Gender-specific usage of intramyocellular lipids and glycogen during exercise

PURPOSE: Gender-specific differences in substrate utilization during exercise have been reported, typically such that women rely more on fat than men. This study investigated whether gender differences exist in the utilization of intramyocellular lipids (IMCL) and glycogen. METHODS: IMCL and glycogen, as well as total fat and carbohydrate (CHO) oxidation were measured in nine males and nine females before, during, and after an endurance exercise. The trained subjects exercised on a bicycle ergometer at 50% maximal workload for 3 h. IMCL and glycogen were determined in the thigh by magnetic resonance spectroscopy. Oxygen uptake (VO(2)) and carbon dioxide production were determined by open circuit spirometry to calculate total fat and CHO oxidation. Relative power output, percent of maximum heart rate, VO(2peak), and respiratory exchange ratio were the same. RESULTS: Average fat oxidation was the same, whereas CHO oxidation was significantly higher in males compared with females. The relative contribution of these fuels to total energy used were similar in males and females. Males and females depleted IMCL and glycogen significantly (P < 0.001) during the 3-h exercise. IMCL levels at rest (P < 0.05) and its depletion during exercise (P < 0.001) were significantly higher in males compared with females, whereas glycogen was stored and used in the same range by both genders. CONCLUSION: During this 3-h exercise, energy supplies from fat and CHO were similar in both genders, and males as well as females reduced their IMCL stores significantly. The larger contribution of IMCL during exercise in males compared with females could either be a result of gender-specific substrate selection, or different long-term training habit.

Current trends in hormone replacement therapy: perceptions and usage

OBJECTIVE: To determine whether physicians' confidence in the use of hormone replacement therapy (HRT) for climacteric symptoms has been affected by the negative media interpretation of data from landmark studies investigating HRT usage such as the Women's Health Initiative (WHI) study. METHODS: A structured questionnaire was completed via the internet by European and US gynecologists, obstetrician/gynecologists and general practitioners - all experienced in treating women with climacteric symptoms. RESULTS: Six hundred physicians completed the survey in six countries. Overall, 98% agreed that the menopause significantly affects quality of life and 97% considered that the majority/all of their patients experienced positive benefits from HRT. Most physicians (90%) believed the benefits of HRT outweigh the risks in suitable patients, and 92% would prescribe HRT for themselves/spouse/family. For treatment of atrophic vaginitis, 86% agreed that local estrogen was the most effective course of action. While 82% of participants were aware of the latest recommendations on low-dose HRT, and estrogen dose in particular, 67% cited lowering the progestogen dose as important. With regard to the recent negative media coverage on HRT, 78% of physicians felt this was unjustified. CONCLUSIONS: These results provide reassurance that health-care professionals in Europe and the US, experienced in treating women with climacteric symptoms, have not lost confidence in HRT. Despite a consensus on the importance of lowering the dose of HRT and a focus on estrogen, there remains a need to heighten prescribers' awareness on the pivotal role that a lower progestogen dose plays in optimizing the risk-benefit profile.

Differences in Internet Usage - Social Inequality and Informal Education

In the public debate the internet is regarded as a central resource for knowledge and information. Associated with this is the idea that everyone is able and even expected to serve himself or herself according to his or her own needs via this medium. Since more and more services are also delivered online the internet seems to allow its users to enjoy specific advantages in dealing with their everyday life. However, using the internet is based on a range of preconditions. New results of empirical and theoretical research indicate the rise of a social divide in this context. Within the internet, different ways of use can be identified alongside social inequalities. Boundaries of the "real life" are mirrored in the virtual space e.g. in terms of forms of communification and spaces for appropriation. These are not only shaped by invidual preferences but particularly by social structures and processes. In the context of the broader debate on education it is stated that formal educational structures are to be completed by arrangements which are structured in informal respectively nonformal ways. Particularly the internet is suggested to play an important role in this respect. However, the phenomenon of digital inequality points to limitations consolidated by effects of economic, social, and cultural ressources: Economical resources affect opportunities of access, priorities of everyday life shape respective intentions of internet use, social relationships have an impact on the support structures available and ways of appropriation reproduce a specific understanding of informal education ("informelle Bildung"). This produces an early stratification of opportunities especially for the subsequent generation and may lead to extensive inequalities regarding the distribution of advantages in terms of education. Thus the capacity of the virtual space in terms of participatory opportunities and democratic potentials raises concerns of major relevance with respect to social and educational policy. From the perspective of different disciplines involved in these issues it is essential to clarify this question in an empirical as well as in a theoretical way and to make it utilizable for a future-orientied practice. This article discusses central questions regarding young people's internet use and its implications for informal education and social service delivery on the basis of empirical findings. It introduces a methodological approach for this particular perspective and illustrates that the phenomena of digital divide and digital inequality are as much created by social processes as by technical issues.

Simulator Network project report: a tool for improvement of teaching materials and targeted resource usage in Skills Labs

During the last decade, medical education in the German-speaking world has been striving to become more practice-oriented. This is currently being achieved in many schools through the implementation of simulation-based instruction in Skills Labs. Simulators are thus an essential part of this type of medical training, and their acquisition and operation by a Skills Lab require a large outlay of resources. Therefore, the Practical Skills Committee of the Medical Education Society (GMA) introduced a new project, which aims to improve the flow of information between the Skills Labs and enable a transparent assessment of the simulators via an online database (the Simulator Network).

Correction: Usage of Complementary Medicine in Switzerland: Results of the Swiss Health Survey 2012 and Development Since 2007.

[This corrects the article DOI: 10.1371/journal.pone.0141985.]

Minority preferences and disease types for non-emergent emergency department usage in a CHIP population

Background. Of the over five million annual pediatric visits to U.S. emergency departments, one-third to one-half are for non-emergent conditions. Minorities are more likely to utilize the emergency department (ED) for non-emergent conditions. Very little research has analyzed the role of illness type, perceived need, or family preferences in explaining this disparity. ^ Objectives. This study examined racial-ethnic differences in preferences for care among non-emergent users of the ED. ^ Research design. A random selection of pediatric non-emergent ED users within a single CHIP managed care plan were surveyed regarding attitudes and health care preferences. Preferences for ED utilization were analyzed by racial-ethnic category, controlling for illness type, child and guardian age, education level, language, and perceived need. ^ Results. A total of 250 families were surveyed. Most respondents reported having a regular doctor, satisfaction with their physician, and ready access to their physician. Fifteen percent of White, 39% of Hispanic, and 38% of Black families reported they preferred the emergency department for ill care. In multivariate analysis, Whites families were significantly less likely to prefer the emergency department for ill visits (odds ratio, 0.12; 95% confidence interval 0.03-0.55) compared to Blacks and Hispanics. ^ Conclusions. Racial-ethnic disparities in non-emergent ED utilization may be partially explained by different preferences for care. ^ Key words: children, emergency department, preferences for care, disparities ^

Emergency department usage patterns among residents of Hardin, Jefferson, and Orange Counties in southeast Texas

Emergency departments (EDs) have been called the net below the safety net due to their long history of providing care to the uninsured and others lacking access to the healthcare system. In past years, those with Medicaid and, more recently, those with Medicare, are also utilizing the ED as a medical home for routine primary care. There are many reasons for this but the costs to the community have become increasingly burdensome. ^ To evaluate how often the ED is being utilized for primary care, we applied a standardized tool, the New York University Algorithm, to over 43,000 ED visits when no hospitalization was required made by Hardin, Jefferson, and Orange County residents over a 12 month period. We compared our results to Harris County, where studies using the same framework have been performed, and found that sizeable segments of the population in both areas are utilizing the ED for non-emergent primary care that could be treated in a more cost-effective community setting. ^ We also analyzed our dataset for visit-specific characteristics. We found evidence of two possible health care disparities: (1) Blacks had a higher rate of primary care-related ED visits in relation to their percentage of the population when compared to other racial/ethnic groups; and (2) when form of payment is considered, the uninsured were more likely to have a primary care-related ED visit than any other group. These findings suggest a lack of community-based primary care services for the medically needy in Southeast Texas. ^ We believe that studies such as this are warranted elsewhere in Texas as well. We plan to present our findings to local policy makers, who should find this information helpful in identifying gaps in the safety net and assist them in better allocating scarce community resources. ^

Chapter 2 On the usage of the measurements of geographical concentration and specialization with areal data

Measures have been developed to understand tendencies in the distribution of economic activity. The merits of these measures are in the convenience of data collection and processing. In this interim report, investigating the property of such measures to determine the geographical spread of economic activities, we summarize the merits and limitations of measures, and make clear that we must apply caution in their usage. As a first trial to access areal data, this project focus on administrative areas, not on point data and input-output data. Firm level data is not within the scope of this article. The rest of this article is organized as follows. In Section 2, we touch on the the limitations and problems associated with the measures and areal data. Specific measures are introduced in Section 3, and applied in Section 4. The conclusion summarizes the findings and discusses future work.

Interval-based resource usage verification: Formalization and prototype

In an increasing number of applications (e.g., in embedded, real-time, or mobile systems) it is important or even essential to ensure conformance with respect to a specification expressing resource usages, such as execution time, memory, energy, or user-defined resources. In previous work we have presented a novel framework for data size-aware, static resource usage verification. Specifications can include both lower and upper bound resource usage functions. In order to statically check such specifications, both upper- and lower-bound resource usage functions (on input data sizes) approximating the actual resource usage of the program which are automatically inferred and compared against the specification. The outcome of the static checking of assertions can express intervals for the input data sizes such that a given specification can be proved for some intervals but disproved for others. After an overview of the approach in this paper we provide a number of novel contributions: we present a full formalization, and we report on and provide results from an implementation within the Ciao/CiaoPP framework (which provides a general, unified platform for static and run-time verification, as well as unit testing). We also generalize the checking of assertions to allow preconditions expressing intervals within which the input data size of a program is supposed to lie (i.e., intervals for which each assertion is applicable), and we extend the class of resource usage functions that can be checked.

Mesh traversal and sorting for efficient memory usage in scientific codes

Applications that operate on meshes are very popular in High Performance Computing (HPC) environments. In the past, many techniques have been developed in order to optimize the memory accesses for these datasets. Different loop transformations and domain decompositions are com- monly used for structured meshes. However, unstructured grids are more challenging. The memory accesses, based on the mesh connectivity, do not map well to the usual lin- ear memory model. This work presents a method to improve the memory performance which is suitable for HPC codes that operate on meshes. We develop a method to adjust the sequence in which the data are used inside the algorithm, by means of traversing and sorting the mesh. This sorted mesh can be transferred sequentially to the lower memory levels and allows for minimum data transfer requirements. The method also reduces the lower memory requirements dra- matically: up to 63% of the L1 cache misses are removed in a traditional cache system. We have obtained speedups of up to 2.58 on memory operations as measured in a general- purpose CPU. An improvement is also observed with se- quential access memories, where we have observed reduc- tions of up to 99% in the required low-level memory size.