bluuebunny/crossref_metadata_2025 huggingface dataset:
" Bem me queres, mal me queres": ambivalência discursiva na avaliação canônica do desempenho da ONU
Authors: Gama Carlos Frederico , Lopes Dawisson Belém
Published: August 2009

Neste ensaio, questionamos a avaliação - que, argumentamos, é canônica nas Relações Internacionais - do desempenho da Organização das Nações Unidas (ONU). A referida organização, desde a origem, tem sido simultaneamente considerada "cronicamente ineficiente" e "exemplarmente eficaz". Para demonstrá-lo, lançamos mão de dois conjuntos de "episteme": o primeiro, manifesto em artigos publicados desde a fundação da ONU, em 1945, aborda sistematicamente uma suposta "crise" da entidade; o segundo, relativo à atribuição reiterada do prêmio Nobel da Paz à ONU, ao longo de seis décadas, por suas alegadas contribuições à promoção da paz e segurança internacionais. Essa avaliação bipolar da atuação da ONU reproduz, a nosso ver, um padrão de análise sobre as organizações internacionais que é comum, de resto, à disciplina acadêmica das Relações Internacionais. A ONU é louvada e lamentada com os olhos voltados para aquela que é a fórmula institucional da política moderna por excelência: o Estado nacional soberano. Julgamos, como conclusão, que avaliar a ONU de 2009 com os olhos de 1945 constitui perigosa impropriedade. O próprio conceito-padrão de Estado requer, hoje, uma redefinição de termos - a fim de que possa absorver as mudanças sociais e históricas havidas com o passar dos anos. O desafio, portanto, é oferecer perspectivas para um novo enquadramento teórico da Organização das Nações Unidas - que, idealmente, esteja isento dos efeitos colaterais desencadeados pelo que aqui chamamos de "estadismo metodológico".
Prática política, qualificações profissionais e trabalho imaterial hoje
Authors: Amorim Henrique
Published: August 2009

O desenvolvimento das forças produtivas caracteriza-se como um importante objeto de estudos da teoria social contemporânea. No entanto, a consideração desse tema esteve limitada a aspectos técnicos dos processos de trabalho. Tecnologia, novos conhecimentos, técnicas administrativas e produtivas foram indicadas como elementos centrais para a constituição da "consciência" revolucionária da classe trabalhadora. Hoje, no debate sobre o trabalho imaterial, a relação entre os conteúdos cognitivos do trabalho e a "tomada de consciência" política revolucionária, como nexo causal da unidade política da classe trabalhadora, é apresentada como eixo fundamental para a constituição de uma sociedade livre das amarras do capital. Nesse artigo, pretendo discutir qual o papel das qualificações profissionais na composição das teses sobre o trabalho imaterial como força produtiva central nas sociedades capitalistas.
Avolatilidade eleitoral nos estados sistema partidário e democracia no Brasil
Authors: Bohn Simone R. , Paiva Denise
Published: August 2009

De acordo com alguns autores, a volatilidade eleitoral é um dos indicadores da institucionalização de um sistema partidário sob um regime democrático. Graus baixos ou moderados de oscilação da preferência eleitoral indicam que os partidos políticos participantes das disputas eleitorais são exitosos na tarefa de efetivamente canalizar as preferências do eleitorado de um país. Níveis elevados de volatilidade eleitoral, por outro lado, são vistos como evidência do precário enraizamento dos partidos na sociedade. O objetivo primordial deste artigo é verificar se a tendência de declínio da volatilidade eleitoral no Brasil, observada no plano nacional em vários estudos, (a) também se repete no plano estadual e (b) em eleições outras que as disputas presidenciais. O artigo abrange o período de 1982 a 2006 e examina os cinco tipos de pleitos do sistema eleitoral brasileiro: as eleições presidenciais, para os governos estaduais, Senado, Câmara dos Deputados e Assembléias Legislativas. Sua principal inovação consiste na análise da volatilidade eleitoral no âmbito dos distritos estaduais, o que nos permite começar a mapear e a entender o impacto das peculiaridades da política subnacional sobre a dinâmica eleitoral. A principal conclusão desse artigo é a de que o Brasil vem experimentando, embora com importantes exceções, uma tendência geral de declínio da volatilidade tanto no plano nacional quanto estadual, o que, da perspectiva da institucionalização do sistema partidário, representa uma boa notícia. Salientamos também, no entanto, que, como essa tendência declinante não é acompanhada pela melhora dos níveis de satisfação dos brasileiros com os partidos políticos e nem pelo aumento da taxa de identificação partidária, a poliarquia brasileira parece estar diante de um grave problema de representação política.
De H. Cleckley ao DSM-IV-TR: a evolução do conceito de psicopatia rumo à medicalização da delinquência
Authors: Henriques Rogério Paes
Published: August 2009

A psicopatia é descrita como personalidade antissocial pelos manuais nosográficos contemporâneos: CID-10 e DSM-IV-TR. Contrastando tais nosografias entre si quanto aos critérios diagnósticos propostos para a psicopatia, assinalam-se as consequências de sua operacionalização, promovida, sobretudo, pelo DSM. Dentre elas, destacam-se: (1) a degradação do diagnóstico ao mero levantamento protocolar; (2) a acentuação da correlação histórica entre psicopatia e delinquência.
A transferência como articuladora entre a clínica e a política nos serviços de atenção psicossocial
Authors: Bezerra Daniela Santos , Rinaldi Doris Luz
Published: August 2009

Este trabalho visa analisar as questões que surgiram no cotidiano de serviços de atenção psicossocial, evidenciando a importância do manejo da relação entre técnicos, usuários e familiares na efetivação da clínica oferecida. A partir de exemplos clínicos e utilizando o conceito de transferência como contribuição da clínica psicanalítica à clínica ampliada, propõe-se a inclusão do sujeito do inconsciente como fundamental ao processo de Reforma Psiquiátrica, já que este sujeito, que difere do cidadão de direitos, é radicalmente responsável por sua posição.
Estigma e esquizofrenia: repercussões do estudo sobre discriminação experimentada e antecipada
Authors: Teixeira Mônica
Published: August 2009

O artigo "Padrão global da discriminação experimentada e antecipada contra pessoas com esquizofrenia: estudo transversal", publicado originalmente na Lancet, despertou interesse entre psiquiatras de vários países da Europa. As cartas enviadas por eles à revista inglesa foram reunidas aqui.
Krafft-Ebing, a Psychopathia Sexualis e a criação da noção médica de sadismo
Authors: Pereira Mário Eduardo Costa
Published: August 2009

Escrita na segunda metade do século XIX, a Psychopathia Sexualis de Richard Krafft-Ebing participa de um movimento histórico-cultural que institui o olhar e a autoridade médica como referências necessárias para se deliberar quanto à legitimidade dos diferentes comportamentos sexuais humanos. Suas incidências se estendem mesmo sobre o campo legal e jurídico. Obra que sintetiza e aprofunda os estudos da sexologia de seu tempo, Psychopathia Sexualis introduz uma delimitação do campo das perversões sexuais, uma nomenclatura - que inclui termos que seriam posteriormente consagrados como sadismo, masoquismo e fetichismo, e um rigor classificatório que a tornarão uma referência incontornável para todos os estudos posteriores nesse campo, incluindo a obra freudiana.
Historicidade e interdiscurso: pensando a educação em ciências na escola básica
Authors: Almeida Maria José P. M. de
Published: August 2009

É discutida a possibilidade de diferentes abordagens da dimensão histórica na História da Ciência e apontada a necessidade de que elas sejam explicitadas quando se pensa a utilização da História da Ciência no ensino da Ciência.
História da ciência, interdisciplinaridade e ensino de física: o problema do demônio de Maxwell
Authors: Mattos Cristiano , Hamburger Amélia Império
Published: August 2009

Propomos que uma evolução de idéias científicas seja usada como instrumento de aprendizagem de conteúdos específicos e, em particular, para ressaltar como os conteúdos se articulam entre as disciplinas. Como exemplo, apresentamos um estudo sobre a proposta do "demônio de Maxwell" e discussões sobre sua "exorcização", isto é, um estudo sobre a compreensão da natureza de um ser inteligente que atua dentro de um sistema físico e de como seria essa atuação. Estão envolvidos nesse problema fenômenos relacionados com várias teorias - Termodinâmica, Física Molecular, Mecânica Estatística, Teoria da Informação - dentro das disciplinas de Física, Química, Biologia, Computação. Entre diversas questões epistemológicas e conceituais aí contidas, será enfatizada a questão do objeto limitado de uma eoria científica, isto é, da limitação de seu significado aos fenômenos por ela compreendidos. A delimitação dos fenômenos estudados e as teorias e técnicas caracterizam a compreensão que vai realizar sua emergência concreta nos laboratórios. Essa compreensão vai dar também a possibilidade de atuação interdisciplinar.
A epistemologia de Maturana
Authors: Moreira Marco Antonio
Published: August 2009

Diferentemente dos epistemólogos mais conhecidos no Ensino de Ciências, geralmente oriundos das ciências físicas e predominantemente racionalistas, Maturana vem das ciências biológicas e procura explicar o conhecer explicando o conhecedor e tomando como ponto de partida a experiência do observador e o observar. Esse observador não pode distinguir, na experiência, entre ilusão e percepção, mas pode gerar explicações da experiência que são reformulações da experiência. As explicações científicas, por exemplo, são reformulações da experiência aceitas pela comunidade científica por satisfazerem um critério de validação estabelecido por ela mesma. Este texto procura detalhar essas idéias.
Estrogen receptor 1 mRNA is a prognostic factor in ovarian carcinoma: determination by kinetic PCR in formalin-fixed paraffin-embedded tissue
Authors: Darb-Esfahani Silvia , Wirtz Ralph M , Sinn Bruno V , Budczies Jan , Noske Aurelia , Weichert Wilko , Faggad Areeg , Scharff Susanne , Sehouli Jalid , Oskay-Özcelik Guelten , Zamagni Claudio , De Iaco Pierandrea , Martoni Andrea , Dietel Manfred , Denkert Carsten
Published: August 2009

Epidemiological and cell culture studies indicate that ovarian carcinoma growth is dependent on estrogen stimulation. However, possibly due to the lack of a reliable biomarker that helps to select patients according to prognostically relevant estrogen receptor (ER) levels, clinical trials using anti-estrogenic therapeutics in ovarian carcinoma have had inconsistent results. Therefore, we tested if ER expression analysis by a quantitative method might be useful in this regard in formalin-fixed paraffin-embedded (FFPE) tissue. In a study group of 114 primary ovarian carcinomas expression of estrogen receptor 1 (ESR1) mRNA was analyzed using a new method for RNA extraction from FFPE tissue that is based on magnetic beads, followed by kinetic PCR. The prognostic impact of ESR1 mRNA expression was investigated and compared to ERα protein expression as determined by immunohistochemistry. In univariate survival analysis the expression level of ESR1 mRNA was a significant positive prognostic factor for patient survival (hazard ratio (HR) 0.230 (confidence interval (CI) 0.102–0.516), P=0.002). ERα protein expression was correlated to ESR1 mRNA expression (P=0.0001); however, ERα protein expression did not provide statistically significant prognostic information. In multivariate analysis, ESR1 mRNA expression emerged as a prognostic factor, independent of stage, grade, residual tumor mass, age, and ERα protein expression (HR 0.227 (CI 0.078–0.656), P=0.006). Our results indicate that the determination of ESR1 levels by kinetic PCR may be superior to immunohistochemical methods in assessment of biologically relevant levels of ER expression in ovarian carcinoma, and is feasible in routinely used FFPE tissue.
Symbolic Interactionism and Nurse–Mother Communication in the Neonatal Intensive Care Unit
Authors: Cleveland Lisa Marie
Published: August 2009

The admission of an infant to the neonatal intensive care unit (NICU) has the potential to cause significant stress for the mothers of these infants. Researchers have found that nurse–mother communication has the potential to either aid or hinder the mother’s adaptation to the NICU environment. These communication patterns are relatively complex in nature and therefore warrant further investigation. Symbolic interactionism (SI) is a theoretical framework that offers the potential to direct such an investigation. The purpose of this article is to examine nurse–mother communication patterns in the NICU through the theoretical lens of SI.
Compositional Space Parameterization: Theory and Application for Immiscible Displacements
Authors: Voskov D. V. , Tchelepi H. A.
Published: August 2009

Thermodynamic equilibrium calculations in compositional flow simulators are used to find the partitioning of components among fluid phases, and they can be a time consuming kernel in a compositional flow simulation. We describe a tie-line-based compositional space parameterization (CSP) approach for dealing with immiscible gas-injection processes with large numbers of components. The multicomponent multiphase equilibrium problem is recast in terms of this parameterized compositional space, in which the solution path can be represented in a concise manner. This tie-line-based parameterization approach is used to speed up the phase behavior calculations of standard compositional simulation. Two schemes are employed. In the first method, the parameterization of the phase behavior is computed in a preprocessing step, and the results are stored in a table. During the course of a simulation, the flash calculation procedure is replaced by the solution of a multidimensional optimization problem in terms of the parameterized space. For processes where significant changes in pressure and temperature take place, this optimization procedure is combined with linear interpolation in tie-line space. In the second method, compositional space adaptive tabulation (CSAT) is used to accelerate the equation of state (EOS) computations associated with standard compositional reservoir simulation. The CSAT strategy takes advantage of the fact that, in gas injection processes, the solution path involves a limited number of tie-lines. The adaptively collected tie-lines are used to avoid redundant phase-stability checks in the course of a flow simulation. Specifically, we check if a given composition belongs to one of the tie-lines (or its extension) already in the table. If not, a new tie-line is computed and added to the table. The CSAT technique was implemented in a general-purpose research simulator (GPRS), which is designed for compositional flow simulation on unstructured grids. Using a variety of challenging models, we show that, for immiscible compositional processes, CSAT leads to significant speed up (at least a several-fold improvement) of the EOS calculations compared with standard techniques.
Efficient and Accurate Quantification of Uncertainty for Multiphase Flow With the Probabilistic Collocation Method
Authors: Li Heng , Zhang Dongxiao
Published: August 2009

In this study, we explore an efficient and accurate method for uncertainty analysis of petroleum reservoir simulations. The essence of the approach is the combination of Karhunen-Loeve (KL) expansion and probabilistic collocation method. Monte Carlo (MC) simulation is the most common and straightforward approach for uncertainty quantification. It generates a large number of realizations of the underlying reservoir. Solving the multiple realizations leads to a large computational effort, especially for large-scale problems. We present an accurate and efficient alternative. In this approach, the underlying random fields, such as permeability and porosity are represented by the KL expansion and the resulting random fields (e.g., fluid saturations and pressures) or variables (e.g., hydrocarbon production) are expressed by the polynomial chaos expansions. The probabilistic collocation method (PCM) is used to determine the coefficients of the polynomial chaos expansions by solving for the fluid saturation and pressure fields via the original partial differential equations for selected sets of collocation points. This approach is nonintrusive because it results in independent deterministic differential equations, which, similar to the MC method, can be implemented with existing codes or simulators. However, the required number of simulations in the PCM is much less than that in the MC method. The approach is demonstrated with black-oil problems in heterogeneous reservoirs with the commercial Eclipse simulator. The accuracy, efficiency, and compatibility of this approach are compared against MC simulations. This study reveals that, while its computational efforts are greatly reduced compared to the MC method, the PCM is able to estimate accurately the statistical moments and probability density functions of the fluid saturations (and pressures) and the hydrocarbon production.
Prediction of Proppant Transport From Rheological Data
Authors: Harris Phillip C. , Walters Harold G. , Bryant Jason
Published: August 2009

To ensure that a fracturing treatment will be successful, fracturing gels are formulated and viscosity parameters are measured. Steady-shear viscosity cannot measure the elastic component of viscoelas-tic fluids. Dynamic-oscillatory shear can provide measurements of elastic properties, but such measurements are made in the absence of any particles. A third technique, a slurry viscometer (SV), can incorporate particles and measure proppant-transport characteristics of the fluid. This paper compares all three measurement techniques for verification of transport prediction.

Steady-shear viscosities of gelled fracturing fluids were measured using couette viscometers. Viscoelastic characteristics of the same fluids were measured with a dynamic-oscillatory viscometer to determine G′ and G″ moduli and crossover frequency. Proppant particles were added to these same fluids, and properties were measured with the SV to determine elastic transport and viscous transport times.

Comparison of the three data sets shows that the elastic modulus, G′, and crossover frequency have a high correlation with elastic transport times measured with the SV. Steady-shear viscosities greater than 10 sec−1 do not correlate directly with transport times.

For years, dynamic-oscillatory measurements have been thought to predict particle-transport phenomena, but any correlations generated could be incomplete because particles are excluded from the measurements. The SV does include particles in the fracturing gel and can be used to verify trends of proppant transport indicated by G′ and the crossover frequency.
Muscle Contraction, but Not Insulin, Increases Microvascular Blood Volume in the Presence of Free Fatty Acid–Induced Insulin Resistance
Authors: Inyard April C. , Chong Daniel G. , Klibanov Alexander L. , Barrett Eugene J.
Published: August 2009

OBJECTIVE

Insulin and contraction each increase muscle microvascular blood volume (MBV) and glucose uptake. Inhibiting nitric oxide synthase blocks insulin's but not contraction's effects. We examined whether contraction could augment the MBV increase seen with physiologic hyperinsulinemia and whether free fatty acid (FFA)-induced insulin resistance differentially affects contraction- versus insulin-mediated increases in MBV.

RESEARCH DESIGN AND METHODS

Rats were fasted overnight. Plasma FFAs were increased by intralipid/heparin infusion (3 h), insulin was increased with a euglycemic clamp (3 mU · min−1 · kg−1), and hindlimb muscle contraction was electrically stimulated. Muscle MBV was measured using contrast-enhanced ultrasound. Insulin transport into muscle was measured using 125I-insulin. BQ-123 (0.4 mg/h) was used to block the endothelin-1 (ET-1) receptor A.

RESULTS

Superimposing contraction on physiologic hyperinsulinemia increased MBV within 10 min by 37 and 67% for 0.1 or 1 Hz, respectively (P < 0.01). FFA elevation alone did not affect MBV, whereas 0.1 Hz stimulation doubled MBV (P < 0.05) and increased muscle insulin uptake (P < 0.05) despite high FFA. Physiologic hyperinsulinemia during FFA elevation paradoxically decreased MBV (P < 0.05). This MBV decrease was reversed by either 0.1 Hz contraction or ET-1 receptor A antagonism, and the combination raised MBV above basal.

CONCLUSIONS

Contraction recruits microvasculature beyond that seen with physiologic hyperinsulinemia by a distinct mechanism that is not blocked by FFA-induced vascular insulin resistance. The paradoxical MBV decline seen with insulin plus FFA may result from differential inhibition of insulin-stimulated nitric oxide–dependent vasodilation relative to ET-1 vasoconstriction. Our results implicate ET-1 as a potential mediator of FFA-induced vascular insulin resistance.
Paradoxical Coupling of Triglyceride Synthesis and Fatty Acid Oxidation in Skeletal Muscle Overexpressing DGAT1
Authors: Liu Li , Shi Xiaojing , Choi Cheol Soo , Shulman Gerald I. , Klaus Katherine , Nair K. Sreekumaran , Schwartz Gary J. , Zhang Yiying , Goldberg Ira J. , Yu Yi-Hao
Published: August 2009

OBJECTIVE

Transgenic expression of diacylglycerol acyltransferase-1 (DGAT1) in skeletal muscle leads to protection against fat-induced insulin resistance despite accumulation of intramuscular triglyceride, a phenomenon similar to what is known as the “athlete paradox.” The primary objective of this study is to determine how DGAT1 affects muscle fatty acid oxidation in relation to whole-body energy metabolism and insulin sensitivity.

RESEARCH DESIGN AND METHODS

We first quantified insulin sensitivity and the relative tissue contributions to the improved whole-body insulin sensitivity in muscle creatine kisase (MCK)-DGAT1 transgenic mice by hyperinsulinemic-euglycemic clamps. Metabolic consequences of DGAT1 overexpression in skeletal muscles were determined by quantifying triglyceride synthesis/storage (anabolic) and fatty acid oxidation (catabolic), in conjunction with gene expression levels of representative marker genes in fatty acid metabolism. Whole-body energy metabolism including food consumption, body weights, oxygen consumption, locomotor activity, and respiration exchange ratios were determined at steady states.

RESULTS

MCK-DGAT1 mice were protected against muscle lipoptoxicity, although they remain susceptible to hepatic lipotoxicity. While augmenting triglyceride synthesis, DGAT1 overexpression also led to increased muscle mitochondrial fatty acid oxidation efficiency, as compared with wild-type muscles. On a high-fat diet, MCK-DGAT1 mice displayed higher basal metabolic rates and 5–10% lower body weights compared with wild-type littermates, whereas food consumption was not different.

CONCLUSIONS

DGAT1 overexpression in skeletal muscle led to parallel increases in triglyceride synthesis and fatty acid oxidation. Seemingly paradoxical, this phenomenon is characteristic of insulin-sensitive myofibers and suggests that DGAT1 plays an active role in metabolic “remodeling” of skeletal muscle coupled with insulin sensitization.
11β-Hydroxysteroid Dehydrogenase Type 1 Regulates Glucocorticoid-Induced Insulin Resistance in Skeletal Muscle
Authors: Morgan Stuart A. , Sherlock Mark , Gathercole Laura L. , Lavery Gareth G. , Lenaghan Carol , Bujalska Iwona J. , Laber David , Yu Alice , Convey Gemma , Mayers Rachel , Hegyi Krisztina , Sethi Jaswinder K. , Stewart Paul M. , Smith David M. , Tomlinson Jeremy W.
Published: August 2009

OBJECTIVE

Glucocorticoid excess is characterized by increased adiposity, skeletal myopathy, and insulin resistance, but the precise molecular mechanisms are unknown. Within skeletal muscle, 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) converts cortisone (11-dehydrocorticosterone in rodents) to active cortisol (corticosterone in rodents). We aimed to determine the mechanisms underpinning glucocorticoid-induced insulin resistance in skeletal muscle and indentify how 11β-HSD1 inhibitors improve insulin sensitivity.

RESEARCH DESIGN AND METHODS

Rodent and human cell cultures, whole-tissue explants, and animal models were used to determine the impact of glucocorticoids and selective 11β-HSD1 inhibition upon insulin signaling and action.

RESULTS

Dexamethasone decreased insulin-stimulated glucose uptake, decreased IRS1 mRNA and protein expression, and increased inactivating pSer307 insulin receptor substrate (IRS)-1. 11β-HSD1 activity and expression were observed in human and rodent myotubes and muscle explants. Activity was predominantly oxo-reductase, generating active glucocorticoid. A1 (selective 11β-HSD1 inhibitor) abolished enzyme activity and blocked the increase in pSer307 IRS1 and reduction in total IRS1 protein after treatment with 11DHC but not corticosterone. In C57Bl6/J mice, the selective 11β-HSD1 inhibitor, A2, decreased fasting blood glucose levels and improved insulin sensitivity. In KK mice treated with A2, skeletal muscle pSer307 IRS1 decreased and pThr308 Akt/PKB increased. In addition, A2 decreased both lipogenic and lipolytic gene expression.

CONCLUSIONS

Prereceptor facilitation of glucocorticoid action via 11β-HSD1 increases pSer307 IRS1 and may be crucial in mediating insulin resistance in skeletal muscle. Selective 11β-HSD1 inhibition decreases pSer307 IRS1, increases pThr308 Akt/PKB, and decreases lipogenic and lipolytic gene expression that may represent an important mechanism underpinning their insulin-sensitizing action.
Caveolin-1 and Altered Neuregulin Signaling Contribute to the Pathophysiological Progression of Diabetic Peripheral Neuropathy
Authors: McGuire James F. , Rouen Shefali , Siegfreid Eric , Wright Douglas E. , Dobrowsky Rick T.
Published: August 2009

OBJECTIVE

Evaluate if Erb B2 activation and the loss of caveolin-1 (Cav1) contribute to the pathophysiological progression of diabetic peripheral neuropathy (DPN).

RESEARCH DESIGN AND METHODS

Cav1 knockout and wild-type C57BL/6 mice were rendered diabetic with streptozotocin, and changes in motor nerve conduction velocity (MNCV), mechanical and thermal hypoalgesia, Erb B2 phosphorylation (pErb B2), and epidermal nerve fiber density were assessed. The contribution of Erb B2 to DPN was assessed using the Erb B2 inhibitors PKI 166 and erlotinib and a conditional bitransgenic mouse that expressed a constitutively active form of Erb B2 in myelinated Schwann cells (SCs).

RESULTS

Diabetic mice exhibited decreased MNCV and mechanical and thermal sensitivity, but the extent of these deficits was more severe in diabetic Cav1 knockout mice. Diabetes increased pErb B2 levels in both genotypes, but the absence of Cav1 correlated with a greater increase in pErb B2. Erb B2 activation contributed to the mechanical hypoalgesia and MNCV deficits in both diabetic genotypes because treatment with erlotinib or PKI 166 improved these indexes of DPN. Similarly, induction of a constitutively active Erb B2 in myelinated SCs was sufficient to decrease MNCV and induce a mechanical hypoalgesia in the absence of diabetes.

CONCLUSIONS

Increased Erb B2 activity contributes to specific indexes of DPN, and Cav1 may be an endogenous regulator of Erb B2 signaling. Altered Erb B2 signaling is a novel mechanism that contributes to SC dysfunction in diabetes, and inhibiting Erb B2 may ameliorate deficits of tactile sensitivity in DPN.
Prevalence and Management of Diabetes in Korean Adults
Authors: Choi Yong Jun , Kim Hyeon Chang , Kim Hee Man , Park Seok Won , Kim Jongoh , Kim Dae Jung
Published: August 2009

OBJECTIVE

This research investigated recent changes in the prevalence and management status of diabetes among Korean adults.

RESEARCH DESIGN AND METHODS

The Korea National Health and Nutrition Examination Survey (KNHANES), a nationwide survey examining the general health and nutrition status of the Korean people, was conducted in 1998, 2001, and 2005. Using the first (1998; n = 5,645), second (2001; n = 4,154), and third (2005; n = 4,628) KNHANES datasets, in the present study, we estimated the prevalence of diabetes among Korean adults (aged ≥30 years), the proportions of known cases of diabetes, and the proportions of well-controlled cases of diabetes, as defined by either the American Diabetes Association (A1C <7%) or the International Diabetes Federation guidelines (A1C <6.5%).

RESULTS

In 2005, the prevalence of diabetes was estimated to be 9.1% (∼2.58 million people: 10.2% of men and 7.9% of women), including 6.2% with known diabetes and 2.9% with newly diagnosed diabetes. The prevalence of impaired fasting glucose was 17.4% (∼4.94 million people). The proportion of known cases of diabetes drastically increased from 23.2% in 1998 to 41.2% in 2001 and 68.0% in 2005 (P < 0.0001). Among known diabetic patients in 2005, 43.5 and 22.9% had A1C levels <7.0 and <6.5%, respectively.

CONCLUSIONS

The overall prevalence of diabetes in Korea has not changed significantly between 1998 and 2005. Physician diagnosis and treatment rates of diabetes have significantly improved during this period, but glycemic control was still poorer than that in other developed countries.
Blunted Counterregulatory Hormone Responses to Hypoglycemia in Young Children and Adolescents With Well-Controlled Type 1 Diabetes
Authors:   Diabetes Research in Children Network (DirecNet) Study Group
Published: August 2009

OBJECTIVE

Hypoglycemia in young children with type 1 diabetes is an acute complication of intensive insulin therapy and is commonly observed in the absence of signs or symptoms. The effect of intensive treatment and patient age on sympathoadrenal responses has not been established in youth with type 1 diabetes because of difficulties in testing procedures.

RESEARCH DESIGN AND METHODS

We developed a standardized inpatient continuous subcutaneous insulin infusion protocol to produce a progressive fall in plasma glucose concentrations in insulin pump–treated patients. Plasma glucose and counterregulatory hormone concentrations were measured in 14 young children (3 to <8 years, A1C 7.7 ± 0.6%) vs. 14 adolescents (12 to <18 years, A1C 7.6 ± 0.8%).

RESULTS

Plasma glucose decreased to similar nadir concentrations in the two groups. Four young children and four adolescents never had an epinephrine response. In the four young children and five adolescents who had a modest epinephrine response, this only occurred when plasma glucose fell to <60 mg/dl. In evaluating symptom scores, 29% of parents of young children felt that their child looked hypoglycemic, even at the lowest plasma glucose concentrations. Adolescents were better able to detect symptoms of hypoglycemia. In comparison with our data, epinephrine response to hypoglycemia in 14 nondiabetic adolescents studied at the Children's Hospital of Pittsburgh was higher.

CONCLUSIONS

These data suggest that even young children and adolescents with type 1 diabetes are prone to develop hypoglycemia-associated autonomic failure regardless of duration. Whether these abnormalities can be reversed using continuous glucose monitoring and closed-loop insulin delivery systems awaits further study.
Determinants of Quality in Diabetes Care Process
Authors: Gnavi Roberto , Picariello Roberta , la Karaghiosoff Ludmi , Costa Giuseppe , Giorda Carlo
Published: August 2009

OBJECTIVE

To investigate the role of clinical and socioeconomic variables as determinants of adherence to recommended diabetes care guidelines and assess differences in the process of care between diabetologists and general practitioners.

RESEARCH DESIGN AND METHODS

We identified diabetic residents in Torino, Italy, as of 31 July 2003, using multiple independent data sources. We collected data on several laboratory tests and specialist medical examinations registered during the subsequent 12 months and performed regression analyses to identify associations with quality-of-care indicators based on existing guidelines.

RESULTS

After 1 year, only 35.8% of patients had undergone a comprehensive assessment. In the multivariate models, factors independently and significantly associated with lower quality of care were age ≥75 years (prevalence rate ratio [PRR] 0.66 [95% CI 0.61–0.70]) and established cardiovascular disease (0.89 [0.86–0.93]). Disease severity (PRR for insulin-treated patients 1.45 [1.38–1.53]) and diabetologist consultation (PRR 3.34 [3.17–3.53]) were positively associated with high quality of care. No clear association emerged between sex and socioeconomic status. These differences were strongly reduced in patients receiving diabetologist care compared with patients receiving general practitioner care only.

CONCLUSIONS

Despite widespread availability of guidelines and simple screening procedures, a nonnegligible portion of the diabetic population, namely elderly individuals and patients with less severe forms of the disease, are not properly cared for. As practitioners in diabetes centers are more likely to adhere to guidelines than general practitioners, quality in the diabetes care process can be improved by increasing the intensity of disease management programs, with greater participation by general practitioners.
Diabetic Retinopathy Is Associated With Elevated Serum Asymmetric and Symmetric Dimethylarginines
Authors: Abhary Sotoodeh , Kasmeridis Nicholas , Burdon Kathryn P. , Kuot Abraham , Whiting Malcolm J. , Yew Wai Ping , Petrovsky Nikolai , Craig Jamie E.
Published: August 2009

OBJECTIVE

Asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA), and l-arginine directly influence nitric oxide production. Our objective was to test whether serum ADMA, SDMA, or l-arginine levels correlate with diabetic retinopathy subtype or severity.

RESEARCH DESIGN AND METHODS

A total of 162 subjects with type 1 diabetes and 343 with type 2 diabetes, of whom 329 subjects had no diabetic retinopathy, 27 had nonproliferative diabetic retinopathy (NPDR), 101 had proliferative diabetic retinopathy (PDR), and 107 had clinically significant macular edema (CSME), were recruited. Blinding diabetic retinopathy was defined as severe NPDR, PDR, or CSME. Serum ADMA, SDMA, and l-arginine concentrations were determined by mass spectroscopy.

RESULTS

In multivariate analysis, blinding diabetic retinopathy, PDR, and nephropathy were associated with significantly increased serum levels of ADMA (P < 0.001), SDMA (P < 0.001), and l-arginine (P = 0.001). Elevated ADMA (P < 0.001) and SDMA (P < 0.001) were also significantly associated with CSME.

CONCLUSIONS

Severe forms of diabetic retinopathy are associated with elevated serum ADMA, SDMA, and l-arginine. Further investigation is required to determine whether these findings are of clinical relevance.
Association Between Neighborhood-Level Deprivation and Disability in a Community Sample of People With Diabetes
Authors: Schmitz Norbert , Nitka Danit , Gariepy Genevieve , Malla Ashok , Wang JianLi , Boyer Richard , Messier Lyne , Strychar Irene , Lesage Alain
Published: August 2009

OBJECTIVE

The objective of the present study was to analyze the association between neighborhood deprivation and self-reported disability in a community sample of people with type 2 diabetes.

RESEARCH DESIGN AND METHODS

Random digit dialing was used to select a sample of adults with self-reported diabetes aged 18–80 years in Quebec, Canada. Health status was assessed by the World Health Organization Disability Assessment Schedule II. Material and social deprivation was measured using the Pampalon index, which is based on the Canadian Census. Potential risk factors for disability included sociodemographic characteristics, socioeconomic status, social support, lifestyle-related factors (smoking, physical activity, and BMI), health care–related problems, duration of diabetes, insulin use, and diabetes-specific complications.

RESULTS

There was a strong association between disability and material and social deprivation in our sample (n = 1,439): participants living in advantaged neighborhoods had lower levels of disability than participants living in disadvantaged neighborhoods. The means ± SD disability scores for men were 7.8 ± 11.8, 12.0 ± 11.8, and 18.1 ± 19.4 for low, medium, and high deprivation areas, respectively (P < 0.001). The disability scores for women were 13.4 ± 12.4, 14.8 ± 15.9, and 18.9 ± 16.2 for low, medium, and high deprivation areas, respectively (P < 0.01). Neighborhood deprivation was associated with disability even after controlling for education, household income, sociodemographic characteristics, race, lifestyle-related behaviors, social support, diabetes-related variables, and health care access problems.

CONCLUSIONS

The inclusion of neighborhood characteristics might be an important step in the identification and interpretation of risk factors for disability in diabetes.
Sustained Benefit of Continuous Glucose Monitoring on A1C, Glucose Profiles, and Hypoglycemia in Adults With Type 1 Diabetes
Authors:   The Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group
Published: August 2009

OBJECTIVE

To evaluate long-term effects of continuous glucose monitoring (CGM) in intensively treated adults with type 1 diabetes.

RESEARCH DESIGN AND METHODS

We studied 83 of 86 individuals ≥25 years of age with type 1 diabetes who used CGM as part of a 6-month randomized clinical trial in a subsequent 6-month extension study.

RESULTS

After 12 months, median CGM use was 6.8 days per week. Mean change in A1C level from baseline to 12 months was −0.4 ± 0.6% (P < 0.001) in subjects with baseline A1C ≥7.0%. A1C remained stable at 6.4% in those with baseline A1C <7.0%. The incidence rate of severe hypoglycemia was 21.8 and 7.1 events per 100 person-years in the first and last 6 months, respectively. Time per day with glucose levels in the range of 71–180 mg/dl increased significantly (P = 0.02) from baseline to 12 months.

CONCLUSIONS

In intensively treated adults with type 1 diabetes, CGM use and benefit can be sustained for 12 months.
Factors Predictive of Use and of Benefit From Continuous Glucose Monitoring in Type 1 Diabetes
Authors:   Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group
Published: August 2009

OBJECTIVE

To evaluate factors associated with successful use of continuous glucose monitoring (CGM) among participants with intensively treated type 1 diabetes in the Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Randomized Clinical Trial.

RESEARCH DESIGN AND METHODS

The 232 participants randomly assigned to the CGM group (165 with baseline A1C ≥7.0% and 67 with A1C <7.0%) were asked to use CGM on a daily basis. The associations of baseline factors and early CGM use with CGM use ≥6 days/week in the 6th month and with change in A1C from baseline to 6 months were evaluated in regression models.

RESULTS

The only baseline factors found to be associated with greater CGM use in month 6 were age ≥25 years (P < 0.001) and more frequent self-reported prestudy blood glucose meter measurements per day (P < 0.001). CGM use and the percentage of CGM glucose values between 71 and 180 mg/dl during the 1st month were predictive of CGM use in month 6 (P < 0.001 and P = 0.002, respectively). More frequent CGM use was associated with a greater reduction in A1C from baseline to 6 months (P < 0.001), a finding present in all age-groups.

CONCLUSIONS

After 6 months, near-daily CGM use is more frequent in intensively treated adults with type 1 diabetes than in children and adolescents, although in all age-groups near-daily CGM use is associated with a similar reduction in A1C. Frequency of blood glucose meter monitoring and initial CGM use may help predict the likelihood of long-term CGM benefit in intensively treated patients with type 1 diabetes of all ages.
Association of Type 1 Diabetes With Month of Birth Among U.S. Youth
Authors: Kahn Henry S. , Morgan Timothy M. , Case L. Douglas , Dabelea Dana , Mayer-Davis Elizabeth J. , Lawrence Jean M. , Marcovina Santica M. , Imperatore Giuseppina ,   for the SEARCH for Diabetes in Youth Study Group
Published: August 2009

OBJECTIVE

Seasonal environment at birth may influence diabetes incidence in later life. We sought evidence for this effect in a large sample of diabetic youth residing in the U.S.

RESEARCH DESIGN AND METHODS

We compared the distribution of birth months within the SEARCH for Diabetes in Youth Study (SEARCH study) with the monthly distributions in U.S. births tabulated by race for years 1982–2005. SEARCH study participants (9,737 youth with type 1 diabetes and 1,749 with type 2 diabetes) were identified by six collaborating U.S. centers.

RESULTS

Among type 1 diabetic youth, the percentage of observed to expected births differed across the months (P = 0.0092; decreased in October–February and increased in March–July). Their smoothed birth-month estimates demonstrated a deficit in November–February births and an excess in April–July births (smoothed May versus January relative risk [RR] = 1.06 [95% CI 1.02–1.11]). Stratifications by sex or by three racial groups showed similar patterns relating type 1 diabetes to month of birth. Stratification by geographic regions showed a peak-to-nadir RR of 1.10 [1.04–1.16] in study regions from the northern latitudes (Colorado, western Washington State, and southern Ohio) but no birth-month effect (P > 0.9) in study regions from more southern locations. Among type 2 diabetic youth, associations with birth month were inconclusive.

CONCLUSIONS

Spring births were associated with increased likelihood of type 1 diabetes but possibly not in all U.S. regions. Causal mechanisms may involve factors dependent on geographic latitude such as solar irradiance, but it is unknown whether they influence prenatal or early postnatal development.
Eating Fish and Risk of Type 2 Diabetes
Authors: van Woudenbergh Geertruida J. , van Ballegooijen Adriana J. , Kuijsten Anneleen , Sijbrands Eric J.G. , van Rooij Frank J.A. , Geleijnse Johanna M. , Hofman Albert , Witteman Jacqueline C.M. , Feskens Edith J.M.
Published: August 2009

OBJECTIVE

To investigate the relation between total fish, type of fish (lean and fatty), and eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake and risk of type 2 diabetes in a population-based cohort.

RESEARCH DESIGN AND METHODS

The analysis included 4,472 Dutch participants aged ≥55 years without diabetes at baseline. Dietary intake was assessed with a semiquantitative food frequency questionnaire. Hazard ratios (relative risk [RR]) with 95% CIs were used to examine risk associations adjusted for age, sex, lifestyle, and nutritional factors.

RESULTS

After 15 years of follow-up, 463 participants developed type 2 diabetes. Median fish intake, mainly lean fish (81%), was 10 g/day. Total fish intake was associated positively with risk of type 2 diabetes; the RR was 1.32 (95% CI 1.02–1.70) in the highest total fish group (≥28 g/day) compared with that for non–fish eaters (Ptrend = 0.04). Correspondingly, lean fish intake tended to be associated positively with type 2 diabetes (RR highest group ]≥23 g/day] 1.30 [95% CI 1.01–1.68]; Ptrend = 0.06), but fatty fish was not. No association was observed between EPA and DHA intake and type 2 diabetes (RR highest group [≥149.4 mg/day] 1.22 [0.97–1.53]). With additional adjustment for intake of selenium, cholesterol, and vitamin D, this RR decreased to 1.05 (0.80–1.38; Ptrend = 0.77).

CONCLUSIONS

The findings do not support a beneficial effect of total fish, type of fish, or EPA and DHA intake on the risk of type 2 diabetes. Alternatively, other dietary components, such as selenium, and unmeasured contaminants present in fish might explain our results.
Vitamin D Levels in Subjects With and Without Type 1 Diabetes Residing in a Solar Rich Environment
Authors: Bierschenk Lindsey , Alexander John , Wasserfall Clive , Haller Michael , Schatz Desmond , Atkinson Mark
Published: August 2009

OBJECTIVE

Previous studies, largely in northern Europe, have suggested an association between type 1 diabetes and reduced serum 25-hydroxy(OH) vitamin D levels, a concept we tested in individuals residing in a solar-rich region (Florida).

RESEARCH DESIGN AND METHODS

Serum samples from 415 individuals residing in Florida were cross-sectionally analyzed: 153 control subjects, 46 new-onset type 1 diabetic patients, 110 established type 1 diabetic patients (samples ≥5 months from diagnosis), and 106 first-degree relatives of the diabetic patients.

RESULTS

In this study, 25-OH vitamin D levels (median, range, interquartile range [IQR]) were similar among control subjects (20.1, below detection [bd]–163.5, 13.0–37.4 ng/ml), new-onset type 1 diabetic patients (21.2, bd–48.6, 12.2–30.2 ng/ml), established type 1 diabetic patients (23.2, bd–263.8, 13.8–33.9 ng/ml), and first-degree relatives (22.2, bd–59.9, 12.7–33.1 ng/ml) (P = 0.87). Mean 25-OH vitamin D levels were less than the optimal World Health Organization level of 30 ng/ml in all study groups.

CONCLUSIONS

Reduced serum 25-OH vitamin D levels were not specifically associated with type 1 diabetes. The uniform suboptimal 225-OH vitamin D levels, despite residence in a zone with abundant sunshine, support additional dietary vitamin D fortification practices.
Measurements of Valve Circumferences and Ventricular Wall of Fetal Hearts in Chile
Authors: Velozo Luis F. , Segovia Laura A. , Zapata Luis A. , Peralta Susan , Rodriguez Natalie A.
Published: August 2009

Diagnosis of cardiac pathology, valvular stenosis, cardiac dilation, and/or cardiac hypertrophy is underestimated if measures of weight, wall thickness, and valve circumference are not obtained. Routine study methodology protocols allow us to obtain values of these measurements for a correct diagnosis of these cardiopathies. The aim of the study is to establish reference values for cardiac measurements in fetuses and to compare them with an international curve of reference. One hundred seventy-one autopsies from week 17 through 41 of gestation were performed on fetuses from the Pathology Unit at the Hospital Barros Luco in Santiago de Chile. Cases with malformations were not considered. Anthropometric and cardiac measurements for each gestational week were taken. A tabulation of data with values (in percentiles) of cardiac weight, valve circumference, and ventricular wall thickness was obtained. Values were similar to an international reference. The curves of values obtained allow for identification of normal parameters of heart weight, valve circumference, and ventricular wall thickness, thereby providing easily accessible data for each gestational week. Abnormal values that fall outside of the curve must be attributed to cardiac fetal pathology.
Shear bond stress of composite bonded to excimer laser treated dentin
Authors: Sivakumar M. , Oliveira V , Vilar R. , Oliveira S.
Published: August 2009

The aim of this work was to study the bond strength of resin composite bonded to dentin surfaces treated with KrF excimer laser radiation, untreated surfaces, and acid-etched surfaces using a single-plane shear method. Dentin specimens cut from freshly extracted permanent molar teeth were subjected to laser treatment with a KrF excimer laser (248 nm) using a fluence of 1 J/cm2. The bond strength was greater for acid-etched specimens than for laser treated or untreated specimens. The low strength of the bond to laser treated surfaces is probably due to a shift from a mixed to a cohesive rupture mechanism. It was concluded from this study that surface treatment of dentin surfaces with KrF excimer laser under the conditions described does not significantly improve the shear bond strength to composites.