Relationship of glycemic control, exogenous insulin, and C-peptide levels to ischemic heart disease mortality over a 16-year period in people with older-onset diabetes: the Wisconsin Epidermologic Study of Diabetic Retinopathy (WESDR)

OBJECTIVE - the purpose of this study was to examine the relationship of glycemic control and exogenous and endogenous insulin levels with all-cause and cause-specific mortality (ischemic heart disease and stroke) in an older-onset diabetic population.RESEARCH DESIGN and METHODS - the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) is an ongoing, prospective, population-based cohort study of individuals with diabetes first examined in 1980-1982. A stratified sample of all individuals with diabetes diagnosed at 30 years of age or older was labeled older-onset (n = 1,370). Those participating in the 1984-1986 examination phase (n = 1,007) were included in the analysis. Endogenous insulin was determined by measurements of plasma C-peptide (in nanomoles per liter), and exogenous insulin was calculated in units per kilogram per day. Glycemic control was determined by levels of glycosylated hemoglobin (HbA(1)).RESULTS - After 16 years of follow-up, 824 individuals died (all-cause mortality); 358 deaths involved ischemic heart disease and 137 involved stroke. C-peptide and HbA(1) were significantly associated with all-cause and ischemic heart disease mortality in our study. the hazard ratio (95% CI) values for all-cause mortality were 1.12 (1.07-1.17) per 1% increase in HbA, 1.20 (0.85-1.69) per 1 unit . kg(-1) - day(-1) increase in exogenous insulin, and 1.15 (1.04-1.29) per 1 nmol/l increase in C-peptide and for ischemic heart disease mortality were 1.14 (1.06-1.22), 1.50 (0.92-2.46), and 1.19 (1.02-1.39) for HbA(1), exogenous insulin, and C-peptide, respectively, after adjusting for relevant confounders. C-peptide was associated with stroke mortality only among men (1.65 [1.07-2.53]).CONCLUSIONS - Our results show that individuals with higher endogenous insulin levels are at higher risk of all-cause, ischemic heart disease, and stroke mortality.Univ Wisconsin, Sch Med & Publ Hlth, Dept Ophthalmol & Visual Sci, Madison, WI 53726 USAUniversidade Federal de São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Severe hypoglycemia and smoking in a long-term type 1 diabetic population - Wisconsin Epidemiologic Study of Diabetic Retinopathy

OBJECTIVE - the purpose of this study was to evaluate the relationship of severe hypoglycemia and smoking in a population-based cohort of individuals with long-term type 1 diabetes.RESEARCH DESIGN and METHODS - This was a cross-sectional analysis of the population-based cohort of the Wisconsin Epidemiologic Study of Diabetic Retinopathy. the analyses in this report were limited to 537 type 1 diabetic individuals with complete data who participated in the last examination phase (2000-2001). Severe hypoglycemia was defined as having one or more episodes of loss of consciousness or overnight hospitalization attributable to hypoglycernia in a 1-year period before the examination.RESULTS - the prevalence of severe hypoglycemia in this population was 14.3%. in univariate analysis, current snickers had a greater chance of having severe hypoglycemia compared with never smokers (odds ratio 2.40 [95% CI 1.30-4.401). When we controlled for relevant confounders such as age, sex, AIC, waist-to-hip ratio, orthostatic hypotension, alcohol consumption, intensive insulin treatment, past history of severe hypoglycemia, and late complications of diabetes (nephropathy, neuropathy, and retinopathy), the association remained statistically significant, with current smoking presenting similar to 2.6 times greater odds of developing severe hypoglycernia.CONCLUSIONS - Current smokers with type 1 diabetes have higher odds of severe hypoglycemia episodes.Univ Wisconsin, Dept Ophthalmol & Visual Sci, Madison, WI USAUniversidade Federal de São Paulo, Dept Ophthalmol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Ophthalmol, São Paulo, BrazilWeb of Scienc

Hawaii geothermal drilling guide : Circular C-126

Contents: introduction -- rules and regulations -- drilling -- casing and cementing -- blowout prevention -- well completion & testing -- monitoring and reporting -- workovers, plugging, and abandonment -- emerging technology -- illustrations -- appendices"This Geothermal Drilling Guide has been prepared at the request of the State of Hawaii Department of Land and Natural Resources to provide a single, comprehensive document that describes geothermal drilling and well-testing operations for the use of potential developers, operators, and stakeholders. This guide is intended as a general reference for common practices currently found in the geothermal industry. For site-specific well programs, detailed analysis of all available project data should be performed in order to ensure compliance with applicable federal, state, and county regulations.""Prepared by GeothermEx, Inc., a Schlumberger company."Department of Land and Natural Resources, State of Hawai

The Creation of a Ubiquitous Business Community for an Agribusiness Cluster

Ubiquitous Business Communities (UBC) are information processing systems that offer people the possibility to connect to networks, any time independently from location and computing platforms, which are sensitive to the users´ contexts. UBC allow participants to exchange information and enhance business transactions. These systems may act as market organizers and may affect millions of producers and clients in developing countries. Our research-in-progress paper presents the creation of a UBC to enhance business transactions in an agribusiness cluster. We highlight some characteristics of the UBC under development, considering the main factors that influence the competitiveness of the cluster. We also describe aspects of the development process of the UBC and of the structuration process of the community (organization of a member and product catalog and of product quality standards). Finally we present expectations to be verified in the implementation process of the UBC

Gestão de suprimentos na construção civil: análise dos riscos associados à aquisição de materiais em uma obra

Obras de construção civil são conhecidas por baixa produtividade e atrasos. Com eficiência aquém da planejada, o Brasil vive à sombra dos países desenvolvidos quando o assunto é infraestrutura. Os suprimentos entram como peça chave para atender os prazos e objetivos das construtoras, porém eles são suscetíveis ao impacto de fatores de risco não monitorados. Surge, então, a oportunidade de analisar a variabilidade existente na área de suprimentos, uma vez que para a boa gestão de projeto os insumos devem estar presentes no momento certo para a execução. Assim, este trabalho apresenta uma análise de riscos para gestão de suprimentos, unindo impacto financeiro com probabilidade de ocorrência dos fatores de risco. O trabalho foi aplicado no projeto de um estádio de futebol para os itens de cobertura metálica, fachada e lajes alveolares com o intuído de analisar o comportamento do método em diferentes insumos. A execução das etapas propostas resultou na definição de fatores de riscos para um projeto de construção civil, no aprendizado com a condução da análise à empresa estudada e na priorização desses fatores passiveis de causar os maiores impactos financeiros, possibilitando a mitigação dos riscos através de planos de ação.Construction projects are known for low productivity and delays. With effectiveness short of planned, Brazil lives in the shadow of developed countries when it comes to infrastructure. The supplies go as key to meet deadlines and objectives of construction, but they are susceptible to the impact of risk factors not monitored. Then comes the opportunity to analyze the variability in the supply area, once for good project management inputs must be present at the right time to implement. Thus, this paper presents a risk analysis for supply management, combining financial impact with the probability of occurrence of risk factors. The method was applied in the project of a football stadium for the items of metal roof, facade and pre-cast concrete slab with intuited to analyze the behavior of the method on different inputs. The implementation of the proposed steps resulted in the definition of risk factors for a project construction, in learning to conducting the analysis the company studied and prioritization of these factors liable to cause the greatest financial impacts, enabling risk mitigation plans through action

Identification and pharmacognostic control of the species: Mentha x villosa, Lippia alba, Cymbopogon citratus and Melissa officinalis: Identificação e controle farmacognóstico das espécies: Mentha x villosa, Lippia alba, Cymbopogon citratus e Melissa officinalis

The use of medicinal plants often symbolizes the only therapeutic resource of a community or group of people to establish quality of life and health, as they have bioactive compounds with therapeutic properties, there is a vast amount of plants spread throughout the territory, present in open markets, markets, and beyond the residential backyards. Popular observations on the use of medicinal plants are relevant to therapeutic action, even though we are not aware of all of its components. It emphasizes the care that must be taken with the identification of the desired species, the part that will be used, such as a flower, fruit, leaf, stem or root, as it can cause serious intoxication or poisoning. The main purpose of this study was to study the secondary metabolites of the species Mentha x villosa, Lippia alba, Cymbopogon citratus and Melissa officinalis, in addition to the quantification of their chemical and antimicrobial properties. The samples were acquired from desiccated leaves where tests were performed to determine moisture, total ash and acid-insoluble, showed the presence of cardiotonics, flavonoids, anthraquinones, saponins, alkaloids, tannins and antibacterial properties, as well as the quantification of the content of total flavonoids as a quality control reference for the species described above

Um instrumento de pesquisa qualitativo para analisar fatores de competitividade de conglomerados organizacionais

Clusters are geographic concentrations of interconnected companies, suppliers, service providers, and institutions working together at economically linked activities in a particular sector. Clusters play an important role to improve development through associative organizational forms. Many factors contribute to clusters’ competitiveness (e.g. trust and collaboration among firms, and cluster governance). However, the literature about these factors is broad and their definitions vary according to different disciplines. Moreover, these factors were object of study in industrial settings. Therefore, the purpose of this article is to present a qualitative research instrument to analyze clusters’ competitiveness factors. The final instrument created is a continuity of the work published by Rigoni and Saccol (2012) and it was empirically tested it in a cluster of flower growers. Most of the competitiveness factors of our instrument stemmed from the literature, while others emerged from the field, contributing to foster the development of theory on clusters' competitiveness. This instrument has several applications, such as to qualitatively analyze the level of competitiveness of clusters, helping their members adopt a cluster approach, and assisting police makers to design more effective cluster development policies.Keywords: clusters, competitiveness factors, qualitative research instrument.Clusters são concentrações geográficas de empresas, de fornecedores de insumos e serviços e de instituições, todos trabalhando conectados e em conjunto em atividades de um setor específico. Os clusters têm um importante papel para incrementar o desenvolvimento econômico por meio de formas organizacionais associativas. Muitos fatores contribuem para a competitividade dos clusters (por exemplo, a confiança e a colaboração entre firmas e a governança). Contudo, a literatura sobre esse tema é vasta e a e sua definição varia de acordo com as diferentes disciplinas. Neste contexto, o propósito deste artigo é apresentar um instrumento de pesquisa qualitativo para analisar os fatores competitivos de clusters. O instrumento final criado é uma continuidade do trabalho publicado por Rigoni e Saccol (2012) e foi empiricamente testado em um cluster de produtores de flores. A maior parte dos fatores competitivos do nosso instrumento de pesquisa origina-se da literatura, mas outros emergiram do campo. A elaboração deste instrumento deverá fortalecer um desenvolvimento dos fundamentos teóricos da competitividade de clusters. O instrumento também poderá ser adotado para analisar, qualitativamente, o nível de competitividade de clusters, apoiando seus integrantes na adoção de uma abordagem de clusters e assistindo os formuladores de políticas públicas na elaboração de políticas para o desenvolvimento de clusters mais efetivos.Palavras-chave: conjunto de empresas inter-relacionadas, clusters, fatores de competitividade, instrumento de pesquisa qualitativo