Modest weight loss and physical activity in overweight patients with chronic liver disease results in sustained improvements in alanine aminotransferase, fasting insulin, and quality of life

Background and aim: Obesity is a risk factor for progression of fibrosis in chronic liver diseases such as non-alcoholic fatty liver disease and hepatitis C. The aim of this study was to investigate the longer term effect of weight loss on liver biochemistry, serum insulin levels, and quality of life in overweight patients with liver disease and the effect of subsequent weight maintenance or regain. Patients: Thirty one patients completed a 15 month diet and exercise intervention. Results: On completion of the intervention, 21 patients (68%) had achieved and maintained weight loss with a mean reduction of 9.4 (4.0)% body weight. Improvements in serum alanine aminotransferase (ALT) levels were correlated with the amount of weight loss (r=0.35, p=0.04). In patients who maintained weight loss, mean ALT levels at 15 months remained significantly lower than values at enrolment (p=0.004), while in regainers (n=10), mean ALT levels at 15 months were no different to values at enrolment (p=0.79). Improvements in fasting serum insulin levels were also correlated with weight loss (r=0.46, p=0.04), and subsequent weight maintenance sustained this improvement. Quality of life was significantly improved after weight loss. Weight maintainers sustained recommended levels of physical activity and had higher fasting insulin levels (p=0.03) at enrolment than weight regainers. Conclusion: In summary, these findings demonstrate that maintenance of weight loss and exercise in overweight patients with liver disease results in a sustained improvement in liver enzymes, serum insulin levels, and quality of life. Treatment of overweight patients should form an important component of the management of those with chronic liver disease.

A randomised controlled study of the efficacy of hypromellose and Lacri-Lube combination versus polyethylene/Cling wrap to prevent corneal epithelial breakdown in the semiconscious intensive care patient

Objective. To compare the efficacy of two forms of eye care (hypromellose and Lacri-Lube combination vs polyethylene/Cling wrap covers) for intensive care patients. Design. Randomised-controlled trial. Setting. University affiliated, tertiary referral hospital. Patients and participants. One hundred ten patients with a reduced or absent blink reflex were followed through until they regained consciousness, were discharged from the facility during study enrolment, died or developed a positive corneal ulcer or eye infection. Interventions. All patients received standard eye cleansing every 2 h. In addition to this, group one (n=60) received a treatment combining hypromellose drops and Lacri-Lube (HL) to each eye every 2 h. Group two (n=50) had polyethylene covers only placed over the eye to create a moisture chamber. Measurements and results. Corneal ulceration was determined using corneal fluorescein stains and mobile slit lamp evaluation, performed daily. No patients had corneal ulceration in the polyethylene cover group, but 4 patients had corneal ulceration in the HL group. Conclusions. Polyethylene covers are as effective as HL in reducing the incidence of corneal damage in intensive care patients.

Foetal malformations and seizure control: 52 months data of the Australian Pregnancy Registry

The Australian Pregnancy Registry, affiliated European Register of Antiepileptic drugs in Pregnancy (EURAP), recruits informed consenting women with epilepsy on treatment with antiepileptic drugs (AEDs), those untreated, and women on AEDs for other indications. Enrolment is considered prospective if it has occurred before presence or absence of major foetal malformations (FMs) are known, or retrospective, if they had occurred after the birth of infant or detection of major FM. Telephone Interviews are conducted to ascertain pregnancy outcome and collect data about seizures. To date 630 women have been enrolled, with 565 known pregnancy outcomes. Valproate (VPA) above 1100 mg/day was associated with a significantly higher incidence of FMs than other AEDs (P < 0.05). This was independent of other AED use or potentially confounding factors on multivariate analysis (OR = 7.3, P < 0.0001). Lamotrigine (LTG) monotherapy (n = 65), has so far been free of malformations. Although seizure control was not a primary outcome, we noted that more patients on LTG than on VPA required dose adjustments to control seizures. Data indicate an increased risk of FM in women taking VPA in doses > 1100 mg/day compared with other AEDs. The choice of AED for pregnant women with epilepsy requires assessment of balance of risks between teratogenicity and seizure control.

An audit of structured diabetes care in a rural general practice

Objective: To assess the impact of structured diabetes care in a rural general practice. Design and setting: A cohort study of structured diabetes care (care plans, multidisciplinary involvement and regular patient recall) in a large general practice in a medium-sized Australian rural town. Medical care followed each doctor's usual practice. Participants: The first 404 consecutive patients with type 2 diabetes who consented to take part in the program were evaluated 24 months after enrolment in July 2002 to December 2003. Main outcome measures: Change in cardiovascular disease risk factors (waist circumference, body mass index, serum lipid levels, blood pressure); change in indicators of risks associated with poorly controlled diabetes (glycated haemoglobin [HbA1(c]) concentration, foot lesions, clinically significant hypoglycaemia); change in 5-year cardiovascular disease risk. Results: Women had a lower 5-year risk of a cardiovascular event at enrolment than men. Structured care was associated with statistically significant reductions in mean cardiovascular disease risk factors (waist circumference, -2.6 cm; blood pressure [systolic, -3 mmHg; diastolic -7 mmHg]; and serum lipid levels [total cholesterol, -0.5 mmol/L; HDL cholesterol, 0.02 mmol/L; LDL cholesterol, -0.4 mmol/L; triglycerides, -0.3 mmol/L]); and improvements in indicators of diabetic control (proportion with severe hypoglycaemic events, -2.2%; proportion with foot lesions, -14%). The greatest improvements in risk factors occurred in patients with the highest calculated cardiovascular risk. There was a statistically significant increase in the proportion of patients with ideal blood pressure (systolic,

Comunicação, Valores Comunitários e Sustentabilidade: os portais da UMESP, FEI e FSA.

Este trabalho analisou a relação entre comunicação e sustentabilidade em universidades comunitárias no Estado de São Paulo associadas à ABRUC (Associação Brasileira das Universidades Comunitárias). O objetivo foi examinar a imagem das universidades, a partir das estratégias de comunicação utilizadas nos portais institucionais. Procurou entender se e como utilizam o diferencial de caráter comunitário no marketing institucional. A pesquisa é de natureza qualitativa, tendo como metodologia central o estudo de caso múltiplos de Yin (2005). Foram também utilizados alguns dos aspectos da Análise de Conteúdo de Bardin (2006) para a categorização dos termos que identificam os valores comunitários. Os portais das universidades comunitárias localizadas na região do ABC paulista (Universidade Metodista do Estado de São Paulo UMESP, Centro Universitário Engenharia Industrial FEI e Centro Universitário Fundação Santo André FSA), se constituem no corpus principal desta pesquisa. A técnica para a análise dos portais foi estruturada a partir do trabalho de Vilella (2003). Foram avaliados aspectos voltados para a facilidade da navegação no uso das informações, tais como: usabilidade, funcionalidade e conteúdo. O período para a coleta de dados foi de um mês, assim distribuído: uma semana durante o período de inscrições para o vestibular e três semanas no início do período letivo do ano de 2008. Como parte da análise da construção da imagem institucional foi também verificado, a partir dos resultados econômicos e financeiros, se existe correlação entre a política de comunicação das instituições comunitárias e a sustentabilidade financeira. Os principais resultados foram: a) não existe uma visibilidade clara dos valores comunitários nos portais institucionais; b) os portais seguem os padrões tradicionais, sem incorporar as inovações tecnológicas, que garantam visibilidade e transparência nas ações das instituições; c) existe correlação entre os resultados econômico-financeiros e o diferencial comunitário como estratégia de comunicação e sustentabilidade das instituições.(AU)

Empirical analysis of human capital development and economic growth in Europe

Recent discussion of the knowledge-based economy draws increasingly attention to the role that the creation and management of knowledge plays in economic development. Development of human capital, the principal mechanism for knowledge creation and management, becomes a central issue for policy-makers and practitioners at the regional, as well as national, level. Facing competition both within and across nations, regional policy-makers view human capital development as a key to strengthening the positions of their economies in the global market. Against this background, the aim of this study is to go some way towards answering the question of whether, and how, investment in education and vocational training at regional level provides these territorial units with comparative advantages. The study reviews literature in economics and economic geography on economic growth (Chapter 2). In growth model literature, human capital has gained increased recognition as a key production factor along with physical capital and labour. Although leaving technical progress as an exogenous factor, neoclassical Solow-Swan models have improved their estimates through the inclusion of human capital. In contrast, endogenous growth models place investment in research at centre stage in accounting for technical progress. As a result, they often focus upon research workers, who embody high-order human capital, as a key variable in their framework. An issue of discussion is how human capital facilitates economic growth: is it the level of its stock or its accumulation that influences the rate of growth? In addition, these economic models are criticised in economic geography literature for their failure to consider spatial aspects of economic development, and particularly for their lack of attention to tacit knowledge and urban environments that facilitate the exchange of such knowledge. Our empirical analysis of European regions (Chapter 3) shows that investment by individuals in human capital formation has distinct patterns. Those regions with a higher level of investment in tertiary education tend to have a larger concentration of information and communication technology (ICT) sectors (including provision of ICT services and manufacture of ICT devices and equipment) and research functions. Not surprisingly, regions with major metropolitan areas where higher education institutions are located show a high enrolment rate for tertiary education, suggesting a possible link to the demand from high-order corporate functions located there. Furthermore, the rate of human capital development (at the level of vocational type of upper secondary education) appears to have significant association with the level of entrepreneurship in emerging industries such as ICT-related services and ICT manufacturing, whereas such association is not found with traditional manufacturing industries. In general, a high level of investment by individuals in tertiary education is found in those regions that accommodate high-tech industries and high-order corporate functions such as research and development (R&D). These functions are supported through the urban infrastructure and public science base, facilitating exchange of tacit knowledge. They also enjoy a low unemployment rate. However, the existing stock of human and physical capital in those regions with a high level of urban infrastructure does not lead to a high rate of economic growth. Our empirical analysis demonstrates that the rate of economic growth is determined by the accumulation of human and physical capital, not by level of their existing stocks. We found no significant effects of scale that would favour those regions with a larger stock of human capital. The primary policy implication of our study is that, in order to facilitate economic growth, education and training need to supply human capital at a faster pace than simply replenishing it as it disappears from the labour market. Given the significant impact of high-order human capital (such as business R&D staff in our case study) as well as the increasingly fast pace of technological change that makes human capital obsolete, a concerted effort needs to be made to facilitate its continuous development.

Effect of a protein and energy dense n-3 fatty acid enriched oral supplement on loss of weight and lean tissue in cancer cachexia:A randomised double blind trial

Aim: N-3 fatty acids, especially eicosapentaenoic acid (EPA), may possess anticachectic properties. This trial compared a protein and energy dense supplement enriched with n-3 fatty acids and antioxidants (experimental: E) with an isocaloric isonitrogenous control supplement (C) for their effects on weight, lean body mass (LBM), dietary intake, and quality of life in cachectic patients with advanced pancreatic cancer. Methods: A total of 200 patients (95 E; 105 C) were randomised to consume two cans/day of the E or C supplement (480 ml, 620 kcal, 32 g protein ± 2.2 g EPA) for eight weeks in a multicentre, randomised, double blind trial. Results: At enrolment, patients' mean rate of weight loss was 3.3 kg/month. Intake of the supplements (E or C) was below the recommended dose (2 cans/day) and averaged 1.4 cans/day. Over eight weeks, patients in both groups stopped losing weight (Δweight E: -0.25 kg/month versus C: -0.37 kg/month; p=0.74) and LBM (ΔLBM E: +0.27 kg/month versus C: +0.12 kg/month; p=0.88) to an equal degree (change from baseline E and C, p<0.001). In view of evident non-compliance in both E and C groups, correlation analyses were undertaken to examine for potential dose-response relationships. E patients demonstrated significant correlations between their supplement intake and weight gain (r=0.50, p<0.001) and increase in LBM (r=0.33, p=0.036). Such correlations were not statistically significant in C patients. The relationship of supplement intake with change in LBM was significantly different between E and C patients (p=0.043). Increased plasma EPA levels in the E group were associated with weight and LBM gain (r=0.50, p<0.001; r=0.51, p=0.001). Weight gain was associated with improved quality of life (p<0.01) only in the E group. Conclusion: Intention to treat group comparisons indicated that at the mean dose taken, enrichment with n-3 fatty acids did not provide a therapeutic advantage and that both supplements were equally effective in arresting weight loss. Post hoc dose-response analysis suggests that if taken in sufficient quantity, only the n-3 fatty acid enriched energy and protein dense supplement results in net gain of weight, lean tissue, and improved quality of life. Further trials are required to examine the potential role of n-3 enriched supplements in the treatment of cancer cachexia.

Advanced education and training in bioenergy in Europe

The paper explains how bioenergy education and training is growing in Europe. Employment estimates are included for renewable energy in general, and bioenergy in particular, to highlight the need for a broadly based education and training programme that is essential to build a knowledgeable workforce that can drive Europe's growing bioenergy sector. The paper reviews current provisions in bioenergy at Masters and PhD levels across the 27 members of the EU (EU27) plus Norway and Switzerland. This identifies a very active and expanding bioenergy education provision. 65 English-language Masters Courses in bioenergy (either focussing completely on bioenergy or with significant bioenergy content or specialisation) were identified. 231 providers of PhD studies in bioenergy were found.Masters Course offerings have grown rapidly across Europe during the last five years, but where data is available, enrolment has been quite low suggesting that there is an oversupply of courses and that course organisers are being optimistic in their projections. Existing provisions in Europe at Masters and PhD levels are clearly more than sufficient for short term needs, but further work is needed to evaluate the take-up rate and the content and focus of the provisions. To ensure talented graduates are attracted to these programmes, better promotion, stronger links with the research community and industry, and increased collaboration among course providers are needed. Short Courses of two to five days are an excellent way of meeting post-experience training needs but require further growth and development to serve the needs of the bioenergy community. © 2011 Elsevier Ltd.

Patterns for Active E-Learning in CMS Environments

The proliferation of course management systems (CMS) in the last decade stimulated educators in establishing novel active e-learning practices. Only a few of these practices, however, have been systematically described and published as pedagogic patterns. The lack of formal patterns is an obstacle to the systematic reuse of beneficial active e-learning experiences. This paper aims to partially fill the void by offering a collection of active e-learning patterns that are derived from our continuous course design experience in standard CMS environments, such as Moodle and Black-board. Our technical focus is on active e-learning patterns that can boost student interest in computing-related fields and increase student enrolment in computing-related courses. Members of the international e-learning community can benefit from active e-learning patterns by applying them in the design of new CMS-based courses – in computing and other technical fields.

Improving the cost-effectiveness of photographic screening for diabetic macular oedema:a prospective, multi-centre, UK study

Background/aims: Retinal screening programmes in England and Scotland have similar photographic grading schemes for background (non-proliferative) and proliferative diabetic retinopathy, but diverge over maculopathy. We looked for the most cost-effective method of identifying diabetic macular oedema from retinal photographs including the role of automated grading and optical coherence tomography, a technology that directly visualises oedema. Methods: Patients from seven UK centres were recruited. The following features in at least one eye were required for enrolment: microaneurysms/dot haemorrhages or blot haemorrhages within one disc diameter, or exudates within one or two disc diameters of the centre of the macula. Subjects had optical coherence tomography and digital photography. Manual and automated grading schemes were evaluated. Costs and QALYs were modelled using microsimulation techniques. Results: 3540 patients were recruited, 3170 were analysed. For diabetic macular oedema, England's scheme had a sensitivity of 72.6% and specificity of 66.8%; Scotland 's had a sensitivity of 59.5% and specificity of 79.0%. When applying a ceiling ratio of £30 000 per quality adjusted life years (QALY) gained, Scotland's scheme was preferred. Assuming automated grading could be implemented without increasing grading costs, automation produced a greater number of QALYS for a lower cost than England's scheme, but was not cost effective, at the study's operating point, compared with Scotland's. The addition of optical coherence tomography, to each scheme, resulted in cost savings without reducing health benefits. Conclusions: Retinal screening programmes in the UK should reconsider the screening pathway to make best use of existing and new technologies.

Learning to research - researching to learn

Learning to Research Researching to Learn explores the integration of research into teaching and learning at all levels of higher education. The chapters draw on the long and ongoing debate about the teaching research nexus in universities. Although the vast majority of academics believe that there is an important and valuable link between teaching and research, the precise nature of this relationship continues to be contested. The book includes chapters that showcase innovative ways of learning to research; how research is integrated into coursework teaching; how students learn the processes of research, and how universities are preparing students to engage with the world. The chapters also showcase innovative ways of researching to learn, exploring how students learn through doing research, how they conceptualise the knowledge of their fields of study through the processes of doing research, and how students experiment and reflect on the results produced. These are the key issues addressed by this anthology, as it brings together analyses of the ways in which university teachers are developing research skills in their students, creating enquiry-based approaches to teaching, and engaging in education research themselves. The studies here explore the links between teaching, learning and research in a range of contexts, from pre-enrolment through to academic staff development, in Australia, the UK, the US, Singapore and Denmark. Through a rich array of theoretical and methodological approaches, the collection seeks to further our understanding of how universities can play an effective role in educating graduates suited to the twenty-first century

As escolas polivalentes do Triângulo Mineiro e Alto Paranaíba (MG): sondagem vocacional no projeto desenvolvimentista civil-militar (1965–1976)

This study has as object eight state vocational schools located in Araguari, Araxá, Frutal, Ituiutaba, Monte Carmelo, Patos de Minas, Uberaba and Uberlândia, in Minas Gerais. The period analyzed comprises the years from 1965 to 1976, from the signature of the Agreement 512-11-610-042 beteween the Ministry of Education and Culture (MEC) and the American Agency for International Development (USAID), which started a series of other agreements, and actions ending up with the creation of the Expansion and Improvement of High Schools Program (Programa de Expansão e Melhoria do Ensino Médio - PREMEM) and, from this, the Vocational Schools. The upper limit of the study, 1976, was the year when these agreements, known as MEC/USAID agreements ceased. The Vocational Schools were characterized as vocation probing schools, directing the professional formation of the population in general, which would happen a posteriori, turning it shorter and more effective, since the labor market would demand, urgently, capable professionals for an expanding economy. The project of Vocational Schools had a national scope, and foresaw, for its unfolding, the complete substitution of State Schools for the new model, called “multi-curricula”. The theme Vocational schools was the object of my Master’s degree study, when I focused the State School Guiomar de Freitas Costa, in Uberlândia. That study raised questionings and concerns that resulted in the central problem of the thesis presented here: understanding the measure in which such schools integrated the country’s development project – mostly in the first half of the military rule – and to understand its structure, functionality and efficacyThe development of the study presented here, demanded the use of several sources: 1) specialized literature about the topics presented, i.e., the situation of national education in a temporal analysis, the political, economical and social context, research methodologies, the theory of human capital, vocational teaching, pedagogical trends and practices, agreements MEC-USAID and PREMEM; 2) national, state and county laws related to the discussion: laws of national education directives and basis, decrees and reports stating about the program of technical cooperation between Brazil and the United States of America, the Program of Expansion and Improvement of Teaching (PREMEM), formation of professors, establishment of Vocational Schools and educational planning; 3) documentation of school archives: books of minutes of Collegiate and of faculty and staff, registrar books with final scores, enrolment, visits of inspector, accounting books, punch clock records, student, professor and staff occurrences, inventory, class schedules, school year calendar, school rules, class reports, payment rolls, bills of sales, exchanged mail, personal documentation of professional personnel, documents of land acquisition, blueprints, manuals of PREMEM, didactic materials/resources used in classes, books available in the school library, structured evaluations for follow-up of school processes, pictures of events, texts prepared for special dates, and news from the official newspaper and, finally, 4) national and local press reports, especially from Folha de São Paulo, Correio de Araxá, Correio de Uberlândia and Lavoura e Comércio (Uberaba). The proposition of Vocational schools was conciliate theoretical and practical formation through an active education permeated by technological resources. The contact with knowledge and several practical activities under professional supervision, the student would identify the knowledge area that would interest him the most and his aptitude. This formation in primary school would make way for the vocation studies in high school, which became mandatory by the law 5.692/71, that reformed school education from the previous levels of elementary, middle high and high school. However, the multi-curricula proposal that would be spread to the other public schools in the country ended up succumbing to the model already established. From its ephemeral existence, maybe the Vocational Schools have not reached the more general goals in political, economic and social aspects; however, this study demonstrated that, for the people that, directly or indirectly, had contact with such schools, a legacy of vocational and quality teaching was made, so much so, that forty years after the end of that proposal, they are still remembered.

Análisis de una política universitaria : El caso del ProProE en la FCNyM de la UNLP

Este trabajo apunta al análisis del programa denominado ProProE (Programa de Promoción de Egreso de las Carreras de Grado), como política pública, implementado en la Facultad de Ciencias Naturales y Museo de la Universidad Nacional de La Plata con el objetivo de acompañar hasta la graduación a los alumnos avanzados que han tenido demoras o detenimientos hacia la finalización de sus trayectorias. Se exponen los antecedentes existentes en la UNLP, las características del programa, con sus diferentes etapas, y evaluación final, el material considerado de interés para su investigación, y se desarrolla el marco teórico metodológico con el que se abordó la investigación. El estudio de las políticas universitarias como herramientas que apuntan al progreso y egreso de todos los estudiantes, sus aplicaciones y los resultados de las mismas es fundamental para comprender de qué modo las autoridades universitarias enfrentan fenómenos como el de la heterogeneización y masificación matricular. Se describe la experiencia desarrollada en la FCNyM, considerando los diferentes desempeños y vivencias vinculados a los gestores del programa, los alumnos incorporados, y los docentes que trabajaron en el mismo. Respecto a sus resultados se exponen los progresos y el objetivo futuro de rediseño y aplicación del programa considerando lo relevado en la primera experiencia de aplicación

Rasgos de extracción popular entre asistentes a la educación superior. Argentina, 2010-12

Entre las grandes transformaciones que ha sufrido la sociedad argentina en las últimas décadas se encuentra el fuerte proceso de expansión del sistema educativo, por el cual grandes masas de la población han logrado acceder no sólo al nivel secundario sino también al nivel superior de enseñanza. Este fuerte incremento en la matrícula superior ha sido vinculado con el acceso a este nivel educativo de capas tradicionalmente excluidas del mismo. ¿Cuál es el peso de las capas de extracción popular en la matrícula superior? El presente trabajo aporta datos a partir de un ejercicio que utiliza como fuente el procesamiento de información estadística oficial para el conjunto de la población urbana correspondiente a los años 2010 y 2012

Análisis de una política universitaria : El caso del ProProE en la FCNyM de la UNLP

Este trabajo apunta al análisis del programa denominado ProProE (Programa de Promoción de Egreso de las Carreras de Grado), como política pública, implementado en la Facultad de Ciencias Naturales y Museo de la Universidad Nacional de La Plata con el objetivo de acompañar hasta la graduación a los alumnos avanzados que han tenido demoras o detenimientos hacia la finalización de sus trayectorias. Se exponen los antecedentes existentes en la UNLP, las características del programa, con sus diferentes etapas, y evaluación final, el material considerado de interés para su investigación, y se desarrolla el marco teórico metodológico con el que se abordó la investigación. El estudio de las políticas universitarias como herramientas que apuntan al progreso y egreso de todos los estudiantes, sus aplicaciones y los resultados de las mismas es fundamental para comprender de qué modo las autoridades universitarias enfrentan fenómenos como el de la heterogeneización y masificación matricular. Se describe la experiencia desarrollada en la FCNyM, considerando los diferentes desempeños y vivencias vinculados a los gestores del programa, los alumnos incorporados, y los docentes que trabajaron en el mismo. Respecto a sus resultados se exponen los progresos y el objetivo futuro de rediseño y aplicación del programa considerando lo relevado en la primera experiencia de aplicación