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The photooxidative stability of an aromatic segmented poly(urethane-urea) (PUU) elastomer, stabilised with a range of carbon black fillers, was assessed after very low UVA doses as a means to identify components that are highly susceptible to UV degradation, and suggest better design of such materials. Fourier-transform infrared (FTIR) analysis indicated rapid degradation of the urea bonds in the hard segments, followed by chain scission and photo-Fries reaction of the urethane linkages. In the soft segments, the oxidation of the original ether groups resulted in the formation of large amounts of ester groups, while some crosslinking of the ether groups was also evident. Carbon black provided moderate protection against degradation, with the smallest-sized particles being the most effective. Protection was evidenced by reduced surface cracking as well as an increased resistance to chemical changes in both the soft segments and hard segments. Even so, significant degradation was still evident at low UV doses suggesting that further stabilisation is required to increase the UV durability of these elastomers and improve their long-term performance.\ud \ud

The service lifetime of polymer films is controlled by the chemical reactions leading to chain scission and the mediating environmental factors. For application as agricultural cropping film, controlled accelerated degradation is required. For a photo-sensitive linear low density polyethylene (LLDPE) + 1% nano-titania (as the anatase/rutile mixed phase P25), the environmental factors are not only UV dose and temperature but also soil parameters such as moisture and organic material content. This provides a challenge in predicting the useful lifetime from laboratory accelerated ageing studies. To enhance degradation when the (LLDPE + 1% P25) is buried, UV-C pre-irradiation has been shown to accelerate strength loss but the rate of embrittlement is not sufficient for the application as crop propagation film. Biodegradable poly(butylene adipate-co-terephthalate) or PBAT has a higher rate of degradation when buried outdoors in soil than when buried under laboratory conditions: The elongation at break fell from 900% to 70% in one month in the field while similar changes required 6 months in the laboratory. The small changes in M n ¯ for embrittlement in the field suggests that the loss of mechanical properties was not linked to bulk property changes but rather to surface morphology (cracks and holes) as seen by SEM. This suggests that even in thin films, enzyme-mediated hydrolysis of PBAT is surface controlled. DNA analysis of the soil around the buried films after 35 days ageing outdoors showed fungi play a more dominant role in PBAT biodegradation compared to bacteria. UV degradation of PBAT film is controlled by the photochemistry of the terephthalate moiety in the polymer and the development of fluorescence is a useful indicator of the extent of photo-degradation.

The determination of the safe working life of polymer materials is important for their successful use in engineering, medicine and consumer-goods applications. An understanding of the physical and chemical changes to the structure of widely-used polymers such as the polyolefins, when exposed to aggressive environments, has provided a framework for controlling their ultimate service lifetime by either stabilising the polymer or chemically accelerating the degradation reactions. The recent focus on biodegradable polymers as replacements for more bio-inert materials such as the polyolefins in areas as diverse as packaging and as scaffolds for tissue engineering has highlighted the need for a review of the approaches to being able to predict the lifetime of these materials. In many studies the focus has not been on the embrittlement and fracture of the material (as it would be for a polyolefin) but rather the products of degradation, their toxicity and ultimate fate when in the environment, which may be the human body. These differences are primarily due to time-scale. Different approaches to the problem have arisen in biomedicine, such as the kinetic control of drug delivery by the bio-erosion of polymers, but the similarities in mechanism provide real prospects for the prediction of the safe service lifetime of a biodegradable polymer as a structural material. Common mechanistic themes that emerge include the diffusion-controlled process of water sorption and conditions for surface versus bulk degradation, the role of hydrolysis versus oxidative degradation in controlling the rate of polymer chain scission and strength loss and the specificity of enzyme-mediated reactions.

A range of profluorescent nitroxides (PFNs) were tested as probes to monitor photo-induced radical-mediated damage in polymer materials. The most stable and sensitive probe of the PFNs tested was an alkyne-linked perylenediimide PFN, 6b, with napthalimide and 9,10-bis(phenylethnyl)anthranene-based versions giving lower stability and sensitivity. Results from photo-ageing of poly(1-trimethylsilyl)-1-propyne (PTMSP) and the ethylene norbornene copolymer (TOPAS®) films doped with PFN probes demonstrated that sensors employing these support materials deliver significantly enhanced sensitivity compared to traditional techniques used to monitor photo-oxidative degradation of polymers, such as infrared spectroscopy. This enhanced sensitivity for detecting polymer damage improved methods for the determination of the serviceable application lifetime of polymers.

Background Many CpGs become hyper or hypo-methylated with age. Multiple methods have been developed by Horvath et al. to estimate DNA methylation (DNAm) age including Pan-tissue, Skin & Blood, PhenoAge, and GrimAge. Pan-tissue and Skin & Blood try to estimate chronological age in the normal population whereas PhenoAge and GrimAge use surrogate markers associated with mortality to estimate biological age and its departure from chronological age. Here, we applied Horvath’s four methods to calculate and compare DNAm age in 499 subjects with type 1 diabetes (T1D) from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study using DNAm data measured by Illumina EPIC array in the whole blood. Association of the four DNAm ages with development of diabetic complications including cardiovascular diseases (CVD), nephropathy, retinopathy, and neuropathy, and their risk factors were investigated. Results Pan-tissue and GrimAge were higher whereas Skin & Blood and PhenoAge were lower than chronological age (p < 0.0001). DNAm age was not associated with the risk of CVD or retinopathy over 18–20 years after DNAm measurement. However, higher PhenoAge (β = 0.023, p = 0.007) and GrimAge (β = 0.029, p = 0.002) were associated with higher albumin excretion rate (AER), an indicator of diabetic renal disease, measured over time. GrimAge was also associated with development of both diabetic peripheral neuropathy (OR = 1.07, p = 9.24E−3) and cardiovascular autonomic neuropathy (OR = 1.06, p = 0.011). Both HbA1c (β = 0.38, p = 0.026) and T1D duration (β = 0.01, p = 0.043) were associated with higher PhenoAge. Employment (β = − 1.99, p = 0.045) and leisure time (β = − 0.81, p = 0.022) physical activity were associated with lower Pan-tissue and Skin & Blood, respectively. BMI (β = 0.09, p = 0.048) and current smoking (β = 7.13, p = 9.03E−50) were positively associated with Skin & Blood and GrimAge, respectively. Blood pressure, lipid levels, pulse rate, and alcohol consumption were not associated with DNAm age regardless of the method used. Conclusions Various methods of measuring DNAm age are sub-optimal in detecting people at higher risk of developing diabetic complications although some work better than the others.

An ambipolar poly(diketopyrrolopyrrole-terthiophene)-based field-effect transistor (FET) sensitively detects xylene isomers at low ppm levels with multiple sensing features. Combined with pattern-recognition algorithms, a sole ambipolar FET sensor, rather than arrays of sensors, can discriminate highly similar xylene structural isomers from one another.

The impact of commonly used agrichemicals (Paraquat, Mancozeb, Chlorpyrifos and Sulfur) on the environmental stability of polyethylene films has been evaluated under accelerated photo-oxidative conditions. Paraquat and Mancozeb when applied to unstabilized clear polyethylene film, followed by exposure to UV radiation, resulted in direct attack of the polymer, evident by faster rates of oxidation and shorter times to embrittlement compared to a polyethylene control. Reapplication of these chemicals during exposure, as often occurs in agricultural practice, resulted in even faster degradation. In contrast, Sulfur and Chlorpyrifos did not have a significant effect on the photodegradation of exposed unstabilized polyethylene film. When the polyethylene film was pigmented (white top layer containing rutile titanium dioxide and carbon black in the bottom layer) and stabilized with the addition of hindered amine stabilizers (HAS), differences in oxidation susceptibility were seen with repeated exposure to Paraquat showing the most dramatic effect. This was evident by an increased carbonyl index, decrease in elongation at break and an increase in tensile stress at yield compared to a control film and other agrichemical treatments. These studies enable degradation from accelerated consumption of stabilizers by the agrichemicals (and their degradation products) to be differentiated from enhanced photochemical initiation of the polyethylene degradation.

Aircraft coatings are generally multi-layered with both barrier properties and are corrosion inhibitor filled to prevent corrosion. A new technique, automated in situ block face ultramicrotome imaging using an FEG-SEM has been employed for high resolution 3-D imaging of such aircraft coatings. A pristine and a cracked aged coating were visualised by this method clearly showing the coatings microstructure and subsequent crack growth properties. Filler particles were segmented and labelled allowing the coating to be more clearly visualised and enabling statistical particle analysis and meshing. Finally the method was used to investigate the inhibitor leaching properties of four aircraft primers.

The burden of cardiovascular disease (CVD) among patients with diabetes is substantial. Individuals with diabetes are at two- to fourfold increased risk of cardiovascular events compared with age- and sex-matched individuals without diabetes. In diabetic patients over the age of 65 years, 68% of deaths are from coronary heart disease (CHD) and 16% are from stroke (1). A number of mechanisms for the increased cardiovascular risk with diabetes have been proposed, including increased tendency toward intracoronary thrombus formation (2), increased platelet reactivity (3), and worsened endothelial dysfunction (4). The increased risk for cardiovascular events and mortality in patients with diabetes has led to considerable interest in identifying effective means for cardiovascular risk reduction. Aspirin has been shown to be effective in reducing cardiovascular morbidity and mortality in high-risk patients with myocardial infarction (MI) or stroke (secondary prevention) (5). The Food and Drug Administration has not approved aspirin for use in primary prevention, and its net benefit among patients with no previous cardiovascular events is more controversial, for both patients with and without a history of diabetes (5). The U.S. Preventive Services Task Force recently updated its recommendation about aspirin use for primary prevention. The Task Force recommended encouraging aspirin use in men age 45–79 years and women age 55–79 years and not encouraging aspirin use in younger adults. They did not differentiate their recommendations based on the presence or absence of diabetes (6,7). In 2007, the American Diabetes Association (ADA) and the American Heart Association (AHA) jointly recommended that aspirin therapy (75–162 mg/day) be used as a primary prevention strategy in those with diabetes at increased cardiovascular risk, including those who are over 40 years of age or who have additional risk factors (family history of CVD, hypertension, smoking, dyslipidemia, or albuminuria) (8). These recommendations were …

The burden of cardiovascular disease (CVD) among patients with diabetes is substantial. Individuals with diabetes are at two- to fourfold increased risk of cardiovascular events compared with age- and sex-matched individuals without diabetes. In diabetic patients over the age of 65 years, 68% of deaths are from coronary heart disease (CHD) and 16% are from stroke (1). A number of mechanisms for the increased cardiovascular risk with diabetes have been proposed, including increased tendency toward intracoronary thrombus formation (2), increased platelet reactivity (3), and worsened endothelial dysfunction (4). The increased risk for cardiovascular events and mortality in patients with diabetes has led to considerable interest in identifying effective means for cardiovascular risk reduction. Aspirin has been shown to be effective in reducing cardiovascular morbidity and mortality in high-risk patients with myocardial infarction (MI) or stroke (secondary prevention) (5). The Food and Drug Administration has not approved aspirin for use in primary prevention, and its net benefit among patients with no previous cardiovascular events is more controversial, for both patients with and without a history of diabetes (5). The U.S. Preventive Services Task Force recently updated its recommendation about aspirin use for primary prevention. The Task Force recommended encouraging aspirin use in men age 45–79 years and women age 55–79 years and not encouraging aspirin use in younger adults. They did not differentiate their recommendations based on the presence or absence of diabetes (6,7). In 2007, the American Diabetes Association (ADA) and the American Heart Association (AHA) jointly recommended that aspirin therapy (75–162 mg/day) be used as a primary prevention strategy in those with diabetes at increased cardiovascular risk, including those who are over 40 years of age or who have additional risk factors (family history of CVD, hypertension, smoking, dyslipidemia, or albuminuria) (8). These recommendations were …

SummaryLongitudinal population-based surveys are widely used in the health sciences to study patterns of change over time. In many of these data sets unique patient identifiers are not publicly available, making it impossible to link the repeated measures from the same individual directly. This poses a statistical challenge for making inferences about time trends because repeated measures from the same individual are likely to be positively correlated, i.e., although the time trend that is estimated under the naïve assumption of independence is unbiased, an unbiased estimate of the variance cannot be obtained without knowledge of the subject identifiers linking repeated measures over time. We propose a simple method for obtaining a conservative estimate of variability for making inferences about trends in proportions over time, ensuring that the type I error is no greater than the specified level. The method proposed is illustrated by using longitudinal data on diabetes hospitalization proportions in South Carolina.

PURPOSE Nearly one third of diabetes cases in the United States is undiagnosed, with mounting evidence that complications accrue even before clinical diagnosis. We wanted to determine whether persons with undiagnosed diabetes have signs of nephropathy and peripheral neuropathy METHODS We examined the prevalence of positive screening tests for nephropathy and peripheral neuropathy in adults aged ≥40 years with undiagnosed diabetes using secondary analysis of survey and examination data from the population-based United States National Health and Nutrition Examination Survey 1999-2002. We defined a positive screening test for nephropathy as a spot urine albumin-creatinine ratio >30.0 mg/g, representing at least microalbuminuria. We defined ≥1 insensate area on Semmes-Weinstein monofilament testing as a positive finding for neuropathy. Undiagnosed diabetes was defined as a combination of no history of diagnosed diabetes and a measured fasting glucose ≥126 mg/dL. We used SUDAAN for χ2 and regression analyses. RESULTS The prevalence of a positive test when screening for nephropathy among those with undiagnosed diabetes was 26.5% compared with 7.1% in those with no diabetes (χ2, P

Accelerated atherosclerosis and the increased risk of thrombotic vascular events in diabetes may result from dyslipidemia, endothelial dysfunction, platelet hyperreactivity, an impaired fibrinolytic balance, and abnormal blood flow. There is also a correlation between hyperglycemia and cardiovascular (CV) events. The importance of platelets in the atherothrombotic process has led to investigation of using antiplatelet agents to reduce CV risk. A meta-analysis conducted by the Antiplatelet Trialists’ Collaboration demonstrated that aspirin reduced the risk of ischemic vascular events as a secondary prevention strategy in numerous high-risk groups, including patients with diabetes. Based on results from placebo-controlled randomized trials, the American Diabetes Association recommends low-dose enteric-coated aspirin as a primary prevention strategy for people with diabetes at high risk for CV events. Clopidogrel is recommended if aspirin allergy is present. There is occasionally a need for an alternative to aspirin or for additive antiplatelet therapy. Aspirin in low doses inhibits thromboxane production by platelets but has little to no effect on other sites of platelet reactivity. Agents such as ticlopidine and clopidogrel inhibit ADP-induced platelet activation, whereas the platelet glycoprotein (Gp) IIb/IIIa complex receptor antagonists block activity at the fibrinogen binding site on the platelet. These agents appear to be useful in acute coronary syndromes (ACSs) in diabetic and nondiabetic patients. A combination of clopidogrel plus aspirin was more effective than placebo plus standard therapy (including aspirin) in reducing a composite CV outcome in patients with unstable angina and non-ST segment elevation myocardial infarction. In a meta-analysis of six trials in diabetic patients with ACSs, intravenous GpIIb-IIIa inhibitors reduced 30-day mortality when compared with control subjects. Results from controlled prospective clinical trials justify the use of enteric-coated low-dose aspirin (81–325 mg) as a primary or secondary prevention strategy in adult diabetic individuals (aged >30 years) at high risk for CV events. Recent studies support the use of clopidogrel in addition to standard therapy, as well as the use of GpIIb-IIIa inhibitors in ACS patients.

Implementation of multicenter and/or longitudinal studies requires an effective quality assurance program to identify trends, data inconsistencies and process variability of results over time. The Diabetes Control and Complications Trial (DCCT) and the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study represent over 30 years of data collection among a cohort of participants across 27 clinical centers. The quality assurance plan is overseen by the Data Coordinating Center and is implemented across the clinical centers and central reading units. Each central unit incorporates specific DCCT/EDIC quality monitoring activities into their routine quality assurance plan. The results are reviewed by a data quality assurance committee whose function is to identify variances in quality that may impact study results from the central units as well as within and across clinical centers, and to recommend implementation of corrective procedures when necessary. Over the 30-year period, changes to the methods, equipment, or clinical procedures have been required to keep procedures current and ensure continued collection of scientifically valid and clinically relevant results. Pilot testing to compare historic processes with contemporary alternatives is performed and comparability is validated prior to incorporation of new procedures into the study. Details of the quality assurance plan across and within the clinical and central reading units are described, and quality outcomes for core measures analyzed by the central reading units (e.g. biochemical samples, fundus photographs, ECGs) are presented.

Refractive error (RE) is a complex, multifactorial disorder characterized by a mismatch between the optical power of the eye and its axial length that causes object images to be focused off the retina. The two major subtypes of RE are myopia (nearsightedness) and hyperopia (farsightedness), which represent opposite ends of the distribution of the quantitative measure of spherical refraction. We performed a fixed effects meta-analysis of genome-wide association results of myopia and hyperopia from 9 studies of European-derived populations: AREDS, KORA, FES, OGP-Talana, MESA, RSI, RSII, RSIII and ERF. One genome-wide significant region was observed for myopia, corresponding to a previously identified myopia locus on 8q12 (p = 1.25×10-8), which has been reported by Kiefer et al. as significantly associated with myopia age at onset and Verhoeven et al. as significantly associated to mean spherical-equivalent (MSE) refractive error. We observed two genome-wide significant associations with hyperopia. These regions overlapped with loci on 15q14 (minimum p value = 9.11×10-11) and 8q12 (minimum p value 1.82×10-11) previously reported for MSE and myopia age at onset. We also used an intermarker linkage- disequilibrium-based method for calculating the effective number of tests in targeted regional replication analyses. We analyzed myopia (which represents the closest phenotype in our data to the one used by Kiefer et al.) and showed replication of 10 additional loci associated with myopia previously reported by Kiefer et al. This is the first replication of these loci using myopia as the trait under analysis. "Replication-level" association was also seen between hyperopia and 12 of Kiefer et al.'s published loci. For the loci that show evidence of association to both myopia and hyperopia, the estimated effect of the risk alleles were in opposite directions for the two traits. This suggests that these loci are important contributors to variation of refractive error across the distribution.

OBJECTIVE: Microalbuminuria can reflect the progress of microvascular complications and may be predictive of macrovascular disease in type 2 diabetes. The effect of intensive glycemic control on microalbuminuria in patients in the U.S. who have had type 2 diabetes for several years has not previously been evaluated. RESEARCH DESIGN AND METHODS: We randomly assigned 153 male patients to either intensive treatment (INT) (goal HbA(1c) 7.1%) or to standard treatment (ST) (goal HbA(1c) 9.1%; P = 0.001), and data were obtained during a 2-year period. Mean duration of known diabetes was 8 years, mean age of the patients was 60 years, and patients were well matched at baseline. We obtained 3-h urine samples for each patient at baseline and annually and defined microalbuminuria as an albumin:creatinine ratio of 0.03-0.30. All patients were treated with insulin and received instructions regarding diet and exercise. Hypertension and dyslipidemia were treated with similar goals in each group. RESULTS: A total of 38% of patients had microalbuminuria at entry and were evenly assigned to both treatment groups. INT retarded the progression of microalbuminuria during the 2-year period: the changes in albumin:creatinine ratio from baseline to 2 years of INT versus ST were 0.045 vs. 0.141, respectively (P = 0.046). Retardation of progressive urinary albumin excretion was most pronounced in those patients who entered the study with microalbuminuria and were randomized to INT. Patients entering with microalbuminuria had a deterioration in creatinine clearance at 2 years regardless of the intensity of glycemic control. In the group entering without microalbuminuria, the subgroup receiving ST had a lower percentage of patients with a macrovascular event (17%) than the subgroup receiving INT (36%) (P = 0.03). Use of ACE inhibitors or calcium-channel blockers was similarly distributed among the groups. CONCLUSIONS: Intensive glycemic control retards microalbuminuria in patients who have had type 2 diabetes for several years but may not lessen the progressive deterioration of glomerular function. Increases in macrovascular event rates in the subgroup entering without albuminuria who received INT remain unexplained but could reflect early worsening, as observed with microvascular disease in the Diabetes Control and Complications Trial.

OBJECTIVE: The Veterans Affairs Cooperative Study in Type 2 Diabetes Mellitus (VA CSDM) was a multicenter randomized prospective study of 153 male type 2 diabetic patients to assess the ability to sustain clinically significant glycemic separation between intensive and standard treatment arms. A trend toward an excess of combined cardiovascular events in the intensive treatment arm of this trial was reported earlier. The present analysis was done to evaluate the effect of 2 years of intensive glycemic control on the left ventricular (LV) function. RESEARCH DESIGN AND METHODS: The patients were randomized to intensive step treatment with insulin alone or with sulfonylurea (intensive treatment arm [INT], n = 75) or to standard once-daily insulin injection (standard treatment arm [STD], n = 78) treatment. A total of 136 patients (standard treatment arm [STD], n = 70; INT, n = 66) had radionuclide ventriculography at entry and at 24 months for the assessment of LV function. RESULTS: There was no difference in the mean LV ejection fraction (at entry: STD 57.1+/-9.51%; INT 58.1+/-8.7%; at 24 months: STD 57.3+/-10.8%, INT 59.5+/-10.7%), peak filling rate (at entry: STD 2.6+/-0.7 end diastolic volume per second, INT 2.4+/-0.8 end diastolic volume per second; at 24 months: STD 2.7+/-1.0 end diastolic volume per second, INT 2.5+/-0.7 end diastolic volume per second), or time to peak filling rate (at entry: STD 195.3+/-69.5 ms, INT 185.6 +/-62.4 ms; at 24 months: STD 182.6+/-64.8 ms, INT 179.2+/-61.2 ms) between the 2 treatment arms. A subgroup analysis of 104 patients (STD, n = 53; INT, n = 51) that omitted individuals with intervening cardiac events/revascularization or a change in cardioactive medications also showed no difference in the LV function at entry and at 24 months between the 2 groups. Abnormal LV ejection fraction at baseline predicted cardiac events (interval between cardiac beats [RR] = 2.5). CONCLUSIONS: Two years of intensive glycemic control does not affect the LV systolic or diastolic function in patients with type 2 diabetes.

An ambipolar organic field-effect transistor (OFET) based on poly(diketopyrrolopyrrole-terthiophene) (PDPPHD-T3) is shown by P. Sonar, H. Haick, and co-workers on page 4012 to sensitively detect xylene isomers at low to 40 ppm level in multiple sensing features. Combined with pattern-recognition algorithms, a sole ambipolar FET sensor, rather than arrays of sensors, is able to discriminate highly similar xylene structural isomers from each other.

(1991). Proclamation as Event: Barth’s supposed ‘universalim’ in the context of his mission. Baptist Quarterly: Vol. 34, No. sup1, pp. 42-46.

OBJECTIVE To examine the persistence of the original treatment effects 10 years after the Diabetes Control and Complications Trial (DCCT) in the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study. In the DCCT, intensive therapy aimed at near-normal glycemia reduced the risk of microvascular complications of type 1 diabetes mellitus compared with conventional therapy. METHODS Retinopathy was evaluated by fundus photography in 1211 subjects at EDIC year 10. Further 3-step progression on the Early Treatment Diabetic Retinopathy Study scale from DCCT closeout was the primary outcome. RESULTS After 10 years of EDIC follow-up, there was no significant difference in mean glycated hemoglobin levels (8.07% vs 7.98%) between the original treatment groups. Nevertheless, compared with the former conventional treatment group, the former intensive group had significantly lower incidences from DCCT close of further retinopathy progression and proliferative retinopathy or worse (hazard reductions, 53%-56%; P < .001). The risk (hazard) reductions at 10 years of EDIC were attenuated compared with the 70% to 71% over the first 4 years of EDIC (P < .001). The persistent beneficial effects of former intensive therapy were largely explained by the difference in glycated hemoglobin levels during DCCT. CONCLUSION The persistent difference in diabetic retinopathy between former intensive and conventional therapy ("metabolic memory") continues for at least 10 years but may be waning. TRIAL REGISTRATION (clinicaltrials.gov) Identifiers: NCT00360815 and NCT00360893.

To determine if racial differences exist for trends in diabetes-related cardiovascular disease (CVD) hospitalization rates, we analyzed data from an inpatient hospital discharge database maintained by the South Carolina Office of Research and Statistics. All hospitalizations involving a diagnosis of diabetes were collected from 1996 through 2003. International Classification of Diseases codes were used to determine diagnosis for diabetes, acute myocardial infraction (AMI), stroke, and other CVD outcomes. Multiple linear regression was performed to model the age-standardized rates during the study period. An interaction parameter for race and discharge year was used in the models to determine if the trend slopes varied between African Americans and Caucasians.The diabetes-related hospitalization rates for AMI and stroke declined for both race groups. Although the stroke rates for African Americans were consistently higher than those for Caucasians, the African American trend declined more sharply (P=.027). AMI rates showed sharper declines among Caucasians (P.001). Rates of CVD procedures (percutaneous transluminal coronary angioplasty and coronary artery bypass graft) were two to three times greater among Caucasians. Cardiomyopathy rates were significantly greater among African Americans and showed a larger increasing trend (P.001), and findings for congestive heart failure trends were similar (P.001).Diabetes-related CVD rates and trends vary considerably by race. Rates of AMI and stroke declined in African Americans and Caucasians from 1996 through 2003, while other CVD rates increased. Further research is needed to understand the underlying components of these disparities.

Accelerated atherosclerosis and the increased risk of thrombotic vascular events in diabetes may result from dyslipidemia, endothelial dysfunction, platelet hyperreactivity, an impaired fibrinolytic balance, and abnormal blood flow. There is also a correlation between hyperglycemia and cardiovascular (CV) events. The importance of platelets in the atherothrombotic process has led to investigation of using antiplatelet agents to reduce CV risk. A meta-analysis conducted by the Antiplatelet Trialists' Collaboration demonstrated that aspirin reduced the risk of ischemic vascular events as a secondary prevention strategy in numerous high-risk groups, including patients with diabetes. Based on results from placebo-controlled randomized trials, the American Diabetes Association recommends low-dose enteric-coated aspirin as a primary prevention strategy for people with diabetes at high risk for CV events. Clopidogrel is recommended if aspirin allergy is present. There is occasionally a need for an alternative to aspirin or for additive antiplatelet therapy. Aspirin in low doses inhibits thromboxane production by platelets but has little to no effect on other sites of platelet reactivity. Agents such as ticlopidine and clopidogrel inhibit ADP-induced platelet activation, whereas the platelet glycoprotein (Gp) IIb/IIIa complex receptor antagonists block activity at the fibrinogen binding site on the platelet. These agents appear to be useful in acute coronary syndromes (ACSs) in diabetic and nondiabetic patients. A combination of clopidogrel plus aspirin was more effective than placebo plus standard therapy (including aspirin) in reducing a composite CV outcome in patients with unstable angina and non-ST segment elevation myocardial infarction. In a meta-analysis of six trials in diabetic patients with ACSs, intravenous GpIIb-IIIa inhibitors reduced 30-day mortality when compared with control subjects. Results from controlled prospective clinical trials justify the use of enteric-coated low-dose aspirin (81-325 mg) as a primary or secondary prevention strategy in adult diabetic individuals (aged30 years) at high risk for CV events. Recent studies support the use of clopidogrel in addition to standard therapy, as well as the use of GpIIb-IIIa inhibitors in ACS patients.

The Veterans Affairs Cooperative Study in Type II Diabetes Mellitus prospectively studied insulin-treated patients with type 2 (non-insulin-dependent) diabetes mellitus, achieving 2.1% glycosylated hemoglobin separation between intensive- and standard-treatment arms (P.001) for 2 years.To assess the effect of intensive therapy on serum fibrinogen and lipid levels, compared with standard treatment.One hundred fifty-three male subjects with type 2 diabetes mellitus and who required insulin treatment were recruited from 5 Veterans Affairs medical centers. The subjects were divided into intensive- and standard-treatment arms for a randomized prospective study. Dyslipidemia was managed identically in both arms (diet, drugs). Fibrinogen levels and lipid fractions were measured in the full cohort. Lipid fractions are separately reported in patients not treated with hypolipidemic agents.There were no baseline differences between arms. Fibrinogen levels rose in the intensive-treatment arm at 1 year (from 3.34+/-0.12 to 3.75+/-0.15 g/L; P.001) but returned to baseline at 2 years (3.47+/-0.12 g/L). There was no change in the standard-treatment arm. Triglyceride levels decreased in the intensive-treatment arm from 2.25+/-0.27 to 1.54+/-0.14 mmol/L (199+/-24 to 136+/-12 mg/ dL) at 1 year (P = .004) and to 1.74+/-0.18 mmol/L (154+/-16 mg/dL) at 2 years (P = .03); there was no change in the standard-treatment arm. Cholesterol levels decreased in the intensive-treatment arm at 1 year from 5.4+/-0.21 to 4.99+/-0.13 mmol/L (207+/-8 to 193+/-5 mg/dL) (P = .02); there was no change in the standard-treatment arm. Levels of low- and high-density lipoprotein cholesterol decreased in the standard-treatment arm only by 2 years, from 3.44+/-0.13 to 3.16+/-0.10 mmol/L (133+/-5 to 122+/-4 mg/ dL) (P =.02) and from 1.10+/-0.03 to 1.00+/-0.03 mmol/L (42+/-1 to 38+/-1 mg/dL) (P.001) for low-density and high-density lipoprotein cholesterol, respectively. Levels of apolipoprotein B decreased in both treatment arms (P.001), and apolipoprotein A1 levels decreased in the standard-treatment arm (P.01). Lipoprotein (a) levels did not change in either treatment arm. Lipid results were essentially identical whether examined in the full cohort or excluding those patients receiving hypolipidemic agents.Intensive insulin therapy led to a potentially beneficial reduction in serum triglyceride levels and preservation of high-density lipoprotein cholesterol and apolipoprotein A1 levels. However, it caused transient elevation in plasma fibrinogen levels, a possible thrombogenic effect.

This report presents results of a study on the effectiveness of a prenatal group hypnosis smoking cessation program. The postpartum smoking behaviours of those who stopped smoking during the pregnancy are also presented. The multifactorial intervention emphasized is the use of multiple hypnosis sessions with accompanying information booklets and personal physician encouragement. This study group of 55 people included both pregnant women and their significant others who lived with them and smoked. Only 83% follow-up was achieved of the 47 patients eligible for analysis (n=39). Results showed a quit rate of 18% and positive smoking behaviour changes in 90% of the study group. Of those 7 individuals who quit during pregnancy, only two resumed smoking at three and six months, respectively. These preterm and postpartum preliminary results are promising given the small sample size of the study and the potential room for improvement of this intervention modality. Normal 0 false false false EN-CA X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;}

ince the first Landsat was launched in 1972, satellite data have contributed significantly to large-area inventory and monitoring tasks (e.g., MacDonald and Hall 1978). One of the few criticisms of original Landsat multispectral scanner (MSS) data was that the resolution (80 m) seemed too coarse for some applications. A great deal of interest has therefore accompanied recent launchings of Landsats 4 and 5 with their thematic mapper (TM) sensors and France's SPOT, which offer data of considerably finer resolution than those available from Landsats 1, 2, and 3. For many tasks, high-resolution TM and SPOT data will undoubtedly be helpful. On the other hand, some investigators are exploring a very different proposition (e.g., Schneider et al. 1981): that data with coarser resolution than Landsat MSS data, such as those available from National Oceanic and Atmospheric Administration (NOAA) satellites, will also be useful for certain applications. These applications include inventory, monitoring, and biophysical characterization of very large areas, considerably larger than the approximately 34,000 km2 in a single Landsat scene. Furthermore, NOAA satellite data are especially useful for tasks requiring

The early Mesozoic, quartz normative, North Mountain basalts in southwestern Nova Scotia (Digby area) form three units: a coarse massive lower flow (~190 m) bearing minor lenses of mafic pegmatite, a middle unit of thin amygdaloidal basaltic flows (~50 m), and an upper flow unit of massive phenocryst-rich basalt (~160 m). The two thick units show phenocrysts of orthopyroxene (bronzite) and (or) pigeonite, augite, and zoned plagioclase in a granular matrix of augite, pigeonite, and plagioclase. Variation diagrams and chondrite-normalized rare-earth-element patterns relate all chemical diversity between and within flows to removal and (or) accumulation of plagioclase and pyroxene phenocrysts (~1:1). High K, Rb, and Ba, appear related to assimilation of continental crust. Constancy of fractionation-independent element ratios and variations in phenocryst content vertically and along the 200 km strike of the basalts suggest (1) crystal settling and accumulation together with assimilation and mixing in a lower crustal magma chamber, (2) rise to upper crustal levels in a central conduit followed by northeast-ward emplacement along a tension-induced dyke system, and (3) extrusion along a fissure in two major and numerous minor pulses that formed the lower, upper, and middle units. Assimilation did not occur as magma moved through the dyke system, for assimilation-related variations in composition do not occur along strike.

This article discusses some of the demonstrated and potential uses of data from satellites with large fields of view and high frequency of coverage, such as NOAA AVHRR data and Nimbus-7 CZCS data. The use of such data is discussed for three types of applications: (a) stratification, (b) change detection, and (c) area estimation. It is concluded that such data have considerable promise as an aid to a variety of large-area inventory and monitoring tasks.

Growth hormone (GH) has been implicated in the pathogenesis of diabetic angiopathy although the exact mechanism remains unknown, von Willebrand factor activity (vWF) is significantly higher in diabetic than in normal plasma (pA single intramuscular injection of GH produced a marked increase of vWF activity in all 3 patients within 30 minutes and a later increase after 5–6 hours. We conclude that a regulator of glucose metabolism, possibly GH, is involved in regulation of vWF activity.

The purpose of the present investigation was the study of HDL lipoprotein changes in patients with diabetes mellitus. The comparison was made between 40 normal and 109 diabetic subjects and the following data was obtained: relative HDL concentration (polyacrylamide gel electrophoresis), HDL-cholesterol and apolipoprotein A concentrations. We found significant decreases in HDL (18–28%) and HDL-cholesterol (31–40 mg/ 100 ml) in most diabetics except in those with normalized serum levels of glucose and lipids (34% and 50 mg/100 ml respectively). There was a statistically significant difference in HDL and HDL-cholesterol concentrations between patients in the latter group and other diabetic patients. There was a negative correlation between HDL and HDL-cholesterol and serum glucose levels. No statistically significant difference was found when apolipoprotein A was compared in normal and diabetic subjects. Our results suggest that a deficient binding of cholesterol to apoprotein A might be present in diabetes.

To determine if endothelial cell metabolism is affected by the elevated glucose concentrations known to occur in diabetes mellitus, we measured cellular Factor VIIIR:Ag in endothelial cells grown under conditions of increased glucose concentration. The results of this study illustrate that, under cell culture conditions, an increase in glucose concentration results in increased cellular levels of Factor VIIIR:Ag. Specifically, a glucose concentration of 300 mg/dl resulted in a 23% increase in Factor VIIIR:Ag levels while a glucose concentration of 600 mg/dl resulted in a 54% increase in Factor VIIIR:Ag levels. These in vitro findings may relate to the increase in plasma Factor VIIIR:Ag levels known to occur in diabetic patients.

A series of 148 diabetic patients were studied for the presence of soluble immune complexes using five different screening techniques. The percentage of positive results was 26% with direct nephelometry and PEG-C4, 27% with PEG-IgG, 33% with radiolabelled Clq binding and 57% with a specific technique for detection of insulin-anti-insulin immune complexes. The percentages of positivity in a group of 40 healthy donors were 2.5% for direct nephelometry and radiolabelled Clq binding, 5% for the PEG-C4 technique, and 10% for the PEG-IgG technique. Sixteen percent of the patients studied had positive results in three or more of the screening tests. When the results of the different screening tests in all patients and controls were compared among themselves, we found correlation coefficients between-0.01 (p = 0.854) when the direct nephelometry and the PEG-C4 tests were compared and 0.29 (p < 0.0003) when the direct nephelometry and PEG-IgG tests were compared. When the results of each test for the whole group of patients and the group of normal healthy donors were compared, significant differences were found for direct nephelometry (p = 0.004), PEG-IgG, PEG-C4, and insulin-anti-insulin immune complexes (p < 0.0001), as well as for anti-insulin antibodies (p < 0.001); no significant difference was observed when the results of radiolabelled Clq binding in diabetics and controls were compared (p = 0.2). Significant correlations were found between the results of several screening tests for soluble immune complexes, insulin dosage, and clinical or biochemical expressions of microangiopathy, nephropathy, or vasculopathy. These correlations were more consistent when we divided the patients into normal or abnormal groups for proteinuria, microangiopathy, and diabetic complications and considered the number of positive tests in each patient rather than the results of individual tests.

A previous study of low density lipoprotein metabolism by cultured cells focused on the metabolism of normal lipoproteins in vitro by fibroblasts isolated from diabetic patients. No abnormalities were found. We have followed the opposite approach. Using normal human fibroblasts as test cells we compared the metabolism in vitro of low density lipoproteins isolated from diabetic patients before and after metabolic control. We found a significant decrease (p less than 0.02) in internalization and degradation of low density lipoproteins isolated from diabetic patients before metabolic control when compared with those isolated from normal control subjects or from the same patients after metabolic control. The observed changes were mainly apparent in intracellular degradation. To evaluate whether the observed differences in low density lipoprotein behaviour were correlated with lipid or apolipoprotein composition, we measured cholesterol, triglyceride, apolipoprotein B and total protein levels in the low density lipoproteins tested. A significant decrease (p less than 0.05) of the triglyceride/protein ratio was found in post-control low density lipoproteins suggesting that a high triglyceride content may interfere with low density lipoprotein metabolism. The present study represents the first observation that metabolic control in diabetes mellitus can alter low density lipoprotein-cell interaction and suggests a possible mechanism for the enhanced incidence of atherosclerosis in diabetic patients.

1189 USE OF BIOSTATOR GLUCOSE CONTROLLER (CLOSED-LOOP) TO ESTIMATE INSULIN NEEDS ON A PORTABLE PUMP (OPEN-LOOP): EFFECT OF PREVIOUS METABOLIC CONTROL