Vascular risk factors and diabetic neuropathy

Background: Other than glycemic control, there are no treatments for diabetic neuropathy. Thus, identifying potentially modifiable risk factors for neuropathy is crucial. We studied risk factors for the development of distal symmetric neuropathy in 1172 patients with type 1 diabetes mellitus from 31 centers participating in the European Diabetes (EURODIAB) Prospective Complications Study. Methods: Neuropathy was assessed at baseline (1989 to 1991) and at follow-up (1997 to 1999), with a mean (±SD) follow-up of 7.3±0.6 years. A standardized protocol included clinical evaluation, quantitative sensory testing, and autonomic-function tests. Serum lipids and lipoproteins, glycosylated hemoglobin, and the urinary albumin excretion rate were measured in a central laboratory. Results: At follow-up, neuropathy had developed in 276 of 1172 patients without neuropathy at baseline (23.5 percent). The cumulative incidence of neuropathy was related to the glycosylated hemoglobin value and the duration of diabetes. After adjustment for these factors, we found that higher levels of total and low-density lipoprotein cholesterol and triglycerides, a higher body-mass index, higher von Willebrand factor levels and urinary albumin excretion rate, hypertension, and smoking were all significantly associated with the cumulative incidence of neuropathy. After adjustment for other risk factors and diabetic complications, we found that duration of diabetes, current glycosylated hemoglobin value, change in glycosylated hemoglobin value during the follow-up period, body-mass index, and smoking remained independently associated with the incidence of neuropathy. Cardiovascular disease at baseline was associated with double the risk of neuropathy, independent of cardiovascular risk factors. Conclusions: This prospective study indicates that, apart from glycemic control, the incidence of neuropathy is associated with potentially modifiable cardiovascular risk factors, including a raised triglyceride level, body-mass index, smoking, and hypertension

Does clinician continuity over two brief motivational sessions improve outcomes in college students?

Previous research has shown that brief motivational interventions (BMIs) are an effective treatment approach for reducing college student alcohol use and associated negative consequences. The purpose of this study was to determine whether clinician continuity (having the same vs. a different clinician) across an initial BMI and follow-up booster session was related to differences in session satisfaction, self-reported alcohol use, and alcohol-related negative consequences. Participants included 358 undergraduate students who were part of a larger randomized clinical trial. Results revealed no significant differences in alcohol use and associated consequences at follow-up between participants who met with the same versus a different clinician. Clinician continuity was not significantly related to intervention fidelity in terms of BMI-consistent qualities, relevance of information presented, or session satisfaction. These findings suggest that clinician continuity across BMIs for college students is not related to participant satisfaction or intervention effectiveness, especially if the clinicians adhere to empirically supported techniques

Alternatives to potentially inappropriate medications for use in e-prescribing software: triggers and treatment algorithms

Objective: To describe the development of evidence-based electronic prescribing (e-prescribing) triggers and treatment algorithms for potentially inappropriate medications (PIMs) for older adults. Design: Literature review, expert panel and focus group. Setting: Primary care with access to e-prescribing systems. Participants: Primary care physicians using e-prescribing systems receiving medication history. Interventions: Standardised treatment algorithms for clinicians attempting to prescribe PIMs for older patients. Main outcome measure: Development of 15 treatment algorithms suggesting alternative therapies. Results: Evidence-based treatment algorithms were well received by primary care physicians. Providing alternatives to PIMs would make it easier for physicians to change decisions at the point of prescribing. Conclusion: Prospectively identifying older persons receiving PIMs or with adherence issues and providing feasible interventions may prevent adverse drug events

Spatial Patch Occupancy Patterns of the Lower Keys Marsh Rabbit

Reliable estimates of presence or absence of a species can provide substantial information on management questions related to distribution and habitat use but should incorporate the probability of detection to reduce bias. We surveyed for the endangered Lower Keys marsh rabbit (Sylvilagus palustris hefneri) in habitat patches on 5 Florida Key islands, USA, to estimate occupancy and detection probabilities. We derived detection probabilities using spatial replication of plots and evaluated hypotheses that patch location (coastal or interior) and patch size influence occupancy and detection. Results demonstrate that detection probability, given rabbits were present, was \u3c0.5 and suggest that naı¨ve estimates (i.e., estimates without consideration of imperfect detection) of patch occupancy are negatively biased. We found that patch size and location influenced probability of occupancy but not detection. Our findings will be used by Refuge managers to evaluate population trends of Lower Keys marsh rabbits from historical data and to guide management decisions for species recovery. The sampling and analytical methods we used may be useful for researchers and managers of other endangered lagomorphs and cryptic or fossorial animals occupying diverse habitats

Diálogo institucional através do amicus curiae: repensando a legitimidade do Supremo Tribunal Federal

The present qualitative study aims to discuss the institutional dialogue between the powers and the Federal Supreme Court from the amicus curiae institute. It uses the inductive method with support of bibliographic research and jurisprudential analysis. It brings, as a starting point, the practice of judicial activism consolidated in several judgments. After, it discusses the legitimacy of the court from a doctrinal referential. Finally, it points out in the amicus curiae an effective instrument of dialogue between the executive, the legislature and the judiciary.O presente estudo qualitativo tem como objetivo discutir o diálogo institucional entre os poderes e o Supremo Tribunal Federal a partir do instituto do amicus curiae. Utiliza do método indutivo com suporte de pesquisa bibliográfica e análise jurisprudencial. Traz, como ponto de partida, a prática do ativismo judicial consolidada em diversos julgados. Após, discute a legitimidade da corte a partir de referencial doutrinário. Por fim, aponta no amicus curiae um instrumento efetivador do diálogo entre executivo, legislativo e judiciário

Analisis Kesediaan Membayar Wtp (Willingness To Pay) dalam Upaya Pengelolaan Obyek Wisata Taman Alun Kapuas Pontianak, Kalimantan Barat

Berbagai fungsi yang terkait dengan sumber daya alam (fungsi ekologis, sosial, ekonomi, dan arsitektural) dannilai estetika yang dimilikinya (obyek dan lingkungan) dapat meningkatkan kualitas lingkungan dan untukkelangsungan kehidupan perkotaan juga dapat menjadi nilai kebanggaan dan identitas kota. Sebagai obyekwisata alam, Taman Alunalun Kapuas belum tertata dengan baik, pelaksanaan upaya pengelolaan objek wisataTaman Alun Kapuas membutuhkan biaya yang tidak sedikit. Untuk itu diharapkan bagi pengunjung untukmembayar dalam pengelolaan Taman Alun Kapuas. Penelitian ini menggunakan analisis regresi logistik dalammenganalisis faktor-faktor kesediaan pengunjung untuk membayar. Sedangkan metode CVM (ContingenValuation Method) digunakan untuk mengestimasi biaya yang akan dikeluarkan oleh pengunjung, dan metoderegresi berganda digunakan untuk menganalisis faktor-faktor apa yang mempengaruhi besar kesediaanmembayar pengunjung. Program yang dapat membantu dalam penelitian ini yaitu Microsoft Excel 2007 danMinitab For Windows Realise 16. Hasil penelitian menunjukkan bahwa sebanyak 84% responden bersediamembayar dalam upaya pengelolaan lingkungan obyek wisata Taman Alun Kapuas. Faktor-faktor yangmempengaruhi kesediaan membayar responden pengunjung dalam upaya pengelolaan lingkungan obyekwisata Taman Alun Kapuas antara lain pendapatan (PNDPTN3) dan pengetahuan (PNGTHUAN). Nilai rata-rataWTP responden pengunjung adalah sebesar Rp 3360,00/orang. Faktor yang mempengaruhi nilai WTPresponden yaitu usia (U)

Exploiting dietary fibre and the gut microbiota in pelvic radiotherapy patients

ACKNOWLEDGEMENTS We thank Mrs Pat Bain for her assistance in creating Fig. 1. Funding Information: AEK’s salary is funded by Friends of ANCHOR and the University of Aberdeen Development Trust. CKT’s DPhil was funded by the Clarendon Fund, Balliol College, Oxford and Cancer Research UK. JK’s summer research project was funded by a Royal College of Radiologists’ Summer Undergraduate Research Fellowship. The authors received no specific funding for this work.Peer reviewedPublisher PD

Investigating Genetic Determinants of Plasma Inositol Status in Adult Humans

BACKGROUND: Myo-inositol (MI) is incorporated into numerous biomolecules, including phosphoinositides and inositol phosphates. Disturbance of inositol availability or metabolism is associated with various disorders, including neurological conditions and cancers, while supplemental MI has therapeutic potential in conditions such as depression, polycystic ovary syndrome and congenital anomalies. Inositol status may be influenced by diet, synthesis, transport, utilisation and catabolism. OBJECTIVES: We aimed to investigate potential genetic regulation of circulating MI status and to evaluate correlation of MI concentration with other metabolites. METHODS: Gas chromatography mass spectrometry was used to determine plasma MI concentration of more than 2,000 healthy, young adults (aged 18-28 years) from the Trinity Student Study. Genotyping data was used to test association of plasma MI with SNPs in candidate genes, encoding inositol transporters and synthesising enzymes, and test for genome-wide association. We evaluated potential correlation of plasma MI with D-chiro inositol, glucose and other metabolites by Spearman's rank correlation. RESULTS: Mean plasma MI showed a small but significant difference between males and females (28.5 and 26.9 µM, respectively). Candidate gene analysis revealed several nominally significant associations with plasma MI, most notably for SLC5A11, encoding a sodium-coupled inositol transporter, also known as SMIT2 (sodium-dependent myo-inositol transporter 2). However, these did not survive correction for multiple testing. Subsequent testing for genome-wide association with plasma MI did not identify associations of genome-wide significance (p < 5 × 10-8). However, 8 SNPs exceeded the threshold for suggestive significant association with plasma MI concentration (p < 1 × 10-5), 3 of which were located within or close to genes: MTDH, LAPTM4B and ZP2. We found significant positive correlation of plasma MI concentration with concentration of D-chiro-inositol and several other biochemicals including glucose, methionine, betaine, sarcosine and tryptophan. CONCLUSION: Our findings suggest potential for modulation of plasma MI in young adults by variation in SLC5A11 which is worthy of further investigation

Sexual Functioning Among Endometrial Cancer Patients Treated With Adjuvant High-Dose-Rate Intra-Vaginal Radiation Therapy

Purpose—We used the Female Sexual Function Index (FSFI) to investigate the prevalence of sexual dysfunction (SD) and factors associated with diminished sexual functioning in early stage endometrial cancer (EC) patients treated with simple hysterectomy and adjuvant brachytherapy. Methods and Materials—A cohort of 104 patients followed in a radiation oncology clinic completed questionnaires to quantify current levels of sexual functioning. The time interval between hysterectomy and questionnaire completion ranged from 5 years. Multivariate regression was performed using the FSFI as a continuous variable (score range, 1.2–35.4). SD was defined as an FSFI score of <26, based on the published validation study. Results—SD was reported by 81% of respondents. The mean (±standard deviation) domain scores in order of highest-to-lowest functioning were: satisfaction, 2.9 (±2.0); orgasm, 2.5 (±2.4); desire, 2.4 (±1.3); arousal, 2.2 (±2.0); dryness, 2.1 (±2.1); and pain, 1.9 (±2.3). Compared to the index population in which the FSFI cut-score was validated (healthy women ages 18–74), all scores were low. Compared to published scores of a postmenopausal population, scores were not statistically different. Multivariate analysis isolated factors associated with lower FSFI scores, including having laparotomy as opposed to minimally invasive surgery (effect size, −7.1 points; 95% CI, −11.2 to −3.1; P<.001), lack of vaginal lubricant use (effect size, −4.4 points; 95% CI, −8.7 to −0.2, P = .040), and short time interval (<6 months) from hysterectomy to questionnaire completion (effect size, −4.6 points; 95% CI, −9.3–0.2; P = .059). Conclusions—The rate of SD, as defined by an FSFI score <26, was prevalent. The postmenopausal status of EC patients alone is a known risk factor for SD. Additional factors associated with poor sexual functioning following treatment for EC included receipt of laparotomy and lack of vaginal lubricant use