Value of glycaemic control in diabetes

Full text: Several Lancet publications have questioned the value of glycaemic control in diabetic patients. For example, in their Comment (Sept 29, p 1103),1 John Cleland and Stephen Atkin state that “Improved glycaemic control is not a surrogate for effective care of patients who have diabetes”, and Victor Montori and colleagues (p 1104)2 claim that “HbA1c loses its validity as a surrogate marker when patients have a constellation of metabolic abnormalities”. We are concerned that the reaction against “glucocentricity” in the field of diabetes has gone too far. Even the UK's National Prescribing Centre website, carrying the National Health Service logo, includes comments that undermine the value of glycaemic control. For example, referring to the United Kingdom Prospective Diabetes Study (UKPDS), this site states that “Compared with ‘conventional control’ there was no benefit from tight control of blood glucose with sulphonylureas or insulin with regard to total mortality, diabetes-related death, macrovascular outcomes or microvascular outcomes, including all the most serious ones such as blindness or kidney failure”.3 It is well established that better glycaemic control reduces long-term microvascular complications in type 1 and type 2 diabetes.4 In type 2 diabetes, the UKPDS reported that a composite microvascular endpoint (retinopathy requiring photocoagulation, vitreous haemorrhage, and fatal or non-fatal renal failure) was reduced by 25% in patients randomised to intensive glucose control (p=0·0099).4 To imply that these are not patient-relevant outcomes is to distort the evidence. Many studies have also found that improved glycaemic control reduces macrovascular complications.5 Do not be misled: glycaemic control remains a crucial component in the care of people with diabetes. The authors have received research support and undertaken ad hoc consultancies and speaker engagements for several pharmaceutical companies.

Novel Virtual Environment for Alternative Treatment of Children with Cerebral Palsy

Cerebral palsy is a severe condition usually caused by decreased brain oxygenation during pregnancy, at birth or soon after birth. Conventional treatments for cerebral palsy are often tiresome and expensive, leading patients to quit treatment. In this paper, we describe a virtual environment for patients to engage in a playful therapeutic game for neuropsychomotor rehabilitation, based on the experience of the occupational therapy program of the Nucleus for Integrated Medical Assistance (NAMI) at the University of Fortaleza, Brazil. Integration between patient and virtual environment occurs through the hand motion sensor “Leap Motion,” plus the electroencephalographic sensor “MindWave,” responsible for measuring attention levels during task execution. To evaluate the virtual environment, eight clinical experts on cerebral palsy were subjected to a questionnaire regarding the potential of the experimental virtual environment to promote cognitive and motor rehabilitation, as well as the potential of the treatment to enhance risks and/or negatively influence the patient’s development. Based on the very positive appraisal of the experts, we propose that the experimental virtual environment is a promising alternative tool for the rehabilitation of children with cerebral palsy.

The permafrost carbon inventory on the Tibetan Plateau : a new evaluation using deep sediment cores

Acknowledgements We are grateful for Dr. Jens Strauss and the other two anonymous reviewers for their insightful comments on an earlier version of this MS, and appreciate members of the IBCAS Sampling Campaign Teams for their assistance in field investigation. This work was supported by the National Basic Research Program of China on Global Change (2014CB954001 and 2015CB954201), National Natural Science Foundation of China (31322011 and 41371213), and the Thousand Young Talents Program.

"Llovió y llovió hasta que quedó cielo y tierra... y todo se terminó ahí" : Discurso e identidad en la comunidad de Asampay, Catamarca

El objetivo del presente trabajo es realizar una aproximación al análisis de aquellas prácticas sociales que dentro de la comunidad de Asampay -ubicada en el departamento de Belén, provincia de Catamarca (Argentina)- otorgan un sentido de pertenencia y de devenir a sus habitantes en tanto grupo social. Por consiguiente, nuestro objetivo específico será examinar la construcción de sentido de determinados fenómenos sociales que son significativos dentro de la comunidad. El marco metodológico a ser utilizado será aquel proveniente del análisis del discurso y de la semiótica cognitiva (Courtine 1981, Magariños de Morentín 1996) -sobre la base de los fundamentos establecidos por Foucault (1970,1971)-, así como también, ciertos lineamientos teóricos y método lógicos procedentes de los trabajos de Lévi-Strauss (1996, 1984, 983)

"Llovió y llovió hasta que quedó cielo y tierra... y todo se terminó ahí" : Discurso e identidad en la comunidad de Asampay, Catamarca

El objetivo del presente trabajo es realizar una aproximación al análisis de aquellas prácticas sociales que dentro de la comunidad de Asampay -ubicada en el departamento de Belén, provincia de Catamarca (Argentina)- otorgan un sentido de pertenencia y de devenir a sus habitantes en tanto grupo social. Por consiguiente, nuestro objetivo específico será examinar la construcción de sentido de determinados fenómenos sociales que son significativos dentro de la comunidad. El marco metodológico a ser utilizado será aquel proveniente del análisis del discurso y de la semiótica cognitiva (Courtine 1981, Magariños de Morentín 1996) -sobre la base de los fundamentos establecidos por Foucault (1970,1971)-, así como también, ciertos lineamientos teóricos y método lógicos procedentes de los trabajos de Lévi-Strauss (1996, 1984, 983)

"Llovió y llovió hasta que quedó cielo y tierra... y todo se terminó ahí" : Discurso e identidad en la comunidad de Asampay, Catamarca

El objetivo del presente trabajo es realizar una aproximación al análisis de aquellas prácticas sociales que dentro de la comunidad de Asampay -ubicada en el departamento de Belén, provincia de Catamarca (Argentina)- otorgan un sentido de pertenencia y de devenir a sus habitantes en tanto grupo social. Por consiguiente, nuestro objetivo específico será examinar la construcción de sentido de determinados fenómenos sociales que son significativos dentro de la comunidad. El marco metodológico a ser utilizado será aquel proveniente del análisis del discurso y de la semiótica cognitiva (Courtine 1981, Magariños de Morentín 1996) -sobre la base de los fundamentos establecidos por Foucault (1970,1971)-, así como también, ciertos lineamientos teóricos y método lógicos procedentes de los trabajos de Lévi-Strauss (1996, 1984, 983)

UNDERSTANDING ESSAY RATING AS A SOCIALLY MEDIATED ACTIVITY: THE CASE OF A HIGH-STAKES ENGLISH TEST IN CHINA

Most essay rating research in language assessment has examined human raters’ essay rating as a cognitive process, thus overlooking or oversimplifying the interaction between raters and sociocultural contexts. Given that raters are social beings, their practices have social meanings and consequences. Hence it is important to situate essay rating within its sociocultural context for a more meaningful understanding. Drawing on Engeström’s (1987, 2001) cultural-historical activity theory (CHAT) framework with a sociocultural perspective, this study reconceptualized essay rating as a socially mediated activity with both cognitive (individual raters’ goal-directed decision-making actions) and social layers (raters’ collective object-oriented essay rating activity at related settings). In particular, this study explored raters’ essay rating at one provincial rating centre in China within the context of a high-stakes university entrance examination, the National Matriculation English Test (NMET). This study adopted a multiple-method multiple-perspective qualitative case study design. Think-aloud protocols, stimulated recalls, interviews, and documents served as the data sources. This investigation involved 25 participants at two settings (rating centre and high schools), including rating centre directors, team leaders, NMET essay raters who were high school teachers, and school principals and teaching colleagues of these essay raters. Data were analyzed using Strauss and Corbin’s (1990) open and axial coding techniques, and CHAT for data integration. The findings revealed the interaction between raters and the NMET sociocultural context. Such interaction can be understood through a surface structure (cognitive layer) and a deep structure (social layer) concerning how raters assessed NMET essays, where the surface structure reflected the “what” and the deep structure explained the “how” and “why” in raters’ decision-making. This study highlighted the roles of goals and rules in rater decision-making, rating tensions and raters’ solutions, and the relationship between essay rating and teaching. This study highlights the value of a sociocultural view to essay rating research, demonstrates CHAT as a sociocultural approach to investigate essay rating, and proposes a direction for future washback research on the effect of essay rating. This study also provides support for NMET rating practices that can potentially bring positive washback to English teaching in Chinese high schools.

An exploration of parent ivolvement in Response to Intervention (RTI) in Title I schools

Research demonstrates that parental involvement positively impacts student achievement and enhances targeted instruction. Notably, however, little research currently exists on how schools involve parents in Response to Intervention (RTI), a framework for implementing targeted, tiered, research-based instruction. The purpose of this study was to interview selected parents, teachers, RTI specialists, and principals in three Title I elementary schools in one school district, plus one district-level administrator, in order to examine how elementary schools currently involve parents in RTI prereferral interventions, and to understand the factors that might facilitate or challenge such parent involvement. I employed a comparative case study qualitative design with each elementary school as the main unit of analysis. I conducted individual, in-depth interviews that lasted approximately 45-60 minutes with a total of 33 participants across the three school sites, including 11 parents, 12 teachers, and six RTI specialists, three principals, and one district-level administrator. I also analyzed documents related to RTI processes that are available through websites and participants. I used Strauss and Corbin’s (1998) three-step scheme for thematic/grounded theory analysis, and Atlas.ti as the electronic tool for management and analysis. Analyses of the data revealed that personnel across the sites largely agreed on how they explain RTI to parents and notify parents of student progress. Parents mostly disagreed with these accounts, stating instead that they learn about RTI and their child’s progress by approaching teachers or their own children with questions, or by examining report cards and student work that comes home. Personnel and parents cited various challenges for involving parents in RTI. However, they all also agreed that teachers are accessible and willing to reach out to parents, and that teachers already face considerable workloads. It appears that no district- or school-wide plan guides parent involvement practices in RTI at any of the three schools. Finally, I present a discussion of findings; implications for teachers, RTI implementation leaders, and Title school leaders; study limitations; and possibilities for future research.

UNDERSTANDING ESSAY RATING AS A SOCIALLY MEDIATED ACTIVITY: THE CASE OF A HIGH-STAKES ENGLISH TEST IN CHINA

Thesis (Ph.D, Education) -- Queen's University, 2016-09-22 22:05:24.246

Genetic Predictors Of Long-term Response To Growth Hormone (gh) Therapy In Children With Gh Deficiency And Turner Syndrome: The Influence Of A Socs2 Polymorphism.

There is great interindividual variability in the response to GH therapy. Ascertaining genetic factors can improve the accuracy of growth response predictions. Suppressor of cytokine signaling (SOCS)-2 is an intracellular negative regulator of GH receptor (GHR) signaling. The objective of the study was to assess the influence of a SOCS2 polymorphism (rs3782415) and its interactive effect with GHR exon 3 and -202 A/C IGFBP3 (rs2854744) polymorphisms on adult height of patients treated with recombinant human GH (rhGH). Genotypes were correlated with adult height data of 65 Turner syndrome (TS) and 47 GH deficiency (GHD) patients treated with rhGH, by multiple linear regressions. Generalized multifactor dimensionality reduction was used to evaluate gene-gene interactions. Baseline clinical data were indistinguishable among patients with different genotypes. Adult height SD scores of patients with at least one SOCS2 single-nucleotide polymorphism rs3782415-C were 0.7 higher than those homozygous for the T allele (P < .001). SOCS2 (P = .003), GHR-exon 3 (P= .016) and -202 A/C IGFBP3 (P = .013) polymorphisms, together with clinical factors accounted for 58% of the variability in adult height and 82% of the total height SD score gain. Patients harboring any two negative genotypes in these three different loci (homozygosity for SOCS2 T allele; the GHR exon 3 full-length allele and/or the -202C-IGFBP3 allele) were more likely to achieve an adult height at the lower quartile (odds ratio of 13.3; 95% confidence interval of 3.2-54.2, P = .0001). The SOCS2 polymorphism (rs3782415) has an influence on the adult height of children with TS and GHD after long-term rhGH therapy. Polymorphisms located in GHR, IGFBP3, and SOCS2 loci have an influence on the growth outcomes of TS and GHD patients treated with rhGH. The use of these genetic markers could identify among rhGH-treated patients those who are genetically predisposed to have less favorable outcomes.

Psychogenetics of Turner syndrome: an investigation of 28 subjects and respective controls using the Bender test and Piagetian scales

Piagetian scales and the Bender visual motor gestalt test (BT) were applied to 28 subjects with universal 45, X Turner syndrome (TS), and their respective controls, in order to investigate their cognitive performance. Dermatoglyphics were also analyzed to obtain clues concerning embryological changes that may have appeared during development of the nervous system and could be associated with cognitive performance of TS patients. Dermatoglyphic pattern distribution was similar to that reported in previous studies of TS individuals: ulnar loops in the digital patterns and finger ridge, a-b, and A'-d counts were more frequent, while arch and whorl patterns were less frequent compared to controls. However, we did not find higher frequencies of hypothenar pattern, maximum atd angle, and ulnarity index in our TS subjects, unlike other investigations. Furthermore, we found significant differences between TS and control T line index values. The BT scores were also lower in probands, as has been previously reported, revealing a neurocognitive deficit of visual motor perception in TS individuals, which could be due to an absence of, or deficiency in, cerebral hemispheric lateralization. However, TS subjects seemed to improve their performance on BT with age. Cognitive performance of the TS subjects was not significantly different from that of controls, confirming a previous study in which TS performance was found to be similar to that of the normal Brazilian population. There were significant correlations between BT scores and Piagetian scale levels with dermatoglyphic parameters. This association could be explained by changes in the common ectodermal origin of the epidermis and the central nervous system. TS subjects seem to succeed in compensating their spatial impairments in adapting their cognitive and social contacts. We concluded that genetic counseling should consider cognitive and psychosocial difficulties presented by TS subjects, providing appropriate treatment and orientation for them and their families.

Cardiovascular assessment of patients with Ullrich-Turner's Syndrome on Doppler echocardiography and magnetic resonance imaging

OBJECTIVE: To assess the cardiovascular features of Ullrich-Turner's syndrome using echocardiography and magnetic resonance imaging, and to correlate them with the phenotype and karyotype of the patients. The diagnostic concordance between the 2 methods was also assessed. METHODS: Fifteen patients with the syndrome were assessed by echocardiography and magnetic resonance imaging (cardiac chambers, valves, and aorta). Their ages ranged from 10 to 28 (mean of 16.7) years. The karyotype was analyzed in 11 or 25 metaphases of peripheral blood lymphocytes, or both. RESULTS: The most common phenotypic changes were short stature and spontaneous absence of puberal development (100%); 1 patient had a cardiac murmur. The karyotypes detected were as follows: 45,X (n=7), mosaics (n=5), and deletions (n=3). No echocardiographic changes were observed. In regard to magnetic resonance imaging, coarctation and dilation of the aorta were found in 1 patient, and isolated dilation of the aorta was found in 4 patients. CONCLUSION: The frequencies of coarctation and dilation of the aorta detected on magnetic resonance imaging were similar to those reported in the literature (5.5% to 20%, and 6.3% to 29%, respectively). This confirmed the adjuvant role of magnetic resonance imaging to Doppler echocardiography for diagnosing cardiovascular alterations in patients with Ullrich-Turner's syndrome.

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (EGPA) Consensus Task Force recommendations for evaluation and management.

OBJECTIVE: To develop disease-specific recommendations for the diagnosis and management of eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) (EGPA). METHODS: The EGPA Consensus Task Force experts comprised 8 pulmonologists, 6 internists, 4 rheumatologists, 3 nephrologists, 1 pathologist and 1 allergist from 5 European countries and the USA. Using a modified Delphi process, a list of 40 questions was elaborated by 2 members and sent to all participants prior to the meeting. Concurrently, an extensive literature search was undertaken with publications assigned with a level of evidence according to accepted criteria. Drafts of the recommendations were circulated for review to all members until final consensus was reached. RESULTS: Twenty-two recommendations concerning the diagnosis, initial evaluation, treatment and monitoring of EGPA patients were established. The relevant published information on EGPA, antineutrophil-cytoplasm antibody-associated vasculitides, hypereosinophilic syndromes and eosinophilic asthma supporting these recommendations was also reviewed. DISCUSSION: These recommendations aim to give physicians tools for effective and individual management of EGPA patients, and to provide guidance for further targeted research.