Cycling Pathways

In an effort to fight climate change, many cities try to boost their cycling levels. They often look towards the Dutch for guidance. However, historians have only begun to uncover how and why the Netherlands became the premier cycling country of the world. Why were Dutch cyclists so successful in their fight for a place on the road? Cycling Pathways explores the long political struggle that culminated in today’s high cycling levels. Delving into the archives, it uncovers the important role of social movements and shows in detail how these interacted with national, provincial, and urban engineers and policymakers to govern the distribution of road space and construction of cycling infrastructure. It discusses a wide range of topics, ranging from activists to engineering committees, from urban commuters to recreational cyclists and from the early 1900s to today in order to uncover the long and all-but-forgotten history of Dutch cycling governance

The existence of an insulin-stimulated glucose and non-essential but not essential amino acid substrate interaction in diabetic pigs

<p>Abstract</p> <p>Background</p> <p>The generation of energy from glucose is impaired in diabetes and can be compensated by other substrates like fatty acids (Randle cycle). Little information is available on amino acids (AA) as alternative energy-source in diabetes. To study the interaction between insulin-stimulated glucose and AA utilization in normal and diabetic subjects, intraportal hyperinsulinaemic euglycaemic euaminoacidaemic clamp studies were performed in normal (n = 8) and streptozotocin (120 mg/kg) induced diabetic (n = 7) pigs of ~40-45 kg.</p> <p>Results</p> <p>Diabetic vs normal pigs showed basal hyperglycaemia (19.0 ± 2.0 vs 4.7 ± 0.1 mmol/L, <it>P </it>< .001) and at the level of individual AA, basal concentrations of valine and histidine were increased (<it>P </it>< .05) whereas tyrosine, alanine, asparagine, glutamine, glutamate, glycine and serine were decreased (<it>P </it>< .05). During the clamp, diabetic vs normal pigs showed reduced insulin-stimulated glucose clearance (4.4 ± 1.6 vs 16.0 ± 3.0 mL/kg·min, <it>P </it>< .001) but increased AA clearance (166 ± 22 vs 110 ± 13 mL/kg· min, <it>P </it>< .05) at matched arterial euglycaemia (5-7 mmol/L) and euaminoacidaemia (2.8-3.5 mmol/L). The increase in AA clearance was mainly caused by an increase in non-essential AA clearance (93.6 ± 13.8 vs 46.6 ± 5.4 mL/kg·min, <it>P </it>< .01), in particular alanine (14.2 ± 2.4 vs 3.2 ± 0.4 mL/kg·min, <it>P </it>< .001)<b/>. Essential AA clearance was largely unchanged (72.9 ± 8.5 vs 63.3 ± 8.5 mL/kg· min), however clearances of threonine (<it>P </it>< .05) and tyrosine (<it>P </it>< .01) were increased in diabetic vs normal pigs (8.1 ± 1.3 vs 5.2 ± 0.5, and 14.3 ± 2.5 vs 6.4 ± 0.7 mL/kg· min, respectively).</p> <p>Conclusions</p> <p>The ratio of insulin-stimulated glucose versus AA clearance was decreased 5.4-fold in diabetic pigs, which was caused by a 3.6-fold decrease in glucose clearance and a 2.0-fold increase in non-essential AA clearance. In parallel with the Randle concept (glucose - fatty acid cycle), the present data suggest the existence of a glucose and non-essential AA substrate interaction in diabetic pigs whereby reduced insulin-stimulated glucose clearance seems to be partly compensated by an increase in non-essential AA clearance whereas essential AA are preferentially spared from an increase in clearance.</p

Losing Track of Lipids in Children and Adolescents with Type 1 Diabetes:Towards Individualized Patient Care

Aim To assess 1) the prevalence of children and adolescents with type 1 diabetes (T1D) changing from low-risk into borderline-high-risk lipid levels or from borderline-high-risk into high-risk lipid levels ('lose track of lipids') and 2) the power of a risk score including the determinants HbA1c, body mass index (BMI), gender, age, diabetes duration and ethnicity in predicting which patients lose track of lipids. Methods 651 children and adolescents with T1D were included in this longitudinal retrospective cohort study. Lipid dynamics and the impact of the risk score on losing track of lipids were evaluated. Kaplan-Meier analysis was used to estimate screening intervals. Results 31-43% percent of the patients had lost track of one or more lipids at the next lipid measurement. This happened more frequently in patients with a low-risk lipid level at start. Depending on the lipid parameter, 5% of patients with low-risk lipid levels lost track of lipids after 13-23 months. The risk score based on concomitant information on the determinants was moderately able to predict which patients would lose track of lipids on the short term. Conclusions A considerable number of children and adolescents with T1D loses track of lipids and does so within a 2-year screening interval. The predictive power of a risk score including age, BMI, gender, HbA1c, diabetes duration and ethnicity is only moderate. Future research should focus on another approach to the determinants used in this study or other determinants predictive of losing track of lipids on the short term

Effects of Peri-Conception and Pregnancy Glycemic Variability on Pregnancy and Perinatal Complications in Type 1 Diabetes:A Pilot Study

Background Not much is known about the effects of glycemic variability (GV) during the pre- and periconception period on pregnancy/perinatal complications. GV could potentially contribute to identification of high-risk pregnancies in women with type 1 diabetes. Methods An explorative retrospective cohort study was conducted between January 2014 and May 2019. Glucose data were retrieved from electronic patient charts. Pre-/periconceptional GV and GV during all three trimesters was expressed as mean glucose, standard deviation (SD), Coefficient of Variation (CV), High Blood Glucose Index (HBGI), Low Blood Glucose Index (LBGI) and Average Daily Risk Range (ADRR). Maternal and neonatal complications were summarized using a composite total complication score. Binary logistic regression analyses were conducted to assess associations between the GV measures and a total complication score>3, a maternal complication score>1 and a neonatal complication score>1. Results Of 63 eligible women, 29 women (38 pregnancies) were included. Women in the group with a total complication score>3 had a significantly higher ADRR at conception (OR 1.1, CI 1.0–1.2, p=0.048). No statistically significant correlations between complication score and any other GV metric besides the ADRR were found. Although not significant, in the group with a complication score>3, odds ratios>1 were found for SD in trimester 1 (OR 1.6, CI 0.6–4.5, p=0.357) and trimester 2 (OR 1.8, CI 0.5–6.2, p=0.376). Conclusions Presence of a positive association between GV and pregnancy and perinatal complications depends on which pregnancy period is assessed and the GV metrics that are used

Health-related physical fitness in patients with complaints of hand, wrist, forearm and elbow:an exploratory study

OBJECTIVES: Little is known about the physical fitness of patients with complaints of hand, wrist, forearm and/or elbow and its possible determinants. Aims were to assess health-related physical fitness (HRPF) in these patients, to compare HRPF with reference values of healthy persons, and to explore whether HRPF was correlated with symptom severity, upper limb function (ULF) and physical activity (PA). METHODS: Cardiorespiratory fitness, handgrip strength and body composition, self-reported symptom severity, ULF and PA were assessed in adult outpatients with complaints of hand, wrist, forearm and/or elbow diagnosed as CANS. RESULTS: Measurements were completed in 25 subjects (8 males) aged 46.1±14.5 years, of which 44% had specific CANS and 56% had non-specific CANS. Peak oxygen consumption (VO(2)peak) of men was 2978±983 mL/min and of women was 1978±265 mL/min. Handgrip strength of men was 47.0±11.1 kgf and of women was 32.4±6.3 kgf. Body mass index (BMI) of men was 24.2±2.6 kg/m(2) and of women was 27.4±6.1 kg/m(2). VO(2)peak of the study sample was lower than that of healthy adults (−414±510 mL/min, p<0.001). Handgrip strength and BMI were similar to reference values. VO(2)peak was correlated with PA (r=0.58, p=0.004); BMI was correlated with disability (r=0.48, p=0.022). Other correlations between HRPF and symptom severity and ULF were non-significant. CONCLUSIONS: Patients with CANS have lower cardiorespiratory fitness, but similar handgrip strength and body composition, compared with the healthy population. Cardiorespiratory fitness was correlated with PA and BMI was correlated with disability, no other correlations were observed with symptom severity and ULF

Care for mental well-being of cancer patients:Support during and after primary treatment

Item does not contain fulltextCancer is associated with sometimes strong emotions. However, emotions are mostly adaptive - they help people adapt to cancer. Adaptive emotions do not need to be treated; instead, emotional support is key. Professional mental health care is indicated only when emotions are no longer adaptive. Oncologists, nurses, and especially general practitioners play an important role in identifying people who qualify for referral to mental health care. Prior mental health problems, a weak social support system, and a relatively stressful disease course or treatment are risk factors for cancer-related emotional problems. Training and the development of professional networks can contribute to optimizing the availability, accessibility and quality of supportive care for mental well-being during and after cancer treatment. In addition, providing good information to patients is important, to enable them to find supportive care