The impact of coastal landfills on shoreline management plans

This paper reports preliminary results of a study that investigated the issues that old landfills located within a coastal setting in southeast England present to future shoreline management plans. The study was based on three case study sites, selected from a total of over 148 historic landfill sites that intersected the 1 in 200 year tidal floodplain in the study area and 61 sites threatened by erosion (under a no active intervention policy scenario) in the next century. One site is currently on a cliff top and is eroding into the sea. The second landfill sitsbehind an existing coastal defence structure and is constraining options for managing and adapting the shoreline management plan. The final site is an example where a landfill is protected by informal coastal defence structures in a low wave energy environment. The impact of potential sea level rises over the next 100 years are considered in the context of landfill management and shoreline management planning

Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes

BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events

Movement and physiological demands of international and regional men's touch Rugby matches.

This study compared the internal and external match demands imposed on international and regional standard male touch rugby players. The study adopted a cohort design with independent groups. Twelve international players (mean age, 27.8 ± 6.2 years; body mass, 72.8 ± 3.7 kg; stature, 174.5 ± 5.4 cm) and 9 regional players (mean age, 25.5 ± 5.5 years; body mass 74.2 ± 7 kg; stature 174.1 ± 7 cm) were analyzed during 9 competitive matches from the 2013 season. Movement demands were measured using a 5-Hz global positioning system, alongside heart rate (HR) and session rating of perceived exertion (s-RPE) to quantify internal load. Total distance covered by international players was lower than regional players (2265.8 ± 562.3 cf. 2970 ± 558.9 m; p ≤ 0.05). However, international players had greater relative distance (137.1 ± 13.6 cf. 126.2 ± 17.2 m·min−1) due to shorter playing times per match (p ≤ 0.05). Absolute high-speed running (>14 km·h−1) was not different between groups (p > 0.05), but relative high-speed running (39.3 ± 12.0 cf. 26.0 ± 13.6 m·min−1) was higher for international players. Regional players performed more absolute low-speed activity (≤14 km·h−1) than international players (p ≤ 0.05), whereas relative low-speed activity was not different between groups (p > 0.05). Very high-speed running (>20 km·h−1) distance, bout number and frequency, peak, and average speed were all greater in international players (p ≤ 0.05). Higher average HR, summated HR, and s-RPE (p ≤ 0.05) indicated higher internal loads during matches for regional players. These data indicate that performance in men's touch rugby is characterized by more relative high-speed running and better repeated sprint capacities in higher standard players

Fetal haemoglobin levels in adult type 1 (insulin-dependent) diabetic patients

Glycated haemoglobin levels (HbA1 and HbA1c) are established parameters of long-term glycaemic control in diabetic patients. Depending on the method used, fetal haemoglobin interferes with the assays for glycated haemoglobin. If present in high amounts, fetal haemoglobin may lead to overestimation of glycated haemoglobin levels, and therefore, of average blood glucose concentration in diabetic patients. Glycated (HbA1c) and fetal haemoglobin levels were measured by high pressure liquid chromatography in 60 (30 female) adult Type 1 (insulin-dependent) diabetic patients of Swiss descent, and were compared with levels obtained from 60 normal, non-diabetic control subjects matched for age and sex. Fetal haemoglobin levels were significantly higher in the diabetic patients (0.6 +/- 0.1%, mean +/- SEM; range: 0-3.6%) than in the control subjects (0.4 +/- 0.1%, p or = 0.6%) were found in 23 of 60 diabetic patients (38%) compared to 9 of 60 control subjects (15%; chi 2 = 8.35, p < 0.01). In addition, fetal haemoglobin levels in diabetic patients are weakly correlated with glycated haemoglobin (HbA1c) (r = 0.38, p < 0.01). Fetal haemoglobin results were confirmed with the alkali denaturation procedure, and by immunocytochemistry using a polyclonal rabbit anti-fetal haemoglobin antibody. A significant proportion of adult patients with Type 1 diabetes has elevated fetal haemoglobin levels. In certain patients this may lead to a substantial over-estimation of glycated haemoglobin levels, and consequently of estimated, average blood glucose levels. The reason for this increased prevalence of elevated fetal haemoglobin remains unclear, but it may be associated with poor glycaemic control