bluuebunny/crossref_metadata_2025 huggingface dataset:
Representações sociais de parlamentares brasileiros sobre a redução da maioridade penal
Authors: Corte Real Fabíola Geoffroy Veiga , Conceição Maria Inês Gandolfo
Published: October 2013

O projeto de redução da maioridade penal no Brasil encontra-se em adiantado processo de tramitação no Congresso Nacional. Apresentamos aqui o estudo das representações sociais dos parlamentares brasileiros responsáveis pelos rumos da maioridade penal no País. Trata-se de pesquisa documental que visa a analisar a consistência jurídica e psicossocial dos argumentos favoráveis e contrários à redução da maioridade penal presentes nos documentos em trâmite legislativo na Câmara dos Deputados e no Senado Federal. Os dados foram tratados e analisados com a ajuda do software ALCESTE, e os resultados revelam que as representações sociais dos parlamentares favoráveis à redução da maioridade penal se coadunam com aquelas do discurso do antigo Código de Menores, e que os adolescentes brasileiros se encontram em sério risco de perderem os direitos conquistados historicamente.
Abordagens de gênero e sexualidade na Psicologia: revendo conceitos, repensando práticas
Authors: Borges Lenise Santana , Canuto Alice de Alencar Arraes , Oliveira Danielle Pontes de , Vaz Renatha Pinheiro
Published: October 2013

Este artigo explora os sentidos sobre gênero e sexualidades a partir da análise das produções acadêmicas dos programas de graduação e pós-graduação do Curso de Psicologia da PUC/Goiás. A partir de uma análise discursiva que tem como enquadre epistemológico o construcionismo social e as teorias feministas, a pesquisa investiga as produções que contenham no título os indexadores: gênero, sexualidade, homossexualidade e/ou homossexual(is), no período de 1993 a 2008. A escolha dessa investigação se dá em razão de que tais produções constituem fontes privilegiadas de informação e de formação. Locais de (re)produção de saber, as universidades operam muitas vezes como lugares que se outorgam o estatuto de verdade, prescrevendo formas morais de comportamento aos sujeitos, o que tem instigado estudiosos/ as a investigar os discursos que circulam no meio acadêmico. Analisam-se, neste estudo, as perspectivas teóricas privilegiadas na descrição do objeto, as áreas e os temas centrais bem como os avanços e as lacunas da produção acadêmica, tomando como contraponto a proposta curricular oferecida pelo curso. Dessa forma, é possível concluir que, no contexto de produção acadêmica analisado, o ensino da Psicologia ainda se concentra predominantemente nos estudos das identidades, em uma visão normativa, polarizada e patologizada quanto ao gênero e às sexualidades.
Método para aplicação do trabalho padronizado
Authors: Mariz Renato Nunes , Picchi Flávio Augusto
Published: October 2013

O trabalho padronizado tem sido amplamente utilizado na manufatura. Através de sua aplicação, resultados positivos em termos de produtividade e estabilização de processos tem alcançados. Na construção, a adoção desta forma de padronização é ainda incipiente, sendo observadas apenas aplicações parciais. Como consequência, não existe ainda conhecimento suficiente sobre as formas eficazes de adaptação deste conceito ao contexto da construção, com resultados tão significativos quanto os observados na manufatura. O objetivo deste artigo é propor um método para aplicação do trabalho padronizado ao contexto da construção. Foram realizados dois estudos de caso exploratórios em atividades de características diferentes: assentamento de porcelanato no piso e execução de estaca Franki. O método proposto consiste em uma adaptação de outro método de aplicação do trabalho padronizado, que vem sendo utilizado na manufatura. Constatou-se, ao final da pesquisa, que este método pode ser adaptado ao setor da construção, possibilitando uma análise estruturada com foco na otimização de recursos utilizados. A principal contribuição do trabalho é evidenciar a potencialidade de aplicação do trabalho padronizado no contexto da construção e despertar o interesse na aplicação prática deste conceito, e na continuidade de pesquisas neste tópico.
Modelo do processo de ação fiscal de segurança e saúde do trabalho na construção de edificações
Authors: Silva Júnior Didier Cardoso , Cambraia Fabrício Borges
Published: October 2013

Muitos esforços pela redução dastretanto o serviço estatal de fiscalização do cumprimento das legislações de segurança e saúde na construção de edificações seja considerado como um indutor para introdução de mudanças, seus processos operacionais pouco conhecidos. Este artigo objetiva a construção de um modelo deste processo particular de ação fiscal. Para tanto, foram realizadas entrevistas com agentes de inspeção do trabalho, gerentes de segurança e gerentes de obra, análise de documentos e acompanhamento prático de ações fiscais. Após a produção de uma versão inicial, o modelo foi revisado por um conjunto de agentes fiscais e os gerentes das empresas. O modelo construído é graficamente representado por um fluxograma do processo que descreve, em especial, um ciclo de ação fiscal, sendo constituído por planejamento das ações fiscais, visita de disparo, inspeção direta no empreendimento, resultados e possibilidade de aplicação dos instrumentos de intervenção, término e fatores favoráveis para abertura de novos ciclos. O modelo proposto tem função de organização e estruturação, embora seja limitado em descrever a variabilidade real que um ciclo fiscal pode apresentar.
Identificação de práticas de gestão da segurança e saúde no trabalho em obras de construção civil
Authors: Bridi Marcelle Engler , Formoso Carlos Torres , Pellicer Eugenio , Fabro Fabiana , Viguer Castello Maria Encarnacion , Echeveste Marcia Elisa Soares
Published: October 2013

O setor da construção civil apresenta índices de acidentes de trabalho mais elevados em relação à maioria dos demais setores industriais. Melhorias nas práticas atuais de gestão da segurança e saúde no trabalho (SST) podem trazer benefícios como a preservação da vida humana e o aumento da competitividade das empresas no mercado com a redução dos custos decorrentes de acidentes, multas e embargos. Este artigo apresenta um levantamento e uma avaliação do grau de implementação das práticas de gestão em SST e a identificação das dificuldades na implementação destas práticas e no cumprimento das normas, na perspectiva dos responsáveis pela gestão da segurança em empresas construtoras. Os dados foram coletados através da realização de uma survey, com questionários aplicados nos canteiros de obra de 40 empresas do segmento de edificações residenciais de Porto Alegre (RS). Estes dados foram comparados com os resultados de uma survey similar realizada na Espanha com 20 empresas construtoras. Para analisar e classificar as práticas utilizaram-se técnicas estatísticas de análise de componentes principais e múltiplas respostas. Foram criadas cinco categorias de práticas de gestão da SST, sendo analisadas as práticas individuais mais utilizadas na amostra de empresas. Faz-se também uma comparação entre as categorias de práticas mais utilizadas e a percepção de importância por parte dos gerentes.
Novas demandas para as empresas de projeto de edifícios
Authors: Paula Nathália de , Uechi Mônica Emiko , Melhado Silvio Burrattino
Published: October 2013

Desempenho, sustentabilidade ambiental de edifícios e BIM (Building Information Modeling) são assuntos em evidência no subsetor Edificações. A proposta deste artigo é analisar as características e o posicionamento de um grupo de sete empresas de projeto de edifícios da cidade de São Paulo, participantes de um programa dedicado ao desenvolvimento gerencial de empresas de projeto, diante das novas demandas de desempenho, sustentabilidade ambiental e BIM, em sua interação com o mercado e clientes. O trabalho de pesquisa foi realizado em duas fases. A Fase 1 teve como objetivo verificar se as demandas estavam sendo consideradas pelas empresas, e intervir para evidenciar a importância de considerá-las estrategicamente, na busca de sua preparação para atender ao mercado. O método de pesquisa utilizado nessa fase foi a pesquisa-ação. A Fase 2 de pesquisa consistiu na aplicação de um questionário, via correio eletrônico, para realizar uma verificação pós-intervenção dos pesquisadores sobre o posicionamento das empresas em relação a essas demandas. Apesar de reconhecer os pontos a trabalhar referentes às demandas, parte das empresas insiste em uma postura passiva diante delas. Recomenda-se que todas as empresas trabalhem seu planejamento estratégico e definam sua atuação, considerando seus pontos fortes e fracos, ameaças e oportunidades. Recomenda-se ainda que as empresas analisem se estão preparadas para atender às demandas e verifiquem a necessidade de alteração de seus processos, capacitação, treinamento interno e equipamentos, além de parcerias com os clientes.
Materiais compósitos particulados em matriz epóxi reforçados com serragem, cimento e silicato de magnésio
Authors: Missagia Zélia Maria Velloso , Santos Júlio Cesar , Panzera Túlio Hallak , Brandão Lincoln Cardoso , Silva Diogo Aparecido Lopes , Christoforo André Luis
Published: October 2013

Este trabalho tem como objetivo investigar propriedades físicas (densidade volumétrica e absorção de água) e mecânicas (módulo de elasticidade e resistência à compressão) de materiais compósitos particulados em matriz epóxi reforçados com serragem de madeira, cimento Portland e silicato de magnésio. Um planejamento experimental inicial foi elaborado envolvendo apenas a resina epóxi e a serragem de madeira. Posteriormente, elegeu-se o tratamento que forneceu os maiores valores para o módulo de elasticidade na compressão. Sobre a condição escolhida, foram desenvolvidas outras quatro, incorporando-se 10% e 20% em frações mássicas de partículas de silicato de magnésio e cimento Portland sobre a resina. Os compostos com 30% de serragem de madeira Eucalyptus grandis e faixa granulométrica 50-80 US-Tyler apresentaram os melhores valores para o módulo de elasticidade na compressão, sendo utilizados como condição de referência para a inclusão das partículas de cimento e do talco. O emprego do cimento nos compostos conferiu aumentos significativos no módulo de elasticidade à compressão, densidade e redução na absorção de água.
Fitossociologia e estrutura do estrato arbóreo de um reflorestamento com espécies nativas em Mogi-Guaçu, SP, Brasil
Authors: Colmanetti Michel Anderson Almeida , Barbos Luiz Mauro
Published: October 2013

Foi realizado um estudo fitossociológico do estrato arbóreo, de um reflorestamento com nove anos após o plantio, na Reserva Particular do Patrimônio Natural Parque Florestal São Marcelo, em Mogi-Guaçu, SP, Brasil. Analisaram-se todos os indivíduos do estrato arbóreo com perímetro a 1,3 m de altura do solo ≥ 15 cm, obtidos em amostragens realizadas em 20 subparcelas (12,5 × 18 m), instaladas em 20 parcelas permanentes. Obtiveram-se, no levantamento, 364 indivíduos pertencentes a 76 espécies, de 63 gêneros e 24 famílias, para uma área total de 0,45 ha. O dossel variou, predominantemente, entre cinco e 11 m de altura. A área basal foi estimada em 18,29 m² ha-1, sendo que as espécies pioneiras contribuíram com 69,2%. Parâmetros como a área basal e altura média aumentaram, enquanto a diversidade não variou ao longo do tempo. A diversidade encontrada foi considerada alta para um reflorestamento.
Enriquecimento de floresta em restauração por meio de semeadura direta de lianas
Authors: Le Bourlegat Jeanne Marie Garcia , Gandolfi Sergius , Brancalion Pedro Henrique Santim , Dias Carlos Tadeu dos Santos
Published: October 2013

Este trabalho objetivou verificar a viabilidade da semeadura direta de lianas no sub-bosque de floresta plantada em restauração. Para isso, sementes das espécies Phanera sp., Macfadyena unguis-cati (L.) A.H. Gentry and Peltastes peltatus (Vell.) Woodson, de lianas foram submetidas a testes de germinação com e sem luz, e com e sem alternância de temperatura. Posteriormente, essas espécies foram semeadas sob a copa de quatro espécies arbóreas em uma Floresta Estacional Semidecidual em restauração no Município de Iracemápolis, SP, Brasil. Em laboratório, apenas Macfadyena unguis-cati apresentou característica de fotoblastismo positivo. As outras espécies não tiveram germinação limitada pela ausência de luz e alternância de temperatura. No sub-bosque, Peltastes peltatus não emergiu; as outras duas espécies não tiveram a emergência alterada em função das espécies arbóreas do dossel sob as quais foram semeadas. Esses resultados sugerem que, apesar da baixa taxa de emergência, é possível o enriquecimento de florestas em processo de restauração a partir da semeadura direta de algumas espécies de lianas.
Enriquecimento de florestas em processo de restauração: aspectos de epífitas e forófitos que podem ser considerados
Authors: Duarte Marina Melo , Gandolfi Sergius
Published: October 2013

Pelo monitoramento de florestas em restauração, detectou-se que elas dificilmente atingem alta diversidade de formas de vida. Epífitas, plantas que vivem sobre árvores hospedeiras (forófitos), são fundamentais em um ecossistema. É importante promover o enriquecimento de matas com essa forma de vida. O objetivo deste trabalho é fornecer subsídios teóricos para realizar transplantes de epífitas de florestas que tiveram que ser legalmente desmatadas para florestas em restauração. Para isso, analisou-se a sobrevivência e desenvolvimento de indivíduos de Aechmea bromeliifolia (Rudge) Baker (Bromeliaceae) um ano após terem sido transplantados a seis distintas espécies de forófitos, em Floresta Estacional Semidecidual em restauração há 23 anos. As variáveis analisadas não responderam significativamente de acordo com espécie de forófito, rugosidade de sua casca ou cobertura de dossel. Mostraram diferenças significativas de acordo com o porte das epífitas, de forma que aquelas de massa intermediárias (105,5 a 239,4 g) tiveram maior sucesso no transplante.
Evolução dos processos ecossistêmicos em reflorestamentos da Floresta Estacional Semidecídua
Authors: Suganuma Marcio Seiji , Torezan José Marcelo Domingues
Published: October 2013

Para avaliar o sucesso na restauração ecológica é possível recorrer a comparações com ecossistemas de referência (áreas não degradadas ou fragmentos de habitat natural) selecionados em locais próximos. Neste trabalho comparamos aspectos do ecossistema em quatro reflorestamentos com espécies nativas (de três a cinco anos de implantação) adjacentes a quatro fragmentos de Floresta Estacional Semidecídua. Os reflorestamentos apresentaram em média 50% da densidade de árvores dos fragmentos, mas a necromassa variou entre 24% e 33% e a biomassa entre 18% e 75% da média dos fragmentos. Compactação do solo considerada de alta resistência (> 2,0 Mpa) foi encontrada apenas nos reflorestamentos de três e quatro anos, e a massa de raízes diminuiu com a compactação do solo. Reflorestamentos jovens (até cinco anos) são importantes para a captura de carbono atmosférico, mas podem ter pouco efeito sobre a compactação e a infiltração de água no solo.
A Comparison of Domestic Violence Recidivism Rates of Defendant-Initiated Diversion and Court-Mandated Treatment
Authors: McClure Thomas E.
Published: October 2013

This study examines court records of 244 defendants assigned to court-connected treatment to determine whether “defendant-initiated diversion” offenders recidivated less than defendants who were mandated by the court to undergo treatment. The study population consisted of 140 defendants who voluntarily opted to participate in a domestic violence (DV) court diversion program and 104 convicted offenders who were ordered by the court to complete treatment as part of their sentence of probation. Defendants who had prior felony or DV convictions were not accepted into the diversion program. A logit model analysis revealed a statistically significant negative relationship between diversion completion and DV recidivism during the 24 months after treatment completion or case closure. These results illustrate the importance of including defendant-initiated diversion for low risk offenders as part of a court system strategy to address DV.
Norms Regarding the Acceptability of Abuse in Heterosexual Dating Relationships
Authors: Bartholomew Kim , Schmitt Michael T. , Yang Liu , Regan Katherine V.
Published: October 2013

We examined how individuals’ personal attitudes toward the acceptability of partner abuse relate to their perceptions of corresponding peer norms. University students (Study 1: N = 476; Study 2: N = 451) reported on their personal attitudes and their perceptions of other students’ attitudes toward male and female violence and psychological abuse in heterosexual dating relationships. Participants of both genders believed that their male peers were more accepting of male partner abuse than themselves, and that their female peers were more accepting of female partner abuse than themselves. Thus, discrepancies between personal attitudes and perceived norms were moderated by gender of the abuse perpetrator. As well, for participants of both genders, perceived female and male peer norms for dating abuse were independently associated with personal attitudes. However, only female norms were independently related to intentions to hit a dating partner in a hypothetical scenario. Discussion focuses on mechanisms underlying these effects, future research directions, and applications to programs to combat partner abuse.
Periodontal Diseases in an Omani Adult Population: A Preliminary Study
Authors: Al‐Harthi Latfiya S. , Cullinan Mary P. , Leichter Jonathan W. , Thomson W. Murray
Published: October 2013

Background: Data on the periodontal status of the adult population in the Arab world are scarce. The aim of this pilot study is to assess the prevalence, extent, and severity of periodontal diseases in an adult group from Oman.

Methods: This is a cross‐sectional study of 319 teachers who were randomly sampled from the list of teachers from the Muscat region schools in Oman. Dental caries, tooth loss, and periodontal attachment loss (AL) were recorded for each of the participants. A questionnaire collected data on participants’ sociodemographic characteristics, dental‐care characteristics, self‐rated periodontal status, and self‐rated well‐being.

Results: A total of 99% of participants had at least one site with probing depth (PD) or clinical AL of ≥3 mm. More than one third (36%) of participants had at least one site with AL ≥5 mm, and 12% had at least one site with AL ≥6 mm; for PD, the prevalence estimates were 26% and 8%, respectively, and a gradient by age group was evident across the different thresholds. Regarding the extent of disease, 17.6% of sites had PD ≥3 mm, and 21% of sites had AL ≥3 mm.

Conclusions: The prevalence, extent, and severity of periodontitis were higher than estimates reported from industrialized countries, such as Australia, New Zealand, and the United States. This is of concern, especially when considering the relatively young age of the study population. Because of this high prevalence, investigation of periodontitis in a national sample of Omanis is desirable to confirm the findings of this study.
Osteoclasts Lose Innate Inflammatory Reactivity to Metal and Polymer Implant Debris Compared to Monocytes/Macrophages
Authors: Yadav Jessica , Samelko Lauryn , Gilvar Phil , McAllister Kyron , Hallab Nadim James
Published: October 2013

Long-term aseptic failures of joint replacements are generally attributed to implant debris-induced inflammation and osteolysis. This response is largely mediated by immune and bone cells (monocytes/macrophages and osteoclasts, respectively), that in the presence of implant debris (e.g. metal particles and ions), release pro-inflammatory cytokines such as IL-1β, TNF-α, and IL-6. The relative degree to which implant debris can illicit inflammatory response(s) from osteoclasts vs monocytes/macrophages is unknown, i.e. are osteoclasts a viable target for anti-inflammatory therapy for implant debris? We investigated relative monocyte versus osteoclast inflammatory responses in a side-by-side comparison using implant debris from the perspective of both danger signaling (IL-1β) and pathogenic recognition (TNF-α) reactivity (Challenge Agents: Cobalt-alloy, Titanium-alloy, and PMMA particles, 0.9-1.8um-dia ECD and Cobalt, and Nickel-ions 0.01-0.1mM, all with and without LPS priming). Human monocytes/macrophages reacted to implant debris with >100 fold greater production of cytokines compared to osteoclast-like cells. Particulate Co-alloy challenge induced >1000 pg/ml of IL-1β and TNF-α, in monocytes and <50pg/mL IL-1β and TNF-α in osteoclasts. Cobalt ions induced >3000pg/mL IL-1β and TNF-α in monocytes/macrophages and <50pg/mL IL-1β and TNF-α in osteoclasts. The paracrine effect of supernatants from debris-treated monocytes/macrophages was capable of inducing greater osteoclastogenesis (TRAP+, p<0.06) and inflammation than direct debris challenge on osteoclasts. Our results indicate that as monocytes/macrophages differentiate into osteoclasts, they largely lose their innate immune reactivity to implant debris and thus may not be as relevant a therapeutic target as monocytes/macrophages for mitigating debris-induced inflammation.
Detecting the single line to ground short circuit fault in the submarine’s power system using the artificial neural network
Authors: Behniafar Ali , Darabi Ahmad , Banejad Mahdi , Baghayipour Mohammadreza
Published: October 2013

The electric marine instruments are newly inserted in the trade and industry,
for which the existence of an equipped and reliable power system is
necessitated. One of the features of such a power system is that it cannot
have an earth system causing the protection relays not to be able to detect
the single line to ground short circuit fault. While on the other hand, the
occurrence of another similar fault at the same time can lead to the double
line fault and thereby the tripping of relays and shortening of vital loads.
This in turn endangers the personals' security and causes the loss of
military plans. From the above considerations, it is inferred that detecting
the single line to ground fault in the marine instruments is of a special
importance. In this way, this paper intends to detect the single line to
ground fault in the power systems of the marine instruments using the
wavelet transform and Multi-Layer Perceptron (MLP) neural network. In the
numerical analysis, several different types of short circuit faults are
simulated on several marine power systems and the proposed approach is
applied to detect the single line to ground fault. The results are of a high
quality and preciseness and perfectly demonstrate the effectiveness of the
proposed approach.
Effects of wound toroidal core dimensional and geometrical parameters on measured magnetic properties of electrical steel
Authors: Koprivica Branko , Milovanovic Alenka , Djekic Milic
Published: October 2013

The aim of this paper is to present the results of measurements for the
magnetic hysteresis loop and the specific power loss of the electrical steel
obtained with the toroidal samples of various dimensions. All samples have
been made of the same material. Numerous measurements have been performed
after the annealing of the samples. The measurements have been performed with
control of the sinusoidal shape of the secondary voltage. Differences between
the results of measurements have been analyzed. Change in the measured
results, e.g. the shape of the hysteresis loop or the specific power loss has
been correlated to the dimensions of the sample.
Managerial Discourse, Child Safeguarding, and the Elimination of Virtue from In Loco Parentis Relationships: An Example from Music Education
Authors: Piper Heather , Duggan James R. , Rogers Stephen
Published: October 2013

In response to high-profile cases of child abuse and heightened public concern, the safeguarding agenda in England seeks to reform relationships between in loco parentis adults and children or young people across a range of settings, applying managerial methods to regulating conduct. Referring to material relevant to many such settings, this article considers the way in which the application of managerialism has imposed particular approaches to moral issues, specifically by reframing moral distinctions (e.g. ‘right’ and ‘wrong’) in terms of technical language and pro/prescriptions of practice. Policies and practices premised on the imperative that touch between adults and children should be avoided at all costs are considered in particular, and the managerial approach is contrasted with ideas derived from MacIntyre's account of practice based on virtue ethics. To exemplify these issues a video campaign, Keeping Children Safe in Music, devised and promoted by the National Society for the Prevention of Cruelty to Children (NSPCC) and the Musicians' Union, and one episode in particular, is analysed. The focus is on how moral (and musical) issues are sidelined and replaced by managerial and defensive instructions, based on the notion that children will be protected from harm if even well-intentioned adults avoid touching them.
Epigenome-Wide Association Study of Fasting Measures of Glucose, Insulin, and HOMA-IR in the Genetics of Lipid Lowering Drugs and Diet Network Study
Authors: Hidalgo Bertha , Irvin M. Ryan , Sha Jin , Zhi Degui , Aslibekyan Stella , Absher Devin , Tiwari Hemant K. , Kabagambe Edmond K. , Ordovas Jose M. , Arnett Donna K.
Published: October 2013

Known genetic susceptibility loci for type 2 diabetes (T2D) explain only a small proportion of heritable T2D risk. We hypothesize that DNA methylation patterns may contribute to variation in diabetes-related risk factors, and this epigenetic variation across the genome can contribute to the missing heritability in T2D and related metabolic traits. We conducted an epigenome-wide association study for fasting glucose, insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) among 837 nondiabetic participants in the Genetics of Lipid Lowering Drugs and Diet Network study, divided into discovery (N = 544) and replication (N = 293) stages. Cytosine guanine dinucleotide (CpG) methylation at ∼470,000 CpG sites was assayed in CD4+ T cells using the Illumina Infinium HumanMethylation 450 Beadchip. We fit a mixed model with the methylation status of each CpG as the dependent variable, adjusting for age, sex, study site, and T-cell purity as fixed-effects and family structure as a random-effect. A Bonferroni corrected P value of 1.1 × 10−7 was considered significant in the discovery stage. Significant associations were tested in the replication stage using identical models. Methylation of a CpG site in ABCG1 on chromosome 21 was significantly associated with insulin (P = 1.83 × 10−7) and HOMA-IR (P = 1.60 × 10−9). Another site in the same gene was significant for HOMA-IR and of borderline significance for insulin (P = 1.29 × 10−7 and P = 3.36 × 10−6, respectively). Associations with the top two signals replicated for insulin and HOMA-IR (P = 5.75 × 10−3 and P = 3.35 × 10−2, respectively). Our findings suggest that methylation of a CpG site within ABCG1 is associated with fasting insulin and merits further evaluation as a novel disease risk marker.
Age at Menarche and Type 2 Diabetes Risk
Authors: Elks Cathy E. , Ong Ken K. , Scott Robert A. , van der Schouw Yvonne T. , Brand Judith S. , Wark Petra A. , Amiano Pilar , Balkau Beverley , Barricarte Aurelio , Boeing Heiner , Fonseca-Nunes Ana , Franks Paul W. , Grioni Sara , Halkjaer Jytte , Kaaks Rudolf , Key Timothy J. , Khaw Kay Tee , Mattiello Amalia , Nilsson Peter M. , Overvad Kim , Palli Domenico , Quirós J. Ramón , Rinaldi Sabina , Rolandsson Olov , Romieu Isabelle , Sacerdote Carlotta , Sánchez María-José , Spijkerman Annemieke M.W. , Tjonneland Anne , Tormo Maria-Jose , Tumino Rosario , van der A Daphne L. , Forouhi Nita G. , Sharp Stephen J. , Langenberg Claudia , Riboli Elio , Wareham Nicholas J. ,   The InterAct Consortium
Published: October 2013

OBJECTIVE

Younger age at menarche, a marker of pubertal timing in girls, is associated with higher risk of later type 2 diabetes. We aimed to confirm this association and to examine whether it is explained by adiposity.

RESEARCH DESIGN AND METHODS

The prospective European Prospective Investigation into Cancer and Nutrition (EPIC)-InterAct case-cohort study consists of 12,403 incident type 2 diabetes cases and a stratified subcohort of 16,154 individuals from 26 research centers across eight European countries. We tested the association between age at menarche and incident type 2 diabetes using Prentice-weighted Cox regression in 15,168 women (n = 5,995 cases). Models were adjusted in a sequential manner for potential confounding and mediating factors, including adult BMI.

RESULTS

Mean menarcheal age ranged from 12.6 to 13.6 years across InterAct countries. Each year later menarche was associated with 0.32 kg/m2 lower adult BMI. Women in the earliest menarche quintile (8–11 years, n = 2,418) had 70% higher incidence of type 2 diabetes compared with those in the middle quintile (13 years, n = 3,634), adjusting for age at recruitment, research center, and a range of lifestyle and reproductive factors (hazard ratio [HR], 1.70; 95% CI, 1.49–1.94; P < 0.001). Adjustment for BMI partially attenuated this association (HR, 1.42; 95% CI, 1.18–1.71; P < 0.001). Later menarche beyond the median age was not protective against type 2 diabetes.

CONCLUSIONS

Women with history of early menarche have higher risk of type 2 diabetes in adulthood. Less than half of this association appears to be mediated by higher adult BMI, suggesting that early pubertal development also may directly increase type 2 diabetes risk.
Disproportionate Body Composition and Neonatal Outcome in Offspring of Mothers With and Without Gestational Diabetes Mellitus
Authors: Persson Martina , Fadl Helena , Hanson Ulf , Pasupathy Dharmintra
Published: October 2013

OBJECTIVE

High birth weight is a risk factor for neonatal complications. It is not known if the risk differs with body proportionality. The primary aim of this study was to determine the risk of adverse pregnancy outcome in relation to body proportionality in large-for-gestational-age (LGA) infants stratified by maternal gestational diabetes mellitus (GDM).

RESEARCH DESIGN AND METHODS

Population-based study of all LGA (birth weight [BW] >90th percentile) infants born to women with GDM (n = 1,547) in 1998–2007. The reference group comprised LGA infants (n = 83,493) born to mothers without diabetes. Data were obtained from the Swedish Birth Registry. Infants were categorized as proportionate (P-LGA) if ponderal index (PI) (BW in grams/length in cm3) was ≤90th percentile and as disproportionate (D-LGA) if PI >90th percentile. The primary outcome was a composite morbidity: Apgar score 0–3 at 5 min, birth trauma, respiratory disorders, hypoglycemia, or hyperbilirubinemia. Logistic regression analysis was used to obtain odds ratios (ORs) for adverse outcomes.

RESULTS

The risk of composite neonatal morbidity was increased in GDM pregnancies versus control subjects but comparable between P- and D-LGA in both groups. D-LGA infants born to mothers without diabetes had significantly increased risk of birth trauma (OR 1.19 [95% CI 1.09–1.30]) and hypoglycemia (1.23 [1.11–1.37]). D-LGA infants in both groups had significantly increased odds of Cesarean section.

CONCLUSIONS

The risk of composite neonatal morbidity is significantly increased in GDM offspring. In pregnancies both with and without GDM, the risk of composite neonatal morbidity is comparable between P- and D-LGA.
Effect of Postmenopausal Status and Age at Menopause on Type 2 Diabetes and Prediabetes in Japanese Individuals: Toranomon Hospital Health Management Center Study 17 (TOPICS 17)
Authors: Heianza Yoriko , Arase Yasuji , Kodama Satoru , Hsieh Shiun Dong , Tsuji Hiroshi , Saito Kazumi , Shimano Hitoshi , Hara Shigeko , Sone Hirohito
Published: October 2013

OBJECTIVE

Findings on the effect of menopause or age at menopause on the presence of hyperglycemia are controversial, and why women after menopause have a higher probability of having hyperglycemia than men in the same age range remains unknown.

RESEARCH DESIGN AND METHODS

We reviewed data on 29,189 men, 6,308 premenopausal women, and 4,570 postmenopausal women in Japan. Odds ratios (ORs) for diabetes or prediabetes indicated by American Diabetes Association criteria were calculated for men and for pre- and postmenopausal women.

RESULTS

Compared with premenopausal women, women after natural menopause had an age-adjusted OR of 1.40 (95% CI 1.03–1.89) for diabetes, and women after menopause by surgical or other causes had an age-adjusted OR of 1.59 (1.07–2.37). The age-adjusted OR in men was 4.02 (3.15–5.14). Compared with premenopausal nondiabetic women, postmenopausal nondiabetic women had a significantly elevated OR of 1.33 (1.20–1.48) for prediabetes; nondiabetic men had an OR of 1.93 (1.77–2.10) independently of age and demographic and metabolic factors. Even among women aged <50 years, postmenopausal status was significantly associated with an elevated OR (1.50 [1.18–1.91]) for dysglycemia (either diabetes or prediabetes). Postmenopausal women aged ≥50 years had a particularly elevated OR for dysglycemia, regardless of age at menopause.

CONCLUSIONS

The postmenopausal state was significantly associated with the presence of dysglycemia independently of normal aging, although the increased probability in postmenopausal women did not equal that in men. Among women, menopause and older age might additively influence the elevated probability of dysglycemia.
Does a Patient-Managed Insulin Intensification Strategy With Insulin Glargine and Insulin Glulisine Provide Similar Glycemic Control as a Physician-Managed Strategy? Results of the START (Self-Titration With Apidra to Reach Target) Study
Authors: Harris Stewart B. , Yale Jean-François , Berard Lori , Stewart John , Abbaszadeh Babak , Webster-Bogaert Susan , Gerstein Hertzel C.
Published: October 2013

OBJECTIVE

Diabetes self-management is universally regarded as a foundation of diabetes care. We determined whether comparable glycemic control could be achieved by self-titration versus physician titration of a once-daily bolus insulin dose in patients with type 2 diabetes who are unable to achieve optimal glycemia control with a basal insulin.

RESEARCH DESIGN AND METHODS

Patients with type 2 diabetes, an HbA1c level >7% (53 mmol/mol), and either nocturnal hypoglycemia episodes or an insufficient basal insulin glargine level (with or without oral agents) to achieve a fasting plasma glucose level ≤6 mmol/L (108 mg/dL) were studied. Participants all had bolus insulin glulisine added at breakfast and were allocated to either algorithm-guided patient self-titration or physician titration. The primary outcome was an HbA1c level ≤7% (53 mmol/mol) without severe hypoglycemia.

RESULTS

After a mean (SD) follow-up of 159.4 days (36.2 days), 28.4% of participants in the self-titration arm vs. 21.2% in the physician titration arm achieved an HbA1c level of ≤7% (53 mmol/mol) without severe hypoglycemia (between-group absolute difference 7.2%; 95% CI −3.2 to 17.7). The lower end of this 95% confidence interval was within the predetermined noninferiority boundary of −5% (P noninferiority = 0.011).

CONCLUSIONS

In stable patients with type 2 diabetes who are receiving doses of basal insulin glargine who require bolus insulin, a simple bolus insulin patient-managed titration algorithm is as effective as a physician-managed algorithm.
Preoperative A1C and Clinical Outcomes in Patients With Diabetes Undergoing Major Noncardiac Surgical Procedures
Authors: Underwood Patricia , Askari Reza , Hurwitz Shelley , Chamarthi Bindu , Garg Rajesh
Published: October 2013

OBJECTIVE

To evaluate the relationship between preoperative A1C and clinical outcomes in individuals with diabetes mellitus undergoing noncardiac surgery.

RESEARCH DESIGN AND METHODS

Data were obtained from the National Surgical Quality Improvement Program database and the Research Patient Data Registry of the Brigham and Women’s Hospital. Patients admitted to the hospital for ≥1 day after undergoing noncardiac surgery from 2005 to 2010 were included in the study.

RESULTS

Of 1,775 patients with diabetes, 622 patients (35%) had an A1C value available within 3 months before surgery. After excluding same-day surgeries, patients with diabetes were divided into four groups (A1C ≤6.5% [N = 109]; >6.5–8% [N = 202]; >8–10% [N = 91]; >10% [N = 47]) and compared with age-, sex-, and BMI-matched nondiabetic control subjects (N = 888). Individuals with A1C values between 6.5 and 8% had a hospital length of stay (LOS) similar to the matched control group (P = 0.5). However, in individuals with A1C values ≤6.5 or >8%, the hospital LOS was significantly longer compared with the control group (P < 0.05). Multivariate regression analysis demonstrated that a higher A1C value was associated with increased hospital LOS after adjustments for age, sex, BMI, race, type of surgery, Charlson Comordity Index, smoking status, and glucose level on the day of surgery (P = 0.02). There were too few events to meaningfully evaluate for death, infections, or readmission rate.

CONCLUSIONS

Our study suggests that chronic hyperglycemia (A1C >8%) is associated with poor surgical outcomes (longer hospital LOS). Providing a preoperative intervention to improve glycemic control in individuals with A1C values >8% may improve surgical outcomes, but prospective studies are needed.
Factors influencing veterinarian referral to oncology specialists for treatment of dogs with lymphoma and osteosarcoma in Ontario, Canada
Authors: Stoewen Debbie L. , Coe Jason B. , MacMartin Clare , Stone Elizabeth A. , Dewey Catherine E.
Published: October 2013

Objective—To elucidate factors influencing practitioner decisions to refer dogs with cancer to veterinary oncology specialists.

Design—Cross-sectional study.

Sample—2,724 Ontario primary care companion animal veterinarians.

Procedures—Practitioners were invited to participate in a survey involving clinical scenarios of canine cancer patients, offered online and in paper format from October 2010 through January 2011. Analyses identified factors associated with the decision to refer patients to veterinary oncology specialists.

Results—1,071 (39.3%) veterinarians responded, of which 603 (56.3%) recommended referral for dogs with multicentric lymphoma and appendicular osteosarcoma. Most (893/1,059 [84.3%]) practiced within < 2 hours’ drive of a specialty referral center, and most (981/1,047 [93.7%]) were completely confident in the oncology service. Few (230/1,056 [21.8%] to 349/1,056 [33.0%]) were experienced with use of chemotherapeutics, whereas more (627/1,051 [59.7%]) were experienced with amputation. Referral was associated with practitioner perception of patient health status (OR, 1.54; 95% confidence interval [CI], 1.15 to 2.07), the interaction between the client's bond with the dog and the client's financial status, practitioner experience with treating cancer (OR, 2.79; 95% CI, 1.63 to 4.77), how worthwhile practitioners considered treatment to be (OR, 1.66 to 3.09; 95% CI, 1.08 to 4.72), and confidence in the referral center (OR, 2.20; 95% CI, 1. 11 to 4.34).

Conclusions and Clinical Relevance—Several factors influenced practitioner decisions to refer dogs with lymphoma or osteosarcoma for specialty care. Understanding factors that influence these decisions may enable practitioners to appraise their referral decisions and ensure they act in the best interests of patients, clients, and the veterinary profession.
Evaluation of a modified proportional margins approach for surgical resection of mast cell tumors in dogs: 40 cases (2008–2012)
Authors: Pratschke Kathryn M. , Atherton Matt J. , Sillito Jack A. , Lamm Catherine G.
Published: October 2013

Objective—To evaluate a modified proportional margins approach to resection of mast cell tumors (MCTs) in dogs.

Design—Retrospective case series.

Animals—40 dogs with subcutaneous and cutaneous MCTs undergoing curative intent surgery.

Procedures—Medical records were searched to identify dogs with a cytologically or histologically confirmed diagnosis of MCT that had not previously been treated surgically and that had undergone full oncological staging. In those dogs, tumors were resected with lateral margins equivalent to the widest measured diameter of the tumor and a minimum depth of 1 well-defined fascial plane deep to the tumor. Surgical margins were evaluated histologically. Cutaneous tumors were graded by use of the Patnaik system and the 2-tier system described by Kiupel et al. The prognosis for subcutaneous tumors was assessed in accordance with published recommendations. Follow-up information on dog health status was obtained through clinical examination, the dog owners, and the referring veterinarians.

Results—The 40 dogs had 47 tumors. Forty-one (87%) tumors were cutaneous, and 6 (13%) were subcutaneous. On the basis of the Patnaik system, 21 (51%) cutaneous tumors were considered grade I, 18 (44%) were considered grade II, and 2 (5%) were considered grade III. On the basis of the Kiupel system, 37 (90%) cutaneous tumors were considered low grade, and 4 (10%) were considered high grade. The prognosis for the 6 subcutaneous tumors was classified as likely resulting in a shorter (2) or longer (4) survival time. Forty tumors were deemed to have been excised with clear margins and 7 with incomplete margins. Local recurrence was not recorded for any dog but was suspected for 1 (2%) tumor, although not confirmed. Interval from tumor excision to follow-up ranged from 30 to 1,140 days (median, 420 days).

Conclusions and Clinical Relevance—The modified proportional margins system resulted in satisfactory local disease control in dogs with MCTs.
Effects of early pregnancy diagnosis by per rectal palpation of the amniotic sac on pregnancy loss in dairy cattle
Authors: Romano Juan E. , Fahning Melvyn L.
Published: October 2013

Objective—To determine effects of per rectal amniotic sac palpation (ASP) for pregnancy diagnosis during early gestation on pregnancy loss in lactating cows.

Design—Controlled, randomized block design.

Animals—368 pregnant dairy cows.

Procedures—Pregnancy was detected via transrectal ultrasonography (TRUS) at day 29 (day of estrus = day 0), and cows were allocated into a control group (n = 167 cows) and ASP group (180). Control cows were not subjected to pregnancy diagnosis via palpation per rectum. Per rectal ASP was performed between days 34 and 43 by only 1 experienced veterinarian. All cows were reevaluated with TRUS on days 45, 60, and 90.

Results—21 cows were removed because of illness. Pregnancy loss between days 29 and 90 occurred in 44 of 347 (12.7%) cows. Pregnancy loss for the control and ASP groups from days 29 to 90 occurred in 22 of 167 (13.2%) and 22 of 180 (12.2%) cows, respectively. Late embryonic pregnancy loss (days 29 to 45) for the control and ASP groups occurred in 18 (10.8%) and 15 (8.3%) cows, respectively. Early fetal pregnancy loss (days 46 to 60) for the control and ASP groups occurred in 2 of 149 (1.3%) and 6 of 165 (3.6%) cows, respectively, and late fetal pregnancy loss (days 61 to 90) for the same groups occurred in 2 of 147 (1.4%) and 1 of 159 (0.6%) cows, respectively.

Conclusions and Clinical Relevance—Pregnancy diagnosis via per rectal ASP during early gestation did not increase pregnancy loss in dairy cattle.
Sinonasal Involvement in Systemic Vasculitides and Cocaine-Induced Midline Destructive Lesions: Diagnostic Controversies
Authors: Armengot M. , Garćia-Lliberós A. , Gómez M. J. , Navarro A. , Martorell A.
Published: October 2013

Multiple systemic diseases produce various clinical manifestations in the sinonasal area. They usually appear as difficult-to-diagnose disease processes with slow, atypical clinical courses. The aim of this study was to evaluate the sinonasal manifestations of systemic vasculitides, highlighting key points for diagnosis and differential diagnosis with other pathological entities, especially cocaine-induced midline destructive lesions (CIMDL). A retrospective study was performed of 10 patients treated in our hospital during the last 5 years with an initial diagnosis of systemic vasculitides with sinonasal involvement: eight patients with granulomatosis with polyangiitis (GPA; new nomenclature for Wegener granulomatosis) and two patients with Churg-Strauss syndrome (CSS). The study variables were clinical presentation, nasal endoscopy results, maxillofacial scan results, nasal biopsy results, erythrocyte sedimentation rate, and autoimmune antibody levels. The definitive diagnosis was GPA in six (60%) patients, CSS in two (20%) patients, and CIMDL in two (20%) patients. Nasal symptoms were similar in all patients, but nasal polyps were present in only one patient with CSS. Systemic manifestations were absent in patients with CIMDL. Likewise, peripheral eosinophilia was observed only in the two patients with CSS. Specific positive biopsy specimens were obtained in six patients (all six patients with GPA, one with CSS, and one with CIMDL). Antineutrophil cytoplasmic antibodies (ANCA) were positive in all patients with GPA (proteinase 3 antigen in five patients and myeloperoxidase in one patient), and perinuclear ANCA was positive in one patient with CIMDL; however, this patient showed an undefined pattern. Finally, the response to treatment was adequate in all patients excluding those with CIMDL. GPA and CIMDL syndromes pose a difficult differential diagnosis because they have common clinical, serological, and histological presentations. Negative histological results do not exclude the diagnosis of sinonasal vasculitides. The absence of systemic manifestations and the lack of response to treatment will lead to the confirmation of CIMDL syndrome in a cocaine user. Otolaryngologists play an important role in the early and differential diagnosis of these diseases.
Validation of a Grading System for Lateral Nasal Wall Insufficiency
Authors: Tsao Gabriel J. , Fijalkowski Natalia , Most Sam P.
Published: October 2013

This study was designed to validate a grading scheme for lateral nasal wall insufficiency with interrater and intrarater reliability measures. Representative endoscopic videos depicting varied degrees of lateral nasal wall insufficiency were collated into a 30-clip video (15 clips in duplicate). This was rated by five reviewers for a total of 150 observations. Interrater and intrarater reliability were determined using Fleiss kappa and intraclass correlation coefficient (ICC) statistics, respectively. Good agreement was established between reviewers (interrater reliability), with a Fleiss kappa of 0.7733 (p < 0.01). Analysis of intrarater variability with the ICC revealed a very strong agreement (ICC = 0.88; p < 0.01). The proposed grading system is shown to have good interrater and intrarater reliability. It provides a reliable instrument for assessing lateral wall insufficiency.