The Effect of Cigarette Smoking on Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis.

OBJECTIVE: Studies suggest that smoking may be a risk factor for the development of microvascular complications such as diabetic peripheral neuropathy (DPN). The objective of this study was to assess the relationship between smoking and DPN in persons with type 1 or type 2 diabetes. RESEARCH DESIGN AND METHODS: A systematic review of the PubMed, Embase, and Cochrane clinical trials databases was conducted for the period from January 1966 to November 2014 for cohort, cross-sectional and case-control studies that assessed the relationship between smoking and DPN. Separate meta-analyses for prospective cohort studies and case-control or cross-sectional studies were performed using random effects models. RESULTS: Thirty-eight studies (10 prospective cohort and 28 cross-sectional) were included. The prospective cohort studies included 5558 participants without DPN at baseline. During follow-up ranging from 2 to 10 years, 1550 cases of DPN occurred. The pooled unadjusted odds ratio (OR) of developing DPN associated with smoking was 1.26 (95% CI 0.86-1.85; I(2) = 74%; evidence grade: low strength). Stratified analyses of the prospective studies revealed that studies of higher quality and with better levels of adjustment and longer follow-up showed a significant positive association between smoking and DPN, with less heterogeneity. The cross-sectional studies included 27,594 participants. The pooled OR of DPN associated with smoking was 1.42 (95% CI 1.21-1.65; I(2) = 65%; evidence grade: low strength). There was no evidence of publication bias. CONCLUSIONS: Smoking may be associated with an increased risk of DPN in persons with diabetes. Further studies are needed to test whether this association is causal and whether smoking cessation reduces the risk of DPN in adults with diabetes

Comparing Performance of Construction Projects Delivered through Different Delivery Methods

When new delivery methods are introduced in public procurement, it is customary to analyze and compare their performance against traditional methods. Many early studies compared performance of different project delivery systems, and often developed decision support tools to help owners follow a structured path in measuring performance and, consequently, choose the most appropriate project delivery method. However, the measurement process adopted by these studies was mostly specific to the dataset to be analyzed. Only rarely, it took into account differences deriving from varying project characteristics, and, therefore was not generalizable. Building upon these studies, this study proposes a general framework for comparing performance of projects delivered through different delivery methods. A discussion of how the framework could also be adapted to every industry sector is included. This work can help owners choose a set of metrics to evaluate and compare the performance of project portfolios delivered with more than one delivery method and different industry secto

Managing tobacco use: the neglected cardiovascular disease risk factor.

Cigarette smoking is a major risk factor for cardiovascular disease (CVD) and the leading avoidable cause of death worldwide. Exposure to secondhand smoke (SHS) increases the risk of CVD among non-smokers. Smoking cessation benefits all smokers, regardless of age or amount smoked. The excess risk of CVD is rapidly reversible, and stopping smoking after a myocardial infarction reduces an individual's risk of CVD mortality by 36% over 2 years. Smoking cessation is a key component of primary and secondary CVD prevention strategies, but tobacco use often receives less attention from cardiologists than other risk factors, despite the availability of proven treatments that improve smoking cessation rates. Both psychosocial counselling and pharmacotherapy are effective methods to help smokers quit, but they are most effective when used together. The first-line medications licensed to aid smoking cessation, nicotine replacement therapy, bupropion and varenicline, are effective in and appropriate for patients with CVD. An evidence-based approach for physicians is to routinely ask all patients about smoking status and SHS exposure, advise all smokers to quit and all patients to adopt smoke-free policies for their home and car, and offer all smokers in the office or hospital brief counselling, smoking cessation pharmacotherapy, and referral to local programmes where psychosocial support can be sustained in person or by telephone. Like other chronic diseases, tobacco use requires a long-term management strategy. It deserves to be managed as intensively as other CVD risk factors

Biomarkers of potential harm in people switching from smoking tobacco to exclusive e-cigarette use, dual use or abstinence: secondary analysis of Cochrane systematic review of trials of e-cigarettes for smoking cessation

Aims This study aims to compare biomarkers of potential harm between people switching from smoking combustible cigarettes (CC) completely to electronic cigarettes (EC), continuing to smoke CC, using both EC and CC (dual users) and using neither (abstainers), based on behaviour during EC intervention studies. Design Secondary analysis following systematic review, incorporating inverse variance random-effects meta-analysis and effect direction plots. Setting This study was conducted in Greece, Italy, Poland, the United Kingdom and the United States. Participants A total of 1299 adults smoking CC (nine studies) and provided EC. Measurements Measurements were conducted using carbon monoxide (CO) and 26 other biomarkers. Findings In pooled analyses, exhaled CO (eCO) was lower in EC versus EC + CC [mean difference (MD) = −4.40 parts per million (p.p.m.), 95% confidence interval (CI) = −12.04 to 3.24, two studies] and CC (MD = −9.57 p.p.m., 95% CI = −17.30 to −1.83, three studies). eCO was lower in dual users versus CC only (MD = −1.91 p.p.m., 95% CI = −3.38 to −0.45, two studies). Magnitude rather than direction of effect drove substantial statistical heterogeneity. Effect direction plots were used for other biomarkers. Comparing EC with CC, 12 of 13 biomarkers were significantly lower in EC users, with no difference for the 13th. Comparing EC with dual users, 12 of the 25 biomarkers were lower for EC, and five were lower for dual use. For the remaining eight measures, single studies did not detect statistically significant differences, or the multiple studies contributing to the outcome had inconsistent results. Only one study provided data comparing dual use with CC; of the 13 biomarkers measured, 12 were significantly lower in the dual use group, with no statistically significant difference detected for the 13th. Only one study provided data on abstainers. Conclusions Switching from smoking to vaping or dual use appears to reduce levels of biomarkers of potential harm significantly

Redundancy, Deduction Schemes, and Minimum-Size Bases for Association Rules

Association rules are among the most widely employed data analysis methods in the field of Data Mining. An association rule is a form of partial implication between two sets of binary variables. In the most common approach, association rules are parameterized by a lower bound on their confidence, which is the empirical conditional probability of their consequent given the antecedent, and/or by some other parameter bounds such as "support" or deviation from independence. We study here notions of redundancy among association rules from a fundamental perspective. We see each transaction in a dataset as an interpretation (or model) in the propositional logic sense, and consider existing notions of redundancy, that is, of logical entailment, among association rules, of the form "any dataset in which this first rule holds must obey also that second rule, therefore the second is redundant". We discuss several existing alternative definitions of redundancy between association rules and provide new characterizations and relationships among them. We show that the main alternatives we discuss correspond actually to just two variants, which differ in the treatment of full-confidence implications. For each of these two notions of redundancy, we provide a sound and complete deduction calculus, and we show how to construct complete bases (that is, axiomatizations) of absolutely minimum size in terms of the number of rules. We explore finally an approach to redundancy with respect to several association rules, and fully characterize its simplest case of two partial premises.Comment: LMCS accepted pape

Multicentre Withinperson Randomised Controlled Trial of 0.5 Mm Versus 1.5 Mm Subcrestal Placement of Dental Implants With Internal Conical Connection: Five-year Post-loading Results

PURPOSE. To assess whether there are any clinical benefits to placing single dental implants either 0.5 or 1.5 mm subcrestally in healed bone crests. MATERIALS AND METHODS. Sixty partially edentulous patients at six centres requiring two single implant-supported crowns had both sites randomly allocated according to a split-mouth design to either 0.5 mm or 1.5 mm subcrestal implant placement; implants in aesthetic areas were submerged for 3 months while those in non-aesthetic areas were not. Provisional acrylic crowns were fitted and replaced with definitive metal-ceramic crowns after 2 months. Patients were followed up to 5 years after loading. Outcome measures were: crown and implant failures, complications, aesthetics assessed using the pink esthetic score (PES), peri-implant marginal bone level changes, and patient prefe-rence, recorded by blinded assessors. RESULTS. Two patients dropped out. There were no statistically significant differences in failure rate (out of 58 patients, four implants failed in the 0.5 mm group versus one in the 1.5 mm group; difference =-5.17%; 95% CI-10.87% to 0.53%; P = 0.250) or complications (out of 58 patients eight complications occurred in eight patients from the 0.5 mm group versus five complications in five patients from the 1.5 mm group (difference =-5.17%; 95% CI-14.01% to 3.67%; P = 0.453) between groups. At 5 years after loading, the mean pink aesthetic scores were 10.89 ± 2.30 and 10.79 ± 2.41 in the 0.5 and 1.5 mm groups, respecti-vely, a difference that was not statistically significant (P = 0.943). Patients from the 0.5 mm group lost on average 0.53 ± 1.43 mm peri-implant marginal bone, and those in the 1.5 mm group lost 0.31 ± 0.98 mm, a statistically significant difference (0.26 mm; 95% CI 0.05 to 0.47; P = 0.016). Patients did not prefer any depth of implant placement over the other. There were no differences in outcomes between centres. CONCLUSIONS. No clinically appreciable differences were noted when placing implants surrounded by at least 1 mm of bone 0.5 mm or 1.5 mm subcrestally. Clinicians are therefore free to choose which strategy they prefer

Multisensory causal inference in the brain

At any given moment, our brain processes multiple inputs from its different sensory modalities (vision, hearing, touch, etc.). In deciphering this array of sensory information, the brain has to solve two problems: (1) which of the inputs originate from the same object and should be integrated and (2) for the sensations originating from the same object, how best to integrate them. Recent behavioural studies suggest that the human brain solves these problems using optimal probabilistic inference, known as Bayesian causal inference. However, how and where the underlying computations are carried out in the brain have remained unknown. By combining neuroimaging-based decoding techniques and computational modelling of behavioural data, a new study now sheds light on how multisensory causal inference maps onto specific brain areas. The results suggest that the complexity of neural computations increases along the visual hierarchy and link specific components of the causal inference process with specific visual and parietal regions

Correlation among monitoring methods of surface cleaning and disinfection in outpatient facilities

Objectives: To evaluate the correlation among microbiological culture, ATP bioluminescence assay, and visual inspection in monitoring the effectiveness of surface cleaning and disinfection in an outpatient facility and determine the ATP bioluminescence cutoff capable of indicating a clean surface regarding microbiological evaluation. Methods: Exploratory, cross-sectional, and correlation study consisting of 720 evaluations in five surfaces before and after cleaning and disinfection. The results were used to run two-proportions tests, calculate Spearman's correlation, and plot the receiver operating characteristic curve. Results: Similar proportions (p≥0.05) occurred for non-approval rates between ATP-bioluminescence and aerobic colony count only when the evaluations of all the surfaces before and after cleaning and disinfection were put together. There was a significant correlation between the ATP quantification and microbial count methods for the reception desk and the stretcher. Receiver operating characteristic analysis indicated that ATP quantification showed a significant result in comparison with aerobic colony count (p=0.044). Conclusion: There was a discrete correlation between the ATP quantification and microbial count methods for two surfaces. It is suggested that surfaces showing values ≤49 relative light units are clean.publishersversionpublishe

Epicardial fat, abdominal adiposity and insulin resistance in obese pre-pubertal and early pubertal children.

OBJECTIVE: To assess the cross-sectional association of epicardial fat with insulin resistance, major abdominal adipose depots, and cardiovascular disease (CVD) risk factors in obese pre-pubertal and early pubertal children. METHODS: By using magnetic resonance imaging in 30 pre-pubertal and early pubertal patients [21 males, Tanner Stage I-II, median age 11.2 (2.95) y, BMI z-score 2.56 \ub1 0.11 SDS], visceral (VAT), subcutaneous (SAT), epicardial adipose tissues (EAT) and hepatic fat fraction (HFF) were estimated. Lipid profile, liver function tests, circulating adipokines and markers of inflammation [leptin, adiponectin, tumor necrosis factors-alpha (TNF-alpha), C-reactive protein (CRP), interleukins 6 and 10 (IL-6, IL-10)] were assayed. Insulin resistance was estimated by the homeostasis model assessment of insulin resistance (HOMA-IR). Body composition was measured by dual-energy X-ray absorptiometry. RESULTS: In 14 insulin resistant children (HOMA-IR >2.5), median values of EAT were significantly higher than in insulin sensitive mates [54.0 (35.45) cm(3) vs. 27.2 (17.03) cm(3); p = 0.03]. Moreover, EAT performed no differently in identifying insulin resistant patients (AUC 0.737; 95% CI 0.538-0.936; p = 0.028) from VAT (AUC 0.772; 95% CI 0.599-0.945; p = 0.011); SAT (AUC 0.795; 95% CI 0.628-0.0.962; p = 0.006); and HFF (AUC 0.777; 95% CI 0.607-0.947; p = 0.010). Stepwise regression analysis showed that EAT (\u3b2 = 0.025; 95% CI 0.012-0.038, p = 0.001) and CRP (\u3b2 = 0.622; 95% CI 0.069-0.238, p = 0.002) predicted HOMA-IR (R(2) = 0.71; p = 0.001), while VAT, SAT and HFF were excluded from the model. CONCLUSIONS: In pre-pubertal and early pubertal obese children, EAT is a significant marker of increased insulin resistance and associated cardiovascular risk

Immune activation, immune senescence and levels of Epstein Barr Virus in kidney transplant patients: Impact of mTOR inhibitors

Post-transplant lymphoproliferative disorders (PTLD) represent a severe complication in transplanted patients and Epstein-Barr Virus (EBV) is the main driver. Besides immunodepression, immune activation/chronic inflammation play an important role in both virus reactivation and expansion of EBV-positive B cells. The aim of this study was to assess the impact of immunosuppressive strategies on factors involved in the PTLD's pathogenesis. 124 kidney transplanted patients were enrolled in this study: 71 were treated with mycophenolic acid (MPA) and 53 treated with mTOR inhibitor (mTORi), both in combination with different doses of calcineurin inhibitor. At the time of the transplant (T0), profile of inflammation/immune activation and immune senescence didn't differ between the two groups, but after one year of treatment (T1) markers were significantly higher in MPA-treated patients; their immunosenescence process was supported by the greater erosion of telomeres despite their younger age. Percentages of activated B cells and levels of EBV-DNA significantly increased in MPA-treated patients, and at T1 were significantly higher in MPA- than in mTORi-treated patients. Overall, these findings indicate that mTOR inhibitors constrain the inflammation/immune activation and senescence status, thus reducing the expansion of EBV-infected B cells and the risk of virus-associated PTLD in kidney transplant recipients. \ua9 2019 The Author