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This article provides practical tips for advising people with type 2 diabetes on how to engage in regular exercise safely and effectively. Its focus is on individuals who wish to exceed the minimum physical activity recommendation of 150 minutes/week of moderate-intensity exercise or even compete in their chosen sport. Health care professionals who work with such individuals must have a basic understanding of glucose metabolism during exercise, nutritional requirements, blood glucose management, medications, and sport-related considerations. This article reviews three key aspects of individualized care for physically active people with type 2 diabetes: 1) initial medical assessment and pre-exercise screenings, 2) glucose monitoring and nutritional considerations, and 3) the combined glycemic effects of exercise and medications. [ABSTRACT FROM AUTHOR]

Caenorhabditis elegans is an attractive model system for determining the targets of neuroactive compounds. Genetic screens in C. elegans provide a relatively unbiased approach to the identification of genes that are essential for behavioral effects of drugs and neuroactive compounds such as alcohol. Much work in vertebrate systems has identified multiple potential targets of ethanol but which, if any, of those candidates are responsible for the behavioral effects of alcohol is uncertain. Here we provide detailed methodology for a genetic screen for mutants of C. elegans that are resistant to the depressive effects of ethanol on locomotion and for the subsequent behavioral analysis of those mutants. The methods we describe should also be applicable for use in screening for mutants that are resistant or hypersensitive to many neuroactive compounds and for identifying the molecular targets or biochemical pathways mediating drug responses.

Abstract Background The optimal operative approach for carcinoma at the lower esophagus and esophagogastric junction remains controversial. The aim of this study was to assess a single unit experience of transhiatal esophagectomy in an era when the use of systemic oncological therapies has increased dramatically. Study Design Between January 2000 and November 2006, 215 consecutive patients (182 males, 33 females, median age = 65 years) underwent transhiatal esophagectomy; invasive malignancy was detected preoperatively in 188 patients. 90 patients (42%) received neoadjuvant chemotherapy. Prospective data was obtained for these patients and cross-referenced with cancer registry survival data. Results There were 2 in-hospital deaths (0.9%). Major complications included: respiratory complications in 65 patients (30%), cardiovascular complications in 31 patients (14%) and clinically apparent anastomotic leak in 12 patients (6%). Median length of hospital stay was 14 days. The radicality of resection was inversely related to T stage: an R0 resection was achieved in 98–100% of T0/1 tumors and only 14% of T4 tumors. With a median follow up of 26 months, one and five year survival rates were estimated at 81% and 48% respectively. Conclusion Transhiatal esophagectomy is an effective operative approach for tumors of the infracarinal esophagus and the esophagogastric junction. It is associated with low mortality and morbidity and a five survival rate of nearly 50% when combined with neoadjuvant chemotherapy.

Abstract Background Gastro-Intestinal stromal tumours (GISTs) are rare and our understanding of their natural history and optimal treatment are continually evolving. Port site metastasis after laparoscopy for a GIST is an extremely rare phenomenon. Case presentation We report a case with relevant imaging and discuss factors that may have contributed to the development of this isolated metastasis. Conclusion Percutaneous methods of sampling GIST tumours for analysis should be avoided if at all possible. When necessary, prophylactic measures should be utilised to minimise the risk of seeding.

The protection of biodiversity is critical to ecosystem function and is a primary management goal for conservation areas globally. Maintaining a current inventory of known diversity is a central component of achieving this goal and serves as an essential starting point for future research endeavours. Since the first published survey of termites in South Africa's Kruger National Park (KNP) over 55 years ago, our understanding of termite diversity has expanded sufficiently to merit an update and formal checklist. Here we revise the inventory of termite diversity in KNP and summarise the taxonomic and functional diversity of termites in the park. A thorough review of recent termite research in KNP added 6 new genera and 13 species to what was found in Coaton's original survey, with one genus, Anenteotermes , recorded for the first time in southern Africa. Based on the updated species checklist, the majority of genera in the park belong to Feeding Group II (39%) and the Termitidae family (75%). Conservation implications : In savannas, termites play crucial roles in nutrient cycling, water redistribution and plant dynamics. Systematically cataloguing termite diversity and assemblage composition in the park provides an essential baseline for scientific research, aids biodiversity conservation efforts and encourages scientists and managers to consider termites in ecosystem functioning and management. Having more detailed descriptions of genera, species and feeding groups allows for more tangible, ecologically relevant attributions of termite influence, facilitates enhanced inquiry and allows for more realistic quantification of termite roles in key ecosystem processes. Keywords: termite; Kruger National Park; feeding groups; diversity; savanna. [ABSTRACT FROM AUTHOR]

We characterize a self-imaging multipass amplifier scheme that provides both high extraction efficiency and overall gain. A diode-pumped slab amplifier with a single-pass small-signal gain of 2.5 is used in a 16-pass mode to amplify an input pulse from 50 [micro]J to 50 mJ, extracting approximately 22% of the stored energy. A stimulated Brillouin-scattering phase-conjugate mirror provides isolation from amplified spontaneous emission, prevents gain depletion, and also ensures good beam quality. The system can be operated from 10 Hz to in excess of 450 Hz, with modest changes in the beam quality and energy. The scheme has the potential to be scaled to higher-energy and higher-power systems. OCIS codes: 140.3280, 190.5040, 140.3530.

Abstract: Megafauna strongly affect vegetation structure and composition, often leading to management concern. However, the extent of their influence across large scales and varying ecosystems remains largely unknown. Using high resolution airborne Light Detection and Ranging (LiDAR), we investigated landscape‐scale changes in vegetation height and three‐dimensional (3D) structure across landscapes of varying elephant densities and presence over time, and in response to surface water distribution and terrain variability in the heavily managed thicket biome of the Addo Elephant National Park, South Africa. Elephants caused up to a fourfold reduction in vegetation height and altered the vertical profile, but increased vegetation height variability. Vegetation height also increased with elevation and distance from water, particularly in areas that elephants had long occupied at high densities. Slope had opposing effects on vegetation height, with height increasing with slope in areas long exposed to elephants, but decreasing where elephants had only recently been granted access. Our results suggest that elephants are the primary agents of vegetation change in this ecosystem, but that the strength of their effects varies across the landscape, enabling management to use water and terrain as mitigation tools. We further highlight the necessity of landscape‐level experimental studies on megafaunal effects to untangle mechanisms and establish causality. [ABSTRACT FROM AUTHOR]

Air travel has grown steadily in the region of 5–6% every year since 1970 meaning that in the UK alone, around 750,000 people use flying as a means of transport every day. Disability rates are also increasing in the UK, with over 13 million people having at least one. Air travel for the mobility impaired has been relatively unexplored, but with increasing rates of disability and passenger numbers, it is crucial to know what the most severely disabled people think of the current process. This study used qualitative interviews of a semi-structured nature with eight wheelchair-using participants who were invited to discuss their experiences of air travel as well as offering opinions. Key findings showed notable issues when wheelchair users interact with the aircraft. The manual handling, the equipment used, seating, communication and accessing the toilet on the aircraft led to physical pain and discomfort and in turn emotional distress. Recommendations include developing consistency, further disability training and a review of the equipment involved. [ABSTRACT FROM AUTHOR]

Purpose: The pattern of symptoms of knee osteoarthritis has been thought to be indicative of specific compartment involvement. This study investigated whether there was a true correlation between patellofemoral joint (PFJ) symptoms and unicompartmental patellofemoral arthritis. Materials and Methods: A prospective analysis of 34 patients rendered to be suffering from PFJ osteoarthritis and subsequently undergoing unicompartmental patellofemoral arthroplasty (PFA) was performed. A control cohort of 32 patients suffering from medial tibiofemoral joint (MTFJ) osteoarthritis was included in the analysis. Four questions derived from the Oxford knee score questionnaire, traditionally deemed to be indicative of PFJ osteoarthritis, were combined to create a PFJ subscore and statistically analyzed for their potential relationship with PFJ osteoarthritis and outcomes following PFA. Results: The PFJ subscore indicated slightly worse pathology in patients undergoing PFA compared to MTFJ replacement, but the difference was not significant (9.7 and 9.6, respectively; p=0.851). The improvement in PFJ symptoms was higher in those undergoing PFA compared to MTFJ surgery; however, the difference was not statistically significant (3.7 and 2.2 respectively, p=0.074). Conclusions: We were unable to prove that these symptoms were predictive of PFJ pathology in the preoperative setting, nor were they useful in interpreting which symptoms would likely improve following PFA. [ABSTRACT FROM AUTHOR]

Objective: Primary graft dysfunction, a severe form of lung injury that occurs in the first 72 hours after lung transplant, is associated with morbidity and mortality. We sought to assess the impact of an evidence-based guideline as a protocol for respiratory and hemodynamic management. Methods: Preoperative and postoperative data for patients treated per the guideline (n = 56) were compared with those of a historical control group (n = 53). Patient data such as ratio of arterial Po 2 to inspired oxygen fraction, central venous pressure, cumulative fluid balance, vasopressor dose, and serum urea and creatinine were measured and documented at specific times. Primary outcome was severity of primary graft dysfunction within the first 72 hours. Results: Primary graft dysfunction grade was progressively lower in patients treated after introduction of the guideline (P = .01). Lower postoperative fluid balances (P = .01) and vasopressor doses (P = .007) were seen, with no associated renal dysfunction. There were no differences in duration of mechanical ventilation or mortality. Nonadherence to the guideline occurred in 10 cases (18%). Conclusions: Implementation of an evidence-based guideline for managing respiratory and hemodynamic status is feasible and safe and was associated with reduction in severity of primary graft dysfunction. Further studies are required to determine whether such a guideline would lead to a consistent reduction in severity of primary graft dysfunction at other institutions. Creation of a protocol for postoperative care provides a template for further studies of novel therapies or management strategies for primary graft dysfunction. [Copyright &y& Elsevier]

The article focuses on a study which described the use of Caenorhabditis elegans (C. elgans) in screening for targets of ethanol and behavior-altering drugs. Specifically, it provided detailed methodoloy for a genetic screen for mutants of C. elegans that are resistant to the depressive effects of ethanol on locomotion and the behavioral analysis of those mutants. Methods used are also applicable for use in screening for mutants that are resistant or hypersensitive to neuroactive compounds.

Objective: Single-lung transplantation for chronic obstructive pulmonary disease can cause unique postoperative problems that might require independent lung ventilation. We evaluated preoperative and immediate postoperative factors to predict the need for independent lung ventilation. Methods: We retrospectively studied 170 patients who received a single-lung transplant over a 15-year period, 20 (12%) of whom required independent lung ventilation. Results: Patients requiring independent lung ventilation were similar in age, sex, ischemic time, and donor characteristics to those who required conventional ventilation. Patients receiving independent lung ventilation had a greater degree of preoperative airflow limitation, more hyperinflation, lower postoperative Pao 2/fraction of inspired oxygen ratios, more radiologic mediastinal shift, and more transplant lung infiltrate on the postoperative chest radiograph. Multivariate logistic regression analysis showed that independent lung ventilation was associated with increasing levels of recipient hyperinflation (percentage total lung capacity compared with predicted value; odds ratio, 1.04; 95% confidence interval, 1.01-1.07; P = .032) and reduced early postoperative Pao 2/fraction of inspired oxygen ratio (odds ratio, 0.97; 95% confidence interval, 0.95-0.99; P = .005). Length of ventilation and intensive care unit stay and mortality were higher in the independent lung ventilation group. Among patients who survived to hospital discharge, there were no differences in long-term mortality between the 2 groups. Conclusions: The need for independent lung ventilation in patients undergoing single-lung transplantation for obstructive lung disease is predicted by the combination of increased hyperinflation measured on recipients’ preoperative lung function tests and a low Pao 2/fraction of inspired oxygen ratio, indicating graft dysfunction in the immediate postoperative period. [Copyright &y& Elsevier]

This article examines how the rival soccer teams of Glasgow, the Rangers and Celtic, represent the religious and tribal frictions of the city. The Celtic team was established elusively for Catholics and expressed their solidarity for Irish home rule. The Rangers quickly become their polar opposites: Protestant and pro-British.http://bkstrm1.epnet.com:8080/ai/images/save.gifSave

We describe a case of simultaneous bilateral anterior shoulder dislocation in a 70-year-old gentleman post-trauma. There was no associated motor, sensory or vascular deficit. Patient underwent closed reduction for both his dislocated shoulder joints under general anaesthesia followed by immobilisation for 4 weeks, and subsequent follow-up showed good functional outcomes. [ABSTRACT FROM AUTHOR]

Summary The impacts of different macronutrients on body weight regulation remain unresolved, with different studies suggesting increased dietary fat, increased carbohydrates (particularly sugars), or reduced protein may all stimulate overconsumption and drive obesity. We exposed C57BL/6 mice to 29 different diets varying from 8.3% to 80% fat, 10% to 80% carbohydrate, 5% to 30% protein, and 5% to 30% sucrose. Only increased dietary fat content was associated with elevated energy intake and adiposity. This response was associated with increased gene expression in the 5-HT receptors, and the dopamine and opioid signaling pathways in the hypothalamus. We replicated the core findings in four other mouse strains (DBA/2, BALB/c, FVB, and C3H). Mice regulate their food consumption primarily to meet an energy rather than a protein target, but this system can be over-ridden by hedonic factors linked to fat, but not sucrose, consumption. [ABSTRACT FROM AUTHOR]