The impact of a brief foot care intervention for persons with diabetes

Purpose of the study. The purpose of this randomized controlled clinical trial was to determine if a brief intervention would improve foot self-care behaviors in adult patients with Type 2 diabetes who presented to the emergency department for non-emergent care in a predominantly Hispanic southwestern border community. ^ Methods. A pre-post-test, three-group design was used to compare the foot self-care behaviors of patients who received usual care to those who received lower extremity amputation (LEA) risk assessment and to those who received LEA risk assessment plus a brief foot self-care intervention. After being randomized into 3 groups (N = 167), baseline assessments of demographics, diabetes history, acculturation, and the Summary of Diabetes Self Care Activities (SDSCA) questionnaire and Modified Insulin Management Diabetes Self Efficacy Scale (MIMDSES) were completed in English or Spanish. At one-month, 144 (84%) participants were available for follow-up by the research assistant masked to group assignment. ^ Results. At baseline, significant differences in foot self-care behaviors and self monitoring blood glucose were noted based on ethnicity and gender. Men had significantly lower confidence in their ability to manage their diabetes overall. There was a significant difference between baseline and follow up self reported foot self-care behaviors within the intervention group (t (47) = −4.32, p < .01) and the control group (t (46) = −2.06, p < .05). There were no significant differences between groups for self-reported foot self-care behaviors. There was a significant difference in observed foot self-care behaviors between groups (F(2,135) = 2.99, p < .05). Self-efficacy scores were positively correlated with self-reported self-care behaviors. ^ Conclusions. This predominantly Hispanic population with type 2 diabetes reported performing diabetes self-care behaviors less than five days a week. There were within group changes, but no significant between group changes in reported self-care behaviors. However, at the one month follow up, there were significant differences between groups in observed foot self-care behaviors with the intervention group demonstrating the most accurate behaviors. Differences based on gender and ethnicity emphasize the need to individualize diabetes education. Priorities for culturally competent diabetes education, approaches to increasing self-efficacy and future research directions are suggested. ^

Workers and respirators: What factors influence medical clearance? Experience in the petrochemical industry 2004--2008

This retrospective cohort study analyzed data from more than 2200 OSHA-mandated respirator medical evaluations performed between 2004 and 2008, with information initially obtained using an online questionnaire, to determine what factors influence medical clearance and the ability to safely wear respiratory protection in a large petrochemical company.^ The employees were mostly white males with a high school education, ranging in age from 25 to 60 years of age, who had been employed with the company an average of eight years. Their work was typically performed outdoors in a rural or offshore setting. Respirators were typically required for emergency response – escape or rescue only – and/or limited to less than four hours per month.^ Approximately 90% of the population achieved medical clearance by utilizing the online questionnaire. Of the remaining 10%, 66% were cleared after additional "hands-on" medical examination exam; 28% of the individuals' jobs were modified by their supervisor in order to not use a respirator, and 6% of the individuals (n=13) were excluded from wearing a respirator on the basis of the medical examination. The primary causes for exclusion from respirator use were cardiovascular (37.5%) and respiratory (31.3%) issues, followed by psychological (18.8%) and musculoskeletal (12.5%) concerns. Ultimately, over 99% of workers evaluated under this system were found capable of using respiratory protection safely. This questionnaire has proven to be an excellent health screening tool capable of initiating early detection and further investigation of potentially serious medical conditions within a large and diverse population in multiple locations. ^

Systematic interpretation of molecular beacon polymerase chain reaction for identifying rpoB mutations in Mycobacterium tuberculosis isolates with mixed resistant and susceptible bacteria

Detection of multidrug-resistant tuberculosis (MDR-TB), a frequent cause of treatment failure, takes 2 or more weeks to identify by culture. RIF-resistance is a hallmark of MDR-TB, and detection of mutations in the rpoB gene of Mycobacterium tuberculosis using molecular beacon probes with real-time quantitative polymerase chain reaction (qPCR) is a novel approach that takes ≤2 days. However, qPCR identification of resistant isolates, particularly for isolates with mixed RIF-susceptible and RIF-resistant bacteria, is reader dependent and limits its clinical use. The aim of this study was to develop an objective, reader-independent method to define rpoB mutants using beacon qPCR. This would facilitate the transition from a research protocol to the clinical setting, where high-throughput methods with objective interpretation are required. For this, DNAs from 107 M. tuberculosis clinical isolates with known susceptibility to RIF by culture-based methods were obtained from 2 regions where isolates have not previously been subjected to evaluation using molecular beacon qPCR: the Texas–Mexico border and Colombia. Using coded DNA specimens, mutations within an 81-bp hot spot region of rpoB were established by qPCR with 5 beacons spanning this region. Visual and mathematical approaches were used to establish whether the qPCR cycle threshold of the experimental isolate was significantly higher (mutant) compared to a reference wild-type isolate. Visual classification of the beacon qPCR required reader training for strains with a mixture of RIF-susceptible and RIF-resistant bacteria. Only then had the visual interpretation by an experienced reader had 100% sensitivity and 94.6% specificity versus RIF-resistance by culture phenotype and 98.1% sensitivity and 100% specificity versus mutations based on DNA sequence. The mathematical approach was 98% sensitive and 94.5% specific versus culture and 96.2% sensitive and 100% specific versus DNA sequence. Our findings indicate the mathematical approach has advantages over the visual reading, in that it uses a Microsoft Excel template to eliminate reader bias or inexperience, and allows objective interpretation from high-throughput analyses even in the presence of a mixture of RIF-resistant and RIF-susceptible isolates without the need for reader training.^

Genetic analysis of Pitx2 in left -right asymmetry and cardiovascular development

Pitx2, a paired-related homeobox gene that is mutated in human Rieger Syndrome, plays a key role in transferring the early asymmetric signals to individual organs. Pitx2 encodes three isoforms, Pitx2a, Pitx2b and Pitx2c. I found that Pitx2c was the Pitx2 isoform for regulating left-right asymmetry in heart, lung and the predominant isoform in guts. Previous studies suggested that the generation of left-right asymmetry within individual organs is an all or none, random event. Phenotypic analysis of various Pitx2 allelic combinations, that encode graded levels of Pitx2c, reveals an organ-intrinsic mechanism for regulating left-right asymmetric morphogenesis based on differential response to Pitx2c levels. The heart needs low Pitx2c levels, while the lungs and duodenum require higher doses of Pitx2c. In addition, the duodenal rotation is under strict control of Pitx2c activity. Left-right asymmetry development for aortic arch arteries involves complex vascular remodeling. Left-sided expression of Pitx2c in these developing vessels implied its potential function in this process. In order to determine if Pitx2c also can regulate the left-right asymmetry of the aortic arch arteries, a Pitx2c-specific loss of function mutation is generated. Although in wild type mice, the direction of the aortic arch is always oriented toward the left side, the directions of the aortic arches in the mutants were randomized, showing that Pitx2c also determined the left-right asymmetry of these vessels. I have further showed that the cardiac neural crest wasn't involved in this vascular remodeling process. In addition, all mutant embryos had Double Outlet Right Ventricle (DORV), a common congenital heart disease. This study provided insight into the mechanism of Pitx2c-mediated late stages of left-right asymmetry development and identified the roles of Pitx2c in regulation of aortic arch remodeling and heart development. ^

Nd isotope data for planktonic foraminifera from within and around sapropels S1 and S5 from ODP Site 160-967

The development of widespread anoxic conditions in the deep oceans is evidenced by the accumulation and preservation of organic-carbon-rich sediments, but its precise cause remains controversial. The two most popular hypotheses involve (1) circulation-induced increased stratification resulting in reduced oxygenation of deep waters or (2) enhanced productivity in the surface ocean, increasing the raining down of organic matter and overwhelming the oxic remineralization potential of the deep ocean. In the periodic development of deep-water anoxia in the Pliocene-Pleistocene Mediterranean Sea, increased riverine runoff has been implicated both as a source for nutrients that fuel enhanced photic-zone productivity and a source of a less dense freshwater cap leading to reduced circulation, basin-wide stagnation, and deep-water oxygen starvation. Monsoon-driven increases in Nile River discharge and increased regional precipitation due to enhanced westerly activity-two mechanisms that represent fundamentally different climatic driving forces-have both been suggested as causes of the altered freshwater balance. Here we present data that confirm a distinctive neodymium (Nd) isotope signature for the Nile River relative to the Eastern Mediterranean-providing a new tracer of enhanced Nile outflow into the Mediterranean in the past. We further present Nd isotope data for planktonic foraminifera that suggest a clear increase in Nile discharge during the central intense period of two recent anoxic events. Our data also suggest, however, that other regional freshwater sources were more important at the beginning and end of the anoxic events. Taken at face value, the data appear to imply a temporal link between peaks in Nile discharge and enhanced westerly activity.

Ground beetle (Carabidae) abundance data from north-eastern Australian rainforest, between June 2008 - January 2010, using pitfall traps

Understanding how the environment influences patterns of diversity is vital for effective conservation management, especially in a changing global climate. While assemblage structure and species richness patterns are often correlated with current environmental factors, historical influences may also be considerable, especially for taxa with poor dispersal abilities. Mountain-top regions throughout tropical rainforests can act as important refugia for taxa characterised by low dispersal capacities such as flightless ground beetles (Carabidae), an ecologically significant predatory group. We surveyed flightless ground beetles along elevational gradients in five different subregions within the Australian Wet Tropics World Heritage Area to investigate (1) whether the diversity and composition of flightless ground beetles are elevationally stratified, and, if so, (2) what environmental factors (other than elevation per se) are associated with these patterns. Generalised linear models and model averaging techniques were used to relate patterns of diversity to environmental factors. Unlike most taxonomic groups, flightless ground beetles increased in species richness and abundance with elevation. Additionally, each subregion consisted of distinct assemblages containing a high level of regional endemic species. Species richness was most strongly positively associated with the historical climatic conditions and negatively associated with severity of recent disturbance (treefalls) and current climatic conditions. Assemblage composition was associated with latitude and current and historical climatic conditions. Our results suggest that distributional patterns of flightless ground beetles are not only likely to be associated with factors that change with elevation (current climatic conditions), but also factors that are independent of elevation (recent disturbance and historical climatic conditions). Variation in historical vegetation stability explained both species richness and assemblage composition patterns, probably reflecting the significance of upland refugia at a geographic time scale. These findings are important for conservation management as upland habitats are under threat from climate change.

Chemical composition of bottom waters and interstitial waters from sediments and deposits within and outside the Haakon Mosby submarine mud volcano in the Norwegian Sea

On the base of data of Cruise 40 of R/V Akademik Keldysh features of formation of saline composition of interstitial waters from sediments containing free hydrocarbons (methane) and gas hydrates (CH4 x 6H2O) were considered. Chemical composition of the interstitial waters is presented for three zones of sediments from the Haakon Mosby submarine mud volcano: (1) zone of kettles containing free hydrocarbons, (2) gas hydrate sediments, and (3) periphery of the volcano. Abnormally high concentrations of bromine and especially iodine characteristic of the interstitial and particularly of the oil-field waters were found. Because of a great interest in natural gas hydrates found in marine sediments, we obtained a possibility to supplement scarce of available published data with some new information.

Thermal reaction norms of growth in Atlantic and Pacific silverside fishes

How organisms may adapt to rising global temperatures is uncertain, but concepts can emerge from studying adaptive physiological trait variations across existing spatial climate gradients. Many ectotherms, particularly fish, have evolved increasing genetic growth capacities with latitude (i.e. countergradient variation (CnGV) in growth), which are thought to be an adaptation primarily to strong gradients in seasonality. In contrast, evolutionary responses to gradients in mean temperature are often assumed to involve an alternative mode, 'thermal adaptation'. We measured thermal growth reaction norms in Pacific silverside populations (Atherinops affinis) occurring across a weak latitudinal temperature gradient with invariant seasonality along the North American Pacific coast. Instead of thermal adaptation, we found novel evidence for CnGV in growth, suggesting that CnGV is a ubiquitous mode of reaction-norm evolution in ectotherms even in response to weak spatial and, by inference, temporal climate gradients. A novel, large-scale comparison between ecologically equivalent Pacific versus Atlantic silversides (Menidia menidia) revealed how closely growth CnGV patterns reflect their respective climate gradients. While steep growth reaction norms and increasing growth plasticity with latitude in M. menidia mimicked the strong, highly seasonal Atlantic coastal gradient, shallow reaction norms and much smaller, latitude-independent growth plasticity in A. affinis resembled the weak Pacific latitudinal temperature gradient.

Sedimentation across the Great Barrier Reef

The continental margin off northeast Australia, comprising the Great Barrier Reef (GBR) platform and Queensland Trough, is the largest tropical mixed siliciclastic/carbonate depositional system in existence. We describe a suite of 35 piston cores and two Ocean Drilling Program (ODP) sites from a 130*240 km rectangular area of the Queensland Trough, the slope and basin setting east of the central GBR platform. Oxygen isotope records, physical property (magnetic susceptibility and greyscale) logs, analyses of bulk carbonate content and radiocarbon ages at these locations are used to construct a high resolution stratigraphy. This information is used to quantify mass accumulation rates (MARs) for siliciclastic and carbonate sediments accumulating in the Queensland Trough over the last 31,000 years. For the slope, highest MARs of siliciclastic sediment occur during transgression (1.0 Million Tonnes per year; MT/yr), and lowest MARs of siliciclastic (<0.1 MT/yr) and carbonate (0.2 MT/yr) sediment occur during sea level lowstand. Carbonate MARs are similar to siliciclastic MARs for transgression and highstand (1.1-1.4 MT/yr). In contrast, for the basin, MARs of siliciclastic (0-0.1 MT/yr) and carbonate sediment (0.2-0.4 MT/yr) are continuously low, and within a factor of two, for lowstand, transgression, and highstand. Generic models for carbonate margins predict that maximum and minimum carbonate MARs on the slope will occur during highstand and lowstand, respectively. Conversely, most models for siliciclastic margins suggest maximum and minimum siliciclastic MARs will occur during lowstand and transgression, respectively. Although carbonate MARs in the Queensland Trough are similar to those predicted for carbonate depositional systems, siliciclastic MARs are the opposite. Given uniform siliciclastic MARs in the basin through time, we conclude that terrigenous material is stored on the shelf during sea level lowstand, and released to the slope during transgression as wave driven currents transport shelf sediment offshore.

Consolidation tests, elastic properties and grain size measurements at the consolidations samples from different Holes of IODP Expedition 302

The Integrated OceanDrilling Program's Expedition 302, the Arctic Coring Expedition (ACEX), recovered the first Cenozoic sedimentary sequence from the central Arctic Ocean. ACEX provided ground truth for basin scale geophysical interpretations and for guiding future exploration targets in this largely unexplored ocean basin. Here, we present results from a series of consolidation tests used to characterize sediment compressibility and permeability and integrate these with high-resolution measurements of bulk density, porosity and shear strength to investigate the stress history and the nature of prominent lithostratigraphic and seismostratigraphic boundaries in the ACEX record. Despite moderate sedimentation rates (10-30 m/Myr) and high permeability values (10**-15 -10**-18 m**2), consolidation and shear strength measurements both suggest an overall state of underconsolidation or overpressure. One-dimensional compaction modelling shows that to maintain such excess pore pressures, an in situ fluid source is required that exceeds the rate of fluid expulsion generated by mechanical compaction alone. Geochemical and sedimentological evidence is presented that identifes the Opal A-C/T transformation of biosiliceous rich sediments as a potential additional in situ fluid source.However, the combined rat of chemical and mechanical compaction remain too low to fully account for the observed pore pressure gradients, implying an additional diagenetic fluid source from within or below the recovered Cenozoic sediments from ACEX. Recognition of the Opal A-C/T reaction front in the ACEX record has broad reaching regional implications on slope stability and subsurface pressure evolution, and provides an important consideration for interpreting and correlating the spatially limited seismic data from the Arctic Ocean.

Highly stereoselective decarboxylation of (+)-1-Bromo-1-chloro-2,2,2-trifluoropropanoic acid gives (+)-1-Bromo-1-chloro-2,2,2-trifluoroethane ((+)-Halothane) with retention of configuration

The absolute configuration of the title acid (2) has been determined to be S by X-ray crystallography. Thus, decarboxylation of 2 produces (S)-(+)-halothane with 99% retention of configuration. This behavior is compared to other stereoselective decarboxylation reactions of ?-haloacids from the literature that also give high degrees of retention of configuration when in the form of their quaternary ammonium salts, which contain one proton. The proton of the ammonium salt is necessary to protonate the anionic intermediate formed from decarboxylation. In the absence of this relatively acidic proton, we had previously found that using triethylene glycol (TEG) as both solvent and proton source for the decarboxylation reaction of acid 2 caused poor stereoselectivity. This was in contrast to 1,2,2,2-tetrafluoro-1-methoxypropionic acid (6), which showed a high degree of retention of configuration in TEG. To rationalize this differing behavior we report DFT studies at PCM-B3LYP/6-31++G** level of theory (the results were additionally confirmed with 6-311++G** and aug-cc-pVDZ basis sets). The energy barrier to inversion of configuration of the anionic reaction intermediate of acid 2 (11) is 10.23 kcal/mol. However, we find that the anionic intermediate from acid 6 (10) would rather undergo ?-elimination instead of inversion of configuration. Thus the planar transition state required for inversion of configuration is never reached, regardless of the rate of proton transfer to the anion.

Biogeochemical parameters (oxygen, nitrate, phosphate, TOC and strontium) at three sites from the Clarion-Clipperton Fracture Zone

The Clarion-Clipperton Fracture Zone (CCFZ) in the Pacific Ocean is characterized by organic carbon-starved sediments and meter-scale oxygen penetration into the sediment. Furthermore, numerous seamounts occur throughout its deep-sea plain, which may serve as conduits for low-temperature hydrothermal circulation of seawater through the oceanic crust. Recent studies in deep-sea environments of the Pacific and Atlantic Oceans have suggested and presented evidence of an exchange of dissolved constituents between the seawater flowing in the basaltic crust and the pore water of the overlying sediments. Through high-resolution pore-water oxygen and nutrient measurements, we examined fluxes and geochemical interactions between the seamount basaltic basement and pore waters of the overlying sediments at three sites located on a radial transect from the foot of Teddy Bare, a small seamount in the CCFZ. At three sites, located 1000, 700 and 400 m away from the foot of the seamount, we found that oxygen concentrations initially decrease with sediment depth but start to increase at depths of 3 and 7 m towards the basaltic basement. NO32- concentrations mirror the oxygen concentration profiles, as they increase with sediment depth but decrease towards the basement. We performed transport reaction modeling and determined at one site the 87Sr/86Sr ratio of the pore water and the bottom water overlying the sediments, which indicated that the 87Sr/86Sr ratio of the pore water at the bottom of the sediment column is similar to the seawater Transport-reaction modeling revealed that (1) the diffusive flux of oxygen from the basaltic basement outpaces the oxygen consumption through organic matter oxidation and nitrification in the basal sediments and (2) the nutrient exchange between the sediment and the underlying basaltic crust occurs at orders-of-magnitude lower rates than between the upper sediment and the overlying bottom water. Our results suggest an upward diffusion of oxygen from seawater circulating within the seamount crust into the overlying basal sediments. The oxygen profiles presented here represent the first of their kind ever measured in the Pacific Ocean, as they indicate an upward flux of molecular oxygen from a basaltic aquifer, something that has so far only been documented - at one other location worldwide - the North Pond site in the Atlantic Ocean. We show that the diffusion of oxygen from the seamount basaltic basement into the overlying pore waters affects the preservation of organic compounds and helps to maintain a completely oxygenated sedimentary column at all 3 sites near the seamount.