Probabilistic Evacuation Assessment with Real-time Monitoring Information

The present paper proposes a probabilistic modeling approach for assessment and decision support of tactical loss reduction for roadway tunnel systems subject to fire events. The proposed probabilistic modeling approach combines scenario-based risk models for the probabilistic representation of accidents and fires with agent-based probabilistic representations of the escape scenarios of persons. The Fehmarn-belt tunnel is used as case study and a real-time daily traffic (RTDT) curve is considered. The vehicle population and the number and categories of persons in individual vehicles are modelled probabilistically based on statistics from the European Union. The example focuses on the modelling and assessment of the effects of tunnel closure, as a risk reducing measure in case of fire, on the evacuation dynamics. The results show that fast hindrance of traffic entry into the tunnel system efficiently reduces the expected value of the number of exposed persons but at the same time increases the variance associated with the number of persons evacuated within a given time frame.This work is part of Femern SafetyLab Project, funded by the Danish Agency for Science and Higher Education

Effects of maternal calcium propionate supplementation on offspring productivity and meat metabolomic profile in sheep

This study determined the effect of dietary calcium propionate (CaPr) as a source of energy supplementation during the First Half of Gestation (FMG), the Second Half of Gestation (SMG), and during All Gestation (AG), on offspring post-weaning growth performance, meat quality, and meat metabolomic profile. Thirty-one pregnant ewes were assigned to one of four treatments: a) supplementation of 30 gd-1 of CaPr during the first half of gestation (day 1 to day 75, n = 8) (FMG); b) supplementation of 30 gd-1 of CaPr during the second half of gestation (day 76 to day 150, n = 8) (SMG); c) supplementation of 30 gd-1 of CaPr during all gestation (AG, n = 8); d) no CaPr supplementation (control; CS, n = 7). The ewes were ad libitum fed a basal diet based on oat hay and corn silage. Ewes were distributed in a completely randomized unbalanced design to four treatments. The FMG group had lower (P ≤ 0.05) birth weight and weaning weight than the CS group. However, the average daily gain was similar across all treatments. Empty body weight and FMG had lower values (P ≤ 0.05) than the other groups. Both FMG and AG had lower hot carcass weight (P ≤ 0.05) compared to CS, while CaPr treatments resulted in reduced hot carcass yield (P ≤ 0.05). Meat color and texture were similar among treatments. A principal component analysis between gestation stages showed a trend for separating CS and FMG from SMG and AG, and that was explained by 93.7% of the data variability (PC1 = 87.9% and PC2 = 5.8%). Regarding meat metabolomic profile, 23 compounds were positively correlated between all treatments. Only 2 were negatively correlated (eicosane and naphthalene 1,2,3); but tetradecanoic acid, hexadecane, undecane 5-methyl, (-)-alpha, hexadecenoic acid, octadecanoic acid, and octadecane had a highly significant correlation (P ≤ 0.05). Overall, dam supplementation with CaPr during different periods of gestation provoked changes in meat metabolites related to the biosynthesis of fatty acids in lambs without negative changes in lamb's growth performance and carcass quality

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Global variations in diabetes mellitus based on fasting glucose and haemogloblin A1c

Fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) are both used to diagnose diabetes, but may identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening had elevated FPG, HbA1c, or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardised proportion of diabetes that was previously undiagnosed, and detected in survey screening, ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the agestandardised proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global gap in diabetes diagnosis and surveillance.peer-reviewe

Depresión y ansiedad en las embarazadas

La pesquisa de depresión y ansiedad en las gestantes permite evitar el deterioro de la salud mental materna y las graves consecuencias sobre sus hijos. Se planteó analizar los niveles de depresión y ansiedad en embarazadas que acudieron a la consulta de perinatología y medicina materno-fetal de un Hospital Materno Infantil entre junio–agosto 2012. Se llevó a cabo un estudio correlacional, transversal y no experimental, con una muestra de 236 embarazadas excluyendo aquellas con diagnóstico anterior de depresión o ansiedad, enfermedad psiquiátrica previamente diagnosticada, patologías de base: Diabetes mellitus tipo 1 y 2, diabetes gestacional, hipertensión arterial sistémica, hipertensión arterial inducida por el embarazo, enfermedades inmunológicas, cáncer, síndrome de Down e infecciones de transmisión sexual y pacientes con discapacidad, a quienes se aplicó los Test de Hamilton para la depresión y ansiedad. El 56,4% pertenecen al estrato socioeconómico IV. 81% tenía una relación de pareja estable y 54,2% tenía un embarazo deseado, de las cuales 67,3% tuvo algún nivel de ansiedad y el 66,1% algún nivel de depresión. Las embarazadas con pareja inestable tienen un riesgo 8,5 veces mayor de presentar ansiedad y 6,5 veces mayor de presentar depresión, con respecto a las que tienen pareja estable. En mujeres con embarazo no deseado, el riesgo de presentar ansiedad fue 1,63 veces mayor que las que querían su gravidez y para la depresión el riesgo fue 1,66 veces mayor, sin embargo este hallazgo no fue estadísticamente significativo. Se concluye que hay elevados niveles de depresión y ansiedad en las embarazadas que tienen relación con tener una pareja inestable