Objective assessment of functional and motor-cognitive outcomes among asymptomatic primary hyperparathyroidism patients undergoing parathyroidectomy using wearable technologies: a pilot study towards better informed clinical decision-making

For the past 40 years, most patients with Primary Hyperparathyroidism (PHPT) have presented with the asymptomatic form of PHPT. Despite the dominance of the asymptomatic PHPT phenotype, current National Institutes of Health (NIH) indications for parathyroidectomy fail to identify as many as 80% of patients afflicted with asymptomatic PHPT. To date, studies of the therapeutic benefits of parathyroidectomy among asymptomatic PHPT patients have relied on general health questionnaires and patient reports of their satisfaction with the surgery. The purpose of the present study was to implement objective, quantifiable metrics in assessing whether or not asymptomatic PHPT patients experience improvements in domains salient to them such as mobility and cognitive function following parathyroidectomy. This information may help set the foundation for more accurately identifying patients who would benefit from parathyroidectomy. We hypothesized that asymptomatic patients would exhibit improvement in motor-cognitive outcomes following successful parathyroidectomy. We performed a single-center prospective assessment of gait, frailty, and motor-cognitive function among patients diagnosed with PHPT. Demographics, medical history, and perioperative labs were recorded. Pre- and post-surgical measures included the Fried frailty criteria, the PROMIS 10 Global Health Scale, and gait analysis under habitual (ST), walking while performing working memory test (dual-task: DT), and fast-walking conditions, an upper extremity frailty (UEF) test, and an interactive trail-making task (iTMT) . Descriptive statistics, Chi-squared, 2-sample t tests, and repeated measures analysis of variance were applied where appropriate. 22 parathyroidectomy patients (male 7; 31.8%); median age of 54.9 (standard deviation=15.5) years participated. The prevalence of frailty/pre-frailty was 60% at baseline and reduced to 33% at 3 weeks post-op. PROMIS 10 physical health improved significantly by 3 months post-op (d=0.93, p=0.010). DT and fast walk velocities were significantly increased by 3 weeks post-op (p<0.050) with highest effect size observed during DT conditions (24%, Cohen's effect size d=1.30 , p=0.017). ST velocity increased but not significantly (17.5%, d=0.46, p=0.422). Results from UEF tests and iTMT did not achieve statistical significance at any visit date. Asymptomatic PHPT patients experience significant resolution of motor-cognitive symptoms as measured by DT gait and PROMIS 10 Global Health Scale following parathyroidectomy performed by a skilled surgeon

Green Housing = Improved Health: A Winning Combination

The case studies in this paper explore the relationship between housing and health. It explains how building affordable green housing provides health benefits to low-income residentsand it identifies the benefits of green housing for the environment and energy efficiency

The question of objectivity in Zola's Thérse Raquin : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in French at Massey University

Some French throughout.The first chapter examines the fascination the concept of objectivity held for certain French Realists including Emile Zola, acknowledged leader of the Naturalists who believed in the application of the scientific method to novel-writing. These writers sought to produce works of mimetic value and attached themselves to the tenets of objectivity in an attempt to achieve this. However it was recognized that their efforts at producing 'objective' novels were threatened by a requirement for artistry in published fiction. More recent thinking acknowledges that objectivity is not achievable, at least not in absolute terms. The problems inherent in various definitions of objectivity in fiction are examined and reveal general agreement that this kind of objectivity requires at least the appearance of detachment and neutrality by the author. In order to examine the question of the author's detachment, Chapter 2 ,makes a case for the distinctions of author, implied author and narrator to be blurred in Zola's Therese Raguin. Four distinct aspects of the narrating voice are examined. Examples are given of the various forms of commentary in the narrative which reveal the presence of the author-narrator. The author's preconceptions which threaten his neutrality are focused on in Chapter 3. The theory of determinism involving both causality and fatalism is seen as both abetting and threatening the author's attainment of a semblance of objectivity in the text. We examine the basis on which characters are presented and milieu is described in Therese Raquin. Zola is shown to be far from neutral

Insulin Dynamic Measures and Weight Change

ABSTRACT Insulin Dynamic Measures and Weight Change By Noreen Kloc B.S. Computer Information Technology, Purdue University December 7, 2015 INTRODUCTION: Weight gain and obesity are risk factors for insulin resistance that can lead to type 2 diabetes and cardiovascular disease; however, there is a complicated interplay between insulin sensitivity (SI), fasting insulin, acute insulin response (AIR), and disposition index (DI) and the relationship of these dynamic measures with weight change is not well understood. AIM: The aim of this study was to investigate the relationships between insulin dynamic measures, SI, fasting insulin, AIR, and DI, with weight change during a 5-years follow-up period in the multi-ethnic cohort of the Insulin Resistance Atherosclerosis Study (IRAS). METHODS: Data on 879 men and women of Hispanic, non-Hispanic White, and African-American race/ethnicity aged 40-69 years were obtained at baseline (1992-1994) and at 5 year follow-up. Crude associations between the insulin dynamic measures and weight change were evaluated using Kruskal-Wallis test and the relationships between log-transformed insulin-related variables were examined using Spearman rank-order analysis. Multivariate regression models evaluated associations of interest adjusted for age, sex, ethnicity, and diabetes status in a time-dependent manner using mixed models. RESULTS: Insulin sensitivity SI inversely coevolves with weight, i.e. greater weight is predicted by lower SI at any time point. To answer the question whether SI is the cause or a consequence of weight change, we examined the associations with the baseline values and a change in SI. In this model, both the baseline SI and change in SI were inversely correlated with weight gain. A similar approach showed that baseline values and change in fasting insulin were directly associated with weight gain. Weight change over time was associated with AIR, i.e. increases in AIR and greater AIR at baseline predicted weight gain. We did not find strong relationships between DI and weight change. DISCUSSION: These results suggest that insulin sensitivity and insulin secretion can modulate weight in a non-diabetic population

The AMSC mobile satellite system: Design summary and comparative analysis

Mobile satellite communications will be provided in the United States by the American Mobile Satellite Consortium (AMSC). Telesat Mobile, Inc. (TMI) and AMSC are jointly developing MSAT, the first regional Mobile Satellite Service (MSS) system. MSAT will provide diverse mobile communications services - including voice, data and position location - to mobiles on land, water, and in the air throughout North America. Described here are the institutional relationships between AMSC, TMI and other organizations participating in MSAT, including the Canadian Department of Communications and NASA. The regulatory status of MSAT in the United States and international allocations to MSS are reviewed. The baseline design is described