Cardiac Autonomic Function Correlates with Arterial Stiffness in the Early Stage of Type 1 Diabetes

Arterial stiffness is increased in type 1 diabetes (T1D), before any clinical complications of the disease are evident. The aim of the present paper was to investigate the association between cardiac autonomic function and arterial stiffness in a cohort of young T1D patients, without history of hypertension and any evidence of macrovascular and/or renal disease. Large artery stiffness was assessed by measurement of carotid-femoral pulse wave velocity (PWV). Cardiac autonomic function was assessed by the cardiovascular tests proposed by Ewing and Clarke. Patients with a high cardiac autonomic neuropathy score (≥4) had significantly higher PWV than those with a low score (0-1). A negative, heart rate-independent, correlation between PWV and heart rate variation during respiration was observed (r = −0.533,  P < 0.001). In multivariable analysis, E/I index was the strongest correlate of PWV (β-coefficient = −0.326, P = 0.002). Cardiac parasympathetic function is a strong predictor of large arterial stiffness, in young T1D patients free of macrovascular and renal complications

Quality in bank service encounters: Assessing the equivalence of customers’ and front-line employees’ perceptions

Purpose: The paper discusses the need to evaluate perception-based quality in service encounters. It sets out to diagnose potential mismatches in how customers and front-line employees perceive quality in high involvement service settings, based on the premise that any initiatives towards quality enhancement in service encounters is advisable only when employees and customers evaluate quality utilizing common perceptual structures. Design/methodology/approach: The study utilizes invariance analysis. The survey involved 165 bank branches and 1522 respondents (463 front-line employees and 1059 customers) and operationalized the same set of questions for both groups of participants. Multisample Confirmatory Factor Analysis tested a series of measurement models. Findings: Results revealed equivalence for tangibles, responsiveness, and assurance but also mismatches between customers and front-line employees perceptions of reliability and empathy. Practical implications: Findings add to current knowledge of how both groups of participants evaluate quality in service encounters and are discussed with reference to managerial consequences for perception-based quality mismatches. Originality/value: So far only a few studies have simultaneously examined front-line employees’ and customers’ perceptions of service quality in service encounters. Unlike previous research designs, this study addresses the critical aspect of potential mismatches in how customers and employees perceive service quality, and presents a methodological procedure to detect them

Arterial stiffness is inversely related to plasma adiponectin levels in young normotensive patients with type 1 diabetes

OBJECTIVE This study investigated the association between arterial stiffness and plasma adiponectin in patients with type 1 diabetes. RESEARCH DESIGN AND METHODS Participants were normotensive patients with type 1 diabetes who were up to age 40 years. Subjects on statins with macrovascular disease or overt nephropathy were excluded. Large artery stiffness was assessed by measurement of carotid-femoral pulse wave velocity (PWV), whereas plasma adiponectin was measured by radioimmunoassay. RESULTS Data from 80 patients (age 27.1 ± 6.1 years, BMI 24.2 ± 3.1 kg/m2, HbA1c 7.5 ± 1.6%, 39 men, adiponectin 13.9 ± 6.7 μg/mL, and PWV 5.6 ± 0.9 m/s) were analyzed. Log adiponectin inversely correlated with age-adjusted PWV (r = −0.291, P = 0.009) and waist circumference (r = −0.427, P < 0.001). In a fully adjusted model, age, expiration/inspiration index, and log adiponectin were independently associated with PWV, explaining 39.6% of its variance. CONCLUSIONS Arterial stiffness is inversely related to adiponectin concentration in young patients with type 1 diabetes without major complications

Roux-en-Y Gastric Bypass Increases Glycemic Variability and Time in Hypoglycemia in Patients With Obesity and Prediabetes or Type 2 Diabetes: A Prospective Cohort Study

OBJECTIVE: Roux-en-Y gastric bypass (RYGB) is an established treatment for type 2 diabetes and obesity. The study objective was to establish RYGB's effects on glycemic variability (GV) and hypoglycemia. RESEARCH DESIGN AND METHODS: This was a prospective observational study of 10 participants with obesity and prediabetes or type 2 diabetes who underwent RYGB. Patients were studied before RYGB (Pre) and 1 month, 1 year, and 2 years postsurgery with continuous glucose measurement (CGM). A mixed-meal test (MMT) was conducted at Pre, 1 month, and 1 year. RESULTS: After RYGB, mean CGM decreased (at 1 month, 1 year, and 2 years), and GV increased (at 1 year and 2 years). Five of the 10 participants had a percent time in range (%TIR) <3.0 mmol/L (54 mg/dL) greater than the international consensus target of 1% at 1 or 2 years. Peak glucagon-like peptide-1 (GLP-1) and glucagon area under the curve during MMT were positively and negatively associated, respectively, with contemporaneous %TIR <3.0 mmol/L. CONCLUSIONS: Patients undergoing RYGB are at risk for development of postbariatric hypoglycemia due to a combination of reduced mean glucose, increased GV, and increased GLP-1 response

Genomics reveals the role of admixture in the evolution of structure among sperm whale populations within the Mediterranean Sea

In oceanic ecosystems, the nature of barriers to gene flow and the processes by which populations may become isolated are different from the terrestrial environment, and less well understood. In this study we investigate a highly mobile species (the sperm whale, Physeter macrocephalus) that is genetically differentiated between an open North Atlantic population and the populations in the Mediterranean Sea. We apply high-resolution single nucleotide polymorphism (SNP) analysis to study the nature of barriers to gene flow in this system, assessing the putative boundary into the Mediterranean (Strait of Gibraltar and Alboran Sea region), and including novel analyses on structuring among sperm whale populations within the Mediterranean basin. Our data support a recent founding of the Mediterranean population, around the time of the last glacial maximum, and show concerted historical demographic profiles in both the Atlantic and the Mediterranean. In each region there is evidence for a population decline around the time of the founder event. The largest decline was seen within the Mediterranean Sea where effective population size is substantially lower (especially in the eastern basin). While differentiation is strongest at the Atlantic/Mediterranean boundary, there is also weaker but significant differentiation between the eastern and western basins of the Mediterranean Sea. We propose, however, that the mechanisms are different. While post-founding gene flow was reduced between the Mediterranean and Atlantic populations, within the Mediterranean an important factor differentiating the basins is probably a greater degree of admixture between the western basin and the North Atlantic and some level of isolation between the western and eastern Mediterranean basins. Subdivision within the Mediterranean Sea exacerbates conservation concerns and will require consideration of what distinct impacts may affect populations in the two basins

On the Topic of Pseudoclefts

This paper presents arguments in favor of a pseudocleft analysis of a certain class of sentences in Malagasy, despite the lack of an overt wh-element. It is shown that voice morphology on the verb creates an operator-variable relationship much like the one created by wh-movement in free relatives in English and other languages. The bulk of the paper argues in favor of an inversion analysis of specificational pseudoclefts in Malagasy: a predicate DP is fronted to a topic position from within a small clause constituent. Moreover, it is shown that the same inversion occurs in equative and specificational sentences in Malagasy, which suggests that these types of sentences share the same syntactic structure. The proposed analysis also provides support for the view that specificational pseudoclefts have a topic \u3e focus structure, where the wh-clause has been overtly topicalized

Change-of-state Paradigms and the middle in Kinyarwanda

This paper investigates the derivational relationships among members of verbal paradigms in Kinyarwanda (Bantu JD.61; Rwanda) by pursuing two interrelated goals. First, I describe a variety of derivational strategies for marking transitive and intransitive variants in change-of-state verb paradigms. Second, I focus on the detransitivizing morpheme –ik which serves as one possible marking for intransitive members of these paradigms. Ultimately, I argue that this morpheme is a marker of middle voice, and the variety of readings which appear with this form can be subsumed under a single operation of argument suppression. Finally, I provide a discussion of reflexives and the apparent lack of a reflexive reading with –ik by arguing that this reading is blocked by either lexical reflexives or the reflexive prefix i–

One step closer to understanding the role of bacteria in diabetic foot ulcers: characterising the microbiome of ulcers

Background: The aim of this study was to characterise the microbiome of new and recurrent diabetic foot ulcers using 16S amplicon sequencing (16S AS), allowing the identification of a wider range of bacterial species that may be important in the development of chronicity in these debilitating wounds. Twenty patients not receiving antibiotics for the past three months were selected, with swabs taken from each individual for culture and 16S AS. DNA was isolated using a combination of bead beating and kit extraction. Samples were sequenced on the Illumina Hiseq 2500 platform. Results: Conventional laboratory culture showed positive growth from only 55 % of the patients, whereas 16S AS was positive for 75 % of the patients (41 unique genera, representing 82 different operational taxonomic units (OTU’s). S. aureus was isolated in 72 % of culture-positive samples, whereas the most commonly detected bacteria in all ulcers were Peptoniphilusspp., Anaerococcus spp. and Corynebacterium spp., with the addition of Staphylococcus spp. in new ulcers. The majority of OTU’s residing in both new and recurrent ulcers (over 67 %) were identified as facultative or strict anaerobic Gram-positive organisms. Principal component analysis (PCA) showed no difference in clustering between the two groups (new and recurrent ulcers). Conclusions: The abundance of anaerobic bacteria has important implications for treatment as it suggests that the microbiome of each ulcer “starts afresh” and that, although diverse, are not distinctly different from one another with respect to new or recurrent ulcers. Therefore, when considering antibiotic therapy the duration of current ulceration may be a more important consideration than a history of healed ulcer

Minimalist C/case

This article discusses A-licensing and case from a minimalist perspective, pursuing the idea that argument NPs cyclically enter a number of A-relations, rather than just a single one, resulting in event-licensing, case-licensing and phi-licensing. While argument case commonly reflects Voice/v-relations, canonical A-movement is driven by higher elements, either in the C-T system or in a superordinate v-system (in ECM constructions). In addition, there is a distinction to be drawn between the triggering of A-movement, by for example C, and the licensing of the landing site, by for instance T, C-probing leading to tucking-in into Spec-T. Much of the evidence presented comes from quirky case constructions in Icelandic and from ECM and raising constructions in Icelandic and English. It is argued that T in ECM constructions inherits phi-licensing from the matrix v, regardless of the case properties of v

Internationalisation and migrant academics: the hidden narratives of mobility

Internationalisation is a dominant policy discourse in higher education today. It is invariably presented as an ideologically neutral, coherent, disembodied, knowledgedriven policy intervention - an unconditional good. Yet it is a complex assemblage of values linked not only to economic growth and prosperity, but also to global citizenship, transnational identity capital, social cohesion, intercultural competencies and soft power (Clifford and Montgomery 2014; De Wit et al. 2015; Kim 2017; Lomer 2016; Stier 2004). Mobility is the sine qua non of the global academy (Sheller 2014). International movements, flows and networks are perceived as valuable transnational and transferable identity capital and as counterpoints to intellectual parochialism. Fluidity metaphors abound as an antidote to stasis e.g. flows, flux and circulations (Urry 2007). For some, internationalisation is conceptually linked to the political economy of neoliberalism and the spatial extension of the market, risking commodification and commercialisation (Matus and Talburt 2009). Others raise questions about what/whose knowledge is circulating and whether internationalisation is a form of re-colonisation and convergence that seeks to homogenise higher education systems (Stromquist 2007). Internationalisation policies and practices, it seems, are complex entanglements of economic, political, social and affective domains. They are mechanisms for driving the global knowledge 2 economy and the fulfilment of personal aspirations (Hoffman 2009). Academic geographical mobility is often conflated with social mobility and career advancement (Leung 2017). However, Robertson (2010: 646) suggested that ‘the romance of movement and mobility ought to be the first clue that this is something we ought to be particularly curious about.