CD8+ T cell responses equivalent or superior to a range of heterologous and homologous adenovirus-only two-stage regimes[5], making this immunization approach the current ‘gold-standard’

among adeno- and pox-viral vectored regimes. This study primarily sought to assess whether the antibody immunogenicity of our existing A–M PfMSP1 regime could be enhanced by the addition of a protein-adjuvant vaccine Ibrutinib manufacturer component, and has demonstrated that an encouraging combination of cellular and humoral responses can be achieved

by this three-platform strategy. The protein available to us – a Pichia produced, sequence-unmodified PfMSP119 originally used in an NMR structural study – is likely to be conformationally accurate [33]. Good correlations between anti-PfMSP119 ELISA titer and IgG-mediated in vitro growth inhibitory activity (GIA) against P. falciparum strains have previously been demonstrated both for our viral vectored vaccines and for a range of protein PfMSP119 vaccines [5] and [44]. Direct GIA measurement was not possible with the small quantities of mouse serum available Y 27632 in this study. As the protein antigen used here was only a portion of the viral-vector antigen, caution is necessary in the interpretation of our

results. Although the use of BALB/c mice facilitated the investigation of antibody responses, which was our primary aim, some of the studies undertaken here could have benefited from detectable T cell responses Ketanserin against the MSP119 moiety, which is small and poorly processed [45]. In future studies PfMSP142 might be preferable as a protein antigen due to the known induction of T cell responses against MSP133 epitopes in P. yoelii and P. falciparum as well as against PfMSP133 in humans [5], [6] and [46]. Despite this, our results clearly show that protein did not prime or boost appreciable CD8+ T cell responses in C57BL/6 mice in which a CD8+ T cell epitope is present in PfMSP119. However, we have not yet fully investigated the potential effects of viral vector/protein-adjuvant mixing on CD8+ T cell responses when there is a CD8+ T cell epitope in a larger protein antigen that is less refractory to antigen processing. There is a possibility that CD4+ T cell responses at sub-detectable levels to epitopes present in the viral vector antigen but absent from the protein antigen may have contributed to the reliability of the viral vector priming, although the superior reliability of viral vector priming does not seem to be unique to this antigen (de Cassan et al., unpublished observations). Our results demonstrate that adenovirus is a highly reliable primer of antibody and CD8+ T cell responses.

Their response was published in the Bulletin of the Association o

Their response was published in the Bulletin of the Association of Swiss Physicians (FMH), and was subsequently distributed by CFV to physicians. Available on the Internet, it informs the public on the non-objectivity of the brochure

as it relates to vaccination questions. Indeed, a group of experts made up of members of the CFV has provided Selisistat order responses to questions raised by the brochure in a document titled Guide sur les vaccinations: évidences et croyances [3] (a guide for vaccinations: evidence and beliefs). Preparation of meetings, including setting agendas and proposing areas of work, is shared between the committee and the Secretariat under the auspices of FOPH, within the Federal Department of Home Affairs. FOPH and external bodies can make suggestions but cannot impose them; theoretically, proposals can come from different political or medical groups, such as medical societies concerned with occupational health. At each meeting, the CFV identifies issues for future discussion. These issues may be identified

during the commission’s work meetings, or be requested by other commissions, specialist groups, physicians or other involved parties. All topical requests that fall under the competencies of the CFV, in particular those concerning vaccines, prevention strategies and applications, check details can be brought to the CFV’s attention through the Secretariat. Vaccination recommendations must be based on scientific evidence, integrating whenever possible a hierarchical classification system for study validity. This analytical framework is used as a foundation for discussions within the CFV, as well as for approaching the federal commission concerning the benefits of compulsory health insurance. The potential benefits of each vaccine for individual and public health are identified by the CFV, in collaboration with the FOPH, after a rigorous assessment of numerous parameters

in response to a series others of analytical questions. The working group for new vaccines has decided to develop an analytical framework allowing for a systematic and exhaustive assessment of all factors pertinent to the decision-making process and ultimately for the recommendation of a vaccine. A similar process was already established in Quebec and was made available to the commission. Quebec’s process was adapted to Swiss needs and is comprised of a series of essential questions as well as a list of elements requiring analysis. The questions are as follows [4]: • Do the properties of the vaccine allow for the establishment of an efficacious and safe recommendation? Using answers to these questions as a basis, the CFV has established four categories of vaccines for recommended use: 1. Basic vaccines – they are essential to individual and public health, and offer a level of protection that is indispensable to people’s well-being (e.g., diphtheria, tetanus, pertussis, polio, MMR, HBV, HPV).

After review of abstracts and full-text articles, 17 trials were

After review of abstracts and full-text articles, 17 trials were included in the review. Data from 13 of the trials were included in the meta-analyses. The flow of studies through the review is presented in Figure 1. The 17 included trials involved 2689 participants. The characteristics of these trials are presented in Table 1. All trials except one18 satisfied the first item on the PEDro scale, which relates to the eligibility criteria and source of participants and does not contribute to the total score. The remaining PEDro item ratings and total scores for

the included Epigenetics inhibitor trials are presented in Table 2. The median PEDro score of the included trials was 6 (range 3 to 8), indicating that the methodological quality of the included trials varied Ion Channel Ligand Library purchase from poor to good. The sample sizes of the included trials ranged from 41 to 406, consisting mainly of male participants. The experimental interventions included exercise training, inspiratory muscle training, education, relaxation, counselling, and complex/multiple interventions. Outcome data from at least one trial were available

for postoperative pulmonary complications, time to extubation, length of stay in ICU and the hospital, physical function and costs. Based on data from six trials (661 participants), there was a significant reduction in the relative risk of developing postoperative pulmonary complications with preoperative intervention, Fossariinae as presented in Figure 2. When the results from trials included in this meta-analysis were pooled, no heterogeneity was present and the pooled relative risk of developing postoperative pulmonary complications was 0.39 (95% CI 0.23 to 0.66). The relative risk reduction was 61% and the number needed to treat was 12 (95% CI 8 to 27). Preoperative intervention shortened the time to extubation by a pooled mean difference of 0.14 days (95% CI 0.01 to 0.26), based on data from four trials (291 participants). There was moderate heterogeneity in the analysis, which is presented in Figure 3. Meta-analysis of data from three trials (233

participants) indicated a non-significant reduction in ICU length of stay due to preoperative intervention, with a pooled mean difference of -0.15 days (95% CI -0.37 to 0.08) and low heterogeneity, as presented in Figure 4. Data from ten trials (1573 participants) showed no significant effect on hospital length of stay, with a pooled mean difference of -0.55 days (95% CI -1.32 to 0.23) and moderate heterogeneity, as presented in Figure 5. Exploratory meta-regression demonstrated no influence on this outcome by study design, geographical region, or type of intervention (either intensive education versus booklet only, or breathing exercises versus no breathing exercises). Age, however, had a significant effect (I2 = 26%, co-efficient = -0.08 (SE 0.03), p = 0.04).