Moving from health disparities to health inequities - and why it matters

This commentary is on the original article by Harris and Lord on pages 774–779 of this issue

The Prediabetes Detection and Physical Activity Intervention Delivery (PRE-PAID) Project

Prediabetes is a prevalent condition which is a precursor to type 2 diabetes (T2D) and physical activity is known to counter T2D. Given the potential for alleviating health care expenditures through the prevention or delay of T2D, targeting individuals with prediabetes using physical activity intervention is a critical research question. The aim of this project was to; i) identify persons with prediabetes and thus at high risk for developing T2D, ii) engage individuals with prediabetes in community-based, culturally-preferred physical activity classes led by culturally-matched instructors with the goal of improving glycemic control and iii) investigate how two modes of laboratory-based aerobic exercise intervention (high intensity intervals versus continuous moderate intensity) impact glycemic control in persons with prediabetes. Participants were recruited in various ethnic communities known to have high prevalence rates of T2D. Critical blood biomarkers and measures of physical and physiological fitness were assessed at different time points to ascertain the effectiveness of both community-based physical activity classes and two modes of laboratory-based exercise. The results of this project show that the PRE-PAID risk questionnaire coupled with point-of-care testing of glycated hemoglobin (A1C) are an effective tool for identifying persons with prediabetes who are at high risk for T2D. Individuals, who participated in community-based culturally matched physical activity classes, experienced improved glycemic control evidenced by reductions in A1C after 3 and 6 months plus improvements in resting blood pressure, combined hand grip strength and aerobic fitness after 6 months. There were no differences between the laboratory-based aerobic exercise interventions of high intensity intervals vs. continuous moderate intensity for any of the measured outcomes. However, the participants who underwent both laboratory exercise modes experienced significant improvements in glycemic control, beta cell function, waist circumference and aerobic fitness following 3 months of supervised exercise. This research provides evidence for early detection of persons with prediabetes and strategies for improving glycemic control and physical plus physiological fitness in this population. The observed improvements could potentially help prevent or delay the onset of T2D

Clinical Importance of the Drug interaction Between Statins and CYP3A4 Inhibitors

Statins reduce the risk of major coronary outcomes and all cause mortality. They are generally well tolerated, but are associated with uncommon but serious adverse events. Pharmacokinetic studies show statins metabolized by the CYP3A4 isoenzyme (statin 3A4 substrates) are susceptible to drug interactions when concomitantly administered with drugs that inhibit the CYP3A4 isoenzyme (CYP3A4 inhibitors) - potentially increasing the risk for adverse events. Studies to evaluate the clinical importance of the statin-CYP3A4 inhibitor interaction are limited to anecdotal findings. This research endeavored to evaluate the clinical importance of the statin-CYP3A4 inhibitor drug interaction in two empiric investigations and a methodologic study. The preliminary empiric study was an analysis of spontaneous rhabdomyolysis reports. It showed an increased rhabdomyolysis reporting rate for simvastatin (a statin 3A4 substrate) but not for pravastatin (a statin non-3A4 substrate) with a concomitant CYP3A4 inhibitor. Substantial internal validity limitations, inherent in spontaneous reporting analyses, warranted additional research. To further assess the clinical importance of this drug interaction, we evaluated the validity of the multinomial propensity score as a confounding adjustment method in a simulated drug interaction study. The results from the simulation study provided support for using the multinomial propensity score in the second empiric study. The results showed the multinomial propensity score reduced bias, had greater coverage probability, and increased precision compared to binary propensity score methods. Investigators studying multinomial exposures, such as drug interactions, should consider the multinomial propensity score for confounding adjustment. The second empiric study was a large retrospective cohort study. The objective was to evaluate the hazard of muscle toxicity, renal dysfunction, and hepatic dysfunction among patients exposed to statin 3A4 substrates (atorvastatin and simvastatin) compared to statin non-3A4 substrates (fluvastatin, pravastatin, and rosuvastatin) with and without CYP3A4 inhibitor concomitancy. We found no overall increased hazard of muscle toxicity, renal dysfunction, or hepatic dysfunction associated with statin 3A4 substrates compared to statin non-3A4 substrates with versus without a concomitant CYP3A4 inhibitor. Given the magnitude and validity of this investigation, the drug interaction between statins and CYP3A4 inhibitors therefore does not represent a substantial public health concern

Digital Collections in the University Classroom: Inspiring your faculty with regional content

This presentation explores a model collaboration between the Digital Collections Center of the library and the History Department that has been highly successful in introducing students to researching with digital collections. We consider the use of history department undergraduate and graduate interns in the library and discuss the benefits and challenges to both parties. Dr. Christopher Davis shares the research project that was embedded in his course syllabus, highlighting various relevant digital collections and the results of student research. He also discusses what aspect of the collections he found intriguing and inspired him to create a research project and his expectations of students. The hope is that this presentation will help librarians view their collections as the potential research projects they could be. In this presentation, librarians will learn to assess their collections for unique content that may be particularly well-suited for research projects. Additionally, we help librarians, directors, and supervisors evaluate whether the use of history students in their department would be beneficial for them by exploring elements such as time spent on training, the effectiveness of history interns as metadata specialists, and space and technology concerns. The ultimate goal of this presentation is to provide attendees with a model of collaboration that should result in broader discovery and use of their digital collections in the classroom

General hospital care for people with intellectual disabilities

Purpose – The purpose of this paper is to explore the extent of compliance of commissioners and providers of hospital services in England with their duty under equalities legislation to be aware of patients with intellectual disabilities as a first step to making appropriate provision for their consequent specific needs. Design/methodology/approach – National survey of healthcare commissioners undertaken as part of an annual learning disabilities services audit. Findings – In total, 41.4 per cent of local areas were unable to supply information about numbers of people with intellectual disabilities among those admitted to hospital, 46.7 and 48 per cent, respectively, could not supply this information about out-patient and accident and emergency department attenders. Figures supplied by those able to provide data varied very substantially and overall were so low as to suggest considerable numbers had been missed. Research limitations/implications – The study is testing what local health commissioners are able to find out from hospitals. The authors do not know the accuracy of the data they reported. Practical implications – The study suggests approaching half of healthcare commissioners in England have little or no information about the extent of proper adjustment of hospital care for people with intellectual disability in their area. Their responsibility to assure this has been repeatedly asserted by government. Social implications – The study indicates a need for more work to improve hospital care for people with intellectual disabilities. Originality/value – This was a government sponsored national study to which local healthcare commissioners were expected to contribute

Neogene paleomagnetism and geodynamics of the Hikurangi margin, East Coast, New Zealand

Vertical-axis rotations are an important component of Neogene deformation in the New Zealand plate boundary region, and potentially offer fundamental insights into the rheology of continental crust. Extensive paleomagnetic sampling along the Hikurangi margin, on the East Coast of the North Island, has provided new insights into the patterns, rates and timings of tectonic rotation, and also an improved understanding of the magnetic signature of New Zealand Cenozoic mudstones. Rigorous field tests reveal numerous late remagnetizations, which haveoften formed several million years after deposition and can be irregularly distributed within an outcrop. Scanning electron microscopy and rock magnetic analyses indicate that the remanence carrier is predominantly the ferrimagnetic iron sulphide, greigite, which is present as a mixed population of single domain and superparamagnetic grains that are characteristic of arrested authigenic growth. Strong viscous overprints are the result of later, usually recent, oxidation of these sulphides. The recognition of late-forming magnetizations leads to a completely new view of the Neogene tectonic evolution of the Hikurangi margin, with no tectonic rotations being evident prior to 8–10 Ma; coherent rotation of most of the Hikurangi margin since that time refutes the existence of the independently rotating ‘domains’ that were inferred from earlier paleomagnetic data. This pattern is more consistent with the short-term velocity field, and allows all Neogene rotation to be more simply explained as a large-scale response to realignment of the subducting Pacific plate. Tectonic rotations have been accommodated by a variety of structures since 10 Ma; in the Late Miocene and Pliocene, rates of tectonic rotation were 3–4 times faster than presently observed and possibly involved a much larger region, before initiation of the North Island Dextral Fault Belt and the Taupo Volcanic Zone at 1-2 Ma instigated the current tectonic regime. Collision of the Hikurangi Plateau in the Late Miocene is interpreted to have caused both the initiation of tectonic rotation, and the widespread remagnetization of sediments, making it a key event in the Neogene evolution of the plate boundary region.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Comparison of head impact measurements via an instrumented mouthguard and an anthropometric testing device

The purpose of this study was to determine and compare the efficacy of head impact measurements via an electronic sensor framework, embedded within a mouthguard, against an anthropometric testing device. Development of the former is in response to the growing issue of head impacts and concussion in rugby union. Testing was conducted in a vehicle safety laboratory using a standard impact protocol utilising the headforms of anthropometric testing devices. The headforms were subjected to controlled front and side impacts. For each impact, the linear acceleration and rotational velocity was measured over a 104-ms interval at a frequency of 1 kHz. The magnitude of peak linear acceleration and peak rotational velocity was determined from the measured time-series traces and statistically compared. The peak linear acceleration and rotational velocity had intraclass correlation coefficients of 0.95 and 0.99, respectively. The root-mean-square error between the measurement systems was 4.3 g with a standard deviation of 3.5 g for peak linear acceleration and 0.7 rad/s with a standard deviation of 0.4 rad/s for rotational velocity. Bland and Altman analysis indicated a systematic bias of 2.5 g and − 0.5 rad/s and limits of agreement (1.96 × standard deviation) of ± 13.1 g and ± 1.25 rad/s for the instrumented mouthguard. These results provide the basis on which the instrumented mouthguard can be further developed for deployment and application within professional rugby, with a view to accurately and reliably quantify head collision dynamics

Levels of Science Identity, Belonging and Experiences of Discrimination for Commencing Science Students at an Australian University

A key step in achieving gender equality in the science, technology, engineering, and mathematics (STEM) workforce is recruiting more women into undergraduate STEM degrees. Some disciplines, such as biology, have been more successful at this than others. Yet, gender issues at university still exist in these science disciplines, which may be deterring women from remaining in this career pathway. This case study at an Australian university explored known risk factors for attrition by surveying 215 first-year undergraduate science students. It also investigated how these factors differ for students in the ‘gender-balanced’ and ‘gender-unbalanced’ science fields. Findings showed that female students in both the ‘gender-balanced’ and ‘gender-unbalanced’ science fields begin university with low levels of belonging, and encounter experiences of discrimination early on. These findings highlight potential risk factors for attrition for incoming Australian science undergraduates, and some potential challenges tertiary educators need to be aware of within their first-year classrooms