Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study:preeclampsia

Objective: The purpose of this study was to examine associations of fasting C-peptide, body mass index (BMI), and maternal glucose with the risk of preeclampsia in a multicenter multinational study. Study Design: We conducted a secondary analysis of a blinded observational cohort study. Subjects underwent a 75-g oral glucose tolerance test at 24-32 weeks' gestation. Associations of preeclampsia with fasting C-peptide, BMI, and maternal glucose were assessed with the use of multiple logistic regression analyses and adjustment for potential confounders. Results: Of 21,364 women who were included in the analyses, 5.2% had preeclampsia. Adjusted odds ratios for preeclampsia for 1 SD higher fasting C-peptide (0.87 ug/L), BMI (5.1 kg/m), and fasting (6.9 mg/dL), 1-hour (30.9 mg/dL), and 2-hour plasma glucose (23.5 mg/dL) were 1.28 (95% confidence interval [CI], 1.20-1.36), 1.60 (95% CI, 1.60-1.71), 1.08 (95% CI, 1.00-1.16), 1.19 (95% CI, 1.11-1.28), and 1.21 (95% CI,1.13-1.30), respectively. Conclusion: Results indicate strong, independent associations of fasting C-peptide and BMI with preeclampsia. Maternal glucose levels (below diabetes mellitus) had weaker associations with preeclampsia, particularly after adjustment for fasting C-peptide and BMI. © 2010 Mosby, Inc. All rights reserved.

Radiation retinopathy--clinical, histopathological, ultrastructural and experimental correlations

Clinical, pathological and experimental studies of radiation retinopathy confirm that the primary vascular event is endothelial cell loss and capillary closure. Pericytes are less susceptible, but typically atrophy as the capillaries become non-functional. The immediate effects of radiation reflect interphase and early mitotic death of injured endothelial cells, whereas later changes may be attributed to delayed mitotic death of compromised endothelial cells as they attempt division in the ordinary course of repair and replacement. Capillary occlusion leads to the formation of dilated capillary collaterals which may remain serviceable and competent for years. Microaneurysms develop in acellular and poorly supported capillaries, predominantly on the arterial side of the circulation and adjacent to regions of poorly perfused retina. Alterations in haemodynamics produce large telangiectatic-like channels which, typically develop a thick collagenous adventitia and may become fenestrated. Limited capillary regeneration occurs, usually evident as recanalisation of arterioles or venules by new capillaries. Vitreo-retinal neovascularisation may occur where retinal ischaemia is widespread. Radiation produces an exaggerated vasculopathy in patients with diabetes mellitus, and five month streptozotocin-induced diabetic rats develop a severe ischaemic retinopathy with vitreoretinal neovascularisation when exposed to 1500 cGy of radiation. Later photocoagulation is useful in containing or reversing microvascular incompetence and vasoproliferation in some patients with advanced radiation retinopathy.

Model selection for prognostic time-to-event gene signature discovery with applications in early breast cancer data

Model selection between competing models is a key consideration in the discovery of prognostic multigene signatures. The use of appropriate statistical performance measures as well as verification of biological significance of the signatures is imperative to maximise the chance of external validation of the generated signatures. Current approaches in time-to-event studies often use only a single measure of performance in model selection, such as logrank test p-values, or dichotomise the follow-up times at some phase of the study to facilitate signature discovery. In this study we improve the prognostic signature discovery process through the application of the multivariate partial Cox model combined with the concordance index, hazard ratio of predictions, independence from available clinical covariates and biological enrichment as measures of signature performance. The proposed framework was applied to discover prognostic multigene signatures from early breast cancer data. The partial Cox model combined with the multiple performance measures were used in both guiding the selection of the optimal panel of prognostic genes and prediction of risk within cross validation without dichotomising the follow-up times at any stage. The signatures were successfully externally cross validated in independent breast cancer datasets, yielding a hazard ratio of 2.55 [1.44, 4.51] for the top ranking signature.

North Atlantic marine radiocarbon reservoir ages through Heinrich event H4: A new method for marine age model construction

Cooling and sinking of dense saline water in the Norwegian–Greenland Sea is essential for the formation of North Atlantic Deep Water. The convection in the Norwegian–Greenland Sea allows for a northward flow of warm surface water and southward transport of cold saline water. This circulation system is highly sensitive to climate change and has been shown to operate in different modes. In ice cores the last glacial period is characterized by millennial-scale Dansgaard–Oeschger (D–O) events of warm interstadials and cold stadials. Similar millennial-scale variability (linked to D–O events) is evident from oceanic cores, suggesting a strong coupling of the atmospheric and oceanic circulations system. Particularly long-lasting cold stadials correlate with North Atlantic Heinrich events, where icebergs released from the continents caused a spread of meltwater over the northern North Atlantic and Nordic seas. The meltwater layer is believed to have caused a stop or near-stop in the deep convection, leading to cold climate. The spreading of meltwater and changes in oceanic circulation have a large influence on the carbon exchange between atmosphere and the deep ocean and lead to profound changes in the 14C activity of the surface ocean. Here we demonstrate marine 14C reservoir ages (R) of up to c. 2000 years for Heinrich event H4. Our R estimates are based on a new method for age model construction using identified tephra layers and tie-points based on abrupt interstadial warmings.

Hydroclimatic changes during the 8.2 ka event inferred from Irish subfossil pines

A significant cold event, derived from the Greenland ice cores, took place between 8200 and 8000 cal. BP. Modeling of the event suggests that higher northern latitudes would have experienced considerable decreases in precipitation and that Ireland would have witnessed one of the greatest depressions. However, no well-dated proxy record exists from the British Isles to test the model results. Here we present independent evidence for a phase of major pine recruitment on Irish bogs at around 8150 cal. BP. Dendrochronological dating of subfossil trees from three sites reveal synchronicity in germination across the region, indicative of a regional forcing, and allows for high-precision radiocarbon based dates. The inner-rings of 40% of all samples from the north of Ireland dating to the period 8,500-7,500 cal. BP fall within a 25-year window. The concurrent colonization of pine on peatland is interpreted as drier conditions in the region and provide the first substantive proxy data in support of a significant hydrological change in the north of Ireland accompanying the 8.2 ka event. Our results also indicate that the apparent temporal asynchrony between anomalies in proxy records at the time could be a result of differences in dating methods.

Hydroclimatic changes during the 8.2 ka event revealed by Irish pines

A pivotal cold event, deduced from the Greenland ice cores, took place between 8200 and 8000 cal. BP. Modelling of this climatic episode suggests that higher northern latitudes would have also experienced substantial reduction in rainfall and that Ireland would have observed a notable decline. No well-dated proxy record exists from the British Isles to test the model results. We present significant independent data for a phase of increased Scots pine initiation on Irish bogs at around 8150 cal. BP. Dendrochronological dating of sub-fossil Scots pine trees from three locations reveals synchronicity in germination across the area, indicative of a regional forcing, and allows for high-precision radiocarbon based dates. The starting rings of 40% of all samples from the north of Ireland dating to the period 8500-7500 cal. BP fall within a period of 25 years. The present colonisation model of Scots pine on peatland is interpreted as increasing drier conditions in the region and provides the first meaningful proxy data in support of a significant hydrological change in the north of Ireland accompanying the 8.2 ka event. The dating uncertainties associated with the Irish Scots pine record and the Greenland Ice Core Chronology 2005 (GICC05) do not allow for any overlap between the two. The results indicate that the discrepancy could be a result of dating inaccuracy that could have affected analysis of prior proxy alignments.

Prevalence of potentially inappropriate prescribing and prescribing omissions in Irish adults: findings from the Irish LongituDinal Study on Ageing (TILDA)

Purpose: We sought to estimate the prevalence of potentially inappropriate prescriptions (PIP) and potential prescribing omissions (PPOs) using a subset of the STOPP/START criteria in a population based sample of Irish adults aged ≥65 years using data from The Irish LongituDinal Study on Ageing (TILDA).

Methods: A subset of 26 PIP indicators and 10 PPO indicators from the STOPP/START criteria were applied to the TILDA dataset. PIP/PPO prevalence according to individual STOPP/START criteria and the overall prevalence of PIP/PPO were estimated. The relationship between PIP and PPOs and polypharmacy, age, gender and multimorbidity was examined using logistic regression.

Results: The overall prevalence of PIP in the study population (n = 3,454) was 14.6 %. The most common examples of PIP identified were NSAID with moderate-severe hypertension (200 participants; 5.8 %) and aspirin with no history of coronary, cerebral, or peripheral vascular symptoms or occlusive event (112 participants; 3.2 %). The overall prevalence of PPOs was 30 % (n = 1,035). The most frequent PPO was antihypertensive therapy where systolic blood pressure consistently >160 mmHg (n = 341, 9.9 %), There was a significant association between PIP and PPO and polypharmacy when adjusting for age, sex and multimorbidity (adjusted OR 2.62, 95 % CI 2.05–3.33 for PIP and adjusted OR 1.46, 95 % CI 1.23–1.75 for prescribing omissions).

Conclusion: Our findings indicate prescribing omissions are twice as prevalent as PIP in the elderly using a subset of the STOPP/START criteria as an explicit process measure of potentially inappropriate prescribing and prescribing omissions. Polypharmacy was independently associated with both PPO and PIP. Application of such screening tools to prescribing decisions may reduce unnecessary medication, related adverse events, healthcare utilisation and cost.

An Enchanted Tool? Humanitarian Assistance and the ILC Draft Articles on the Protection of Persons in the Event of Disasters

Despite previous attempts at codification of international law regarding international responses to natural and human-made disasters, there is currently no binding international legal framework to regulate the provision of humanitarian assistance outside armed conflicts. Nevertheless, since the International Law Commission (ILC) included the protection of persons in the event of disasters on its programme of work in 2006, it has provisionally adopted eleven draft articles that have the potential to create binding obligations on states and humanitarian actors in disaster settings. Draft articles adopted include the definition of ‘a disaster’, the relationship of the draft articles to the international humanitarian law of armed conflict, recognition of the inherent dignity of the human person, and the duty of international cooperation. However, the final form of the draft articles has not been agreed. The Codification Division of the UN Office of Legal Affairs has proposed a framework convention format, which has seen support in the ILC and the UN General Assembly Sixth Committee. The overall aim of this article is to provide an analysis of the potential forms of international regulation open to the ILC and states in the context of humanitarian responses to disasters. However to avoid enchanting the ILC draft articles with unwarranted power, any examination of form requires an understanding of the substantive subject matter of the planned international regulation. The article therefore provides an overview of the international legal regulation of humanitarian assistance following natural and human-made disasters, and the ILC’s work to date on the topic. It then examines two key issues that remain to be addressed by the ILC and representatives of states in the UN General Assembly Sixth Committee. Drawing on the UN Guiding Principles on Internal Displacement, the development and implications of binding and non-binding international texts are examined, followed by an analysis of the suggested framework convention approach identified by the Special Rapporteur as a potential outcome of the ILC work.

Tephrochronology and the extended intimate (integration of ice‐core, marine and terrestrial records) event stratigraphy 8-128kab2k

The comparison of palaeoclimate records on their own independent timescales is central to the work of the INTIMATE (INTegrating Ice core, MArine and TErrestrial records) network. For the North Atlantic region, an event stratigraphy has been established from the high-precision Greenland ice-core records and the integrated GICC05 chronology. This stratotype provides a palaeoclimate signal to which the timing and nature of palaeoenvironmental change recorded in marine and terrestrial archives can be compared. To facilitate this wider comparison, without assuming synchroneity of climatic change/proxy response, INTIMATE has also focussed on the development of tools to achieve this. In particular the use of time-parallel marker horizons e.g. tephra layers (volcanic ash). Coupled with the recent temporal extension of the Greenland stratotype, as part of this special issue, we present an updated INTIMATE event stratigraphy highlighting key tephra horizons used for correlation across Europe and the North Atlantic. We discuss the advantages of such an approach, and the key challenges for the further integration of terrestrial palaeoenvironmental records with those from ice cores and the marine realm.

An Extended Event Reasoning Framework for Decision Support under Uncertainty

To provide in-time reactions to a large volume of surveil- lance data, uncertainty-enabled event reasoning frameworks for CCTV and sensor based intelligent surveillance system have been integrated to model and infer events of interest. However, most of the existing works do not consider decision making under uncertainty which is important for surveillance operators. In this paper, we extend an event reasoning framework for decision support, which enables our framework to predict, rank and alarm threats from multiple heterogeneous sources.

An Event Driven Fusion Approach for Enjoyment Recognition in Real-time

Social signals and interpretation of carried information is of high importance in Human Computer Interaction. Often used for affect recognition, the cues within these signals are displayed in various modalities. Fusion of multi-modal signals is a natural and interesting way to improve automatic classification of emotions transported in social signals. Throughout most present studies, uni-modal affect recognition as well as multi-modal fusion, decisions are forced for fixed annotation segments across all modalities. In this paper, we investigate the less prevalent approach of event driven fusion, which indirectly accumulates asynchronous events in all modalities for final predictions. We present a fusion approach, handling short-timed events in a vector space, which is of special interest for real-time applications. We compare results of segmentation based uni-modal classification and fusion schemes to the event driven fusion approach. The evaluation is carried out via detection of enjoyment-episodes within the audiovisual Belfast Story-Telling Corpus.

Sport Mega-Event Hosting and Environmental Concern: From Sydney to Rio

This paper examines the extent to which the proclamation by the International Olympic Committee (IOC) that Olympic Games hosting can improve the environmental capacity of the host nation holds. It singles out the post-event environmental concern exhibited by the population of the host country as the most important indicator and proceeds towards examining how successive host nations have performed in relation to that. The intervening variable of the global environmental crisis is put under the microscope and as a result the general conclusion suggests that environmental concern is much more tied to the general socio-economic predicament that the host country finds itself to be in the post-event phase than the successful hosting of green Games.

Efficacy and safety of radium-223 dichloride in patients with castration-resistant prostate cancer and symptomatic bone metastases, with or without previous docetaxel use: A prespecified subgroup analysis from the randomised, double-blind, phase 3 ALSYMPCA trial

Background: Primary results from the phase 3 ALSYMPCA trial showed that radium-223 dichloride (radium-223), a targeted α-emitter, improved overall survival compared with placebo and was well tolerated in patients with castration-resistant prostate cancer and symptomatic bone metastases. We did a prespecified subgroup analysis from ALSYMPCA to assess the effect of previous docetaxel use on the efficacy and safety of radium-223. 

Methods: In the phase 3, randomised, double-blind ALSYMPCA trial, patients with symptomatic castration-resistant prostate cancer, at least two symptomatic bone metastases, no known visceral metastases, and who were receiving best standard of care were randomly assigned (2:1) via an interactive voice response system to receive six injections of radium-223 (50 kBq/kg intravenously) or matching placebo, with one injection given every 4 weeks. Patients had either received previous docetaxel treatment or were unsuitable for or declined docetaxel; previous docetaxel use (yes or no) was a trial stratification factor. We investigated the effect of previous docetaxel use on radium-223 treatment for the primary endpoint of overall survival, the main secondary efficacy endpoints, and safety. Efficacy analyses were done for the intention-to-treat population; safety analyses were done for the safety population. The trial has been completed and is registered with ClinicalTrials.gov, number NCT00699751. 

Findings: Randomisation took place between June 12, 2008, and Feb 1, 2011. 526 (57%) of 921 randomly assigned patients had received previous docetaxel treatment (352 in the radium-223 group and 174 in the placebo group) and 395 (43%) had not (262 in the radium-223 group and 133 in the placebo group). Radium-223 prolonged median overall survival compared with placebo, irrespective of previous docetaxel use (previous docetaxel use, hazard ratio [HR] 0·70, 95% CI 0·56-0·88; p=0·002; no previous docetaxel use, HR 0·69, 0·52-0·92; p=0·01). The benefit of radium-223 compared with placebo was seen in both docetaxel subgroups for most main secondary efficacy endpoints; risk for time to time to first symptomatic skeletal event was reduced with radium-223 versus placebo in patients with previous docetaxel use, but the difference was not significant in those with no previous docetaxel use. 322 (62%) of 518 patients previously treated with docetaxel had grade 3-4 adverse events, compared with 205 (54%) of 383 patients without docetaxel. Patients who had previously been treated with docetaxel had a higher incidence of grade 3-4 thrombocytopenia with radium-223 than with placebo (31 [9%] of 347 patients vs five [3%] of 171 patients), whereas the incidence was similar between treatment groups among patients with no previous docetaxel use (seven [3%] of 253 patients vs one [1%] of 130 patients). The incidences of grade 3-4 anaemia and neutropenia were similar between the radium-223 and placebo groups within both docetaxel subgroups. 

Interpretation: Radium-223 is effective and well tolerated in patients with castration-resistant prostate cancer and symptomatic bone metastases, irrespective of previous docetaxel use. 

Funding: Algeta ASA and Bayer HealthCare Pharmaceuticals.