bluuebunny/crossref_metadata_2025 huggingface dataset:
Troponin T Measurements by High-Sensitivity vs Conventional Assays for Risk Stratification in Acute Dyspnea
Authors: van Wijk Sandra , Jacobs Leo , Eurlings Luc W , van Kimmenade Roland , Lemmers Roosmarijn , Broos Pieter , Bekers Otto , Prins Martin H , Crijns Harry J , Pinto Yigal M , van Dieijen-Visser Marja P , Brunner-La Rocca Hans-Peter
Published: November 2011

BACKGROUND

Cardiac troponin T measured by a high-sensitivity assay (hs-cTnT) recently proved to be of prognostic value in several populations. The hs-cTnT assay may also improve risk stratification in acute dyspnea.

METHODS

We prospectively studied the prognostic value of hs-cTnT in 678 consecutive patients presenting to the emergency department with acute dyspnea. On the basis of conventional cardiac troponin T assay (cTnT) and hs-cTnT assay measurements, patients were divided into 3 categories: (1) neither assay increased (cTnT <0.03 μg/L, hs-cTnT <0.016 μg/L), (2) only hs-cTnT increased ≥0.016 μg/L (cTnT <0.03 μg/L), and (3) both assays increased (cTnT ≥0.03 μg/L, hs-cTnT ≥0.016 μg/L). Moreover, the prognostic value of hs-cTnT was investigated if cTnT was not detectable (<0.01).

RESULTS

One hundred seventy-two patients were in the lowest, 282 patients in the middle, and 223 patients in the highest troponin category. Patients in the second and third categories had significantly higher mortality compared to those in the first category (90-day mortality rate 2%, 10%, and 26% in groups 1, 2, and 3, respectively, P < 0.001; 1-year mortality rate 9%, 21%, and 39%, P < 0.001). Importantly, in patients with undetectable cTnT (n = 347, 51%), increased hs-cTnT indicated worse outcome [90-day mortality, odds ratio 4.26 (95% CI 1.19–15.21); 1-year mortality, hazard ratio 2.27 (1.19–4.36), P = 0.013], whereas N-terminal pro–brain-type natriuretic peptide (NT-proBNP) was not predictive of short-term outcome.

CONCLUSIONS

hs-cTnT is associated with mortality in patients presenting with acute dyspnea. hs-cTnT concentrations provide additional prognostic information to cTnT and NT-proBNP testing in patients with cTnT concentrations below the detection limit. In particular, the hs-cTnT cutoff of 0.016 μg/L enables identification of low-risk patients.
Shaping the CD4+ memory immune response against tuberculosis: the role of antigen persistence, location and multi-functionality
Authors: Ancelet Lindsay , Kirman Joanna
Published: November 2011

Effective vaccination against intracellular pathogens, such as tuberculosis (TB), relies on the generation and maintenance of CD4 memory T cells. An incomplete understanding of the memory immune response has hindered the rational design of a new, more effective TB vaccine. This review discusses how the persistence of antigen, the location of memory cells, and their multifunctional ability shape the CD4 memory T cell response against TB.
Stickbreaking: A Novel Fitness Landscape Model That Harbors Epistasis and Is Consistent with Commonly Observed Patterns of Adaptive Evolution
Authors: Nagel Anna C , Joyce Paul , Wichman Holly A , Miller Craig R
Published: November 2011

In relating genotypes to fitness, models of adaptation need to both be computationally tractable and qualitatively match observed data. One reason that tractability is not a trivial problem comes from a combinatoric problem whereby no matter in what order a set of mutations occurs, it must yield the same fitness. We refer to this as the bookkeeping problem. Because of their commutative property, the simple additive and multiplicative models naturally solve the bookkeeping problem. However, the fitness trajectories and epistatic patterns they predict are inconsistent with the patterns commonly observed in experimental evolution. This motivates us to propose a new and equally simple model that we call stickbreaking. Under the stickbreaking model, the intrinsic fitness effects of mutations scale by the distance of the current background to a hypothesized boundary. We use simulations and theoretical analyses to explore the basic properties of the stickbreaking model such as fitness trajectories, the distribution of fitness achieved, and epistasis. Stickbreaking is compared to the additive and multiplicative models. We conclude that the stickbreaking model is qualitatively consistent with several commonly observed patterns of adaptive evolution.
A Screen for X-Linked Mutations Affecting Drosophila Photoreceptor Differentiation Identifies Casein Kinase 1α as an Essential Negative Regulator of Wingless Signaling
Authors: Legent Kevin , Steinhauer Josefa , Richard Magali , Treisman Jessica E
Published: November 2011

The Wnt and Hedgehog signaling pathways are essential for normal development and are misregulated in cancer. The casein kinase family of serine/threonine kinases regulates both pathways at multiple levels. However, it has been difficult to determine whether individual members of this family have distinct functions in vivo, due to their overlapping substrate specificities. In Drosophila melanogaster, photoreceptor differentiation is induced by Hedgehog and inhibited by Wingless, providing a sensitive system in which to identify regulators of each pathway. We used a mosaic genetic screen in the Drosophila eye to identify mutations in genes on the X chromosome required for signal transduction. We recovered mutations affecting the transcriptional regulator CREB binding protein, the small GTPase dynamin, the cytoskeletal regulator Actin-related protein 2, and the protein kinase Casein kinase 1α. Consistent with its reported function in the β-Catenin degradation complex, Casein Kinase 1α mutant cells accumulate β-Catenin and ectopically induce Wingless target genes. In contrast to previous studies based on RNA interference, we could not detect any effect of the same Casein Kinase 1α mutation on Hedgehog signaling. We thus propose that Casein kinase 1α is essential to allow β-Catenin degradation and prevent inappropriate Wingless signaling, but its effects on the Hedgehog pathway are redundant with other Casein kinase 1 family members.
The Double-Bromodomain Proteins Bdf1 and Bdf2 Modulate Chromatin Structure to Regulate S-Phase Stress Response in Schizosaccharomyces pombe
Authors: Garabedian Mikael V , Noguchi Chiaki , Ziegler Melissa A , Das Mukund M , Singh Tanu , Harper Logan J , Leman Adam R , Khair Lyne , Moser Bettina A , Nakamura Toru M , Noguchi Eishi
Published: November 2011

Bromodomain proteins bind acetylated histones to regulate transcription. Emerging evidence suggests that histone acetylation plays an important role in DNA replication and repair, although its precise mechanisms are not well understood. Here we report studies of two double bromodomain-containing proteins, Bdf1 and Bdf2, in fission yeast. Loss of Bdf1 or Bdf2 led to a reduction in the level of histone H4 acetylation. Both bdf1Δ and bdf2Δ cells showed sensitivity to DNA damaging agents, including camptothecin, that cause replication fork breakage. Consistently, Bdf1 and Bdf2 were important for recovery of broken replication forks and suppression of DNA damage. Surprisingly, deletion of bdf1 or bdf2 partially suppressed sensitivity of various checkpoint mutants including swi1Δ, mrc1Δ, cds1Δ, crb2Δ, chk1Δ, and rad3Δ, to hydroxyurea, a compound that stalls replication forks and activates the Cds1-dependent S-phase checkpoint. This suppression was not due to reactivation of Cds1. Instead, we found that bdf2 deletion alleviates DNA damage accumulation caused by defects in the DNA replication checkpoint. We also show that hydroxyurea sensitivity of mrc1Δ and swi1Δ was suppressed by mutations in histone H4 acetyltransferase subunits or histone H4. These results suggest that the double bromodomain-containing proteins modulate chromatin structure to coordinate DNA replication and S-phase stress response.
Multiple Roles of the Cox20 Chaperone in Assembly of Saccharomyces cerevisiae Cytochrome c Oxidase
Authors: Elliott Leah E , Saracco Scott A , Fox Thomas D
Published: November 2011

The Cox2 subunit of Saccharomyces cerevisiae cytochrome c oxidase is synthesized in the mitochondrial matrix as a precursor whose leader peptide is rapidly processed by the inner membrane protease following translocation to the intermembrane space. Processing is chaperoned by Cox20, an integral inner membrane protein whose hydrophilic domains are located in the intermembrane space, and Cox20 remains associated with mature, unassembled Cox2. The Cox2 C-tail domain is exported post-translationally by the highly conserved translocase Cox18 and associated proteins. We have found that Cox20 is required for efficient export of the Cox2 C-tail. Furthermore, Cox20 interacts by co-immune precipitation with Cox18, and this interaction requires the presence of Cox2. We therefore propose that Cox20 binding to Cox2 on the trans side of the inner membrane accelerates dissociation of newly exported Cox2 from the Cox18 translocase, promoting efficient cycling of the translocase. The requirement for Cox20 in cytochrome c oxidase assembly and respiratory growth is partially bypassed by yme1, mgr1 or mgr3 mutations, each of which reduce i-AAA protease activity in the intermembrane space. Thus, Cox20 also appears to stabilize unassembled Cox2 against degradation by the i-AAA protease. Pre-Cox2 leader peptide processing by Imp1 occurs in the absence of Cox20 and i-AAA protease activity, but is greatly reduced in efficiency. Under these conditions some mature Cox2 is assembled into cytochrome c oxidase allowing weak respiratory growth. Thus, the Cox20 chaperone has important roles in leader peptide processing, C-tail export, and stabilization of Cox2.
Age-Specific Administration of Chemotherapy and Long-Term Quality of Life in Stage II and III Colorectal Cancer Patients: A Population-Based Prospective Cohort
Authors: Jansen Lina , Hoffmeister Michael , Chang-Claude Jenny , Koch Moritz , Brenner Hermann , Arndt Volker
Published: November 2011

Learning Objectives

After completing this course, the reader will be able to: Critically appraise the current pattern of administration of chemotherapy in older patients with colorectal cancer.Describe the survival benefits associated with chemotherapy as well as its long-term effects on quality of life in stage II/III colorectal cancer patients.

CME This article is available for continuing medical education credit at CME.TheOncologist.com

Purpose.

To investigate the age-specific pattern of administration of chemotherapy and its association with long-term survival and quality of life (QoL) in stage II and III colorectal cancer patients.

Methods.

Chemotherapy allocation according to disease and patient characteristics was investigated in a population-based cohort of 562 stage II and III colorectal cancer patients. Five years after diagnosis, survival was determined and QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 Items and a tumor specific module. The association among chemotherapy, survival, and QoL was examined while controlling for potential confounders.

Results.

Chemotherapy was administered in 71% of patients aged <60 years and in only 20% of patients aged ≥80 years. A significant association between chemotherapy and longer survival time was found for stage III cancer only. Chemotherapy was associated with higher symptom levels for trouble with taste, anxiety, and hair loss. In age-specific analyses, younger survivors (<70 years at time of follow-up) with a history of chemotherapy reported significantly lower physical, role, and cognitive functioning and higher pain, appetite loss, hair loss, and trouble with taste symptom levels. In contrast, for older survivors (≥70 years), only two (hair loss and dry mouth) out of 38 QoL scores were significantly associated with chemotherapy.

Discussion.

Chemotherapy is associated with lower long-term QoL, especially in younger survivors. In cases of uncertain survival benefits of chemotherapy, consideration of its long-term effects on QoL should be incorporated into final decisions on treatment.
Quantification of hydration phases in supersulfated cements: review and new approaches
Authors: Gruskovnjak Astrid , Lothenbach Barbara , Winnefeld Frank , Münch Beat , Figi Renato , Ko Suz-Chung , Adler Michael , Mäder Urs
Published: November 2011

Quantification of the progress of hydration of supersulfated cements (SSC) may be approached in two ways: (a) from recording the increasing dissolution of the slag particles directly, and (b) indirectly from quantifying the formation of the hydration phases. Image analysis based on backscattered electron imaging in a scanning electron microscope (SEM), the dissolution of hydrates (EDTA), differential thermal analysis (DTA) and sulfide concentration (SP) were used to quantify the dissolution of the slag particles; selective extraction of hydrates by sodium carbonate (SE), X-ray diffraction (XRD) with Rietveld analysis and thermogravimetric (TGA) refinement methods were used to quantify the amount of hydration products formed. SEM-based image analysis was found to be a direct and promising way for the quantification of slag particles. With the help of selective extraction by sodium carbonate (SE), it was possible to quantify the amorphous C–S–H phase in SSC. Mass balance calculations constrained by thermodynamic stability were used to calculate the amount of reacted slag in the system. XRD Rietveld and TGA methods were used to assess the amounts of specific hydration products formed in SSC but did not allow an absolute quantification of the amount of slag reacted. Other methods such as the dissolution of the hydrates by EDTA and DTA were not found to be reliable due to intrinsic problems.
Effects of alkali metal hydroxides on alkali-free accelerators
Authors: Maltese Cristiano , Pistolesi Carlo , Bravo Anna , Cella Fiorenza , Cerulli Tiziano , Salvioni Davide , Negro Enrico Dal
Published: November 2011

Alkali-free accelerators are relatively new admixtures which allow concrete to be projected onto the rock wall during tunnel excavation. This sprayed concrete layer acts as a consolidating shield avoiding the convergence (the tendency of the section to squeeze) or dangerous structural collapses. Their efficiency could be related to: cement class and its chemical composition; environmental conditions (humidity; temperature); concrete mix design. A loss of accelerator efficiency is extremely dangerous for workers' safety as sudden collapses of the sprayed material can occur. Only a few studies have been published on the effects of these factors on the accelerating properties of alkali-free accelerators. In the present study, the influence of alkali metals (sodium and potassium) on cement pastes to which different alkali-free accelerators had been added was studied. It was discovered that the higher the alkali content the worse was the accelerator performance. In order to elucidate this phenomenon an analytical investigation was carried out. This included morphological (environmental scanning electron microscopy – field emission gun), chemical (induced coupled plasma – atomic emission spectroscopy), crystal-chemical (X-ray powder diffraction) and physical–chemical (hydration temperature profile; thermogravimetry/differential scanning calorimetry) evaluations. The results revealed significant morphological and crystal chemical differences among the investigated samples.
Assessment of soft clay ground improvement from SCPTU results
Authors: Cai Guojun , Liu Songyu , Puppala Anand J.
Published: November 2011

Some in situ seismic piezocone penetration tests (SCPTU) were performed in undisturbed soils and the inter-pile soils between T-shaped, bidirectional, soil–cement deep mixing columns at lacustrine clay sites to quantitatively assess the effects of ground improvement. The difference of cone resistance and sleeve friction of soils among the columns after cement column construction was analysed. From pore pressure dissipation tests, the consolidation characteristics of the inter-pile soils were evaluated. The effect of the deep mixing column on the behaviour of the inter-pile soils is discussed. Preconsolidation pressures were estimated using some methods based solely on net cone tip resistance, excess pore pressure, effective cone resistance and a multiple regression based on cone tip resistance and shear wave velocity. Cement columns increase the lateral stress locally within the zone of influence of the column. Soils initially appear to be normally consolidated to slightly overconsolidated, and a significant increase in preconsolidation pressure was noticed in clay layers after treatment.
Effective communication in contaminated risk management
Authors: Cross Martin
Published: November 2011

The process of managing contaminated land projects is complex and the necessary skill set required to communicate contaminated land risk has become extensive. The communication of contaminated land risk has become more important as a result of greater pressure placed on the redevelopment of brownfield sites, easier access to basic environmental information, increased public concern about human health risk and possible harm to controlled waters, and less trust that risk is communicated fully and honestly to stakeholders. These drivers have culminated in the task of effective communication associated with contaminated land becoming more onerous but a detailed consideration of their impact on stakeholders is critical to the successful delivery of remediation projects. The necessary skills required for the effective communication of contaminated land risk are considered. These skills are appropriate for contaminated land consultants, planners, civil engineers, specialist contractors and land owners who have to communicate risk issues to a lay audience. The part IIA Manywells landfill site is provided as an appropriate case study, in which effective communication and stakeholder management has been successfully implemented.
Future skill sets for the municipal engineer
Authors: Cooper Martin W. , Ashurst Jeff
Published: November 2011

Municipal engineering, at one time the career of choice for many civil engineers, has changed, as has the manner in which municipal works are now delivered. This paper looks at what the municipal engineer does, where the work is done and the skill sets required to perform the work. New skill sets, required for the future, are then examined against a background of changes in legislation together with environmental pressures affecting local authorities. The information has been examined to show what the skill sets of the engineer of the future might be and how the municipal engineer might need to change in order to meet future challenges. Account is taken of the authors' experience in local government and private industry. Visits were made to seven local authorities in the north west of England and a staff questionnaire was conducted in the region in order that data could be gathered on the topic.
Developing competences for water utility change programmes
Authors: Sansom Kevin Roy , Coates Sue
Published: November 2011

African and Asian urban water sector organisations recognise the need to support performance improvement and organisational change programmes to meet the growing demands for improved services in challenging environments. Yet many such programmes have not resulted in the desired service improvements. This paper looks at three successful water utilities in Africa and Southern Asia to identify the factors that are contributing to substantial service delivery improvement. This analysis is used to inform the competencies required of senior managers and engineers responsible for water utility change programmes. How to develop the necessary competences through targeted management development programmes is considered by reviewing selected urban water sector management development programmes in India and Africa. Increasingly engineers working in the developing world are expected to focus on effective service management in challenging environments, and develop appropriate competences.
Training for real: matching employer needs to training supply
Authors: Reed Brian , Coates Sue , Odhiambo Frank , Kayaga Sam
Published: November 2011

For 40 years, the Water, Engineering and Development Centre of Loughborough University has trained engineers in the practical requirements for infrastructure services in low- and middle-income countries. This was started to rectify a mismatch between what was being taught in universities and what was being done in practice. Often this gap was addressed by ad hoc, uncoordinated, costly and often ineffective training courses. This mismatch is still apparent and so researchers explored why training providers are not meeting employers' needs. The action research went behind training needs analysis to examine the dialogue between the ‘suppliers’ (universities) and the ‘demands’ of the employers (local authorities and water utilities), across the water and sanitation sector in Uganda, through a series of forums, interviews, workshop appraisals and case studies, as well as trialling innovative training techniques. The research identified areas for improvement, especially in the area of employer engagement, skill needs and the management of human resource development.
Briefing: Study of the relationship between stiffness parameters for base materials
Authors: Rosyidi Sri A. P. , Abbiss Colin P. , Nayan Khairul A. M. , Taha Mohd. Raihan , Chik Zamri , Ismail Amiruddin
Published: November 2011

The stiffness of the base layer is an important parameter for designing the pavement thickness needed to support traffic loads. It is normally related to the California bearing ratio (CBR). The spectral analysis of surface waves (SASW) method is introduced here as an in situ non-destructive seismic technique to obtain the CBR and dynamic cone penetrometer (DCP) values. They are found from measurement of wave velocity and correlation with the dynamic properties of the pavement system. In this study, the relationship between the shear wave velocity and dynamic stiffness of the SASW was found to correlate well with the DCP and CBR values. The empirical correlation of CBR to dynamic stiffness in terms of elastic modulus was found to be similar to a previously suggested correlation. Preliminary analysis also indicates that the empirical model could be used to predict the modulus of pavement base layer.
Prediction of hot mix asphalt dynamic modulus using dimensional analysis
Authors: Abu Abdo Ahmad , Muhunthan Balasingam
Published: November 2011

This study uses dimensional analysis to develop a consistent predictive model for the widely used dynamic modulus of hot mix asphalt in pavement design. The key variables that capture the effects of aggregate binder on the dynamic modulus of these materials were identified first. The Buckingham PI theorem was used to formulate the functional relationship among a set of non-dimensional variables from the original set. The functional form was defined based on 17 mixes commonly used in the state of Idaho in the USA. Subsequently the predictive model performance was verified on different field mixes in the literature. The results show that the proposed model, when utilised as level 1 inputs into the American Association of State Highway and Transportation Officials Mechanistic–Empirical Pavement Design Guide software, predicted pavement rutting values that were closer to measured values than those evaluated by existing prediction models.
Size at Birth, Weight Gain in Infancy and Childhood, and Adult Diabetes Risk in Five Low- or Middle-Income Country Birth Cohorts
Authors: Norris Shane A. , Osmond Clive , Gigante Denise , Kuzawa Christopher W. , Ramakrishnan Lakshmy , Lee Nanette R. , Ramirez-Zea Manual , Richter Linda M. , Stein Aryeh D. , Tandon Nikhil , Fall Caroline H.D. ,   the COHORTS Group
Published: November 2011

OBJECTIVE

We examined associations of birth weight and weight gain in infancy and early childhood with type 2 diabetes (DM) risk in five cohorts from low- and middle-income countries.

RESEARCH DESIGN AND METHODS

Participants were 6,511 young adults from Brazil, Guatemala, India, the Philippines, and South Africa. Exposures were weight at birth, at 24 and 48 months, and adult weight, and conditional weight gain (CWG, deviation from expected weight gain) between these ages. Outcomes were adult fasting glucose, impaired fasting glucose or DM (IFG/DM), and insulin resistance homeostasis model assessment (IR-HOMA, three cohorts).

RESULTS

Birth weight was inversely associated with adult glucose and risk of IFG/DM (odds ratio 0.91[95% CI 0.84–0.99] per SD). Weight at 24 and 48 months and CWG 0–24 and 24–48 months were unrelated to glucose and IFG/DM; however, CWG 48 months–adulthood was positively related to IFG/DM (1.32 [1.22–1.43] per SD). After adjusting for adult waist circumference, birth weight, weight at 24 and 48 months and CWG 0–24 months were inversely associated with glucose and IFG/DM. Birth weight was unrelated to IR-HOMA, whereas greater CWG at 0–24 and 24–48 months and 48 months–adulthood predicted higher IR-HOMA (all P < 0.001). After adjusting for adult waist circumference, birth weight was inversely related to IR-HOMA.

CONCLUSIONS

Lower birth weight and accelerated weight gain after 48 months are risk factors for adult glucose intolerance. Accelerated weight gain between 0 and 24 months did not predict glucose intolerance but did predict higher insulin resistance.
Lower Risk of Cancer in Patients on Metformin in Comparison With Those on Sulfonylurea Derivatives
Authors: Ruiter Rikje , Visser Loes E. , van Herk-Sukel Myrthe P.P. , Coebergh Jan-Willem W. , Haak Harm R. , Geelhoed-Duijvestijn Petronella H. , Straus Sabine M.J.M. , Herings Ron M.C. , Stricker Bruno H.Ch.
Published: November 2011

OBJECTIVE

Numerous studies have suggested a decreased risk of cancer in patients with diabetes on metformin. Because different comparison groups were used, the effect magnitude is difficult to estimate. Therefore, the objective of this study was to further analyze whether, and to what extent, use of metformin is associated with a decreased risk of cancer in a cohort of incident users of metformin compared with users of sulfonylurea derivatives.

RESEARCH DESIGN AND METHODS

Data for this study were obtained from dispensing records from community pharmacies individually linked to hospital discharge records from 2.5 million individuals in the Netherlands. The association between the risk of cancer in those using metformin compared with those using sulfonylurea derivatives was analyzed using Cox proportional hazard models with cumulative duration of drug use as a time-varying determinant.

RESULTS

Use of metformin was associated with a lower risk of cancer in general (hazard ratio 0.90 [95% CI 0.88–0.91]) compared with use of sulfonylurea derivatives. When specific cancers were used as end points, similar estimates were found. Dosage-response relations were identified for users of metformin but not for users of sulfonylurea derivatives.

CONCLUSIONS

In our study, cumulative exposure to metformin was associated with a lower risk of specific cancers and cancer in general, compared with cumulative exposure to sulfonylurea derivatives. However, whether this should indeed be seen as a decreased risk of cancer for the use of metformin or as an increased risk of cancer for the use sulfonylurea derivatives remains to be elucidated.
Explaining the Increase of Diabetes Prevalence and Plasma Glucose in Mauritius
Authors: Magliano Dianna J. , Söderberg Stefan , Zimmet Paul Z. , Chen Lei , Joonas Noorjehan , Kowlessur Sudhir , Larhubarbe Jose , Gaoneadry Dhanunjaye , Pauvaday Vassen , Tuomilehto Jaakko , Alberti K. George M.M. , Shaw Jonathan E.
Published: November 2011

OBJECTIVE

Secular trends in the epidemiology of diabetes are best described by studying the same population over time, but few such studies exist. Using surveys from Mauritius in 1987 and 2009, we examined 1) the change in the prevalence of diabetes, 2) the extent to which changes in traditional diabetes risk factors explained the increase, and 3) the change in the distribution of plasma glucose levels over time.

RESEARCH DESIGN AND METHODS

Independent population-based surveys were undertaken in Mauritius in 1987 and 2009 using similar methodology in adults aged 20–74 years. Physical measurements and fasting blood samples were taken, and an oral glucose tolerance test was performed at both surveys.

RESULTS

The age-standardized prevalence of diabetes in 2009 was 22.3% (95% CI 20.0–24.6) among men and 20.2% (18.3–22.3) among women, representing an increase since 1987 of 64 and 62% among men and women, respectively. Concurrent changes in the distribution of age, ethnicity, waist circumference, BMI, physical activity, smoking, family history of diabetes, and hypertension explained more of the increase in the prevalence of diabetes in men than in women. Increases in plasma glucose (especially fasting glucose) were seen across the population but were greater at the upper levels.

CONCLUSIONS

In Mauritius, there has been a marked increase in diabetes prevalence over 22 years. This mainly results from changes in traditional risk factors, leading to population-wide increases in plasma glucose levels. Interventions to control this escalation of diabetes should focus on population-wide strategies.
Assessment of the Medial Dorsal Cutaneous, Dorsal Sural, and Medial Plantar Nerves in Impaired Glucose Tolerance and Diabetic Patients With Normal Sural and Superficial Peroneal Nerve Responses
Authors: Im Sun , Kim Sung-Rae , Park Joo Hyun , Kim Yang Soo , Park Geun-Young
Published: November 2011

OBJECTIVE

This study evaluated the nerve conduction study (NCS) parameters of the most distal sensory nerves of the lower extremities—namely, the medial dorsal cutaneous (MDC), dorsal sural (DS), and medial plantar (MP) nerves—in diabetic (DM) and impaired glucose tolerance (IGT) patients who displayed normal findings on their routine NCSs.

RESEARCH DESIGN AND METHODS

Standard NCSs were performed on healthy control (HC), DM, and IGT groups (N = 147). The bilateral NCS parameters of the MDC, DS, and MP nerves were investigated. The Toronto Clinical Scoring System (TCSS) was assessed for the DM and IGT groups.

RESULTS

The mean TCSS scores of the IGT and DM groups were 2.5 ± 2.3 and 2.8 ± 2.2, respectively. No significant differences between the two groups were observed. After adjustment of age and BMI, the DM group showed significant NCS differences in DS and MDC nerves compared with the HC group (P < 0.05). These differences were also exhibited in the left DS of the IGT group (P = 0.0003). More advanced NCS findings were observed in the DM group. Bilateral abnormal NCS responses in these distal sensory nerves were found in 40 and 16% of DM and IGT patients, respectively.

CONCLUSIONS

These results showed that the simultaneous assessment of the most distal sensory nerves allowed the detection of early NCS changes in the IGT and DM groups, even when the routine NCS showed normal findings.
Short- and Long-Term Effects of Real-Time Continuous Glucose Monitoring in Patients With Type 2 Diabetes
Authors: Vigersky Robert A. , Fonda Stephanie J. , Chellappa Mary , Walker M. Susan , Ehrhardt Nicole M.
Published: November 2011

OBJECTIVE

To determine whether short-time, real-time continuous glucose monitoring (RT-CGM) has long-term salutary glycemic effects in patients with type 2 diabetes who are not on prandial insulin.

RESEARCH DESIGN AND METHODS

This was a randomized controlled trial of 100 adults with type 2 diabetes who were not on prandial insulin. This study compared the effects of 12 weeks of intermittent RT-CGM with self-monitoring of blood glucose (SMBG) on glycemic control over a 40-week follow-up period. Subjects received diabetes care from their regular provider without therapeutic intervention from the study team.

RESULTS

There was a significant difference in A1C at the end of the 3-month active intervention that was sustained during the follow-up period. The mean, unadjusted A1C decreased by 1.0, 1.2, 0.8, and 0.8% in the RT-CGM group vs. 0.5, 0.5, 0.5, and 0.2% in the SMBG group at 12, 24, 38, and 52 weeks, respectively (P = 0.04). There was a significantly greater decline in A1C over the course of the study for the RT-CGM group than for the SMBG group, after adjusting for covariates (P < 0.0001). The subjects who used RT-CGM per protocol (≥48 days) improved the most (P < 0.0001). The improvement in the RT-CGM group occurred without a greater intensification of medication compared with those in the SMBG group.

CONCLUSIONS

Subjects with type 2 diabetes not on prandial insulin who used RT-CGM intermittently for 12 weeks significantly improved glycemic control at 12 weeks and sustained the improvement without RT-CGM during the 40-week follow-up period, compared with those who used only SMBG.
Urinary F2-Isoprostanes as a Biomarker of Reduced Risk of Type 2 Diabetes
Authors: Il'yasova Dora , Spasojevic Ivan , Base Karel , Zhang Haoyue , Wang Frances , Young Sarah P. , Millington David S. , D’Agostino Ralph B. , Wagenknecht Lynne E.
Published: November 2011

OBJECTIVE

We have previously reported evidence of an inverse association between a urinary F2-isoprostane and type 2 diabetes risk in a pilot case-control study nested within the Insulin Resistance Atherosclerosis Study (IRAS). Here, we report the results from the study extended to the entire IRAS cohort.

RESEARCH DESIGN AND METHODS

This prospective study included 138 incident type 2 diabetes case and 714 noncase subjects. Four F2-isoprostanes (iPF2α-III; 2,3-dinor-iPF2α-III; iPF2α-VI; and 8,12-iso-iPF2α-VI) were assayed in baseline urine samples using liquid chromatography–tandem mass spectrometry.

RESULTS

Three F2-isoprostanes showed significant inverse associations with type 2 diabetes risk: the adjusted odds ratios were 0.52 (95% CI 0.39–0.67), 0.56 (0.42–0.73), 0.62 (0.48–0.79), and 0.91 (0.72–1.12) for iPF2α-III; 2,3-dinor-iPF2α-III; iPF2α-VI; and 8,12-iso-iPF2α-VI, respectively.

CONCLUSIONS

Our findings indicate that urinary F2-isoprostanes are inversely associated with type 2 diabetes risk beyond the traditional risk factors and may be useful in identifying high-risk populations.
High Plasma 5-Hydroxyindole-3-Acetic Acid Concentrations in Subjects With Metabolic Syndrome
Authors: Fukui Michiaki , Tanaka Muhei , Toda Hitoshi , Asano Mai , Yamazaki Masahiro , Hasegawa Goji , Imai Saeko , Nakamura Naoto
Published: November 2011

OBJECTIVE

Serotonin mediates vasoconstriction and induces the activation of platelets, which may promote atherosclerosis. The aim of this study was to investigate whether plasma 5-hydroxyindole-3-acetic acid (5-HIAA; a derivative end product of serotonin) concentrations are high in subjects with metabolic syndrome (MetS) and to investigate the relationship between plasma 5-HIAA concentrations and clinical and biochemical metabolic parameters.

RESEARCH DESIGN AND METHODS

Plasma 5-HIAA concentrations were measured in 311 subjects (152 men and 159 women) recruited from the Oike Clinic, which provides regular health check-ups for employees. We evaluated the relationship between plasma 5-HIAA concentrations and clinical and biochemical metabolic parameters, including waist circumference, serum lipid concentrations, fasting plasma glucose, or blood pressure.

RESULTS

Plasma 5-HIAA concentrations were higher in subjects with MetS than in those without, in both men (6.5 ± 4.4 vs. 4.9 ± 1.3 ng/mL, P < 0.005) and women (7.9 ± 6.5 vs. 5.2 ± 1.6 ng/mL, P < 0.005). In men, fasting plasma glucose (r = 0.197, P = 0.0146) was positively correlated, whereas HDL cholesterol (r = −0.217, P = 0.0071) was negatively correlated, with logarithmic (log) (plasma 5-HIAA concentrations). In women, triglycerides (r = 0.252, P = 0.0013) and fasting plasma glucose (r = 0.344, P < 0.0001) were positively correlated, whereas HDL cholesterol (r = −0.328, P < 0.0001) was negatively correlated, with log (5-HIAA concentrations). Furthermore, log (plasma 5-HIAA concentrations) were higher in subjects with more components of MetS.

CONCLUSIONS

Plasma 5-HIAA concentrations are high in subjects with MetS, suggesting the potential importance of serotonin in the development of cardiovascular disease in MetS.
‘In the Mouth of a True Orator’ (Jerusalem's Operating Instructions)
Authors: Sklar Susanne
Published: November 2011

Blake declares that every word of Jerusalem has been chosen to suit ‘the mouth of a true Orator.’ Though it is not written in the form of a play, the poem has been designed to be read aloud and heard. When I try to be a ‘true Orator,’ the poem's peculiar language, characters, and structure become clearer, and its complexities less baffling. This article discusses why oral interpretation is appropriate to the ‘Sublime Allegory’ Blake has created, and how oral interpretation delivers us from misinterpretations of the poem's eponymous heroine. Giving voice to the poem opens up the possibilities for historical antecedents for the character in the poem called Hand, and supports G.E. Bentley, Jr's recent observations about the dating of the poem.
‘humble but respectable’: Recovering the Neighbourhood Surrounding William and Catherine Blake's Last Residence, No. 3 Fountain Court, Strand, c. 1820–27
Authors: Whitehead Angus
Published: November 2011

In this paper, drawing upon a wide range of unpublished archival sources, I present a detailed reconstruction of Fountain Court and its residents, William and Catherine Blake during the period William and Catherine Blake were resident at No. 3 Fountain Court (c. 1820–27). The paper presents important new information concerning the society and milieu in Fountain Court and its neighbourhood during 1820–27. This fresh archival evidence enables us to identify and precisely locate for the first time the 'humble but respectable' fellow lodgers and neighbours living in Fountain Court during William and Catherine Blake's period of residence, and provides a detailed picture of life in the Blakes' neighbourhood during this period, and of trades conducted in the court, as well as the close familial and social relationships existing between a number of households immediately surrounding the Blakes' residence. Such relationships provide a context for William and Catherine's own relationships with their brother-in-law and landlord at 3 Fountain Court, Henry Banes and his wife Sarah Banes (née Boucher) and two of their neighbours and fellow lodgers in the court, the carver and gilder John George Lohr, and Blake's employer and fellow artist John Barrow. The Blakes' last residence was not in a sleepy, forgotten backwater, as some contemporary accounts and later biographers appear to suggest. As my paper demonstrates, Fountain Court in the 1820s, leading directly off the Strand, a major commercial thoroughfare of the largest metropolis of the period, was comprised of a small community, thriving with social and commercial activity. The reconstruction provides a detailed immediate context in which to view afresh William and Catherine's years living and working in Fountain Court.
‘Catalogue of Some of Blake's Pictures at “The Salterns”’: Captain Butts as Exhibitor, Litigator, and Co-Heir (With His Sister Blanche)
Authors: Johnson Mary Lynn
Published: November 2011

Beginning in 1863, to a greater extent than has been recognized, Captain Frederick John Butts (1833–1905) controlled the lion's share of the largest Blake collection ever assembled, works that his grandfather, Thomas Butts (1739–1845), had commissioned or purchased from Blake himself. A proposed redating of a visit from William Michael Rossetti, an examination of previously unreported court records, and an analysis of newly accessible papers of Mary Butts in the Beinecke Library – including a list of at least ‘some’ of Blake's works in the Captain's home – help clarify the division of property between the siblings and offer a fresh perspective on the Captain's actions and likely motives as preserver, manager, and guardian of his and his sister's heritage.
‘Without Contraries There is No Progression’: Cinematic Montage and the Relationship of Illustration to Text in William Blake's The [First] Book of Urizen
Authors: Leonard Garry
Published: November 2011

My claim is that Blake's illustrations are not a supplement depicting what happens in the text, but a translation into visual terms of his central tenet, at play throughout The [First] Book of Urizen, that ‘[w]ithout Contraries is no progression. Attraction and Repulsion, Reason and Energy, Love and Hate, are necessary to Human existence’ (The Marriage of Heaven and Hell, Plate 3). And I am claiming further that this strategy is comparable to the cinematic technique of montage: whereas the collision of two contrary images in montage creates an explosion famously described by Benjamin as ‘the dynamite of the tenth of a second’. Blake, too, creates tension and ‘collision’ in his illustrations in order to depict not the actual image of Los delivering his hammer blows, for example, but rather the hoped for effect of these blows – the breaking apart of Urizen's ‘solid without fluctuation’ (The [First] Book of Urizen, Plate 4). This ‘solid,’ if allowed to stand, imposes a restrictive view of the cosmos that reduces our visionary capacity to that of ‘two little orbs…fixed in two little caves/Hiding carefully from the wind…’ (The [First] Book of Urizen, Plate 12).
Nutrition Screening for Seniors in Health Care Facilities: A Survey of Health Professionals
Authors: Villalon Lita , Laporte Manon , Carrier Natalie
Published: November 2011

Purpose: Several studies show that malnutrition is prevalent in health care facilities, especially among elderly patients and nursing home residents. Although validated screening tools exist, little evidence exists on the feasibility of implementing nutrition screening in health care facilities. We examined New Brunswick health care professionals’ perceptions of and practices involving nutrition screening in elderly clients, as well as barriers to screening.

Methods: A survey was conducted with questionnaires intended for physicians, nurses, and dietitians.

Results: Participants were 457 health care professionals (physicians, 34.6%; nurses, 50.3%; dietitians, 15.1%). Perceptions of nutrition screening varied. For example, most nurses (94.7%) and dietitians (98.5%) indicated that screening was important/ very important, while only 63.5% of physicians indicated this. Screening methods also differed among professionals and few used a screening tool. Several barriers to implementing nutrition screening were reported, such as lack of time, lack of professional resources, and clients’ short stays.

Conclusions: These findings will help professionals address the feasibility of implementing standardized screening tools in health care facilities. A more consistent and systematic approach for detecting populations at high nutritional risk may result.
Weight Maintenance Through Behaviour Modification: With a Cooking Course or Neurolinguistic Programming
Authors: Sørensen Lone Brinkmann , Greve Tine , Kreutzer Martin , Pedersen Ulla , Nielsen Claus Meyer , Toubro Søren , Astrup Arne
Published: November 2011

We compared the effect on weight regain of behaviour modification consisting of either a gourmet cooking course or neurolinguistic programming (NLP) therapy. Fifty-six overweight and obese subjects participated. The first step was a 12-week weight loss program. Participants achieving at least 8% weight loss were randomized to five months of either NLP therapy or a course in gourmet cooking. Follow-up occurred after two and three years. Forty-nine participants lost at least 8% of their initial body weight and were randomized to the next step. The NLP group lost an additional 1.8 kg and the cooking group lost 0.2 kg during the five months of weight maintenance (NS). The dropout rate in the cooking group was 4%, compared with 26% in the NLP group (p=0.04). There was no difference in weight maintenance after two and three years of follow-up. In conclusion, weight loss in overweight and obese participants was maintained equally efficiently with a healthy cooking course or NLP therapy, but the dropout rate was lower during the active cooking treatment.
n-3 Polyunsaturated Fatty Acids Increase: Thermic Effect of Food in Men with Metabolic Syndrome
Authors: Matheson Kelly M. , Cutting Jennifer E. , Mazurak Vera C. , Robinson Lindsay E. , Buchholz Andrea C.
Published: November 2011

Purpose: Effects on energy metabolism of a test meal and a two-week dietary intervention were observed in men with metabolic syndrome (MetS). Both the meal and the intervention included foods containing fish-derived n-3 polyunsaturated fats (PUFA).

Methods: Six men with MetS (46.7 ± 12.1 years, 37.2 ± 5.6 kg/m2, mean ± standard deviation) completed two test days, separated by a 14-day dietary intervention during which they consumed at least 2.0 g per day of n-3 PUFA from supplied foods. Pre- and post-intervention measurements included body composition, resting metabolic rate (RMR), and the thermic effect of food (TEF) measured for six hours after ingestion of a test meal consisting of 1.43 g of fish-derived n-3 PUFA.

Results: Intakes of n-3 PUFA increased over the 14-day intervention, from 0.43 g per day ± 0.48 to 2.92 g per day ± 1.97 (p=0.013), while no changes were observed in total energy intakes, weight, body composition, or RMR (all p>0.05). The TEF increased by 51.3% (p=0.036), and the non-protein respiratory quotient decreased by 36.0% (p=0.700).

Conclusions: Subjects increased their intake of fish-derived n-3 PUFA in an isocaloric manner while maintaining body weight and composition, and increased the TEF. More studies with larger sample sizes and longer intervention periods are required to confirm the use of fish-derived n-3 PUFA as a therapeutic dietary strategy for people with MetS.
Implementing Elementary School Nutrition Policy: Principals’ Perspectives
Authors: Taylor Jennifer P. , MacLellan Debbie , Caiger Jane Mary , Hernandez Kimberley , McKenna Mary , Gray Bob , Veugelers Paul
Published: November 2011

Purpose: We assessed principals’ perceptions about the level of school nutrition policy (SNP) implementation in Prince Edward Island elementary schools, objectively evaluated how closely elementary schools are following SNP regulations for types and frequency of foods offered at school, and explored principals’ beliefs about the key enablers and barriers to SNP implementation.

Methods: Phase I involved a cross-sectional survey of principals’ assessment of perceived and actual adherence to SNP components. Phase II included in-depth interviews to explore principals’ perceptions about factors influencing policy adherence. Descriptive statistics were generated. Thematic content analysis was used to identify themes.

Results: Forty-one (93%) principals participated in Phase I, and nine of these participated in Phase II. The level of implementation of SNP components varied. Seventy-four percent of all foods sold were categorized as allowed by the SNP; 68% of schools sold at least one “not allowed” food. Key barriers included lost revenue, a higher cost of healthy foods, and limited availability of policy-allowed foods. Enablers were a high level of community support, ready access to food suppliers, and active parent volunteers.

Conclusions: While schools are making progress in implementing the SNP, challenges remain. Identifying and communicating strategies for healthy fundraising activities and finding ways to involve parents in SNP implementation are recommended.
Démocratisation de l'enseignement et diversité géographique systèmes éducatifs
Authors: Herin Robert
Published: November 2011

Equal opportunities in education and selectivity of regional schooling system.

Despite an increasing school-leaving age, opportunities to reach the higher levels of long secondary education remain unequal, and vary with the social and geographical backgrounds of the young people. The schooling systems of French regions not only reveal the differences in the social structure of the regions, but also show some specific and complex factors linked to both socio-cultural environment and educational performance of the regions. Such factors can either amplify or alleviate the effects of selection.