Moderate glucose control results in less negative nitrogen balances in medical intensive care unit patients: a randomized, controlled study

INTRODUCTION: Hyperglycemia and protein loss are common in critically ill patients. Insulin can be used to lower blood glucose and inhibit proteolysis. The impact of moderate insulin therapy on protein metabolism in critically ill patients has not been evaluated. We compared urinary nitrogen excretion, nitrogen balance, serum albumin concentrations, prealbumin concentrations, and clinical outcomes between patients receiving moderate insulin therapy (MIT) and conventional insulin therapy (CIT) in a medical ICU. METHODS: Patients were randomly divided into groups and treated with MIT (glucose target 120 to 140 mg/dl) or CIT (glucose target 180 to 200 mg/dl). Calories and protein intake were recorded each day. On days 3, 7 and 14, the 24-hour urinary nitrogen excretion, nitrogen balance, and serum albumin and prealbumin concentrations were measured. Clinical outcomes data were collected. RESULTS: A total of 112 medical ICU patients were included, with 55 patients randomized to the MIT group and 57 patients randomized to the CIT group. Patients treated with MIT showed a trend towards increased nitrogen balance (P = 0.070), significantly lower urinary nitrogen excretion (P = 0.027), and higher serum albumin (P = 0.047) and prealbumin (P = 0.001) concentrations than patients treated with CIT. The differences between the two groups were most significant on day 3, when all factors showed significant differences (P < 0.05). CONCLUSIONS: Moderate glucose control results in less negative nitrogen balances in medical ICU patients. Differences are more significant in the early stages compared with the late stages of critical illness. TRIAL REGISTRATION: ClinicalTrial.Gov NCT 0122714

Risk Factors for HIV-1 seroconversion among Taiwanese men visiting gay saunas who have sex with men

<p>Abstract</p> <p>Background</p> <p>Men having sex with men (MSM) accounts for 33.6% of all reported cases of HIV-1 infection in Taiwan. The aim of this study was to investigate the epidemiology of HIV-1 infection among MSM in gay saunas in Taiwan.</p> <p>Methods</p> <p>Patrons of 5 gay saunas were recruited for a weekly volunteer counseling and testing program from 2001 to 2005. Questionnaires were collected for a risk factor analysis. HIV-1 subtypes were determined using DNA sequencing and phylogenetic analyses.</p> <p>Results</p> <p>HIV-1 prevalence rates among MSM in gay saunas in 2001 through 2005 were 3.4%, 5.1%, 8.9%, 8.5%, and 8.3%, respectively. In total, 81 of 1, 093 (7.4%) MSM had HIV-1 infection. Fifty-two HIV-1 strains were genotyped, and all of them were subtype B. HIV-seropositive men were significantly younger than the seronegatives. Only 37.1% used condoms every time during sexual intercourse. A multivariate logistic regression analysis showed that the risk factors for HIV-1 were being uncircumcised (odds ratio (OR) = 2.19; 95% confidence interval (CI), 1.08~4.45); having sexual intercourse with at least 2 partners during each sauna visit (≥ 2 vs. ≤ 1, OR = 1.71; 95% CI, 1.02~2.89); and the role played during anal intercourse (versatile vs. an exclusively insertive role, OR = 2.76; 95% CI, 1.42~5.36).</p> <p>Conclusions</p> <p>Overall, 7.4% Taiwanese MSM participating in this study had HIV-1 subtype B infection. Uncircumcised, being versatile role during anal intercourse, and having sex with more than one person during each sauna visit were main risk factors for HIV-1 infection.</p

Incident type 2 diabetes attributable to suboptimal diet in 184 countries

The global burden of diet-attributable type 2 diabetes (T2D) is not well established. This risk assessment model estimated T2D incidence among adults attributable to direct and body weight-mediated effects of 11 dietary factors in 184 countries in 1990 and 2018. In 2018, suboptimal intake of these dietary factors was estimated to be attributable to 14.1 million (95% uncertainty interval (UI), 13.8–14.4 million) incident T2D cases, representing 70.3% (68.8–71.8%) of new cases globally. Largest T2D burdens were attributable to insufficient whole-grain intake (26.1% (25.0–27.1%)), excess refined rice and wheat intake (24.6% (22.3–27.2%)) and excess processed meat intake (20.3% (18.3–23.5%)). Across regions, highest proportional burdens were in central and eastern Europe and central Asia (85.6% (83.4–87.7%)) and Latin America and the Caribbean (81.8% (80.1–83.4%)); and lowest proportional burdens were in South Asia (55.4% (52.1–60.7%)). Proportions of diet-attributable T2D were generally larger in men than in women and were inversely correlated with age. Diet-attributable T2D was generally larger among urban versus rural residents and higher versus lower educated individuals, except in high-income countries, central and eastern Europe and central Asia, where burdens were larger in rural residents and in lower educated individuals. Compared with 1990, global diet-attributable T2D increased by 2.6 absolute percentage points (8.6 million more cases) in 2018, with variation in these trends by world region and dietary factor. These findings inform nutritional priorities and clinical and public health planning to improve dietary quality and reduce T2D globally.publishedVersio

The effects of mirror therapy on cross transfer of fine motor skills in healthy adults

Cross-transfer (CT) is a phenomenon where the training of one limb enhances the performance in the untrained limb. Mirror therapy (MT) is the use of a mirror to create a reflective illusion of the corresponding limb movement. The study aims to determine whether the combination of MT with cross-transfer training (CTT) will increase cross-transfer effect (CTE) than just CTT alone. It was hypothesized that the addition of MT will increase CTE compared to CTT alone. 30 right-handed students (16 male, 14 females) from Nanyang Technological University were recruited. Participants were randomly assigned to an intervention or control group and tasked to complete 13 star tracing task (STT) – 3 with the dominant hand, 7 with the non-dominant hand, then 3 with the dominant hand. The intervention group performed the middle 7 STT with MT and CTT, while the control group conducted them with CTT alone. A head-cap containing functional near-infrared spectroscopy (fNIRS) technology that measures oxyhemoglobin (HbO) and deoxyhemoglobin concentration changes in the primary motor cortex (M1) was utilized. Reaction time (RT), accuracy, HbO concentration in both right and left hemispheres of M1 were measured. Significant difference in RT between Pretest and Posttest (p = 0.029) was found, but not found in accuracy (p = 0.90), HbO concentration in the right (p = 537) and left (p = 0.09) M1. In conclusion, addition of MT to CTT increasing CTE is only associated with RT improvement but not with other variables.Bachelor of Science (Sport Science and Management

Discrete choice experiment examining the preferences of people with cancer

&nbsp;Our study suggest that patient-centred health care models should focus on improving patient access to health care, supporting the role of carers and non-oncology health care providers as well as providing education about health care resources

Corporate governance and code development in Singapore.

Studies the evolution and developments of the code and other corporate governance issues in Singapore. Discusses important topics such as the definition of independence and the state's role in influencing corporate governance in Singapore

Significant determinants of knowledge-worker productivity in Singapore today.

Identifies significant determinants of Knowledge-Worker Productivity in Singapore Companies Toda

A comparison of supply chain decision-making factors between foreign and local retailers in Taiwan

With the present economic trends of globalization, the retailing businesses, along with many other businesses, have extended their operations beyond the national boundaries. Meanwhile, the competition scenario within retailing industry has now evolved from competition between individual companies to that between supply chains. Thus, retailing companies need to consider the relevant factors determining their performance from a holistic view. This paper studies and compares the decision factors related to supply chain network design between international and local retailers in Taiwan. By comparing the different views from local retailers and the international retailers, the authors try to obtain a general understanding of the differences regarding the importance of the factors to the two groups of retailers. This research outcome could be used as a guide by the retailing industry in their supply chain network design in this particular region, and also as a fundament for further research in a wider range