A randomized controlled trial of the effect of thyroxine replacement on cognitive function in community-living elderly subjects with subclinical hypothyroidism: the Birmingham elderly thyroid study

Context: Subclinical hypothyroidism (SCH) and cognitive dysfunction are both common in the elderly and have been linked. It is important to determine whether T4 replacement therapy in SCH confers cognitive benefit. Objective: Our objective was to determine whether administration of T4 replacement to achieve biochemical euthyroidism in subjects with SCH improves cognitive function. Design and Setting: We conducted a double-blind placebo-controlled randomized controlled trial in the context of United Kingdom primary care. Patients: Ninety-four subjects aged 65 yr and over (57 females, 37 males) with SCH were recruited from a population of 147 identified by screening. Intervention: T4 or placebo was given at an initial dosage of one tablet of either placebo or 25 µg T4 per day for 12 months. Thyroid function tests were performed at 8-weekly intervals with dosage adjusted in one-tablet increments to achieve TSH within the reference range for subjects in treatment arm. Fifty-two subjects received T4 (31 females, 21 males; mean age 73.5 yr, range 65–94 yr); 42 subjects received placebo (26 females, 16 males; mean age 74.2 yr, 66–84 yr). Main Outcome Measures: Mini-Mental State Examination, Middlesex Elderly Assessment of Mental State (covering orientation, learning, memory, numeracy, perception, attention, and language skills), and Trail-Making A and B were administered. Results: Eighty-two percent and 84% in the T4 group achieved euthyroidism at 6- and 12-month intervals, respectively. Cognitive function scores at baseline and 6 and 12 months were as follows: Mini-Mental State Examination T4 group, 28.26, 28.9, and 28.28, and placebo group, 28.17, 27.82, and 28.25 [not significant (NS)]; Middlesex Elderly Assessment of Mental State T4 group, 11.72, 11.67, and 11.78, and placebo group, 11.21, 11.47, and 11.44 (NS); Trail-Making A T4 group, 45.72, 47.65, and 44.52, and placebo group, 50.29, 49.00, and 46.97 (NS); and Trail-Making B T4 group, 110.57, 106.61, and 96.67, and placebo group, 131.46, 119.13, and 108.38 (NS). Linear mixed-model analysis demonstrated no significant changes in any of the measures of cognitive function over time and no between-group difference in cognitive scores at 6 and 12 months. Conclusions: This RCT provides no evidence for treating elderly subjects with SCH with T4 replacement therapy to improve cognitive function.

Role of community acceptance in sustainable bioenergy projects in India

Community acceptance has been identified as one of the key requirements for a sustainable bioenergy project. However less attention has been paid to this aspect from developing nations and small projects perspective. Therefore this research examines the role of community acceptance for sustainable small scale bioenergy projects in India. While addressing the aim, this work identifies influence of community over bioenergy projects, major concerns of communities regarding bioenergy projects and factors influencing perceptions of communities about bioenergy projects. The empirical research was carried out on four bioenergy companies in India as case studies. It has been identified that communities have significant influence over bioenergy projects in India. Local air pollution, inappropriate storage of by-products and credibility of developer are identified as some of the important concerns. Local energy needs, benefits to community from bioenergy companies, level of trust on company and relationship between company and the community are some of the prime factors which influence community's perception on bioenergy projects. This research sheds light on important aspects related to community acceptance of bioenergy projects, and this information would help practitioners in understanding the community perceptions and take appropriate actions to satisfy them. © 2014 Elsevier Ltd.

The Ecumenical movement and the making of the European Community

The European Community has largely been considered a predominantly secular project, bringing together the economic and political realms, while failing to mobilise the public voice and imagination of churchmen and the faithful. Drawing on a wide range of archival sources, this is the first study to assess the political history of religious dialogue in the European Community. It challenges the widespread perception that churches started to engage with European institutions only after the 1979 elections to the European Parliament, by detailing close relations between churchmen and high-ranking officials in European institutions, immediately after the 1950 Schuman Declaration. Lucian N. Leustean demonstrates that Cold War divisions between East and West, and the very nature of the ecumenical movement, had a direct impact on the ways in which churches approached the European Community. He brings to light events and issues which have not previously been examined, such as the response of churches to the Schuman Plan, and the political mobilisation of church representations in Brussels, Strasbourg and Luxembourg. Leustean argues that the concept of a 'united Europe' has been impeded by competing national differences between religious and political institutions, having a long-standing legacy on the making of a fragmented European Community.