Genome-wide association with bone mass and geometry in the Framingham Heart Study

BACKGROUND:Osteoporosis is characterized by low bone mass and compromised bone structure, heritable traits that contribute to fracture risk. There have been no genome-wide association and linkage studies for these traits using high-density genotyping platforms.METHODS:We used the Affymetrix 100K SNP GeneChip marker set in the Framingham Heart Study (FHS) to examine genetic associations with ten primary quantitative traits: bone mineral density (BMD), calcaneal ultrasound, and geometric indices of the hip. To test associations with multivariable-adjusted residual trait values, we used additive generalized estimating equation (GEE) and family-based association tests (FBAT) models within each sex as well as sexes combined. We evaluated 70,987 autosomal SNPs with genotypic call rates [greater than or equal to]80%, HWE p [greater than or equal to] 0.001, and MAF [greater than or equal to]10% in up to 1141 phenotyped individuals (495 men and 646 women, mean age 62.5 yrs). Variance component linkage analysis was performed using 11,200 markers.RESULTS:Heritability estimates for all bone phenotypes were 30-66%. LOD scores [greater than or equal to]3.0 were found on chromosomes 15 (1.5 LOD confidence interval: 51,336,679-58,934,236 bp) and 22 (35,890,398-48,603,847 bp) for femoral shaft section modulus. The ten primary phenotypes had 12 associations with 100K SNPs in GEE models at p < 0.000001 and 2 associations in FBAT models at p < 0.000001. The 25 most significant p-values for GEE and FBAT were all less than 3.5 x 10-6 and 2.5 x 10-5, respectively. Of the 40 top SNPs with the greatest numbers of significantly associated BMD traits (including femoral neck, trochanter, and lumbar spine), one half to two-thirds were in or near genes that have not previously been studied for osteoporosis. Notably, pleiotropic associations between BMD and bone geometric traits were uncommon. Evidence for association (FBAT or GEE p < 0.05) was observed for several SNPs in candidate genes for osteoporosis, such as rs1801133 in MTHFR; rs1884052 and rs3778099 in ESR1; rs4988300 in LRP5; rs2189480 in VDR; rs2075555 in COLIA1; rs10519297 and rs2008691 in CYP19, as well as SNPs in PPARG (rs10510418 and rs2938392) and ANKH (rs2454873 and rs379016). All GEE, FBAT and linkage results are provided as an open-access results resource at http://www.ncbi.nlm.nih.gov/projects/gap/cgi-bin/study.cgi?id=phs000007.CONCLUSION:The FHS 100K SNP project offers an unbiased genome-wide strategy to identify new candidate loci and to replicate previously suggested candidate genes for osteoporosis.

STAR 3 randomized controlled trial to compare sensor-augmented insulin pump therapy with multiple daily injections in the treatment of type 1 diabetes: research design, methods, and baseline characteristics of enrolled subjects.

BACKGROUND: Sensor-augmented pump therapy (SAPT) integrates real-time continuous glucose monitoring (RT-CGM) with continuous subcutaneous insulin infusion (CSII) and offers an alternative to multiple daily injections (MDI). Previous studies provide evidence that SAPT may improve clinical outcomes among people with type 1 diabetes. Sensor-Augmented Pump Therapy for A1c Reduction (STAR) 3 is a multicenter randomized controlled trial comparing the efficacy of SAPT to that of MDI in subjects with type 1 diabetes. METHODS: Subjects were randomized to either continue with MDI or transition to SAPT for 1 year. Subjects in the MDI cohort were allowed to transition to SAPT for 6 months after completion of the study. SAPT subjects who completed the study were also allowed to continue for 6 months. The primary end point was the difference between treatment groups in change in hemoglobin A1c (HbA1c) percentage from baseline to 1 year of treatment. Secondary end points included percentage of subjects with HbA1c < or =7% and without severe hypoglycemia, as well as area under the curve of time spent in normal glycemic ranges. Tertiary end points include percentage of subjects with HbA1c < or =7%, key safety end points, user satisfaction, and responses on standardized assessments. RESULTS: A total of 495 subjects were enrolled, and the baseline characteristics similar between the SAPT and MDI groups. Study completion is anticipated in June 2010. CONCLUSIONS: Results of this randomized controlled trial should help establish whether an integrated RT-CGM and CSII system benefits patients with type 1 diabetes more than MDI.

The professionalism disconnect: do entering residents identify yet participate in unprofessional behaviors?

BACKGROUND: Professionalism has been an important tenet of medical education, yet defining it is a challenge. Perceptions of professional behavior may vary by individual, medical specialty, demographic group and institution. Understanding these differences should help institutions better clarify professionalism expectations and provide standards with which to evaluate resident behavior. METHODS: Duke University Hospital and Vidant Medical Center/East Carolina University surveyed entering PGY1 residents. Residents were queried on two issues: their perception of the professionalism of 46 specific behaviors related to training and patient care; and their own participation in those specified behaviors. The study reports data analyses for gender and institution based upon survey results in 2009 and 2010. The study received approval by the Institutional Review Boards of both institutions. RESULTS: 76% (375) of 495 PGY1 residents surveyed in 2009 and 2010 responded. A majority of responders rated all 46 specified behaviors as unprofessional, and a majority had either observed or participated in each behavior. For all 46 behaviors, a greater percentage of women rated the behaviors as unprofessional. Men were more likely than women to have participated in behaviors. There were several significant differences in both the perceptions of specified behaviors and in self-reported observation of and/or involvement in those behaviors between institutions.Respondents indicated the most important professionalism issues relevant to medical practice include: respect for colleagues/patients, relationships with pharmaceutical companies, balancing home/work life, and admitting mistakes. They reported that professionalism can best be assessed by peers, patients, observation of non-medical work and timeliness/detail of paperwork. CONCLUSION: Defining professionalism in measurable terms is a challenge yet critical in order for it to be taught and assessed. Recognition of the differences by gender and institution should allow for tailored teaching and assessment of professionalism so that it is most meaningful. A shared understanding of what constitutes professional behavior is an important first step.

Historia del currículo de Matemáticas en España para educación secundaria (1970-1990)

Conocer la historia de la propia profesión es uno de los signos de identidad que caracteriza a los grupos sociales. Los educadores matemáticos españoles están comenzando a considerarse como grupo profesional diferenciado, con necesidades formativas propias y unas condiciones de trabajo específicas bien definidas, que necesitan de infraestructura adecuada. La caracterización de esta profesión es resultado de un proceso lento de profundización teórica e implementación práctica llevado a cabo a lo largo de muchos años, con avances y retrocesos, e interconectado con los recientes cambios sociales y políticos ocurridos en España. Por ello, constituir una comunidad de educadores matemáticos, formada por profesionales autónomos y críticos, socialmente eficaces, es una tarea lo suficentemente importante como para necesitar el esfuerzo de todos.

Transformaciones básicas de las funciones

En el desarrollo de esta actividad se discute cómo se transforma una función, de la cual se conoce su representación gráfica y no su representación algebraica. La actividad consiste en un estudio de la gráfica de una función prototipo totalmente descontextualizada. Se propone la composición de funciones, operaciones entre gráficas y su relación con algunas formas analíticas asociadas al variar algunos de sus parámetros, para mirar el comportamiento global tanto de la función compuesta, como de la familia de funciones resultantes; que permita relacionar la representación gráfica de una función compuesta con las funciones que la componen y explorar patrones en las familias de éstas y así poder predecir el comportamiento de una función cualquiera bajo este tipo de transformaciones.

Feature-oriented grid topology design for aerospace configurations

The last few years have seen a substantial increase in the geometric complexity for 3D flow simulation. In this paper we describe the challenges in generating computation grids for 3D aerospace configuations and demonstrate the progress made to eventually achieve a push button technology for CAD to visualized flow. Special emphasis is given to the interfacing from the grid generator to the flow solver by semi-automatic generation of boundary conditions during the grid generation process. In this regard, once a grid has been generated, push button technology of most commercial flow solvers has been achieved. This will be demonstrated by the ad hoc simulation for the Hopper configuration.

Impacts of fisheries on plankton community structure

There has been much debate on the extent to which resource availability (bottom-up) versus predation pressure from fish (top-down) modulates the dynamics of plankton in marine systems. Physico/chemical bottom-up forcing has been considered to be the main mechanism structuring marine ecosystems, although some field observations and empirical correlations support top-down modulation. Models have indicated possible feedback loops to the plankton and other studies have interpreted a grazing impact from long-term changes in fish stocks. In freshwater systems, evidence for top-down forcing by fish and trophic cascading is well documented. First, evidence for equivalent top-down effects in the marine environment is presented, with an overview of relevant publications. In the second part, time series, averaged for the North Sea (when possible from 1948 to 1997), of fish catch, recruitment, and spawning stock biomass are related to the abundance of species or larger groupings of zooplankton and phytoplankton from the Continuous Plankton Recorder survey and selected environmental parameters. Preliminary analysis suggests that there is strong interaction between different fish species and the plankton and that the fishery, through top-down control, may at times be an important contributor to changes in the North Sea ecosystem.