Petrology, tectonic setting, and 40Ar/ 39Ar (hornblende) dating of the Late Ordovician - Early Silurian Belle Côte Road orthogneiss, western Cape Breton Highlands, Nova Scotia

The Belle Côte Road orthogneiss is a major component of the western Cape Breton Highlands, where it forms a belt approximately 60 km in length. Previous U-Pb dating has shown that the granodioritic to tonalitic protolith of the gneiss crystallized at 442 ± 3 Ma, providing a minimum age for the metavolcanic and metasedimentary units of the Aspy terrane intruded by the orthogneiss. The gneissic fabric in the orthogneiss is mainly conformable with the regional fabric, and generally trends north-south, except in the southern part of the unit where it is oriented east-west. Typical orthogneiss contains quartz, plagioclase, and biotite, with variable amounts of K-feldspar and muscovite and rarely epidote or garnet. A tonalitic variant contains amphibole. The orthogneiss is peraluminous, with A/CNK values of 1to 1.2. Petrochemical characteristics are consistent with syntectonic emplacement in the roots of a volcanic arc built on continental crust. 40Ar/39Ar dating was done on hornblende from three samples of orthogneiss and seven samples of amphibolite from xenoliths in the orthogneiss and an adjacent amphibolite unit. Eight of these samples yielded cooling ages ranging between 384 and 370 Ma. Two younger ages (ca. 363 and 353 Ma) may reflect localized effects of younger plutonism and/or shearing. The 40Ar/39Ar data combined with previous U-Pb data from titanite indicate that the orthogneiss and associated units experienced rapid cooling from ca. 600 to 400°C between ca. 386 Ma and 370 Ma, perhaps related to uplift associated with ongoing terrane amalgamation in Cape Breton Island. RÉSUMÉ Les orthogneiss de Route de Belle Côte est un composant important des hautes terres du Cap Breton occidental, où il forme une ceinture approximative de 60 kilomètres de longueur. Des mesures connues d'U-Pb a prouvé que le granodioritique au protolite tonalitique du gneiss a cristallisé au ± 442 3 Ma, fournissant un âge minimum pour les unités métavolcaniques et métasédimentaires du terrane d'Aspy imposé par les orthogneiss. Le tissu gneissique dans les orthogneiss est principalement conforme au tissu régional, et a une tendance généralement nord-sud excepté dans la partie sud de l'unité où la tendance est est-ouest. Les orthogneiss typiques contient le quartz, le plagioclase, et la biotite, avec des quantités variables de K-feldspath et de muscovite et rarement d'épidote ou de grenat. Une variante tonalitique contient l'amphibole. Les orthogneiss sont péralumineux. avec des valeurs A/CNK de 1 à 1.2. Les caractéristiques p&rochimiques sont conformées a là mise en place syntectonique dans les racines d'un arc volcanique construit sur la croute continentale. La datation d' 40Ar/39Ar à été faite sur la hornblende de trois échantillons d'orthogneiss et de sept échantillons d'amphibolite provenant de xénolites dans les orthogneiss et une unité adjacente d'amphibolite. Huit de ces échantillons ont rapporté des âges de refroidissement s'étendant entre 384 et 370 de Ma. Deux àges plus jeunes (ca. 363 et 353 Ma) peuvent refléter des effets localises des plus jeunes plutonismes et/ou cisaillement. Les données 40Ar/39Ar combing avec des données précédentes d'U-Pb de titanite indiquent que les orthogneiss et les unites associées ont éprouve' le refroidissement rapide ca de 600 a 400°C entre ca. 386 Ma et 370 Ma, peut-ètre assocté au soulèvement en plus d'amalgamation continue de terrane sur Tile du Cap Breton. [Traduit par la rédaction

Young people's experiences of managing Type 1 diabetes at university: a national study of UK university students

Aim: Little is known about the challenges of transitioning from school to university for young people with Type 1 diabetes. In a national survey, we investigated the impact of entering and attending university on diabetes self‐care in students with Type 1 diabetes in all UK universities. Methods: Some 1865 current UK university students aged 18–24 years with Type 1 diabetes, were invited to complete a structured questionnaire. The association between demographic variables and diabetes variables was assessed using logistic regression models. Results: In total, 584 (31%) students from 64 hospitals and 37 university medical practices completed the questionnaire. Some 62% had maintained routine diabetes care with their home team, whereas 32% moved to the university provider. Since starting university, 63% reported harder diabetes management and 44% reported higher HbA1c levels than before university. At university, 52% had frequent hypoglycaemia, 9.6% reported one or more episodes of severe hypoglycaemia and 26% experienced diabetes‐related hospital admissions. Female students and those who changed healthcare provider were approximately twice as likely to report poor glycaemic control, emergency hospital admissions and frequent hypoglycaemia. Females were more likely than males to report stress [odds ratio (OR) 4.78, 95% confidence interval (CI) 3.19–7.16], illness (OR 3.48, 95% CI 2.06–5.87) and weight management issues (OR 3.19, 95% CI 1.99–5.11) as barriers to self‐care. Despite these difficulties, 91% of respondents never or rarely contacted university support services about their diabetes. Conclusion: The study quantifies the high level of risk experienced by students with Type 1 diabetes during the transition to university, in particular, female students and those moving to a new university healthcare provider

An observational study of patient characteristics associated with the mode of admission to acute stroke services in North East, England

Objective Effective provision of urgent stroke care relies upon admission to hospital by emergency ambulance and may involve pre-hospital redirection. The proportion and characteristics of patients who do not arrive by emergency ambulance and their impact on service efficiency is unclear. To assist in the planning of regional stroke services we examined the volume, characteristics and prognosis of patients according to the mode of presentation to local services. Study design and setting A prospective regional database of consecutive acute stroke admissions was conducted in North East, England between 01/09/10-30/09/11. Case ascertainment and transport mode were checked against hospital coding and ambulance dispatch databases. Results Twelve acute stroke units contributed data for a mean of 10.7 months. 2792/3131 (89%) patients received a diagnosis of stroke within 24 hours of admission: 2002 arrivals by emergency ambulance; 538 by private transport or non-emergency ambulance; 252 unknown mode. Emergency ambulance patients were older (76 vs 69 years), more likely to be from institutional care (10% vs 1%) and experiencing total anterior circulation symptoms (27% vs 6%). Thrombolysis treatment was commoner following emergency admission (11% vs 4%). However patients attending without emergency ambulance had lower inpatient mortality (2% vs 18%), a lower rate of institutionalisation (1% vs 6%) and less need for daily carers (7% vs 16%). 149/155 (96%) of highly dependent patients were admitted by emergency ambulance, but none received thrombolysis. Conclusion Presentations of new stroke without emergency ambulance involvement were not unusual but were associated with a better outcome due to younger age, milder neurological impairment and lower levels of pre-stroke dependency. Most patients with a high level of pre-stroke dependency arrived by emergency ambulance but did not receive thrombolysis. It is important to be aware of easily identifiable demographic groups that differ in their potential to gain from different service configurations

Using non-invasive biomarkers to identify hepatic fibrosis in people with type 2 diabetes mellitus: the Edinburgh type 2 diabetes study

BACKGROUND & AIMS: It is difficult to determine the different stages of non-alcoholic fatty liver disease without the use of invasive liver biopsy. In this study we investigated five non-invasive biomarkers used previously to detect hepatic fibrosis and determined the level of agreement between them in order to inform future research. METHODS: In the Edinburgh Type 2 Diabetes Study, a population-based cohort aged 60-74 years with type 2 diabetes, 831 participants underwent ultrasound assessment for fatty liver and had serum aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT), aspartate to platelet ratio index (APRI), European Liver Fibrosis panel (ELF), Fibrosis-4 Score (FIB4) and liver stiffness measurement (LSM) measured. RESULTS: Literature based cut-offs yielded marked differences in the proportions of the cohort with probable liver fibrosis in the full cohort. Agreement between the top 5% of the distribution for each biomarker pair was poor. APRI and FIB4 had the best positive agreement at 76.4%, but agreement for all of the other serum biomarker pairs was between 18% and 34%. Agreement with LSM was poor (9-16%). CONCLUSIONS: We found poor correlation between the five biomarkers of liver fibrosis studied. Using the top 5% of each biomarker resulted in good agreement on the absence of advanced liver disease but poor agreement on the presence of advanced disease. Further work is required to validate these markers against liver biopsy and to determine their predictive value for clinical liver-related endpoints, in a range of different low and high risk population groups

White Matter Hyperintensities in Vascular Contributions to Cognitive Impairment and Dementia (VCID): Knowledge Gaps and Opportunities

White matter hyperintensities (WMHs) are frequently seen on brain magnetic resonance imaging scans of older people. Usually interpreted clinically as a surrogate for cerebral small vessel disease, WMHs are associated with increased likelihood of cognitive impairment and dementia (including Alzheimer\u27s disease [AD]). WMHs are also seen in cognitively healthy people. In this collaboration of academic, clinical, and pharmaceutical industry perspectives, we identify outstanding questions about WMHs and their relation to cognition, dementia, and AD. What molecular and cellular changes underlie WMHs? What are the neuropathological correlates of WMHs? To what extent are demyelination and inflammation present? Is it helpful to subdivide into periventricular and subcortical WMHs? What do WMHs signify in people diagnosed with AD? What are the risk factors for developing WMHs? What preventive and therapeutic strategies target WMHs? Answering these questions will improve prevention and treatment of WMHs and dementia

Cardiovascular risk factors and cognitive decline in older people with type 2 diabetes

AIMS/HYPOTHESIS: The aim of this work was to assess the role of well-established cardiovascular risk factors in the late-life cognitive decline of patients with type 2 diabetes. METHODS: Data from 831 participants (aged 60-75 years) attending the 4 year follow-up of the Edinburgh Type 2 Diabetes Study (ET2DS) were used. Smoking history (pack-years), BP, HbA1c, plasma glucose and cholesterol were determined at baseline clinics (single time measurements) and/or from serial data recorded on a clinical management database from diagnosis until recruitment ('historical' data). Principal component analysis derived a factor, g, of general ability from seven cognitive tests. Linear regression models of follow-up g were adjusted for baseline g to represent 4 year cognitive change. 'Accelerated late-life cognitive decline' was defined as scoring in the lowest tertile of '4 year cognitive change' regression scores. Analyses controlled for age and sex. RESULTS: A baseline history of moderate/heavy smoking (>/= 10 pack-years) and a 1% increased historical HbA1c (equivalent to an increase by 11 mmol/mol) predicted a 64% (OR 1.64; 95% CI 1.14, 2.34; p = 0.007) and 21% (OR 1.21; 95% CI 1.00, 1.45; p = 0.046) increased risk of accelerated cognitive decline, respectively. When treated as continuous measures, higher pack-years, historical HbA1c and historical BP emerged as significant independent predictors of 4 year decline in g (standardised beta range -0.07 to -0.14; all p </= 0.05). CONCLUSIONS/INTERPRETATION: Increased smoking and poorer glycaemic control (with relatively weaker findings for BP) during the life-course were independently associated with accelerated late-life cognitive decline. Where possible, evaluation is warranted of these risk factors as targets for intervention to reduce the burden of cognitive impairment in diabetes

γ-Glutamyltransferase, but not markers of hepatic fibrosis, is associated with cardiovascular disease in older people with type 2 diabetes mellitus: the Edinburgh Type 2 Diabetes Study

AIMS/HYPOTHESIS: We examined the association of prevalent and incident cardiovascular disease (CVD) with chronic liver disease in a cohort of community-based people with type 2 diabetes, in order to clarify the relationship between these two important conditions. METHODS: 1,066 participants with type 2 diabetes aged 60–75 years underwent assessment of a range of liver injury markers (non-specific injury, steatosis, steatohepatitis, fibrosis, portal hypertension). Individuals were followed up for incident cardiovascular events. RESULTS: At baseline there were 370/1,033 patients with prevalent CVD, including 317/1,033 with coronary artery disease (CAD). After a mean follow-up of 4.4 years there were 44/663 incident CVD events, including 27/663 CAD events. There were 30/82 CVD-related deaths. Risk of dying from or developing CVD was no higher in participants with steatosis than in those without (HR 0.90; 95% CI 0.40, 2.00; p > 0.05). The only notable relationship was with γ-glutamyltransferase (GGT) (incident CVD: adjusted HR for doubling GGT 1.24 [95% CI 0.97, 1.59] p = 0.086; incident CAD: adjusted HR 1.33 [95% CI 1.00, 1.78] p = 0.053), suggesting that in our study population, chronic liver disease may have little effect on the development of, or mortality from, CVD. CONCLUSIONS/INTERPRETATION: An independent association between GGT and CVD warrants further exploration as a potentially useful addition to current cardiovascular risk prediction models in diabetes. However, overall findings failed to suggest that there is a clinical or pathophysiological association between chronic liver disease and CVD in elderly people with type 2 diabetes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00125-015-3575-y) contains peer-reviewed but unedited supplementary material, which is available to authorised users