Premature cardiovascular events and mortality in south Asians with type 2 diabetes in the United Kingdom Asian Diabetes Study - effect of ethnicity on risk

Background/Aim - People of south Asian origin have an excessive risk of morbidity and mortality from cardiovascular disease. We examined the effect of ethnicity on known risk factors and analysed the risk of cardiovascular events and mortality in UK south Asian and white Europeans patients with type 2 diabetes over a 2 year period. Methods - A total of 1486 south Asian (SA) and 492 white European (WE) subjects with type 2 diabetes were recruited from 25 general practices in Coventry and Birmingham, UK. Baseline data included clinical history, anthropometry and measurements of traditional risk factors – blood pressure, total cholesterol, HbA1c. Multiple linear regression models were used to examine ethnicity differences in individual risk factors. Ten-year cardiovascular risk was estimated using the Framingham and UKPDS equations. All subjects were followed up for 2 years. Cardiovascular events (CVD) and mortality between the two groups were compared. Findings - Significant differences were noted in risk profiles between both groups. After adjustment for clustering and confounding a significant ethnicity effect remained only for higher HbA1c (0.50 [0.22 to 0.77]; P?=?0.0004) and lower HDL (-0.09 [-0.17 to -0.01]; P?=?0.0266). Baseline CVD history was predictive of CVD events during follow-up for SA (P?Europeans. Enhanced and ethnicity specific targets and effective treatments are needed if these inequalities are to be reduced.

Retinal vascular function and cardiovascular risk factors

The current platform of conventional cardiovascular risk assessments tends to forsake the importance of endothelial function - a key biological mechanism by which cardiovascular risk factors exert their propensity for adverse vascular events. Moreover, the presence and severity of endothelial dysfunction in ‘low-risk’ individuals suggests considerable variability in pre-clinical risk that could potentially be detected well before the onset of disease. The aim of the present thesis was to investigate the presence and impact of retinal vascular dysfunction, as a barometer of endothelial function, in otherwise healthy individuals with one or more cardiovascular risk factors, but low to moderate cardiovascular risk. Systemic circulatory influences on retinal vascular function were also evaluated. The principle sections and findings of this work are: 1. Ageing effect on retinal vascular function • In low-risk individuals, there are age differences in retinal vascular function throughout the entire functional response curve for arteries and veins. Gender differences mainly affect the dilatory phase and are only present in young individuals. 2. Retinal vascular function in healthy individuals with a family history of cardiovascular disease • In low-risk individuals with a family history of cardiovascular disease, impairments in microvascular function at the retinal level correlate with established plasma markers for cardiovascular risk. 3. Ethnic differences in retinal vascular function • When compared to age-matched White Europeans, in low-risk middle-aged South Asians, there are impairments in retinal vascular function that correlate with established cardiovascular risk indicators. 4. Systemic circulatory influences on retinalµvascular function • Systemic antioxidant capacity (redox index) and plasma markers for cardiovascular risk (lipids) influence retinal microvascular function at both arterial and venous levels. 5. Retinal vascular function in individuals with obstructive sleep apnoea: a preliminarystudy • Patients with moderate to severe sleep apnoea exhibit attenuated retinal vascular function.

Obstructive sleep apnoea is associated with sight threatening retinopathy and predicts the developement of preproliferative and proliferative retinopathy in patients with type 2 diabetes:a longitudinal analysis

troduct I on . An observational longitudinal study. P ur P ose . Assess the relationship between obstructive sleep apnoea (OSA) and DR cross-sectionally and longitudinally. M ethods . Adults with Type 2 diabetes mellitus (T2DM), who were re - cruited from a hospital-based diabetes clinic in the UK. Patients with pre-existing OSA, end-stage renal disease and non-diabetic retinopa - thy were excluded. OSA (apnoea hypopnea index ≥ 5 events/hour) was assessed by a single overnight home-based cardio-respiratory study (Alice PDX, Philips Respironics, USA). DR was assessed us - ing retinal images between 2007 and 2012. Sight threatening diabetic retinopathy (STDR) was defined as presence of pre-proliferative or proliferative DR, maculopathy or photocoagulation. Advanced DR was defined as pre-proliferative or proliferative DR. r esults . 199 patients were included (57.3% (n=114) men, 47.7% (n=95) White Europeans). STDR and OSA prevalence were 38.7% (n=77) and 62.8% respectively. A t b A sel I ne . STR prevalence was higher in patients with OSA (OSA+) compared to those without OSA (OSA-) [48.8% n=61 vs. 21.6% n=16, p<0.001]. After adjustment for confounders, OSA remained independently associated with STR (OR 3.7, 95% CI 1.6-8.9, p=0.006), maculopathy (OR 4.5, 95% CI 1.8-11.4, p=0.002) and advanced DR (OR 3.9, 95% CI 1.02-15.3, p=0.047). Mild and moderate to severe OSA were independently associated with STR and maculopathy and only moderate to severe OSA was associated with advanced DR following adjustment for con - founders. l ong I tud I n A lly . Over the follow-up period of (4.4±1 years), more OSA+ patients progressed from no or background DR to advanced DR (15.3% (n=17) vs. 3% (n=2), p=0.01). OSA was an independent pre - dictor of advanced DR development after adjustment for confounders (OR 6.6, 95% CI 1.2-35.1, p=0.03). OSA did not predict the develop - ment of maculopathy. c onclus I ons . OSA is independently associated with STR and predicts the development of preproliferative and proliferative DR. Intervention - al studies are needed to assess the impact of OSA treatment on DR.

Obstructive sleep apnoea predicts the development of preproliferative and proliferative retinopathy in patients with type 2 diabetes:a longitudinal analysis

Background and aims: Diabetic Retinopathy (DR) is a leading cause of blindness. OSA is associated with increased oxidative and nitrosative stress and endothelial dysfunction in patients with type 2 diabetes (T2DM). Hence, it is plausible that OSA can promote the development and progression of DR. Materials and methods: An observational longitudinal study in adults with T2DM. Patients with pre-existing OSA, end-stage renal disease and non-diabetic retinopathy were excluded. OSA (apnoea hypopnea index ≥ 5 events/hour) was assessed by a single overnight home-based cardio-respiratory monitoring (Alice PDX, etc.). DR was assesses using retinal images between 2007 and 2012. Sight threatening retinopathy (STR) was defined as pre-proliferative or proliferative DR, maculopathy or photocoagulation. Advanced DR was defined as pre-proliferative or proliferative DR. Results: 199 patients were included (57.3% men, 47.7% White Europeans). STR and OSA prevalence were 38.7 % and 62.8% respectively. STR preva-lence was higher in patients with OSA (OSA+) compared to those with-out (OSA-) [48.8% vs. 21.6%, p <0.001]. After adjustment for confounders, OSA remained independently associated with STR (OR 3.7, 95%CI 1.6-8.9, p=0.006, maculopathy (OR 4.5, 1.8-11.4, p=0.002) and advanced DR (OR 3.9, 1.02-15.3, p=0.047). Over 4.4±1 years, more OSA+ patients progressed from no or background DR to advanced DR (15.3% vs. 3%, p=0.01). OSA was an independent predictor of advanced DR development after adjustment (OR 6.6, 95%CI 1.2-35.1, p=0.03). OSA did not predict the development of maculopathy. Patients received continuous positive airway pressure treatment were less likely to develop advanced DR. Conclusion: OSA is independently associated with STR and predicts the development of preproliferative and proliferative DR. Interventional studies are needed to assess the impact of OSA treatment on DR.Supported by: NIHR (UK) and The UK Novo Nordisk Research Foundation.

On the periphery of Europe:an investigation of the construction of Turkish-Cypriot adolescent identities

This research study investigates the identities of a group of adolescent Turkish Cypriot (TC) students in their final year of secondary education in northern Cyprus, which it is argued, lies on the periphery of Europe. The main aim is to explore the linguistic construction of TC youth identities within school contexts but primarily the classroom in a political context in which the uniquely ambiguous status of Turkish Cypriots within the European Union (EU) continues, and where Turkish Cypriots are considered to be Europeans as individuals but not as a separate political entity. A secondary focus is upon the students’ investment in learning the English language. Identity is defined as a lifelong process of 'the social positioning of self and the other' (Bucholtz and Hall, 2005:586) which is endlessly re-created (Tabouret-Keller, 1997) and the distinction between the terms 'identity' and 'identities' is discussed. The study explores the social construction of TC students' identities using an ethnomethodological case study. By using Conversation Analysis of selected extracts from the data collected through observations of classroom interactions, focus group discussions and interviews, the thesis shows that TC students perceive and enact 'in-betweener identities' in terms of their ethnicity, societal values, age, religion, languages and Europeanness. Being on the periphery of the EU, it is argued that the Turkish Cypriots of northern Cyprus are the ‘peripheral members of the EU, remaining present yet absent. They are personally EU citizens but not as a society and cannot be represented within EU institutions. But will they ever acquire full membership, as any peripheral member would aspire to have or will they remain in between occident and orient? The possible answers to this question and the resulting ideological associations will shape how and to what extent these TC students perceive and enact their identities.

The Role of Chinese Plants in Hungarian Landscape Architecture

Most outdoor plants in Hungarian horticulture are exotas mainly from Middle and East Asia and North America. The flora of China is diversified and has many species because the last glacial period did not reach China. The richness of the Chinese flora was known for Europeans by the missionaries and medics first in 19th cectury. Later some bigger nurseries sent expeditions in China to collect new plants. Nowadays the Hungarian landscape architecture is impossible without Chinese plants.

The peopling of the Bahamas: A phylogeographical perspective

During the past 500 years, the Bahamas has been influenced by a wide array of settlers, including but not limited to, the Arawak Indians, Eleutherian Adventurers, British Loyalists, Creole slaves, liberated Africans as well as Chinese, Greek, Jewish, Lebanese, Jamaican and Haitian migrants. To date, however, only a few reports analyzing the genetic makeup and population dynamics of the Bahamas have been published, making this work pivotal in the endeavor to ascertain the genetic ancestry of these groups. As such, the current investigation was undertaken to genetically characterize six of the more densely populated islands throughout the Northwest (Grand Bahama and Abaco) and Central (Eleuthera, Exuma, Long Island and New Providence) Bahamas using different forensic marker systems. When autosomal STR markers are employed, the Bahamian collections were all found to receive differential contributions from the African, European, East Asian and Native American collections utilized in the analyses. Similar findings were also observed for two other Afro-Caribbean populations, Haiti and Jamaica, although the latter populace was found to share a greater proportion of its autosomal component with non-African sources than the former. On the contrary, analysis of the six Bahamian collections using high-resolution Y-chromosome markers identifies genetic signals emanating exclusively from Africans and Europeans, but this is likely the result of smaller sample sizes collected from each island and/or sex-biased gene flow from East Asian and Native American groups.

Re -"interpreting" the conquest: European and Amerindian translators and go -betweens in the colonization of the Americas, 1492--1675

This dissertation aims to recover the lives and careers of those Amerindians and Europeans who voluntarily or involuntarily took on the role of intercultural interpreters in the contact, conquest, and early colonial period in the Americas between 1492 and 1675. It intends to prove that these so-called “marginal” figures assumed roles that went far beyond those of linguistic and cultural translators, and often had a decisive impact on early Indian-colonial relations. ^ In the course of my research, I consulted hundreds of published sixteenth- and seventeenth-century chronicles, narratives, and memoirs in my search for references to interpreters. I augmented these accounts with information derived from unpublished archival documents, drawn primarily from the Archivo General de Indias, in Seville, Spain. ^ I organized my findings in theme-driven chapters that begin with a consideration of the historiography of that subject. Each chapter is further subdivided into chronologically-arranged historical vignettes that focus on the interpreters who mediated between the Spanish, Portuguese, French, English and Dutch and the various Native American polities and cultures. ^ I found that colonial authorities and Amerindian communities alike recognized the absolute necessity of recruiting competent and loyal interpreters and go-betweens, and that both sides tried to secure their loyal service by means both fair and foul. Although pressured, pushed, and pulled in contrary directions, most interpreters recognized the pivotal position they held in cross-cultural negotiations and rarely remained passive pawns in the contests between the forces of domination and defense. ^ All across the Americas, interpreters used their linguistic and diplomatic skills, and their intimate knowledge of the “other” not simply to facilitate conquest or spearhead the opposition, but to transform themselves from “culture brokers” into “power brokers.” Many of the decisive events that shaped colonial-Indian relations turned on the actions of these culturally-ambiguous individuals, a fact bemoaned and begrudgingly acknowledged by most of the contemporary conquistadors, chroniclers, and colonial founders, and recognized by this author. ^

The Modern State and the Re-Creation of the Indigenous Other: The Case of the Authentic Sámi in Sweden and the White Man’s Indian in the United States of America.

The present study comparatively examined the socio-political and economic transformation of the indigenous Sámi in Sweden and the Indian American in the United States of America occurring first as a consequence of colonization and later as a product of interaction with the modern territorial and industrial state, from approximately 1500 to 1900. The first colonial encounters of the Europeans with these autochthonous populations ultimately created an imagery of the exotic Other and of the noble savage. Despite these disparaging representations, the cross-cultural settings in which these interactions took place also produced the hybrid communities and syncretic life that allowed levels of cultural accommodation, autonomous space, and indigenous agency to emerge. By the nineteenth century, however, the modern territorial and industrial state rearranges the dynamics and reaches of power across a redefined territorial sovereign space, consequently, remapping belongingness and identity. In this context, the status of indigenous peoples, as in the case of Sámi and of Indian Americans, began to change at par with industrialization and with modernity. At this point in time, indigenous populations became a hindrance to be dealt with the legal re-codification of Indigenousness into a vacuumed limbo of disenfranchisement. It is, thus, the modern territorial and industrial state that re-creates the exotic into an indigenous Other. The present research showed how the initial interaction between indigenous and Europeans changed with the emergence of the modern state, demonstrating that the nineteenth century, with its fundamental impulses of industrialism and modernity, not only excluded and marginalized indigenous populations because they were considered unfit to join modern society, it also re-conceptualized indigenous identity into a constructed authenticity.

Atlantic Ais in the Sixteenth and Seventeenth Centuries: Maritime Adaptation, Indigenous Wrecking, and Buccaneer Raids on Florida’s Central East Coast

The Ais were a Native American group who lived along the Atlantic shoreline of Florida south of Cape Canaveral. This coastal population’s position adjacent to a major shipping route afforded them numerous encounters with the Atlantic world that linked Europe, Africa, the Caribbean, and the Americas. Through their exploitation of the goods and peoples from the European shipwrecks thrown ashore, coupled with their careful manipulation of other Atlantic contacts, the Ais polity established an influential domain in central east Florida during the sixteenth and seventeenth centuries. The pre-contact peoples of Florida’s east coast, including the ancestors of the Ais, practiced a maritime adaptation concentrated on the exploitation of their bountiful riverine, estuarine, and marine environments. The Ais then modified their maritime skills to cope with the opportunities and challenges that accompanied European contact. Using their existing aquatic abilities, they ably salvaged goods and castaways from the Spanish, French, English, and Dutch vessels dashed on the rocks and reefs of Florida’s coast. The Ais’ strategic redistribution of these materials and peoples to other Florida Native Americans, the Spaniards of St. Augustine, and other passing Europeans gained them greater influence. This process, which I call indigenous wrecking, enabled the Ais to expand their domain on the peninsula. Coastal Florida Native Americans’ maritime abilities also attracted the attention of Europeans. In the late seventeenth century, English buccaneers and salvagers raided Florida’s east coast to capture indigenous divers, whom they sent to work the wreck of a sunken Spanish treasure ship located in the Bahamas. The English subsequently sold the surviving Native American captives to other Caribbean slave markets. Despite population losses to such raids, the Ais and other peoples of the east coast thrived on Atlantic exchange and used their existing maritime adaptation to resist colonial intrusions until the start of the eighteenth century. This dissertation thus offers a narrative about Native Americans and the Atlantic that is unlike most Southeastern Indian stories. The Ais used their maritime adaptation and the process of indigenous wrecking to engage and exploit the arriving Atlantic world. In the contact era, the Ais truly became Atlantic Ais.

A SENSIBILIDADE CULTURAL DO ADVENTISMO COMO MODELO MISSIOLÓGICO EM GRANDES CENTROS URBANOS: UMA ANÁLISE DE IGREJAS ADVENTISTAS ÉTNICAS NA CIDADE DE SÃO PAULO

Esta pesquisa objetiva analisar o desenvolvimento da missão adventista na cidade de São Paulo em busca de um modelo missiológico para centros urbanos. São Paulo, uma das maiores metrópoles do mundo tem uma formação cultural plural, não apenas pelas forças atuantes da modernização, secularização, globalização e pós-modernidade. A composição da população da cidade possui uma gênese étnica plural. Além da matriz autóctone indígena, do colonizador branco europeu e dos escravos africanos, desde o início do século XIX chegaram outros imigrantes, europeus e asiáticos. Nas primeiras décadas do século XX, o Brasil foi o país que mais recebeu imigrantes em todo o mundo. Estima-se que nos anos de 1920, apenas um terço da população na cidade de São Paulo fosse de brasileiros, o restante era composto por imigrantes. A inserção do adventismo em São Paulo se deu por missionários imigrantes que trabalharam primeiro com outros imigrantes antes de evangelizar e desenvolver a missão adventista com os brasileiros nacionais. De alguma forma, esse início deixou marcas na missão adventista paulistana. São Paulo é hoje a cidade com o maior número total de adventistas no mundo e a única com Igrejas Adventistas étnicas que atendem cinco grupos étnicos distintos: japoneses, coreanos, judeus, árabes e bolivianos/peruanos. Esta pesquisa busca investigar a formação de uma sensibilidade cultural no adventismo paulistano que lhe permitiu dialogar com a pluralidade cultural da metrópole paulistana

Eventual benefits : kristevan readings of female subjectivity in Henry James’s Late Novels

“Eventual Benefits: Kristevan Readings of Female Subjectivity in Henry James’s Late Novels” examine la construction de la subjectivité féminine dans les romans de la phase majeure de Henry James, notamment What Maisie Knew, The Awkward Age, The Portrait of a Lady, The Wings of the Dove et The Golden Bowl. Les personnages féminins de James se trouvent souvent dans des circonstances sociales ou familiales qui défavorisent l’autonomie psychique, et ces subordinations sont surtout nuisibles pour les jeunes personnages de l’auteur. Quant aux femmes américaines expatriées de ces romans, elles éprouvent l’objectification sociale et pécuniaire des européens : en conséquence, elles déploient des tactiques contraires afin d’inverser leurs diminutions et instaurer leurs individualités. Ma recherche des protocoles qui subventionnent l’affranchissement de ces femmes procède dans le cadre des théories avancées par Julia Kristeva. En utilisant les postulats kristeviens d’abjection et de mélancolie, d’intertextualité, de maternité et de grossesse, du pardon et d’étrangeté, cette thèse explore les stratégies disparates et résistantes des femmes chez James et elle parvient à une conception de la subjectivité féminine comme un processus continuellement ajourné.

Eventual benefits : kristevan readings of female subjectivity in Henry James’s Late Novels

“Eventual Benefits: Kristevan Readings of Female Subjectivity in Henry James’s Late Novels” examine la construction de la subjectivité féminine dans les romans de la phase majeure de Henry James, notamment What Maisie Knew, The Awkward Age, The Portrait of a Lady, The Wings of the Dove et The Golden Bowl. Les personnages féminins de James se trouvent souvent dans des circonstances sociales ou familiales qui défavorisent l’autonomie psychique, et ces subordinations sont surtout nuisibles pour les jeunes personnages de l’auteur. Quant aux femmes américaines expatriées de ces romans, elles éprouvent l’objectification sociale et pécuniaire des européens : en conséquence, elles déploient des tactiques contraires afin d’inverser leurs diminutions et instaurer leurs individualités. Ma recherche des protocoles qui subventionnent l’affranchissement de ces femmes procède dans le cadre des théories avancées par Julia Kristeva. En utilisant les postulats kristeviens d’abjection et de mélancolie, d’intertextualité, de maternité et de grossesse, du pardon et d’étrangeté, cette thèse explore les stratégies disparates et résistantes des femmes chez James et elle parvient à une conception de la subjectivité féminine comme un processus continuellement ajourné.

Flammability Standards – A Major Role in Flame Retardant Exposure? Televisions as a case study.

Flame retardants (FRs) are added to materials to enhance the fire safety level of readily combustible polymers. Although they have been purported to aid in preventing fires in some cases, they have also become a significant cause for concern given the vast data on environmental persistence and human and animal adverse health effects. Evidence since the 1980s has shown that Canadian, American and Europeans have detectable levels of FRs in their bodies. North Americans in particular have high levels of these chemicals due to stringent flammability standards and the higher use of polybrominated diphenyl ethers (PBDEs) in North America as opposed to Europe. FRs have been detected in household dust and some evidence suggests that TVs could be a significant source of exposure to FRs. It is imperative to re-visit the flammability standard (UL94V) that allows for FR use in TVs plastic materials by providing a risk versus benefit analysis to determine if this standard provides a fire safety benefit and if it plays a major role in FR exposure. This report first examined the history of televisions and the progression to the UL94V flammability test standard to understand why FRs were first added to polymers used in the manufacturing of TVs. It has been demonstrated to be due to fire hazards resulting from the use of plastic materials in cathode-ray tube (CRT) TVs that had an “instant-on” feature and high voltage and operating temperatures. In providing a risk versus benefit analysis, this paper presents the argument that 1) by providing a market survey the current flammability test standard (UL94V) is outdated and lacks relevance to current technology as flat, thin, energy efficient Liquid Crystal Displays (LCDs) dominate over traditionally used heavy, bulky and energy-intensive CRTs; 2) FRs do not impart fire safety benefits considering that there is a lack of valid fire safety concern, such as reduced internal and external ignition and fire hazard, and a lack of valid fire data and hazard for television fires in general and finally; 3) the standard is overly stringent as it does not consider the risk due to exposure to FRs in household dust due to the proliferation and greater use of televisions in households. Therefore, this report argues that the UL94V standard has become trapped in history and needs to be updated as it may play a major role in FR exposure.

The evolution of lactase persistence in Europe. A synthesis of archaeological and genetic evidence

Lactase persistence, the ability to digest the milk sugar lactose in adulthood, is highly associated with a T allele situated 13,910 bp upstream from the actual lactase gene in Europeans. The frequency of this allele rose rapidly in Europe after transition from hunter–gatherer to agriculturalist lifestyles and the introduction of milkable domestic species from Anatolia some 8000 years ago. Here we first introduce the archaeological and historic background of early farming life in Europe, then summarize what is known of the physiological and genetic mechanisms of lactase persistence. Finally, we compile the evidence for a co-evolutionary process between dairying culture and lactase persistence. We describe the different hypotheses on how this allele spread over Europe and the main evolutionary forces shaping this process. We also summarize three different computer simulation approaches, which offer a means of developing a coherent and integrated understanding of the process of spread of lactase persistence and dairying.