Home About us Contact
|
Home About us Contact | ||
|
|
||
Subsequent Episodes (subsequent + episode)
Selected AbstractsEvidence for a vicious cycle of exercise and hypoglycemia in type 1 diabetes mellitusDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 2 2004A. C. Ertl Abstract Exercise is a cornerstone of diabetes management as it aids in glycemic control, weight management, reducing blood pressure, and improving the quality of life of patients. Unfortunately, owing to the complexity and difficulties of regulating exogenous insulin in a physiologic manner during exercise, physical activity often results in hypoglycemia in patients with type 1 diabetes mellitus (type 1 DM). When glucose levels fall below threshold glycemic levels, neuroendocrine, autonomic nervous system (ANS), and metabolic glucose counterregulatory mechanisms are activated. These hypoglycemic counterregulatory mechanisms in type 1 DM can be blunted irreversibly by disease duration or by acute episodes of prior stress. These reduced (or absent) counterregulatory responses result in a threefold increase in severe hypoglycemia when intensive glycemic control is implemented in type 1 DM 1. Much recent work has been focused on determining the in vivo mechanisms responsible for causing the increased incidence of severe hypoglycemia in type 1 DM. Studies from several laboratories have demonstrated the role played by episodes of antecedent hypoglycemia in producing blunted glucose counterregulatory responses during subsequent exposures of hypoglycemia. Until recently, the mechanisms responsible for exercise related hypoglycemia in type 1 DM have been attributed to relative or absolute increases of insulin levels or incomplete glycogen repletion after physical activity. Owing to the qualitative similarity of neuroendocrine, ANS, and metabolic responses to hypoglycemia and exercise, we have hypothesized that neuroendocrine and ANS counterregulatory dysfunction may also play an important role in the pathogenesis of exercise-related hypoglycemia in type 1 DM. Vicious cycles can be created in type 1 DM, where an episode of hypoglycemia or exercise can feed forward to downregulate neuroendocrine and ANS responses to a subsequent episode of either stress, thereby creating further hypoglycemia (Figure 1). This article will review the recent work that has studied the contribution of counterregulatory dysfunction to exercise-induced hypoglycemia in type 1 DM. Copyright © 2004 John Wiley & Sons, Ltd. 1. Reciprocal vicious cycles may be created in type 1 diabetes mellitus (type 1 DM), whereby an episode of hypoglycemia or exercise can feed forward to downregulate neuroendocrine and autonomic nervous system responses to a subsequent episode of either stress, thereby creating further hypoglycemia [source] Geological overview and cratering model for the Haughton impact structure, Devon Island, Canadian High ArcticMETEORITICS & PLANETARY SCIENCE, Issue 12 2005Gordon R. Osinski Regional geological mapping has refined the sedimentary target stratigraphy and constrained the thickness of the sedimentary sequence at the time of impact to ,1880 m. New 40Ar,39Ar dates place the impact event at ,39 Ma, in the late Eocene. Haughton has an apparent crater diameter of ,23 km, with an estimated rim (final crater) diameter of ,16 km. The structure lacks a central topographic peak or peak ring, which is unusual for craters of this size. Geological mapping and sampling reveals that a series of different impactites are present at Haughton. The volumetrically dominant crater-fill impact melt breccias contain a calcite-anhydrite-silicate glass groundmass, all of which have been shown to represent impact-generated melt phases. These impactites are, therefore, stratigraphically and genetically equivalent to coherent impact melt rocks present in craters developed in crystalline targets. The crater-fill impactites provided a heat source that drove a post-impact hydrothermal system. During this time, Haughton would have represented a transient, warm, wet microbial oasis. A subsequent episode of erosion, during which time substantial amounts of impactites were removed, was followed by the deposition of intra-crater lacustrine sediments of the Haughton Formation during the Miocene. Present-day intra-crater lakes and ponds preserve a detailed paleoenvironmental record dating back to the last glaciation in the High Arctic. Modern modification of the landscape is dominated by seasonal regional glacial and niveal melting, and local periglacial processes. The impact processing of target materials improved the opportunities for colonization and has provided several present-day habitats suitable for microbial life that otherwise do not exist in the surrounding terrain. [source] Neural correlates of the spacing effect in explicit verbal semantic encoding support the deficient-processing theoryHUMAN BRAIN MAPPING, Issue 4 2010Daniel E. Callan Abstract Spaced presentations of to-be-learned items during encoding leads to superior long-term retention over massed presentations. Despite over a century of research, the psychological and neural basis of this spacing effect however is still under investigation. To test the hypotheses that the spacing effect results either from reduction in encoding-related verbal maintenance rehearsal in massed relative to spaced presentations (deficient processing hypothesis) or from greater encoding-related elaborative rehearsal of relational information in spaced relative to massed presentations (encoding variability hypothesis), we designed a vocabulary learning experiment in which subjects encoded paired-associates, each composed of a known word paired with a novel word, in both spaced and massed conditions during functional magnetic resonance imaging. As expected, recall performance in delayed cued-recall tests was significantly better for spaced over massed conditions. Analysis of brain activity during encoding revealed that the left frontal operculum, known to be involved in encoding via verbal maintenance rehearsal, was associated with greater performance-related increased activity in the spaced relative to massed condition. Consistent with the deficient processing hypothesis, a significant decrease in activity with subsequent episodes of presentation was found in the frontal operculum for the massed but not the spaced condition. Our results suggest that the spacing effect is mediated by activity in the frontal operculum, presumably by encoding-related increased verbal maintenance rehearsal, which facilitates binding of phonological and word level verbal information for transfer into long-term memory. Hum Brain Mapp, 2010. © 2009 Wiley-Liss, Inc. [source] Long-chain polyunsaturated fatty acids in a diabetic teenager during and after nine repeated episodes of diabetic ketoacidosisPEDIATRIC DIABETES, Issue 3 2009Éva Szabó Abstract:, Type 1 diabetes is often accompanied with acute hypoinsulinemia that may theoretically inhibit the conversion of essential fatty acids to their longer-chain metabolites. Previously, we found significant reduction in plasma arachidonic (C20:4n-6) and docosahexaenoic (C22:6n-3) acid values in a group of diabetic children during diabetic ketoacidosis. Here we report data on the changes of fatty acids in plasma phospholipids in a diabetic teenager during and after nine subsequent episodes of diabetic ketoacidosis (DKA). Plasma phospholipid linoleic acid (C18:2n-6) values significantly decreased [23.05 (1.05) versus 19.22 (3.22), % w/w, median (IQR), p < 0.01], while values of dihomo-gamma-linolenic acid (C20:3n-6) and docosatetraenoic acid (C22:4n-6) significantly increased [1.72 (0.44) versus 1.80 (0.63) and 0.40 (0.01) versus 0.45 (0.07), respectively, p < 0.05]. Values of alpha-linolenic acid (C18:3n-3) did not change, while values of docosahexaenoic acid were significantly higher after than during the ketoacidosis [1.57 (0.67) versus 1.87 (0.32), p < 0.05). These data obtained in the same patient during repeated episodes of diabetic ketoacidosis support the concept that hypoinsulinemia plays an important role in disturbances of essential fatty acid metabolism in diabetes. [source] Patterns and costs of treatment for heroin dependence over 12 months: fndings from the Australian Treatment Outcome StudyAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2006Marian Shanahan Objective: To determine patterns and costs of treatment for heroin dependence over a 12-month period among a cohort of heroin users seeking treatment. Methods: The design was a longitudinal cohort study of heroin users seeking treatment who participated in the Australian Treatment Outcome Study (ATOS), which was conducted in Sydney, Melbourne and Adelaide, Australia. Treatment for heroin dependence, for those who were followed up at 12 months, was recorded and costed. Unit costs, obtained from secondary sources, were used to estimate the cost of treatment. This study does not include wide societal costs and only includes personal costs as they pertain to treatment. Results: A follow-up rate of 81% at 12 months was achieved, resulting in data for 596 participants. Participants spent an average of 188 days in treatment over 2.7 episodes. Sixty-nine per cent of the sample reported at least one episode of treatment following their index treatment. There was a noticeable trend for subjects who received maintenance or residential rehabilitation as their index treatment to return to the same form of treatment for subsequent episodes. In contrast, those who received detoxifcation as index treatment accessed a wider variety of treatment types over the follow-up period. The cost of treatment over the 12-month follow-up totalled 3,901,416, with a mean of 6,517 per person. Conclusions and Implications: This study demonstrates that individuals seeking treatment have multiple treatment episodes throughout a 12-month period, with a tendency to return to the same form of treatment. This study also demonstrates that it is feasible and affordable to provide ongoing treatment for a group of heroin users seeking treatment. [source] Provenance of siliciclastic and hybrid turbiditic arenites of the Eocene Hecho Group, Spanish Pyrenees: implications for the tectonic evolution of a foreland basinBASIN RESEARCH, Issue 2 2010M. A. Caja ABSTRACT The Eocene Hecho Group turbidite system of the Aínsa-Jaca foreland Basin (southcentral Pyrenees) provides an excellent opportunity to constrain compositional variations within the context of spatial and temporal distribution of source rocks during tectonostratigraphic evolution of foreland basins. The complex tectonic setting necessitated the use of petrographic, geochemical and multivariate statistical techniques to achieve this goal. The turbidite deposits comprise four unconformity-bounded tectonostratigraphic units (TSU), consisting of quartz-rich and feldspar-poor sandstones, calclithites rich in extrabasinal carbonates and hybrid arenites dominated by intrabasinal carbonates. The sandstones occur exclusively in TSU-2, whereas calclithites and hybrid arenites occur in the overlying TSU-3, TSU-4 and TSU-5. The calclithites were deposited at the base of each TSU and hybrid arenites in the uppermost parts. Extrabasinal carbonate sources were derived from the fold-and-thrust belt (mainly Cretaceous and Palaeocene limestones). Conversely, intrabasinal carbonate grains were sourced from foramol shelf carbonate factories. This compositional trend is attributed to alternating episodes of uplift and thrust propagation (siliciclastic and extrabasinal carbonates supplies) and subsequent episodes of development of carbonate platforms supplying intrabasinal detrital grains. The quartz-rich and feldspar-poor composition of the sandstones suggests derivation from intensely weathered cratonic basement rocks during the initial fill of the foreland basin. Successive sediments (calclithites and hybrid arenites) were derived from older uplifted basement rocks (feldspar-rich and, to some extent, rock fragments-rich sandstones), thrust-and-fold belt deposits and from coeval carbonate platforms developed at the basin margins. This study demonstrates that the integration of tectono-stratigraphy, petrology and geochemistry of arenites provides a powerful tool to constrain the spatial and temporal variation in provenance during the tectonic evolution of foreland basins. [source] Safety of Paramedics with Extended SkillsACADEMIC EMERGENCY MEDICINE, Issue 7 2008Suzanne Mason MBBS Abstract Background:, The role of paramedics with extended skills is evolving, enabling them to assess and treat patients in the community. A United Kingdom service led by extended-role paramedic practitioners (PPs) is aimed at managing minor acute illness and injury among older people in the home when appropriate, avoiding unnecessary transfer to the emergency department (ED). Objectives:, The objectives were to evaluate the safety of clinical decisions made by PPs operating within the new service. Methods:, As part of a cluster-randomized controlled trial, patients aged >60 years contacting the emergency medical services (EMS) with a minor injury or illness were included in the study. The safety of the new PP intervention was compared with standard practice of EMS transfer and ED treatment. Outcomes included unplanned ED attendance within 7 days of the index episode. Clinical records were rated independently by two senior ED clinicians to identify related episodes, avoidable subsequent episodes, and suboptimal care. Results:, Of the 2,025 patients included in this analysis, 219 (10.9%) went on to have an unplanned ED attendance within 7 days. Of these, 162 (74.0%) re-presented with a condition related to their index episode. The independent raters agreed on suboptimal care 83.4% of the time. There were 16 agreed upon episodes related to suboptimal care (0.80%). No significant differences were found between intervention and control groups in relation to re-presentation at hospital within 7 days for a related condition or rates of assessed suboptimal care. Conclusions:, This study suggests that appropriately trained paramedics with extended skills treating older people with minor acute conditions in the community are as safe as standard EMS transfer and treatment within the ED. [source] | ||||||||||