bluuebunny/crossref_metadata_2025 huggingface dataset:
Gênero e super-heróis: o traçado do corpo masculino pela norma
Authors: Beiras Adriano , Lodetti Alex , Cabral Arthur Grimm , Toneli Maria Juracy Filgueiras , Raimundo Pablo
Published: January 2008

As Histórias em Quadrinhos de super-heróis ganham vida na imaginação dos leitores, estabelecendo fortes ligações com seu cotidiano. Um corpo musculoso e viril vem historicamente se tornando o referencial de corporeidade masculina, enquanto corpos que desviam desse modelo são comumente satirizados ou excluídos da mídia. Este ensaio objetiva discutir as formas de representação do corpo masculino nas HQs da DC Comics, especificamente nas histórias de Superman e de Batman, conforme a caracterização de personagens como "heróis", "vilões" ou "coadjuvantes". Nossa premissa é a de que estas caracterizações remetem a tendências distintas de representação dos corpos, (re)produzindo normas sociais e valores de estética sobre as corporeidades.
O que conhecemos sobre o trabalho infantil?
Authors: Kassouf Ana Lúcia
Published: January 2008

O interesse em pesquisas e análises econômicas sobre o trabalho infantil ressurge por volta de 1995, principalmente graças à crescente ênfase na redução da pobreza e na acumulação de capital humano para se obter desenvolvimento, que faz com que o trabalho de crianças seja visto como um impedimento ao progresso econômico. As análises empíricas visando obter as causas, conseqüências e soluções para o trabalho infantil estão agora sendo facilitadas pelo aumento da disponibilidade de microdados e pelas facilidades computacionais disponíveis. A pobreza, a escolaridade dos pais, o tamanho e a estrutura da família, o sexo do chefe, idade em que os pais começaram a trabalhar e o local de residência são os determinantes mais analisados e dos mais importantes para explicar a alocação do tempo da criança para o trabalho. As principais conseqüências socioeconômicas do trabalho de crianças e de adolescentes são sobre a educação, o salário e a saúde dos indivíduos. Este estudo tem como objetivo apresentar, de forma resumida, o que se conhece na literatura econômica sobre trabalho infantil e indicar direções para futuros estudos.
As flores sobressaltadas
Authors: Motta Leda Tenório da
Published: January 2008

Joga-se com a idéia de que os poemas em prosa de Baudelaire relacionam-se agressivamente com As Flores do Mal, ao retomá-las em enunciados narrativos, ainda que sob a alegação da busca de uma nova musicalidade. Institui-se assim um interessante conflito de códigos na poesia baudelairiana. Mais que isso, através da noção de linguagem poética, impõe-se a prosificação à melhor posteridade.
Nonmedical Use of Prescription Stimulants Among College Students: Associations with Attention‐Deficit‐Hyperactivity Disorder and Polydrug Use
Authors: Arria Amelia M. , Caldeira Kimberly M. , O'Grady Kevin E. , Vincent Kathryn B. , Johnson Erin P. , Wish Eric D.
Published: January 2008

Study Objective. To define, among a sample of college students, the nature and extent of nonmedical use of prescription stimulants (NPS), including both overuse and use of someone else's drug, for attention‐deficit‐hyperactivity disorder (ADHD); to characterize NPS among individuals not medically using a prescription stimulant for ADHD; and to determine whether NPS and overuse of a medically prescribed stimulant for ADHD were independently associated with an increased risk of other illicit drug use and dependence on alcohol and marijuana.

Design. Cross‐sectional analysis of personal interview data.

Setting. Large public university in the mid‐Atlantic region.

Participants. A cohort of 1253 first‐year college students aged 17–20 years.

Measurements and Main Results. All students completed a 2‐hour personal interview to ascertain medical use and overuse of prescription stimulants, NPS, nonmedical use of other prescription drugs and illicit drug use, and dependence on alcohol and marijuana. Comparisons were made among nonusers, nonmedical users, and medical users of prescription stimulants for ADHD (ADHD+), some of whom overused their drug. Of 1208 students who were not using prescription stimulants medically for ADHD (ADHD‐), 218 (18.0%) engaged in NPS. Of 45 ADHD+ students, 12 (26.7%) overused their ADHD drug at least once in their lifetime, and seven (15.6%) nonmedically used someone else's prescription stimulants at least once in their lifetime. Among 225 nonmedical users, NPS was infrequent and mainly associated with studying, although 35 (15.6%) used prescription stimulants to party or to get high. Lifetime NPS was associated with past‐year other drug use. Both NPS and overuse of prescribed stimulants for ADHD were independently associated with past‐year use of five drugs, holding constant sociodemographic characteristics; NPS was also associated with alcohol and marijuana dependence.

Conclusions. Physicians should be vigilant for possible overuse and/or diversion of prescription stimulants for ADHD among college students who are medical users of these drugs, as well as the occurrence of illicit drug use with NPS. Initiation of comprehensive drug prevention activities that involve parents as well as college personnel is encouraged to raise awareness of NPS and its association with illicit drug use.
Propofol‐Related Infusion Syndrome in Intensive Care Patients
Authors: Corbett Stephanie Mallow , Montoya Isaac D. , Moore Frederick A.
Published: January 2008

The Institute of Medicine has identified adverse drug events as factors that significantly contribute to increased patient morbidity and mortality. As critically ill patients receive numerous drugs to treat a multitude of complicated health problems, they are at high risk for adverse drug events. Sedation is often a key requirement for the optimal management of critical illness, and propofol, a common sedative, has many desirable characteristics that make it the ideal agent in numerous circumstances. However, over the last decade, increasing numbers of reports have described a potentially fatal adverse effect called propofol‐related infusion syndrome. Whether this adverse drug event is preventable is unclear, but recommendations have been proposed to minimize the potential for development of this syndrome. Research is under way to collect data on the use of propofol in intensive care units and on its prevalence.
Novel highly reflective and bistable electrowetting displays
Authors: Blankenbach Karlheinz , Schmoll Andreas , Bitman Andriy , Bartels Frank , Jerosch Dieter
Published: January 2008

Abstract— Novel displays have been developed using the effect of moving a droplet by electrowetting. This approach enables bistable and reflective monochrome and color displays which could also be made on plastic substrates. Prototypes show promising performance in terms of contrast ratio, gray scale, and color.
A novel diffractive backlight concept for mobile displays
Authors: Kimmel Jyrki , Levola Tapani , Saarikko Pasi , Bergquist Johan
Published: January 2008

Abstract— Power‐efficiency demands on mobile communications device displays have become severe with the emergence of full‐video‐capable cellular phones and mobile telephony services such as third‐generation (3G) networks. The display is the main culprit for power consumption in the mobile‐phone user interface and the backlight unit (BLU) of commonly used active‐matrix liquid‐crystal displays (AMLCDs) is the main power drain in the display. One way of reducing the power dissipation of a mobile liquid‐crystal display is to efficiently distribute and outcouple the light available in the backlight unit to direct the primary wavelength bands in a spectrum‐specific fashion through the respective color subpixels. This paper describes a diffractive‐optics approach for a novel backlight unit to realize this goal. A model grating structure was fabricated and the distribution of outcoupled light was studied. The results verify that the new BLU concept based on an array of spectrum‐specific gratings is feasible.
Electrical feedback control for driving mercury‐free flat fluorescent lamp
Authors: Park Joung‐Hu , Baek Jong‐Bok , Cho Bo‐Hyung
Published: January 2008

Abstract— Recently, a mercury‐free flat fluorescent lamp has been developed for LCD backlight application, utilizing a glow‐discharge mode instead of a discharge contraction. This paper proposes a lamp‐driving system with a feedback loop which prevents discharge contraction and stabilizes the operation of the lamp ignition and radiation. By measuring the current that flows through the lamp, the loop can adjust the current level to a normal operational level and suppress the long‐term excitation that causes discharge contraction. The proposed method has been verified by hardware experiments which are compared to that of a conventional open‐loop circuit by discharge contraction time and a change in luminance.
Flicker visibility in scanning‐backlight displays
Authors: Wang Lili , Teunissen Kees , Tu Yan , Chen Li
Published: January 2008

Abstract— Scanning‐backlight technology reduces motion blur caused by the sample‐and‐hold effect of traditional liquid‐crystal displays. A side effect of impulse‐type backlight systems is that large‐area flicker may be introduced (like in displays using cathode‐ray tubes). The seriousness of the perceived large‐area flicker is investigated in perception experiments for various implementations of a scanning‐backlight system and for different types of image material. Results show that the main factors contributing to the visibility of large‐area flicker are refresh rate, temporal luminance distribution within a frame period, spatial luminance distribution in the image, and whether or not there is motion in the image.
Mature Field Rejuvenation of a Tight Gas Carbonate Utilizing Coiled Tubing Underbalanced Drilling Techniques
Authors: Mykytiw C. , Killip D. , Brewin R. , Capps J.
Published: January 2008

The Margham Dubai Establishment (MDE) asset is a mature gas-condensate field that was put on production in 1985. As the energy demands of Dubai are ever increasing, MDE has been releasing (net) gas resulting in rapid dwindling of remaining reserves. In order to reduce the amount of alternate fuels required to meet the Dubai energy demands, MDE initiated a drastic field intervention campaign prior to June 1, 2006. Preliminary feasibility studies concluded that the only identified practical option of increasing drainage capacity was to re-enter existing wells drilling high deviation multi-laterals with coiled-tubing, underbalanced drilling (CTUBD) techniques. After approximately three months of rigorous project planning and engineering, the well sequence of Phase I was initiated (4 wells). Upon completion, a 73% net increase (including average field decline) of gas from the Margham field was observed equating to a gas lift cost of less than $2/Mscf (25% less cost than alternate fuels). Due to the success of Phase I, an additional four wells were approved. Upon Phase II completion, a 125% increase (over nonintervention predicted field production rate) resulted, equating to a gas lift cost of less than $1.33/Mscf. The reduction in lift cost in Phase II was attributed to the cost of front-end engineering, mobilization, retention of equipment and additional start-up costs all being absorbed in Phase I. Also, the technical limit (rig move, milling time, drilling time, etc.) for the CTUBD operation was not reached until the drilling of the third well. Thereafter a third and final phase was approved consisting of three additional wells. The total number of wells rejuvenated was eleven.

This paper addresses the conceptualization of the project, the well selection criteria, identified risk and uncertainties, the risk management methods employed, environmental impact, implementation practices, key achievements, production improvement, ultimate recovery enhancement and a cost versus value summary. Overall the CTUBD intervention campaign as a mature field rejuvenation technique has been a great technical and economic achievement. In addition to the apparent increase in production, the rejuvenation of the Margham field will allow for more efficient gas storage methods in the future (if required) due to the increased injectivity index and the ability to use fewer wells for gas cycling.
Enhancement of Well Productivity: Investigation of the Feasibility of UBD for Minimizing Formation Damage
Authors: Salimi Siroos , Tronvoll Johan
Published: January 2008

This paper describes the use of a numerical simulator for study of productivity improvement by application and proper performance of UBD in wells, which are faced with near-wellbore damage. Minimizing formation damage in the near- wellbore region and thus ensuring proper well performance for enhanced productivity of the well also results in increased recovery factor. Formation damage caused by conventional overbalanced drilling (OBD) can be reduced or eliminated through UBD, which may ensure the original formation productivity is maintained. A single horizontal well numerical model has been built that simulates the UBD and OBD processes and their impacts on production of hydrocarbon under a variety of reservoir conditions. The paper describes study methodology, models, simulation results and analysis results. It also summarises the formation criteria for successful UBD operations. For the purpose of expressing rate versus time, the production rate as a series of steady state production with increasing radius of drainage is considered. This dimensionless analysis of productivity (PID) provides a simple way to describe the productivity trend with different reservoir and fluid properties and well geometry. Several hundred cases have been numerically simulated for different reservoirs and drilling operations. Dry gas, gas condensate reservoir, dead oil reservoir and black oil reservoir have been considered. Several sensitivity analyses such as impact of OBP pressure and OBP time and effect of horizontal well length have been simulated. The results clearly show that proper candidate selection is the key to success of UBD projects. This clearly demonstrates that UBD operation is good choice for some reservoirs but not for all. The results of this study provide a set of reservoir criteria that can be used as guidelines to evaluate potential UBD candidates.
Highly Advanced Multitechnical MPD Concept Extends Achievable HPHT Targets in the North Sea
Authors: Syltøy Svein , Eide Svein Erik , Torvund Steinar , Berg Per Cato , Larsen Tore , Fjeldberg Helge , Bjørkevoll Knut Steinar , McCaskill John , Prebensen Ole Iacob , Low Eric
Published: January 2008

Drilling wells in high-pressure, high-temperature (HPHT) reservoirs is often characterized by a narrow operating window between formation pore pressure and fracture pressure. Depletion further reduces this window. Managed Pressure Drilling (MPD) provides methods for operating within safe limits in the narrow HPHT windows. Exceptional control over downhole pressures can be achieved with advanced MPD technologies that are uniquely suited for the HPHT environment. Such control can extend achievable HPHT targets, yet still have the flexibility to deal with the troubles that so often arise in these difficult environments.

The advanced MPD system developed for StatoilHydro's Kvitebjørn HPHT field are presented along with experiences from their use in the field. This includes: ManagementRunning a real-time, online, advanced dynamic flow modelAutomatic dual redundant choke system with continuously updated pressure set-point from the flow modelContinuous Circulation System (CCS)Pressure Control While Drilling (PCWD)Caesium Formate mud system - A designer mud containing formation strengthening particles.Balanced Mud Pill (BMP) - An innovative fluid technology developed for performing a precision top kill, producing minimal pressure surge when pulling the drillstring and running liner.
Opportunities and Challenges for Diabetes Prevention at Two Community Health Centers
Authors: Rosal Milagros C. , Benjamin Evan M. , Pekow Penelope S. , Lemon Stephenie C. , von Goeler Dorothea
Published: January 2008

OBJECTIVE—Translating evidence-based diabetes prevention interventions to disadvantaged groups is a public health priority that poses unique challenges. Community health centers (CHCs) provide unequaled opportunities to prevent diabetes among poor and minority high-risk groups. This formative study sought to assess structural, processes-of-care (health care quality domains), and patient factors that need to be considered for diabetes prevention at CHCs.

RESEARCH DESIGN AND METHODS—A multimethod approach was implemented to assess system-, provider-, and patient-level factors at two large CHCs serving diverse urban communities.

RESULTS—Medical chart audits (n = 303) showed limited documentation of risks. Provider surveys (n = 74) evidenced knowledge gaps regarding factors associated with increased diabetes risk, efficacy of pharmacological interventions, and low perceived efficacy in promoting patient behavior change. Patient focus groups (two groups) with at-risk Hispanics and African Americans suggested mixed knowledge regarding whether diabetes can be prevented, some knowledge gaps regarding factors related to risk, and multiple challenges for lifestyle change.

CONCLUSIONS—Multiple and multilevel challenges to translating diabetes prevention interventions for the benefit of at-risk populations who seek care at CHCs were observed.
Accuracy of Perceptions of Overweight and Relation to Self-Care Behaviors Among Adolescents With Type 2 Diabetes and Their Parents
Authors: Skinner Asheley Cockrell , Weinberger Morris , Mulvaney Shelagh , Schlundt David , Rothman Russell L.
Published: January 2008

OBJECTIVE—To examine how adolescents with type 2 diabetes and their parents/primary caregivers perceive the adolescents’ weight and the relationship of those perceptions to diet and exercise behaviors and perceived barriers to healthy behaviors.

RESEARCH DESIGN AND METHODS—Interviews were conducted with adolescents and their parents about perceptions of the adolescents’ weight, diet, and exercise behaviors, as well as barriers to engaging in healthy diet and exercise behaviors. Interviews were linked with clinic records to provide BMI.

RESULTS—A total of 104 parent-adolescent dyads participated. Parents and adolescents typically perceived the adolescents’ weight as less severe than it actually was. For parents and adolescents, underestimating the adolescents ’ weight was associated with poorer diet behaviors and more perceived barriers to following healthy diet or exercise behaviors.

CONCLUSIONS—Addressing misperceptions of weight by adolescents and their parents may be an important first step to improving weight in these patients.
Sensitivity and Specificity of Death Certificates for Diabetes
Authors: Cheng W. Susan , Wingard Deborah L. , Kritz-Silverstein Donna , Barrett-Connor Elizabeth
Published: January 2008

OBJECTIVE—Diabetes is the sixth leading cause of death in U.S adults, which may be an underestimate because of under-reporting on death certificates. In this study we examined death certificate sensitivity and specificity for diabetes, as well as the factors related to better reporting, in a community-based sample.

RESEARCH DESIGN AND METHODS—Death certificates were obtained for 3,209 decedents who were enrolled in the Rancho Bernardo cohort in 1972–1974 and followed through 2003. Diabetes status was reassessed at periodic clinic visits and annual mailed surveys during an average follow-up of 15.2 ± 7.6 years. Diabetes reported anywhere on death certificates was abstracted. Sensitivity and specificity calculations among diabetic participants were stratified by age, sex, year, place, cause of death, and diabetes medication use.

RESULTS—Among 1,641 men and 1,568 women, 378 decedents had a history of diabetes, 168 of whom had diabetes listed anywhere on their death certificates. The sensitivity and specificity were 34.7 and 98.1%. Diabetes reporting on death certificates did not improve over time or vary significantly by age and sex, but sensitivity for diabetes reporting was better for recent (1992–2003) cardiovascular disease (CVD) deaths compared with any other causes of death (48.9 vs. 28.6%, respectively, P < 0.05).

CONCLUSIONS—Although diabetes reporting on death certificates did not improve over time, sensitivity was better for diabetes in the context of CVD deaths, probably reflecting the increasing recognition that diabetes is a major cardiovascular risk factor.
Salsalate Improves Glycemia and Inflammatory Parameters in Obese Young Adults
Authors: Fleischman Amy , Shoelson Steven E. , Bernier Raquel , Goldfine Allison B.
Published: January 2008

OBJECTIVE—Sedentary lifestyle and a western diet promote subacute-chronic inflammation, obesity, and subsequently dysglycemia. The aim of the current study was to evaluate the efficacy of the anti-inflammatory drug salsalate to improve glycemia by reducing systemic inflammation in obese adults at risk for the development of type 2 diabetes.

RESEARCH DESIGN AND METHODS—In a double-masked, placebo controlled trial, we evaluated 20 obese nondiabetic adults at baseline and after 1 month of salsalate or placebo.

RESULTS—Compared with placebo, salsalate reduced fasting glucose 13% (P < 0.002), glycemic response after an oral glucose challenge 20% (P < 0.004), and glycated albumin 17% (P < 0.0003). Although insulin levels were unchanged, fasting and oral glucose tolerance test C-peptide levels decreased in the salsalate-treated subjects compared with placebo (P < 0.03), consistent with improved insulin sensitivity and a known effect of salicylates to inhibit insulin clearance. Adiponectin increased 57% after salsalate compared with placebo (P < 0.003). Additionally, within the group of salsalate-treated subjects, circulating levels of C-reactive protein were reduced by 34% (P < 0.05).

CONCLUSIONS—This proof-of-principle study demonstrates that salsalate reduces glycemia and may improve inflammatory cardiovascular risk indexes in overweight individuals. These data support the hypothesis that subacute-chronic inflammation contributes to the pathogenesis of obesity-related dysglycemia and that targeting inflammation may provide a therapeutic route for diabetes prevention.
High Prevalence of Type 2 Diabetes and Pre-Diabetes in Adult Offspring of Women With Gestational Diabetes Mellitus or Type 1 Diabetes
Authors: Clausen Tine D. , Mathiesen Elisabeth R. , Hansen Torben , Pedersen Oluf , Jensen Dorte M. , Lauenborg Jeannet , Damm Peter
Published: January 2008

OBJECTIVE—The role of intrauterine hyperglycemia and future risk of type 2 diabetes in human offspring is debated. We studied glucose tolerance in adult offspring of women with either gestational diabetes mellitus (GDM) or type 1 diabetes, taking the impact of both intrauterine hyperglycemia and genetic predisposition to type 2 diabetes into account.

RESEARCH DESIGN AND METHODS—The glucose tolerance status following a 2-h 75-g oral glucose tolerance test (OGTT) was evaluated in 597 subjects, primarily Caucasians, aged 18–27 years. They were subdivided into four groups according to maternal glucose metabolism during pregnancy and genetic predisposition to type 2 diabetes: 1) offspring of women with diet-treated GDM (O-GDM), 2) offspring of genetically predisposed women with a normal OGTT (O-NoGDM), 3) offspring of women with type 1 diabetes (O-type 1), and 4) offspring of women from the background population (O-BP).

RESULTS—The prevalence of type 2 diabetes and pre-diabetes (impaired glucose tolerance or impaired fasting glucose) in the four groups was 21, 12, 11, and 4%, respectively. In multiple logistic regression analysis, the adjusted odds ratios (ORs) for type 2 diabetes/pre-diabetes were 7.76 (95% CI 2.58–23.39) in O-GDM and 4.02 (1.31–12.33) in O-type 1 compared with O-BP. In O-type 1, the risk of type 2 diabetes/pre-diabetes was significantly associated with elevated maternal blood glucose in late pregnancy: OR 1.41 (1.04–1.91) per mmol/l.

CONCLUSIONS—A hyperglycemic intrauterine environment appears to be involved in the pathogenesis of type 2 diabetes/pre-diabetes in adult offspring of primarily Caucasian women with either diet-treated GDM or type 1 diabetes during pregnancy.
Squatting Amplifies Pulse Pressure Increase With Disease Duration in Patients With Type 1 Diabetes
Authors: Philips Jean-Christophe , Marchand Monique , Scheen André J.
Published: January 2008

OBJECTIVE—To evaluate pulse pressure changes according to duration of type 1 diabetes and to assess the influence of posture.

RESEARCH DESIGN AND METHODS—We performed continuous measurement of blood pressure with a Finapres device during a 3 × 1 min posture test (standing, squatting, standing) in 159 type 1 diabetic patients divided into four groups according to diabetes duration (≤10, 11–20, 21–30, and >30 years, groups 1–4, respectively) and compared the results with those of age-matched nondiabetic subjects.

RESULTS—Pulse pressure progressively increased according to type 1 diabetes duration (P < 0.0001), especially in women, but not in age-matched nondiabetic subjects (NS). Pulse-pressure increase from group 1 to group 4 was amplified in the squatting position (from 50 ± 17 to 69 ± 14 mmHg) compared with standing (from 44 ± 15 to 55 ± 12 mmHg).

CONCLUSIONS—Pulse pressure increases according to type 1 diabetes duration more in women than in men, and the squatting position sensitizes such pulse-pressure increase in both sexes.
Evaluation of the Self-Administered Indicator Plaster Neuropad for the Diagnosis of Neuropathy in Diabetes
Authors: Tentolouris Nicholas , Achtsidis Vasilis , Marinou Kyriaki , Katsilambros Nicholas
Published: January 2008

OBJECTIVE—To evaluate the inter-rater reliability between patient and health care provider of the indicator plaster neuropad (IPN) in the diagnosis of peripheral neuropathy and the feasibility of the IPN.

RESEARCH DESIGN AND METHODS—A total of 156 patients with diabetes were examined. At the same visit, the IPN was evaluated by the health care provider. Afterward, the IPN with written instructions for its use and evaluation for self-testing at home were provided together with a questionnaire asking for the easiness of the IPN.

RESULTS—Neuropathy was diagnosed in 56.9% of the participants by the health care provider. The k statistic to measure overall agreement between patient and health care provider of the IPN was very good: 0.88 (95% CI 0.85–0.91). The indicated instructions and the IPN were evaluated as easy by the patients.

CONCLUSIONS—The high degree of reliability and the easiness of the IPN suggest that it is proper for self-testing for the identification of peripheral neuropathy.
The Nuts and Bolts of Achieving End Points With Real-Time Continuous Glucose Monitoring
Authors: Wolpert Howard A.
Published: January 2008

Real-time continuous glucose monitoring (RT-CGM) provides detailed information on glucose patterns and trends and promises to be a major advance in diabetes care. To derive full potential benefit from RT-CGM, the patient needs to be skilled in diabetes self-management. In addition, several key concepts and issues need to be addressed in training patients to use RT-CGM. These include 1) the implications of the physiologic lag between interstitial and capillary blood glucose levels and 2) the increased risk among RT-CGM users for hypoglycemia related to blind postprandial bolusing. Patients need to understand the importance of calibrating during steady-state conditions to improve sensor accuracy. In addition, they need to use fingerstick measurements for treatment decision-making when the glucose level is changing rapidly, i.e., conditions when physiologic lag can lead to a marked discrepancy between blood and interstitial glucose. Consideration of “insulin on board” and the impact of the glycemic index of different foodstuffs on postprandial glucose patterns can help minimize the risk for hypoglycemia from supplemental boluses taken to correct postprandial hyperglycemia. To use continuous glucose data safely and effectively, patients need to be skilled in diabetes self-management, and the widespread adoption of RT-CGM into diabetes care will need to be coupled with comprehensive self-management education.
Natural History of Cardiovascular Disease in Patients With Diabetes
Authors: Milicevic Zvonko , Raz Itamar , Beattie Scott D. , Campaigne Barbara N. , Sarwat Samiha , Gromniak Elwira , Kowalska Irina , Galic Edvard , Tan Meng , Hanefeld Markolf
Published: January 2008

Atherosclerotic vascular disease is more common in diabetic than in nondiabetic individuals. Diabetic macrovascular disease also has a more severe course with greater prevalence of multiple-vessel coronary artery disease and more diffuse elongated atheromas in affected blood vessels. In this review, we discuss possible reasons for increased incidence of cardiovascular (CV) events in individuals with diabetes. Although an increased prevalence of standard CV risk factors has been clearly documented in association with diabetes, diabetes-related abnormalities, particularly hyperglycemia, also play an important role. Epidemiological studies suggest that the effect of hyperglycemia on CV risk is independent of other known risk factors, but no data from primary interventional trials are available yet. Analysis of datasets from populations that included individuals with impaired glucose tolerance and impaired fasting glucose suggest that the pathogenic role of hyperglycemia on the blood vessel wall already exists in the early stages of glucose intolerance. The effect of postprandial or postchallenge hyperglycemia seems to be greater than the effect of fasting blood glucose abnormalities. The relationship of postprandial glycemia, fasting blood glucose, and CV risk in individuals with diagnosed (or overt) diabetes is less clear, although most reports indicate a greater pathogenic potential of postprandial hyperglycemia rather than fasting hyperglycemia. Based on the results of epidemiological reports, the most appropriate targets in interventional trials are postprandial hyperglycemia or A1C.
Glycemic Variability
Authors: Monnier Louis , Colette Claude
Published: January 2008

Diabetes is characterized by glycemic disorders that include both sustained chronic hyperglycemia and acute glucose fluctuations. There is now cogent evidence for the deleterious effects of sustained chronic hyperglycemia that results in excessive protein glycation and generation of oxidative stress. The role of glucose variability from peaks to nadirs is less documented, but there are many reasons to think that both upward (postprandial) and downward (interprandial) acute fluctuations of glucose around a mean value activate the oxidative stress. As a consequence, it is strongly suggested that a global antidiabetic strategy should be aimed at reducing to a minimum the different components of dysglycemia (i.e., A1C, fasting and postprandial glucose, as well as glucose variability). All the therapeutic agents that act on postprandial glucose excursions seem of particular interest for reducing the latter parameter (i.e., the glucose instability). Particular attention should be paid to such emerging therapeutic agents as the glucagon-like peptide 1 agonists and the dipeptidyl peptidase (DPP)-IV inhibitors that act through the incretin pathway.
Targets for Intervention in Dyslipidemia in Diabetes
Authors: Tomkin Gerald H.
Published: January 2008

Treatment for dyslipidemia in diabetes reduces cardiovascular events. Diabetes is associated with major abnormalities in fatty acid metabolism. The resulting disturbance results in an abnormal lipoprotein cascade from the large chylomicron through to the small HDL particle. This suggests that drugs that alter formation of the chylomicron particle might have a very important role in diabetic dyslipidemia. Achieving normal glycemia will reverse the abnormalities in fatty acid metabolism, but this is difficult, particularly as the disease progresses. Genes that regulate cholesterol absorption and excretion have been described (Niemann Pick C1-like 1 [NPC1-L1] and ATP binding cassette proteins [ABC] G5 and G8). An effective NPC1-L1 inhibitor (ezetimibe) improves the reduction in cholesterol caused by statins. Agonists of ABCG5 and G8 may become important in the treatment of dyslipidemia. Microsomal triglyceride transfer protein (MTP) is responsible for the assembly of the chylomicron and VLDL particles. New MTP inhibitors, acting only on the intestine, are exciting possible treatments. The advisability of sitosterol-enriched foods to lower cholesterol may have to be reassessed for patients with diabetes, since these products may lead to an increase in chylomicron sitosterol in diabetic patients. More successful treatment of diabetic dyslipidemia is essential if we are to reduce the burden of cardiovascular disease so commonly found in diabetes.
Insulin Resistance and Hyperinsulinemia
Authors: Shanik Michael H. , Xu Yuping , Škrha Jan , Dankner Rachel , Zick Yehiel , Roth Jesse
Published: January 2008

Insulin resistance, recently recognized as a strong predictor of disease in adults, has become the leading element of the metabolic syndrome and renewed as a focus of research. The condition exists when insulin levels are higher than expected relative to the level of glucose. Thus, insulin resistance is by definition tethered to hyperinsulinemia. The rising prevalence of medical conditions where insulin resistance is common has energized research into the causes. Many causes and consequences have been identified, but the direct contributions of insulin itself in causing or sustaining insulin resistance have received little sustained attention. We examine situations where insulin itself appears to be a proximate and important quantitative contributor to insulin resistance. 1) Mice transfected with extra copies of the insulin gene produce basal and stimulated insulin levels that are two to four times elevated. The mice are of normal weight but show insulin resistance, hyperglycemia, and hypertriglyceridemia. 2) Somogyi described patients with unusually high doses of insulin and hyperglycemia. Episodes of hypoglycemia with release of glucose-raising hormones, postulated as the culprits in early studies, have largely been excluded by studies including continuous glucose monitoring. 3) Rats and humans treated with escalating doses of insulin show both hyperinsulinemia and insulin resistance. 4) The pulsatile administration of insulin (rather than continuous) results in reduced requirements for insulin. 5) Many patients with insulinoma who have elevated basal levels of insulin have reduced (but not absent) responsiveness to administered insulin. In summary, hyperinsulinemia is often both a result and a driver of insulin resistance.
Abdominal Fat and Sleep Apnea
Authors: Pillar Giora , Shehadeh Naim
Published: January 2008

Obstructive sleep apnea (OSA) syndrome is a disorder characterized by repetitive episodes of upper airway obstruction that occur during sleep. Associated features include loud snoring, fragmented sleep, repetitive hypoxemia/hypercapnia, daytime sleepiness, and cardiovascular complications. The prevalence of OSA is 2–3% and 4–5% in middle-aged women and men, respectively. The prevalence of OSA among obese patients exceeds 30%, reaching as high as 50–98% in the morbidly obese population. Obesity is probably the most important risk factor for the development of OSA. Some 60–90% of adults with OSA are overweight, and the relative risk of OSA in obesity (BMI >29 kg/m2) is ≥10. Numerous studies have shown the development or worsening of OSA with increasing weight, as opposed to substantial improvement with weight reduction. There are several mechanisms responsible for the increased risk of OSA with obesity. These include reduced pharyngeal lumen size due to fatty tissue within the airway or in its lateral walls, decreased upper airway muscle protective force due to fatty deposits in the muscle, and reduced upper airway size secondary to mass effect of the large abdomen on the chest wall and tracheal traction. These mechanisms emphasize the great importance of fat accumulated in the abdomen and neck regions compared with the peripheral one. It is the abdomen much more than the thighs that affect the upper airway size and function. Hence, obesity is associated with increased upper airway collapsibility (even in nonapneic subjects), with dramatic improvement after weight reduction. Conversely, OSA may itself predispose individuals to worsening obesity because of sleep deprivation, daytime somnolence, and disrupted metabolism. OSA is associated with increased sympathetic activation, sleep fragmentation, ineffective sleep, and insulin resistance, potentially leading to diabetes and aggravation of obesity. Furthermore, OSA may be associated with changes in leptin, ghrelin, and orexin levels; increased appetite and caloric intake; and again exacerbating obesity. Thus, it appears that obesity and OSA form a vicious cycle where each results in worsening of the other.
Physical growth of preterm girls with visual impairment
Authors: Umławska Wioleta
Published: January 2008

The aim of this study was to estimate pubertal age and to assess the level of physical development of preterm girls with defective vision. The study material - anthropometric data (body height and weight, BMI) and information on the age of menarche were collected from 155 subjects with defective vision (partially sighted and blind). Median age at menarche was estimated by probit analysis. The girls, ranging in age from 7-18 years, attended Centers for Blind and Partially Sighted Children in Wroclaw and Cracow (Poland). 22% of the subjects were prematurely born, were born with low birth mass and their sight defect diagnosed as retinopathy due to prematurity (ROP). The girls with ophthalmic impairments were shorter and lighter than their age peers from the reference data. Blind girls reached pubertal age 2 months earlier than the partially sighted (Me=13.31 and Me=13.44) and, the preterm subjects entered puberty 6 months earlier than the full-term girls, irrespective of degree of defect (Me=12.93 and Me=13.42, respectively). The results suggest that earlier puberty is associated with visual impairment. The results show also that irrespective of the degree of defect, preterm girls reach menarche significantly earlier than those who were full-term. It seems possible that mechanisms responsible for earlier puberty in the preterm subjects and with low body mass play an important a role in sexual maturation in girls with sight dysfunction. There appears to be a need to pursue further studies in this sphere.
Can economic stress affect secondary sex ratio in Poland?
Authors: Żądzińska Elżbieta , Rosset Iwona , Domański Czesław , Pawłowski Bogusław , Mikulec Artur
Published: January 2008

The ratio of male to female births described as the male proportion is expected to be about 1.06. The secondary sex ratio can be influenced by various stresses experienced by parents (e.g., parents' exposure to chemical and physical pollution, natural phenomena, wars and economic crises). The seminal study in this field speculated that fewer goods and services than needed or desired might sufficiently stress human populations to lower the secondary sex ratio. The main purpose of this study is to examine the relationship between economic stress and the fluctuations of sex ratio at birth in Poland. The statistical analysis was based on annual demographic data obtained from year-books issued by the Central Statistical Office on the overall number of male and female live births in Poland in the years 1956-2005 as well as on the annual data of percentage change in total private consumption. In order to verify the hypothesis that the observed time-series of the secondary sex ratio in Poland declines with deterioration in economic conditions, we constructed mathematical models (ARIMA) of both analyzed phenomena following the statistical procedure proposed by Catalano and Bruckner [2005]. We found a statistically significant decline of SSR in Poland over the last 50 years. The decrease appeared to be stronger in villages than in towns. However, the consumption rate as related to the strength of economic stress had no effect on the fluctuation of the sex ratio at birth.
Analysis of 28-Day Global Positioning System Panel Survey
Authors: Stopher Peter , FitzGerald Camden , Zhang Jun , Bretin Tiphaine
Published: January 2008

The Institute of Transport and Logistics Studies at the University of Sydney, Australia, has pioneered the use of the Global Positioning System (GPS) as a means of measuring personal travel in Australia. The results of a 28-day GPS survey of 50 households are reported, specifically in terms of variability in the daily travel of individuals. The first evidence examined is the frequency with which people stay at home all day, because it often has been suggested as a possible measure of survey quality and because it is fairly easy for people to decide to leave the GPS device at home on certain days or to forget to take it with them during a GPS survey. Next, the actual variability in daily travel is examined by looking at the variability in the means and variances of daily passenger kilometers of travel, daily number of trips, average travel time per trip, average distance per trip, and total travel time per day. Subsequently, the proportions of variance that arise from intrapersonal variability and interpersonal variability are examined.
Trends in Out-of-Home and At-Home Activities
Authors: Wilson Ryan , Krizek Kevin J. , Handy Susan L.
Published: January 2008

Expectations remain high that information communications technology (ICT) might reduce travel. The rapid evolution of technology, combined with a dearth of longitudinal data, has made it extremely difficult to assess the affects of ICT on travel. Results are compared from two independent but similar household surveys in 1995 and 2003 to examine changes in home ICT use and store travel. Multiple analysis of covariance is used to control for differences in sample characteristics, attitudes, and city type and to examine changes in the frequency of out-of-home and at-home shopping and banking between 1995 and 2003. Results indicate that the year of the survey has a main effect in explaining shopping, but not banking frequencies. Respondents in 2003 shop out of home and at home with greater frequency and bank out of home and at home with less frequency, though the latter finding is not statistically significant. Despite reported increases in at-home activities substituting out-of-home shopping trips, the most likely explanation of the results—examining several behaviors—is that people engage in multiple forms of shopping and banking and do so in the ways that are most convenient. Preferences for store shopping and online security concerns may limit observable changes in past growth and the future potential of ICT to replace physical trips.
Sustainability in Transport
Authors: May Tony , Crass Mary
Published: January 2008

This paper draws on a review prepared for the meeting of the European Conference of Ministers of Transport in May 2006. Four separate studies were considered: reducing CO2 emissions from transport, accessibility for those with reduced mobility, implementation of sustainable urban travel policies, and road safety. The purpose of this paper is to draw together the common strands related to sustainable transport and to make recommendations for ministers and their advisers. In doing so, it concentrates on the barriers to achieving sustainability and the ways in which they might be overcome. The paper starts by considering definitions of sustainability and the underlying objectives that governments might pursue. It then considers the varying contexts within which these objectives might be pursued. It reviews the policy instruments that might be employed in achieving these objectives and reviews the barriers to their introduction. Finally, it offers a series of recommendations to governments on ways of overcoming those barriers. The issues raised are of concern to international policy makers. To focus discussion, the questions for ministers in the original version have been recast as issues that policy makers may wish to consider in their own contexts.
Greenhouse Gas Emissions of the U.S. Transportation Sector
Authors: Davies John , Grant Michael , Venezia John , Aamidor Joseph
Published: January 2008

The transportation sector accounted for almost 28% of total U.S. greenhouse gas (GHG) emissions in 2004, according to Inventory of U.S. Greenhouse Gas Emissions and Sinks: 1990–2004, published in 2006 by the U.S. Environmental Protection Agency (EPA). Over the period 1990 to 2004, GHG emissions from the transportation sector increased at the fastest rate of any end-use economic sector in the United States and accounted for the largest absolute increase of any of these sectors. The largest sources of U.S. transportation GHG emissions continued to be light-duty vehicles, heavy-duty trucks, and aircraft. While these three modes demonstrated increases in travel activity from 1990 to 2004, their GHG growth rates differed considerably: GHGs from heavy-duty trucks increased by 62%, light-duty vehicles by 23%, and commercial aircraft by only about 10%. This paper (a) analyzes factors affecting transportation GHG emissions in the United States, including the output from specific modes and travel purposes; (b) examines sources of uncertainty in these estimates; and (c) describes methodological improvements used in EPA's 1990–2004 inventory and other planned improvements.
Effects of Tire Pressure Monitoring Systems on Tire Pressures in Consumer Vehicles
Authors: Tyrrell Richard A. , Balk Stacy A. , Switzer Fred S. , Brooks Johnell O.
Published: January 2008

In response to a federal mandate, all new light passenger vehicles in the United States will soon be required to include tire pressure monitoring systems (TPMSs) that alert drivers when one or more tires become 25% or more underinflated relative to the pressure level recommended by the vehicle manufacturer. Although the goal of TPMSs is to reduce the population of underinflated tires, their ultimate effect on tire pressure in consumer vehicles is unknown. Tire pressure and survey data were collected from approximately 1,200 vehicles that had just entered a rest area from an Interstate highway. Comparisons between vehicles with and without a TPMS were made from 864 vehicles in the full sample and from a subset of 123 target vehicles. The presence of TPMSs was generally associated with a small (0.7 to 1.5 psi) but significant decrease in the severity of tire underinflation. In addition, vehicles equipped with TPMSs were significantly less likely to have at least one tire that was 25% or more underinflated. The effect of TPMSs on tire pressure might have been larger had the systems been designed to activate at a less severe underinflation level. Less than 2% of survey respondents believed that TPMSs should have a trigger threshold as extreme as the currently mandated 25% threshold. Surveys also revealed that drivers without a TPMS do not report large differences in their tire maintenance behaviors relative to drivers with a TPMS and that more than 25% of drivers of vehicles with a TPMS are unaware that their vehicle is so equipped.