Chronic kidney disease in type 2 diabetic patients followed-up by primary care physicians in Switzerland: prevalence and prescription of antidiabetic drugs.

QUESTION UNDER STUDY: The aim of this study was to assess the prevalence of chronic kidney disease (CKD) among type 2 diabetic patients in primary care settings in Switzerland, and to analyse the prescription of antidiabetic drugs in CKD according to the prevailing recommendations. METHODS: In this cross-sectional study, each participating physician was asked to introduce anonymously in a web database the data from up to 15 consecutive diabetic patients attending her/his office between December 2013 and June 2014. Demographic, clinical and biochemical data were analysed. CKD was classified with the KDIGO nomenclature based on estimated glomerular filtration rate (eGFR) and urinary albumin/creatinine ratio. RESULTS: A total of 1 359 patients (mean age 66.5 ± 12.4 years) were included by 109 primary care physicians. CKD stages 3a, 3b and 4 were present in 13.9%, 6.1%, and 2.4% of patients, respectively. Only 30.6% of patients had an entry for urinary albumin/creatinine ratio. Among them, 35.6% were in CKD stage A2, and 4.1% in stage A3. Despite prevailing limitations, metformin and sulfonylureas were prescribed in 53.9% and 16.5%, respectively, of patients with advanced CKD (eGFR <30 ml/min). More than a third of patients were on a dipeptidyl-peptidase-4 inhibitor across all CKD stages. Insulin use increased progressively from 26.8% in CKD stage 1-2 to 50% in stage 4. CONCLUSIONS: CKD is frequent in patients with type 2 diabetes attending Swiss primary care practices, with CKD stage 3 and 4 affecting 22.4% of cases. This emphasizes the importance of routine screening of diabetic nephropathy based on both eGFR and urinary albumin/creatinine ratio, the latter being largely underused by primary care physicians. A careful individual drug risk/benefit balance assessment is mandatory to avoid the frequently observed inappropriate prescription of antidiabetic drugs in CKD patients.

Future development of gastrointestinal cancer incidence and mortality rates in Switzerland: a tumour registry- and population-based projection up to 2030.

QUESTIONS UNDER STUDY: Since tumour burden consumes substantial healthcare resources, precise cancer incidence estimations are pivotal to define future needs of national healthcare. This study aimed to estimate incidence and mortality rates of oesophageal, gastric, pancreatic, hepatic and colorectal cancers up to 2030 in Switzerland. METHODS: Swiss Statistics provides national incidences and mortality rates of various cancers, and models of future developments of the Swiss population. Cancer incidences and mortality rates from 1985 to 2009 were analysed to estimate trends and to predict incidence and mortality rates up to 2029. Linear regressions and Joinpoint analyses were performed to estimate the future trends of incidences and mortality rates. RESULTS: Crude incidences of oesophageal, pancreas, liver and colorectal cancers have steadily increased since 1985, and will continue to increase. Gastric cancer incidence and mortality rates reveal an ongoing decrease. Pancreatic and liver cancer crude mortality rates will keep increasing, whereas colorectal cancer mortality on the contrary will fall. Mortality from oesophageal cancer will plateau or minimally increase. If we consider European population-standardised incidence rates, oesophageal, pancreatic and colorectal cancer incidences are steady. Gastric cancers are diminishing and liver cancers will follow an increasing trend. Standardised mortality rates show a diminution for all but liver cancer. CONCLUSIONS: The oncological burden of gastrointestinal cancer will significantly increase in Switzerland during the next two decades. The crude mortality rates globally show an ongoing increase except for gastric and colorectal cancers. Enlarged healthcare resources to take care of these complex patient groups properly will be needed.

Geology Students

Geology Students outside Brock in the late 1960's.

Quaternary geology of the Campbellford, Trenton, Consecon, Tweed, Belleville, Wellington, Sydenham, Bath, and Yorkshire Island map-areas, Ontario /

Sediment relationships observed during geological mapping in southeastern Ontario indicate a relatively simple deglaciation history for the area during late Wisconsin time. The ice from the north (part of the Lake Simcoe lobe) and the Lake Ontario ice lobe, which were coalesced during most of late Wisconsin time, initially separated along the crest of the Oak Ridges Moraine. Available data indicate that the Oak Ridges Moraine is composed primarily of sediments pre-late Wisconsin in age capped by late Wisconsin till and interlobate deposits. Retreat of the northern ice was relatively steady and resulted in the deposition of the Dummer Moraines, a facies of the drumlinized till to the south. Retreat of the Lake Ontario ice lobe into the Lake Ontario basin was interrupted by a re-advance which covered the southeastern half of the map area. The northern ice had already retreated from the area by this time. The Lake Ontario lobe was fed through the St. Lawrence Valley, indicating that the Ottawa Valley was ice filled at this time. High level glacial lakes fronted the ice during deglaciation. These waters quickly fell to low levels as the ice retreated from the St. Lawrence Valley, opening lower outlets.

Drift dispersal in central Southern Ontario /

Two tills are readily identi-f i able in central Southern Ontario, a very stony, loose deposit o-f variable matrix (Dummer till) and a moderately stony, fissile and compact deposit that is more homogeneous (drumlinized till). The quantity o-f Precambr i an, Paleozoic and Shadow Lake Formation (Paleozoic) rock types were determined and corresponding isopleth maps drawn. The changes in lithology content occurred in the direction o-f transport, there-fore, compositional isopleths o-f till may be considered equipotential lines for the reconstruction of glacier flow paths. Areal gradations of drift lithology indicated that the prime agents of dispersal were ice and glacial meltwaters. The down-ice abundance trend of till components indicated a dispersal pattern showing the concentration of a given lithology type peaking within a few kilometres of the source followed by a rapid decline and thereafter, a more gradual decrease with increasing distance. Within the esker deposits, igneous rocks may form the major component and can extend further onto the limestone plain than in the adjacent till. Evidence is presented that indicates the "style" of dispersal was one in which glacial ice may have been strongly influenced by local bedrock topography and the regional structural trends. The ice tended to follow pre-existing valleys and lows, depositing till composed mainly of local bedrock. Gradations in Paleozoic clast content showed that the local bedrock lithology became the primary till component within 3 km of down-ice transport. Evidence is presented that indicated the last glaciation may have occurred as a relatively thin ice mass, followed by stagnation and recession. No evidence of a lateglacial re-advance was found within the study area. Because of the lack of a contact between the Dummer and drumlinized till, and because of results showing gradation of the Dummer till into the drumlinized till (as indicated by lithology content and grain size), it is suggested that no re-advance occurred.

The surficial geology, sedimentology and geochemistry of the late glacial sediments and Paleozoic bedrock in the Campbellford area, Ontario, with special reference to the Dummer Complex /

The Dummer Complex extends 180 km along the Precambrian - Paleozoic contact from Tamworth to Lake Simcoe. It is composed of coarse, angular Paleozoic clasts in discontinuous, pitted, hummocky deposits. Deposits are usually separated by bare or boulder strewn bedrock, but have been found in the southern drumlinized till sheet. Dummer Complex deposits show rough alignment with ice-flow. Eskers cross-cut many of the deposits. Dummer sediment subfacies are defined on the basis of dominant coarse grain size and lithology, which relate directly to the underlying Paleozoic formation. Three subglacial tills are identified based on the degree of comminution and distance of transport; the immature facies of the Dummer Complex; the mature facies of the drumlinized till sheet and; the submature facies which is transitional. Carbonate geochemistry was used for till-bedrock correlation in various grain sizes. Of the 3 Paleozoic formations underlying the Dummer Complex, the Gull River Fm. is geochemically distinctive from the Bobcaygeon and Verulam Formations using Ca, Mg, Sr, Cu, Mn, Fe and Na. The Bobcaygeon Fm. and Verulam Fm. can be differentiated using Ca and the Sr/Ca ratio. The immature facies from 1.0 phi and finer is dominated by the non-carbonate, long distance transported component which decreases slightly downice. The submature till facies contains more long distance material than the immature facies. Sr and Mn can be used to correlate the Gull River immature till facies to the underlying bedrock the other subfacies could not be distinguished from each other or their respective source formation. This method proved to be ineffective for sediments with greater than 35% non-carbonate component, due to leaching of elements by the dissolving acid.The Dummer Complex is produced subglacially , as the compressional ice encounters the permeable Paleozoic carbonates. The increased shear strength of the ice and pore pressures in the carbonates results in the basal ice zones becoming debris ladden. Cleaner ice overrides the basal debris . laden dead ice which then acts as the glacier bed. During retreat, the Simcoe lobe stagnates as flow is cut-off by the Algonquin Highlands.

Geology of the Rankin Inlet area, Northwest Territories /

The Rankin Inlet area, on the west shore of Hudson Bay in the Northwest Territories, is in the Churchill Structural Province. Metamorphosed volcanic and sedimentary rocks, previously mapped as Archean and part of the Kaminak Group, underlie most of the area. The Rankin Inlet Group consists of greywacke, with minor conglomeratic greywacke, quartzite and dolomite, overlain by massive and pillowed basaltic flows. Gabbro sills intrude the sediments near the base of the volcanic sequence and three serpentinite sills outcrop at the base of the volcanic sequence. The sediments are in fault-contact with quartz monzonite to the south and were intruded by granitic rocks to the northwest. Two periods of folding were defined by the mapping. The first generation folds are recumbent isoclinal folds, with northwest-trending and northeast-dipping axial planes, formed through gravitational sliding. The second generation folds are symmetrically disposed about the axis of the granitic intrusion and have east-southeast trending and nearly vertical axial planes. Whole-rock analysis of 64 rock samples indicates that metasomatic alteration accompanied the intrusion of both the granitic rocks and the serpentinite. The volcanic rocks, gabbro and serpentinite were derived from a magma of oceanic tholeiitic affinities. The stratigraphic sequence and chemistry of the volcanic rocks of the Rankin Inlet Group indicate that this assemblage is correlative with the Hurwitz Group rather than the Kaminak Group and is therefore Aphebian in age.

Geology of the Sand Creek porphyry molybdenum prospect /

The Sand Creek Prospect is located within the eastern exposed margin of the Coast Plutonic Complex. The occurrence is a plug and dyke porphyry molybdenum deposit. The rock types, listed in decreasing age: 1) metamorphlc schists and gneisses; 2) diorite suite rocks - diorite, quartz diorite, tonalite; 3) rocks of andesitic composition; 4) granodiorites, coarse porphyritic granodiorite, quartzfeldspar porphyry, feldspar porphyry; and 5) lamprophyre. Hydrothermal alteration is known to have resulted from emplacement of the hornblende-feldspar porphyry through to the quartz-feldspar porphyry. Molybdenum mineralization is chiefly associated with the quartz-feldspar porphyry. Ore mineralogy is dominated by pyrite with subordinate molybdenite, chalcopyrite, covelline, sphalerite, galena, scheelite, cassiterite and wolframite. Molybdenite exhibits a textural gradation outward from the quartz-feldspar porphyry. That is, disseminated rosettes and rosettes in quartz veins to fine-grained molybdenite in quartz veins and potassic altered fractures to fine-grained molybdenite paint or 6mears in the peripheral zones. The quartz-feldspar porphyry dykes were emplaced in an inhomogeneous stress field. The trend of dykes, faults and shear zones is 0^1° to 063° and dips between 58° NW and 86* SE. Joint Pole distribution reflects this fault orientation. These late deformatior maxima are probably superimposed upon annuli representing diapiric emplacement of the plutons. A model of emplacement involving two magmatic pulses is given in the following sequence: Diorite pulse (i) dioritequartz diorite, (ii) tonalites; granodiorite pulse (iii) hornblende-fildspar microporphyry, hornblende/biotite porphyry, (iv) coarse grained granodiorite, (v) quartz-feldspar porphyry, (vi) feldspar porphyry, and (vii) lamprophyre. The combination of plutonic and coarse porphyritic textures, extensive propylitic overprinting of potassic alteration assemblages suggests that the. prospect represents the lower reaches of a porphyry system.

Geology of the Gander Group, Gander River Ultramafic Belt and Davidsville Group in the Jonathan's Pond - Weir's Pond Area, northeast Newfoundland /

The study area is situated in NE Newfoundland between Gander Lake and the north coast and on the boundary between the Gander and Botwood tectonostratigraphic zones (Williams et al., 1974). The area is underlain by three NE trending units; the Gander Group, the Gander River Ultramafic Belt (the GRUB) and the Davidsville Group. The easternmost Gander Group consists of a thick, psammitic unit composed predominantly of psammitic schist and a thinner, mixed unit of semipelitic and pelitic schist with minor psammite. The mixed unit may stratigraphically overlie the psammitic unit or be a lateral facies equivalent of the latter. No fossils have been recovered from the Gander Group. The GRUB is a terrain of mafic and ultramafic plutonic rocks with minor pillow lava and plagiogranite. It is interpreted to be a dismembered ophiolite in thrust contact with the Gander Group. The westernmost Davidsville Group consists of a basal conglomerate, believed deposited unconformably upon the GRUB from which it was derived, and an upper unit of greywacke and slate, mostly of turbidite origin, with minor limestone and calcareous sandstone. The limestone, which lies near the base of the unit, contains Upper Llanvirn to Lower Llandeilo fossils. The Gander and Davidsville Groups display distinctly different sedimentological , structural and metamorphic histories. The Gander Group consists of quartz-rich, relatively mature sediment. It has suffered three pre-Llanvirn deformations, of which the main deformation, Dp produced a major, NE-N-facing recumbent anticline in the southern part of the study area. Middle greenschist conditions existed from D^ to D- with growth of metamorphic minerals during each dynamic and static phase. In contrast, the mineralogically immature Davidsville Group sediment contains abundant mafic and ultramafic detritus which is absent from the Gander Group. The Davidsville Group displays the effects of a single penetrative deformation with localized D_ and D_ features, all of which can be shown to postdate D_ in the Gander Group. Rotation of the flat Gander S- into a subvertical orientation near the contact with the GRUB and the Davidsville Group is believed to be a Davidsville D^ feature. Regional metamorphism in the Davidsville Group is lower greenschist with a single growth phase, MS . These sedimentological, structural and metamorphic differences between the Gander and Davidsville Groups persist even where the GRUB is absent and the two units are in contact, indicating that the tectonic histories of the Gander and Davidsville Groups are distinctly different. Structural features in the GRUB, locally the result of multiple deformations, may be the result of Gander and/or Davidsville deformations. Metamorphism is in the greenschist facies. Geochemical analyses of the pillow lava suggest that these rocks were formed in a back-arc basin. Mafic intrusives in the Gander Group appear to be the result of magraatism separate from that producing the pillow lava. The Gander Group is interpreted to be a continental rise prism deposited on the eastern margin of the Late Precambrian-Lower Paleozoic lapetus Ocean. The GRUB, oceanic crust possibly formed in a marginal basin to the west, is believed to have been thrust eastward over the Gander Group, deforming the latter, during the pre-Llanvirnian, possibly Precambrian, Ganderian Orogeny. The Middle Ordovician and younger Davidsville Group was derived from, and deposited unconformably on, this deformed terrain. Deformation of the Davidsville Group occurred during the Middle Devonian Acadian Orogeny.

The sedimentology of unconsolidated deltaic and aeolian sediments east of Dunnville, Ontario /

Surficial sediments east of Dunnville, Ontario representing a limited deltaic/lacustrine/aeolian system are investigated with the aim of defining and interpreting their geological history by means of exarrrrning their sedimentology and interrelationships. The Folk and \oJard grain size statistics of samples fran the area were calculated. These sample parameters were e1en plotted on maps to detennine regional patterns. The strongest pattern observed was one of distinct fining to the east, away fran the sand source. Aeolian deposits were fourrl to be better sorted than the surrcunding sediments. The grain size parameter values were also plotted on bivariate graphs in an attempt to separate the samples according to depositional environment. This exercise met with little success, as rrost of the sediments sampled in the area have similar grain size parameters. This is believed to be because the sediment sources for the different environments (delta, distal delta, aeolian dune) are intimately related, to the point that nnst dunes appear to have been sourcErl fran immediately local sediments. It is FOstulated that in such a srrall sedimentological sub-system, sediments were not involved in active transport for a length of time sufficient for the rraterial to cane to equilibritnn with its transporting medium. Thus, fe..v distinctive patterns of parameters were developed that would enable one to differentiate between various environments of neposition. The i.rnTaturity of rrany dune forms and the i.Imaturity of mineralogical composition of all deposits support the above hyt:XJthesis of limited transport time. Another hypothesis proposen is that eadh geologically or geographically distinct area or "sub-system" rray have its o,.m "signature" of grain size relationships as plotted on bivariate graphs. Thus, the emphasis, concerning graphs of this type, should not be placErl on attempting to nifferentiate between various environnents of deposition, hut raB1er on investigating the interrelationships between sanples am environments within that "sub-system". Through the course of this investigation, the existence of nelta plain distributary Channels in the thesis area is SUG0ested, and the mscovery of significantly mfferent sub-units within the TUnnville dune sediments is documented. It is inferred by reference to other authors interpretations of the glacial history of the area, that the tirre of effective aeolian acti vi ty in the Dunnville area was between 12,300 to 12,100 years R.p.