A prospective cohort study measuring cost-benefit analysis of the Otago Exercise Programme in Community Dwelling Adults with Rheumatoid Arthritis

Det er en sammenheng mellom bachelorstudentenes karakterpoeng fra videregående skole og resultater til eksamen i anatomi, fysiologi, biokjemi (AFB). Enkelte studenter med lavere opptakskarakterer enn landsgjennomsnittet oppnådde bedre eksamensresultat enn det nasjonale gjennomsnittsresultatet i AFB for 2016. Hensikten med studien var å undersøke hvordan bachelorstudenter i sykepleie med lave opptakspoeng og gode eksamensresultater i AFB lærte og tilegnet seg emnet. Studien har et kvalitativ forskningsdesign og det ble gjennomført semistrukturerte intervju av 12 bachelorstudenter i sykepleie, som ble analysert ved hjelp av innholdsanalyse. Funnene er beskrevet ut fra tre hovedkategorier: A) Relevansen til sykepleieryrket styrker læring, B) tilhørighet har betydning for læring, og C) læring skjer i samarbeid med andre. Vi fant at studentene lærte AFB mer inngående i samhandling med andre studenter. Samlinger på campus er viktig for studenters læring, til tross for at det er stort fokus på fleksible utdanninger og digitale pedagogiske metoder. Selvstendig arbeid kombinert med læring i et sosialt studentfellesskap, oppgis som motivasjonsfaktorer til målrettet arbeid med studiene. Studentene erfarer mestringsforventning, i et miljø som preges av anerkjennelse og samtidig gir opplevelse av tilhørighet. Studentene vektlegger studienes relevans sett i lys av det profesjonsyrket som de utdanner seg til, som en betydningsfull motivasjonsfaktor for læring.publishedVersio

Dose Effect of Whey Protein on Gut Hormone Responses in Pre-Diabetics and Type 2 Diabetics

GLP-1 and GIP have been shown to increase following a 50 g dose of whey protein prior to a high glycemic load in type 2 diabetics. However, this increase is reduced in diabetics compared to healthy individuals. Pancreatic polypeptide (PP) and peptide tyrosine tyrosine (PYY) also increase, while ghrelin decreases after the consumption of whey protein; however, it is not known if a similar hormone response occurs with a lower dose of whey protein prior to a glycemic load or if there is a dose effect. Our hypothesis was that 20 g and 30 g of whey protein would increase GLP-1, GIP, PP, and PYY and decrease ghrelin in a dose dependent manner. PURPOSE: The purpose of this study was to examine the effect of two different doses of whey protein ingested 30 min prior to a 50 g OGTT on gut hormone and incretin response. METHODS: Nine diabetic and pre-diabetic participants (n=9, mean ± SD; age: 64.3 + 8.1 yrs.; BMI: 29.4 + 6.0 kg/m2; HbA1c: 6.4 + 0.6%) completed three trials. The randomly assigned trials consisted of: ingestion of 250ml of water (CON); 250 ml of water + 20 g whey (20g); 250ml of water + 30 g whey (30g), prior to completing a 50 g OGTT. Blood was collected at -30, 0, 15, 30, 60, 90, 120, and 150 min for the measurement of GIP, GLP-1, ghrelin, PP, and PYY. The whey protein was administered immediately following the -30 min and the 50 g OGTT began immediately after the 0 min blood draw. Metabolites were measured using multiplex fluorescent detection. One-way repeated measure ANOVA was used for statistical analysis for each dependent variable (P \u3c 0.05). RESULTS: 20g and 30g of whey protein significantly increased incremental area under the curve (AUC) of GIP 32% and 38% compared to CON. 30g significantly decreased ghrelin AUC -13.9% and -20% compared to 20g and CON. 30g significantly increased PP AUC 28% compared to CON only. There were no differences in ghrelin and PP AUC between 20g and CON. There were no significant differences for GLP-1 and PYY between all trials. CONCLUSION: 30 g of whey protein prior to a glucose challenge increased secretion of GIP and PP and decreased ghrelin in type 2 and pre-diabetics. There seems to be a dose effect relationship between whey, ghrelin, and PP. 30 g of whey preload may induce insulinotropic and satiety effects from GIP, PP, and ghrelin responses in type 2 and pre-diabetics

The Dose Effect of Whey Protein on Insulin Responses in Pre-Diabetics and Type 2 Diabetics

People with pre-diabetes and type 2 diabetes have shown an increase in insulin secretion after ingesting 55 g of whey protein coupled with a glycemic challenge. However, the effect of lower amounts of whey protein on insulin responses remains unclear. Our hypothesis was that both 20 g and 30 g of whey consumption prior to an oral glucose tolerance test (OGTT) would produce an increase in insulin secretion, with 30 g producing the greatest increase compared to a control. PURPOSE: The purpose of this study was to examine the effect of two different doses of whey protein ingested 30 min prior to a 50 g OGTT on glucose, insulin, C-peptide, and glucagon responses. METHODS: Diabetic or pre-diabetic participants (n=9, mean ± SD; age: 64.3 + 8.1 yrs; BMI: 29.4 + 6.0 kg/m2; body fat percentage: 42.5 + 7.8 %; fasting plasma glucose: 6.9 + 1.2 mmol/l; HbA1c: 6.4 + 0.6 %) completed three trials. The randomly assigned trials consisted of: 250 ml of water (CON), 250 ml of water + 20 g whey (20g), and 250 ml of water + 30 g whey (30g), followed by an OGTT. Blood was collected at -30, 0, 15, 30, 60, 90, 120, and 150 min for the measurement of glucose, insulin, C-peptide, and glucagon. The whey protein mixture was administered immediately following the -30 min blood draw, and the 50 g OGTT began immediately following the 0 min blood draw. Glucose was analyzed using a YSI 2900D glucose analyzer and insulin, C-peptide, and glucagon were measured via multiplex fluorescent detection (MagPix). A one-way repeated measures ANOVA (pRESULTS: Incremental area under the curve (AUC) for glucose presented no difference between the 3 trials. Insulin AUC was significantly increased from CON to 20g (p=0.004, 36.3%), CON to 30g (p=0.002, 61.7%), and 20g to 30g (p=0.030, 18.6%). C-peptide and glucagon AUC significantly increased from CON to 20g (p=0.018, 20.6%; p=0.046, 33.1%) and CON to 30g (p=0.001, 30.1%; p=0.017, 33.7%). CONCLUSION: Whey protein elicited a dose response on plasma insulin, increasing concentrations from CON to 20g, and 20g to 30g, however plasma glucose was unaffected. 20g and 30g displayed similar responses for glucagon. Neither 20 g nor 30 g of whey protein may be adequate to provide glycemic improvement in the disease management of type 2 or pre-diabetes

Fear-of-falling and associated risk factors in persons with rheumatoid arthritis: a 1 year prospective study

Abstract: Background: Falls, associated injuries and fear-of-falling are common in adults with RA. Fear-of-falling can be a major consequence of, and as debilitating as falling, resulting in a cycle of activity restriction, reduced quality of life, institutionalisation and potentially increase risk of falls. The objective of this study was to examine the relationship between fear-of-falling and risk factors associated with fear-of-falling in adults with rheumatoid arthritis (RA) over a 1 year period. Methods: Five hundred fifty-nine patients with RA were recruited from four outpatient clinics in this prospective cohort study. Baseline assessments included socio-demographic, medical and lifestyle related risk factors. Fall incidence was prospectively obtained monthly using postal cards over a 1 year period. Fear-of-falling was assessed at baseline and 1 year using the Short Falls Efficacy Scale-International (Short FES-I). Logistic regression was used to determine the association between high fear-of-falling (Short FES-I > 11) at baseline (outcome) and a range of putative predictor variables including previous falls, and also baseline factors associated with a high fear-of-falling at follow-up. Results: Five hundred thirty-five (ninety-six percent) participants (mean age 62.1 yrs.; 18–88 yrs) completed 1 year follow-up and of these, 254 (47%) completed the Short FES-I questionnaire at 1 year. In a multivariate model, a history of multiple falls (OR = 6.08) higher HAQ score (OR = 4.87) and increased time to complete the Chair Stand Test (OR = 1.11) were found to be independent predictors of high fear-of-falling and had an overall classification rate of 87.7%. There were no significant differences found in fear-of-falling at 1 year follow-up in those who reported falls during the study, participant’s baseline fear appeared to predict future fear, regardless of further falls. Conclusions: Fear-of-falling is significantly associated with previous falls and predictive of future falls and fear. RA patients would benefit from fall prevention measures whether or not they have previously fallen

Pulmonary endothelial cell ATP depletion following intestinal ischemia

Multiple organ failure (MOF) is known to follow systemic inflammatory mediator activation associated with intestinal ischemia--reperfusion injury. In particular, the pulmonary microvasculature appears to be susceptible to MOF-related injury. This study was designed to evaluate the hypothesis that non-cellular plasma factors associated with intestinal ischemia without reperfusion also mediate pulmonary endothelial cell injury. Male Sprague--Dawley rats had intestinal ischemia induced by microvascular clip occlusion of the superior mesenteric artery for 30, 60, 90, or 120 min. Following each period of ischemia, plasma samples were obtained from the portal vein. Time-matched sham-operated animals served as controls. Monolayers of cultured rat pulmonary artery endothelial cells were then incubated with the plasma samples and ATP levels determined using a luciferin--luciferase assay. A 51Cr-release assay using labeled endothelial cells was performed under identical conditions to assess cytotoxicity. Endothelial cell ATP levels were 1.99 +/- 0.23 x 10-11 mole/[mu]g DNA in sham preparations. After a 4-hr incubation in plasma from the 90 and 120 min ischemia groups, cellular ATP levels fell significantly to 1.07 +/- 0.23 x 10-11 mole/[mu]g DNA, respectively (P P = NS). All animals survived 24 hr in the sham, 30, and 60 min groups. However, survival was 40 and 0% in the 90 and 120 min groups, respectively (P in vitro data with in vivo survival.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30022/1/0000390.pd

A prospective cohort study measuring cost-benefit analysis of the Otago Exercise Programme in community dwelling adults with rheumatoid arthritis.

BACKGROUND: Falls are one of the major health problems in adults with Rheumatoid Arthritis (RA). Interventions, such as the Otago Exercise Programme (OEP), can reduce falls in community dwelling adults by up to 35%. The cost-benefits of such a programme in adults with RA have not been studied. The aims of this study were to determine the healthcare cost of falls in adults with RA, and estimate whether it may be cost efficient to roll out the OEP to improve function and prevent falls in adults living with RA. METHODS: Patients with Rheumatoid Arthritis aged ≥18 years were recruited from four rheumatology clinics across the Northwest of England. Participants were followed up for 1 year with monthly fall calendars, telephone calls and self-report questionnaires. Estimated medical cost of a fall-related injury incurred per-person were calculated and compared with OEP implementation costs to establish potential economic benefits. RESULTS: Five hundred thirty-five patients were recruited and 598 falls were reported by 195 patients. Cumulative medical costs resulting from all injury leading to hospital services is £374,354 (US$540,485). Average estimated cost per fall is £1120 (US$1617). Estimated cost of implementing the OEP for 535 people is £116,479 (US$168,504) or £217.72 (US$314.34) per-person. Based on effectiveness of the OEP it can be estimated that out of the 598 falls, 209 falls would be prevented. This suggests that £234,583 (US$338,116) savings could be made, a net benefit of £118,104 (US$170,623). CONCLUSIONS: Implementation of the OEP programme for patients with RA has potentially significant economic benefits and should be considered for patients with the condition

Manual / Issue 6 / Assemblage

Manual, a journal about art and its making. Assemblage. The sixth issue. An assemblage is both an act and a result-the work of gathering and conjoining as well as the state of having been gathered and conjoined. This issue of Manual pieces together works made out of practical necessity and others that marry dazzling embellishments for optimal effect, examining how history (or one version of it) was (and is) pastiched from disparate sources, how fashionable textile samples were collected, and more (always more). An assembly of assemblages, an assortment of intended and unintended interrelationships, Manual issue six is the sum of its parts and the parts themselves, a dynamic gathering of artists and authors, objects and interpretations, mash-ups and remixes, lemons and lightbulbs, vibrantly inter-animating each other. Softcover, 68 pages. Published 2016 by the RISD Museum. Manual 6 (Assemblage) contributors include Eric Anderson, Taylor Elyse Anderson, Bob Dilworth, Christina Hemauer, Roman Keller, Mariani Lefas-Tetenes, Simone Leigh, Leora Maltz-Leca, Ingrid A. Neuman, Tara Nummedal, Todd Oldham, and Britany Salsbury.https://digitalcommons.risd.edu/risdmuseum_journals/1032/thumbnail.jp

High Intensity Interval Exercise Does Not Influence Overnight GH Secretion in Overweight Sedentary Young Women

Exercise and sleep are the two major factors that influence growth hormone (GH) secretion and it has been well established that there is a strong positive relationship between exercise intensity and GH release. This dose-dependent response may also be correlated with the lactate response to exercise, with steady-state exercise intensities above the lactate threshold eliciting a greater GH pulse. It has yet to be determined, however, if high-intensity interval exercise (HIE) can influence overnight pulsatile GH secretion, which accounts for the majority of daily GH release. PURPOSE: To determine if HIE significantly increased overnight GH secretion compared to continuous moderate-intensity exercise (MOD), or no exercise (CON) in young women. METHODS: Five young, sedentary women (mean ± SD age: 22.6 ± 1.3 y; BMI: 27.4 ± 3.1 kg/m2; body fat: 39.2 ± 1.7 %; VO2max: 29.4 ± 5.7 mL/kg/min) were studied on three different occasions during the follicular phase of their menstrual cycle (CON: no exercise; MOD: 30-min of continuous cycling at 50% of peak power determined from the VO2max test; and HIE: 4 30-s “all-out” sprints at a resistance equal to 6.5% body mass with 4.5-min recovery. Each trial was randomly assigned and separated by a minimum of one month. For each visit, participants reported to the lab at 1700h, exercised from 1730h – 1800h, and remained in the lab until 0700h the following morning. The overnight GH secretory profile of each trial was determined from 10-min sampling of venous blood from 1730h – 0600h (12.5 h) using deconvolution analysis. RESULTS: Mean power output during MOD was 80.6 ± 6.3 W (68.2 ± 9.7 %VO2max). Estimated exercising energy expenditure for MOD (145.1 ± 11.2 kcal) was significantly lower than HIE (204.5 ± 15.5 kcal, P = 0.002). Peak lactate was significantly higher during MOD (4.7 ± 0.9 mmol/L) compared to CON (0.9 ± 0.2 mmol/L, P = 0.002) and was highest during HIE (11.2 ± 2.1 mmol/L) compared to MOD (P \u3c 0.001) and CON (P \u3c 0.001). Calculated GH AUC (0 – 120 min) was significantly greater in HIE (1018.2 ± 576.1 ng· min/mL) than CON (181.7 ± 138.9 ng· min/mL, P = 0.009), but not MOD (544.7 ± 160.7 ng· min/mL). Overnight GH production rate (ng/mL/min) determined by deconvolution analysis was not significantly different between CON (1040.3 ± 242.0), MOD (1429.2 ± 206.0), and HIE (1831.2 ± 873.8, P = 0.107). Other GH secretory variables: basal GH concentration (ng/mL), number of GH peaks, GH pulse amplitude and mass, and interpulse interval were not different between the three trials. CONCLUSION: For these untrained, overweight sedentary young women, a single bout of exercise was insufficient to significantly affect overnight pulsatile GH secretion. Adiposity is a negative determinant of GH secretion, and the GH response to exercise in these women was extremely variable. Aerobic fitness, prior training, as well as several metabolic factors associated with obesity (e.g., increased insulin and circulating free fatty acids) can also influence GH secretion and should be taken into account as potential mediators of the GH response to exercise

Herpetological observations from field expeditions to North Karnataka and Southwest Maharashtra, India

The Western Ghats of India are one of the 34 global hotspots of biodiversity. They are one of the most important large natural areas in the world and are fast becoming recognised for their biological importance. The herpetofauna of the Western Ghats is hugely diverse, with many species exhibiting rare, endemic styles of autecology and niche preference that could equal that of countries such as Borneo and Madagascar. In this report we detail 18 amphibian and 37 reptile species from eight sites following three expeditions to the Western Ghats from 2007-2009. The report details species descriptions, habitat, ecology and conservation to alert the herpetological community to the importance of future research to address the lack of knowledge in species ecology. It also presents newinformation on species distribution and behaviour

A novel Alzheimer disease locus located near the gene encoding tau protein

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this recordAPOE ε4, the most significant genetic risk factor for Alzheimer disease (AD), may mask effects of other loci. We re-analyzed genome-wide association study (GWAS) data from the International Genomics of Alzheimer's Project (IGAP) Consortium in APOE ε4+ (10 352 cases and 9207 controls) and APOE ε4- (7184 cases and 26 968 controls) subgroups as well as in the total sample testing for interaction between a single-nucleotide polymorphism (SNP) and APOE ε4 status. Suggestive associations (P<1 × 10-4) in stage 1 were evaluated in an independent sample (stage 2) containing 4203 subjects (APOE ε4+: 1250 cases and 536 controls; APOE ε4-: 718 cases and 1699 controls). Among APOE ε4- subjects, novel genome-wide significant (GWS) association was observed with 17 SNPs (all between KANSL1 and LRRC37A on chromosome 17 near MAPT) in a meta-analysis of the stage 1 and stage 2 data sets (best SNP, rs2732703, P=5·8 × 10-9). Conditional analysis revealed that rs2732703 accounted for association signals in the entire 100-kilobase region that includes MAPT. Except for previously identified AD loci showing stronger association in APOE ε4+ subjects (CR1 and CLU) or APOE ε4- subjects (MS4A6A/MS4A4A/MS4A6E), no other SNPs were significantly associated with AD in a specific APOE genotype subgroup. In addition, the finding in the stage 1 sample that AD risk is significantly influenced by the interaction of APOE with rs1595014 in TMEM106B (P=1·6 × 10-7) is noteworthy, because TMEM106B variants have previously been associated with risk of frontotemporal dementia. Expression quantitative trait locus analysis revealed that rs113986870, one of the GWS SNPs near rs2732703, is significantly associated with four KANSL1 probes that target transcription of the first translated exon and an untranslated exon in hippocampus (P≤1.3 × 10-8), frontal cortex (P≤1.3 × 10-9) and temporal cortex (P≤1.2 × 10-11). Rs113986870 is also strongly associated with a MAPT probe that targets transcription of alternatively spliced exon 3 in frontal cortex (P=9.2 × 10-6) and temporal cortex (P=2.6 × 10-6). Our APOE-stratified GWAS is the first to show GWS association for AD with SNPs in the chromosome 17q21.31 region. Replication of this finding in independent samples is needed to verify that SNPs in this region have significantly stronger effects on AD risk in persons lacking APOE ε4 compared with persons carrying this allele, and if this is found to hold, further examination of this region and studies aimed at deciphering the mechanism(s) are warranted