Combined Use of Waist and Hip Circumference to Identify Abdominally Obese HIV-Infected Patients at Increased Health Risk

OBJECTIVES: To determine whether for a given waist circumference (WC), a larger hip circumference (HC) was associated with a reduced risk of insulin resistance, type 2 diabetes (T2D), hypertension and cardiovascular disease (CVD) in HIV-infected patients. A second objective was to determine whether, for a given WC, the addition of HC improved upon estimates of abdominal adiposity, in particular visceral adipose tissue (VAT), compared to those obtained by WC alone. METHODS: HIV-infected men (N\u200a=\u200a1481) and women (N\u200a=\u200a841) were recruited between 2005 and 2009. WC and HC were obtained using standard techniques and abdominal adiposity was measured using computed tomography. RESULTS: After control for WC and covariates, HC was negatively associated with risk of insulin resistance (p<0.05) and T2D [Men: OR\u200a=\u200a0.91 (95% CI: 0.86-0.96); Women: OR\u200a=\u200a0.91 (95% CI: 0.84-0.98)]. For a given WC, HC was also negatively associated with a lower risk of hypertension (p<0.05) and CVD [OR\u200a=\u200a0.94 (95% CI: 0.88-0.99)] in men, but not women. Although HC was negatively associated with VAT in men and women after control for WC (p<0.05), the addition of HC did not substantially improve upon the prediction of VAT compared to WC alone. CONCLUSIONS: The identification of HIV-infected individuals at increased health risk by WC alone is substantially improved by the addition of HC. Estimates of visceral adipose tissue by WC are not substantially improved by the addition of HC and thus variation in visceral adiposity may not be the conduit by which HC identifies increased health risk

FisicaMente: supporting first-year students in transferring mathematical skills and knowledge to a physical context.

Research in physics education shows that students often enter university-level physics courses lacking the prerequisite mathematics skills and knowledge and/or the ability to apply them in a physical context. To analyze these difficulties and provide students with effective feedback, we have designed two multiple-choice tests, inspired by current research in physics education and in cognitive psychology, and starting from a taxonomy of the most frequent errors made by students. We assessed the tests’ content reliability and discriminatory power both globally and at the single-item level. The tests were administered to first-year students enrolled in Science and Engineering courses

Ocean 2D eddy energy fluxes from small mesoscale processes with SWOT

We investigate ocean dynamics at different scales in the Agulhas Current system, a region of important interocean exchange of heat and energy. While ocean observations and some of the most advanced climate models capture the larger mesoscale dynamics (&gt; 100 km), the smaller-scale fronts and eddies are underrepresented. The recently launched NASA–CNES Surface Water and Ocean Topography (SWOT) wide-swath altimeter mission observes the smaller ocean geostrophic scales down to 15 km in wavelength globally. Here we will analyse different eddy diagnostics in the Agulhas Current region and quantify the contributions from the larger mesoscales observable today and the smaller scales to be observed with SWOT. Surface geostrophic diagnostics of eddy kinetic energy, strain, and energy cascades are estimated from modelled sea surface height (SSH) fields of the Massachusetts Institute of Technology general circulation model (MITgcm) latitude–longitude polar cap (LLC4320) simulation subsampled at 1/10∘. In this region, the smaller scales (&lt;150 km) have a strong signature on the horizontal geostrophic strain rate and for all eddy diagnostics in the Western Boundary Current and along the meandering Agulhas Extension. We investigate the horizontal cascade of energy using a coarse-graining technique, and we observe that the wavelength range where the inverse cascade occurs is biased towards larger mesoscale wavelengths with today’s altimetric sampling. We also calculate the projected sampling of the eddy diagnostics under the SWOT swaths built with the NASA–CNES simulator to include the satellite position and realistic noise. For the swaths, a neural network noise mitigation method is implemented to reduce the residual SWOT random error before calculating eddy diagnostics. In terms of SSH, observable wavelengths of 15 to 20 km are retrieved after neural network noise mitigation, as opposed to wavelengths larger than 40 km before the noise reduction.</p

ESPEN guideline: Clinical nutrition in surgery.

Early oral feeding is the preferred mode of nutrition for surgical patients. Avoidance of any nutritional therapy bears the risk of underfeeding during the postoperative course after major surgery. Considering that malnutrition and underfeeding are risk factors for postoperative complications, early enteral feeding is especially relevant for any surgical patient at nutritional risk, especially for those undergoing upper gastrointestinal surgery. The focus of this guideline is to cover nutritional aspects of the Enhanced Recovery After Surgery (ERAS) concept and the special nutritional needs of patients undergoing major surgery, e.g. for cancer, and of those developing severe complications despite best perioperative care. From a metabolic and nutritional point of view, the key aspects of perioperative care include: • integration of nutrition into the overall management of the patient • avoidance of long periods of preoperative fasting • re-establishment of oral feeding as early as possible after surgery • start of nutritional therapy early, as soon as a nutritional risk becomes apparent • metabolic control e.g. of blood glucose • reduction of factors which exacerbate stress-related catabolism or impair gastrointestinal function • minimized time on paralytic agents for ventilator management in the postoperative period • early mobilisation to facilitate protein synthesis and muscle function The guideline presents 37 recommendations for clinical practice

Innovating physics teaching through teachers’ learning communities and action research

The paper provides information, foundation and supporting evidence about a possible structure of a research-based in-service program for physics teachers aimed at improving their use of the laboratory. We present our model and we describe the CoLLabora project where the model was first implemented. The results suggest that the program actually produced positive changes in the participants’ ideas about the laboratory, its actual use in their teaching practice, and in students’ outcomes. We also present two case studies and we outline some research lines and the ‘teacher training cascade’ that have developed from the project

Enhanced recovery after surgery: are we ready, and can we afford not to implement these pathways for patients undergoing radical cystectomy?

Enhanced recovery after surgery (ERAS) for radical cystectomy seems logical, but our study has shown a paucity in the level of clinical evidence. As part of the ERAS Society, we welcome global collaboration to collect evidence that will improve patient outcomes

Patient-Reported Outcomes and Quality of Life Assessment. New Targets for New Targeted Therapy?

No abstract availabl

Sobre caso de doença de Chagas aguda em região de vetores controlados no Estado de São Paulo, Brasil

No vector transmitted cases of Chagas disease had been notified in the state of São Paulo since the 1970s. However, in March, 2006, the death of a six-year-old boy from the municipality of Itaporanga was notified to the Center for Epidemiological Survey of the São Paulo State Health Secretariat: an autochthonous case of acute Chagas disease. The postmortem histopathological examination performed in the Hospital das Clínicas of the Botucatu School of Medicine confirmed the diagnosis. Reference to hospital records, consultation with the health professionals involved in the case and interviews with members of the patient's family supplied the basis for this study. We investigated parasite route of transmission, probable local reservoirs and vectors. No further human cases of acute Chagas disease were diagnosed. No locally captured vectors or reservoirs were found infected with Trypanosoma cruzi. Alternative transmission hypotheses - such as the possible ingestion of foods contaminated with vector excreta - are discussed, as well as the need to keep previously endemic regions and infested houses under close surveillance. Clinicians should give due attention to such signs as uni- or bilateral palpebral edema, cardiac failure, myocarditis, pericarditis, anasarca and atypical signs of nephrotic syndrome or nephritis and consider the diagnostic hypothesis of Chagas disease.Desde a década de 1970 não se notificavam casos autóctones de doença de Chagas aguda em São Paulo. Em março de 2006 a Vigilância Epidemiológica registrou óbito por doença de Chagas aguda, em Itaporanga, de paciente de seis anos de idade. Exame histopatológico post mortem realizado no Hospital das Clínicas da Faculdade de Medicina de Botucatu confirmou o diagnóstico. Consultamos prontuários de hospitais e entrevistamos profissionais de saúde envolvidos além de familiares do paciente. Descrevemos medidas adotadas in loco para identificar a via de transmissão, reservatórios e vetores. Discutimos as possíveis fontes de infecção. Na região não foram identificados outros casos humanos, vetores ou reservatórios vertebrados infectados por Trypanosoma cruzi. Salientamos a importância de manter a vigilância, mesmo em áreas onde a transmissão de doença de Chagas está interrompida e naquelas ainda infestadas por triatomíneos. Deve-se admitir a hipótese diagnóstica de doença de Chagas quando observados: edema palpebral (uni ou bilateral), insuficiência cardíaca, miocardite, pericardite, anasarca, quadros similares aos de síndrome nefrótica ou glomerulonefrite sem causas outras aparentes, em pacientes com dados epidemiológicos positivos. Encontro, mesmo em raras ocasiões, de triatomíneos na região ou ainda contato com alimento contaminável com formas infectantes de T. cruzi

Energy Linearity and Resolution of the ATLAS Electromagnetic Barrel Calorimeter in an Electron Test-Beam

A module of the ATLAS electromagnetic barrel liquid argon calorimeter was exposed to the CERN electron test-beam at the H8 beam line upgraded for precision momentum measurement. The available energies of the electron beam ranged from 10 to 245 GeV. The electron beam impinged at one point corresponding to a pseudo-rapidity of eta=0.687 and an azimuthal angle of phi=0.28 in the ATLAS coordinate system. A detailed study of several effects biasing the electron energy measurement allowed an energy reconstruction procedure to be developed that ensures a good linearity and a good resolution. Use is made of detailed Monte Carlo simulations based on Geant which describe the longitudinal and transverse shower profiles as well as the energy distributions. For electron energies between 15 GeV and 180 GeV the deviation of the measured incident electron energy over the beam energy is within 0.1%. The systematic uncertainty of the measurement is about 0.1% at low energies and negligible at high energies. The energy resolution is found to be about 10% sqrt(E) for the sampling term and about 0.2% for the local constant term