bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nitrogen dynamics in a constructed wetland system treating landfill leachate
Authors: Kinsley C.B. , Crolla A.M. , Kuyucak N. , Zimmer M. , Laflèche A. 
Published: July 2007

A pilot scale treatment system was established in 2002 at the Laflèche Landfill in Eastern Ontario, Canada. The system consists of a series of treatment steps: a stabilisation basin (10,000 m3), a woodland peat trickling filter (5,200 m2), a subsurface flow constructed wetland planted in Phragmites sp. (2,600 m2), a surface flow constructed wetland planted in Typha sp. (3,600 m2) and a polishing pond (3,600 m2). The system operates from May to December with leachate being recycled within the landfill during the winter months.
Hydraulic loading was increased three-fold over four operating seasons with nitrogen and organic mass loading increasing six-fold. Excellent removal efficiencies were observed with 93% BOD5, 90% TKN and 97% NH4-N removed under the highest loading conditions. Almost complete denitrification was observed throughout the treatment system with NO3-N concentrations never exceeding 5 mg·L−1. The peat filter reached treatment capacity at a hydraulic loading of 4 cm·d−1 and organic loading rate of 42 kg BOD·ha−1·d−1, which is consistent with design criteria for vertical flow wetland systems and intermittent sand filters.
The first order plug flow kinetic model was effective at describing TKN and ammonium removal in the SSF and FWS wetlands when background concentrations were taken into account. Ammonium removal k-values were consistent with the literature at 52.6 and 57.7 yr−1 for the SSF and FWS wetlands, respectively, while TKN k-values at 6.9 and 7.7 yr−1 were almost an order of magnitude lower than literature values, suggesting that leachate TKN could contain refractory organics not found in domestic wastewater.
The Effect of Intensive Diabetes Treatment on Resting Heart Rate in Type 1 Diabetes
Authors: Paterson Andrew D. , Rutledge Brandy N. , Cleary Patricia A. , Lachin John M. , Crow Richard S. ,   for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group
Published: July 2007

OBJECTIVE—Cardiovascular disease is a major cause of morbidity and mortality in individuals with type 1 diabetes. Resting heart rate (RHR) is a risk factor for cardiovascular disease in the general population, and case-control studies have reported a higher RHR in individuals with type 1 diabetes. In individuals with type 1 diabetes, there is a positive correlation between A1C and RHR; however, no prospective studies have examined whether a causal relationship exists between A1C and RHR. We hypothesized that intensive diabetes treatment aimed to achieve normal A1C levels has an effect on RHR in individuals with type 1 diabetes.
RESEARCH DESIGN AND METHODS—A total of 1,441 individuals with type 1 diabetes who participated in the Diabetes Control and Complications Trial (DCCT) had their RHR measured biennially by an electrocardiogram during the DCCT and annually for 10 years during the Epidemiology of Diabetes Interventions and Complications (EDIC) follow-up study.
RESULTS—During the DCCT, intensive treatment was associated with lower mean RHR than conventional treatment, both in adolescents (69.0 vs. 72.0 bpm [95% CI 62.8–75.7 and 65.7–78.9, respectively], P = 0.013) and adults (66.8 vs. 68.2 [65.3–68.4 and 66.6–69.8, respectively], P = 0.0014). During follow-up in the EDIC, the difference in RHR between the treatment groups persisted for at least 10 years (P &lt; 0.0001).
CONCLUSIONS—Compared with conventional therapy, intensive diabetes management is associated with lower RHR in type 1 diabetes. The lower RHR with intensive therapy may explain, in part, its effect in reducing cardiovascular disease, recently demonstrated in type 1 diabetes.
Prevalence and Risk Factors of Diabetic Nephropathy in an Urban South Indian Population
Authors: Unnikrishnan Ranjit , Rema Mohan , Pradeepa Rajendra , Deepa Mohan , Shanthirani Coimbatore Subramaniam , Deepa Raj , Mohan Viswanathan 
Published: July 2007

OBJECTIVE—The aim of this study was to determine the prevalence of diabetic nephropathy among urban Asian-Indian type 2 diabetic subjects.
RESEARCH DESIGN AND METHODS—Type 2 diabetic subjects (n = 1,716), inclusive of known diabetic subjects (KD subjects) (1,363 of 1,529; response rate 89.1%) and randomly selected newly diagnosed diabetic subjects (NDD subjects) (n = 353) were selected from the Chennai Urban Rural Epidemiology Study (CURES). Microalbuminuria was estimated by immunoturbidometric assay and diagnosed if albumin excretion was between 30 and 299 μg/mg of creatinine, and overt nephropathy was diagnosed if albumin excretion was ≥300 μg/mg of creatinine in the presence of diabetic retinopathy, which was assessed by stereoscopic retinal color photography.
RESULTS—The prevalence of overt nephropathy was 2.2% (95% CI 1.51–2.91). Microalbuminuria was present in 26.9% (24.8–28.9). Compared with the NDD subjects, KD subjects had greater prevalence rates of both microalbuminuria with retinopathy and overt nephropathy (8.4 vs. 1.4%, P &lt; 0.001; and 2.6 vs. 0.8%, P = 0.043, respectively). Logistic regression analysis showed that A1C (odds ratio 1.325 [95% CI 1.256–1.399], P &lt; 0.001), smoking (odds ratio 1.464, P = 0.011), duration of diabetes (1.023, P = 0.046), systolic blood pressure (1.020, P &lt; 0.001), and diastolic blood pressure (1.016, P = 0.022) were associated with microalbuminuria. A1C (1.483, P &lt; 0.0001), duration of diabetes (1.073, P = 0.003), and systolic blood pressure (1.031, P = 0.004) were associated with overt nephropathy.
CONCLUSIONS—The results of the study suggest that in urban Asian Indians, the prevalence of overt nephropathy and microalbuminuria was 2.2 and 26.9%, respectively. Duration of diabetes, A1C, and systolic blood pressure were the common risk factors for overt nephropathy and microalbuminuria.
Maternal Obesity and Risk of Gestational Diabetes Mellitus
Authors: Chu Susan Y. , Callaghan William M. , Kim Shin Y. , Schmid Christopher H. , Lau Joseph , England Lucinda J. , Dietz Patricia M. 
Published: July 2007

OBJECTIVE—Numerous studies in the U.S. and elsewhere have reported an increased risk of gestational diabetes mellitus (GDM) among women who are overweight or obese compared with lean or normal-weight women. Despite the number and overall consistency of studies reporting a higher risk of GDM with increasing weight or BMI, the magnitude of the association remains uncertain. This meta-analysis was conducted to better estimate this risk and to explore differences across studies.
RESEARCH DESIGN AND METHODS—We identified studies from three sources: 1) a PubMed search of relevant articles published between January 1980 and January 2006, 2) reference lists of publications selected from the PubMed search, and 3) reference lists of review articles on obesity and maternal outcomes published between January 2000 and January 2006. We used a Bayesian model to perform the meta-analysis and meta-regression. We included cohort-designed studies that reported obesity measures reflecting pregnancy body mass, that had a normal-weight comparison group, and that presented data allowing a quantitative measurement of risk.
RESULTS—Twenty studies were included in the meta-analysis. The unadjusted ORs of developing GDM were 2.14 (95% CI 1.82–2.53), 3.56 (3.05–4.21), and 8.56 (5.07–16.04) among overweight, obese, and severely obese compared with normal-weight pregnant women, respectively. The meta-regression analysis found no evidence that these estimates were affected by selected study characteristics (publication date, study location, parity, type of data collection [retrospective vs. prospective], and prevalence of GDM among normal-weight women).
CONCLUSIONS—Our findings indicate that high maternal weight is associated with a substantially higher risk of GDM.
Fenofibrate Therapy Ameliorates Fasting and Postprandial Lipoproteinemia, Oxidative Stress, and the Inflammatory Response in Subjects With Hypertriglyceridemia and the Metabolic Syndrome
Authors: Rosenson Robert S. , Wolff David A. , Huskin Anna L. , Helenowski Irene B. , Rademaker Alfred W. 
Published: July 2007

OBJECTIVE—The aim of this study was to determine the effects of fenofibrate (160 mg/day) on fasting and postprandial lipoproteins, oxidized fatty acids, and inflammatory mediators in subjects with hypertriglyceridemia and the metabolic syndrome.
RESEARCH DESIGN AND METHODS—Fifty-nine subjects with fasting hypertriglyceridemia (≥1.7 and &lt;6.9 mmol/l) and two or more of the Adult Treatment Panel III criteria for the metabolic syndrome were randomly assigned to fenofibrate (160 mg/day) or placebo in a double-blind, controlled clinical trial.
RESULTS—Fenofibrate treatment lowered fasting triglycerides (−46.1%, P &lt; 0.0001) and postprandial (area under the curve) triglycerides (−45.4%, P &lt; 0.0001) due to significant reductions in postprandial levels of large (−40.8%, P &lt; 0.0001) and medium (−49.5%, P &lt; 0.0001) VLDL particles. The number of fasting total LDL particles was reduced in fenofibrate-treated subjects (−19.0%, P = 0.0033) primarily due to reductions in small LDL particles (−40.3%, P &lt; 0.0001); these treatment differences persisted postprandially. Fasting and postprandial oxidized fatty acids were reduced in fenofibrate-treated subjects compared with placebo-administered subjects (−15.3%, P = 0.0013, and 31.0%, P &lt; 0.0001, respectively), and fenofibrate therapy lowered fasting and postprandial soluble vascular cell adhesion molecule-1 (VCAM-1) (−10.9%, P = 0.0005, and −12.0%, P = 0.0001, respectively) as well as fasting and postprandial soluble intercellular adhesion molecule-1 (ICAM-1) (−14.8%, P &lt; 0.0001, and −15.3%, P &lt; 0.0001, respectively). Reductions in VCAM-1 and ICAM-1 were correlated with reductions in fasting and postprandial large VLDL particles (P &lt; 0.0001) as well as postprandial oxidized fatty acids (P &lt; 0.0005).
CONCLUSIONS—Triglyceride-lowering therapy with fenofibrate reduced fasting and postprandial free fatty acid oxidation and inflammatory responses, and these antiatherosclerotic effects were most highly correlated with reductions in large VLDL particles.
End-Digit Preference and the Quality of Blood Pressure Monitoring in Diabetic Adults
Authors: Kim Esther S.H. , Samuels T. Alafia , Yeh Hsin-Chieh , Abuid Marcela , Marinopoulos Spyridon S. , McCauley Jeanne M. , Brancati Frederick L. 
Published: July 2007

OBJECTIVE—Although tight blood pressure (BP) control is proven to reduce diabetes-related cardiovascular risk, it has been difficult to achieve in practice, perhaps in part because of low-quality monitoring data. We hypothesized that low-quality BP data, reflected in end-digit preference (EDP), remains common in primary care of diabetic adults.
RESEARCH DESIGN AND METHODS—Data were abstracted from the charts of 404 adults with type 2 diabetes seen at 16 academically affiliated clinics from 1999 to 2001. End-digits of systolic and diastolic BPs taken with nonautomated sphygmomanometers were extracted, and prevalence of EDP for zero was calculated. Associations between EDP and selected patient characteristics were determined using multiple logistic regressions.
RESULTS—EDP was highly prevalent in the BP measurements taken by nonphysicians (4,333 BPs; 50% of systolic, 50% of diastolic readings ended in zero; P &lt; 0.001) and physicians (1,347 BPs; 69% of systolic, 64% of diastolic readings ended in zero; P &lt; 0.001). In multivariate analysis, nonphysicians showed greater EDP for systolic BP in older patients (odds ratio [OR] 1.07 per 5 years) and women (OR 1.36 vs. men) and for diastolic BP in African-Americans (OR 1.25 vs. whites; all P &lt; 0.05); physicians showed greater EDP for diastolic BP in less obese patients (OR 0.97 per 5 kg/m2 increment in BMI; P = 0.02).
CONCLUSIONS—Low-quality BP measurement is common in primary care of diabetic adults. Procedural and technological improvements to BP measurement deserve attention as part of an overall strategy to tighten BP control and reduce cardiovascular risk.
Incidence and Risk Factors of Prolonged QTc Interval in Type 1 Diabetes
Authors: Giunti Sara , Bruno Graziella , Lillaz Emma , Gruden Gabriella , Lolli Valentina , Chaturvedi Nish , Fuller John H. , Veglio Massimo , Cavallo-Perin Paolo ,   The EURODIAB IDDM Complications Study Group
Published: July 2007

OBJECTIVE—Corrected QT (QTc) prolongation is predictive of cardiovascular mortality in both the general and diabetic populations. As part of the EURODIAB Prospective Complication Study, we have assessed the 7-year incidence and risk factors of prolonged QTc in people with type 1 diabetes.
RESEARCH DESIGN AND METHODS—A total of 1,415 type 1 diabetic subjects, who had normal QTc at baseline, were reanalyzed after the 7-year follow-up period. QTc &gt;0.44 s was considered abnormally prolonged.
RESULTS—Cumulative incidence of prolonged QTc was 18.7%, which is twofold higher in women than in men (24.5 vs. 13.9%, P &lt; 0.0001). At the baseline examination, incident cases were older and less physically active than nonincident cases, had higher mean values of systolic blood pressure and HDL cholesterol, and had higher frequencies of hypertension, coronary heart disease, and distal symmetrical polyneuropathy. In multivariate logistic regression analyses, female sex and higher values of A1C and systolic blood pressure were associated with the risk of prolonged QTc, whereas physical activity and BMI within the range of 21.5–23.2 kg/m2 were protective factors. In women, association with modifiable factors, particularly BMI, was stronger than in men.
CONCLUSIONS—In type 1 diabetic subjects from the EURODIAB cohort, female sex, A1C, and systolic blood pressure are predictive of prolonged QTc, whereas physical activity and BMI within the range of 21.5–23.2 kg/m2 play a protective role. These findings are clinically relevant, as they may help to identify subjects at higher risk for prolonged QTc, as well as provide potential targets for risk-lowering strategies.
Hypoglycemia During Sleep Impairs Consolidation of Declarative Memory in Type 1 Diabetic and Healthy Humans
Authors: Jauch-Chara Kamila , Hallschmid Manfred , Gais Steffen , Schmid Sebastian M. , Oltmanns Kerstin M. , Colmorgen Caterina , Born Jan , Schultes Bernd 
Published: July 2007

OBJECTIVE—Early nocturnal sleep enhances the consolidation of declarative memories acquired during prior wakefulness. Patients with type 1 diabetes frequently experience hypoglycemic episodes during sleep. We investigated whether short-lasting hypoglycemia during early nocturnal sleep affects the sleep-associated consolidation of declarative memories.
RESEARCH DESIGN AND METHODS—Sixteen type 1 diabetic patients and 16 healthy subjects matched for age and BMI were tested. On one condition, a linear fall of plasma glucose to 2.2 mmol/l was induced within 60 min by infusing insulin during early sleep. On the control condition, euglycemia (&gt;3.86 mmol/l) was maintained throughout the night. In the morning, subjects recalled word pairs learned in the preceding evening. To assess mood and attention, a symptom questionnaire, an adjective check list, and the Stroop test were applied. Also, auditory event-related brain potentials were recorded.
RESULTS—After euglycemia, subjects recalled 1.5 ± 0.5 more word pairs than after hypoglycemia (P &lt; 0.01), remembering 2.0 ± 0.6 more word pairs than at immediate recall before sleep (P = 0.002). Across the hypoglycemic night, no such gain occurred (+0.5 ± 0.6 words; P = 0.41). Hypoglycemia during sleep also impaired mood (P &lt; 0.05) but did not affect attention. Effects compared well between type 1 diabetic patients and healthy control subjects.
CONCLUSIONS—Our findings indicate specific sensitivity of declarative memory consolidation during sleep to rather short episodes of mild hypoglycemia. This effect may disable memory processing in type 1 diabetic patients prone to nocturnal hypoglycemic episodes and underlines the importance of considering sleep as a critical period in the treatment of these patients.
Bone Size Normalizes With Age in Children and Adolescents With Type 1 Diabetes
Authors: Bechtold Susanne , Putzker Stefanie , Bonfig Walter , Fuchs Oliver , Dirlenbach Isa , Schwarz Hans Peter 
Published: July 2007

OBJECTIVE—The aim of this study was to establish whether type 1 diabetes has a long-term effect on bone development in children and adolescents.
RESEARCH DESIGN AND METHODS—Bone characteristics and muscle cross-sectional area (CSA) were analyzed cross-sectionally in 41 (19 female and 22 male) patients and were reevaluated after 5.56 ± 0.4 years using peripheral quantitative computed tomography (pQCT). We hypothesize that bone size and muscle mass normalize with age.
RESULTS—At the first evaluation, mean ± SD age was 9.87 ± 2.3 years and disease duration was 4.31 ± 2.9 years. Height was −0.36 ± 1.9 SD, and BMI was 0.39 ± 0.9 SD. Parameters of bone size were low in the whole patient group (corrected for patient's height). At reevaluation, age was 15.44 ± 2.3 years, and patients had a mean height of −0.12 ± 0.8 SD. BMI SD had increased to 0.57 ± 1.1. Total and cortical CSA had normalized. Those patients with an increase in total CSA had a significant younger age at disease manifestation and a younger age at initial pQCT measurement. Bone size was well adapted to muscle mass expressed as the ratio of bone mineral content per muscle mass, and a close correlation was shown between the increase in bone size and in muscle CSA (r = 0.46, P = 0.03).
CONCLUSIONS—Patients with manifestation of type 1 diabetes at an early age had transient impaired bone development. Within the follow-up period, the greatest increase in bone size was found in these patients. In adolescence, all patients had a normal bone size and appropriate adaptation of bone on muscle.
Defining the Metabolic Syndrome Construct
Authors: Vaidya Dhananjay , Szklo Moyses , Liu Kiang , Schreiner Pamela J. , Bertoni Alain G. , Ouyang Pamela 
Published: July 2007

OBJECTIVE—It is controversial whether the clustering of certain metabolic abnormalities should be separately designated as the metabolic syndrome. We operationalized the “syndrome” concept and tested whether the metabolic syndrome was compatible with these operational constructs.
RESEARCH DESIGN AND METHODS—The baseline cross-section of the Multi-Ethnic Study of Atherosclerosis recruited a population-based cohort of 6,781 individuals, aged 45–84 years, from six communities in the U.S. Metabolic syndrome components (waist circumference, blood pressure, fasting serum HDL cholesterol, triglycerides, and plasma glucose), homeostasis model assessment (HOMA) of insulin resistance (fasting glucose × insulin), and intimal-medial thickness (IMT) in the common and internal carotid arteries by B-mode ultrasound were measured.
RESULTS—Higher syndrome component count is associated with higher HOMA levels (trend P &lt; 0.001). Given the prevalence of individual components, the nonprevalence of any component or the co-prevalence of four or five components is greater than expected (χ2 P &lt; 0.001). After accounting for the additive association of each component, the current definition of metabolic syndrome (co-prevalence of three or more components) does not have supra-additive association with thicker IMT in the common carotid (men: P = 0.075, women: P = 0.949) or internal carotid artery (men: P = 0.106, women: P = 0.121).
CONCLUSIONS—The metabolic syndrome did not have supra-additive association with IMT, but its components clustered greater than chance expectation and a higher component count was associated with greater insulin resistance. The metabolic syndrome was compatible with two of three “syndrome” constructs tested.
Presence of GAD Antibodies During Gestational Diabetes Mellitus Predicts Type 1 Diabetes
Authors: Nilsson Charlotta , Ursing Dag , Törn Carina , Åberg Anders , Landin-Olsson Mona 
Published: July 2007

OBJECTIVE—We sought to study the frequency of β-cell–specific autoantibody markers in women with gestational diabetes mellitus (GDM) and to follow these women to estimate the risk of later development of type 1 diabetes.
RESEARCH DESIGN AND METHODS—Of 385 pregnant women with GDM during 1995–2005 in the district of Lund, 24 (6%) women were found positive for at least one of the following: islet cell antibody (ICA), GAD antibody (GADA), or tyrosine phosphatase antibody (IA-2A). The women were followed and autoantibodies reanalyzed. Those who had not developed diabetes did an oral glucose tolerance test. The frequencies of known risk factors for GDM were compared in women with GDM with and without pancreatic autoantibodies.
RESULTS—Among the autoantibody-positive women, 50% had developed type 1 diabetes compared with none among the GDM control subjects (P = 0.001), 21% had impaired fasting glucose or impaired glucose tolerance compared with 12.5% among control subjects (P = 0.3), and none had developed type 2 diabetes compared with 12.5% among control subjects (P = 0.1).
CONCLUSIONS—Autoantibody screening in pregnant women with GDM and follow-up after delivery should be considered for early recognition of type 1 diabetes.
Combining Population Health and Baseline Risk Strategy by Determining an Age Cutoff for Initiating Statins in Patients With Diabetes
Authors: Siyambalapitiya Sajith , Bulugahapitiya Uditha , Sithole Jabulani , Song Soon , Fernando Devaka J.S. , Idris Iskandar 
Published: July 2007

OBJECTIVE—Strategies for initiating statin use among adult patients with diabetes for primary cardiovascular disease (CVD) prevention include treating all patients (assuming diabetes is a coronary risk equivalent) or treating patients who are at risk of developing CVD. The aim of the study was to combine both strategies to derive an appropriate age cutoff for prescribing statins. By considering different strategies, we also aim to assess the effectiveness and efficiency of different strategies to reduce CVD events.
RESEARCH DESIGN AND METHODS—This was a cross-sectional primary care population study using electronic patient files from 304 general practitioner practices in England and Wales. Of 60,258 patients with diabetes, 11,005 men and women aged 30–74 years fullfilled criteria for primary CVD prevention. Model outcomes were extrapolated to an estimated national diabetes prevalence of 3.6%.
RESULTS—The age transition from a low-risk to a moderate-risk category for diabetic men and women occurred at ages 40.6 and 44.2 years, respectively, and sensitivity and specificity for fulfilling moderate CVD risk criteria were 97.9 and 61.8% for men and 92.0 and 77.0% for women. When applied to the national population, the age cutoff strategies were an effective and efficient strategy, potentially avoiding 11,094 events with a number needed to treat of 25.1.
CONCLUSIONS—A strategy to treat all men and women with diabetes aged &gt;40 and 45 years, respectively, with statins showed good compromise between high effectiveness and high efficiency for reducing CVD events. Strategy to intervene if cholesterol was &gt;5 mmol/l was the least effective and efficient in preventing CVD events.