Oral glucose tolerance test in children and adolescents: Positives and pitfalls

Objectives: To describe the glycaemic status (assessed by an oral glucose tolerance test (OGTT)) and associated comorbidities in a cohort of Australian children and adolescents at risk of insulin resistance and impaired glucose homeostasis (IGH). Methods: Twenty-one children and adolescents (three male, 18 female) (18 Caucasian, one Indigenous, two Asian) (20 obese, one lipodystrophy) referred to the Paediatric Endocrinology and Diabetes Clinic underwent a 2-h OGTT with plasma glucose and insulin measured at baseline, + 60 and + 120 min. If abnormal, the OGTT was repeated. Results: The mean (SD) age was 14.2 (1.6) years, BMI 38.8 (7.0) kg/m(2) and BMI-SDS 3.6 (0.6). Fourteen patients had fasting insulin levels >21 mU/L. Type 2 diabetes mellitus was diagnosed in one patient, impaired glucose tolerance (IGT) in four patients and impaired fasting glycaemia (IFG) in one patient. Despite no weight loss, only one patient had a persistently abnormal OGTT on repeat testing. Three patients with IGH were medicated with risperidone at the time of the initial OGTT. One patient who had persistent IGT had continued risperidone. The other two patients had initial OGTT results of IGT and diabetes mellitus type 2. They both ceased risperidone between tests and repeat OGTT showed normal glycaemic status. Conclusions: Use of fasting glucose alone may miss cases of IGH. Diagnosis of IGT should not be made on one test alone. Interpretation of glucose and insulin responses in young people is limited by lack of normative data. Larger studies are needed to generate Australian screening recommendations. Further assessment of the potential adverse effects of atypical antipsychotic medication on glucose homeostasis in this at-risk group is important.

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.

Oral uptake and distribution of microspheres

There is a growing body of experimental evidence suggesting that the gastrointestinal tract (GIT) may be penetrated by sub-micron sized polymeric particles which have the capacity to deliver therapeutic compounds. We investigated this, initially with Fluoresbrite™ carboxylate latex microspheres (0.87 m diameter) which were administered orally to rats. Microsphere numbers within blood samples were then quantified using fluorescence microscopy or FACS technology. These studies were prone to quantitative error, but indicated that increased microsphere translocation occurred if particles were administered in conjunction with large volumes of hypotonic liquid, and that uptake was very rapid. Test particles were detected in blood, only a few minutes after dosing. To improve quantification, GPC technology was adopted. 0.22 m latex particles were found to accumulate in greatest numbers within the Mononuclear phagocyte system tissues after gavage. Again translocation was rapid. The ability of test particles to leave the intestinal lumen and access systemic compartments was found to be highly dependent on their size and hydrophobicity, determined by hydrophobic interaction chromatography. Considerably lower numbers of 0.97 m diameter latex microspheres were detectable within extra-intestinal tissue locations after gavage. Histological studies showed that Fluoresbrite™ microspheres accumulate within the liver, spleen, Mesenteric lymph node and vasculature of rats after oral administration. Fluorescent particles were observed in both the Peyer's patches (PPs), and non lymphoid regions of rat intestinal mucosa after gavage, conductive to the acceptance that more than one mechanism of particle absorption may operate.

Variation in spoken discourse in and beyond the english foreign language classroom : a comparative study

This study is concerned with one of the most interesting and the least well-researched areas in contemporary research on classroom interaction: that of the discourse variability exhibited by participants. It investigates the way in which the language of native speakers (NSs) as well as that of non-native speakers (NNSs) may vary according to the circumstances under which it is produced. The study, therefore, attempts to characterise the performance of both NSs and NNSs (with particular emphasis placed on the latter) in various types of interaction in and beyond the EFL classroom. These are: Formal Interview (FI), Formal Classroom Interaction (FCI), Informal Classroom Interaction (ICI), Informal Classroom Discussion (ICD), and Informal Conversation (IC). The corpus of the study consisted of four NSs and fifteen NNSs. Both a video and a tape recording was made for each type of interaction, with the exception of the IC which was only audio-recorded so as not to inhibit the natural use of language. Each lasted for 35 minutes. The findings of the study mark clearly the distinction between the `artificiality' of classroom interaction and the `naturalness' or `authenticity' of non-classroom discourse. Amongst the most interesting findings are the following: Unlike both FCI and ICI, in the FI, ICD, and IC, the language of NNSs was characterised by: greater quantity of oral output, a wider range of errors, the use of natural discourse strategies such as holding the floor and self-correction, and a greater number of initiations in both ICD and IC. It is suggested that if `natural' or `authentic' discourse is to be promoted, the incorporation of FI, ICD, and IC into the EFL classroom activities is much needed. The study differs from most studies on classroom interaction in that it attempts to relate work in the EFL classroom to the `real' world as its prime objective.

Role of β-adrenergic receptors in the oral activity of zinc-α2-glycoprotein (ZAG)

Zinc-a2-glycoprotein (ZAG) is an adipokine with the potential as a therapeutic agent in the treatment of obesity and type 2 diabetes. In this study we show that human ZAG, which is a 41-kDa protein, when administered to ob/ob mice at 50 µg/d-1 orally in the drinking water produced a progressive loss of body weight (5 g after 8 d treatment), together with a 0.5 C increase in rectal temperature and a 40% reduction in urinary excretion of glucose. There was also a 33% reduction in the area under the curve during an oral glucose tolerance test and an increased sensitivity to insulin. These results were similar to those after iv administration of ZAG. However, tryptic digestion was shown to inactivate ZAG. There was no evidence of human ZAG in the serum but a 2-fold elevation of murine ZAG, which was also observed in target tissues such as white adipose tissue. To determine whether the effect was due to interaction of the human ZAG with the ß-adrenergic (ß-AR) in the gastrointestinal tract before digestion, ZAG was coadministered to ob/ob mice together with propanolol (40 mg/kg-1), a nonspecific ß-AR antagonist. The effect of ZAG on body weight, rectal temperature, urinary glucose excretion, improvement in glucose disposal, and increased insulin sensitivity were attenuated by propanolol, as was the increase in murine ZAG in the serum. These results suggest that oral administration of ZAG increases serum levels through interaction with a ß-AR in the upper gastrointestinal tract, and gene expression studies showed this to be in the esophagus.

Assessment of different formulations of oral Mycobacterium bovis Bacille Calmette-Guerin (BCG) vaccine in rodent models for immunogenicity and protection against aerosol challenge with M-bovis

Bovine tuberculosis (bTB) caused by infection with Mycobacterium bovis is causing considerable economic loss to farmers and Government in the United Kingdom as its incidence is increasing. Efforts to control bTB in the UK are hampered by the infection in Eurasian badgers (Metes metes) that represent a wildlife reservoir and source of recurrent M. bovis exposure to cattle. Vaccination of badgers with the human TB vaccine, M. bovis Bacille Calmette-Guerin (BCG), in oral bait represents a possible disease control tool and holds the best prospect for reaching badger populations over a wide geographical area. Using mouse and guinea pig models, we evaluated the immunogenicity and protective efficacy, respectively, of candidate badger oral vaccines based on formulation of BCG in lipid matrix, alginate beads, or a novel microcapsular hybrid of both lipid and alginate. Two different oral doses of BCG were evaluated in each formulation for their protective efficacy in guinea pigs, while a single dose was evaluated in mice. In mice, significant immune responses (based on lymphocyte proliferation and expression of IFN-gamma) were only seen with the lipid matrix and the lipid in alginate microcapsular formulation, corresponding to the isolation of viable BCG from alimentary tract lymph nodes. In guinea pigs, only BCG formulated in lipid matrix conferred protection to the spleen and lungs following aerosol route challenge with M. bovis. Protection was seen with delivery doses in the range 10(6)-10(7) CFU, although this was more consistent in the spleen at the higher dose. No protection in terms of organ CFU was seen with BCG administered in alginate beads or in lipid in alginate microcapsules, although 10(7) in the latter formulation conferred protection in terms of increasing body weight after challenge and a smaller lung to body weight ratio at necropsy. These results highlight the potential for lipid, rather than alginate, -based vaccine formulations as suitable delivery vehicles for an oral BCG vaccine in badgers.

Relationship between changes in postprandial glucagon, patient characteristics, and response to lixisenatide as add-on to oral antidiabetics

Background and aims: Lixisenatide, a once-daily prandial glucagon-like peptide-1 receptor agonist, reduces postprandial (PP) glycaemic excursions and HbA 1c . We report an exploratory analysis of the GetGoal-M and S trials in patients with type 2 diabetes mellitus (T2DM) with different changes in PP glucagon levels in response to lixisenatide treatment. Materials and methods: Patients (n=423) were stratified by their change in 2 hour PP glucagon level between baseline evaluation and Week 24 of treat - ment with lixisenatide as add-on to oral antidiabetics (OADs) into groups of Greater Change (GC; n=213) or Smaller Change (SC; n=210) in plasma glucagon levels (median change -23.57 ng/L). ANOVA and Chi-squared tests were used for the comparison of continuous and categorical variables, respec - tively. Baseline and endpoint continuous measurements in each group were compared using paired t -tests. Results: Mean change from baseline in 2 hour PP glucagon levels for the GC vs SC groups was -47.19 vs -0.59 ng/L (p<0.0001), respectively. Patients in the GC group had a shorter mean duration of diabetes (7.3 vs 9.0 years; p=0.0036) and lesser OAD use (4.5 vs 5.7 years; p=0.0092) than those in the SC group. Patients in the GC group had a greater mean reduction in HbA 1c (-1.10 vs -0.67%; p<0.0001), fasting plasma glucose (FPG; -25.20 vs -9.30 mg/dL [p<0.0001]), PP plasma glucose (PPG; -129.40 vs -78.22 mg/dL [p<0.0001]), and a greater drop in weight (-2.27 vs -1.17 kg; p=0.0002) and body mass index (-0.84 vs -0.44 kg/m 2 ; p=0.0002) than those in the SC group. More patients in the GC group also achieved composite endpoints, including HbA 1c <7% with no symptomatic hypoglycaemia and no weight gain (40.38 vs 19.52%; p<0.0001), than in the SC group. Conclusion: Greater reductions in PP glucagon associated with lixisenatide as add-on to OADs in patients with T2DM are also associated with greater reductions in HbA1c, FPG, PPG, and greater weight loss, highlighting the importance of glucagon suppression on therapeutic response. Clinical Trial Registration Number: NCT00712673; NCT00713830 Supported by: Sanof

An investigation of how foreign language departments at American colleges and universities view American Sign Language

Corwin and Wilcox (1985) sent surveys to more than 100 American colleges and universities to determine the policies on the matter of accepting American Sign Language (ASL) as a foreign language. Their results indicated that 81% of those surveyed rejected ASL as a foreign/modern language equivalent. The most frequently stated opposition to ASL was that it lacked a culture. Some of the other objections to ASL were: ASL is not foreign; there is no written form and therefore no original body of literature; it is a derivative of English; and it is indigenous to the United States and hence not foreign. Based on the work of Corwin and Wilcox this study sent surveys to 222 American colleges and universities. Noting an expanding cognizance and social awareness of ASL and deafness (as seen in the increasing number of movies, plays, television programs, the Americans with Disabilities Act, and related news stories), this study sought to find out if ASL was now considered an acceptable foreign language equivalent. The hypothesis of this study was that change has occurred since the 1985 study: that a significant percent of post secondary schools accepting ASL as a foreign/modern language equivalent has increased. The 165 colleges and universities that responded to this author's survey confirmed there has been a significant shift towards the acceptance of ASL. Only 50% of the respondents objected to ASL as a foreign language equivalent, a significant decrease from the 1985 findings. Of those who objected to granting ASL foreign language credit, the reasons were similar to those of the Corwin and Wilcox study, except that the belief in an absence of a Deaf culture dropped from the top reason listed, to the fifth. That ASL is not foreign was listed as the most frequent objection in this study. One important change which may account for increased acceptance of ASL, is that 16 states (compared to 10 in 1985) now have policies stating that ASL is acceptable as a foreign language equivalent. Two-year colleges, in this study, were more likely to accept ASL than were four-year colleges and universities. Neither two- nor four-year colleges and universities are likely to include ASL in their foreign language departments, and most schools that have foreign language entrance requirements are unlikely to accept ASL. In colleges and universities where ASL was already offered in some department within the system, there was a significantly higher likelihood that foreign language credit was given for ASL. Respondents from states with laws governing the inclusion of ASL did not usually know their state had a policy. Most respondents, 84%, indicated their knowledge on the topic of ASL was fair to poor. ^

História oral de vida de pessoas com úlcera venosa nos serviços de atenção primária à saúde

The Chronic Venous insufficiency is characterized as a set of physical changes including how most serious complication of venous ulcers, characterized by irregular and progressive loss of continuity of the skin. The occurrence of venous ulcers in people with chronic venous insufficiency generates dependence on them with health services, with long-term treatments that cause limitations and high-impact changes, affecting their quality of life, affecting the physical, psychological, social, cultural and spiritual as an important public health problem. This study aimed to describe the experience of having a venous ulcer, in the scenario of primary health care services to Health, which includes Primary Care Units and Family Health Strategy in the city of Natal / RN, based on the life histories of users. This is a qualitative study, exploratory and descriptive, with the Oral History of Life as a methodological framework. From the ponto zero was the recruitment of participants who formed the network, totaling six employees, of both sexes and aged between 57 and 79 years. After approval by the Research Ethics Committee - UFRN under the Protocol 653 788/2014 and CAAE 30408014.0.0000.5537 was held data collection, between the months of July and August, through interviews, using identification and characterization of the instrument employees and open questions. Interviews were recorded, transcribed, transcriadas and returned to employees for a conference. The narratives were subjected to Content thematic analysis technique, according to Bardin, allowing the construction of three themes that encompass categories, namely: Axis I - Perspectives on the changes: the impact wound in social relations (changes with ulcer venous, venous ulcer and social and family relationships); Axis II - Brands in body and soul: the story of being hurt (conceptions of the body injured; therapeutic itinerary in primary care services); and Axis III - Reconstruction of being hurt: coping mechanisms (redefinition of the wounded body, resilience to chronic wound). The impact of having a chronic venous ulcer generates impact of physical, psychological and social order. As aspects related to changes after the appearance of venous ulcers, survey participants reported the presence of pain, physical limitations, psychological distress, social and emotional isolation, incapacity, aesthetic discomfort and dependency on health services; the family was the aspect thatshowed no significant change after the occurrence of wound for most participants, an ally in the therapeutic process as a support network. The redefinition of the body and the wound are the main coping mechanism of chronic condition. The services in the Primary Care Network play a fundamental role in the rehabilitation of patients with venous ulcers, although there are difficulties in accessing appropriate treatment and need for expanded services, with permanent professional training of health teams and providing the resources managers to strengthen the comprehensive care of people with venous ulcers in Health Primary Care.

A produção oral de inglês como LE em uma escola pública de Natal: uma experiência com a abordagem baseada em tarefas

The aim of this action research of mixed-methods was investigating the role of the tasks proposed by the Task-Based Learning, TBL (WILLIS, 1996) in the process of development of speech production in English as a foreign language (EFL) at the public school. Twenty-three students from a grade of secondary school from a state school in Rio Grande do Norte were exposed systematically to the implementation of the learning tasks focused in the speech production in EFL during two months. The instruments used at the data collection – pre and post-questionnaire; field notes; focal group; and pre and post-tests - generated two kinds of data: a) qualitative (the perception of the students about their speech production and the teaching of this ability at the public school; and, the usage of strategies of communication for these learners facing TBL); and, b) quantitative (the development of pronunciation; of accuracy in the proficiency tests (test KET – Cambridge, adapted); and, of Global Oral Proficiency (POG) of these learners after the accomplishment of the learning tasks). The quantitative results of the study indicate that there was a statistically significant development of pronunciation and accuracy at the proficiency tests, after the tasks experience. The qualitative findings, in turn, represented by the learners‟ reports and from the research teacher, show that there has been greater focus on the use of communicative strategies during the learners‟ oral production throughout the intervention with the tasks.

Métodos de avaliação nutricional para a suplementação oral com zinco em crianças pré-púberes não deficientes em zinco

Background: Zinc is an essential nutrient that is required for numerous metabolic functions, and zinc deficiency results in growth retardation, cellmediated immune dysfunction, and cognitive impairment. Objective: This study evaluated nutritional assessment methods for zinc supplementation in prepubertal nonzinc- deficient children. Design: We performed a randomised, controlled, triple-blind study. The children were divided into a control group (10% sorbitol, n = 31) and an experimental group (10 mg Zn/day, n = 31) for 3 months. Anthropometric and dietary assessments as well as bioelectrical measurements were performed in all children. Results: Our study showed (1) an increased body mass index for age and an increased phase angle in the experimental group; (2) a positive correlation between nutritional assessment parameters in both groups; (3) increased soft tissue, and mainly fat-free mass, in the body composition of the experimental group, as determined using bioelectrical impedance vector analysis; (4) increased consumption of all nutrients, including zinc, in the experimental group; and (5) an increased serum zinc concentration in both groups (p < 0.0001). Conclusions: Given that a reference for body composition analysis does not exist for intervention studies, longitudinal studies are needed to investigate vector migration during zinc supplementation. These results reinforce the importance of employing multiple techniques to assess the nutritional status of populations.

Métodos de avaliação nutricional para a suplementação oral com zinco em crianças pré-púberes não deficientes em zinco

Background: Zinc is an essential nutrient that is required for numerous metabolic functions, and zinc deficiency results in growth retardation, cellmediated immune dysfunction, and cognitive impairment. Objective: This study evaluated nutritional assessment methods for zinc supplementation in prepubertal nonzinc- deficient children. Design: We performed a randomised, controlled, triple-blind study. The children were divided into a control group (10% sorbitol, n = 31) and an experimental group (10 mg Zn/day, n = 31) for 3 months. Anthropometric and dietary assessments as well as bioelectrical measurements were performed in all children. Results: Our study showed (1) an increased body mass index for age and an increased phase angle in the experimental group; (2) a positive correlation between nutritional assessment parameters in both groups; (3) increased soft tissue, and mainly fat-free mass, in the body composition of the experimental group, as determined using bioelectrical impedance vector analysis; (4) increased consumption of all nutrients, including zinc, in the experimental group; and (5) an increased serum zinc concentration in both groups (p < 0.0001). Conclusions: Given that a reference for body composition analysis does not exist for intervention studies, longitudinal studies are needed to investigate vector migration during zinc supplementation. These results reinforce the importance of employing multiple techniques to assess the nutritional status of populations.

MNEMOSYNE: NARRATING A PAKHTUN STUDENT’S FOREIGN CURRICULAR EXPERIENCE

Studying abroad is generally viewed as an opportunity for personal and educational transformation for students. In recent years, various studies have been conducted in the area of study abroad. Most of these studies primarily involve quantitative analyses, and do not fully explore the lived experience of this opportunity. Recently, researchers have started exploring the qualitative aspects and impact of studying abroad, but from an external perspective. This study attends to the phenomenon of a foreign curricular experience from an insider’s perspective and explicates the experience through a personal narrative. Countries usually have educational curricula that serve their particular needs. The rise of the number of students studying abroad has made study abroad a lucrative industry but it has also increasingly exposed foreign students to curricula that are different than those of their countries of origin. Subjecting students to dissimilar, and sometimes competing, curricula interrupts their habitual ways of knowing and being. My study is a qualitative study that explores the foreign curricular experience of one Pakhtun student. Specifically, through an autobiography, this study aims to explore how a foreign curricular experience acts as a ‘transitional space’ for a student and how it deeply affects her learning self and identity. This study contributes to the body of literature on the effects of a foreign curriculum on study abroad students by adding narrative to explain the lived experience of studying abroad.

Non-Verbal Categories. Analysis of an Galician Oral Narrative

Based on the concept of the triple basic structure of human communication by Poyatos (1994a, 1994b) and on the analytical and theoretical implications that derive from this, the present paper conceives the human communication as an indivisible whole in which verbal communication can not be separated from body behavior. This paper analyzes nonverbal categories used in oral communication. The corpus consists of an oral narration in Galician from which we highlighted certain kinemes (minimum units of body movement with meaning) by using the model proposed by Bouvet (2001), in order to explain the non-verbal categories with examples taken from said recordings.

Assessment of the EEE-4 oral test: a discourse analysis based on complex networks.

With the development of information technology, the theory and methodology of complex network has been introduced to the language research, which transforms the system of language in a complex networks composed of nodes and edges for the quantitative analysis about the language structure. The development of dependency grammar provides theoretical support for the construction of a treebank corpus, making possible a statistic analysis of complex networks. This paper introduces the theory and methodology of the complex network and builds dependency syntactic networks based on the treebank of speeches from the EEE-4 oral test. According to the analysis of the overall characteristics of the networks, including the number of edges, the number of the nodes, the average degree, the average path length, the network centrality and the degree distribution, it aims to find in the networks potential difference and similarity between various grades of speaking performance. Through clustering analysis, this research intends to prove the network parameters’ discriminating feature and provide potential reference for scoring speaking performance.