Depressive symptoms are associated with fasting insulin resistance in obese youth

BACKGROUND: In adults, depressive symptoms are positively associated with insulin resistance. OBJECTIVE: To determine whether an association exists between depressive symptoms and markers of insulin resistance in youth. METHODS: This study used a retrospective review of data from an obesity clinic. We evaluated the association between depressive symptoms (Children's Depression Inventory, CDI) and fasting insulin and homeostatic model assessment-insulin resistance (HOMA-IR) in obese youth (n = 207, age 10-18 years). Individuals with lower vs. higher CDI T-scores (<65 vs. ≥65) were compared; this cut-point is accepted as indicating the possibility of clinical depression. Multiple linear regression was used to evaluate relationships between CDI T-scores and insulin resistance. RESULTS: Fasting insulin and HOMA-IR values were 40% higher in patients with higher CDI T-scores (P = 0.04). After accounting for gender, race, age and body mass index, CDI T-score remained associated with HOMA-IR, although the strength of the association was small (b = 0.007, P = 0.049). CONCLUSIONS: Relationships between depressive symptoms and insulin resistance should be considered when evaluating obese youth

Trophic ecology of common elasmobranchs exploited by artisanal shark fisheries off south-western Madagascar

Knowledge of the trophic ecology and interactions of marine top predators is fundamental for understanding community structure and dynamics as well as ecosystem function. We examined the feeding relationships of 4 heavily exploited elasmobranchs caught in coastal artisanal shark fisheries in south-western Madagascar in 2009 and 2010—Sphyrna lewini, Loxodon macrorhinus, Carcharhinus falciformis and Rhynchobatus djiddensis—using stable isotope (δ15N and δ13C) analysis. Relative trophic position (indicated by δ15N) and foraging location (indicated by δ13C) differed among species. Isotopic niche width was highly variable: more pelagic species, such as S. lewini and C. falciformis, had the broadest isotopic niches while the benthic R. djiddensis had the narrowest. A high percentage of niche overlap occurred between R. djiddensis and 2 of the species, C. falciformis (93.2%) and L. macrorhinus (73.2%), and to a lesser extent S. lewini (13.3%). Relative trophic position of S. lewini significantly increased with size, suggesting a dietary shift with age. Sex differences in δ15N values were observed in L. macrorhinus, suggesting intraspecific niche partitioning. Variation in stable isotope values among these 4 highly exploited elasmobranch species indicates trophic structuring, likely driven by differences in diet and habitat use as well as by size and sex. This study provides the first baseline information on the trophic ecology of elasmobranchs caught in artisanal fisheries from south-western Madagascar

Discussion of “Auguste Graeff: Dam Designer and Hydraulic Engineer” by Willi H. Hager and Corrado Gisonni

The work of Auguste Graeff is rarely acknowledged for his true contribution to hydraulic engineering and structures. Herein further information on Graeff and his co-worker Emile Delocre are presented together with the influence of their work in France and overseas, and several curved gravity dams built around Saint-Etienne based upon the Gouffre d'Enfer dam design. Altogether Auguste Graeff and Emile Delocre had a significant influence on gravity dam design in France and overseas

A review of satellite-based global agricultural monitoring systems available for Africa

Abstract The increasing frequency and severity of extreme climatic events and their impacts are being realized in many regions of the world, particularly in smallholder crop and livestock production systems in Sub-Saharan Africa (SSA). These events underscore the need for timely early warning. Satellite Earth Observation (EO) availability, rapid developments in methodology to archive and process them through cloud services and advanced computational capabilities, continue to generate new opportunities for providing accurate, reliable, and timely information for decision-makers across multiple cropping systems and for resource-constrained institutions. Today, systems and tools that leverage these developments to provide open access actionable early warning information exist. Some have already been employed by early adopters and are currently operational in selecting national monitoring programs in Angola, Kenya, Rwanda, Tanzania, and Uganda. Despite these capabilities, many governments in SSA still rely on traditional crop monitoring systems, which mainly rely on sparse and long latency in situ reports with little to no integration of EO-derived crop conditions and yield models. This study reviews open-access operational agricultural monitoring systems available for Africa. These systems provide the best-available open-access EO data that countries can readily take advantage of, adapt, adopt, and leverage to augment national systems and make significant leaps (timeliness, spatial coverage and accuracy) of their monitoring programs. Data accessible (vegetation indices, crop masks) in these systems are described showing typical outputs. Examples are provided including crop conditions maps, and damage assessments and how these have integrated into reporting and decision-making. The discussion compares and contrasts the types of data, assessments and products can expect from using these systems. This paper is intended for individuals and organizations seeking to access and use EO to assess crop conditions who might not have the technical skill or computing facilities to process raw data into informational products

Handheld computers and the 21(st )century surgical team: a pilot study

BACKGROUND: The commercial development and expansion of mobile phone networks has led to the creation of devices combining mobile phones and personal digital assistants, which could prove invaluable in a clinical setting. This pilot study aimed to look at how one such device compared with the current pager system in facilitating inter-professional communication in a hospital clinical team. METHODS: The study looked at a heterogeneous team of doctors (n = 9) working in a busy surgical setting at St. Mary's Hospital in London and compared the use of a personal digital assistant with mobile phone and web-browsing facilities to the existing pager system. The primary feature of this device being compared to the conventional pager was its use as a mobile phone, but other features evaluated included the ability to access the internet, and reference data on the device. A crossover study was carried out for 6 weeks in 2004, with the team having access to the personal digital assistant every alternate week. The primary outcome measure for assessing efficiency of communication was the length of time it took for clinicians to respond to a call. We also sought to assess the ease of adoption of new technology by evaluating the perceptions of the team (n = 9) to personal digital assistants, by administering a questionnaire. RESULTS: Doctors equipped with a personal digital assistant rather than a pager, responded more quickly to a call and had a lower of failure to respond rate (RR: 0.44; 95%CI 0.20–0.93). Clinicians also found this technology easy to adopt as seen by a significant reduction in perceptions of nervousness to the technology over the six-week study period (mean (SD) week 1: 4.10 (SD 1.69) vs. mean (SD) week 6: 2.20 (1.99); p = 0.04). CONCLUSION: The results of this pilot study show the possible effects of replacing the current hospital pager with a newer, more technologically advanced device, and suggest that a combined personal digital assistant and mobile phone device may improve communication between doctors. In the light of these encouraging preliminary findings, we propose a large-scale clinical trial of the use of these devices in facilitating inter-professional communication in a hospital setting

Lower doses of carvedilol in Japanese heart failure patients with reduced ejection fraction could show the potential to be non-inferior to higher doses in US patients: An international collaborative observational study

Maeda M., Humber D., Hida E., et al. (2024) Lower doses of carvedilol in Japanese heart failure patients with reduced ejection fraction could show the potential to be non-inferior to higher doses in US patients: An international collaborative observational study. PLoS ONE 19(3.0): e0299510. doi.org/10.1371/journal.pone.0299510.The Japanese national guidelines recommend significantly lower doses of carvedilol for heart failure with reduced ejection fraction (HFrEF) management than the US guidelines. Using real-world data, we determined whether initial and target doses of carvedilol in Japanese patients (JPNs) differ from those in US patients (USPs), especially in Asian Americans (ASA) and Caucasians (CA), and investigated differences in outcomes. We collected data from the electronic medical records, including demographics, carvedilol dosing, tolerability, cardiac functional indicators like EF, cardiovascular events including all-cause deaths, and laboratory values from the University of California, San Diego Health and Osaka University. JPNs had significantly lower doses (mg/day) of carvedilol initiation (66 USPs composed of 38 CAs and 28 ASAs, 17.1±16.2; 93 JPNs, 4.3±4.2, p<0.001) and one year after initiation (33.0±21.8; 11.2±6.5, p<0.001), and a significantly lower relative rate (RR) of dose discontinuation and reduction than USPs (RR: 0.406, 95% confidence interval (CI): 0.181–0.911, p<0.05). CAs showed the highest reduction rate (0.184), and ASAs had the highest discontinuation rate (0.107). A slight mean difference with narrow 95% CI ranges straddling zero was observed between the two regions in the change from the baseline of each cardiac functional indicator (LVEF, -0.68 [−5.49–4.12]; LVDd, −0.55 [−3.24–2.15]; LVDd index, −0.25 [−1.92–1.43]; LVDs, −0.03 [−3.84–3.90]; LVDs index, −0.04 [−2.38–2.30]; heart rate, 1.62 [−3.07–6.32]). The event-free survival showed no difference (p = 0.172) among the races. Conclusively, despite JPNs exhibiting markedly lower carvedilol doses, their dose effectiveness has the potential to be non-inferior to that in USPs. Dose de-escalation, not discontinuation, could be an option in some Asian and ASA HFrEF patients intolerable to high doses of carvedilol

E-health: Determinants, opportunities, challenges and the way forward for countries in the WHO African Region

BACKGROUND: The implementation of the 58(th )World Health Assembly resolution on e-health will pose a major challenge for the Member States of the World Health Organization (WHO) African Region due to lack of information and communications technology (ICT) and mass Internet connectivity, compounded by a paucity of ICT-related knowledge and skills. The key objectives of this article are to: (i) explore the key determinants of personal computers (PCs), telephone mainline and cellular and Internet penetration/connectivity in the African Region; and (ii) to propose actions needed to create an enabling environment for e-health services growth and utilization in the Region. METHODS: The effects of school enrolment, per capita income and governance variables on the number of PCs, telephone mainlines, cellular phone subscribers and Internet users were estimated using a double-log regression model and cross-sectional data on various Member States in the African Region. The analysis was based on 45 of the 46 countries that comprise the Region. The data were obtained from the United Nations Development Programme (UNDP), the World Bank and the International Telecommunications Union (ITU) sources. RESULTS: There were a number of main findings: (i) the adult literacy and total number of Internet users had a statistically significant (at 5% level in a t-distribution test) positive effect on the number of PCs in a country; (ii) the combined school enrolment rate and per capita income had a statistically significant direct effect on the number of telephone mainlines and cellular telephone subscribers; (iii) the regulatory quality had statistically significant negative effect on the number of telephone mainlines; (iv) similarly, the combined school enrolment ratio and the number of telephone mainlines had a statistically significant positive relationship with Internet usage; and (v) there were major inequalities in ICT connectivity between upper-middle, lower-middle and low income countries in the Region. By focusing on the adoption of specific technologies we attempted to interpret correlates in terms of relationships instead of absolute "causals". CONCLUSION: In order to improve access to health care, especially for the majority of Africans living in remote rural areas, there is need to boost the availability and utilization of e-health services. Thus, universal access to e-health ought to be a vision for all countries in the African Region. Each country ought to develop a road map in a strategic e-health plan that will, over time, enable its citizens to realize that vision

Re-stating the post-political: depoliticization, social inequalities, and city-region growth

This paper argues that city-region building debates and relatedly ‘post-political’ literatures are missing critical perspectives on the state, particularly the state’s continued existence as a social relation and an arena for politics, its role in the regulation of uneven development and the conflicts and struggles that arise from this. The paper brings the state centrally into ‘post-political’ debates via a critical analysis of the interrelationships between depoliticization and neoliberalism. Focusing on Sheffield (South Yorkshire, England) in the context of devolution and deal-making public policy, the paper explores the seemingly consensual visionmaking dynamics of this city region and dissects the tensions around economic governance, welfare austerity and social inequalities to get a handle on the ‘postpolitical’ depoliticized state in, and of, contemporary capitalism