JarPi: a low-cost raspberry pi based personal assistant for small-scale fishermen

Small-scale fishermen face various occupational safety hazards due to unavailability of real-time weather information during fishing activities at sea. Whilst provision of such information could greatly reduce these risks, limited personal assistants exist that could support small scale fishermen in their activities at sea with real-time details on wind speed and direction, rainfall, humidity, geographical location and distance from shore, among others. Furthermore, large scale solutions are too expensive for this category of fishermen to afford. Even though the recent emergence of the Raspberry Pi showed to significantly decrease costs of computational systems, the application of this technology to build solutions for small-scale fishermen is yet to be investigated. As such, this paper investigates the implementation and deployment of a low-cost Raspberry Pi based personal assistant for small-scale fishermen, through a proposed device named JarPi

Once-Weekly Exenatide Versus Once- or Twice-Daily Insulin Detemir: Randomized, open-label, clinical trial of efficacy and safety in patients with type 2 diabetes treated with metformin alone or in combination with sulfonylureas

OBJECTIVEdThis multicenter, open-label, parallel-arm study compared the efficacy and safety of exenatide once weekly (EQW) with titrated insulin detemir in patients with type 2 diabetes inadequately controlled with metformin (with or without sulfonylureas). RESEARCH DESIGN AND METHODSdPatients were randomized to EQW (2 mg) or detemir (once or twice daily, titrated to achieve fasting plasma glucose #5.5 mmol/L) for 26 weeks. The primary outcome was proportion of patients achieving A1C #7.0% and weight loss $1.0 kg at end point, analyzed by means of logistic regression. Secondary outcomes included measures of glycemic control, cardiovascular risk factors, and safety and tolerability. RESULTSdOf 216 patients (intent-to-treat population), 111 received EQW and 105 received detemir. Overall, 44.1% (95% CI, 34.7–53.9) of EQW-treated patients compared with 11.4% (6.0–19.1) of detemir-treated patients achieved the primary outcome (P , 0.0001). Treatment with EQW resulted in significantly greater reductions than detemir in A1C (least-square mean 6 SE, 21.30 6 0.08% vs. 20.88 6 0.08%; P , 0.0001) and weight (22.7 6 0.3 kg vs. +0.8 6 0.4 kg; P , 0.0001). Gastrointestinal-related and injection site–related adverse events occurred more frequently with EQW than with detemir. There was no major hypoglycemia in either group. Five (6%) patients in the EQW group and six (7%) patients in the detemir group experienced minor hypoglycemia; only one event occurred without concomitant sulfonylureas (detemir group). CONCLUSIONSdTreatment with EQW resulted in a significantly greater proportion of patients achieving target A1C and weight loss than treatment with detemir, with a low risk of hypoglycemia. These results suggest that EQW is a viable alternative to insulin detemir treatment in patients with type 2 diabetes with inadequate glycemic control using oral antidiabetes drugs

The missing gonadotropin-releasing hormone agonist trigger leading to missing oocytes

Authors present a case of Genuine EFS in a young woman where no oocytes were retrieved in the first stimulation cycle after single ovulation trigger. However, a repeat stimulation performed with double ovulation trigger yielded enough oocytes

Cancer risks of anti-hyperglycemic drugs for type 2 diabetes treatment - a clinical appraisal

AIM: A clinical appraisal of existing scientific literature sought to assess the need for long-term prospective epidemiological studies to investigate an increased cancer risk of anti-hyperglycemic medication in type 2 diabetes. METHOD: A focus statement was formulated as: "With a higher risk of cancers in patients with type 2 diabetes, all anti-hyperglycemic drugs should undergo long-term, prospective epidemiological studies for cancer risks." Field surveys were sent to practicing physicians and endocrinologists to identify the currently prevalent level of acceptance of this statement. Subsequently, a meeting with a six-member panel of key opinion leaders was held to discuss published evidence in support and against the statement. This publication reviews the publications and discussion points brought forth in this meeting and their effect on statement acceptance by the panel. RESULTS: Whereas the majority of field survey responders primarily agreed with the statement, panel members were divided in their statement support. This division remained intact after review of the literature. CONCLUSIONS: While there was evidence that type 2 diabetes is associated with an increased risk of cancer, existing studies seemed insufficient to definitively demonstrate a link between cancer risk and use of specific anti-hyperglycemic therapies

Circadian rhythm of oestradiol: Impact on the bone metabolism of adult males

Background: Few studies have examined the variation in oestradiol with respect to age and circadian rhythm and the subsequent effects on BMD. Aim: Demonstrate the presence or absence of a circadian rhythm for oestrodial in older men and the integral role of concerted circadian rhythms of several factors including parathyroid hormone (PTH) in regulating biochemical markers of bone resorption and formation. Examine whether concentrations of both circulating total and bioavailable oestrogen in men differ with age and BMD. Design: Males were recruited: young men with normal BMD, older men with normal BMD and older men with osteoporosis. Methods: Subjects were hospitalized for a 25-hour period. Blood samples were obtained every 30 minutes. Hormone analysis results were plotted and reviewed. Results: Both total and bioavailable oestradiol concentrations were significantly lower in the older men than the young men (Total oestradiol: 34.5±4.4 pmol/L vs. 49.0±6.5 pmol/L, p<0.0001; Bioavailable oestradiol 16.7±2.2 pmol/L vs. 26.3±3.6 pmol/L, p<0.0001). Bioavailable oestrogen rhythm mirrored that of total estrogen. Conclusion: Both age groups with normal BMD display circadian rhythmicity with respect to circulating and bioavailable oestradiol. Younger men have increased mean total and bioavailable oestrogen concentrations and later acrophase compared to older counterparts. In older men with low BMD, total circulating oestrogen was not significantly different compared to age-matched older men with normal BMD; bioavailable oestrogen was significantly lower. Total oestrogen demonstrated a concerted circadian rhythm in all 3 groups, but bioavailable oestrogen did not demonstrate circadian rhythmicity in older men with decreased BMD

Development of a semi-automated method for measuring urinary iodine and its application in epidemiological studies in Brazilian schoolchildren

In this study we developed a semi-automated method for the measurement of urinary iodine using firstly ammonium persulfate for digestion of urine followed by estimation of iodine content in the Sandell-Kolthoff reaction, in which iodine acts as a catalyst for the reduction of cerium. This method was validated in the 3rd Brazilian National Survey of iodine deficiency in 1994. We studied 16,803 casual urine samples from schoolchildren of 401 cities and found 4 moderately-deficient towns (Almas, Arraias, and Parana, in the State of Tocantins, and Cocos, in the State of Bahia), and 116 mildly-deficient. This work suggests that despite the salt iodization program, there was some iodine-deficient areas in Brazil in 1994. Recent surveys, involving less cities, are indicating an excess of iodine ingestion. Therefore, in a country of continental dimensions and very heterogeneous in terms of public health, periodical evaluations are necessary to monitor the real situation of iodine nutrition in Brazil. the method developed in this paper is suitable for these surveys.Univ Estadual Maringa, Dept Med, Ctr Ciencias Saude, Maringa, Parana, BrazilUniversidade Federal de São Paulo, Mol Endocrinol Lab, Disciplina Endocrinol, Dept Med,Escola Paulista Med, BR-04032029 São Paulo, BrazilUniversidade Federal de São Paulo, Mol Endocrinol Lab, Disciplina Endocrinol, Dept Med,Escola Paulista Med, BR-04032029 São Paulo, BrazilWeb of Scienc

Impact of Cardio-Renal-Metabolic Comorbidities on Cardiovascular Outcomes and Mortality in Type 2 Diabetes Mellitus

BACKGROUND: We evaluated the incremental contribution of chronic kidney disease (CKD) to the risk of major adverse cardiovascular (CV) events (MACE), heart failure (HF), and all-cause mortality (ACM) in type 2 diabetes mellitus (T2DM) patients and its importance relative to the presence of other cardio-renal-metabolic (CaReMe) comorbidities. METHODS: Patients (≥40 years) were identified at the time of T2DM diagnosis from US (Humedica/Optum) and UK (Clinical Practice Research Datalink) databases. Patients were monitored post-diagnosis for modified MACE (myocardial infarction, stroke, ACM), HF, and ACM. Adjusted hazard ratios were obtained using Cox proportional-hazards regression to evaluate the relative risk of modified MACE, HF, and ACM due to CKD. Patients were stratified by the presence or absence of atherosclerotic CV disease (ASCVD) and age. RESULTS: Between 2011 and 2015, of 227,224 patients identified with incident T2DM, 40,063 (17.64%) had CKD. Regardless of prior ASCVD, CKD was associated with higher risk of modified MACE, HF, and ACM; this excess hazard was more pronounced in older patients with prior ASCVD. In time-to-event analyses in the overall cohort, patients with T2DM + CKD or T2DM + CKD + hypertension + hyperlipidemia had increased risks for modified MACE, HF, and ACM versus patients with T2DM and no CaReMe comorbidities. Patients with CKD had higher risks for and shorter times to modified MACE, HF, and ACM than those without CKD. CONCLUSION: In T2DM patients, CKD presence was associated with higher risk of modified MACE, HF, and ACM. This may have risk-stratification implications for T2DM patients based on background CKD and highlights the potential importance of novel renoprotective strategies

Overall Health and the Influence of Physical Therapy on Physical Function Following Total Ankle Arthroplasty

Background: The overall health and the importance of physical therapy for people following total ankle arthroplasty (TAA) have been understudied. Our purpose was to characterize the overall health of patients following TAA, and explore the frequency, influence, and patient-perceived value of physical therapy. Methods: People who received a TAA participated in this retrospective cohort online survey study. The survey included medical history questions and items from the Patient-Reported Outcomes Measurement Information System (PROMIS) Short Forms. Seven PROMIS domains, reflecting the biopsychosocial model of care (physical, mental, social), were included to examine participant overall health status in comparison to the general population. Items regarding physical therapy participation (yes/no), number of visits, and perceived value (scale 0-10; 10 = extremely helpful) were also included. Descriptive statistics were generated for participant characteristics, PROMIS domain T scores, and physical therapy questions. The influence of participant characteristics or physical therapy visits on PROMIS domain T scores that scored below the population mean were examined with multiple linear regression or ordinal regression. Results: The response rate was 61% (n=95). Average postoperative time was approximately 3 years (mean [SD]: 40.0 [35.3] months). Physical function and ability to participate in social roles and activities domain T scores were at least 1 SD below the population mean. Most patients received physical therapy (86%; 17.1 [11.0] visits) and found it helpful (7.2 [3.0]). Participant characteristics were minimally predictive of physical function and social participation T scores. Number of physical therapy visits predicted physical function T scores (P = .03). Conclusions: Most health domain scores approached the population mean. Physical therapy was perceived to have a high value, and greater visits were related to greater physical function. However, lower physical function and social participation scores suggest that postoperative care directed toward these domains could improve the value of TAA and promote overall health

Immigration Enforcement and Fairness to Would-Be Immigrants

This chapter argues that governments have a duty to take reasonably effective and humane steps to minimize the occurrence of unauthorized migration and stay. While the effects of unauthorized migration on a country’s citizens and institutions have been vigorously debated, the literature has largely ignored duties of fairness to would-be immigrants. It is argued here that failing to take reasonable steps to prevent unauthorized migration and stay is deeply unfair to would-be immigrants who are not in a position to bypass visa regulations. Importantly, the argument here is orthogonal to the debate as to how much and what kinds of immigration ought to be allowed