Diet plus insulin compared to diet alone in the treatment of gestational diabetes mellitus: a systematic review

Fetuses of mothers with gestational diabetes mellitus are at increased risk to develop perinatal complications mainly due to macrosomia. However, in view of the marked heterogeneity of this disease, it seems difficult to set guidelines for diagnosis and treatment. This complicates the choice of assigning patients either to diet or to insulin therapy. Also of concern is how much benefit could be expected from insulin therapy in preventing fetal complications in these patients. In a systematic review of the literature assessing the efficacy of insulin in preventing macrosomia in fetuses of mothers with gestational diabetes, we found six randomized controlled trials comparing diet alone to diet plus insulin. The studies included a total of 1281 patients (644 in the diet plus insulin group and 637 in the diet group), with marked differences among trials concerning diagnostic criteria, randomization process and treatment goals. Meta-analysis of the data resulted in a risk difference of -0.098 (95%CI: -0.168 to -0.028), and a number-necessary-to-treat of 11 (95%CI: 6 to 36), which means that it is necessary to treat 11 patients with insulin to prevent one case of macrosomia. This indicates a potential benefit of insulin, but not significantly enough to set treatment guidelines. Because of the heterogeneous evidence available in the literature about this matter, we conclude that larger trials addressing the efficacy of these two therapeutic modalities in preventing macrosomia are warranted.

Design, implementation, and evaluation of an online water quality monitoring system in Lake Saimaa, Finland

Environmental threats are growing nowadays, they became global issues. People around the world try to face these issues by two means: solving the current affected environs and preventing non-affected environs. This thesis describes the design, implementation, and evaluation of online water quality monitoring system in Lake Saimaa, Finland. The water quality in Lake Saimaa needs to be monitored in order to provide responsible bodies with valuable information which allows them to act fast in order to prevent any negative impact on the lake's environment. The objectives were to design a suitable system, implement the system in Lake Saimaa, and then to evaluate the applicability and reliability of such systems for this environment. The needs for the system were first isolated, and then the design, needed modifications, and the construction of the system took place. After that was the testing of the system in Lake Saimaa in two locations nearby Mikkeli city. The last step was to evaluate the whole system. The main results were that the application of online water quality monitoring systems in Lake Saimaa can benefit of many advantages such as reducing the required manpower, time and running costs. However, the point of unreliability of the exact measured values of some parameters is still the drawback of such systems which can be developed by using more advanced equipments with more sophisticated features specifically for the purpose of monitoring in the predefined location.

Anti-tumor necrosis factor-a for the treatment of steroid-refractory acute graft-versus-host disease

Allogeneic stem cell transplantation has been increasingly performed for a variety of hematologic diseases. Clinically significant acute graft-versus-host disease (GVHD) occurs in 9 to 50% of patients who receive allogeneic grafts, resulting in high morbidity and mortality. There is no standard therapy for patients with acute GVHD who do not respond to steroids. Studies have shown a possible benefit of anti-TNF-a (infliximab)for the treatment of acute GVHD. We report here on the outcomes of 10 recipients of related or unrelated stem cell transplants who received 10 mg/kg infliximab, iv, once weekly for a median of 3.5 doses (range: 1-6) for the treatment of severe acute GVHD and who were not responsive to standard therapy. All patients had acute GVHD grades II to IV (II = 2, III = 3, IV = 5). Overall, 9 patients responded and 1 patient had progressive disease. Among the responders, 3 had complete responses and 6 partial responses. All patients with cutaneous or gastrointestinal involvement responded, while only 2 of 6 patients with liver disease showed any response. None of the 10 patients had any kind of immediate toxicity. Four patients died, all of them with sepsis. Six patients are still alive after a median follow-up time of 544 days (92-600) after transplantation. Considering the severity of the cases and the bad prognosis associated with advanced acute GVHD, we find our results encouraging. Anti-TNF-a seems to be a useful agent for the treatment of acute GVHD.

Cost-effective analysis of different algorithms for the diagnosis of hepatitis C virus infection

We compared the cost-benefit of two algorithms, recently proposed by the Centers for Disease Control and Prevention, USA, with the conventional one, the most appropriate for the diagnosis of hepatitis C virus (HCV) infection in the Brazilian population. Serum samples were obtained from 517 ELISA-positive or -inconclusive blood donors who had returned to Fundação Pró-Sangue/Hemocentro de São Paulo to confirm previous results. Algorithm A was based on signal-to-cut-off (s/co) ratio of ELISA anti-HCV samples that show s/co ratio ³95% concordance with immunoblot (IB) positivity. For algorithm B, reflex nucleic acid amplification testing by PCR was required for ELISA-positive or -inconclusive samples and IB for PCR-negative samples. For algorithm C, all positive or inconclusive ELISA samples were submitted to IB. We observed a similar rate of positive results with the three algorithms: 287, 287, and 285 for A, B, and C, respectively, and 283 were concordant with one another. Indeterminate results from algorithms A and C were elucidated by PCR (expanded algorithm) which detected two more positive samples. The estimated cost of algorithms A and B was US$21,299.39 and US$32,397.40, respectively, which were 43.5 and 14.0% more economic than C (US$37,673.79). The cost can vary according to the technique used. We conclude that both algorithms A and B are suitable for diagnosing HCV infection in the Brazilian population. Furthermore, algorithm A is the more practical and economical one since it requires supplemental tests for only 54% of the samples. Algorithm B provides early information about the presence of viremia.

Hyperthermia induced after recirculation triggers chronic neurodegeneration in the penumbra zone of focal ischemia in the rat brain

Chronic neurodegenerative processes have been identified in the rat forebrain after prolonged survival following hyperthermia (HT) initiated a few hours after transient global ischemia. Since transient global ischemia and ischemic penumbra share pathophysiological similarities, this study addressed the effects of HT induced after recirculation of focal brain ischemia on infarct size during long survival times. Adult male Wistar rats underwent intra-luminal occlusion of the left middle cerebral artery for 60 min followed by HT (39.0-39.5°C) or normothermia. Control procedures included none and sham surgery with and without HT, and middle cerebral artery occlusion alone. Part I: 6-h HT induced at recirculation. Part II: 2-h HT induced at 2-, 6-, or 24-h recirculation. Part III: 2-h HT initiated at recirculation or 6-h HT initiated at 2-, 6- or 24-h recirculation. Survival periods were 7 days, 2 or 6 months. The effects of post-ischemic HT on cortex and striatum were evaluated histopathologically by measuring the area of remaining tissue in the infarcted hemisphere at -0.30 mm from bregma. Six-hour HT initiated from 6-h recirculation caused a significant decrease in the remaining cortical tissue between 7-day (N = 8) and 2-month (N = 8) survivals (98.46 ± 1.14 to 73.62 ± 8.99%, respectively). When induced from 24-h recirculation, 6-h HT caused a significant reduction of the remaining cortical tissue between 2- (N = 8) and 6-month (N = 9) survivals (94.97 ± 5.02 vs 63.26 ± 11.97%, respectively). These data indicate that post-ischemic HT triggers chronic neurodegenerative processes in ischemic penumbra, suggesting that similar fever-triggered effects may annul the benefit of early recirculation in stroke patients over the long-term.

In vitro cultivation of canine multipotent mesenchymal stromal cells on collagen membranes treated with hyaluronic acid for cell therapy and tissue regeneration

Support structures for dermal regeneration are composed of biodegradable and bioresorbable polymers, animal skin or tendons, or are bacteria products. The use of such materials is controversial due to their low efficiency. An important area within tissue engineering is the application of multipotent mesenchymal stromal cells (MSCs) to reparative surgery. The combined use of biodegradable membranes with stem cell therapy may lead to promising results for patients undergoing unsuccessful conventional treatments. Thus, the aim of this study was to test the efficacy of using membranes composed of anionic collagen with or without the addition of hyaluronic acid (HA) as a substrate for adhesion and in vitro differentiation of bone marrow-derived canine MSCs. The benefit of basic fibroblast growth factor (bFGF) on the differentiation of cells in culture was also tested. MSCs were collected from dog bone marrow, isolated and grown on collagen scaffolds with or without HA. Cell viability, proliferation rate, and cellular toxicity were analyzed after 7 days. The cultured cells showed uniform growth and morphological characteristics of undifferentiated MSCs, which demonstrated that MSCs successfully adapted to the culture conditions established by collagen scaffolds with or without HA. This demonstrates that such scaffolds are promising for applications to tissue regeneration. bFGF significantly increased the proliferative rate of MSCs by 63% when compared to groups without the addition of the growth factor. However, the addition of bFGF becomes limiting, since it has an inhibitory effect at high concentrations in culture medium.

Impact of training at ventilatory threshold on cardiopulmonary and functional capacity in overweight patients with chronic kidney disease

INTRODUCTION: Chronic kidney disease (CKD) and obesity are both associated with reduced physical capacity. The potential benefit of aerobic training on physical capacity has been recognized. The exercise intensity can be established using different methods mostly subjective or indirect. Ventilatory threshold (VT) is a direct and objective method that allows prescribing exercise intensity according to individual capacity. OBJECTIVES: To evaluate the impact of aerobic training at VT intensity on cardiopulmonary and functional capacities in CKD patients with excess of body weight. METHODS: Ten CKD patients (eight men, 49.7 ± 10.1 years; BMI 30.4 ± 3.5 kg/m², creatinine clearance 39.4 ± 9.8 mL/min/1.73 m²) underwent training on a treadmill three times per week during 12 weeks. Cardiopulmonary capacity (ergoespirometry), functional capacity and clinical parameters were evaluated. RESULTS: At the end of 12 weeks, VO2PEAK increased by 20%, and the speed at VO2PEAK increased by 16%. The training resulted in improvement in functional capacity tests, such as six-minute walk test (9.2%), two-minute step test (20.3%), arm curl test (16.3%), sit and stand test (35.7%), and time up and go test (15.3%). In addition, a decrease in systolic and diastolic blood pressures was observed despite no change in body weight, sodium intake and antihypertensive medication. CONCLUSION: Aerobic exercise performed at VT intensity improved cardipulmonary and functional capacities of overweight CKD patients. Additional benefit on blood pressure was observed. These results suggest that VT can be effectively applied for prescribing exercise intensity in this particular group of patients.

Characterization and Investigation on Material Compatibilities of Building Integrated Photovoltaic Module Components

Building Integrated Photovoltaics (BIPV) are considered as the future of photovoltaic (PV) technology. The advantage of BIPV system is its multi-functionality; they fulfil the functions of a building envelope with the added benefit of generating power by replacing the traditional roofing and façade materials with PV that generate power. In this thesis, different types of PV cells and modules have been described in detail with their efficiencies and usage trends in the last decade. The different BIPV products for roof and façade are discussed in detail giving several examples. The electricity generation potential of BIPV in selected countries is compared with their actual electricity consumption. Further, the avoided greenhouse gas (GHG) emissions associated with electricity generation from traditional sources and transportation and distribution (T&D) losses are calculated. The results illustrate huge savings in GHGs. In BIPV different types of façade and backsheets are used. In this thesis, selected backsheets and façade were characterized in terms of their surface structure identification using infrared spectroscopy (FTIR-ATR), scanning electron microscopy with energy dispersive X-ray (SEM-EDX) and physical characterization using surface energy measurements. By using FTIR-ATR, surface polymeric materials were identified and with SEM-EDX, identification of the surface elements was possible. Surface energy measurements were useful in finding the adhesives and knowing the surface energies of the various backsheets and façade. The strength of adhesion between the facade and backsheets was studied using peel test. Four different types of adhesives were used to study the fracture pattern and peel tests values to identify the most suitable adhesive. It was found out that pretreatment increased the adhesive strength significantly.

Utilization of Statistical Methods for Management in the Forest Industry

The strongest wish of the customer concerning chemical pulp features is consistent, uniform quality. Variation may be controlled and reduced by using statistical methods. However, studies addressing the application and benefits of statistical methods in forest product sector are scarce. Thus, the customer wish is the root cause of the motivation behind this dissertation. The research problem addressed by this dissertation is that companies in the chemical forest product sector require new knowledge for improving their utilization of statistical methods. To gain this new knowledge, the research problem is studied from five complementary viewpoints – challenges and success factors, organizational learning, problem solving, economic benefit, and statistical methods as management tools. The five research questions generated on the basis of these viewpoints are answered in four research papers, which are case studies based on empirical data collection. This research as a whole complements the literature dealing with the use of statistical methods in the forest products industry. Practical examples of the application of statistical process control, case-based reasoning, the cross-industry standard process for data mining, and performance measurement methods in the context of chemical forest products manufacturing are brought to the public knowledge of the scientific community. The benefit of the application of these methods is estimated or demonstrated. The purpose of this dissertation is to find pragmatic ideas for companies in the chemical forest product sector in order for them to improve their utilization of statistical methods. The main practical implications of this doctoral dissertation can be summarized in four points: 1. It is beneficial to reduce variation in chemical forest product manufacturing processes 2. Statistical tools can be used to reduce this variation 3. Problem-solving in chemical forest product manufacturing processes can be intensified through the use of statistical methods 4. There are certain success factors and challenges that need to be addressed when implementing statistical methods

Deviations of Governance In IT Multi-Sourcing: A Case Study

IT outsourcing (ITO) refers to the shift of IT/IS activities from internal to external of an organization. In prior research, the governance of ITO is recognized with persistent strategic importance for practice, because it is tightly related to ITO success. Under the rapid transformation of global market, the evolving practice of ITO requires updated knowledge on effective governance. However, research on ITO governance is still under developed due to the lack of integrated theoretical frameworks and the variety of empirical settings besides dyadic client-vendor relationships. Especially, as multi-sourcing has become an increasingly common practice in ITO, its new governance challenges must be attended by both ITO researchers and practitioners. To address this research gap, this study aims to understand multi-sourcing governance with an integrated theoretical framework incorporating both governance structure and governance mechanisms. The focus is on the emerging deviations among formal, perceived and practiced governance. With an interpretive perspective, a single case study is conducted with mixed methods of Social Network Analysis (SNA) and qualitative inquiries. The empirical setting embraces one client firm and its two IT suppliers for IT infrastructure services. The empirical material is analyzed at three levels: within one supplier firm, between the client and one supplier, and among all three firms. Empirical evidences, at all levels, illustrate various deviations in governance mechanisms, with which emerging governance structures are shaped. This dissertation contributes to the understanding of ITO governance in three domains: the governance of ITO in general, the governance of multi-sourcing in particular, and research methodology. For ITO governance in general, this study has identified two research strands of governance structure and governance mechanisms, and integrated both concepts under a unified framework. The composition of four research papers contributes to multi-sourcing research by illustrating the benefits of zooming in and out across the multilateral relationships with different aspects and scopes. Methodologically, the viability and benefit of mixed-method is illustrated and confirmed for both researchers and practitioners.

Women’s Literary Club of St. Catharines Fonds

The Women's Literary Club of St. Catharines was founded in 1892 by a local author, Emma Harvey (Mrs. J.G.) Currie (1829-1913) and held its last official meeting on February 19, 1994. The Club developed, flourished and eventually waned. After more than one hundred successful years, the last members deposited the Club's archives at Brock University for the benefit of researchers, scholars and the larger community. The ‘object of the Club’ was established as “the promotion of literary pursuits.” The Club was a non-profit social organization composed of predominantly white, upper middle class women from the St. Catharines and surrounding areas. Club meetings were traditionally held fortnightly from March to December each year. The last meeting of the year was a celebration of their Club anniversary. The early meetings of the Club include papers presented and music performed by Club members. The literary pursuits that would dominate the agendas for the entire life of the Club reflected an interest in selected authors, national and local history, classical history, musical performances and current cultural and newsworthy events. For example in 1893 a typical meeting agendas would contain papers on Henry Wadsworth Longfellow, Hawaii, Brook Farm, Miss Louisa May Alcott and “Education of Women 100 years Ago.” Within the first year of the Club’s existence, detailed minute books became the norm and an annual agenda or program developed. The WLC collection contains a near complete set of meeting minutes from 1892 until 1995 and a comprehensive collection of yearly programs from 1983-1967 which members took great care to publish each year. Mrs. Currie brought together a group of women with a shared interest in literature and history, who wanted to pursue that interest in a formal and structured manner. She was well educated and influenced at an early age by her tutor and mentor William Kirby, local historian, writer and newspaper editor from Niagara-on-the-Lake. While Currie’s private education influenced her love of literature and history, the Club movement of the 1890’s offered a more public forum for her to share knowledge and learning with other women. Mrs. Currie was the wife of St. Catharines lawyer, James G. Currie, who also served as a Member of Parliament for the county of Lincoln. Mrs. W.H. McClive, who was also married to a St. Catharines lawyer, worked closely with Currie and they began research into the possibility of a literary Club in St. Catharines. Currie corresponded with a variety of literary Clubs across North America before she and Mrs.McClive tagged onto the momentum of the Club movement and published “A Clarion call for Women of St. Catharines To Form a Literary Club” in the local paper The St. Catharines Evening Journal. in 1892 and asked like Clubs to publish the news of their new Club. The early years of the WLC set the foundation of how the Club meetings and events would unfold for the next 80 plus years. Photos and minutes from the first ten years reveal an excitement and interest in organized Club outings. One particular event, an annual pilgrimage to the homestead of Laura Secord, became a yearly celebration for the Club. Club President, Mrs. Currie’s own personal work on Laura Secord amplified the Club’s interest in the ‘heroine of 1812’ and she allocated the profits from her publication on Secord in order to create a commemorative plaque/monument in the name of Laura Secord. The Club celebrated this event with a regular pilgrimage to this site. The connection felt by Club members and this memorial would continue until the Club’s last meetings. The majority of members in the early years were of the upper middle classes in the growing city of St. Catharines. Many of the charter members were the wives of merchants, business men, lawyers, doctors, even a hatter. Furthermore, the position of president was most often held by a woman with a comprehensive list of interests. This is particularly the case in Isabel Brighty McComb (1876-1941). Brighty who became a member in 1903, became Club president in 1932 and stayed in her post until her death in 1941. Similar to Mrs. Currie, Brighty was a local historian and published 2 booklets on local history. Her obituary indicates her position in the community as an author and involved community member committed to lifetime memberships in the Imperial Order of Daughters of Empire, I.O.D.E., the National Organization of Women, N.O.W. and the United Empire Loyalist Society, as well as the WLC. She was a locally known ‘teacher of elocution’ and a devoted researcher of Upper Canadian history. In a Club scrapbook dedicated to her, the biographical sketch illustrates the professionalism surrounding Brighty. There is very little personal history mentioned and the focus is on her literary works, her published essay, booklets and poetry. This professional focus, evident in both her obituary and the scrapbook, illustrate the diversity of these women, especially in their roles outside of the home. The WLC collection contains a vast array of essay, lectures clippings and scrapbooks from past meetings. Organized predominantly by topic or author, the folders and scrapbooks offer a substantial amount of research opportunity in the literary history of Canada. The dates, scope of topics and authors covered offer historians an exciting opportunity to examine the consumption of particular literary trends, artists and topics within the context of a midsized industrial city in English Canada. This is especially important because the agenda adhered to by the Club was bent on promoting, discussing and reviewing predominantly Canadian material. By connecting when and what these women were studying, scholars many gain a better understanding of the broader consumption and appreciation of literary and social trends of Canadian women outside of publishing and institutional records. Furthermore, because the agendas were set by and for these women, outside of the constructs of an institutionalized canon or agenda, they offer a fresh and on the ground examination of literary consumption over an extensive length of time.

Global migration : patriarchy, propoganda and the well- being of women and children

This critical analysis explores the conflicted position of women as ''trailing spouses" and the effects on families who relocate globally under the auspices of a multinational corporation, by utilizing a discursive analysis of two contemporary films and available literature. Current portrayals of women and children in contemporary media provide emotional yet conflicting images of the perfect woman, wife, mother, child and family. The basic tenets of a North American patriarchal economic system are being televised around the world. Technological advancements have made it possible to advertise political agendas on a global television screen. Much of what we see is propaganda couched in films and advertisements that are designed to romantic~e the practice of deriving profits from the unpaid labor of woman and invisibility of children and child rearing. I intend to show that the materiality of trailing a spouse globally conflicts with these romanticized images and supports feminist literature that asserts the notion that mothers and children are oppressed and managed for the benefit of capital.

Fair of Nations (1906)

Official program "Fair of Nations" for the benefit of the Niagara Falls General Hospital.

Certificate of Acceptance and Initiation to Canadian Order Chosen Friends - Thomas Cowan

A certificate of initiation and acceptance to the Canadian Order Chosen Friends, Thomas Cowan. The certificate reads "This certifies that evidence has been received that Thomas Cowan has been accepted and initiated by the Council name below, and has thus become a member of the Canadian Order of Chosen Friends, and entitled to all the rights and privileges of membership and a benefit of not exceeding one thousand dollars from the relief fund of said order, which shall in case of death be paid to Annie Cowan his wife in the manner and subject to the conditions set forth in the laws governing said relief fund and in the application for membership. This certificate to be in force and binding when accepted in writing by the said member, with the acceptance attested by the Councilor and Recorder and the seal of the Subordinate Council affixed, so long as said member shall comply with the requirements of the Constitution, Laws and Regulations now in force or hereafter adopted for the government of the Order: otherwise, and also in the case of granting of a new certificate, to be null and void. In witness whereof, we have hereunto attached our signatures, and affixed the seal of the Grand Council of the Canadian Order of Chosen Friends. Dated the Twenty Seventh day of July, A.D. 1891." The front and back of the certificate are available for viewing.

Fur Council of Canada records

The Fur Council of Canada is an association that represents people working in all sectors of the Canadian fur trade, including trappers, processors, designers, manufacturers and retail furriers. The association aims to “promote, defend and enhance the professional, economic, social and moral interests of our members”. The Council supports fair trading practices for the benefit of producers and artisans; the responsible use of renewable resources; partnerships between the fur trade and other sectors of the Canadian and international fashion industry; and innovative use of fur by young designers.