A systematic review of real-world diabetes prevention programs: Learnings from the last 15 years

Background The evidence base for the prevention of type 2 diabetes mellitus (T2DM) has progressed rapidly from efficacy trials to real-world translational studies and practical implementation trials over the last 15 years. However, evidence for the effective implementation and translation of diabetes programs and their population impact needs to be established in ways that are different from measuring program effectiveness. We report the findings of a systematic review that focuses on identifying the critical success factors for implementing diabetes prevention programs in real-world settings. Methods A systematic review of programs aimed at diabetes prevention was undertaken in order to evaluate their outcomes using the penetration, implementation, participation, and effectiveness (PIPE) impact metric. A search for relevant articles was carried out using PubMed (March 2015) and Web of Science, MEDLINE, CENTRAL, and EMBASE. A quality coding system was developed and included studies were rated independently by three researchers. Results Thirty eight studies were included in the review. Almost all (92 %) provided details on participation; however, only 18 % reported the coverage of their target population (penetration). Program intensity or implementation—as measured by frequency of contacts during first year and intervention duration—was identified in all of the reported studies, and 84 % of the studies also reported implementation fidelity; however, only 18 % of studies employed quality assurance measures to assess the extent to which the program was delivered as planned. Sixteen and 26 % of studies reported ‘highly’ or ‘moderately’ positive changes (effectiveness) respectively, based on weight loss. Six (16 %) studies reported ‘high’ diabetes risk reduction but ‘low’ to ‘moderate’ weight loss only. Conclusion Our findings identify that program intensity plays a major role in weight loss outcomes. However, programs that have high uptake—both in terms of good coverage of invitees and their willingness to accept the invitation—can still have considerable impact in lowering diabetes risk in a population, even with a low intensity intervention that only leads to low or moderate weight loss. From a public health perspective, this is an important finding, especially for resource constrained settings. More use of the PIPE framework components will facilitate increased uptake of T2DM prevention programs around the world

potential biomarkers of haemophilic arthropathy correlations with compatible additive magnetic resonance imaging scores

Introduction: Although biomarkers are useful diagnostic tools to assess joint damage in osteoarthritis and rheumatoid arthritis, few data exist for biomarkers of haemophilic arthropathy. Aim: To evaluate the association between biomarkers and compatible additive magnetic resonance imaging (MRI) scores in patients with severe haemophilia A. Methods: Patients aged 12–35 years with no history of factor VIII (FVIII) inhibitors were enrolled in a controlled, cross-sectional, multinational investigation. Patients received primary or secondary prophylaxis or on-demand treatment with FVIII and underwent MRI on four joints (two ankles, two knees). Soluble biomarkers of cartilage and bone degradation, inflammation, and angiogenesis were assessed (serum levels of C-terminal telopeptides of type I collagen [CTX-I], cartilage oligomeric matrix protein [COMP], chondroitin-sulphate aggrecan turnover 846 epitope [CS846], tissue inhibitor of metalloproteinase 1 [TIMP-1]; plasma levels of vascular endothelial growth factor [VEGF], matrix metalloproteinases 3 and 9 [MMP3, MMP9]). Relationships between biomarkers and MRI scores were evaluated using Spearman rank correlation. Results: Biomarkers were assessed in 117 of 118 per-protocol patients. Mean and median CTX-I, COMP, TIMP-1, MMP3, MMP9, and VEGF values were within normal ranges (reference range not available for CS846 in healthy volunteers). No correlations between biomarkers and MRI scores were found, with the exception of CS846, which showed significant correlation in a subgroup of 22 on-demand patients (r = 0.436; P = 0.04). Conclusions: Compatible additive MRI scores showed no clear correlations with any of the potential biomarkers for haemophilic arthropathy in the overall population. CS846 levels were significantly correlated with MRI scores in patients treated on demand. (Less

Partonic effects on anisotropic flows at RHIC

We report recent results from a multiphase transport (AMPT) model on the azimuthal anisotropies of particle momentum distributions in heavy ion collisions at the Relativistic Heavy Ion Collider. These include higher-order anisotropic flows and their scaling, the rapidity dependence of anisotropic flows, and the elliptic flow of charm quarks.Comment: 7 pages, 5 figures, talk given at "Hot Quarks 2004", July 18-24, 2004, Taos Valley, NM, US

Measuring and Modeling Fault Density for Plume-Fault Encounter Probability Estimation

Emission of carbon dioxide from fossil-fueled power generation stations contributes to global climate change. Storage of this carbon dioxide within the pores of geologic strata (geologic carbon storage) is one approach to mitigating the climate change that would otherwise occur. The large storage volume needed for this mitigation requires injection into brine-filled pore space in reservoir strata overlain by cap rocks. One of the main concerns of storage in such rocks is leakage via faults. In the early stages of site selection, site-specific fault coverages are often not available. This necessitates a method for using available fault data to develop an estimate of the likelihood of injected carbon dioxide encountering and migrating up a fault, primarily due to buoyancy. Fault population statistics provide one of the main inputs to calculate the encounter probability. Previous fault population statistics work is shown to be applicable to areal fault density statistics. This result is applied to a case study in the southern portion of the San Joaquin Basin with the result that the probability of a carbon dioxide plume from a previously planned injection had a 3% chance of encountering a fully seal offsetting fault

Experience with the introduction of dry, urine-diverting sanitation systems in Ethiopia

To overcome the drawbacks of conventional sanitation systems, new approaches to sanitation are necessary. Human faeces and urine as well as greywater represent potential resources requiring efficient management. Thus, source-separating systems, which safe water and allow the recycling of nutrients to agriculture, can provide an alternative. These systems can even be integrated into multistorey houses, therefore addressing the need for resource efficient sanitation in condominium housing programmes. Several urine separating facilities are implemented in Ethiopia showing a high acceptance by their users. The cost comparison between source-separating systems and the conventional system for condominium houses shows an advantage for the new approach due to savings of water for toilet flushing as well as reduced costs for the treatment of the wastewater in septic tanks. The use of human urine as fertiliser in several trials resulted in significant benefits in terms of improved crop growth

Long-term effectiveness of a lifestyle intervention on the prevention of type 2 diabetes in a middle-income country

This study aims to assess the effects of a community-based lifestyle intervention program on the incidence of type 2 diabetes (T2D). For this purpose, three communities in Tehran were chosen; one community received a face-to-face educational session embedded in a long-term community-wide lifestyle intervention aimed at supporting lifestyle changes. We followed up 9,204 participants (control: 5,739, intervention: 3,465) triennially from 1999 to 2015 (Waves 1–5). After a median follow-up of 3.5 years (wave 2), the risk of T2D was 30% lower in the intervention community as compared with two control communities by (Hazard-ratio: 0.70 [95% CI 0.53; 0.91]); however, the difference was not statistically significant in the following waves. After a median follow-up of 11.9 years (wave 5), there was a non-significant 6% reduction in the incidence of T2D in the intervention group as compared to the control group (Hazard-ratio: 0.94 [0.81, 1.08]). Moreover, after 11.9 years of follow-up, the intervention significantly improved the diet quality measured by the Dietary Approaches to Stop Hypertension concordance (DASH) score. Mean difference in DASH score in the intervention group versus control group was 0.2 [95% CI 0.1; 0.3]. In conclusion, the intervention prevented T2D by 30% in the short-term (3.5 years) but not long-term; however, effects on improvement of the diet maintained in the long-term.Registration: This study is registered at IRCT, a WHO primary registry (https://irct.ir). The registration date 39 is 2008-10-29 and the IRCT registration number is IRCT138705301058N1

Case studies of the application of the Certification Framework to two geologic carbon sequestration sites

We have developed a certification framework (CF) for certifying that the risks of geologic carbon sequestration (GCS) sites are below agreed-upon thresholds. The CF is based on effective trapping of CO2, the proposed concept that takes into account both the probability and impact of CO2 leakage. The CF uses probability estimates of the intersection of conductive faults and wells with the CO2 plume along with modeled fluxes or concentrations of CO2 as proxies for impacts to compartments (such as potable groundwater) to calculate CO2 leakage risk. In order to test and refine the approach, we applied the CF to (1) a hypothetical large-scale GCS project in the Texas Gulf Coast, and (2) WESTCARB's Phase III GCS pilot in the southern San Joaquin Valley, California