Diabetic renal disease

Diabetic nephropathy (DN) is an important long-term complication of diabetes. DN is now the most common cause of end-stage renal disease (ESRD) in many countries [1]. Both the increasing prevalence of type 2 DMand increased acceptance of diabetic patients into renal replacement therapy (RRT) programmes have contributed to this. Indeed, there has been a marked increase in the incidence of renal replacement therapy (RRT) for type 2 DM over time [1]. DN is also a major burden on health care budgets [2] and is associated with a reduction in health-related quality of life [3, 4].Moreover, DN is associated with increased cardiovascular mortality in both type 1 and type 2 diabetic patients [5, 6].peer-reviewe

A Summary of the Experimental Results for a Generic Tractor-Trailer in the Ames Research Center 7- by 10-Foot and 12-Foot Wind Tunnels

Experimental measurements of a generic tractor-trailer were obtained in two wind tunnels at Ames Research Center. After a preliminary study at atmospheric conditions in the 7- by 10-Foot Wind Tunnel, additional testing was conducted at Reynolds numbers corresponding to full-scale highway speeds in the 12-Foot Pressure Wind Tunnel. To facilitate computational modeling, the 1:8-scale geometry, designated the Generic Conventional Model, included a simplified underbody and omitted many small-scale details. The measurements included overall and component forces and moments, static and dynamic surface pressures, and three-component particle image velocimetry. This summary report highlights the effects of numerous drag reduction concepts and provides details of the model installation in both wind tunnels. To provide a basis for comparison, the wind-averaged drag coefficient was tabulated for all configurations tested. Relative to the baseline configuration representative of a modern class-8 tractor-trailer, the most effective concepts were the trailer base flaps and trailer belly box providing a drag-coefficient reduction of 0.0855 and 0.0494, respectively. Trailer side skirts were less effective yielding a drag reduction of 0.0260. The database of this experimental effort is publicly available for further analysis

Modern approaches to pediatric brain injury therapy.

Each year, pediatric traumatic brain injury (TBI) accounts for 435,000 emergency department visits, 37,000 hospital admissions, and approximately 2,500 deaths in the United States. TBI results in immediate injury from direct mechanical force and shear. Secondary injury results from the release of biochemical or inflammatory factors that alter the loco-regional milieu in the acute, subacute, and delayed intervals after a mechanical insult. Preliminary preclinical and clinical research is underway to evaluate the benefit from progenitor cell therapeutics, hypertonic saline infusion, and controlled hypothermia. However, all phase III clinical trials investigating pharmacologic monotherapy for TBI have shown no benefit. A recent National Institutes of Health consensus statement recommends research into multimodality treatments for TBI. This article will review the complex pathophysiology of TBI as well as the possible therapeutic mechanisms of progenitor cell transplantation, hypertonic saline infusion, and controlled hypothermia for possible utilization in multimodality clinical trials

Evaluating the impact of patients' online access to doctors' visit notes: designing and executing the OpenNotes project

Background: Providers and policymakers are pursuing strategies to increase patient engagement in health care. Increasingly, online sections of medical records are viewable by patients though seldom are clinicians' visit notes included. We designed a one-year multi-site trial of online patient accessible office visit notes, OpenNotes. We hypothesized that patients and primary care physicians (PCPs) would want it to continue and that OpenNotes would not lead to significant disruptions to doctors' practices. Methods/Design: Using a mixed methods approach, we designed a quasi-experimental study in 3 diverse healthcare systems in Boston, Pennsylvania, and Seattle. Two sites had existing patient internet portals; the third used an experimental portal. We targeted 3 key areas where we hypothesized the greatest impacts: beliefs and attitudes about OpenNotes, use of the patient internet portals, and patient-doctor communication. PCPs in the 3 sites were invited to participate in the intervention. Patients who were registered portal users of participating PCPs were given access to their PCPs' visit notes for one year. PCPs who declined participation in the intervention and their patients served as the comparison groups for the study. We applied the RE-AIM framework to our design in order to capture as comprehensive a picture as possible of the impact of OpenNotes. We developed pre- and post-intervention surveys for online administration addressing attitudes and experiences based on interviews and focus groups with patients and doctors. In addition, we tracked use of the internet portals before and during the intervention. Results: PCP participation varied from 19% to 87% across the 3 sites; a total of 114 PCPs enrolled in the intervention with their 22,000 patients who were registered portal users. Approximately 40% of intervention and non-intervention patients at the 3 sites responded to the online survey, yielding a total of approximately 38,000 patient surveys. Discussion: Many primary care physicians were willing to participate in this "real world" experiment testing the impact of OpenNotes on their patients and their practices. Results from this trial will inform providers, policy makers, and patients who contemplate such changes at a time of exploding interest in transparency, patient safety, and improving the quality of care

Autosomal dominant reticuloendothelial iron overload associated with a 3-base pair deletion in the ferroportin 1 gene (SLC11A3)

We describe a family with autosomal dominant inheritance of increased body iron stores characterized by raised serum ferritin concentration and normal transferrin saturation. Liver biopsy showed iron deposition in Kupffer cells without fibrosis. The clinical features of HFE-related hemochromatosis were absent, as were the Cys282Tyr and His63Asp mutations. Venesection therapy was poorly tolerated, suggesting a defect in iron release from reticuloendothelial stores. A 3-base pair deletion in exon 5 of the ferroportin 1 gene (SLC11A3) predicting Val162 deletion was found in affected members, but not in unaffected individuals or in 100 control subjects. Consensus structural predictions of the transmembrane helices showed that the deletion is in the extracellular loop between the third and fourth predicted transmembrane helices and lies within a spatial cluster of other known ferroportin 1 mutations. These results indicate that this extracellular cluster is functionally important for iron transport, and its disruption leads to iron overload

Seasonal decline in leaf photosynthesis in perennial switchgrass explained by sink limitations and water deficit

Leaf photosynthesis of perennial grasses usually decreases markedly from early to late summer, even when the canopy remains green and environmental conditions are favorable for photosynthesis. Understanding the physiological basis of this photosynthetic decline reveals the potential for yield improvement. We tested the association of seasonal photosynthetic decline in switchgrass (Panicum virgatum L.) with water availability by comparing plants experiencing ambient rainfall with plants in a rainfall exclusion experiment in Michigan, USA. For switchgrass exposed to ambient rainfall, daily net CO2 assimilation ( Anet') declined from 0.9 mol CO2 m-2 day-1 in early summer to 0.43 mol CO2 m-2 day-1 in late summer (53% reduction; P<0.0001). Under rainfall exclusion shelters, soil water content was 73% lower and Anet' was 12% and 26% lower in July and September, respectively, compared to those of the rainfed plants. Despite these differences, the seasonal photosynthetic decline was similar in the season-long rainfall exclusion compared to the rainfed plants; Anet' in switchgrass under the shelters declined from 0.85 mol CO2 m-2 day-1 in early summer to 0.39 mol CO2 m-2 day-1 (54% reduction; P<0.0001) in late summer. These results suggest that while water deficit limited Anet' late in the season, abundant late-season rainfalls were not enough to restore Anet' in the rainfed plants to early-summer values suggesting water deficit was not the sole driver of the decline. Alongside change in photosynthesis, starch in the rhizomes increased 4-fold (P<0.0001) and stabilized when leaf photosynthesis reached constant low values. Additionally, water limitation under shelters had no negative effects on the timing of rhizome starch accumulation, and rhizome starch content increased ~ 6-fold. These results showed that rhizomes also affect leaf photosynthesis during the growing season. Towards the end of the growing season, when vegetative growth is completed and rhizome reserves are filled, diminishing rhizome sink activity likely explained the observed photosynthetic declines in plants under both ambient and reduced water availability

Identification of mantle peridotite as a possible Iapetan ophiolite sliver in south Shetland, Scottish Caledonides

The Neoproterozoic Dunrossness Spilite Subgroup of south Shetland, Scotland, has been interpreted as a series of komatiitic and mafic lava flows formed in a marginal basin in response to Laurentian continental margin rifting. We show that ultramafic rocks previously identified as komatiites are depleted mantle peridotites that experienced seafloor hydrothermal alteration. The presence of positive Bouguer gravity and aeromagnetic anomalies extending from the Dunrossness Spilite Subgroup northward to the Shetland Ophiolite Complex suggests instead that these rocks may form part of an extensive ophiolite sliver, obducted during Iapetus Ocean closure in a forearc setting